Gamesmanship

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numbmd

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Why is it such a game? How did it evolve into such? All my residents tell me that the interview and match is all just a game. Virtually every applicant tells me that my program is their number one choice upon leaving. Now I think I run a pretty neat little program, but I also know that it isn't everybody's number one choice. Why the BS?

We as a profession have created a match system that in many ways is great, but on the same hand promotes lying, deceit, and game playing. And to your future employer!

The funny part is I buy it almost every time.
 
I only told one program that they were my number one, although I did express "serious interest" in many programs. I felt kind of bad, but I knew most programs were kind of playing the same game. However, the fact was that I interviewed at a lot of programs that I would have been quite content to match with, and sure as hell didn't want to have to scramble.

If interviewees are falsely stating that you are their number one choice, that is a bit much, especially since that is something that can be proven false, if you have to go below any of them on your rank list to fill. I'm curious though, if that's the case do you really try to take any recourse? What can you do, find out where someone matched and tell the program director you think they're a lying scumbag?

In the grand scheme of things, it seems like it all works out. If you rank qualified applicants that seem to mesh with your program highest, the ones that match will be the ones who were most interested in your program and feeding you the least amount of BS.
 
The reality of life in the 21st century....gamesmanship....

Why do diplomats and ambassadors dance around each other when they negotiate?

Why is it that every time I'm talking with the CEO of my hospital, I feel that there are 3 layers of information being communicated.

You're right....life should be simpler, but for some reason those who give it to you straight in real life usually wind up being the loser in the "game"....

That's why I like the internet forums....where one can give it to you "straight" and have no real consequences....other than having people call you names.
 
We're a generation that's learned that playing the game gets you ahead, and trusting the system can only work against you.

We saw in high school how those with cleverly orchestrated and packaged applications got in to the big schools ahead of those who were smarter and/or with more sincere interests inside and out of the classroom. The med school application process was worse. Hard work was important, but more significant for the top places was being able to play a game of kissing the right asses, taking the easy classes, getting the volunteer project that looked good on paper (but didn't do much to actually serve anyone), and telling everyone at interview that they wanted to do academic research or help the underserved when they really just wanted to make a lot of money in a respected career. I've visited 2 of what I think are among the best 3 med schools in the country, and many attendings complain that the students are lazy and have a sense of entitlement. Surprise -- your admissions criteria have limited reward for hard workers.

Those interview processes failed to pick up on those games, and rewarded many who played them. I'm on a med school adcom and I admit that there are probably a lot of applicants who are less than genuine, and we only catch the stupid ones who contradict themselves too much.

Hence many of my peers believe (and they are probably right) that they should play the game. It's safe, effective, and up to this stage has always worked for those willing to do it. Everyone's scared that if they don't play the game, they'll lose to the ones who do.
 
hey just wanted to say glad you're back.

militarymd said:
The reality of life in the 21st century....gamesmanship....

Why do diplomats and ambassadors dance around each other when they negotiate?

Why is it that every time I'm talking with the CEO of my hospital, I feel that there are 3 layers of information being communicated.

You're right....life should be simpler, but for some reason those who give it to you straight in real life usually wind up being the loser in the "game"....

That's why I like the internet forums....where one can give it to you "straight" and have no real consequences....other than having people call you names.
Click to expand...
 
I'll second that--good to see ya back Militaryman! Regards, --Zip
 
the games go both ways. a program recently told me I would be ranked to match with them if I ranked them first. well if that were really the case they could have offered me the contract right then as I am a d.o. and can sign outside the match. i don't think applicants are the only ones playing the game....
 
I agree with Amy, the game goes both ways.

Applicants hear how competitive their specialty is: They feel that they have to hedge their bets by getting PD's to rank them high so they can have a "definite" match. Also, applicants don't truly understand how the match process works: some of my 4th year MS buddies explain how they think it works, only to have me explain that it's nothing like that at all.

In the end, I don't think we'll ever get away from games. The match process will continue to remain like the dating process...two parties dancing around each other, unable to say what's truly on their mind. Enjoy!

numbmd said:
Why is it such a game? How did it evolve into such? All my residents tell me that the interview and match is all just a game. Virtually every applicant tells me that my program is their number one choice upon leaving. Now I think I run a pretty neat little program, but I also know that it isn't everybody's number one choice. Why the BS?

We as a profession have created a match system that in many ways is great, but on the same hand promotes lying, deceit, and game playing. And to your future employer!

The funny part is I buy it almost every time.
Click to expand...
 
I keep hearing that people dont understand how the match works. How is that possible? What do the MS4s say about how they think it works. Its really a simple concept, I dont get how you can misunderstand it.

The match process is great, but I really dont see why they cant offer contracts sooner or offer contracts at all. Why not? It would save everyone time and money.

How about this concept; early contract offerings. Jan 1st-Jan15th programs can offer contracts to as many applicants as they may choose - very similar to an early acceptance. Its up to applicants to accept the contracts. Most would have interviewed where they want, can accept, and cancel their other interviews. A second round of contracts could be offered Feb 15th-Feb31st.

Benefits:
Less interviews, less cost
Sooner knowldege of acceptance (you can plan moving sooner)
Less games

Cons:
More pressure to interview earlier at top choice
Pressure to sign early even if you have an interview later on

This is how the real world works; you get offered a job and have a certain time frame to accept it, too bad if you dont feel comfortable until youve interviewed somewhere else - we're in a high pressure field, why do we need to be pampered with a match process - I like the free market approach
 
my understanding of the match is that it temporarily matches you to your first choice but will bump you off your first choice list if other people want to match there and are higher on the programs list. then it sticks you at your number two...etc. is that right?
is that the lesser of sums?
i agree that there must be a better way (an less expensive way) to do this. with everyone hedging their bets, applicants and programs, it just gets more and more expensive for everyone.
sometimes i wonder how people are selected for interviews...it truly seems random. i just don't understand at all what criteria they use to sort through the 100s of applications (based on who i am meeting at interviews and comparing notes with)
 
Coastie said:
The match process will continue to remain like the dating process...two parties dancing around each other, unable to say what's truly on their mind. Enjoy!
Click to expand...

That's only the case with dating if one of the two people is a liar.

True about the match process though.
 
Jack Burton said:
How about this concept; early contract offerings. Jan 1st-Jan15th programs
Click to expand...

The problem with this approach is that it would likely drive resident salaries up. Residents would like this, hospitals . . . not so much. If you are a stellar applicant and get several offers you could bargain for more money, etc. The match is anti-competitive and prevents residents from directly comparing offers (they can only look at what was offered last year and hope that it is what is offered again this year when they are ranking).

AFAIK the reason we started having a match was that programs that were less competitive would call people at 11pm and tell them they have a spot, if they commit in the next 30 seconds, otherwise, no dice. Maybe these horror stories are exaggerated. However I still believe if there were to be an open offer time frame everything would need to be strictly regulated (i.e. earliest that offers could be made, time frame offer must remain open, etc).
 
The match isnt anticompetitive - you already compare offers to make your match list - you have access to the contracts beforehand, know how much money you will be given etc. Future residents want the competitive residencies as much as competitive residencies want competitive students - it wouldnt lead to a big jump in salaries - you know you arent getting much as a resident going into it, and its roughly the same everywhere. With regards to the horror stories - I agree a little regulation is easy to do, thats why I said having an open contract period. Contracts are offered any time after Jan 1st and are good until Jan 15th at which time they expire, no big deal. Some people may get offers on the 1st good to the 15th, others might get last second offers on the 14th - a free market approach, you would have to play the game a bit - if you get an offer at your number 2 institution on Jan 1st, you can wait until right before the 15th to see if your number 1 gives you an offer, etc.
 
Jack Burton said:
The match isnt anticompetitive -
Click to expand...

The match is anticompetitive. There is a legislative exemption to the Sherman antitrust act for the NRMP (Pension Funding Equity Act of 2004). Pretty clear sign to me it qualifies as anticompetitive.

I think it's hard to argue that residents are currently paid market wages. What has changed in most physicians responsibilities and duties between their last day of residency and their first day of being an attending? Is it so significant the value of their work has increased by a factor of 3, 4, or even 5+? I know at my hospital starting RN's make more than the chief residents. Does a day one RN provide for better financial reimbursement for the hospital than a PGY-5 surgery resident?

Ultimately the Jung v. AAMC decision sided with the AAMC due largely to the new legislation and partly due to the plaintiffs making inconsistent arguments. The court's final opinion in the big anti-trust case can be found here. http://www.aamc.org/newsroom/jungcomplaint/finalruling.pdf
 
Jack Burton said:
I keep hearing that people dont understand how the match works. How is that possible? What do the MS4s say about how they think it works. Its really a simple concept, I dont get how you can misunderstand it.

How about this concept; early contract offerings. Jan 1st-Jan15th programs can offer contracts to as many applicants as they may choose - very similar to an early acceptance.
Click to expand...

It sounds like you don't quite understand how and why the match process is set up. It is set up so applicants match at the highest ranked program that will take them, and programs match the highest ranked applicants they can get. Your system through panic benefits crappy programs and crappy applicants at the expense of better. A good candidate panics and grabs a low rate offer so he isn't left out and a good program panics and grabs some low rate candidates so they aren't left out. The match process is far superior to your alternative.
 
It would be nice to not HAVE to exaggerate your interest in programs that are near the bottom of your rank list, but being that anesthesiology is competitive (especially at some institutions) most residents would rather match at such programs than go unmatched. Likewise, the residency programs do the same thing. Therefore, because both parties might just end up with each other, it works in your interest to be flattering. With a match process, you never know what you're going to get.
Selection committees have created this by creating cutoff scores for your USMLE scores. Your application goes in a pile, and is just a number. So all of those fancy CVs only floral print paper, personal statements, and letters of recommendation don't even get a glance if your scores aren't deemed acceptable. Secondly, if your score is adequate, your file is scrutinized at that point. Thirdly, personal appearance is important during the interview. A candidate that is attractive (in excellent shape, etc.) will be noticed and remembered... I've seen it happen on every level (from college to fellowships). Lastly, the follow up thank you card is a waste of your money! I've found that some program directors don't even open them. Just follow up via email. At least you'll know they'll read it. Lastly, the selection committees have created a selection process that is arduous and at times impossible for most candidates. Every program seems to want an applicant that looks like Megan Fox (with Double D's), multiple clerkship honors, perfect LORs, and published in multiple journals with presentations at major scientific meetings; even if they like to state that they're really interested in "character". This is such a lie, because character only became important to the residency selection committees after cutting 3/4 of applicants just because their Step 1 score is not stellar. IMHO, some of the worst residents have had some of the best USMLE scores and can't hold a candle to at least half of their own entering classes. USMLE scores do not translate into great residents. They only indicate that you can pass a test! And that's about it. Our residency selection committees must learn to utilize more up to date rule out/in criteria besides USMLE Score Reports. I recommend using only letters of recommendation, personal statements, and curriculum vitaes to rule in during initial views of applications... Then, rule out using research interests, scores, the interview rankings, etc.
 
amyl said:
my understanding of the match is that it temporarily matches you to your first choice but will bump you off your first choice list if other people want to match there and are higher on the programs list. then it sticks you at your number two...etc. is that right?
Click to expand...

Not quite. It matches you where it can then tries to move you up your rank list as positions open up at programs higher on your list. Let's say you rank programs A, which has 2 positions, and B which has 3 positions. A ranks you #3 and B ranks you #3. Your rank list is 1. A, 2. B. The computer tries to put you in your first choice. It can't because you're not ranked to match, so it tries to put you in your second choice, which it does because you're ranked to match. The computer then tries to put me in my first choice, which happens to be Program B. I ranked them #1 and they ranked me #1, so I'm set with B and I'm done. However, Program A really liked me and ranked me #1, but they can't have me. After going through everything once, the computer comes back to you to see if it can move you higher up your list. Since I didn't go to Program A, it now has positions 2 and 3 availble. They ranked you #3, which now means you match with your first choice. You're taken out of Program B and put in Program A. The position you left is filled by someone else. This continues until the computer matches everyone it can and those who aren't matched suffer the shame and humiliation of not matching.
 
i guess the message for the programs is the same as they tell us...rank the applicants based on how much you want them not how much they want you. who cares how far down the rank list you go? it really doesn't matter....
 
Calilove said:
It would be nice to not HAVE to exaggerate your interest in programs that are near the bottom of your rank list, but being that anesthesiology is competitive (especially at some institutions) most residents would rather match at such programs than go unmatched. Likewise, the residency programs do the same thing. Therefore, because both parties might just end up with each other, it works in your interest to be flattering. With a match process, you never know what you're going to get.
Selection committees have created this by creating cutoff scores for your USMLE scores. Your application goes in a pile, and is just a number. So all of those fancy CVs only floral print paper, personal statements, and letters of recommendation don't even get a glance if your scores aren't deemed acceptable. Secondly, if your score is adequate, your file is scrutinized at that point. Thirdly, personal appearance is important during the interview. A candidate that is attractive (in excellent shape, etc.) will be noticed and remembered... I've seen it happen on every level (from college to fellowships). Lastly, the follow up thank you card is a waste of your money! I've found that some program directors don't even open them. Just follow up via email. At least you'll know they'll read it. Lastly, the selection committees have created a selection process that is arduous and at times impossible for most candidates. Every program seems to want an applicant that looks like Megan Fox (with Double D's), multiple clerkship honors, perfect LORs, and published in multiple journals with presentations at major scientific meetings; even if they like to state that they're really interested in "character". This is such a lie, because character only became important to the residency selection committees after cutting 3/4 of applicants just because their Step 1 score is not stellar. IMHO, some of the worst residents have had some of the best USMLE scores and can't hold a candle to at least half of their own entering classes. USMLE scores do not translate into great residents. They only indicate that you can pass a test! And that's about it. Our residency selection committees must learn to utilize more up to date rule out/in criteria besides USMLE Score Reports. I recommend using only letters of recommendation, personal statements, and curriculum vitaes to rule in during initial views of applications... Then, rule out using research interests, scores, the interview rankings, etc.
Click to expand...

What this guy said! Don't think looks don't somehow, at least subconsciously, bump up your interview day scores. They do.

So brush those teeth, shave yo' face, cut yo' nails, and make sure you don't have gravy stains on your suit.
 
lord_jeebus said:
We're a generation that's learned that playing the game gets you ahead, and trusting the system can only work against you.

We saw in high school how those with cleverly orchestrated and packaged applications got in to the big schools ahead of those who were smarter and/or with more sincere interests inside and out of the classroom. The med school application process was worse. Hard work was important, but more significant for the top places was being able to play a game of kissing the right asses, taking the easy classes, getting the volunteer project that looked good on paper (but didn't do much to actually serve anyone), and telling everyone at interview that they wanted to do academic research or help the underserved when they really just wanted to make a lot of money in a respected career. I've visited 2 of what I think are among the best 3 med schools in the country, and many attendings complain that the students are lazy and have a sense of entitlement. Surprise -- your admissions criteria have limited reward for hard workers.

Those interview processes failed to pick up on those games, and rewarded many who played them. I'm on a med school adcom and I admit that there are probably a lot of applicants who are less than genuine, and we only catch the stupid ones who contradict themselves too much.

Hence many of my peers believe (and they are probably right) that they should play the game. It's safe, effective, and up to this stage has always worked for those willing to do it. Everyone's scared that if they don't play the game, they'll lose to the ones who do.
Click to expand...

Single handedly one of the smartest things i've ever heard on these forums.

In my college I was passed up by multiple medical schools because I didn't play the game. I was one of those people who didn't play the game of kissing ass, taking the easy courses to get the great grades, etc, and I paid for it by getting those rejection letters in left and right. It was especially painful to see the classmates who would openly cheat in quizzes, tests, etc get acceptances to places I got rejected to. The med school I went to I ended up scoring higher than most in my class, and scored greater than the 93%tile in my boards.

I'm now applying for anesthesia, and I've been passed up again by many programs because I haven't been playing the game like everyone else (the 2 letters D.O. pretty much defaults me into the "not playing the game category in addition to other things"), and I'll tell you that even if I don't match, I'll reapply (and keep reapplying). Quite frankly, I want to do gas, and I'm willing to spend the years it takes to get into the field I want to be in, and i'm not going to let other people tell me I can't do it. I will become an Anesthesiologist, and I will be one of the best at it, not because i'm smarter, but because i will work harder at it than the guy next to me because i've failed so many times trying to get to where I am now.
 
do you really think being a DO means not being able to play the game?
are we really at that much of a disadvantage? i don't really think so. there are places that won't interview us but there are plenty who will look at us as equals.... at least it seems that way...maybe i will eat my words after match day.....
at one of my interviews i compared invites and notes with a girl from the carribean. i don't know what her grades were like but we were super close on step one...she took step two and did well (i haven't taken it yet). she seemed like a great girl, one i would want in my class. but she applied to 100 programs (yes 100!) and has like 6 invites and tons of rejections. at least anecdotally, DO does not equal IMG.
i don't think being a DO is a huge disadvantage, just a slight one.
i am not playing the game either...maybe it will bite me in the $*! too.
good luck
 
amyl said:
do you really think being a DO means not being able to play the game?
are we really at that much of a disadvantage? i don't really think so. there are places that won't interview us but there are plenty who will look at us as equals.... at least it seems that way...maybe i will eat my words after match day.....
at one of my interviews i compared invites and notes with a girl from the carribean. i don't know what her grades were like but we were super close on step one...she took step two and did well (i haven't taken it yet). she seemed like a great girl, one i would want in my class. but she applied to 100 programs (yes 100!) and has like 6 invites and tons of rejections. at least anecdotally, DO does not equal IMG.
i don't think being a DO is a huge disadvantage, just a slight one.
i am not playing the game either...maybe it will bite me in the $*! too.
good luck
Click to expand...

I would strongly advise you to not compare DO's to IMG's to AMG-MD's here. It always, always, always turns ugly.
 
I didn't mean anything negative about anyone. I just meant that I was pleasantly surprised by the number of DOs on the interview trail. and that MD matching for a DO didn't seem to be the hopeless endeavor that some made it out to be. sorry if what I said offended anyone - zero negative comment intended
 
The irony is that a lot of these programs who were begging anyone to take their spots, including IMGs (not just Carib ones) 10 years ago, are now hypocritically excluding the same in the name of increased interest and ability to be more selective. It just proves that economic principle of "supply and demand" is the most powerful driving force in just about any endeavor. It is also why our field is currently so lucrative, and will be for at least the forseeable future. My program literally would grind to a halt without residents to do the work. And, we are still understaffed and adding additional RRC-approved spots, expanding the number of ORs, etc.

-copro
 
ozzie20 said:
In my college I was passed up by multiple medical schools because I didn't play the game. I was one of those people who didn't play the game of kissing ass, taking the easy courses to get the great grades, etc, and I paid for it by getting those rejection letters in left and right. It was especially painful to see the classmates who would openly cheat in quizzes, tests, etc get acceptances to places I got rejected to. The med school I went to I ended up scoring higher than most in my class, and scored greater than the 93%tile in my boards.

I'm now applying for anesthesia, and I've been passed up again by many programs because I haven't been playing the game like everyone else (the 2 letters D.O. pretty much defaults me into the "not playing the game category in addition to other things"), and I'll tell you that even if I don't match, I'll reapply (and keep reapplying). Quite frankly, I want to do gas, and I'm willing to spend the years it takes to get into the field I want to be in, and i'm not going to let other people tell me I can't do it. I will become an Anesthesiologist, and I will be one of the best at it, not because i'm smarter, but because i will work harder at it than the guy next to me because i've failed so many times trying to get to where I am now.
Click to expand...

Holy S*** Ozzie! I hope you wrote that on your personal statement! That is some rockin attitude. There's no doubt you'll get there.
 
I think it is really a stupid thing to do... all "game playing" issues aside to tell more than one program that you will rank them first. Not only is it dishonest but chances are someone will find out and then you will look very foolish. I hope to at some point write ONE letter telling ONE program that they are my number one choice if they truly are but now I am worried that one letter will be meaningless if everyone is already saying this to all programs. Right now I let programs know where they stand relative to the others I have interviewed with (and relative to the others on my list that I have yet to interview with as I perceive them from my research) although that might change a bit I am trying to stay 100% honest.

In general I think those that are honest and forthright will be rewarded and more successful in this process. The one PD who told me I would be ranked at the top of his list was obviously saying this to every single interviewee at the end of the interview and I could see through that immediately. One who told me I would be ranked around 80, well I appreciated his honesty and I will still rank his program where I would have ranked it before. Telling me I will be around 80 was very useful knowledge for me. I think we can all be open about things and it would save everyone much stress and money. Of course, accepting that things can change a bit and might not work out as planned exactly... but I am still unclear about what is and what is not a "violation" of the match terms. At my interview today the chair said that it was a violation for us to tell a program where we will rank them at all, which I was not aware of.
 
anestheticman said:
At my interview today the chair said that it was a violation for us to tell a program where we will rank them at all, which I was not aware of.
Click to expand...


I've had PD's and Chairmen say the same thing to me and I'm not sure if its because they don't really know what the rules are, or its that they don't want to tell where they TRULY are going to rank me because the rules clearly state that neither sides can ask where they are going to be ranked, but either side can volunteer the information.

I found this info on an email I recieved from the NRMP after I signed up:
(number 3 is what applies to this post)


Most Commonly Reported Violations

The violations most commonly reported to the NRMP are:

1. After the Match, an applicant who matched to a program does not accept the matched position. The Match Participation Agreement states that the listing of a program on the applicant's certified rank order list and the listing of an applicant on a program's rank order list establishes a binding commitment to accept/offer an appointment if a match results. Failure to honor that commitment is a breach of the Agreement.

2. The director of a program that participates in the NRMP Main Match offers a written or verbal contract before Match Day to a senior from a U.S. allopathic medical school. The Match Participation Agreement requires an institution that registers programs in the Main Match to select U.S. seniors from allopathic medical schools only through the Main Match for all of its programs (i.e., including those programs that are not registered in the Main Match), unless the program participates in another national matching service.

3. A program director asks for verbal or written confirmation from an applicant about how he/she intends to rank the program. Although the Match Participation Agreement does not prohibit either an applicant or a program from volunteering how one plans to rank the other, it is a violation of the Match Participation Agreement to request such information.
 
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