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Is NRMP fixed?

Dreamer

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Apr 13, 2001
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    Here is a question,
    I have heard for quite a while that you can be "helped" to get residency. It varies from meeting with program directors (what I have to admit I did, no luck) to you pay (literally) and you are in. Now, I know for the fact the residency was obtained in the middle of May, and in a program what was filled during the matching day. Can anybody explain me, how is it possible.
    That, so far applies only to IMG and caused by tough times, but the Q remains.
     

    Winged Scapula

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    1. Attending Physician
      I have NO evidence that the NRMP is "fixed" nor do I believe it is.

      Positions may open up as late as May for a number of reasons:

      1) programs are not required to offer all their available residency spots in the NRMP; thus they may have others available which they can offer to anyone they like

      2) programs may have an opening when a candidate breaks his contract or for some other reason cannot fulfill it (serious illness, visa or ECFMG certifiate problems). This opening can then be filled by another candidate.

      3) candidates who had agreed to a position out of match may also renege and the spot opens up for someone else.

      4) residencies which DON'T fill may transfer their unfilled positions to another residency track at the same institution. This actually happens fairly frequently as long as the other program feels able to handle the additional residents and the money is available for the position (which it should be - just the cost center is transferred).

      As far as paying for a position, perhaps it does happen but as I'm sure you know, it is highly unethical and probably illegal. You would be wise to stay away from a PD and a program which would condone such behavior.

      Meeting PDs DOES help in getting positions; this is why most residency books recommend that you do an Audition rotation - this is true for the US grad as well as an IMG. With some programs getting literally thousands of applications, an applicant who is a known entity will stand a much better chance (provided that they performed well or impressed the PD, faculty, etc.) than just a faceless name on an ERAS application. This is also the case with the scramble and any post-match contracts. Nothing fishy about it and it seems to benefit both the program and the applicant. If some IMGs are better positioned to meet PDs (ie, by being in the US during the scramble and the weeks after) tand this results in a position, then so be it - life is not always fair. There is nothing illegal or wrong with approaching a PD for a personal meeting about a position and then getting that position over someone else who may or may not be (more) qualified. People are offered positions outside of the match all the time.I'm truly sorry it didn't work out well for you Dreamer - but there is no guarantee that meeting with a PD will HELP. In some cases it may hurt (depending on the social awkwardness, personality, impenetrable accent, etc. of the candidate). Even US grads are "warned" that auditions can hurt them if they are stronger on paper than in person.

      It is a matter of playing the odds, being in the righr place at the right time, early bird gets the worm, and any number of other aphorisms.

      Just my 2 cents...
       
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      Djanaba

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        That goes off the assumption that everyone who attempts to match deserves a spot, and also that the students that best match the program are definitely in the match, matched to them, and are US kiddos. I disagree on all counts. The match is an interesting way to do things with pros and cons, but fixed it's not.
         

        Dr. Van Nostrand

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          Originally posted by Dreamer:
          •If programs are not required to declare all spots for match, then, in my personal opinion, it beats the purpose of match.•

          Not really. Programs are required to offer the majority of their positions via the NRMP should they participate but I see nothing wrong with a program holding back a couple of spots "just in case" - they might have a student that they want to offer a spot to outside of the match rather than taking their chances of not matching that candidate. I don't think it defeats the purpose of the match at all, but allows the programs (and candidates) a little more leeway if needed.

          The NRMP isn't perfect but I don't think there is any wholesale bias against a certain group of cadidates.
           

          Winged Scapula

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          1. Attending Physician
            As Dr. Van Nostrand says, the majority of spots must be offered through the NRMP if a program participates in the process. I don't see reserving a couple of spots for students they might meet through the year (and wish to offer a contract outside of the match; often these are given to IMGs - so it might actually benefit you) defeating the purpose of the match.
             

            Dreamer

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              OK guys, you convinced me that not offering all spots benefit medicine in along run, as well as that NRMP is not fixed but might has some flaws.
              I have to admit I was bitter about few things I bumped in while applying to match. Now, my feelings are settled.

              Kimberli, thank you for the encouraging words that it might benefit me, but at the moment I would like to get into Transitional Year only and then finish my Law Degree. I want to have TY just in case, if I decide after Law School to finish teh residency or to go into teh military as a physician rather than a lawyer.

              PS My statement that you convinced me is sincere, not polite way to wrap up discussion.
               

              Winged Scapula

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                Dreamer - I'm glad we could be of some assist.

                Something to bear in mind: you are requied to complete all 3 USMLE steps within 7 years. Therefore, if you haven't taken Step 3 and then leave medicine for law school, you might be bumping up against that deadline (assuming law school is 3-4 years, and you also spend 1 year doing a Transitional Year). Check with ECFMG and your state of practice regarding licensing laws and taking leave of abscences (if you are already licensed).

                You might also talk to some residency directors about your idea of doing a Transitional Year and then possibly leaving medicine for a length of time. You may find that it is not as easy to get back into residency training after being gone for awhile. If you did an internship, then left for law school, by the time you applied for PGY2 spots, you would be 3+ years away from clinical medicine, from letters of recommendation, etc. I'm not sure what field you're interested in, but Transitional Years do not "count" as an internship year for all of them; they are generally designed for those applying to fields with a PGY2 match (ie, Anesth) or those who are undecided about specialty.

                It may be better to either go to law school first or finish a residency first rather than interrupt one or the other.
                 

                Dreamer

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                  Kimberli, can i e-mail you with few questions out of forum for it seems to me that you have a lot of info.
                  PS I am already in thh Law School, wil be done by the summer of 2003.
                   
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