Match Farce

[The_world_is_a_vampire]

I grew up always wanting to be a doctor. I studied meticulously, foregoing parties and social occasions for the promise of reaching my goal. Once accepted to medical school, I knew that I would have to work even harder to both become a competent physician and to get a desirable residency spot. As a first year medical student, residency and the Match seem to be a decade away and there are more pressing matters to address. In second year, Step 1 looms over you like a bully waiting for you in the school yard. Once Step 1 is over, you are immediately thrust into the hospital and clinical setting without any pomp and circumstance. It's a relief to know that you Step 1 went well, but you become nervous and worried that you might make a mistake, which you undoubtedly will.

But now a new issue starts to keep you up at night. You have less than a year until you have to know which specialty you would like to train in, take Step 2, and apply to residencies all across the country. You quickly start to learn about the match process, including the rules, deadlines, and requirements. You study them, memorize them, and ask peers, classmates, faculty, and upperclassmen for clarification. But you don't get clarification; what you get is an education into what the match is really like. Some of what they say is from experience, some is hearsay, some is an attempt to dissuade a potential competitor. Logically, you take all of this “advice” with a grain of salt, not knowing what to believe. Throughout that time, I can't tell you how often a rumor was spread and corroborated by several people that was completely false. However, it was one of these pieces of gossip that both offered a sense of hope, along with a sense of fear.

Programs are forbidden from telling or asking you where you rank on the rank list. Each party can voluntarily express interest in each other, and can even speak to the likelihood with which a program will match, but a specific rank position, offer, and commitment can not be solicited. Understandably so, it would defeat the entire purpose and validity of the match. However, I can say with certainty, that these rules are scoffed at, and not even remotely followed by any of the programs I had rotated through or interviewed. Sure, they explain to the group of applicants that they follow the rules, but sure enough, whether its the next week, the next day, or, in some instances, the same night, each and every program called their top choices, and expressed their desire for them to be part of the next residency class. From a superficial aspect, it seems harmless, but the unscrupulous nature of these interactions becomes quickly evident.

First, these programs will often call several applicants and tell them that the same spot is their's to turn down. Let me repeat that: They are offering the same single spot to several different applicants! A gullible or frankly, trusting applicant that just might be unlucky will be left high and dry without a spot come match day. A different program I am familiar with calls only one applicant per spot, but then requires a commitment from the applicant. What possible commitment could the program demand of the applicant when a contract can not legally be signed? They asked the applicants to cancel the remainder of their interviews and submit a rank list with only their program on it.

It was these unscrupulous practices that the match was designed to combat; yet there is no honor, and it simply leaves the applicant with no recourse other than to lie to every program, proclaim their loyalty, and let the chips fall where they may come match day. Programs know this too, but they are still shocked when an applicant's match list differs from what they were told. I was at a program I was interested during match day, and I knew the two residents that were going to match to that program that day. But around the time the match results were delivered, I heard a lot of confusion, yelling, and some language that is not appropriate in the clinical setting. The program's top candidate, that professes a strong desire and need to match at this particular program, ended up ranking the program lower than another program, and match to a different program. All of the emails, texts and under-the-table agreements, that the program thought they had were meaningless.

I write this to bring to light something that is often unspoken during this time of year. The residency matching system is broken. The students are left powerless, unable to negotiate, with no recourse for violations that programs commit several times a year. If this is the system we are going to impose upon our nation's brightest minds, those entrusted with the health and well being of this country's citizens, then I believe that the match system needs to be abolished. If a program likes an applicant, let them offer said applicant a contract for a job, which is what residency is.

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[GangaMaster]

Ya I'm definitely not reading that.

 

[SouthernSurgeon]

Wut?

 

[Bacchus]

Having gone through the match, got my #1 choice, and was told by said choice I was one of three people they were calling, I think you're being excessively dramatic. The majority of applicants do fine, well, or even exceptionally in the match. Do well on boards, do the "requirements for your specialty (research, networking, etc.)," and try not to overthink it and you'll do more than likely well.

Edit: 2nd to last paragraph: do not piss off a program or lie to them. Karma will bite you, hard.

 

[VisionaryTics]

Go read about the ridiculous BS that residency applications used to be. Sorry you don't get to pick and choose your future as you see fit.

 

[Raryn]

Your rant amuses me. You start out saying that you think the rumors and generalizations you heard from others are awful, and then go on to spread rumors and make generalizations.

The facts remain simple. You're wrong that programs aren't allowed to share how they're ranking you: Anyone involved in the process is allowed to share any information they want. You can email each of your programs and tell them where they fall on your list, and they can do the same. No one does it because it's a dumb idea, but it's not forbidden.

Now, you're right that it is forbidden to ask the other party where they're ranking you and to ask them to make some kind of commitment. Most programs refrain from behavior like this, simply because there's not much to gain (you can't ensure the other party is honest) and it's generally seen to be poor form. Now, there are something like 4500 residency programs in the country, all with their own PDs, PCs, chiefs, interviewers, etc, so violations do happen, but they're fairly uncommon. (Anecdotally, they're a little more common in smaller specialties where programs have 1-2 spots compared to programs with 10, 20, 30, 50 spots).

Programs also know there's a lot of fish in the sea, so your anecdote about the program flipping out about one dishonest applicant is also quite bizarre. The "under the table agreements" were meaningless because they are meaningless.

The match is the worst of all possible systems, except for every other one that's been tried. It is a system that favors the applicants in a very, very strong sense. We aren't powerless, we (as actually aptly shown in your own examples) determine where we match among the programs that would have us. A system where at each interview you had take it or leave it contracts on the other hand would greatly disadvantage us: If I had a binding contract at the second place I interviewed at, but might have theoretically liked place #4 more (and they would have also offered me a contract), I'm screwed out of that possible spot at place #4.

 

[sazerac]

Students are guaranteed to match at the program they rank the highest, as long as the program desires and still has room for them. How exactly does this make the student "powerless" again???

To borrow a phrase from computer science, "Those who don't understand the match system are condemned to reinvent it, poorly."

 

[happygilmore]

You put too much hope in your career. If your medical career ended tomorrow would you still have a reason to live?

You should rename this thread, "Life Farce".

 

[Lavan]

The match is awkward and irritating, but it's the best way to avoid undue pressure on students or arms race issues. Otherwise, programs would offer you a job and say, I have 20 other students who would love this, you have to pick by tomorrow. Before you'd heard from a place you'd rather be. And now you're stuck, do you go with the job you got or the job you want? The match prevents that BS.

Yes the rules are broken, but not in a meaningful way unless you take things too seriously. Don't believe what any program tells you. Make your ROL how you want it. That's how it has to be and you won't get burned.

 

[ruralsurg4now]

Otherwise, programs would offer you a job and say, I have 20 other students who would love this, you have to pick by tomorrow.

Cool story, but for some reason that doesn't happen in any industry in America.

The reality is that the Match system is unfair to applicants but most applicants aren't intelligent enough to see how. Which is fine with me because they get the system they deserve.

 

[Lavan]

Cool story, but for some reason that doesn't happen in any industry in America..

Of course it does. (Not by "tomorrow," of course, that was for effect obviously). For example, it's happening in the radiology job market right now. It happens every day in academia, particularly in the liberal arts. When there are lots of qualified applicants for a single positition, the power is in the company, and bargaining power is curtailed. Job offers often have response deadlines.

The match is frustrating for its uncertainly, and it's definitely has some terrible aspects for couples, those going into advanced specialities, etc. It was frustrating for me as someone who couples matched into radiology, as my intern year wasn't guaranteed to be in the same place and the whole thing was really nervewracking. But on the whole, it's a system that makes it much more difficult for students to be abused. Think about college or medical school admissions. For people that know what they want, apply for early decision, and get in early, it's great. Best system ever. For people who don't, maybe settle, and then hope for a spot off the wait list, it's an entirely different story. The power is in the school for the vast vast majority of cases.

 

[neusu]

The match system is far from perfect.

The OP lists many concerns which are true.

Likewise, the monopoly on the system by ERAS and the NRMP is also unfair. The actual match algorithm is not published, nor any error checking. On the NRMP website, the explanation for the match algorithm is far too simplistic and does not include other considerations, the couples match in particular.

For the majority of applicants, the match successfully works in the fact that both parties, the applicants and the programs, have some choice. Nonetheless, far too much cheating and gamesmanship occurs.

 

[ruralsurg4now]

(Not by "tomorrow," of course, that was for effect obviously).

Oh, then what's the issue? I only had a problem with that part of your scenario. Telling someone that you have 20 other options is perfectly valid. In THAT case, then that's standard for everyone else in America.

 

[Raryn]

The match system is far from perfect.

The OP lists many concerns which are true.

Likewise, the monopoly on the system by ERAS and the NRMP is also unfair. The actual match algorithm is not published, nor any error checking. On the NRMP website, the explanation for the match algorithm is far too simplistic and does not include other considerations, the couples match in particular.

For the majority of applicants, the match successfully works in the fact that both parties, the applicants and the programs, have some choice. Nonetheless, far too much cheating and gamesmanship occurs.

The match algorithm is not only public/published, but every time they've made any edits, they publish long, technical articles explaining the edits, exactly why they were made, and running simulations on multiple years worth of the match to explain exactly what effect they have.

The last set of edits was made in the mid-90s with publications in JAMA. You are welcome to google the articles and read them yourself. There haven't been any more recent publications because the algorithm has been stable since then.

The reason the match has a monopoly is because otherwise, it would include far more gamesmanship (with people/programs tempting each other with out of match spots vs using the match, etc). This system is by far advantageous compared to that. The alternative happened in the mid-late 90s with the GI match with a number of programs dropping out, leading to a number of instabilities in the system. No one wants to see that in the main match. (Programs are welcome to drop out of the match and accept candidates *only* as out of match positions, but US MD M4s aren't allowed to accept those positions. Any program worth a damn doesn't do that because they know all the candidates who can be will be in the match).

There is no way to cheat the match. There is no way to game the match. People who attempt to game the match don't understand it very well and usually end up screwing themselves over compared to what might have happened had they simply ranked the programs in order of preference. People who try to play mind games underestimate the experience of the programs and don't realize they aren't doing themselves any favors.

But maybe I'm one of the not very intelligent people ruralsurg refers to above who doesn't see how the system is actually awful.

 

[Lavan]

Oh, then what's the issue? I only had a problem with that part of your scenario. Telling someone that you have 20 other options is perfectly valid. In THAT case, then that's standard for everyone else in America.

Because having programs offer individual applicants ultimatums with potential positions is obviously not advantageous to the applicants...that favors the programs, not the applicants.

The match system is far from perfect.

The OP lists many concerns which are true.

Likewise, the monopoly on the system by ERAS and the NRMP is also unfair. The actual match algorithm is not published, nor any error checking. On the NRMP website, the explanation for the match algorithm is far too simplistic and does not include other considerations, the couples match in particular.

For the majority of applicants, the match successfully works in the fact that both parties, the applicants and the programs, have some choice. Nonetheless, far too much cheating and gamesmanship occurs.

Raryn has the right of it entirely.

Also, the couples match works as advertised without any gambling except for the inability to tie internships/prelim years in with advanced specialties. So couples pursuing double derm or derm/rad etc have a potential year apart. The bigger issue with the couples match is that the early match specialties screw it up by not being a part of it. That's not the NRMP's fault though, that's an issue optho/urology/etc.

 

[ruralsurg4now]

Because having programs offer individual applicants ultimatums with potential positions is obviously not advantageous to the applicants...that favors the programs, not the applicants.

No, it doesn't. It favors the applicants. You just think it doesn't. You should look into it.

 

[Bacchus]

Snip.

Someone told me last year when we were going through the match that it's hand-checked. Since you seem to know more of the technicalities, can you confirm this? Just wondering because this student said the computer performs the algorithm and then a hand-check is done.

 

[Raryn]

Someone told me last year when we were going through the match that it's hand-checked. Since you seem to know more of the technicalities, can you confirm this? Just wondering because this student said the computer performs the algorithm and then a hand-check is done.

The official explanation for why it takes a month from the rank deadline to match day is that there's a large number of quality assurance measures done with the data is analyzed umpteen ways to make sure that there were no snafus. It's run in different orders, they run diagnostics on parts of the list to make sure they were all done reasonably, etc. But I don't know if any of it amounts to "hand-check"s. I presume there's manual involvement, but I can't imagine someone does the whole algorithm on paper. The data is so interconnected that you can't do just part of it without doing all 25,000 positions and 40,000+ applicants, and that'd just be ridiculous.

 

[Instatewaiter]

I grew up always wanting to be a doctor. I studied meticulously, foregoing parties and social occasions for the promise of reaching my goal. Once accepted to medical school, I knew that I would have to work even harder to both become a competent physician and to get a desirable residency spot. As a first year medical student, residency and the Match seem to be a decade away and there are more pressing matters to address. In second year, Step 1 looms over you like a bully waiting for you in the school yard. Once Step 1 is over, you are immediately thrust into the hospital and clinical setting without any pomp and circumstance. It's a relief to know that you Step 1 went well, but you become nervous and worried that you might make a mistake, which you undoubtedly will.

Um... a few points:
1) Having gone through both the residency match and the fellowship match, you're making a mountain out of a mole hill.

2) You first talk about how people spread rumors and tell stuff that is false about the match and then go on to spread rumors and false into about the match...

3) So I'm guessing you didn't match... by how pissed off you are. So what are you doing with your time?

 

[GCB80]

Cool story, but for some reason that doesn't happen in any industry in America.

Yes, it does. Ask most people who've been out in the real world and they'll tell you that it most certainly does happen.

The reality is that the Match system is unfair to applicants but most applicants aren't intelligent enough to see how. Which is fine with me because they get the system they deserve.

Tell us more, Yoda. You obviously know and understand more than we could ever dream of understanding.

 

[GCB80]

No, it doesn't. It favors the applicants. You just think it doesn't. You should look into it.

Accusing people of not understanding without offering anything of value or depth makes me (and probably everyone else) think you're full of it. Believe it or not, you're not the Match God, the only soul on the planet who "gets it." I actually think YOU'RE the one who's extremely naive and plain ignorant about how the process works, not to mention how the real world operates.

 

[thefritz]

Programs are forbidden from telling or asking you where you rank on the rank list. Each party can voluntarily express interest in each other, and can even speak to the likelihood with which a program will match, but a specific rank position, offer, and commitment can not be solicited. Understandably so, it would defeat the entire purpose and validity of the match.

Every program I have interviewed at has had a single interviewer ask me how many interviews I had. Most have asked which specific programs. I feel that this was intentional and that a single interviewer at each program is delegated the task of determining the number of interviews each candidate has and likelihood of this candidate ranking them highly. This puts the applicant in a highly uncomfortable position of either voluntarily showing his hand or having to deny the request and paint oneself as a disagreeable personality. This question should not be asked.

It was these unscrupulous practices that the match was designed to combat; yet there is no honor, and it simply leaves the applicant with no recourse other than to lie to every program, proclaim their loyalty, and let the chips fall where they may come match day.

It comes as no surprise that some applicants will lie given that people cheat their way into med school and throughout med school and overly competitive people will do whatever it takes to gain an edge. I certainly don't lie about these things and choose to believe most others don't either. In my opinion, the people who do this kind of stuff have a certain 'feel.' I.e., you can tell just talking to the person that he is full of b.s. Humility and sincerity are very, very hard to fake.

The residency matching system is broken. The students are left powerless, unable to negotiate

Yes, but it is not nearly as bad as medical school in terms of being powerless. An MD is worth something without residency training. 3 years of med school without an MD is worth exactly negative 150 thousand dollars.

I believe that the match system needs to be abolished. If a program likes an applicant, let them offer said applicant a contract for a job, which is what residency is.

I agree 100%. We should interview for them like normal jobs. But this would disrupt the July 1st start dates and academic semester system. In reality it's just another graduate program we are applying to. But unlike med schools, they can't just accomodate extra students who accept their offers and less than anticipated decline.

 

[ruralsurg4now]

Accusing people of not understanding without offering anything of value or depth makes me (and probably everyone else) think you're full of it. Believe it or not, you're not the Match God, the only soul on the planet who "gets it." I actually think YOU'RE the one who's extremely naive and plain ignorant about how the process works, not to mention how the real world operates.

You could think that, but you'd be wrong.

 

[ruralsurg4now]

I agree 100%. We should interview for them like normal jobs. But this would disrupt the July 1st start dates and academic semester system.

No, because if there's a cutoff all parties will have a vested interest in having their slots filled/jobs chosen by that time.

 

[mvenus929]

No, because if there's a cutoff all parties will have a vested interest in having their slots filled/jobs chosen by that time.

There is probably at least one med school every year who overaccepts too much and ends up with a larger class than they can accommodate after May 15th. If residencies were based on a similar system and they didn't overaccept, they'd end up with open spots at the deadline. If they did overaccept, they could end up with more residents than they could handle. That doesn't seem as efficient of a system to me.

 

[ruralsurg4now]

There is probably at least one med school every year who overaccepts too much and ends up with a larger class than they can accommodate after May 15th. If residencies were based on a similar system and they didn't overaccept, they'd end up with open spots at the deadline. If they did overaccept, they could end up with more residents than they could handle. That doesn't seem as efficient of a system to me.

You can't "overaccept" in that model because you interview and hire based on open spots. That's how the rest of the world works. Only in a Match system can you hoard applicants.

 

[Darth Doc]

There is probably at least one med school every year who overaccepts too much and ends up with a larger class than they can accommodate after May 15th. If residencies were based on a similar system and they didn't overaccept, they'd end up with open spots at the deadline. If they did overaccept, they could end up with more residents than they could handle. That doesn't seem as efficient of a system to me.

That's the point of the waitlist - preventing overacceptance.

 

[Instatewaiter]

.

 

[J ROD]

I look forward to interviewing and playing the game. Although I have to stay close to home for reasons beyond this discussion. Med school and Residency and even life is a game. Have to learn to play the rules and work it to your advantage. Like I know I am not going for a competitive specialty so I have not killed myself in med school. I think this may have been a bad idea for Step 1 though. I need more time to study for it and my school loads us down the semester before and we only have 4 weeks of dedicated study time. I am not going to be able to get in as much time as I wanted. But then again, I do not have to get a 240. It is all about what you want.

 

[evilbooyaa]

Another bunch of people who don't understand how the match works. Yes, you have to jump through the hoops of blowing smoke up the interviewer's ass. However, when it comes to it, this is better for applicants than the 'Here's my offer, take it or leave it in 2 days' at your #2 place before you even interview at your #1 place. I don't understand how letting applicants get to ALL of their interviews before they decide their optimal rankings is a bad idea.

 

[thefritz]

Another bunch of people who don't understand how the match works. Yes, you have to jump through the hoops of blowing smoke up the interviewer's ass. However, when it comes to it, this is better for applicants than the 'Here's my offer, take it or leave it in 2 days' at your #2 place before you even interview at your #1 place. I don't understand how letting applicants get to ALL of their interviews before they decide their optimal rankings is a bad idea.

It's a bad idea because it's essentially a one time deal. In the real world, when you don't get one job you keep on applying until you eventually find one. You don't get a callback after an interview, no biggie, keep on sending resumes. In the match, you don't match, you're ****ed for minimum of one year and likely ****ed overall because the stigma of not matching follows you. Imagine if you had to wait one year after getting rejected from one job before you could potentially be hired for another one and the other job would have access to all of your previous unsuccessful attempts to find a job..

 

[sazerac]

It's a bad idea because it's essentially a one time deal. In the real world, when you don't get one job you keep on applying until you eventually find one. You don't get a callback after an interview, no biggie, keep on sending resumes. In the match, you don't match, you're ****** for minimum of one year and likely ****** overall because the stigma of not matching follows you. Imagine if you had to wait one year after getting rejected from one job before you could potentially be hired for another one and the other job would have access to all of your previous unsuccessful attempts to find a job..

Except it's not a "one time deal"; if you rank 15 programs in the match and another 45 in the SOAP it's more like a sixty time deal. At a certain point, the July 1st train leaves the station and candidates without a program have to wait a year no matter what system you use. There are a lot of programs and a lot of applicants, and importantly every program is synchronized, so the match is the best system they have been able to come up with.

Do you have an alternative suggestion that would produce a best-fit solution for simultaneously integrating the desires of tens of thousands of candidates and the programs? Most alternate solutions (including reverting to the free-for-all bad old days) result in programs taking advantage of vulnerable applicants, as outlined repeatedly in this thread. That extreme power imbalance is why the match was created in the first place. Maybe you are advocating a "rolling" match system, like doing four matches a year or something? I'm not sure that would be practical, given the realities of a fully synchronized GME.


"Those who don't understand the match system are condemned to reinvent it, poorly."

 

[Raryn]

The match algorithm is not only public/published, but every time they've made any edits, they publish long, technical articles explaining the edits, exactly why they were made, and running simulations on multiple years worth of the match to explain exactly what effect they have.

The last set of edits was made in the mid-90s with publications in JAMA. You are welcome to google the articles and read them yourself. There haven't been any more recent publications because the algorithm has been stable since then.

I had some spare time and looked it up. The article I mentioned above is at http://www.ncbi.nlm.nih.gov/pubmed/9286832 with the full PDF at http://jama.jamanetwork.com/data/Journals/JAMA/9965/jama_278_9_032.pdf

It's an interesting read. I especially like the lines such as "When the applicant-proposing algorithm [which is the one they switched to in 1998] is used, no applicant can possibly improve his match by submitting a ROL different from his true preferences" and [in the conclusion] "Under either algorithm, both applicants and programs can be confidently advised that, when deciding what ROLs to submit, they are extraordinarily unlikely to be able to influence the match in their favor by submitting a list different from their true preferences. This result is supported both by the computational studies conducted on previous matches and by the new results for simple markets."

If you follow some of the references back, you can see a number of commentaries regarding how the match works. Some of them are pretty math heavy if I remember right (it's been a few years since I've looked it up) but they expand on the details nicely. A great example of one of those is in an economics journal published in 1999 that addresses a lot of the points different people have brought up and talks a lot about the history behind the match and why it was necessary. http://kuznets.fas.harvard.edu/~aroth/papers/rothperansonaer.PDF There's nothing new under the sun. (I will admit I can't say that I understood all of the math in the second half of the paper)

You won't see much published in the last decade simply because it's been a stable system since then.

 

[thefritz]

Under either algorithm, both applicants and programs can be confidently advised that, when deciding what ROLs to submit, they are extraordinarily unlikely to be able to influence the match in their favor by submitting a list different from their true preferences. This result is supported both by the computational studies conducted on previous matches and by the new results for simple markets."

If this were true, then emailing your number one program to tell them they are your number one would be pointless, but everybody and his brother does this because they are under the impression that they can positively change the outcome. The two most widely held ideas by med students about the match are totally incongruous (the first being that you should rank the programs in the order you prefer them and not attempt to game the system with a different list, and the second being that you should disclose your number one rank to that program). If the latter notion has merit, it has a number of important implications. First, it implies that the program may alter their rank list. This subsequently implies that your simple email actually increased your true desirability to the program (which is preposterous and would have a number of other ramifications I will touch on briefly.) or else that your email somehow encouraged the program to alter their rank list to deviate away from their true preference (which is equally preposterous and totally at odds with what is posted above). These two axioms collide when you suppose that it is possible to move yourself up on the program's rank list by stating that they are your number one choice. If you believe this, you cannot simultaneously hold the belief that your chances of matching are highest when you rank the programs in your true preferred order. The reason should be obvious, but to demonstrate suppose you interview at 5 places. The first four programs are top-10 programs. The fifth program is a far less desirable program, and certainly is on the bottom of your list. But you are so concerned that you might not match at all, you decide to tell the fifth program you are their number one choice and put them at the top of your list. Based on your belief that you can influence the rank list with your email, you are more likely to get a bigger bump at a less competitive program. You have just increased your chances at matching. Additionally, you could also send that email to every single program and submit your true rank list getting the bump at each one that doesn't figure out what you're up to, and we all know people do this kind of shady stuff.

Instead, my personal belief is that the #1 email does not make any difference and that programs will not change your rank based on this. My point is that if you believe that the email makes a difference, then you can 'game' the match by sending that email to the least competitive program or the program you think you interviewed best at. The reality is that it is possible to game the match if you know exactly how each program is going to rank you. But without this insider information, I believe the true order is your best bet and that you can't increase your position post-interview.

 

[dsm5md]

If you get asked this one, it is an easy one to answer. Your goal should be to blow smoke up the interviewer's ass. Make sure you key in on the fact that you love their program.

[/quote]

Priceless!!
Medicine is truly as much of a con game today is lawyering

 

[sazerac]

The reality is that it is possible to game the match if you know exactly how each program is going to rank you. But without this insider information, I believe the true order is your best bet and that you can't increase your position post-interview.

The quote you posted simply says that you only have absolute control over your own Rank Order List, and you cannot "game" the system by submitting a ROL in a different order than your true desires - you cannot improve your odds of match by submitting a list in a different order, you cannot improve your chances of getting to a specific program by ranking it lower. You can only hurt yourself by ranking a more desirable program lower.

You seem to have a different definition of "game", which is called trying to influence how PROGRAMS rank you. Well duh, if you can influence another program to rank you higher then of course yours odds of matching go up, and if you rank them then your odds of matching there are higher relative to the programs you ranked below them. But that isn't really "gaming" the system. People try to influence programs' behavior all the time. That is why people get good board scores, to influence programs. That is why people do research in the field. That is why people behave and impress on their interviews. They are trying to "game" they system (by your definition) and influence the program to rank them higher. Everybody does it. It's how the system is supposed to work.

You seem particularly interested in trying to influence a program by sending them emails after the interview. Fine. Send them emails if you think it will influence how the program will rank you. Send the same emails to a dozen programs. Whatever. But in the end, the only thing you can truly control is your own personal ROL, and if you should ever submit a list in a different order than your true desires then (assuming you were going to match at all) you are guaranteed to improve your odds of matching a program that is different from your true desires.

 

[Instatewaiter]

It's a bad idea because it's essentially a one time deal. In the real world, when you don't get one job you keep on applying until you eventually find one. You don't get a callback after an interview, no biggie, keep on sending resumes. In the match, you don't match, you're ****** for minimum of one year and likely ****** overall because the stigma of not matching follows you. Imagine if you had to wait one year after getting rejected from one job before you could potentially be hired for another one and the other job would have access to all of your previous unsuccessful attempts to find a job..

You're not just interviewing at one job; you're applying for as many jobs as you want at the same time. It's as if you are getting rejected from every job you applied to at once. Yeah the once per year thing sucks if you don't match but what are you suggesting, a rolling match?

What you're expecting happened before the match. Do a little research and find out what happened before the match. People would be offered a spot and be forced to decide to take the spot within a few days. It has made it more of a meritocracy where both the program and the interviewer can relax and get to weight their options.

Of course there is a stigma if you don't match. It says, "Hey programs, I tried to match and places found me so disagreeable I couldn't get a spot anywhere or I was too cocky and applied to myopically"

 

[Instatewaiter]

The two most widely held ideas by med students about the match are totally incongruous (the first being that you should rank the programs in the order you prefer them and not attempt to game the system with a different list, and the second being that you should disclose your number one rank to that program).

How do you suggest someone "games the system with a different list?" Based on how the match works, can't happen

If (sending a letter of intent) has merit, it has a number of important implications. First, it implies that the program may alter their rank list. This subsequently implies that your simple email actually increased your true desirability to the program or else that your email somehow encouraged the program to alter their rank list to deviate away from their true preference (which is equally preposterous and totally at odds with what is posted above). These two axioms collide when you suppose that it is possible to move yourself up on the program's rank list by stating that they are your number one choice.

The simple e-mail does increase your desirability. This is not training in an emotional bubble. A resident's happiness impacts his/her performance. As a PD, you want happy residents who want to come to your program because they will perform better. Thus between two essentially equivalent candidates, you want the one who wants to come to your program. Residency is a stressful time. Throwing a resident who already doesn't want to be there into a very stressful situation can lead to disaster.

I can tell you that my fellowship program expects a #1 e-mail or something similar. They want people who want to come here. Without it, they worry that the stress of a busy fellowship will swallow people who don't want it.

 

[Raryn]

What you're expecting happened before the match. Do a little research and find out what happened before the match. People would be offered a spot and be forced to decide to take the spot within a few days. It has made it more of a meritocracy where both the program and the interviewer can relax and get to weight their options.

It's much worse than that. Before the match, people would be interviewing for and accepting residency spots years ahead of time. Programs wanted to lock in candidates, so many people would sign contracts as M3s. Or M2s. And if you changed your mind? Well, sucks to be you.

 

[Instatewaiter]

It actually still happens in at the superfellowship level. At that point it's less nervewracking since you know exactly where you want to be.

 

[thefritz]

It's much worse than that. Before the match, people would be interviewing for and accepting residency spots years ahead of time. Programs wanted to lock in candidates, so many people would sign contracts as M3s. Or M2s. And if you changed your mind? Well, sucks to be you.

The elephant in the room is that medical school is horribly inefficient and needs to be largely eliminated. Nearly everything we learn in the first two years beyond big picture concepts are quickly forgotten. Concepts we learn in third year are quickly forgotten that aren't applicable for fields we are going into. I could barely tell you anything about peds. For advanced programs that require prelims, everybody always says how much better it is to do a prelim because it will make you a better doctor. But if you don't use it in your advanced program, 5 years later, no you won't be able to manage diabetes anymore. Yet all you here about from PGY-2's is how you should do an prelim med or surg year instead of a TY.
We waste so much time learning and training to use specialized knowledge that is quickly forgotten because we specialize in something else later on down the road. It's a complete waste of time and only held in place by an anachronistic educational system from way back in a time where only independently wealthy people pursued higher education and could actually afford to truly be renaissance men because they didn't have to worry about specializing and actually being gainfully employed. Do you remember anything from Organic chemistry? Something about carbon chains and electrons pushing each other from all sorts of different directions is all I remember. Physics? F=ma? Gen Chem? What was the point? Well, functionally it's an intelligence test although nobody actually comes out and admits that because that's not PC. And what about college in general? Why do we require a college degree but not care what it is in? Why do we have traditional students majoring in history and going straight through into med school?

We're training to be specialists, why not have specialized training programs that actually teach us more of what we need to know and stop wasting our time overlearning other fields. Yes, we need to understand all the different fields of medicine, but no we don't need to know that much about how to manage gunshot wound trauma patients if we are going to be psychiatrists. An analogy would be an airplane pilot learning to fly helicopters, hot air balloons, floatplanes, and world war II era fighters just barely good enough to not crash while an instructor is looking on the whole time, and then after passing a minimal competency check, never ever touching any of them again instead to spend the rest of his career flying only 737s. Make sense? No. Of course not.

My proposal that I find incredibly logical:
Establish a true "pre-med" bachelors degree that is REQUIRED for further training. Incorporate the MCAT halfway into this degree and require minimum scores to obtain it. Complete the preclinical med school coursework in the last 30-50 credits of this degree (probably a 5 year degree) and require the degree from an accredited program to sit for an exam similar to the USMLE step 1. At this point, you would apply directly to "medical schools" which could either be a university program or community hospital and you would apply for your desired specialty at this time. An internal medicine residency, for example, would be 4 years long. The first year being a traditional third year experience with required rotations through IM, surgery, peds, ob/gyn, etc. with all of the other first years from all training programs at the hospital. This gives you your broad based "foundation" of the medical field to be able to understand and relate to your colleagues. After completion of this "transitional" year, you take an exam similar to USMLE step 2, and continue on to the specialized IM training or else remediate as necessary based on your performance. This trims the fat by getting rid of unnecessary years of education. If you are a non-trad? No problem. Go back to college and get the credits you need to get the degree. No more silly post-bacc fake degrees or pre-meds blowing off college by studying art history or something and not learning anything they can put towards their career for four years. Yes I understand the value of liberal arts, but there is no reason that experience can't also be incorporated into this kind of system.

Will this ever happen? Probably not. Why? Because it eliminates medical school. College->transitional year->residency. Medical schools probably aren't going to want to give up being the gatekeepers to this field. Nor

 

[BurghStudent]

The elephant in the room is that medical school is horribly inefficient and needs to be largely eliminated. Nearly everything we learn in the first two years beyond big picture concepts are quickly forgotten. Concepts we learn in third year are quickly forgotten that aren't applicable for fields we are going into. I could barely tell you anything about peds. For advanced programs that require prelims, everybody always says how much better it is to do a prelim because it will make you a better doctor. But if you don't use it in your advanced program, 5 years later, no you won't be able to manage diabetes anymore. Yet all you here about from PGY-2's is how you should do an prelim med or surg year instead of a TY.
We waste so much time learning and training to use specialized knowledge that is quickly forgotten because we specialize in something else later on down the road. It's a complete waste of time and only held in place by an anachronistic educational system from way back in a time where only independently wealthy people pursued higher education and could actually afford to truly be renaissance men because they didn't have to worry about specializing and actually being gainfully employed. Do you remember anything from Organic chemistry? Something about carbon chains and electrons pushing each other from all sorts of different directions is all I remember. Physics? F=ma? Gen Chem? What was the point? Well, functionally it's an intelligence test although nobody actually comes out and admits that because that's not PC. And what about college in general? Why do we require a college degree but not care what it is in? Why do we have traditional students majoring in history and going straight through into med school?

We're training to be specialists, why not have specialized training programs that actually teach us more of what we need to know and stop wasting our time overlearning other fields. Yes, we need to understand all the different fields of medicine, but no we don't need to know that much about how to manage gunshot wound trauma patients if we are going to be psychiatrists. An analogy would be an airplane pilot learning to fly helicopters, hot air balloons, floatplanes, and world war II era fighters just barely good enough to not crash while an instructor is looking on the whole time, and then after passing a minimal competency check, never ever touching any of them again instead to spend the rest of his career flying only 737s. Make sense? No. Of course not.

My proposal that I find incredibly logical:
Establish a true "pre-med" bachelors degree that is REQUIRED for further training. Incorporate the MCAT halfway into this degree and require minimum scores to obtain it. Complete the preclinical med school coursework in the last 30-50 credits of this degree (probably a 5 year degree) and require the degree from an accredited program to sit for an exam similar to the USMLE step 1. At this point, you would apply directly to "medical schools" which could either be university or community based programs and you would apply for your desired residency at this time. An internal medicine residency, for example, would be 4 years long. The first year being a traditional third year experience with required rotations through IM, surgery, peds, ob/gyn, etc. with all of the other first years from all training programs at the hospital. This gives you your broad based "foundation" of the medical field to be able to understand and relate to your colleagues. After completion of this "transitional" year, you take an exam similar to USMLE step 2, and continue on to the specialized IM training or else remediate as necessary based on your performance. This trims the fat by getting rid of unnecessary years of education. If you are a non-trad? No problem. Go back to college and get the credits you need to get the degree. No more silly post-bacc fake degrees or pre-meds blowing off college by studying art history or something and not learning anything they can put towards their career for four years. Yes I understand the value of liberal arts, but there is no reason that experience can't also be incorporated into this kind of system.

Will this ever happen? Probably not. Why? Because it eliminates medical school. College->transitional year->residency. Medical schools probably aren't going to want to give up being the gatekeepers to this field. Nor

Can we make thefritz president already? Seriously, Bravo! Everything I've wanted the world of medical education to consider right here.

 

[thefritz]

http://www.amazon.com/Academically-Adrift-Limited-Learning-Campuses/dp/0226028569'
'
45% of students haven't learned anything AT ALL after 2 years of college, over a third didn't improve at all over all 4 years. (and remember, not everyone graduates). So it's not entirely med school's fault. It's just extending an already broken system with more broken.

 

[Lavan]

For advanced programs that require prelims, everybody always says how much better it is to do a prelim because it will make you a better doctor. But if you don't use it in your advanced program, 5 years later, no you won't be able to manage diabetes anymore. Yet all you here about from PGY-2's is how you should do an prelim med or surg year instead of a TY.

All I ever heard from advanced residents was to find the easiest TY possible since your prelim year was meaningless in the long term. Which is advice I agree with. But otherwise some good points.

 

[thefritz]

Come to think of it, the broken system extends all the way back to the beginning. Who remembers learning multiplication in 3rd grade? And learning it again in 4th grade? 5th grade comes around -- more multiplication. 6th grade, sweet we've learned this four times already, this is easy! Lets put on a video of Cool runnings in class and let the teacher read the newspaper while we gossip about NBA players anxiously waiting until to spend all afternoon playing N64 at home with no homework, of course. The funny thing is that most people got it a long time ago. They just got bored and became accustomed to school being easy. Finally 9th grade rolls around and shiiiiiiiit, what is this algebra, shiiiiiiiit, and 90% of the class gives up and goes on the rest of their lives saying "i'm just not a math person" and we have to fill most of our engineering classes from overseas (you know where kids actually have homework and are doing our 11th grade level math in 5th-6th grade) in college. Great system we have in the USA. We dumb down K-12 education and reteach the same **** over and over again. And collegiate level education we force people to binge-purge facts they will never remember 1 month later.

 

[pdxhopeful]

Come to think of it, the broken system extends all the way back to the beginning. Who remembers learning multiplication in 3rd grade? And learning it again in 4th grade? 5th grade comes around -- more multiplication. 6th grade, sweet we've learned this four times already, this is easy! Lets put on a video of Cool runnings in class and let the teacher read the newspaper while we gossip about NBA players anxiously waiting until to spend all afternoon playing N64 at home with no homework, of course. The funny thing is that most people got it a long time ago. They just got bored and became accustomed to school being easy. Finally 9th grade rolls around and shiiiiiiiit, what is this algebra, shiiiiiiiit, and 90% of the class gives up and goes on the rest of their lives saying "i'm just not a math person" and we have to fill most of our engineering classes from overseas (you know where kids actually have homework and are doing our 11th grade level math in 5th-6th grade) in college. Great system we have in the USA. We dumb down K-12 education and reteach the same **** over and over again. And collegiate level education we force people to binge-purge facts they will never remember 1 month later.

I wouldn't say that was my experience in school, but I was in a good district and had parents who would go to bat for me to be allowed to take a more advanced math class, etc.

A big part of the reason, IMHO, for the phenomenon you're talking about is that we don't actually value primary education. We dismiss K-6 teachers as 'babysitters' and 7-12th ones as 'cops', and there are more than a few areas where a new elementary teacher must have a Master's yet is paid so little - on full-time status - that they qualify for public assistance but are still buying classroom supplies out of that. Kids pick up on that, older teens and college kids considering career plans pick up on that. There are also a lot of ideas going around that sound good, but are utterly out of touch with the reality of the classroom. And a lot of invalid comparisons made.

Let's take a hint from the countries that do it right - show genuine respect for the profession, give them pay commensurate with their education and the task we're asking of them - to form the base of our kids' intellectual growth.

 

[SouthernSurgeon]

I was talking to a residency applicant last week at our interview dinner.

He literally moved out of his apartment, and hasn't even been in the same city as his med school for the past 6 months except for his interview day there. This is actually something I'm hearing more and more often.

If nothing else, medical schools need to address the fact that fourth year is a complete joke. I spent 40000 tuition for a sub-I month, an ER month, and a couple of BS "research" electives that produced a sum total of one poster presentation.

 

[Lavan]

I was talking to a residency applicant last week at our interview dinner.

He literally moved out of his apartment, and hasn't even been in the same city as his med school for the past 6 months except for his interview day there. This is actually something I'm hearing more and more often.

If nothing else, medical schools need to address the fact that fourth year is a complete joke. I spent 40000 tuition for a sub-I month, an ER month, and a couple of BS "research" electives that produced a sum total of one poster presentation.

Though the simple alternative would probably just involve more clinical rotations that you didn't want anyway, so perhaps the expensive vacation was worth it after all.

 

[evilbooyaa]

Fritz, you make some decent points, however I counter with a couple questions:

1) Many people don't figure out what they want to do (specialty or general) until after they complete 3rd year. Your system of entering medical school with a specialty in mind is a rarity for many, many students in medical school.

2) The part about undergrad being a waste, I completely agree with for the most part. The only issue with a 'pre-med' degree is that if students get that degree without having the scores required to get into medical school, they have pretty much wasted 3-4 years of undergrad. At least if you get a Biology (or even Art History) degree, you have the potential to put that degree to use in getting a job outside of medical school. You likely don't remember much about organic chem or physics, but the knowledge is likely still there in the back of your mind, and you could re-pick it up much easier if you needed to. If you stay a doctor, then it's not necessary, but not remembering something != not learning it.

3) I'm going to assume your bit about not having to learning at least basic math (and by extension, history/english/science) was a bit facetious. I have no interest in history. Does that mean I shouldn't have to learn any of it? I'm not sure I get your point there. At least in K-12, there needs to be a foundation built in multiple subjects that can be built on in the future. In some ways, medical school is the same way. If you're in a specialty, then you should have a rudimentary understanding of what primary care folks do.

4) Your part about psychiatrists not knowing how to manage a trauma is fair (unless there's a gunshot in the psych ward), but the opposite of that is NOT true. If a trauma surgeon does not know how to handle a psychotic patient, it may one day come back to bite him/her in the ass.

The one thing I can agree with is lowering tuition on 4th year. Eliminating isn't really possible because there would still have to be a year to go through the interview and match process (without getting bogged down by 3rd year requirements) but with the lowered amount of structured rotations, they should be able to drop tuition. Of course they won't, because it's a university, and therefore, a business.

 

[Raryn]

Many people don't figure out what they want to do (specialty or general) until after they complete 3rd year. Your system of entering medical school with a specialty in mind is a rarity for many, many students in medical school.

Not only that, but most students who do come into medical school with a field in mind are completely wrong about it. Lots of people think they want to be X until they actually do a rotation in it and realize they hate it.

Otherwise, see http://www.gomerblog.com/2014/01/ma...ed-school-personal-statement-legally-binding/