NRMP Consider Two-Part Match In lieu of SOAP

[Foreverworthless]

Interesting! NRMP® Call for Public Comment Regarding Consideration of a Two-Phase Main Residency Match

---

Members don't see this ad.

 

[NotAProgDirector]

It is interesting. The first round would be the main match ending 2/9. Like current, most spots would fill in the main match. Those who previously were in SOAP would be in the second round -- there would be more time to consider applicants/programs, and a true rank list to ensure applicants get the best spot possible.

Downsides are that the main match becomes a bit more rushed (but not much), and that those left in the second round have more time to worry / suffer / stress over not matching in the first round.

It's not what I had favored -- which was an "early decision" type early round to get 30% of the spots filled.

 

[Mr.Smile12]

Just wondering if it aligns better with the military match timeline, which I presume remains unaffected by these changes...

 

[SooConfused]

Just wondering if it aligns better with the military match timeline, which I presume remains unaffected by these changes...

If it does, I'm sure that's just a coincidence. From everything I have read, the objective here is to turn SOAP into a supplemental match, with ranking, signaling, etc., in order to give those folks the same opportunities everyone else has to find their ideal spot rather than being forced to just grab something at the last minute.

 

[WildWing]

We published an article so people are tracking the topic:

Two-Phase Residency Match Proposed by NRMP - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

My favorite part is the infographic where you can see the differences in the schedule side-by-side:

 

[deleted1081396]

Give FMGs and IMGs without American citizenship/Green Card their own Match amd SOAP period with Scramble for all afterwards. Every American grad matches. Very simple.

 

[SooConfused]

Give FMGs and IMGs without American citizenship/Green Card their own Match amd SOAP period with Scramble for all afterwards. Every American grad matches. Very simple.

Sounds great, if the idea is to screw highly qualified IMGs/FMGs in favor of less well qualified US grads. It isn't.

If they wanted to, residencies and fellowships could do that today simply by not interviewing or ranking IMGs/FMGs. IMGs/FMGs have to overcome a lot in order to match. I'm pretty sure the reason some US grads are still unemployed even after the match and SOAP has nothing to do with unfair competition from foreign grads.

Getting the last few US grads matched isn't what is driving this. Replacing SOAP with another match to give people currently SOAPing the same benefits everyone else gets by successfully matching is the idea here.

 

[voxveritatisetlucis]

Wonder how this would affect specialties of middling competitiveness (rads, gas, surgery)

 

[SooConfused]

Wonder how this would affect specialties of middling competitiveness (rads, gas, surgery)

It seems to me that the impact on the program will be solely determined by the program (i.e., they could choose to be more selective in the first round because there is going to be a second, or not, at their option).

The only intended objective is to give people who don't initially match more options and more time to consider them. An unintended consequence might be to throw more people into the secondary match than currently participate in SOAP, because programs might become more picky about who they rank in the first round.

But it seems to me that will vary by program, and not necessarily by the competitiveness of the specialty. If I was a PD, I wouldn't change anything by trying to be more selective in the first round, since they are very unlikely to do better in the secondary match than had they filled all slots in the first round.

If that's how it turns out, it's not going to change anything for any program, other than giving those with open spots the opportunity to rank applicants, and giving unmatched people choices, as an alternative to the current system of forcing both programs and applicants to grab the first acceptable option that presents itself. The specialties you mentioned don't currently fill a lot of spots through SOAP, do they? Assuming that's the case, why would you think that might change?

 

[throwaway123342]

Sounds great, if the idea is to screw highly qualified IMGs/FMGs in favor of less well qualified US grads. It isn't.

If they wanted to, residencies and fellowships could do that today simply by not interviewing or ranking IMGs/FMGs. IMGs/FMGs have to overcome a lot in order to match. I'm pretty sure the reason some US grads are still unemployed even after the match and SOAP has nothing to do with unfair competition from foreign grads.

Getting the last few US grads matched isn't what is driving this. Replacing SOAP with another match to give people currently SOAPing the same benefits everyone else gets by successfully matching is the idea here.

Americans are more qualified instrinsicly since we are the ones who paid taxes to support these schools in the first place.

 

[SooConfused]

Americans are more qualified instrinsicly since we are the ones who paid taxes to support these schools in the first place.

"Intrinsicly"? An accident of birth does not make anyone intrinsically more qualified to do anything, regardless of whether it is spelling a word or administering potentially life saving medical treatment.

For the record, IMGs are Americans who for one reason or another went to school off-shore. IMGs and FMGs tend to be extremely hard working and accomplished in order to be able to successfully navigate the gauntlet and obtain an American residency. Either that, or they take the spots most others don't want.

Other than the most xenophobic among us, most people in need of medical care would much rather be treated by a foreign medical student who was able to beat the odds and break through than by someone fortunate enough to have had the opportunity to attend an American school, and yet have some deficiency in their residency application that prevented them from being selected for a residency ahead of an "intrinsicly" less qualified IMG/FMG.

 

[Med Ed]

Give FMGs and IMGs without American citizenship/Green Card their own Match amd SOAP period with Scramble for all afterwards. Every American grad matches. Very simple.

For every complex problem there is an answer that is clear, simple, and wrong. -H.L. Mencken

 

[throwaway123342]

"Intrinsicly"? An accident of birth does not make anyone intrinsically more qualified to do anything, regardless of whether it is spelling a word or administering potentially life saving medical treatment.

For the record, IMGs are Americans who for one reason or another went to school off-shore. IMGs and FMGs tend to be extremely hard working and accomplished in order to be able to successfully navigate the gauntlet and obtain an American residency. Either that, or they take the spots most others don't want.

Other than the most xenophobic among us, most people in need of medical care would much rather be treated by a foreign medical student who was able to beat the odds and break through than by someone fortunate enough to have had the opportunity to attend an American school, and yet have some deficiency in their residency application that prevented them from being selected for a residency ahead of an "intrinsicly" less qualified IMG/FMG.

Really? Is it an accident I was born in Virginia and thus I should be entited to in-state tuition at UTennessee?

For every complex problem there is an answer that is clear, simple, and wrong. -H.L. Mencken

The premise of the quote doesn't apply here since the problem is not complex, its in fact very straightforward.

 

[SooConfused]

Really? Is it an accident I was born in Virginia and thus I should be entited to in-state tuition at UTennessee?


The premise of the quote doesn't apply here since the problem is not complex, its in fact very straightforward.

No, but you are mixing apples and fruit salad.

Yes, a residency is a taxpayer funded job, but employers generally want the best, most well qualified applicants. Hospitals are no exception, and there is not, nor should there be, a mandate that less well qualified applicants from American schools receive a preference over IMGs/FMGs.

This is a very different thing from subsidized in-state tuition for students, not employees. If <5% of US medical school students do not match or SOAP, in spite of their huge built-in advantage, there is a reason for it. It is in no one's interest, other than theirs and maybe some dedicated xenophobes, to give an American taxpayer funded residency slot to them over an American who attended schools overseas. Or, heaven forbid, a better qualified foreign citizen who will thereafter contribute to our society as well as our tax revenues.

In any event, the back and forth is pointless because no one is calling for it and it isn't happening. The match already very heavily favors US med school graduates, and no one is seriously suggesting that the few who are unsuccessful owe their situation to unfair competition from foreigners. They invariably owe it to their own under performance and/or over optimism in selecting programs to rank in the match. The IMGs/FMGs who are successful where domestic candidates are not are clearly superior to them, or are willing to go places US graduates are not.

 

[DrStephenStrange]

No, but you are mixing apples and fruit salad.

Yes, a residency is a taxpayer funded job, but employers generally want the best, most well qualified applicants. Hospitals are no exception, and there is not, nor should there be, a mandate that less well qualified applicants from American schools receive a preference over IMGs/FMGs.

This is a very different thing from subsidized in-state tuition for students, not employees. If <5% of US medical school students do not match or SOAP, in spite of their huge built-in advantage, there is a reason for it. It is in no one's interest, other than theirs and maybe some dedicated xenophobes, to give an American taxpayer funded residency slot to them over an American who attended schools overseas. Or, heaven forbid, a better qualified foreign citizen who will thereafter contribute to our society as well as our tax revenues.

In any event, the back and forth is pointless because no one is calling for it and it isn't happening. The match already very heavily favors US med school graduates, and no one is seriously suggesting that the few who are unsuccessful owe their situation to unfair competition from foreigners. They invariably owe it to their own under performance and/or over optimism in the selecting programs to rank in the match. The IMGs/FMGs who are successful where domestic candidates are not are clearly superior to them, or are willing to go places US graduates are not.

What makes someone better qualified for a job, in this case residency? Please don't tell me higher board scores because time and time again this has been proven not to be true. Don't tell me research either, that doesn't have any implications with clinical capabilities. Many many people that barely scrape by in medical school have gone on to become great physicians. Now, I'm not xenophobic, and I have nothing against IMGs/FMGs, but no one graduating with 300K+ in student loans from US medical schools should be jobless after graduating. I don't care what your argument against that is. I know american graduates already have a big advantage against IMGs/FMGs, and that's deservedly so. Outside of people with huge red flags, I really don't think any AMG should be unemployed after the Match.

 

[Med Ed]

Outside of people with huge red flags, I really don't think any AMG should be unemployed after the Match.

How about the ones who aim too high but refuse to formulate a backup plan?

 

[VA Hopeful Dr]

. Outside of people with huge red flags, I really don't think any AMG should be unemployed after the Match.

Not are they

 

[throwaway123342]

No, but you are mixing apples and fruit salad.

Yes, a residency is a taxpayer funded job, but employers generally want the best, most well qualified applicants.

...And colleges do not want well qualified applicants?

 

[SooConfused]

...And colleges do not want well qualified applicants?

Of course they do, and very few, if any, public universities refuse to accept well qualified OOS applicants.

The fact that taxpayer funded public schools have public mandates to prioritize and subsidize IS applicants has nothing to do with federally funded hospital residency programs not prioritizing the bottom 2-3% of domestic applicants over vastly superior applicants from off-shore medical schools.

 

[SooConfused]

What makes someone better qualified for a job, in this case residency? Please don't tell me higher board scores because time and time again this has been proven not to be true. Don't tell me research either, that doesn't have any implications with clinical capabilities. Many many people that barely scape by in medical school have gone on to become great physicians. Now, I'm not xenophobic, and I have nothing against IMGs/FMGs, but no one graduating with 300K+ in student loans from US medical schools should be jobless after graduating. I don't care what your argument against that is. I know american graduates already have a big advantage against IMGs/FMGs, and that's deservedly so. Outside of people with huge red flags, I really don't think any AMG should be unemployed after the Match.

It's PDs who make the final decision. For some it's board scores, for others it's research, connections, whatever. Not for you or me to decide. Given the spectacular domestic match rates, and the abysmal IMG/FMG match rate, exactly why would you think something nefarious is going on, or that foreigners are usurping an American entitlement? If this was actually an issue, don't you think PDs would fix it, or that Congress would fix it for them?

There is no prejudice against domestic applicants in favor of IMGs/FMGs. It takes a lot for a IMG/FMG to break through, and it also takes a lot for a US grad to be unsuccessful, given the 95%+ match rate.

No one "deserves" anything just because they have a pulse, a lot of debt, and were born in America. How "huge" a given red flag is is clearly in the eye of the beholder, but I am pretty sure more than bad luck or woke PDs favoring foreigners over Americans goes into anyone graduating from an American medical school being unemployed after completing their studies.

For the record, this argument is most often advanced by IMGs from the Caribbean complaining about clearly superior FMGs getting slots ahead of them. At the end of day, the deficiencies in the applications of US grads who are passed over in favor of IMGs or FMGs, or of IMGs who are passed over in favor of FMGs, are obvious to most objective observers, other than xenophobes, who objectively believe American citizenship trumps any other possible metric.

 

[NotAProgDirector]

Give FMGs and IMGs without American citizenship/Green Card their own Match amd SOAP period with Scramble for all afterwards. Every American grad matches. Very simple.

For every complex problem there is an answer that is clear, simple, and wrong. -H.L. Mencken

The main problem/confusion with this discussion is that there isn't agreement about what "problem" we are trying to solve.

Let's start with this fact: in the current system, after the match and SOAP conclude, essentially every single GME position in the US is filled. Therefore, no change to the system can improve the overall fill rate. Any reasonable change will leave the fill rate at 99-100%, so the only difference will be in whom gets which spot. With all the changes which have been hinted/proposed on this thread (and others), the vast majority of outcomes will be exactly the same. A minority of applicants will either get a different spot, or some may not match under one system and match under the other.

On this thread we have:

1. Replace SOAP with a 2nd match round (Current NRMP proposal). This would leave the 1st round of the match == current match, so all those spots would be exactly the same. SOAP would turn into a second match, so some changes would be expected there. This would probably favor USMD and USDO applicants in SOAP, who would have more time to interview / consider more programs. Programs would be more likely to interview more people. This options "solves" the problem of SOAP applicants feeling like they were pushed into making a rushed decision. It creates a new problem -- it prolongs the "SOAP" process over a longer period of time. Doesn't feel good to be in SOAP, likely to feel somewhat worse when it lasts 3-4 weeks.

2. Create a two phase match and have the first phase be USMD / USDO grads only. All IMG/FMG would be excluded until the second round. Since there are more spots than USMD/USDO applicants, there are certain to be openings after the first round. Unmatched USMD/USDO grads could then apply to these open programs -- perhaps even programs that are traditionally all filled with IMG's. Would these programs consider these applicants? hard to tell, so unclear if this would really help them. Theoretically, this solution tries to fix the "Some USMD/USDO grads don't get a spot in the match". There would be no mechanism to force programs to take these candidates -- it's still quit eposible that programs in the second round would preferentially pick IMG/FMG's and the outcome for unmatched USMD/USDO may be similar.

3. Same as #2, but limit the first round to USMD/USDO/IMG (i.e. US citizens who graduate from medical schools outside the US and Canada). Everything mentioned in #2 is the same, except now the "fix" is to try to allow all US citizens to match to spots. Whether those who didn't match in the first round would fare better in the second (or whether FMG's would fill most second round spots) is unclear.

None of these solutions address any of the problems facing programs - application inflation along with the removal of most standard metrics by which applications are evaluated (grades, exam scores, etc).

 

[Lem0nz]

Really? Is it an accident I was born in Virginia and thus I should be entited to in-state tuition at UTennessee?

The accident of your birth should be the topic of this thread moving forward, yes.

 

[throwaway123342]

Of course they do, and very few, if any, public universities refuse to accept well qualified OOS applicants.

The fact that taxpayer funded public schools have public mandates to prioritize and subsidize IS applicants has nothing to do with federally funded hospital residency programs not prioritizing the bottom 2-3% of domestic applicants over vastly superior applicants from off-shore medical schools.

So its okay for state schools to have public mandates to prioritize in-state students, but its wrong for federally funded GME programs to be mandated to prioritize US citizens?

The accident of your birth should be the topic of this thread moving forward, yes.

Sick reply. Now I'll have to cry myself to sleep

 

[voxveritatisetlucis]

I think the main difference lies in who the funding is supposed to benefit. Public education funds are aimed at benefiting the students themselves whereas GME funding is aimed at benefiting future patients

 

[SooConfused]

So its okay for state schools to have public mandates to prioritize in-state students, but its wrong for federally funded GME programs to be mandated to prioritize US citizens?


Sick reply. Now I'll have to cry myself to sleep

It's not about right and wrong. State schools actually have those mandates, and the federal GME programs do not.

The idea has never been to guarantee every US graduate, or IMG, a job. It's to staff the residencies with the best possibly candidates, which is exactly what they do. The best American students tend not to go overseas for undergraduate medical training, and this is reflected in IMG match rates as compared to domestic ones.

Domestic match rates are extremely high. The small minority of US MD and DO graduates who find themselves unemployed after the match and SOAP have no one but themselves to blame, given the excess of residency slots over US MD and DO seats.

IMGs also have no entitlement over more talented FMGs by virtue of their citizenship, nor should they. Anyone who feels otherwise should probably lobby their congress person and senator, rather than venting here.

I'm not sure that the argument would gain much traction, since most patients would want to be treated by the most qualified person, without regard to citizenship. Same for who most employers would choose to hire. Which is precisely why most PDs do not engage in the preferential treatment you advocate. Nothing is presently stopping them. Certainly not the FMG lobby.

 

[MadRadLad]

While there can be some exceptions, the majority of AMGs who don't match are either :
1) applying for competitive specialties and may either reapply and match or change specialties and match
2) did not apply broadly enough/overestimated their competitiveness
3) Massive red flags

Most AMGs will match, but many will have to make compromises - this covers 1 and 2. If you're an academically weak candidate or don't interview well, you may have to reset your expectations to do a less competitive specialty, or an undesirable area. Many do not want to do this and if you keep banging your head against a wall and applying derm/ENT/plastics with a below average app I'm not sure what is going to happen. I can't blame any program for taking a superstar IMG/FMG in these fields, they usually are exceptions.

For those AMGs with red flags, I can't blame the program for not wanting to take the risk. It's not like most programs would want to deal with culture differences or visa issues just to spite an acceptable domestic grad. I have had excellent colleagues who are FMG/IMGs and some AMGs who are clearly subpar. If you are in the top 80-90% of US MD/DO you are going to match/SOAP. If you are in the bottom 10% you can't be picky, nobody is entitled a spot in the residency of their choice and you are going to be competing with rockstars from outside.

Taxpayer funding is a weird argument because this is a very small % of AMGs that this applies to - and as a taxpayer myself I'd want a more qualified candidate in that bottom 10% than someone with multiple red flags being my doctor. The deck is stacked highly in your favor as an AMG.

 

[throwaway123342]

While there can be some exceptions, the majority of AMGs who don't match are either :
1) applying for competitive specialties and may either reapply and match or change specialties and match
2) did not apply broadly enough/overestimated their competitiveness
3) Massive red flags

The problem with your assertion is the following

1) If you apply to a competitive field and fail to match, your punishment is extreme and includes an entire year of lost income or to battle it out in the SOAP (and pray you get a categorical IM spot in north dakota)

2) If you believe the remedy to that risk to dual apply, you are equally screwed since programs tend to look down upon backup applications. Dont tell me that it is my fault for going unmatched when applying for neurosurgery when my gen surg backup applications are being thrown in the trash. These program directors aren't stupid and they can clearly see my 3 ortho sub-I's.

3) We already know that students are over applying at dramatic rates. Its time to stop pointing the finger at applicants for not applying broadly enough.

4) Massive red flags are a great reason to go unmatched. I fully agree that a small proportion of our students should not enter residency. But why is the punishment for that 300k in debt?


If our unmatched/SOAP applicants are including students with 250s and multiple publications, then there is something seriously wrong with our process. You cannot convince me otherwise.

 

[VA Hopeful Dr]

The problem with your assertion is the following

1) If you apply to a competitive field and fail to match, your punishment is extreme and includes an entire year of lost income or to battle it out in the SOAP (and pray you get a categorical IM spot in north dakota)

2) If you believe the remedy to that risk to dual apply, you are equally screwed since programs tend to look down upon backup applications. Dont tell me that it is my fault for going unmatched when applying for neurosurgery when my gen surg backup applications are being thrown in the trash. These program directors aren't stupid and they can clearly see my 3 ortho sub-I's.

3) We already know that students are over applying at dramatic rates. Its time to stop pointing the finger at applicants for not applying broadly enough.

4) Massive red flags are a great reason to go unmatched. I fully agree that a small proportion of our students should not enter residency. But why is the punishment for that 300k in debt?


If our unmatched/SOAP applicants are including students with 250s and multiple publications, then there is something seriously wrong with our process. You cannot convince me otherwise.

4) This is absolutely a problem. The solution, as always, is to address the stupidly high tuition not to reformulate the Match or screw over American citizens who are attending a school not in the US.

1) Or apply to FM and get a single FM letter from a 3rd year preceptor. And fake an interest for 4 hours on interview day.

2) Same as above.

3) True, but there are some that don't apply broadly enough. Think less than 20 applications for anything other than FM.

 

[SooConfused]

If our unmatched/SOAP applicants are including students with 250s and multiple publications, then there is something seriously wrong with our process. You cannot convince me otherwise.

Just how prevalent is this, given how relatively few people are unmatched after SOAP?

I would assume the number of unemployed US med school grads with 250s and multiple pubs is tiny, and that most people meeting them would conclude that there is something seriously wrong with them and/or with the choices they made to find themselves in that position. It seems highly unlikely that the problem lies with a process that successfully places almost 40,000 residents, with 42% of US DO and 46% of US MD applicants receiving their top choice and around 72% receiving a top 3 choice.

If the raw numbers cannot convince you otherwise, then it is what it is.

 

[Schwifty]

The main problem/confusion with this discussion is that there isn't agreement about what "problem" we are trying to solve.

Let's start with this fact: in the current system, after the match and SOAP conclude, essentially every single GME position in the US is filled. Therefore, no change to the system can improve the overall fill rate. Any reasonable change will leave the fill rate at 99-100%, so the only difference will be in whom gets which spot. With all the changes which have been hinted/proposed on this thread (and others), the vast majority of outcomes will be exactly the same. A minority of applicants will either get a different spot, or some may not match under one system and match under the other.

On this thread we have:

1. Replace SOAP with a 2nd match round (Current NRMP proposal). This would leave the 1st round of the match == current match, so all those spots would be exactly the same. SOAP would turn into a second match, so some changes would be expected there. This would probably favor USMD and USDO applicants in SOAP, who would have more time to interview / consider more programs. Programs would be more likely to interview more people. This options "solves" the problem of SOAP applicants feeling like they were pushed into making a rushed decision. It creates a new problem -- it prolongs the "SOAP" process over a longer period of time. Doesn't feel good to be in SOAP, likely to feel somewhat worse when it lasts 3-4 weeks.

2. Create a two phase match and have the first phase be USMD / USDO grads only. All IMG/FMG would be excluded until the second round. Since there are more spots than USMD/USDO applicants, there are certain to be openings after the first round. Unmatched USMD/USDO grads could then apply to these open programs -- perhaps even programs that are traditionally all filled with IMG's. Would these programs consider these applicants? hard to tell, so unclear if this would really help them. Theoretically, this solution tries to fix the "Some USMD/USDO grads don't get a spot in the match". There would be no mechanism to force programs to take these candidates -- it's still quit eposible that programs in the second round would preferentially pick IMG/FMG's and the outcome for unmatched USMD/USDO may be similar.

3. Same as #2, but limit the first round to USMD/USDO/IMG (i.e. US citizens who graduate from medical schools outside the US and Canada). Everything mentioned in #2 is the same, except now the "fix" is to try to allow all US citizens to match to spots. Whether those who didn't match in the first round would fare better in the second (or whether FMG's would fill most second round spots) is unclear.

None of these solutions address any of the problems facing programs - application inflation along with the removal of most standard metrics by which applications are evaluated (grades, exam scores, etc).

I agree that non of this solves anything but you mentioned earlier that you would like to see an "early decision" match for 30% of spots. How would that help the situation?

 

[throwaway123342]

Just how prevalent is this, given how relatively few people are unmatched after SOAP?

I would assume the number of unemployed US med school grads with 250s and multiple pubs is tiny, and that most people meeting them would conclude that there is something seriously wrong with them and/or with the choices they made to find themselves in that position. It seems highly unlikely that the problem lies with a process that successfully places almost 40,000 residents, with 42% of US DO and 46% of US MD applicants receiving their top choice and around 72% receiving a top 3 choice.

If the raw numbers cannot convince you otherwise, then it is what it is.

I am talking about SOAP or unmatched, not unmatched only.

 

[DOVinciRobot]

If our unmatched/SOAP applicants are including students with 250s and multiple publications, then there is something seriously wrong with our process. You cannot convince me otherwise.

I am talking about SOAP or unmatched, not unmatched only.

No. Applying to a competitive specialty is competitive. The risk of not matching is a 1 year prelim in SOAP and reapplying to a different specialty (these applicants essentially ALWAYS find a categorical residency spot so where). No one is guaranteed an ortho spot, regardless of how good their app is.

Trust me, our current medical training system is absolutely archaic and full of straight up abuse and exploitation. The Match system is simply not one of these abuses.

 

[throwaway123342]

No. Applying to a competitive specialty is competitive. The risk of not matching is a 1 year prelim in SOAP and reapplying to a different specialty (these applicants essentially ALWAYS find a categorical residency spot so where). No one is guaranteed an ortho spot, regardless of how good their app is.

Trust me, our current medical training system is absolutely archaic and full of straight up abuse and exploitation. The Match system is simply not one of these abuses.

No one is guaranteed an ortho spot. 100% agree on that point.

Is the appropriate punishment for a failed ortho match to end up in FM one year later or the SOAP? I personally feel no. I am very biased however because a close friend faild to match nsg with a dual application to gen surg. The system has flaws. big ones.

 

[Med Ed]

No one is guaranteed an ortho spot. 100% agree on that point.

Is the appropriate punishment for a failed ortho match to end up in FM one year later or the SOAP?

Some do a research year, some do a prelim surgery year. What would you suggest to improve the process?

 

[DOVinciRobot]

s the appropriate punishment for a failed ortho match to end up in FM one year later or the SOAP? I personally feel no. I am very biased however because a close friend faild to match nsg with a dual application to gen surg. The system has flaws. big ones.

What so I should be forced to have a coresident who doesn’t actually want to be a general surgeon? No thanks. This is actually a job application, not sure why people are so quick to forget that.

The risk of not matching a competitive field is that you SOAP into FM, or take a prelim year somewhere and apply something else. It’s not a punishment. It’s the widely known risk. If someone isn’t ok with that risk then they can choose to apply to something else.

Sorry, none of what you said highlights a problem. These risks are not secret. They aren’t surprises.

 

[Lem0nz]

The premise of the quote doesn't apply here since the problem is not complex, its in fact very straightforward.

This is probably the only thing you've said that is actually worth talking about. The problem is not straightforward but since you seem to think it is this should be easy for you to understand. As an American taxpayer, I and many others feel their physician should be the most qualified person, not the most American person. You seem incredibly xenophobic. And yes, I saw your opinion where you listed literally everything in a residency application except race/country as not being applicable to judging criteria for residency. Americans are not inherently better at medicine, or literally anything, and I think your ability to judge what makes a good resident is likely far inferior to that of our many program directors across the country.

Thank goodness we do not HAVE to convince you of anything. You are simply wrong.

 

[NotAProgDirector]

I agree that non of this solves anything but you mentioned earlier that you would like to see an "early decision" match for 30% of spots. How would that help the situation?

The problem I'm trying to solve is app inflation / churn we are seeing. The idea is that applicants could apply "early decision" to programs they have high interest in. This might be a student's home program, or one they rotated at, or just one they have a high interest in for some reason. Programs would interview those programs early, and could offer them a position. There would be some deadline, and applicants would need to pick an early offer or stay in the match. Programs would be limited to only 30% of their positions, so that the match doesn't collapse -- most applicants would remain in the main match.

But those that do take an early offer would withdraw from further interviews. This would free up lots of interview spots for those people who are left. Programs could focus on the people remaining in the match. This would be completely optional -- some programs may choose to simply leave all spots in the match and that would be totally fine.

Would this fix anything? I don't know. It's an idea that would be possible to implement. Would it help students? Hard to say -- getting an early spot would certainly be a plus for those students who get one. I expect every student will choose to apply early -- because they will assume that not doing so somehow limits their options of where they might end up or increase their chances of not matching. That's ridiculous and wrong -- their chances of matching would be exactly the same. Sure, there would only be 70% of the spots left in the match, but also a good number of applicants would be prematched and out of the match -- so in the end would be the same.

Some students may not match early and that may increase their worry / stress about the main match.

 

[NotAProgDirector]

Is the appropriate punishment for a failed ortho match to end up in FM one year later or the SOAP? I personally feel no. I am very biased however because a close friend faild to match nsg with a dual application to gen surg. The system has flaws. big ones.

I hear your concern. And it would be nice that if a candidate doesn't match to NSGY, they can instead match to GS if that's what they want.

From a program standpoint, I expect programs would be happy to have a NSGY applicant who matches to GS if they really want that and plan to stay. Often in situations like this, the resident meets with the PD in July and states they will be reapplying. That causes all sorts of problems for programs, so you can see why programs would prefer applicants who really will be happy and complete the program.

I don't see how we would keep spots open unless NSGY was in an earlier match -- and even in that case, by the time they find out their results it's probably too late to apply to GS. And it's impossible for programs to assess whom is truly interested, and whom is trying to just boost theit NSGY application the next year.

if you have a better solution, I'd love to hear it.

 

[JoaoMoutinho]

The problem I'm trying to solve is app inflation / churn we are seeing. The idea is that applicants could apply "early decision" to programs they have high interest in. This might be a student's home program, or one they rotated at, or just one they have a high interest in for some reason. Programs would interview those programs early, and could offer them a position. There would be some deadline, and applicants would need to pick an early offer or stay in the match. Programs would be limited to only 30% of their positions, so that the match doesn't collapse -- most applicants would remain in the main match.

But those that do take an early offer would withdraw from further interviews. This would free up lots of interview spots for those people who are left. Programs could focus on the people remaining in the match. This would be completely optional -- some programs may choose to simply leave all spots in the match and that would be totally fine.

Would this fix anything? I don't know. It's an idea that would be possible to implement. Would it help students? Hard to say -- getting an early spot would certainly be a plus for those students who get one. I expect every student will choose to apply early -- because they will assume that not doing so somehow limits their options of where they might end up or increase their chances of not matching. That's ridiculous and wrong -- their chances of matching would be exactly the same. Sure, there would only be 70% of the spots left in the match, but also a good number of applicants would be prematched and out of the match -- so in the end would be the same.

Some students may not match early and that may increase their worry / stress about the main match.

I've seen you put forward this idea before, and I think it's interesting. Out of curiosity, how would you see it being implemented in smaller specialties where many programs only take 1-2 residents/year?

 

[throwaway123342]

This is probably the only thing you've said that is actually worth talking about. The problem is not straightforward but since you seem to think it is this should be easy for you to understand. As an American taxpayer, I and many others feel their physician should be the most qualified person, not the most American person. You seem incredibly xenophobic. And yes, I saw your opinion where you listed literally everything in a residency application except race/country as not being applicable to judging criteria for residency. Americans are not inherently better at medicine, or literally anything, and I think your ability to judge what makes a good resident is likely far inferior to that of our many program directors across the country.

Thank goodness we do not HAVE to convince you of anything. You are simply wrong.

Your stance is short sighted. If physicians really cared about their profession being filled with the "best" and to expand access to care for our patients, then they wouldn't lobby so aggressively to keep foreign physicians from participating in our labor force. Its easy for you to say that I am xenophobic, but your professional society turns around and lobbies to prevent UK physicians from undercutting your salary in the job market.

Clearly program directors disagree with you, otherwise a VAST majority of our residency slots would not go to US MD Seniors. After all, why do you think that the slightly above-average IM applicant from UVA is that much better than applicants from India who undoubtably worked harder to get to their position?

 

[VA Hopeful Dr]

Your stance is short sighted. If physicians really cared about their profession being filled with the "best" and to expand access to care for our patients, then they wouldn't lobby so aggressively to keep foreign physicians from participating in our labor force. Its easy for you to say that I am xenophobic, but your professional society turns around and lobbies to prevent UK physicians from undercutting your salary in the job market.

Clearly program directors disagree with you, otherwise a VAST majority of our residency slots would not go to US MD Seniors. After all, why do you think that the slightly above-average IM applicant from UVA is that much better than applicants from India who undoubtably worked harder to get to their position?

We don't lobby to do any such thing.

 

[Lem0nz]

Your stance is short sighted. If physicians really cared about their profession being filled with the "best" and to expand access to care for our patients, then they wouldn't lobby so aggressively to keep foreign physicians from participating in our labor force. Its easy for you to say that I am xenophobic, but your professional society turns around and lobbies to prevent UK physicians from undercutting your salary in the job market.

Clearly program directors disagree with you, otherwise a VAST majority of our residency slots would not go to US MD Seniors. After all, why do you think that the slightly above-average IM applicant from UVA is that much better than applicants from India who undoubtably worked harder to get to their position?

I didn't say that most, or some, or a few residency slots should go to FMGs. Please do not read into my words and comment on how short sighted I may or may not be unless you're actually going to read my words.

Most positions go to US grads. Most positions will continue to go to US grads. I support most positions going to US grads. I do not support your short sighted stance that all US grads deserve a spot or should get a spot without consideration of FMGs at the same time or that somehow the mythical beast of taxes or laws that are not written to support what you are calling for somehow justify excluding FMGs completely until all US grads have a position. Exceptional FMGs get residency positions. Average FMGs do not. This is supported with data. The system looks for the best substrate we can find to put through our residency training to create a physician that will practice medicine in the American medical system as this is a reliable way to create physicians that fit our culture.

The question of if we should bring/allow physicians who have not obtained post-graduate training/residency in the US is a *COMPLETELY* separate question and is not relevant to this discussion.

It is easy for me to say you are xenophobic because you are. Go outside and spend some time working with immigrants who have committed to making lives in America and integrating into our culture. It will make you a better person. One of the best surgical residents I ever had the pleasure of having on my team was an FMG from Sudan. His work ethic was lights years above his peers, his book knowledge was beyond many of our attendings, and his practical knowledge of how to get things done and technical skills in the OR were amazing. He approached every 'cultural' problem he encountered with kindness, laughing at himself if he didn't understand something, patience, and a smile. I would take someone like him time and again over 95% of most US grads. But he is a unicorn and if I interview/proctor 1,000 medical students/residents I suspect I will find only a handful of people like him.

 

[NotAProgDirector]

I've seen you put forward this idea before, and I think it's interesting. Out of curiosity, how would you see it being implemented in smaller specialties where many programs only take 1-2 residents/year?

I don't think it works for small specialties at all.

 

[Goro]

The problem with your assertion is the following

1) If you apply to a competitive field and fail to match, your punishment is extreme and includes an entire year of lost income or to battle it out in the SOAP (and pray you get a categorical IM spot in north dakota)

Well, that's on you to make wise choices.

2) If you believe the remedy to that risk to dual apply, you are equally screwed since programs tend to look down upon backup applications. Dont tell me that it is my fault for going unmatched when applying for neurosurgery when my gen surg backup applications are being thrown in the trash. These program directors aren't stupid and they can clearly see my 3 ortho sub-I's.

See my response above

3) We already know that students are over applying at dramatic rates. Its time to stop pointing the finger at applicants for not applying broadly enough.

*sigh* You're still expected to apply smartly and strategically

4) Massive red flags are a great reason to go unmatched. I fully agree that a small proportion of our students should not enter residency. But why is the punishment for that 300k in debt?

Jeeze, the entitlement dripping off of you is astounding. I had a high school friend who railed on the US being a land of opportunity because to him, opportunity wasn't guaranteed. You want something, you earn it.

If our unmatched/SOAP applicants are including students with 250s and multiple publications, then there is something seriously wrong with our process. You cannot convince me otherwise.

You've never been part of any interview process, have you? If you had been, you know that there are jerks out there and when a residency is looking for people to be part of the team for anywhere to 3-7 years, they want people they can work with and rely on. It has nothing to do with academic success. Life is not merely about stats and pubs.

And where is it a "punishment" if you don't get into an Ortho program? There are only so many of these programs, and there are more applicants than spots take them. This is a job market, after all. Would you prefer that Ortho spots expand so that every applicant gets a spot? That didn't work out so well when Rad Onc did exactly that.

 

[throwaway123342]

I didn't say that most, or some, or a few residency slots should go to FMGs. Please do not read into my words and comment on how short sighted I may or may not be unless you're actually going to read my words.

Most positions go to US grads. Most positions will continue to go to US grads. I support most positions going to US grads. I do not support your short sighted stance that all US grads deserve a spot or should get a spot without consideration of FMGs at the same time or that somehow the mythical beast of taxes or laws that are not written to support what you are calling for somehow justify excluding FMGs completely until all US grads have a position. Exceptional FMGs get residency positions. Average FMGs do not. This is supported with data. The system looks for the best substrate we can find to put through our residency training to create a physician that will practice medicine in the American medical system as this is a reliable way to create physicians that fit our culture.

The question of if we should bring/allow physicians who have not obtained post-graduate training/residency in the US is a *COMPLETELY* separate question and is not relevant to this discussion.

It is easy for me to say you are xenophobic because you are. Go outside and spend some time working with immigrants who have committed to making lives in America and integrating into our culture. It will make you a better person. One of the best surgical residents I ever had the pleasure of having on my team was an FMG from Sudan. His work ethic was lights years above his peers, his book knowledge was beyond many of our attendings, and his practical knowledge of how to get things done and technical skills in the OR were amazing. He approached every 'cultural' problem he encountered with kindness, laughing at himself if he didn't understand something, patience, and a smile. I would take someone like him time and again over 95% of most US grads. But he is a unicorn and if I interview/proctor 1,000 medical students/residents I suspect I will find only a handful of people like him.

You don't understand what im saying.

There is zero question in my mind that the best applicants in the match are FMGs. Period. Not students from Harvard, UCSF or Stanford. They are FMGs. There are literal neurosurgeons in other countries who are applying to be primary care doctors in this country. I met a practicing anesthesiologist in Germany when I was interviewing for radiology a few years ago. How can any student in the US compete with that?

My problem with your logic is this: Why should Harvard/MGH radiology be filled with US MD Seniors over attending physicians who are applying from Germany if not for xenophobia by your definition? How can anyone seriously argue that US MD Seniors are the best applicants in the match when you look at what is being generated overseas?

The simple conclusion is, if we are operating on the logic that the "best" get the spot, then US MD Seniors deserve to have a *much* lower match rate. Luckily a vast majority of program directors overwhelmingly disagree with that logic.

And where is it a "punishment" if you don't get into an Ortho program? There are only so many of these programs, and there are more applicants than spots take them. This is a job market, after all. Would you prefer that Ortho spots expand so that every applicant gets a spot? That didn't work out so well when Rad Onc did exactly that.

I plainly stated that everyone is not entitled to an ortho spot. That was the very first line of my comment. You aluded to making "wise choices". That is a reductionist statement that equates "wisdom" with having the wealth necessary to make risker decisions and fall back on research years if necessary. Also, its a bit rich for you to be lecturing anyone regarding the qualities necessary to participate on an inpatient medicine team no?

 

[jstwannagraduaaate!!!]

Sounds great, if the idea is to screw highly qualified IMGs/FMGs in favor of less well qualified US grads. It isn't.

If they wanted to, residencies and fellowships could do that today simply by not interviewing or ranking IMGs/FMGs. IMGs/FMGs have to overcome a lot in order to match. I'm pretty sure the reason some US grads are still unemployed even after the match and SOAP has nothing to do with unfair competition from foreign grads.

Getting the last few US grads matched isn't what is driving this. Replacing SOAP with another match to give people currently SOAPing the same benefits everyone else gets by successfully matching is the idea here.

So other countries can practice protectionism but we can't?????

 

[jstwannagraduaaate!!!]

The problem with your assertion is the following

1) If you apply to a competitive field and fail to match, your punishment is extreme and includes an entire year of lost income or to battle it out in the SOAP (and pray you get a categorical IM spot in north dakota)

2) If you believe the remedy to that risk to dual apply, you are equally screwed since programs tend to look down upon backup applications. Dont tell me that it is my fault for going unmatched when applying for neurosurgery when my gen surg backup applications are being thrown in the trash. These program directors aren't stupid and they can clearly see my 3 ortho sub-I's.

3) We already know that students are over applying at dramatic rates. Its time to stop pointing the finger at applicants for not applying broadly enough.

4) Massive red flags are a great reason to go unmatched. I fully agree that a small proportion of our students should not enter residency. But why is the punishment for that 300k in debt?


If our unmatched/SOAP applicants are including students with 250s and multiple publications, then there is something seriously wrong with our process. You cannot convince me otherwise.

Points 1 and 2 couldn't be more accurate. As more and more highly competitive applicants fail to match into subspecialties (and dont pull the well they knew it was a risk, many were "sure fire" candidates), they shouldn't have to to face the stigma of dual applying. Sure I would like to be in x field but at the end of the day, I need to pay off my loans and reapplying year after year of surgical intern year isn't going to cut it. But to play devil's advocate, it also highlights the importance of being strategic.

 

[jstwannagraduaaate!!!]

Well, that's on you to make wise choices.

See my response above

*sigh* You're still expected to apply smartly and strategically

Jeeze, the entitlement dripping off of you is astounding. I had a high school friend who railed on the US being a land of opportunity because to him, opportunity wasn't guaranteed. You want something, you earn it.

You've never been part of any interview process, have you? If you had been, you know that there are jerks out there and when a residency is looking for people to be part of the team for anywhere to 3-7 years, they want people they can work with and rely on. It has nothing to do with academic success. Life is not merely about stats and pubs.

And where is it a "punishment" if you don't get into an Ortho program? There are only so many of these programs, and there are more applicants than spots take them. This is a job market, after all. Would you prefer that Ortho spots expand so that every applicant gets a spot? That didn't work out so well when Rad Onc did exactly that.

I would argue the "punishment" is the unrealistic expectations from PDs. If you dual apply, you are looked down upon and are at a disadvantage because the PDs think you are not "fully committed" to your preferred field, when in reality you know it comes with risk even if you are a great student so you dual apply to not end up in financial ruins. Then your "back up" specialty looks down on you for viewing them as a back up, its a lose lose.

 

[voxveritatisetlucis]

Why do you even have to tell anyone you’re dual applying?

 

[jstwannagraduaaate!!!]

Why do you even have to tell anyone you’re dual applying?

You don't, but its pretty blatant if you have 3 ortho/nsgy aways and are applying to IM as a back up in hopes of cards/GI or General surgery