NRMP Match: Good, bad or ugly?

[Goro]

Revised. AAMC is using their monopoly power to forcibly take advantage of medical students. What alternatives do medical students have other than to pay the ERAS fees? What are PDs doing about it? ZIP. ZERO. Because generally PDs do not spend any effort fighting against this gouging of med students. Instead PDs spend their time arguing that making fellow human beings work 28 hours in a row without sleep is not abuse.
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I empathize with what you're trying to say, because my kids have to go through this.

But it would be better if you stick to the original point of this thread, that being the match.

It's not helping to diverge or hijack into other negative aspects of residency.

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[LucidSplash]

My point was simply that a little buffer is reasonable. If 7 programs gives you a 95% chance of matching, going to look at 10 is not unreasonable. If OTOH you go on 19 and then b***h about how much it costs, you're being disingenuous and a bit of a princess.

I feel like this gives a bad name to princesses. Given a tiara and a cape, personally I could rule the world.

 

[BorntobeDO?]

Because FaceTime doesn’t allow the applicants to see the hospital and to talk to current residents. The interview day, although expensive and cumbersome, benefits the applicant as well.

Because it’s easy to fake being polite and mature during an hour long Skype interview. It’s harder to fake it for an entire day. We definitely had applicants who interviewed very well, but showed their true colors during the tour or the post interview social hour.

I did a facetime interview for a job once. They had me facing a wall half the time, I won't do it again.

 

[NotAProgDirector]

Revised. AAMC is using their monopoly power to forcibly take advantage of medical students. What alternatives do medical students have other than to pay the ERAS fees? What are PDs doing about it? ZIP. ZERO. Because generally PDs do not spend any effort fighting against this gouging of med students. Instead PDs spend their time arguing that making fellow human beings work 28 hours in a row without sleep is not abuse.
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Not all programs have 28 hour shifts. Mine doesn't. Also, we "enforce" the 80 hour limit by desiging services and schedules such that it's very unlikely that you would work that much.

Please elaborate why PDs are doing nothing about this obscenity.

The main problem is application inflation / over application. We are discussing this. Any change in the system is going to make someone unhappy (I'm ignoring the AAMC, talking about programs / applicants) and any "solution" ends up potentially hurting someone.

I also agree that lower tier programs would start offering early to try and snag better applicants that might be playing things conservatively. Applicants would have to quantify what level of risk they are willing to live with in order to achieve the best fit for them. Perhaps an early signing date would have to be enacted where no offers could be officially made or accepted before Halloween. That would give programs and applicants an opportunity to see one another and make a more educated decision. They could field multiple offers at one time and accept one or decline all and hope to get another offer from a later interview.

Any plan would likely need a date where applicants would need to decide (or if there is an early match). Halloween would be very early -- we only get MSPE's on 10/1, many programs don't start interviewing until Nov. But I agree that we could add an early application process prior, perhaps in August. The AAMC / Medical schools won't be happy, but that's not my concern.

Maybe a limit on the number of programs would help allow students to apply to the programs that are realistic and then programs wouldn’t need to plow through thousands of applications and could more realistically give interviews to appropriate candidates.

Limiting applications is complicated. Then students would need to decide which programs are "reasonable" to apply to. Couples would need different rules, etc. But I agree that something to help decrease the number of apps is needed.

You're right. But I'm not trying to be in the 5% or 1% that has their career goals ruined by not matching. If I had an offer right now I'd cancel the rest of my interviews and those could go to other applicants.

Hence my thought that some sort of early decision process is needed. As I think about options, I like the idea of giving each applicant 3-5 early apps. These apps would come out earlier -- at a minimum we'd want the same 9/15 date with MSPE's, ideally probably 9/1 or 8/15. Programs could then host 1-2 early interview days, and then offer spots with a limit of 20-30% and students would need to pick one and be done, or decline all. Then, programs could interview for their regular spots and might consider people who applied early but didn't get a spot as "higher interest", but if the number of early apps is small enough (and many/some of them get early offers and hence are removed from the process) programs will still need to consider regular applicants.

This plan won't stop overapplication -- most likely, applicants will still need to send out all of their applications because it's unlikely that early decisions will finailze prior to the regular application season. But it would cut down on interviews and travel.

 

[GoSpursGo]

The PDs could ask ERAS to lower their prices or possibly ask the Canadian or Singapore residency application services if they would be willing to beat ERAS on pricing.

And when ERAS says, "No?"

Your second suggestion, I am kind of making it up but I would ASSUME there's a problem with assigning residency slots that are funded by the NIH via a matching system from outside the US.

 

[Dr. Death]

Not all programs have 28 hour shifts. Mine doesn't. Also, we "enforce" the 80 hour limit by desiging services and schedules such that it's very unlikely that you would work that much.


The main problem is application inflation / over application. We are discussing this. Any change in the system is going to make someone unhappy (I'm ignoring the AAMC, talking about programs / applicants) and any "solution" ends up potentially hurting someone.



Any plan would likely need a date where applicants would need to decide (or if there is an early match). Halloween would be very early -- we only get MSPE's on 10/1, many programs don't start interviewing until Nov. But I agree that we could add an early application process prior, perhaps in August. The AAMC / Medical schools won't be happy, but that's not my concern.



Limiting applications is complicated. Then students would need to decide which programs are "reasonable" to apply to. Couples would need different rules, etc. But I agree that something to help decrease the number of apps is needed.

Hence my thought that some sort of early decision process is needed. As I think about options, I like the idea of giving each applicant 3-5 early apps. These apps would come out earlier -- at a minimum we'd want the same 9/15 date with MSPE's, ideally probably 9/1 or 8/15. Programs could then host 1-2 early interview days, and then offer spots with a limit of 20-30% and students would need to pick one and be done, or decline all. Then, programs could interview for their regular spots and might consider people who applied early but didn't get a spot as "higher interest", but if the number of early apps is small enough (and many/some of them get early offers and hence are removed from the process) programs will still need to consider regular applicants.

This plan won't stop overapplication -- most likely, applicants will still need to send out all of their applications because it's unlikely that early decisions will finailze prior to the regular application season. But it would cut down on interviews and travel.

This is really sensible. It isn't a total solution but I think it's a step in the right direction and would open the door for further changes in the future. Some medical schools have this as an option.

 

[Gastrapathy]

In a free market with no match, why would competitive programs pay anyone at all? In fact, why wouldn’t they make you pay them? Derm would fill no problem with the money flowing the other direction. Since you can’t get a license without residency, a true free market with an oversupply of applicants could have lots of unpaid spots or maybe I pay the better candidates by selling a few spots to some crappy rich applicants from overseas.

The argument that you can get a job without a match is simplistic. Don’t kid yourself, when we offer a job, that offer explodes quickly and we’re on to the next candidate. We’re not waiting for the ideal outcome for the candidates, we’re looking out for our division.

 

[ucladoc2b]

In a free market with no match, why would competitive programs pay anyone at all? In fact, why wouldn’t they make you pay them? Derm would fill no problem with the money flowing the other direction. Since you can’t get a license without residency, a true free market with an oversupply of applicants could have lots of unpaid spots or maybe I pay the better candidates by selling a few spots to some crappy rich applicants from overseas.

The argument that you can get a job without a match is simplistic. Don’t kid yourself, when we offer a job, that offer explodes quickly and we’re on to the next candidate. We’re not waiting for the ideal outcome for the candidates, we’re looking out for our division.

Probably because no one could afford to go into medicine if this were the case. Most programs would go unfilled because it would be a ridiculously unaffordable for anyone to go into it (save for a very wealthy few) if 7-10 years of income-less training were required. I’m sure derm wouldn’t be nearly as competitive if you stopped paying derm residents.

 

[Gastrapathy]

Sure, a free market would favor the little guy.

Look at the variation in the price of med school and the number of quality applicants who don’t get in. There are already $100k plus disparities in options and no lack of applicants for the most expensive schools. I really can’t believe people with this level of education and intelligence believe that magically the marketplace would somehow take good care of them.

 

[VA Hopeful Dr]

Probably because no one could afford to go into medicine if this were the case. Most programs would go unfilled because it would be a ridiculously unaffordable for anyone to go into it (save for a very wealthy few) if 7-10 years of income-less training were required. I’m sure derm wouldn’t be nearly as competitive if you stopped paying derm residents.

You do realize that lots of dental residencies charge tuition, right?

Sure FM and IM can't get away with that, but derm and maybe Ortho sure as **** could.

 

[BigRedBeta]

It's very easy for you to sit where you are and tell applicants to apply to fewer programs and go on fewer interviews. But the reality is that if we don't match we're saddled with hundreds of thousands in student loan debt and the prospect of SOAPing or reapplying next year with far worse odds of matching.

The bolded part would be true and probably even worse in any free-market system.



Any new system would have to demonstrate an ability to at least be non-inferior to the current match in terms of % of spots filled and % of applicants matched, which I think would be challenging to find consistently year to year if all the rules were relaxed/done away with. If nothing else, the current system manages to achieve the above well and falls into a reasonable Nash Equilibrium. Having the algorithm tilt in favor of *each* applicant is also a nice benefit that would be hard to manage in other less rigid systems. That the whole thing works about as equally well for competitive and not-so-competitive fields/programs/applicants is further proof that the game theory elements are sound. While the insanity of a couples match is currently hard, the fact that it works, again strengthens the argument for the algorithm.

The rest of the process is certainly open to improvement but I think there has to be a real thoughtfulness for change to mitigate any unintended consequences and make sure that this isn't just about making things easier at the top.

Undoubtedly, as has been seen by various fellowships coming into ERAS, the application bloat has been a terrible problem for upper tier programs - but a boon for mid-tier and lower programs...or even just places that are geographically less desirable. The PICU fellowship where I did residency is a good fellowship in a not so exciting locale, and they benefited immensely by having their application number go from 15-20/yr to 40-50 with an overall higher quality. Pre-ERAS with paper applications and varying degrees of overlap in terms of what was required really forced PICU applicants to narrow their efforts to places that they really wanted to go, sight unseen. Not a problem for the top places, and top applicants, but certainly less than ideal for everyone else. I don't think it hard to argue that going to ERAS/NRMP has been beneficial for most.

Could you attack other parts individually and leave the algorithm intact? That's probably more feasible - let Podunk IM residency program in Southern Indiana pay everyone $100k and I'm sure word would get out. But wages are only part of the issue, and as long as people are willing to chase prestige, think that it's more fun to live in Chicago than Little Rock, desire to be close to family, or any of the other 100s of reasons people prefer one training program over the other, I'm not sure an equally stable arrangement is likely to be found...at least not one that is less highly regulated than the current system.

 

[ucladoc2b]

You do realize that lots of dental residencies charge tuition, right?

Sure FM and IM can't get away with that, but derm and maybe Ortho sure as **** could.

I do. The difference is that a new dental grad can practice as a general dentist. Physicians can’t. So they have an option.

 

[VA Hopeful Dr]

I do. The difference is that a new dental grad can practice as a general dentist. Physicians can’t. So they have an option.

You didn't read my second paragraph, did you?

Do you honestly not think people would pay tuition, and gladly, for Ortho and derm residency spots?

 

[ucladoc2b]

You didn't read my second paragraph, did you?

Do you honestly not think people would pay tuition, and gladly, for Ortho and derm residency spots?

I’m sure some people would. That was really never in doubt. But I can’t imagine they would have the level of competition they currently have. Especially considering the length of training required in their current form (4 for derm and at least 5 for ortho), I’m sure having to pay tuition would push people into other fields.

 

[LucidSplash]

I’m sure some people would. That was really never in doubt. But I can’t imagine they would have the level of competition they currently have. Especially considering the length of training required in their current form (4 for derm and at least 5 for ortho), I’m sure having to pay tuition would push people into other fields.

The length of the residency doesn’t mean anything if the eventual compensation after training is adequate.

If people could get loans for residency (if they charged for it) like they do for medical school, people would just take out more loans. Without loans, the fields with the best post graduation compensation and lifestyle would just become even more elitist than medicine already is.

If the cost of training was going to keep people out of medicine, applications to medical school would be falling as tuition skyrockets, instead of rising. Also traditionally professional school and grad school apps go down when the economy is doing well. That isn’t happening either.

 

[VA Hopeful Dr]

I’m sure some people would. That was really never in doubt. But I can’t imagine they would have the level of competition they currently have. Especially considering the length of training required in their current form (4 for derm and at least 5 for ortho), I’m sure having to pay tuition would push people into other fields.

Maybe some, but I kinda doubt it would be enough to matter. Given the impressive money that certain fields command, I think people would absolutely pay for the privilege.

 

[raiderette]

This would discourage true competition. We would end up with poor, bright med students abandoning Ortho and derm and filling it with people able to handle an extra 5 years on their parents. All it would take is a slight change to reimbursement to make both specialties cost negative.

You didn't read my second paragraph, did you?

Do you honestly not think people would pay tuition, and gladly, for Ortho and derm residency spots?

 

[VA Hopeful Dr]

This would discourage true competition. We would end up with poor, bright med students abandoning Ortho and derm and filling it with people able to handle an extra 5 years on their parents. All it would take is a slight change to reimbursement to make both specialties cost negative.

Or, you know, loans.

You think banks wouldn't jump at loaning money to soon-to-be orthopedic surgeons?

Oh, and it take more than a slight reimbursement change to tank Ortho salaries.

 

[deleted814217]

To those arguing about a so called zero salary residency-I mean that’s somewhat of a moot argument. Honestly you can say that then about any kind of work where (especially unskilled labor) where there is unskilled labor-why are they getting paid anything at all really. I feel that is something that can and should be enforceable by the acgme.
imo some things aren’t quite being acknowledged here. There are things like geography and how likely people are to come to programs that factor in the match-said verbatim by many program directors who want and have to fill their spots. In a scenario more similar to medical school application process there would be likely more offers made by programs and less gamesmanship regarding this. Furthermore, blaming applicants for over applying is pretty ridiculous imo. Programs are not quite transparent with their numbers, idk about others but at least first me when I was applying I knew where I stood, my gpa and MCat in relation to school averages and knew what to apply to. This is much less transparent imo in residency application processes. There needs to be some give-if PDS want less applying there needs to be more transparency regarding this (eg average step score for a program or grades or whatever criteria published). All said I do like the idea of an “early decision” type approach to be honest as somewhat of a stepping stone.

 

[Giovanotto]

You didn't read my second paragraph, did you?

Do you honestly not think people would pay tuition, and gladly, for Ortho and derm residency spots?

No? Why would they? Are you saying they'd be paying 300k for medical school and on top of that for residency? Lmao. I can't believe people are already taking out loans for 300k+ for school, never mind residency.

 

[Waraba]

Maybe this is a stupid idea, but I wonder if something like this would work:

Candidates apply and interview as they do today. The programs submit their rank order lists. The computer program then tabulates all the places (if any) that the applicant matched (the applicant appeared on the program's rank list within the program's number of open positions). The applicant is notified. After some very limited time period the applicant makes a choice. The computer program runs again, removing this applicant's name from the lists he/she didn't choose, and moving up others in the list who didn't match in round one. Maybe it does this several times or I guess it could continue for several days, like SOAP. At the end of those rounds, any unfilled positions would then revert to filling via the current process and SOAP.

 

[differentiating]

Maybe this is a stupid idea, but I wonder if something like this would work:

Candidates apply and interview as they do today. The programs submit their rank order lists. The computer program then tabulates all the places (if any) that the applicant matched (the applicant appeared on the program's rank list within the program's number of open positions). The applicant is notified. After some very limited time period the applicant makes a choice. The computer program runs again, removing this applicant's name from the lists he/she didn't choose, and moving up others in the list who didn't match in round one. Maybe it does this several times or I guess it could continue for several days, like SOAP. At the end of those rounds, any unfilled positions would then revert to filling via the current process and SOAP.

This is essentially what the match does - except instead of a person responding directly to offers, the rank list tells the algorithm which offer to take. I don’t think it would change anything significantly.

 

[VA Hopeful Dr]

No? Why would they? Are you saying they'd be paying 300k for medical school and on top of that for residency? Lmao. I can't believe people are already taking out loans for 300k+ for school, never mind residency.

People are already taking above 300k for med school. What's another 100k on top of that for a specialty that can clear 500k/year?

And again, the more competitive dental residencies are already doing this and have no shortage of applicants.

 

[hamstergang]

This is essentially what the match does - except instead of a person responding directly to offers, the rank list tells the algorithm which offer to take. I don’t think it would change anything significantly.

I'm pretty sure that's the point.

 

[yeasports]

Not an opinion just asking for clarification. 1. Programs currently are free to take themselves out of the match but as I understand they must be all in or all out is this correct? 2. If a program opts out the only people they can select outside of the match are non US grads or re-applicants correct? Us seniors must participate in the match? 3. If said is true would it be more fair if programs could opt out and select US seniors? Would this destroy the match? Would you consider this APG?

 

[deleted814217]

Things like couples matching imo would also benefit from a more free market system. An earlier timeframe and earlier knowledge of location would also help with things like planning moves and expenses and such.
Yet again in no other professional field is there such a lack of control over the basic aspects of your life. The match requires us all the sign a contract, but we are the only ones beholden to this and the program and institutions do not have to hold up their end of the bargain. Again no other field required this so I fail to see what is so unique about us that requires this. There needs to be a concept of residency granted in medicine as medical school does not prepare a person for independent practice. At least as a starting point for change, the concept of some time of early decision or interviewing processes sounds like a good option to be entirely honest.

 

[GoSpursGo]

Not an opinion just asking for clarification. 1. Programs currently are free to take themselves out of the match but as I understand they must be all in or all out is this correct? 2. If a program opts out the only people they can select outside of the match are non US grads or re-applicants correct? Us seniors must participate in the match? 3. If said is true would it be more fair if programs could opt out and select US seniors? Would this destroy the match? Would you consider this APG?

US seniors can accept an offer outside of the match (for example, urology and ophthalmology both use their own independent matching systems). They generally don't, because most out-of-the-match programs aren't that great and are really only worried about filling their spots with ANYONE minimally qualified rather than getting the MOST qualified applicants. EDIT: I was wrong

There is benefit to the match from the program side as well, because it lets them interview as many applicants as they want and determine which ones would be the best fit for their particular program based on things beyond just USMLE scores. While it's an expensive system, there is real value to everyone making an informed decision rather than a rushed one.

 

[hamstergang]

The match requires us all the sign a contract, but we are the only ones beholden to this and the program and institutions do not have to hold up their end of the bargain.

What do you mean that programs don't have to honor the contracts as well?

 

[GoSpursGo]

What do you mean that programs don't have to honor the contracts as well?

Each year a program can choose to renew your contract or not. If a program feels you're significantly behind your residency peers and/or are a threat to patients, they can non-renew you and essentially end your training at their institution.

That user's characterization is a little misleading, though. Plenty of residents do in fact decide they want a different specialty, or desire to transfer to a different location, and thus they choose to not sign their next PGY contract so they can accept a position somewhere else. So it's not exactly accurate to describe it as a one-sided arrangement.

 

[NotAProgDirector]

To those arguing about a so called zero salary residency-I mean that’s somewhat of a moot argument. Honestly you can say that then about any kind of work where (especially unskilled labor) where there is unskilled labor-why are they getting paid anything at all really. I feel that is something that can and should be enforceable by the acgme.
imo some things aren’t quite being acknowledged here. There are things like geography and how likely people are to come to programs that factor in the match-said verbatim by many program directors who want and have to fill their spots. In a scenario more similar to medical school application process there would be likely more offers made by programs and less gamesmanship regarding this. Furthermore, blaming applicants for over applying is pretty ridiculous imo. Programs are not quite transparent with their numbers, idk about others but at least first me when I was applying I knew where I stood, my gpa and MCat in relation to school averages and knew what to apply to. This is much less transparent imo in residency application processes. There needs to be some give-if PDS want less applying there needs to be more transparency regarding this (eg average step score for a program or grades or whatever criteria published). All said I do like the idea of an “early decision” type approach to be honest as somewhat of a stepping stone.

Salary really isn't related to the match at all. Even with a match, programs could offer zero salary. But the ACGME wouldn't put up with that, and programs would get worse candidates.

I agree that any fix to the application issue will require transparency of programs. This has started (somewhat) with the residency explorer. We would need to do better. No argument from me.

Not an opinion just asking for clarification. 1. Programs currently are free to take themselves out of the match but as I understand they must be all in or all out is this correct? 2. If a program opts out the only people they can select outside of the match are non US grads or re-applicants correct? Us seniors must participate in the match? 3. If said is true would it be more fair if programs could opt out and select US seniors? Would this destroy the match? Would you consider this APG?

Programs out of the match must take all candidates out of the match, and US seniors must be in the match (unless in another match like Ophthal or Uro), so yes only independent applicants. Programs used to be able to "prematch" some candidates and then finalize their quota in January, but now it's all-in or all-out.

If programs were allowed to take US grads out of the match, this would lead to the new problem of: you get an out of match offer, have to decide whether to keep it or stick with the match. Theoretically, this is why the all-in match change was made. If enough spots fill outside the match, it collapses.

Things like couples matching imo would also benefit from a more free market system. An earlier timeframe and earlier knowledge of location would also help with things like planning moves and expenses and such.
Yet again in no other professional field is there such a lack of control over the basic aspects of your life. The match requires us all the sign a contract, but we are the only ones beholden to this and the program and institutions do not have to hold up their end of the bargain. Again no other field required this so I fail to see what is so unique about us that requires this. There needs to be a concept of residency granted in medicine as medical school does not prepare a person for independent practice. At least as a starting point for change, the concept of some time of early decision or interviewing processes sounds like a good option to be entirely honest.

I'm not so certain that couples would do as well. If one half of a couple gets an offer with a 48-72 hour window on it and the other person won't interview in that area in a timely fashion, that's a huge problem. There's also no guarantee that applicants would get spots earlier -- it could be at the same time or even later, depending on how the process plays out.

Not sure what you mean that programs aren't beholden to their contracts. We are. Already mentioned is the Hahnemann issue -- and please, let's not derail this thread with that mess, it already has it's own thread. But when a business declares bankruptcy, contracts are meaningless. Also mentioned is that the match is just a 1 year commitment rather than all years of training, although most residents complete all years, those whom are not renewed would just be terminated if the contract was longer (although it is harder to terminate than not-renew, so there is some potential value there). If your idea is that the match should be for multiyear contracts for full training, I think that's and idea worth considering.

I do think the situation in medical training is unique, so the fact that no one else does it isn't necessarily bad. And even if there was another field that was completely identical without a match, it's possible that the match would be better than a free market.

 

[Waraba]

This is essentially what the match does - except instead of a person responding directly to offers, the rank list tells the algorithm which offer to take. I don’t think it would change anything significantly.

Thanks, I know how the match works. I was speculating about some hybrid that allowed something similar to med school apps, where you know where you got accepted and you choose. Let that happen first, and then the normal match. That would possibly alleviate some complaints about the current match process, or so I would think...

 

[hamstergang]

Have you not read about the hundreds of residents that were terminated in July at Hahnemann?

That's extremely misleading. The hospital going bankrupt doesn't mean they don't have to honor the contracts, it just means you have no way to force them as they're out of business. If a resident dies before starting the program they'renot forced to show up.

Each year a program can choose to renew your contract or not. If a program feels you're significantly behind your residency peers and/or are a threat to patients, they can non-renew you and essentially end your training at their institution.

The Match requires a one-year contract so whatever happens after that has nothing to do with the Match or this thread.

 

[Obnoxious Dad]

Allow me to be the skunk at the garden party.

The federal taxpayers through the military, Medicare, the VA, the CHGME and Medicaid fund residency programs to the tune of approximately $16 billion per year. Some state governments also fund residency programs. Private insurers are also absorbing some of the cost through higher payments to teaching hospitals.

GME Financing - Graduate Medical Education That Meets the Nation's Health Needs - NCBI Bookshelf

www.ncbi.nlm.nih.gov

Since the taxpayers and insurers are paying the band, any changes in residency training would have to be justified by benefits that would accrue to the taxpayers and insurers rather than benefits to programs and politically toothless residents. Where are the studies demonstrating harm, from the current residency arrangements, to the taxpayers? I can assure all of you that 99.5% of the American public couldn't care less that some entitled medical student didn't get his/her dream spot in the match. There are much sadder cases in this world.

Happy Thanksgiving.

 

[NotAProgDirector]

Not quite certain what aspect you're "skunking" here.

Funding of GME is it's own issue and isn't connected to the match. We've had that discussion before, happy to re-open it but would prefer it's own thread.

Changing the match in some way, or getting rid of it, wouldn't cost the gov't anything -- although I guess if the match were to change, that costs money to develop, they might raise match fees, some of those fees are paid by students, who get money from gov't loans. Still, physicians usually pay those loans back with interest.

I agree that the gen public doesn't care about whether some medical student gets the spot they want, or "deserve". But neither would they care if we changed the way we distribute those spots.

Eat well!

 

[Obnoxious Dad]

Not quite certain what aspect you're "skunking" here.

Funding of GME is it's own issue and isn't connected to the match. We've had that discussion before, happy to re-open it but would prefer it's own thread.

Changing the match in some way, or getting rid of it, wouldn't cost the gov't anything -- although I guess if the match were to change, that costs money to develop, they might raise match fees, some of those fees are paid by students, who get money from gov't loans. Still, physicians usually pay those loans back with interest.

I agree that the gen public doesn't care about whether some medical student gets the spot they want, or "deserve". But neither would they care if we changed the way we distribute those spots.

Eat well!

While the NRMP and the ACGME may not be legally bound, the NRMP is a core aspect of the residency system. I think the match process, which is seemingly rational, transparent and the mechanism by which the overwhelming number of medical students are "designated for assignment", gives residency training the appearance of legitimacy and efficiency. If the public perceived the match to be inefficient or corrupt, the dollars wouldn't flow from Uncle Sugar.

 

[VA Hopeful Dr]

While the NRMP and the ACGME may not be legally bound, the NRMP is a core aspect of the residency system. I think the match process, which is seemingly rational, transparent and the mechanism by which the overwhelming number of medical students are "designated for assignment", gives residency training the appearance of legitimacy and efficiency. If the public perceived the match to be inefficient or corrupt, the dollars wouldn't flow from Uncle Sugar.

Pretty sure the public pays no attention to the match

 

[Obnoxious Dad]

Pretty sure the public pays no attention to the match

I'm pretty sure you're dead wrong.

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2013/08/The-Sveriges-Riksbank-Prize-in-Economic-Sciences-in-Memory-of-Alfred-Nobel1.pdf

Science | AAAS

www.sciencemag.org

 

[VA Hopeful Dr]

I'm pretty sure you're dead wrong.

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2013/08/The-Sveriges-Riksbank-Prize-in-Economic-Sciences-in-Memory-of-Alfred-Nobel1.pdf

Science | AAAS

www.sciencemag.org

It's cute you think the average person knows anything about who wins the non-peace Nobels and even less about what they win them for.

Oh, and the Nobel prize committee isn't the public.

 

[Dr.LeoSpaceman]

The argument that you can get a job without a match is simplistic. Don’t kid yourself, when we offer a job, that offer explodes quickly and we’re on to the next candidate. We’re not waiting for the ideal outcome for the candidates, we’re looking out for our division.

As a person now in the process of looking for a job, I can say for certain that I preferred The Match. Not to say there aren't potential ways to improve is as @aProgDirector suggests. but on balance it is certainly less stressful than a free market.

 

[ucladoc2b]

As a person now in the process of looking for a job, I can say for certain that I preferred The Match. Not to say there aren't potential ways to improve is as @aProgDirector suggests. but on balance it is certainly less stressful than a free market.

As in an attending job? If so, this is the first time I’ve heard this. Unless the market for the specialty is too tight, usually the doc has the advantage.

 

[GoSpursGo]

As a person now in the process of looking for a job, I can say for certain that I preferred The Match.

Without getting into specifics, I also GREATLY preferred the match over my current process of going back and forth between a number of different potential employers, all working on differing timelines.

Perhaps not generalizable as I'm trying to stay in academics, but that's my experience.

 

[Dr.LeoSpaceman]

As in an attending job? If so, this is the first time I’ve heard this. Unless the market for the specialty is too tight, usually the doc has the advantage.

Yes, for an academic position.

 

[BigRedBeta]

Third for those saying the Match was preferable to "free market" attending job search.

There were several reasons on why the Match was better (or why the free market wasn't as beneficial as people like to think it is)

• Match had clear distinction of who was hiring/interviewing
• Match had clear timeline as to when a decision would be made
• Match gave greater certainty of getting a position at all (on June 20th of the year I was graduating PICU fellowship, I had zero job offers)
• Free market didn't have any substantially greater negotiating power - each of my three job offers were very much 'this is what we're offering, take it or leave it'
• Free market gave a lot of mixed signals which made it hard to know exactly where I stood - which was a problem for my non-medial partner to make plans for her career

The biggest issue was just the whole trying to figure out who was actually hiring and what their timeline was. PICU is obviously not a huge field and mostly academic, but everyone was resoundingly terrible about getting back to emails and phone calls regarding interest. I would hear from my attendings that they had spoken to someone at Program X that they were hiring, then I email and call and not hear anything back for weeks. Not one program I interviewed at kept to the timeline for making a decision they initially stated, all basically giving some form of "we haven't had a chance to meet to discuss candidates" or "the department head is unexpectedly out of town this week, so we can't make a decision". Some places had really great interviews that I felt really strong about or someone said something bluntly like "we definitely will be getting you an offer" and then would be radio silence for 2+ weeks despite my following up.

One institution actually brought me out for a 2nd interview only to tell me that they were still interviewing one other candidate. Then when it came time to make a decision, they realized they had made an error in their FTE calculations and now there was actually no spots available to hire anyone...and then 2 months later they came back with an offer when one of their faculty announced they were leaving.

Eventually I ended with 3 offers coming my way in the span of about 96 hours. All three basically told me, this is our standard contract, we will be unlikely to make any major changes to the terms we are offering you. I have a family member who is a contract lawyer who reviewed and recommended simple changes to the grammar and syntax that were met with "while you are right this helps the document, we aren't going to make any changes"

My co-fellows similarly had a lot of complaints and frustrations with the process. The only one who really had any negotiations happen was the one doing bench research in which her lab package had a lot of moving parts. Each of us got jerked around substantially by at least one place we looked at - one guy interviewed back where he had gone for med school and thoroughly knew the PICU faculty there, got through a 2nd interview, and then got ghosted completely...and they never hired anyone. Another person got a job offer late Friday night, spouse was out of the country and unreachable on a mission trip, and the institution claimed they needed an answer by Monday morning despite the standard in the field being 2 weeks. They begged to get 7 days so they could discuss with their spouse got home on day 6. Subsequently declined and got a nasty email from the division head about how unprofessional it had been to request an extension in the first place and even moreso to then decline the offer, etc, etc.

Certainly could be field specific, but the complete lack of regulation was not beneficial for me in the slightest. Given how frequently people change jobs in those first three years of being an attending, I don't think the evidence is there to suggest the deregulated market automatically results in a better situation for any and all parties.

 

[ucladoc2b]

Third for those saying the Match was preferable to "free market" attending job search.

There were several reasons on why the Match was better (or why the free market wasn't as beneficial as people like to think it is)

• Match had clear distinction of who was hiring/interviewing
• Match had clear timeline as to when a decision would be made
• Match gave greater certainty of getting a position at all (on June 20th of the year I was graduating PICU fellowship, I had zero job offers)
• Free market didn't have any substantially greater negotiating power - each of my three job offers were very much 'this is what we're offering, take it or leave it'
• Free market gave a lot of mixed signals which made it hard to know exactly where I stood - which was a problem for my non-medial partner to make plans for her career

The biggest issue was just the whole trying to figure out who was actually hiring and what their timeline was. PICU is obviously not a huge field and mostly academic, but everyone was resoundingly terrible about getting back to emails and phone calls regarding interest. I would hear from my attendings that they had spoken to someone at Program X that they were hiring, then I email and call and not hear anything back for weeks. Not one program I interviewed at kept to the timeline for making a decision they initially stated, all basically giving some form of "we haven't had a chance to meet to discuss candidates" or "the department head is unexpectedly out of town this week, so we can't make a decision". Some places had really great interviews that I felt really strong about or someone said something bluntly like "we definitely will be getting you an offer" and then would be radio silence for 2+ weeks despite my following up.

One institution actually brought me out for a 2nd interview only to tell me that they were still interviewing one other candidate. Then when it came time to make a decision, they realized they had made an error in their FTE calculations and now there was actually no spots available to hire anyone...and then 2 months later they came back with an offer when one of their faculty announced they were leaving.

Eventually I ended with 3 offers coming my way in the span of about 96 hours. All three basically told me, this is our standard contract, we will be unlikely to make any major changes to the terms we are offering you. I have a family member who is a contract lawyer who reviewed and recommended simple changes to the grammar and syntax that were met with "while you are right this helps the document, we aren't going to make any changes"

My co-fellows similarly had a lot of complaints and frustrations with the process. The only one who really had any negotiations happen was the one doing bench research in which her lab package had a lot of moving parts. Each of us got jerked around substantially by at least one place we looked at - one guy interviewed back where he had gone for med school and thoroughly knew the PICU faculty there, got through a 2nd interview, and then got ghosted completely...and they never hired anyone. Another person got a job offer late Friday night, spouse was out of the country and unreachable on a mission trip, and the institution claimed they needed an answer by Monday morning despite the standard in the field being 2 weeks. They begged to get 7 days so they could discuss with their spouse got home on day 6. Subsequently declined and got a nasty email from the division head about how unprofessional it had been to request an extension in the first place and even moreso to then decline the offer, etc, etc.

Certainly could be field specific, but the complete lack of regulation was not beneficial for me in the slightest. Given how frequently people change jobs in those first three years of being an attending, I don't think the evidence is there to suggest the deregulated market automatically results in a better situation for any and all parties.

You really want to have your entire adult working life placement controlled by some computer algorithm that basically gives you a choice of take this job or unemployment? Just because there is a match does exempt either party from gamesmanship (love letters, etc).

Honestly, this is the way most of the country finds work. Smaller fields with less demand will have issues like this. However, in several fields, the market clearly favors the physician.

 

[GoSpursGo]

You really want to have your entire adult working life placement controlled by some computer algorithm that basically gives you a choice of take this job or unemployment?

I know it feels like that sometimes, but again that's not how the match works. You still get to decide which place you like the most, and then you get matched to the place that you liked the best that also liked you. If you match to your 5th program, then you were never getting an "offer" from your 4 favorite programs anyways.

Yes, we're somewhat biased by the fact that we're working in academic peds subspecialties. Take that for what you will.

 

[ucladoc2b]

I know it feels like that sometimes, but again that's not how the match works. You still get to decide which place you like the most, and then you get matched to the place that you liked the best that also liked you. If you match to your 5th program, then you were never getting an "offer" from your 4 favorite programs anyways.

Yes, we're somewhat biased by the fact that we're working in academic peds subspecialties. Take that for what you will.

This is very much what the match participation agreement says (well essentially it’s take this contract or get a match violation and a multi year ban from seeking employment through your only market).

At least a free market lets you see all of your offers before you select one vs just seeing the one the match gives/imposes on you. Everyone on here is obtaining multiple offers (and just because they say the offer is non negotiable doesn’t mean it’s true). While no job is going to be perfect, you at least know where you stand with each practice (and maybe you could more easily switch the job you take sucks).

I have yet to meet a single attending who advocated using a match to start/change jobs.

 

[Gastrapathy]

As in an attending job? If so, this is the first time I’ve heard this. Unless the market for the specialty is too tight, usually the doc has the advantage.

What? It’s a market. Good jobs arent advertised. My group knows what they are. I had 24h to decide and even that was slightly irritating to them (now us)

 

[BigRedBeta]

You really want to have your entire adult working life placement controlled by some computer algorithm that basically gives you a choice of take this job or unemployment? Just because there is a match does exempt either party from gamesmanship (love letters, etc).

Honestly, this is the way most of the country finds work. Smaller fields with less demand will have issues like this. However, in several fields, the market clearly favors the physician.

People meet their spouses via algorithm, the Match got me through 2 rounds equally important to my career development, my wife worked in digital marketing and if you don't think algorithms are directly responsible for a significant number of your purchases then youre being naive.

Would I want to be stuck with that posting forever, maybe not. My point was, the free market wasn't demonstrably superior to the Match. Just because that's the way the rest of the world finds work, doesn't mean it's right, wrong, better or worse, just that its a different way.


While there isn't transparency on the offer side of the match, there was a lot less transparency on whether or not someone was even hiring in the free market approach. That was significantly more distressing, not knowing if I was even going to get interviews to begin with.

At least a free market lets you see all of your offers before you select one vs just seeing the one the match gives/imposes on you. Everyone on here is obtaining multiple offers (and just because they say the offer is non negotiable doesn’t mean it’s true). While no job is going to be perfect, you at least know where you stand with each practice (and maybe you could more easily switch the job you take sucks).

Huh? My case of 3 job offers over the span of 96 hours is not common. Had one of those come up a month earlier than the others, I would have taken it because I was without any other options. Most people have to take the first offer they get no matter how subpar, because there is legitimate worry about no other offers coming in at all.

 

[GoSpursGo]

This is very much what the match participation agreement says (well essentially it’s take this contract or get a match violation and a multi year ban from seeking employment through your only market).

At least a free market lets you see all of your offers before you select one vs just seeing the one the match gives/imposes on you. Everyone on here is obtaining multiple offers (and just because they say the offer is non negotiable doesn’t mean it’s true). While no job is going to be perfect, you at least know where you stand with each practice (and maybe you could more easily switch the job you take sucks).

I think you're arguing semantics. If you get offers from your 5th, 8th,and 11th ranked programs, you'd feel better about yourself, but you'd still wind up at your 5th ranked program. You would never realistically decline all 3 in the hopes that you could get something better later on.

I have yet to meet a single attending who advocated using a match to start/change jobs.

We're not saying that. We're saying maybe you should be careful what you wish for, because the free market can suck in its own ways. Yes, it benefits the doc when there are lots of jobs, but the market in residency applications would probably more closely approximate what we are seeing in our job search, where there are roughly an equal number of applicants and positions.

 

[ucladoc2b]

Yes you can meet your spouse online through an algorithm. The algorithm doesn’t force you to marry them and then restrict you from ever dating again if you don’t like them IRL.