NRMP Match: Good, bad or ugly?

[ucladoc2b]

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.


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.

I’m not arguing semantics at all.

I’ve gotten several jobs through the free market (pre residency of course). It is significantly better. When I left my first job, I interviewed with a couple of firms. I’m sure glad I did because one firm basically more than doubled my compensation even though my “preference list” was different.

I’ll post the argument that your pre offer order of preference can change significantly based on what they give you (your #11 may become your #1 fairly quickly with a much better employment package. However, you won’t know that if you never see their offer).

Getting more than one offer in a short time frame is actually fairly common (it forces the other party to actually make a decision)

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[NotAProgDirector]

Your rank list essentially asks: "If you received an offer from all of these programs, what order would you accept them". However, I do recognize that although the match logically results in the same outcome as picking between offers, there is an emotional difference -- it's nice to get multiple offers and then pick. However, if someone gets multiple offers, someone else gets no offers (since the total number of offers is fixed). Which results in the problem hinted at above -- you could get an offer now that you accept, but then a later offer you're more happy with, which then begs the question of when do you become "locked into" your offer. The later this "lock in" date is, the more problematic the whole process becomes as it becomes difficult to plan your transition while awaiting new offers.

Employment packages for residents are not negotiable, and are reviewed during your interview day. Even in a fully free market system, residents can't negotiate for better terms.

 

[GoSpursGo]

I’m not arguing semantics at all.

I’ve gotten several jobs through the free market (pre residency of course). It is significantly better. When I left my first job, I interviewed with a couple of firms. I’m sure glad I did because one firm basically more than doubled my compensation even though my “preference list” was different.

I’ll post the argument that your pre offer order of preference can change significantly based on what they give you (your #11 may become your #1 fairly quickly with a much better employment package. However, you won’t know that if you never see their offer).

Getting more than one offer in a short time frame is actually fairly common (it forces the other party to actually make a decision)

aPD basically said everything I wanted to say. But in summary, the job market that you are describing from your old line of work is not similar to the residency job market, or depending on your specialty the attending job market.

 

[deleted814217]

I do agree salaries won’t change necessarily that much as long as systems are funded by a Medicare/CMS and gme type structure (which I have my own thoughts about but are irrelevant to some degree for the purposes of the arguement). Logically I think the best way to compare this would be to trial this would some kind of an early decision system where there is a timeframe and to see if this works so change can occur incrementally. I do think programs should start being more transperabt regarding their selection process, requirements etc.
Programs themselves are also beholden and game the match to some degree because they have to fill. There are some including where I am at they use geographic filters and other things. Isn’t that supposed to be against the point of the match? Maybe there’s someone who is a stud candidate who is from The mid west and went to school there but for whatever reason doesn’t want to stay there and wants to leave . They get the short end of the stick to some degree no matter how good they are based on some of the selection criteria and imo this has some potential for changing. I have witnessed it as well several times during my own match season.
I can’t believe some people would want a match system for their first job. I am looking right now and people who seriously want that are crazy (imo). I can’t imagine anything more than a small subset of the practicing physician population wants that. This is one of the situations where it seems a lot of people against the idea are the older physicians. Medicine is a very conservative field with very little change and largely behind the general population. We are all fortunate in so many ways to be where we are but I think can we do better. Industries in tech and engineering have learned that is better to treat employees better and that happier employees mean more productivity but we do not do that. I think there are real opportunities here for change and that we should listen to our future generations and not dismiss or mock them (which so often appears to be the case). The barriers to entry and hoops is trending towards and willI inevitably become so crazy that very few will want to do this field anymore.

 

[eduh]

I'm late to this long conversation, but given that many current residency match applicants blanket spray applications (like the 99 applications), why not have a limit to the number of applications that can be submitted over time?

Say in September you can send out 10-15 max, you'd have to be a bit more selective and strategic with some of those first applications and not just go at random or exclusively to your "dream" spots. Then in October 15-20 more max, and so on. Require programs to give out some percent of all interviews according to those same timelines. At the same time limit the number of interviews you can take early on in the cycle, max 10 before date X or a max overall number. Given that more interviews over a certain number doesn't create a much high possibility, this could work. Couple all this in with the current system and it could be helpful.

This could help prevent applicants grossly over-applying as well as applicants hoarding interviews with hopes of a "higher chance" of matching. Anecdotally I have friends with very competitive scores with 20+ interview offers in the same specialty hanging onto to late season interviews until maybe "something better" comes up, unfairly to other friends with under 10 interviews hoping for that "late-season trickle".

I know it's a complex endeavor, but I think it could be better somehow.

Edit: wanted to add - I think allowing slightly higher salaries in some areas to motivate more applicants could also help.

 

[Gastrapathy]

Now I understand, you’ve never had a job in medicine. Good groups don’t advertise on monster.com. Some jobs stay open for years and you can collect up as many of those offers as you want. But, if you told my group that you wanted to wait, we’d just move on to the next person and the opportunity would be lost. That’s normal for the good jobs.

Also, we would never want a match system for hiring. No way we’d give up control like that. We hire who we want. A match would give too much power to the applicants

 

[NotAProgDirector]

I'm late to this long conversation, but given that many current residency match applicants blanket spray applications (like the 99 applications), why not have a limit to the number of applications that can be submitted over time?

Say in September you can send out 10-15 max, you'd have to be a bit more selective and strategic with some of those first applications and not just go at random or exclusively to your "dream" spots. Then in October 15-20 more max, and so on. Require programs to give out some percent of all interviews according to those same timelines. At the same time limit the number of interviews you can take early on in the cycle, max 10 before date X or a max overall number. Given that more interviews over a certain number doesn't create a much high possibility, this could work. Couple all this in with the current system and it could be helpful.

One of the outcomes of the Step 1 P/F discussion has been that if we're serious about "fixing" the UME to GME transition, we need to look at the whole picture. Some sort of limit on ERAS applications has been discussed. If this were to be seriously considered, we'd need to ensure that students had enough information about which programs they were really competitive for. Whether it's a phased timing release of applications (your suggestion) or labeling the first 15 applications "gold", the next 10 "silver", and everything after that "bronze", or some other solution, is def interesting. But I think it would be difficult to force programs to save spots for later, or to force programs to interview some percentage of "bronze" applications. Whether limiting applications is even legal is unclear, and then there's the "problem" of couples.

This could help prevent applicants grossly over-applying as well as applicants hoarding interviews with hopes of a "higher chance" of matching. Anecdotally I have friends with very competitive scores with 20+ interview offers in the same specialty hanging onto to late season interviews until maybe "something better" comes up, unfairly to other friends with under 10 interviews hoping for that "late-season trickle".

This is exactly the problem that could happen without a match. In fact, one suggestion (almost certainly not going to happen) is a match for interviews.

 

[mvenus929]

Programs themselves are also beholden and game the match to some degree because they have to fill. There are some including where I am at they use geographic filters and other things. Isn’t that supposed to be against the point of the match? Maybe there’s someone who is a stud candidate who is from The mid west and went to school there but for whatever reason doesn’t want to stay there and wants to leave . They get the short end of the stick to some degree no matter how good they are based on some of the selection criteria and imo this has some potential for changing. I have witnessed it as well several times during my own match season.

I don't disagree that programs 'game' the system to some degree, but so do applicants. Does the average peds candidate really need to apply to 50 programs? No. So programs use their selection criteria to try to narrow the field to those who are most likely to rank them higher and thus match there. Not filling is just as terrifying to programs as not matching to the applicants (at least at the residency level).

But there are ways around geographic filters. I went to med school on the east coast, but spent most of my time in the western half of the states. I wanted to go 'home', but there was very little on my application that indicated that I was 'from' that region. When I was rejected for interview, I sent an email to the program director listing out why I wanted to attend, and had one of my attendings call on my behalf. I got an interview invite 2 days later. Does it always work? No. But sending a well reasoned argument for why you want the chance to attend one specific interview can cause someone to look at your application again (or unscreen it, at least) and make the decision there. Doesn't mean their initial decision to not interview you will be overturned, but it's a chance...

 

[JustOnePing]

Interesting food for thought conversation here but why would the NRMP and AAMC ERAS ever change the status quo? With an exemption by Congress and year-over-year increasing profit, as evidenced from the graph posted earlier, if anything they are paying lip service to complaining PDs.