PLease Explain to Me Importance/Reason for Matching

[Intrepidation]

Here I am, a year or so from applying to MS, and i can't help but question residency matching. How does it work? I can't find any information outlining the process, all i can find is stuff about the 'algorythms' they use.

Also, how important is it to be matched?

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[Sandpaper]

I'm speechless. [Where do we find these knuckleheads?] Any medical bookstore will have books to answer your questions. How important is it to be matched? You are joking right? Please tell me that you're kidding. I would suggest that you worry about getting into medical school before you worry about residency and matching.

 

[Intrepidation]

Well thank you for your generous help and I am sure any medical bookstore would, in fact, have the answers to my questions. But given my current situation of being stuck on a college campus in the middle of nowhere without a car, that isn't an option. Jeez where do they find these ever-so-helpful knuckleheads?

I am quite sorry my fairly simplistic question has caused you so much grief, but the fact still stands that I would like clarification from (particularly a PGY) someone regarding the process.

I am quite concerned with getting into medical school at the current time, yes indeed. However, how does planning on my future career and the obstacles that I will have to overcome jeopardize that? For me not to learn about such processes as the matching system would be analogous to a hurdler running in the dark, without any clue of where the hurdles are. So sorry if i wasted your valuable time, obviously the amount of devastion I caused on your poor, poor soul was enough for you to ACTUALLY RESPOND citing your frustrations. However, my question is still lacking an answer and as I failed to lace the message with any sublingual or subtextual messages, you have failed in your duty to respond.

Next time if you want to be a jackass, i suggest you take a deep breath and remind yourself that you are, in fact, a good person, and people do, in fact, like you.

 

[Winged Scapula]

Hi Intrepidation...

In my short time available, I'll try and explain the matching process.

Typically there are 3 ways in which to obtain a residency position in the US:

1) through a centralized process called the National Residency Matching Program (NRMP) or via the SF Match (for certain specialties); this is by far the most common way for *most* residents to obtain positions

2) via a pre-match offer. US Allopathic students are not allowed to accept pre-match offers. Thus, this option is only open to Independent candidates which includes DO students, IMGs (both US and non-US citizens) and physician candidates (ie, people who want to change fields).

3) via a post-match offer. Commonly called the scramble, candidates who do not receive an offer via the NRMP/SF Match or whom did not apply (for whatever reason) may contact programs after a certain date and lobby for a position. In competitive fields this may be the only way a less than competitive candidate can obtain a position. Although it is done, candidates who match to a position via the NRMP are barred from accepting another position (ie, if they preferred an open listed listed in the scramble over the one they matched to).

Thus, you can see it is "important" to match and preferable to do so over scrambling as the competition for some spots can be fierce.

Why match? In all states, you are ineligible to be licensed without completion of at least 1 year of postgraduate study in an accredited residency training program. Why complete a residency program? In most states you will be considered unhireable without completing a residency - most hospitals will not give admitting priviledges to non-residency trained physicians, you cannot be Board Certified and patients will not seek you out. However, you are legally able to practice medicine as long as you have a degree and a license. Most states require only a medical degree and 1 year of postgraduate training to get a license - a full and unrestricted license generally takes longer. But you would be able to hang out your shingle and do most anything you wanted - just don't count on being able to admit your patients to the hospital, to have insurance companies pay your patient's claims, etc. without the completion of a residency.

If you would like further information on the algorithm or the actual process of matching, please see the following:
www.nrmp.org

and
www.sfmatch.org

 

[Intrepidation]

Thank You very much Kim. I have a few questions though:

If I want to go to a residency at, say Place "X", but through matching, I am only matched to place Y and Z, I cannot go to X? This is more of the type of clarifcation I should have emphasized that I needed. If this is true, what steps should I take in order to ensure that I can go to my top choices?

 

[PathDoc]

The match is a contract, so if you match to program Y, you go to program Y - you only go to program X if you match there. The programs you place on your rank list and their order should reflect your level of interest in each program and desire to pursue residency there, but it depends on where program X ranks you as to whether you go there. Thus, the "match"

 

[jylu]

Originally posted by Intrepidation:
•Thank You very much Kim. I have a few questions though:
•

During the "match," a computer compares your list of programs (listed in order of desirability) to the list of candidates desired by every program.

Hence, if you want to go to Hospital "X" with 5 positions open and "X" doesn't place you on its list of desired candidates, you will not match with "X."

Another scenario: Let's say you want to go to "X" (you rank it #1) and you are ranked 6th on their list of desirables. If individuals ranked 1, 2, 3, 4, and 5 by "X" to decide to rank "X" as their #1 residency choice, they will all match at "X" and you will not match there. However, for example, if the 4th ranked individual does not rank X or ranks another program higher on his list and is accepted by that program first, you will then be "matched" into X.

 

[Intrepidation]

Thank you very much, that was were I had confusion.

 

[lilycat]

Originally posted by Intrepidation:
•If this is true, what steps should I take in order to ensure that I can go to my top choices?•

Although I'm only a lowly MS1, I'll take a stab at part of your question.

Basically, you'll have a meeting by either the end of your 3rd year, or the beginning of your 4th year, with a Dean from your medical school who's main focus is helping MS4's through the Match, and writing the infamous "Dean's Letter" -- basically a stamp of approval from your med school that you are a good candidate. A line or two will reflect your work in the basic sciences, and then the rest of the letter will be devoted to your clinical rotations, how well you did, excerpts from your clinical evaluations, etc., and also some of the letter may discuss your extracurriculars if they are particularly noteworthy (ie, started some new organization at the school, etc.). Obviously, some letters are stronger than others, based on the candidate's credentials.

Anyways, when you have this meeting with the Dean, you discuss the field you would like to match into, and some of the programs you are interested in. The Dean, based on the match results of previous MS4's at your school, will tell you if your plans are realisitic or not. If you've been a really mediocre student all through med school and have really average board scores, but want to go into Derm or another highly competitive area, the Dean will most likely politely discorage you from this, because the reality is that you would not be a competitive candidate. Same with certain locations -- residencies in Boston (esp. those affiliated with Harvard), New York, and most places in California, tend to be very competitive to place into, based on sheer location. Basically, no matter what area of medicine you want to go into, there are competitive programs in each, and if you are not a competitive candidate, the Dean will discourage you from applying to those programs.

As for what you can do to ensure that your top choices are available to you, my only suggestion would be to work as hard as you can from Day 1. Basically, I have no idea what I want to do at this point, but I really don't want to have certain doors closed to me in 4 years, so I'm going to try to do as well as I possibly can the next 4 years. Med school is extremely time-consuming and draining, much more so than I expected (as least basic sciences-wise), so I know that this won't be easy. If I meet my expectations, great, and if I don't, as long as I knew that I worked as hard as I could, then I'll be okay with that.

In addition to your academics, once you are an MS4, most med schools let you take up to 3 months of away rotations at other hospitals. This may be a good way to check out a program and see if you like, and obviously if you perform well, to get a good recommendation from that program. However, I'm sure there are older and wiser med students in their clinical years, and residents, who can say more definitively how helpful this practice is in terms of matching.

 

[Winged Scapula]

RE: Audition rotations that lilycat mentions

The conventional wisdom is that these can either hurt you or help you. For average candidates who are exceptionally hard-working or who are easy to get along with, have pleasant personalities, etc., an audition rotation can probably significantly increase your chances. I think I fall into this category - I'm almost positive that hadn't I auditioned at some places I wouldn't have been offered an interview. But they got to know me, saw that I "fit in" and considered me a good candidate.

The other side of the coin is the student who looks great "on paper" but doesn't live up to his/her potential in person - perhaps he or she has a poor work ethic, a lackluster or arrogant personality, etc. These people tend not to do as well on auditions. Doesn't matter - stellar creds will likely get you interviews anyway.

Obviously most people fall somewhere between these two extremes - the longer the rotation away the more chances you have to screw up, but the better the team gets to know you. People must not treat them like vacation if they are serious about applying to the program - you should work hard, try and get along well with everyone and fit the predominant mold of the program.

Hope this helps...

 

[KyGrlDr2B]

What happens when you have a married couple who are both 4th yr students and need to match at the same place or reasonably close to the same place?
Thanks..

 

[Winged Scapula]

Originally posted by KyGrlDr2B:
•What happens when you have a married couple who are both 4th yr students and need to match at the same place or reasonably close to the same place?
Thanks..•

There is an process known as the "Couples Match" - not restricted to married or same sex couples, BTW. I do not know the details but essentially you submit ROLs (in the same order) and programs essentially have to take both of you if an offer is made to one (this can help the marginal candidate and hurt the more stellar one).

Information about the process can be obtained from http://www.nrmp.org amongst other sources.

 

[KyGrlDr2B]

Kimberli Cox: Thanks, you've been a great help!!