Post Scramble Available Positions

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[ThoracicGuy]

You have a position now. I wouldn't let that go just because you're a bit homesick. It's only a few years.

 

[gutonc]

What @ThoracicGuy said. No harm in hunting around, but you need to do all of the following:
1. Know that all of those spots are gone.
2. Keep your snooping around on the DL.
3. Put your game face on and totally kick ass in your current residency. If your program finds out you're catting around trying to find a new position, leaving them shorthanded, your residency record better be spotless because you should assume they're going to try to f*** you 6 ways from Sunday. They may not...and likely won't. But behave as if they will.

 

[tdram]

You have a position now. I wouldn't let that go just because you're a bit homesick. It's only a few years.

Only a few years?? That's a pretty long time to be unhappy. I wouldn't be able to take it personally. Though sticking around is probably the smartest move.

 

[Gastrapathy]

You've been there a week or a year?


Sent from my iPhone 6 using Tapatalk

 

[ThoracicGuy]

Only a few years?? That's a pretty long time to be unhappy. I wouldn't be able to take it personally. Though sticking around is probably the smartest move.

3-5 years of training vs 30-35 years of practice. Yeah, it's only a few years. The location was the issue here. If I were the OP, I'd suck it up as the residency position in the hand is worth two in the bush. There are lots of people that wish they were in the OP's position.

 

[tdram]

3-5 years of training vs 30-35 years of practice. Yeah, it's only a few years. The location was the issue here. If I were the OP, I'd suck it up as the residency position in the hand is worth two in the bush. There are lots of people that wish they were in the OP's position.

I agree with you that the wisest thing is for the OP to stick around.

I don't know if I would have been able to put up with it though. I'm impatient. I would have been trying to find my way out ASAP. I just couldn't handle 3-5 years in a place I hate. To me that's too long.

 

[ThoracicGuy]

I agree with you that the wisest thing is for the OP to stick around.

I don't know if I would have been able to put up with it though. I'm impatient. I would have been trying to find my way out ASAP. I just couldn't handle 3-5 years in a place I hate. To me that's too long.

And as a medical student, you guys often don't see the big picture of this and think that if its not good, you'll just change it like that. It's not easy to do. You can read about people's experiences that quit/resigned/fired from one position and had a tough time getting a second spot, sometimes taking multiple years to get back in if at all.

If you can find a new position, great. But what happens if you find one that you think may work and then they want to talk to your current PD, but you haven't mentioned anything about leaving. Well they'll likely not look good upon you. Now if your PD wasn't very nice, he could sabotage your newly found position. Now that found place is closed to you and your current PD is likely to not renew your contract, so you're out. Next time you go through the match or otherwise try to find a position, you have to expect that they will want to hear from your old PD before they will take you on. You're damaged goods at this point, no matter how great your stats were from med school. New programs will wonder how soon it'll be til you want to leave them. It's oftentimes easier just to stay when your complaint is about geography, not your specialty, and not apparently anything about the program specifically either.

 

[tdram]

It's oftentimes easier just to stay when your complaint is about geography, not your specialty, and not apparently anything about the program specifically either.

Hypothetically- what if it were about the specialty or about the program. Would you suggest leaving then, or sticking it out?

 

[Law2Doc]

Hypothetically- what if it were about the specialty or about the program. Would you suggest leaving then, or sticking it out?

A lot would turn on why exactly you ranked it in the first place, and your competitiveness for other things. If you decide you don't like a specialty, then sure people might legitimately want to make a jump. If you just think you matched too low in a specialty you wanted, then no, you get no sympathy. We see few threads each year of people annoyed that they fell to their eighth choice and want to play sour grapes and spit on the hand that actually wanted them. Or If you were an IMG lucky to get a spot at all, then you keep your head down and suffer through. A lot of times people don't seem to get that three years goes by like the blink of an eye if you are busy, and at the end of it the certificate from the place you kept your head down and pushed through was worth more than a slightly more humane call schedule and prettier facilities or whatever...

 

[ThoracicGuy]

Hypothetically- what if it were about the specialty or about the program. Would you suggest leaving then, or sticking it out?

I agree with what @Law2Doc said. If you get into, say, surgery and realize that surgery isn't for you and that another field would be better for you, that is understandable. To clarify that, though, I think you should give the program and specialty you matched in at least the year. If after that year you're sure that the field isn't for you, then assuming no other red flags or other issues, a switch might be worth it. If it was the specific program that you didn't like, if it truly is malignant and you need to switch because of those issues, that's a possibility, again after having given it a shot first. Realize that the program you'd be switching to is likely to be as bad or worse than your first program and there's a chance that you resign from your first program and never have a spot to land in.

I've seen alot of people asking recently about switching when they've barely started in their program or haven't even started. That's not really fair to the program that accepted them for the resident/future resident to already be looking to go elsewhere. You accepted the position in the first place, you owe it to them to give them 100% effort. I bet most people that don't really like a place to start, if they give it a fair shake, they find things they like and end up accepting it.

 

[ahn546]

So, are the statistics in the NRMP Data results before the scramble? Or post scramble?

 

[Crayola227]

Everyone thinks about jumping ship, because it's a slave ship. If you have any time besides work or biological functions like sleep or eating, in those moments of weakness when you indulge in the ridiculous fantasy of escape, I suggest you follow my post history and the threads about switching, dismissal, termination.

You have no idea how fragile your career is.

Do some basic SDN research before asking how you can easily and singlehandedly tie your own noose and end your career.

The only reason to look elsewhere is because after finishing at least your intern year (take doing intern year at your current program as a given because anything less than a PGY1 completed is total ****atude) is because you cannot find it within yourself to practice this specialty, you're worried your current program is going to drive you to suicide, or this program is so malignant it's already setting you up to fail or not only will someone die due to such poor supervision/training but they'll hang you out for it.

If you have to switch, read the other threads on how to do it, knowing that part of the PARQ in that, risks, is never practicing again. These other threads talk about how to find unicorn positions outside the match and scramble.

Hopefully fear of that will keep your shoulder to the wheel appropriately.

 

[Over9000]

I've always thought the match process is kind of a ridiculous thing.

I also cannot see how anyone would hold any type of sympathy for any residency program accepting them, as if it is some sort of favor. It's a favor to do high-risk work for less than minimum-wage. Nice favor.

They say the match exists to keep residents from becoming unpaid. I think it exists to stifle market competition and keep them underpaid.

Nevertheless, keep your trap shut about wanting to switch, and don't let go of the branch you have until you've grasped your next first.

 

[YankeeCandle1141]

I've always thought the match process is kind of a ridiculous thing.

I also cannot see how anyone would hold any type of sympathy for any residency program accepting them, as if it is some sort of favor. It's a favor to do high-risk work for less than minimum-wage. Nice favor.

They say the match exists to keep residents from becoming unpaid. I think it exists to stifle market competition and keep them underpaid.

Nevertheless, keep your trap shut about wanting to switch, and don't let go of the branch you have until you've grasped your next first.

It exists because:
med students need residency, and they need to start in july.
Programs need residents, and their residents need to have graduated med school in that year.

There is no other way to fill 20,000 positions in such a short period of time.
If there werent a match, it would be the biggest cluster**** in humanity.


Theres a good freakanomics podcast episode about this actually.

 

[Crayola227]

It exists because:
med students need residency, and they need to start in july.
Programs need residents, and their residents need to have graduated med school in that year.

There is no other way to fill 20,000 positions in such a short period of time.
If there werent a match, it would be the biggest cluster**** in humanity.


Theres a good freakanomics podcast episode about this actually.

Too lazy to dig out an article about how matching is an antiquated process that is heavily in favor of hospitals while it once was.more mutually helpful. What you say is true to some extent but it doesn't mean the process couldn't be tweaked to be more fair and less evil

 

[NotAProgDirector]

What you say is true to some extent but it doesn't mean the process couldn't be tweaked to be more fair and less evil

How, exactly?

 

[gutonc]

What you say is true to some extent but it doesn't mean the process couldn't be tweaked to be more fair and less evil

How, exactly?

There is nothing "evil" about the current setup of the Match process. Sure, some people will not get what they want, and some will go unmatched. And some will get what they think they want, be wrong about that, and make a change...most will be successful doing so.

Are there winners and losers in this system? Hell yes. But for the most part, the current system puts the overwhelming majority of applicants in a reasonably good place and allows them to become what they want to be. It's not perfect, but it's more than good enough.

If you think you have a better system, by all means skip over telling NRMP about it and just alert the Nobel Committee.

 

[Law2Doc]

...

Are there winners and losers in this system? Hell yes...

I would say there are winners and less appreciative winners. As mentioned above, even some of the self declared losers are actually winners compared to the thousands of people who would love those less desirable matches.

As I mentioned above, three years is a very short period of time compared to a career. If something is tolerable but not ideal, keeping your head down and pushing through actually sometimes opens more doors than trying to make a midstream jump. We all know a guy who finished one residency or a big chunk of that residency and switched to another, and frankly these guys tend to do pretty well in my experience. So that's not always the worst play. Think long and hard before you give up that bird in a hand, especially if its only an issue with geography (rather than specialty choice, malignancy, etc).

 

[YankeeCandle1141]

..not to mention, if the system allowed the "losers" to match higher on their rank list-that displaces more qualified residents from their deserved positions.

 

[Crayola227]

There is nothing "evil" about the current setup of the Match process. Sure, some people will not get what they want, and some will go unmatched. And some will get what they think they want, be wrong about that, and make a change...most will be successful doing so.

Are there winners and losers in this system? Hell yes. But for the most part, the current system puts the overwhelming majority of applicants in a reasonably good place and allows them to become what they want to be. It's not perfect, but it's more than good enough.

If you think you have a better system, by all means skip over telling NRMP about it and just alert the Nobel Committee.

I don't have a better system, but this is why I think it is "evil"

Also, plenty of people are questioning the need for the Match: http://www.forbes.com/sites/theapot...dency-matching-system-for-newly-minted-m-d-s/

I have never seen such a widely accepted nonsensical and harmful system. Steps really need to be taken to get rid of it.

You are not just unlikely to ever work in your desired field ever, the desire of doctors aside they are unlikely to ever work again in SOCIETY'S DESIRED FIELD, PCP gettting people healthier and back to work via primary care fields like FM/IM

Medical students that don't match:
COST: unpaid student loans, worthless medical degree so no care provided
BENEFIT: none
NET VALUE: this is a massive loss to society, probably millions of dollars worth of QALYs when you factor in their suicide and doc shortage of gen pop

However, investing in resident training is the best way to ever get any of the investment put into the med student back

As Perrotfish mentioned (I love that guy, Whedon fan?) the current NRMP process and "all in" and GME funding
results in a collusion where unmatched med students and resigned residents might as well light their MD diploma on fire and die in the flames
what society saves itself by refusing to pay more for GME funding, stopping the collusion so the docs getting trained, is lost by unpaid student loans

I went through all of the above to say what I hate about the system:
No MD with $250K of the taxpayer money blown should worry about
how to pay enough NRMP application and interview costs
to have a residency, a roof, food, medical care
when they are clearly willing to be indentured servants and work for pennies if anyone is willing to pony up a residency slot
What sucks a la this thread regarding NRMP is the collusion that results in such high application costs for anyone that needs to try again for a residency
I couldn't give a **** less about the lack of negotiating power the NRMP gave residents if it meant they could rest assured somewhere would train them without breaking them mentally and physically

 

[Crayola227]

I define "evil" and a "losers" in the system as
med students paying thousands of dollars (not included in student loans even, so how can you do it twice?)
to become unmatched grads or residents that can't get matched again

I'm not considering that you match the first time to Alaska FM program as a loss and the evil in the NRMP system

It just shouldn't be that f*ing hard for an MD to get a slot, any slot, and for that slot to
not resemble indentured servitude to the point that it does

 

[Chicago2012]

I think part of the problem is due to the lower desirability amongst AMGs for primary care. As a result of this FMGs have had rules relaxed to allow easier entry for them into residency. This ends up affecting all specialties, but specialties like Family Medicine more than most. The last two years less than half of matched positions went to American Seniors and of the successful non-Senior applicants, only 139 went to previous AMGs. It's a strange situation, because a proportion of those FMGs will not practice in the US, although I'm pretty sure that the lion's share do. I am not saying that we should return to the days where the hurdles were so high for FMGs that very few stood a chance of getting anything (my wife's uncle graduated from the Caribbean in the 80's and was never able to start residency), but the current system is leaving behind more and more American graduates every year.

 

[Chicago2012]

The fact that a whiney medical student wrote a really poorly thought out editorial for forbes.com is hardly strong evidence that the match is evil.

I definitely think the Match is not inherently good or evil, but the trend of more and more seniors and AMGs going unmatched every year needs to be resolved in some way. This can, most likely, be done while keeping the Match intact.

 

[Chicago2012]

No such trend exists.

http://www.ama-assn.org/ama/ama-wir...h-sees-higher-percentage-of-unmatched-seniors

 

[NotAProgDirector]

This article in Forbes has been discussed in other threads. But we'll go through it here, again.

Becoming a doctor takes time, but those outside of medicine do not always realize how convoluted the process can be. Central to the perversion is the National Resident Matching Program (or “the Match”).

The very first sentence points out that this article is a very partisan view. The author calls the match a "perversion" and we haven't even discussed it yet.

After college and the two years of classroom-based training in medical school, students are ushered into clinical training through predetermined core rotations. In the spring of their third year, students must decide on their career specialty, often without rotating in their chosen specialty yet if it was not a “core” rotation of third year.

Many medical schools have changed their curricula such that you get one or more electives in the 3rd year, and one of the cores gets moved to the 4th. In any case, this has nothing to do with the match. If the author's point is that students don't get enough exposure to fields before they have to choose, then the solution is to push the entire application process forward in time (or change med school curricula)

During their senior year, students spend the first few months completing from zero to three month-long ‘away rotations’ at potential residencies. In mid-September they apply to all residency programs that interest them, sometimes over a hundred programs, submitting a fee for each.

This is wrong. In most fields, away rotations are not needed. Only the most competitive fields with very small numbers of spots will. US students apply to programs, but hardly 100's -- again, only if applying to Derm or Ortho might a US student do this. But this has nothing to do with the match. These fields are competitive.

Starting in October, students interview around the country for three to four months, incurring significant travel costs and missing much of their senior year due. In late February, students and residencies both submit a “rank list” of one another for the NRMP algorithm to optimize.

Students are going to need to interview for spots. That will take time. Only if the author (or someone else) suggests a system by which you could go on less interviews, would it make any difference. Plus, the match creates a situation that it doesn't matter when in those 3-4 months you interview. Whether you are on the first or last interview day, no spots have been given away yet so you have the same chances.

Results of this optimization are released on Match day in late-March, when medical students around the country find out the residency program at which they “Matched”, bound to the program and bound to a non-negotiable contract shown to them months prior. Many students either do not match at all or do not match at their first choice program; nonetheless their fate is sealed by the ivory tower algorithm of the Match.

Most US grads match (more on that later). Some do not get their 1st choice. Welcome to life. Not everyone can get their first choice. Life doesn't work that way. Any system other than the match will still result in many people not getting their 1st choice.

This year, 5.6% of US allopathic (MD) seniors did not match, and 22.3% of US osteopathic (DO) seniors did not match. On the whole, 25.0% of applicants in the NRMP Match did not match – with a 25% unemployment rate, how successful is the Match, really?

This is the paragraph that makes me the most angry. This is plain wrong. About 5% of US MD's don't match. Many of those get spots in SOAP, so ultimately get a spot. Some of them are very focused on a specific field and decide to take another year, doing research, etc, to apply again rather than take a spot in another field. Since there are more applicants that want Derm than Derm spots, some people are not getting a Derm spot no matter what system you use. Unless we change the way training works and let as many people train in each field (by completely changing the way we do training).

Now let's be serious for a second. 25% of US MD and DO grads are not unemployed. That is completely ridiculous. Why? Because about 20% of DO's fail to match in the NRMP (this ignores those that match AOA and are withdrawn). BUT YOU CAN'T ADD 5% of MD AND 20% OF DO GRADS AND GET 25%. There are many less DO grads. In 2014, there were 976 unmatched US MD (5.6% of the total US MD applicants) and 611 unmatched DO's (20% of the total DO applicants). Combining both of those yields 7.9% unmatched MD+DO. But again this ignores post-match spots (of which there are many in the AOA match also). So ultimately the "unemployment rate" is well below 5%. There are at least 20% more spots than US MD+Do grads -- almost everyone can get a spot, if they are willing to be flexible.

This system is highly wasteful. It incurs massive costs for hospitals and students through the interview process, precludes contract negotiations that could optimize value for both parties and results in depressed wages for young physicians. Additionally, it incurs significant opportunity cost in trading interviews for educational senior year curricula, causes undue duress for applicants and their families and contributes to decreased quality of care in physicians unsatisfied with results of the Match.

1. We only decrease interview costs if a different system yields less interviews. There is no guarantee that a new system will yield less interviews. In fact, a "free for all" system would encourage students to interview as early and quickly as possible -- possibly costing more in travel costs etc. Note that "negotiations .... depressed wages for young physicians" actually would increase costs for the "system" (i.e. the hospitals), but as I've mentioned elsewhere the match really isn't the problem with resident wages. Any system other than the match could yield worse results.

The Match was established in 1952 when available resident positions vastly exceeded the number of graduating medical students. As a way to secure top students as residents, hospitals were: 1. Offering positions earlier and earlier, sometimes even prior to a student’s clinical years; 2. “Exploding” offers and demanding a acceptance or rejection of an offer within minutes.

The first problem was remedied by an agreement among medical schools to embargo student records until a specified date in fourth year. The latter was remedied by the Match.

This is correct.

Medical education today is nothing like it was 60 years ago. Today, many specialties have more US medical graduates than residency positions, and international medical graduates and physicians reapplying for residency also compete in the match. Medical schools continue to increase, as have the birth of osteopathic schools and Caribbean schools.

Although the number of US grads has increased, so have the number of spots. At present, there's about 1.5 spots for every US grad in the match. This ratio has varied between 2 and 1.2 over the last few decades, but the current ratio is no worse than much of the past.

Medicare, which funds residencies, is continually threatened. Medical education debt is rising while post-residency earning potential is declining and training time is increasingly extended with required fellowships

The funding of medicare is a topic of other threads. What it has to do with the match, I have no idea. Debt is increasing, also has nothing to do with the match. Fellowships are not required in most fields.

The misbalance between residencies and students is no longer; and resources are tighter than ever, yet the archaic Match system continues to waste time and funds of students and applicants alike in the name of ‘tradition’.

As mentioned, there is no "misbalance" and it is no different than in the past.

Financially, the Match is devastating. Assume a student applies for 35 programs in one specialty, receives 20 interview offers and accepts 12; these are conservative estimates in competitive specialties, in applicants ‘couples-matching’ with a spouse and in specialties requiring a separate ‘preliminary’ internship.

In application fees, this student will spend $465. The 12 interviews, each requiring a $50 motel, a $50 car rental and a $300 flight, cost this student $4,800. All in, this student has spent $5,265 on the Match, against $250,000 in existing student debt. Assuming a Federal Stafford Loan with 6.8% interest paid in 10 years, $5,265 becomes $7,470.76.

With a 15% tax rate, $7,470.76 becomes $8,789.13 in pre-tax income. With 34,270 active applicants in the Match in 2014, $302 million is wasted annually, in the setting of tight graduate medical education funding, increasing student debt and decreasing physician reimbursement.

The author suggests that, given a different system, students might go on less interviews. This is like suggesting that you should have only gone on one medical school interview, the school you ultimately attended. Sounds great, except it clearly doesn't work. Students will need to apply to a bunch of residency programs, just like medical schools. However, not every interview costs a $300 flight. Many students could interview in one geographic area for much less than this.

In addition, the Match precludes an applicant from negotiating their salary or contract in any way. Dual degrees (MD/JD, MD/MBA, MD/MPH) are ever-increasing and many applicants will bring additional value to their hospital, yet are unable to be compensated for it. Additionally, it precludes less competitive applicants from accepting lower salary or early offers in exchange for a position.

I'm not paying an MD/JD anything more. I don't need a lawyer. I'm training a physician. As I'm mentioned on other threads, resident salaries are not really affected by the match. The medicine fellowships were not in a match for many years, and salaries didn't improve. The last sentence should be terrifying. Some people are willing to work for nothing. Are you?

Jung v. AAMC in 2003 challenged the Match on antitrust grounds, claiming that the collusion of hospitals within the Match artificially depressed wages. In response, Congress passed an explicit exemption for NRMP through the Pension Funding Equity Act of 2004, making legal challenges moot.

Nonetheless, labor statistics are daunting. Per the 2012 US Census, mean earnings for 25-34 year olds with a doctorate or professional degree are $74,626 or $86,440 respectively. The AAMC mean first-year resident salary was $50,765 for 2013-2014.

NRMP dodged the legal attack in Jung, but numbers don’t lie and a $23,861-$35,675 difference in salary is robbery.

Of course, most of those other people with a doctorate or prof degree will not make $200K+ 5 years out from graduation. But, sure, it's robbery.

Assume that the double-binding match is the most efficient mechanism for filling the residency labor market (which, notably, was not the intent of the Match).

I can't speak to what the initial founders of the match wanted, but at the present time, the match (IMHO) is the most efficient mechanism for filling the residency labor market.

For hundreds of students a year, the Match means a change in career, as students who do not match in their preferred specialty are often forced into an alternate career specialty if they would like to practice as a physician. It also means a change in life circumstance, notably, for those with preferred location given family situations or with spouses unable to find a new job in the short two-three months between Match day and residency start dates in June.

Ultimately, the Match translates into thousands of physicians training in an undesired specialty, in an undesired city and in an undesired situation split from their families. These physicians, lives forced by the Match, cannot be assumed to perform at the same quality as those that matched into their ‘dream job’.

There are more people who want a Derm spot than Derm spots. Whether we use a match, or any other system, some people are not getting a spot. That's life. This has nothing to do with the match. I'd argue that the match INCREASES the chances of you matching to your desired specialty or geography.

Of this population, do they end up leaving the profession prematurely? Are their career trajectories as successful? Are their satisfaction rates the same? What about their suicide rates, addiction rates and wellness?

Good questions. Too bad you don't have any answers.

Legislation exonerated the Match from legal attacks in Jung v. AAMC, but that does not prove it is good policy. Economist Dr. Alvin Roth won a Nobel Prize in economics for his theory in a double-binding labor market match underlying the NRMP — but notably, academic economists like Dr. Roth himself acquire their positions on the free market, not through a match.

Few other professions utilize this double-binding match, and in explaining the Match to those unfamiliar with medical training, the closest relatable comparison is sorority rush. However, the stakes are a bit higher than selecting Greek letters, and we are physicians, not teenagers. For the good of our profession, our patients, and our future protégés, it’s about time to trash the Match.

All of this is based on nothing.

 

[Crayola227]

So you addressed the one line which was a link in my post, mostly nitpicked numbers, and missed the spirit of my message, and my own post below it.

It's a far more expensive and difficult process than getting into med school was for poor kids (at least for me)

And tell me, the ones that don't get a spot scrambling, then what happens when they try next year?

It's around 5,000-10,000 a year you want to try to get a slot, nevermind chances dwindle each year, and I'm not talking derm, I'm talking this primary care we supposedly need so much of

 

[gutonc]

So you addressed the one line which was a link in my post, mostly nitpicked numbers, and missed the spirit of my message, and my own post below it.

It's a far more expensive and difficult process than getting into med school was for poor kids (at least for me)

And tell me, the ones that don't get a spot scrambling, then what happens when they try next year?

It's around 5,000-10,000 a year you want to try to get a slot, nevermind chances dwindle each year, and I'm not talking derm, I'm talking this primary care we supposedly need so much of

Your primary complaint seems to be the number of available spots then, not the way they're distributed. That's a completely different argument.

 

[Goro]

I read through the article and my first thought was "so much entitlement, so little time".

Colleague, your sage commentary and the rest of the thread reminded me of a Winston Churchill quote:
"Democracy is the worst form of government, except for all the others.”

This article in Forbes has been discussed in other threads. But we'll go through it here, again.
All of this is based on nothing.

 

[Crayola227]

Your primary complaint seems to be the number of available spots then, not the way they're distributed. That's a completely different argument.

Number of slots and distribution, in the sense of expense and interviews.

Step exam expense, prep, and any associated interviews are not included in cost of attendance (I understand the reasoning why it is not, but the reality is still rough) so no Federal loans for this. Family and private loans don't always cut it. And as Goro mentioned this thread or another, apps have become a numbers game for many (I'm talking even low popularity fields here) because people don't want to be left in the dust so they want to hit the reported average number of ranked programs of matched seniors, so hence the confetti of apps.

The lack of slots, AOA and ACGME merger, (nevermind the AOA merger, that won't be for a while), increase in med school class sizes, is part of the distribution problem.

I'm not saying I have solutions. Perhaps virtual interviews to start the process? I admit that might be lame. I appreciate how many programs are providing for hotel in some less desirable programs.

I don't like that yes, it is true that the match process is exempted from other laws regarding employment (antitrust) but I also understand that it may result in the greatest number of matches.

I think that anyone wanting primary care fields should have enough slots for anyone wanting to match.

As far as distribution, due to lack of slots, the emphasis placed on matching fresh seniors (I understand some good arguments why they get first crack) puts people scrambling and trying to match again at a ridiculously horrible disadvantage.

And the NRMP all in policy is making it so hard for anyone to get a spot outside the match.

I think some programs should be allowed to have some slots set aside or offerred outside of match or have a few slots computer designed to give some preference to less desirable candidates seeking to re-enter.

The computer algorithm in actual rank list matching may be in favor of the applicant, and they are free to throw as much money as they can to apply where they want, and mayne this leaves the least number of unfilled spots, but the whole system is vastly at the resident's expense.

 

[Law2Doc]

This article in Forbes has been discussed in other threads. But we'll go through it here, again.



The very first sentence points out that this article is a very partisan view. The author calls the match a "perversion" and we haven't even discussed it yet.



Many medical schools have changed their curricula such that you get one or more electives in the 3rd year, and one of the cores gets moved to the 4th. In any case, this has nothing to do with the match. If the author's point is that students don't get enough exposure to fields before they have to choose, then the solution is to push the entire application process forward in time (or change med school curricula)



This is wrong. In most fields, away rotations are not needed. Only the most competitive fields with very small numbers of spots will. US students apply to programs, but hardly 100's -- again, only if applying to Derm or Ortho might a US student do this. But this has nothing to do with the match. These fields are competitive.



Students are going to need to interview for spots. That will take time. Only if the author (or someone else) suggests a system by which you could go on less interviews, would it make any difference. Plus, the match creates a situation that it doesn't matter when in those 3-4 months you interview. Whether you are on the first or last interview day, no spots have been given away yet so you have the same chances.



Most US grads match (more on that later). Some do not get their 1st choice. Welcome to life. Not everyone can get their first choice. Life doesn't work that way. Any system other than the match will still result in many people not getting their 1st choice.



This is the paragraph that makes me the most angry. This is plain wrong. About 5% of US MD's don't match. Many of those get spots in SOAP, so ultimately get a spot. Some of them are very focused on a specific field and decide to take another year, doing research, etc, to apply again rather than take a spot in another field. Since there are more applicants that want Derm than Derm spots, some people are not getting a Derm spot no matter what system you use. Unless we change the way training works and let as many people train in each field (by completely changing the way we do training).

Now let's be serious for a second. 25% of US MD and DO grads are not unemployed. That is completely ridiculous. Why? Because about 20% of DO's fail to match in the NRMP (this ignores those that match AOA and are withdrawn). BUT YOU CAN'T ADD 5% of MD AND 20% OF DO GRADS AND GET 25%. There are many less DO grads. In 2014, there were 976 unmatched US MD (5.6% of the total US MD applicants) and 611 unmatched DO's (20% of the total DO applicants). Combining both of those yields 7.9% unmatched MD+DO. But again this ignores post-match spots (of which there are many in the AOA match also). So ultimately the "unemployment rate" is well below 5%. There are at least 20% more spots than US MD+Do grads -- almost everyone can get a spot, if they are willing to be flexible.



1. We only decrease interview costs if a different system yields less interviews. There is no guarantee that a new system will yield less interviews. In fact, a "free for all" system would encourage students to interview as early and quickly as possible -- possibly costing more in travel costs etc. Note that "negotiations .... depressed wages for young physicians" actually would increase costs for the "system" (i.e. the hospitals), but as I've mentioned elsewhere the match really isn't the problem with resident wages. Any system other than the match could yield worse results.



This is correct.



Although the number of US grads has increased, so have the number of spots. At present, there's about 1.5 spots for every US grad in the match. This ratio has varied between 2 and 1.2 over the last few decades, but the current ratio is no worse than much of the past.



The funding of medicare is a topic of other threads. What it has to do with the match, I have no idea. Debt is increasing, also has nothing to do with the match. Fellowships are not required in most fields.



As mentioned, there is no "misbalance" and it is no different than in the past.



The author suggests that, given a different system, students might go on less interviews. This is like suggesting that you should have only gone on one medical school interview, the school you ultimately attended. Sounds great, except it clearly doesn't work. Students will need to apply to a bunch of residency programs, just like medical schools. However, not every interview costs a $300 flight. Many students could interview in one geographic area for much less than this.



I'm not paying an MD/JD anything more. I don't need a lawyer. I'm training a physician. As I'm mentioned on other threads, resident salaries are not really affected by the match. The medicine fellowships were not in a match for many years, and salaries didn't improve. The last sentence should be terrifying. Some people are willing to work for nothing. Are you?



Of course, most of those other people with a doctorate or prof degree will not make $200K+ 5 years out from graduation. But, sure, it's robbery.



I can't speak to what the initial founders of the match wanted, but at the present time, the match (IMHO) is the most efficient mechanism for filling the residency labor market.



There are more people who want a Derm spot than Derm spots. Whether we use a match, or any other system, some people are not getting a spot. That's life. This has nothing to do with the match. I'd argue that the match INCREASES the chances of you matching to your desired specialty or geography.



Good questions. Too bad you don't have any answers.



All of this is based on nothing.

I was with you until you said you weren't paying MD/JDs anything more.🙂

 

[NotAProgDirector]

@Crayola227, I think your major complaint is the cost of application, but I'm not certain. I do agree that it costs a good amount of $$ to interview. I think you're incorrect in thinking that, without a match, you'd just go on one interview and that would be it. I expect you'd still need lots of interviews -- except for the very competitive candidates who will get offers early (and then probably sit on them waiting to see if they get better offers).

I'm not convinced that there's an inadequate number of slots. There are more slots than US grads. 95%+ of US grads get a position.

Step exam expense, prep, and any associated interviews are not included in cost of attendance (I understand the reasoning why it is not, but the reality is still rough) so no Federal loans for this. Family and private loans don't always cut it.

I don't know anything about this. Exam prep doesn't need to be very expensive, presumably they are teaching you what you need to know in medical school already.

The lack of slots, AOA and ACGME merger, (nevermind the AOA merger, that won't be for a while), increase in med school class sizes, is part of the distribution problem.

So far any increase in US grads due to class size increases has been matched by an increase in the number of residency slots.

I think that anyone wanting primary care fields should have enough slots for anyone wanting to match.

It depends on how we define "anyone". Any US grad wanting PC can usually get a spot, unless their performance in medical school has been terrible.

I think some programs should be allowed to have some slots set aside or offered outside of match or have a few slots computer designed to give some preference to less desirable candidates seeking to re-enter.

I don't understand what you're saying here. We should purposely give spots to less competitive candidates and hence leave some more competitive candidates without a spot?