Questioning a previous NRMP match result

[Allthingssports]

I haven't been on here in years and imagine this has been previously discussed:

Short story: 5 years ago, matched at number 1 IM preliminary spot (thought I had no chance), and failed to match to an advanced position (10+ interviews, including two PDs emailing essentially asking where I ranked them) . Switched specialties (literally overnight) and found a different advanced position through the SOAP that year. Now after residency, without fear of drawing negative attention etc, I feel ready to question this process and am wondering the best way to find out if there was a mistake (would be surprised if the algorithm itself had a glitch that year, but other mistakes including the assigned NRMP number etc).

More details: I was a US IMG with above average STEP scores without failures, good letters and no red flags as far as I knew, and applied to a medium competitive non surgical specialty (at the time was told it would be harder to get the prelim spot than the advanced). The programs I had applied to all had US IMGs in their programs, many from my school. think I had 12 interviews in the advanced position and 10-12 in the prelim IM position. I ended up ranking 10 advanced spots, didnt match. I was the only IMG in my prelim program which I had ranked #1 but was very surprised to have matched there. I looked at the available spots for the SOAP for advanced positions, and there were 3-4 programs offering a spot in the specialty I ended up in (similar competitiveness, non primary care specialty). I applied without letters from the specialty and was contacted by all of the programs. I was completely honest with the person who ended up becoming my PD, who was confused as to how I didn't match in the other specialty. He had a concern that I would jump ship before PGY2 year and try to get back into the previous specialty, which I didn't do or look into. I was more than grateful for a spot, and 5 years later happy with the decision and the specialty I ended up in - which has been a better experience than I would have imagined otherwise.

I have long acknowledged that this could have been a "me" issue and maybe came off confident during interviews, underestimated being an IMG etc, but eventually stopped thinking about it. I didn't want to risk not matching again the next year, or completing the intern spot and then having to stay in IM.I know the stories about programs emailing every applicant saying they liked them and hoped they would choose the program etc but I did have two PDs individually contact me with details about things we personally discussed and basically asked me where I was ranking them.. which felt strange but definitely gave me confidence they would rank me well. I contacted one of them after the match, obviously disappointed and seeking advice and he said "..very surprised, we ranked you high and would have been very happy if you had ended up here". I also had a program coordinator email and say "we can't find you in the system when we are ranking, what is your eras number?" I emailed back the info i had but never heard back, and was all too trusting in the system at the time to look more into it. This could mean nothing, again, but made me wonder, esp since the number you are assigned is different for a prelim spot compared to an advanced spot since it is essentially two different matches performed at the same time.

Residency jades you in many ways, one of which is that you realize how flawed individuals are, including ourselves as physicians, and the idea of there being flaws in this match system would not surprise me (less so the nobel winning match algorithm, more so the people putting in rank lists, assigning numbers etc.)

If anyone has any info on questioning the process through the NRMP would be interested to hear how it went for them. Thanks

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[GoSpursGo]

Mistakes in the Match do happen, though the are rare. But honestly, the time to question this was 5 years ago. There's no way you will get a meaningful response this far after the fact, and even if you did you couldn't act on the information.

It is best to move on with your career.

 

[Apollyon]

Yeah, now, it's more of an intellectual question. You might get an answer, but with essentially no practical value.

 

[NotAProgDirector]

I have a question. When you say you ranked the prelim #1, what do you mean by that? #1 where? Because if you didn't match to any of your advanced spots, then none of your supplementary lists would have been processed. Did you put all of your programs on your main match list? if so, and you put the prelim spot actually at the top of your rank list, then that explains everything.

 

[Allthingssports]

I have a question. When you say you ranked the prelim #1, what do you mean by that? #1 where? Because if you didn't match to any of your advanced spots, then none of your supplementary lists would have been processed. Did you put all of your programs on your main match list? if so, and you put the prelim spot actually at the top of your rank list, then that explains everything

I remember there was the option for the supplemental list ranking within each advanced rank spot (for example if I ranked a NY advanced program I could rank nearby NY prelim programs high and then change the prelim year rank order with subsequent advanced spots), but as far as I can remember there was also a separate default list for prelim spots. So the prelim #1 I am referring to was on my default list of prelim spots. Unless something has changed in the last couple of years, it was my understanding that the match allows for a partial match, where you can match a prelim spot and not an advanced position, but it will not allow you to match an advanced spot without an intern spot.

 

[NotAProgDirector]

There is no default prelim list per se. What you needed to do was put all of your advanced spots on your main rank list first. Then, you have supplemental lists of only prelim programs -- as few or as many as you want -- that you attach to each advanced match. Then, if you want, you list the prelims under the advanced match options on your main list. If you actually put this prelim in an actual #1 spot, then you mistakenly did it on your main list which is why you didn't get anything else. If you actually mean that you put it in the #15 spot and #1-14 were advanced positions and you meant that you put it, relatively, as your #1 prelim, then we can continue to look at why this might happen. Do you remember?

 

[Allthingssports]

There is no default prelim list per se. What you needed to do was put all of your advanced spots on your main rank list first. Then, you have supplemental lists of only prelim programs -- as few or as many as you want -- that you attach to each advanced match. Then, if you want, you list the prelims under the advanced match options on your main list. If you actually put this prelim in an actual #1 spot, then you mistakenly did it on your main list which is why you didn't get anything else. If you actually mean that you put it in the #15 spot and #1-14 were advanced positions and you meant that you put it, relatively, as your #1 prelim, then we can continue to look at why this might happen. Do you remember?

Correct, and yes, I had actually forgotten that they ended up being combined to one big list-- I did rank the 10 advanced positions first with the supplemental lists for each, then ranked my "#1 prelim" at number 11, and so on for the rest of prelim spots

 

[EMThrowaway2020]

Correct, and yes, I had actually forgotten that they ended up being combined to one big list-- I did rank the 10 advanced positions first with the supplemental lists for each, then ranked my "#1 prelim" at number 11, and so on for the rest of prelim spots

Sounds like you did it properly. I was sure that was going to be it.

IDK. I think only the NRMP can truly answer your question. AFAIK they're the only ones who can look behind the curtain unless a PD looks at their old list (why would they wanna do that?) and sees something like..

*you being ranked 28th*

*the lowest resident they matched that year being ranked 42nd*

 

[Allthingssports]

Thanks- yeah I don’t expect the NRMP would be too helpful, even if I had questioned that year.. IF it was a mistake, I imagine the dominoes that would have fallen affecting multiple people’s match result would be a disaster for other applicants and the NRMP.

I was curious if anyone had successfully challenged that process but ultimately am fortunate I got a spot that year nonetheless, and will likely just leave it at that.

 

[HemeOncHopeful19]

The last time someone tried challenging the NRMP they were given a special exemption to continue their antitrust behavior by Congress.

I totally get it. I don’t trust a completely opaque process to be foolproof either, and IMO there should be more verifiability (is that a word?) to the results after the fact. On the other hand you probably agreed to some fine print somewhere that the NRMP isn’t responsible even if they mess up your match.

 

[gutonc]

Correct, and yes, I had actually forgotten that they ended up being combined to one big list-- I did rank the 10 advanced positions first with the supplemental lists for each, then ranked my "#1 prelim" at number 11, and so on for the rest of prelim spots

So, in this case, you didn't match at any of your advanced programs, so fell to your first prelim spot and matched there. There's no Match problem here. You did it right, the algorithm did it's thing, etc, etc.

You're relying on the BS that some PDs tell applicants (which is the same BS most applicants tell PDs) being "truth" and the reason why you didn't match in your preferred field being a problem with the Match. That's not true. It was a "you" problem.

On the flip side, you found yourself a different advanced specialty, have finished training and are off to the attending races. Good luck.

 

[NotAProgDirector]

I agree the best thing (in fact probably the only thing) to do is let this go, this late after the match.

What I can tell you is that it almost certainly wasn't an error with the match itself. If the match screwed up for you, it would have screwed up for a whole bunch of people. It's never just about 1 or 2 people. And one of the error checks that they do in the match is go through every applicant and check to see if it's at all possible that they could have matched higher on their list -- by checking to see if you were ranked higher by any program higher on your list than the last person they matched. It's simple enough for them to check this on all 30-40K people (simple for a computer). The year the urology match was screwed up it became obvious within a few days that there was a huge problem. It's not what happened here.

In your op, you mentioned that a PD said: "..very surprised, we ranked you high and would have been very happy if you had ended up here" That's not evidence of anything. It's the kind of thing PD's say to candidates all the time, empty of any real meaning. What would have really been telling is if a program said "You should have matched with us, we assume you didn't rank us at all". But that's very different.

You also mentioned that some program had trouble ranking you -- that could certainly be part of the problem.

So, possibilities:
1. You mistakenly ranked a prelim high on your list. It's possible, I guess. If any program told you that you should have matched with them, it would be the most likely explanation. If no program reached out to ask "why didn't you rank us", this probably wasn't the answer. I totally understand when an applicant ranks another program higher than mine. When my program is "worse than nothing", I want to know why.

2. You registered with the match late. The program that contacted you to say they couldn't find you -- the main reason for that would be that you registered with NRMP late. technically you can register right up to the match, but realistically if you're not registered when programs submit their list, you just get skipped over.

3. You simply didn't match at any of your Advanced programs, for whatever reason.