Residency Match Woes

[Forte de Agua]

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I am extremely disappointed in recent UVR Family Med match list. It seems like the PD and residents rank those who are mormon, white, and/or have ties to Utah high, while we out of state applicants are second tier. Not to mention there is only one female in the incoming class!

Am I the only one with an broken heart and venting here??
😡

 

[ERDOC555]

Happens all the time. I've seen multiple students shocked on match day expecting to match a certain program as their #1 based on promises by the PD/faculty (oftentimes the home program) and then end up not matching there. Sometimes they don't even match at all because they were so sure their home program would take them that they didn't bother going to other interviews that they probably should have attended.

 

[Osteoth]

Happens all the time. I've seen multiple students shocked on match day expecting to match a certain program as their #1 based on promises by the PD/faculty (oftentimes the home program) and then end up not matching there. Sometimes they don't even match at all because they were so sure their home program would take them that they didn't bother going to other interviews that they probably should have attended.

So are applicants inherently pretty screwed? I've heard of multiple cases where students have been actively recruited by program directors/chairmen to rank their programs very highly, and even to send them "love letters" on one hand, while not being offered positions on the other.

At the same time, students can only send love letters to one school because apparently program directors talk, and know where you're applying because they ask you even though they're not supposed to. For the students we pretty much just have to rank the programs how we see fit and pray?

 

[mastermind8490]

So are applicants inherently pretty screwed? I've heard of multiple cases where students have been actively recruited by program directors/chairmen to rank their programs very highly, and even to send them "love letters" on one hand, while not being offered positions on the other.

At the same time, students can only send love letters to one school because apparently program directors talk, and know where you're applying because they ask you even though they're not supposed to. For the students we pretty much just have to rank the programs how we see fit and pray?

The NRMP match algorithm works best when both the applicants and programs rank each other independently of what they think the other may feel about them. Regardless of what program A told you, you should rank program B higher because you liked it more and felt it would be a better fit. In the end, the NRMP really does work in the applicants favor.

 

[Osteoth]

The NRMP match algorithm works best when both the applicants and programs rank each other independently of what they think the other may feel about them. Regardless of what program A told you, you should rank program B higher because you liked it more and felt it would be a better fit. In the end, the NRMP really does work in the applicants favor.

I've read that article as well, and I understand in a perfect world it would.

My question is, in a majority of situations, it seems as though students are encouraged to send "love letters" to their #1 program, with the implied consideration that if a program does not receive a love letter from you then they will strongly consider you unlikely to attend their program if offered an opportunity. As a result of the fact that programs all want to match their top applicants, this makes sense to me.

So in a world where the programs know the students match list, and PDs talk so you cannot send multiple love letters, it seems as though students are put between a rock and a hard place.

Either don't send a love letter and possibly don't get ranked very highly, send multiple love letters and risk pissing off your top lets say 3 programs, send one love letter and possibly go unmatched because again the program flat out lied to you about their impression of you and your ability to match there.

What is the "optimal" solution here?

 

[Mad Jack]

Got love letters that ultimately meant nothing, you should generally ignore them

 

[operaman]

We have our applicants ranked before their return flights have left the ground. We don’t touch it again after that. We get love letters and may even respond in kind, but we don’t alter the list.

Sometimes programs can be deceiving even if they don’t mean to. We know about where on our list we tend to fill, but there can be some variation year to year. If we told someone they were ranked to match but then had a weird year and filled much higher on the list, they might feel deceived even though we had acted in good faith. Applicants only have one top choice; programs have as many top choices as they have available positions and “to match” range is generally a little lower than that.

What to do?

Reminds me of my audition days where you’d sing and people would tell you how wonderful you were, maybe even have some back and forth later over the phone about potential jobs, and then crickets. So as a coping strategy I adopted this personal policy:

Everything said should be treated as mere rumor until you’re sent an actual signed contract.

I think Match should be the same way. Ignore whats said, make your list according to your wishes only and not what you’re told, maybe tell your number one that they’re your top choice. Regardless, it’s all rumor until you open that envelope on match day.

 

[mastermind8490]

I've read that article as well, and I understand in a perfect world it would.

My question is, in a majority of situations, it seems as though students are encouraged to send "love letters" to their #1 program, with the implied consideration that if a program does not receive a love letter from you then they will strongly consider you unlikely to attend their program if offered an opportunity. As a result of the fact that programs all want to match their top applicants, this makes sense to me.

So in a world where the programs know the students match list, and PDs talk so you cannot send multiple love letters, it seems as though students are put between a rock and a hard place.

Either don't send a love letter and possibly don't get ranked very highly, send multiple love letters and risk pissing off your top lets say 3 programs, send one love letter and possibly go unmatched because again the program flat out lied to you about their impression of you and your ability to match there.

What is the "optimal" solution here?

Take the following with a grain of salt because the match culture among specialties greatly differs.

I agree, it's very tough for the applicant. I've had many similar discussions with co-applicants in the recent past about this, and we have come to the conclusion that there is no optimal solution in the current culture of the match and post-interview communications. You're absolutely right, there are programs out there that want you to send love letters so that they know they are ranking people who are in turn ranking them #1...but those are programs that generally have a reputation of advertising that they matched their "top X for the past decade" or something along those lines.

That being said, the vast majority of programs out there have no vested interest in advertising such a thing, and play by the rules: meaning they will rank who they like and let the chips fall as they may. Like @operaman said, there are also a lot of programs who rank immediately after the interview and have an internal rule of not changing the rank lists afterwards...so love letters and phone calls mean nothing.

Something that my particular specialty has done to try to stem the tide of this post-interview communication shenanigans is ban post-interview communications all-together between an applicant and a program. Even thank you letters are considered taboo. Though I'm sure attendings talk to other attendings, I think this has worked quite well in forcing people to play by the rules and letting the match work as it should.

Edit: so what should you do? So if your specialty allows love letters, send it to your top #1 place and be honest. Don't send a love letter to your top 5 places because like you said, PDs DO talk to each other. I've heard stories of applicants telling multiple places they were their #1 and PDs found out from each other. Needless to say, this did not help him/her in the match process. Programs understand that they won't match their top 1,2,3, etc in a row. It's not how it's supposed to work, and rarely ever works that way. Just because you didn't send them a love letter doesn't mean they won't like you or rank you highly...and just because you weren't ranked #1, 2, or 3 at a program doesn't mean you won't match there. I guarantee that the majority of applicants ranked to match at programs were applicants that did not send love letters, and were ranked that way because of their overall package, social skills, and how they carried themselves during the interview.

 

[Mad Jack]

Take the following with a grain of salt because the match culture among specialties greatly differs.

I agree, it's very tough for the applicant. I've had many similar discussions with co-applicants in the recent past about this, and we have come to the conclusion that there is no optimal solution in the current culture of the match and post-interview communications. You're absolutely right, there are programs out there that want you to send love letters so that they know they are ranking people who are in turn ranking them #1...but those are programs that generally have a reputation of advertising that they matched their "top X for the past decade" or something along those lines.

That being said, the vast majority of programs out there have no vested interest in advertising such a thing, and play by the rules: meaning they will rank who they like and let the chips fall as they may. Like @operaman said, there are also a lot of programs who rank immediately after the interview and have an internal rule of not changing the rank lists afterwards...so love letters and phone calls mean nothing.

Something that my particular specialty has done to try to stem the tide of this post-interview communication shenanigans is ban post-interview communications all-together between an applicant and a program. Even thank you letters are considered taboo. Though I'm sure attendings talk to other attendings, I think this has worked quite well in forcing people to play by the rules and letting the match work as it should.

I personally am entirely opposed to post-interview communication as I feel it isn't how the process is meant to work, but hey, that's just me.

 

[darklabel]

Something that my particular specialty has done to try to stem the tide of this post-interview communication shenanigans is ban post-interview communications all-together between an applicant and a program.

I think that's the way to go. Even as an applicant I would have loved hearing a response from my love letter or phone call, but it shouldn't bump me or anyone up. Everyone that interviewed took the time and money to go to the program to learn about it and present themselves. I'm sure a lot of people would complain anyways, but just banning any post-interview communications (besides questions about the program obviously) would end posts like Op or even worse heartbreak.

 

[Osteoth]

Got love letters that ultimately meant nothing, you should generally ignore them

You got letters from programs? Jesus thats terrible.

We have our applicants ranked before their return flights have left the ground. We don’t touch it again after that. We get love letters and may even respond in kind, but we don’t alter the list.

Sometimes programs can be deceiving even if they don’t mean to. We know about where on our list we tend to fill, but there can be some variation year to year. If we told someone they were ranked to match but then had a weird year and filled much higher on the list, they might feel deceived even though we had acted in good faith. Applicants only have one top choice; programs have as many top choices as they have available positions and “to match” range is generally a little lower than that.

What to do?

Reminds me of my audition days where you’d sing and people would tell you how wonderful you were, maybe even have some back and forth later over the phone about potential jobs, and then crickets. So as a coping strategy I adopted this personal policy:

Everything said should be treated as mere rumor until you’re sent an actual signed contract.

I think Match should be the same way. Ignore whats said, make your list according to your wishes only and not what you’re told, maybe tell your number one that they’re your top choice. Regardless, it’s all rumor until you open that envelope on match day.

I understand the way you've been thinking and I agree its probably the best way to approach the situation.

My issue is when you have subspecialty programs that match 1-3 people per year and they tell you you're a shoe etc etc. They know if they're going to match you within the top 3, so realistically if you're a top-ranked program in a competitive specialty its not like you're matching at 7 for 3 slots.

At that point the PDs are just straight up lying to you, and I think thats dishonest and honestly extremely unscrupulous from people who are purported educators and trainers of young minds.

I personally am entirely opposed to post-interview communication as I feel it isn't how the process is meant to work, but hey, that's just me.

Agreed, but it happens in pretty much every competitive specialty I've heard about.

I think that's the way to go. Even as an applicant I would have loved hearing a response from my love letter or phone call, but it shouldn't bump me or anyone up. Everyone that interviewed took the time and money to go to the program to learn about it and present themselves. I'm sure a lot of people would complain anyways, but just banning any post-interview communications (besides questions about the program obviously) would end posts like Op or even worse heartbreak.

I mean it would make sense if it were true. The thing that gets me is that PDs that I've heard of us every trick in the book to box an applicant in without giving anything in return.

They ask you what programs you're applying to and you answer, they can talk to those PDs and see how high they need to rank you in order to retain you, if you don't answer you look questionably moral and honestly very few applicants in the competitive specialties have the stones to not answer questions when asked.

Combined with the whole "love-letter" fiasco as described above and it feels as though applicants are forced to play by the rules or else while programs lie cheat and steal their way into who they want while ruining young lives in the process. That might sound melodramatic, but when you're committing 4+ years of your life to a location in your late-20s to early-30s for most people, it's not a trivial consideration.

 

[libertyyne]

Why are pds allowed to talk to each other about candidates and ranking?

 

[mimelim]

Happens all the time. I've seen multiple students shocked on match day expecting to match a certain program as their #1 based on promises by the PD/faculty (oftentimes the home program) and then end up not matching there. Sometimes they don't even match at all because they were so sure their home program would take them that they didn't bother going to other interviews that they probably should have attended.

You got letters from programs? Jesus thats terrible.



I understand the way you've been thinking and I agree its probably the best way to approach the situation.

My issue is when you have subspecialty programs that match 1-3 people per year and they tell you you're a shoe etc etc. They know if they're going to match you within the top 3, so realistically if you're a top-ranked program in a competitive specialty its not like you're matching at 7 for 3 slots.

At that point the PDs are just straight up lying to you, and I think thats dishonest and honestly extremely unscrupulous from people who are purported educators and trainers of young minds.



Agreed, but it happens in pretty much every competitive specialty I've heard about.



I mean it would make sense if it were true. The thing that gets me is that PDs that I've heard of us every trick in the book to box an applicant in without giving anything in return.

They ask you what programs you're applying to and you answer, they can talk to those PDs and see how high they need to rank you in order to retain you, if you don't answer you look questionably moral and honestly very few applicants in the competitive specialties have the stones to not answer questions when asked.

Combined with the whole "love-letter" fiasco as described above and it feels as though applicants are forced to play by the rules or else while programs lie cheat and steal their way into who they want while ruining young lives in the process. That might sound melodramatic, but when you're committing 4+ years of your life to a location in your late-20s to early-30s for most people, it's not a trivial consideration.

Having been on the other side of this now for 5+ years, I have to admit, I tend to take bigger issue with the applicants than the programs. People tend to hear what they want to hear. "Shoe in", "Promised a spot" was actually a program saying, "We really liked you and hope you will consider us!" Unless a PD explicitly tells you, "We are ranking you in our top X where X is less than the number of spots in the program", there really isn't an issue.

 

[operaman]

You got letters from programs? Jesus thats terrible.



I understand the way you've been thinking and I agree its probably the best way to approach the situation.

My issue is when you have subspecialty programs that match 1-3 people per year and they tell you you're a shoe etc etc. They know if they're going to match you within the top 3, so realistically if you're a top-ranked program in a competitive specialty its not like you're matching at 7 for 3 slots.

At that point the PDs are just straight up lying to you, and I think thats dishonest and honestly extremely unscrupulous from people who are purported educators and trainers of young minds.



Agreed, but it happens in pretty much every competitive specialty I've heard about.



I mean it would make sense if it were true. The thing that gets me is that PDs that I've heard of us every trick in the book to box an applicant in without giving anything in return.

They ask you what programs you're applying to and you answer, they can talk to those PDs and see how high they need to rank you in order to retain you, if you don't answer you look questionably moral and honestly very few applicants in the competitive specialties have the stones to not answer questions when asked.

Combined with the whole "love-letter" fiasco as described above and it feels as though applicants are forced to play by the rules or else while programs lie cheat and steal their way into who they want while ruining young lives in the process. That might sound melodramatic, but when you're committing 4+ years of your life to a location in your late-20s to early-30s for most people, it's not a trivial consideration.

Actually you'd be surprised at how variable the match range can be!

Remember that any top program is recruiting from the same small pool of applicants that every other top program is looking at, so while you may usually fill 3 slots within your first 7 ranks, it wouldn't be unheard of to fill in the top 4, or drop into 10-15. With every additional slot available in the program, the variability only increases. There's just too much variability in what applicants are looking for and where they feel they fit, what kind of city they want, and other soft factors that can play into the decision.

It gets even more complicated depending on how you screen applicants for interviews. This is where regional biases come into play and every program views these differently. If a top east coast program interviews and highly ranks a disproportionate number of people with strong west coast affiliations, they may fill much lower than usual, and vice versa. Every program handles this differently, but in general you want to match the best class you can so you have to be strategic about invites. Some programs care about how far they drop on their list and may penalize some applicants even at the rank list stage in order to say they matched in their top-X. Others don't give a flip and just rank based on who they most want to get and let the algorithm sort it out.

While there are probably some unscrupulous people out there, I don't think most people are out to deceive applicants. The overwhelming majority of love letters turn out to be true or moot (applicant ranks another program higher and matches). If someone gets a ranked to match letter and doesn't actually match, I would personally interpret that to mean the ranked me highly but filled higher than they expected. It's a bit of a jump to infer darker motives.

I think being a PD is somewhat of a thankless job. Of all the attendings I know personally who have become chairmen recently, not one of them was a PD first. It doesn't seem to be a sure-fire route to bigger and better things. It probably does come with a modest salary bump to compensate for the additional workload, but I would wager it's peanuts compared to what any academic attending could pull in private practice and probably not even near enough to compensate for all the BS they have to deal with. Whenever I read about a problem resident, my heart goes out to the poor PD whose work life is being consumed by some a--hole who can't be a normal human being and play well in the sandbox with other kids. No, I think most of those people do it because they honestly care about educating residents and enjoy that aspect of academic medicine.

 

[Osteoth]

Why are pds allowed to talk to each other about candidates and ranking?

Better question is how thy get away with asking applicants where they're applying and basically "forcing" people to send love letters.

Having been on the other side of this now for 5+ years, I have to admit, I tend to take bigger issue with the applicants than the programs. People tend to hear what they want to hear. "Shoe in", "Promised a spot" was actually a program saying, "We really liked you and hope you will consider us!" Unless a PD explicitly tells you, "We are ranking you in our top X where X is less than the number of spots in the program", there really isn't an issue.

I can see that. The real issues I've seen are with people who are theoretically "strong" candidates for competitive specialties (>260+, AOA, 25+ pubs, Honors in most rotations). Those people get fewer interview invites than other more "middle of the road" candidates because some programs don't believe they'd come if offered a spot. As a result they're interviewing at maybe the top 10 programs in the country, and with the emphasis on love letters, are boxed into a position where their chances of matching overall are lower because of their success.

Furthermore, I think its different when you're in the interview process year in, year out vs. if you're a student and this is your one shot at doing this whole thing. Most students aren't aware of what the subtleties of the process are, and figure if they worked hard they'd be rewarded, whereas I've seen people with inferior stats (250, no-AOA, 10 pubs, some Honors), get better/more interviews and get accepted to "better" programs because they are seen as candidates who could be a fit at a variety of programs. Just hard to know how to solve that specific problem.

Actually you'd be surprised at how variable the match range can be!

Remember that any top program is recruiting from the same small pool of applicants that every other top program is looking at, so while you may usually fill 3 slots within your first 7 ranks, it wouldn't be unheard of to fill in the top 4, or drop into 10-15. With every additional slot available in the program, the variability only increases. There's just too much variability in what applicants are looking for and where they feel they fit, what kind of city they want, and other soft factors that can play into the decision.

It gets even more complicated depending on how you screen applicants for interviews. This is where regional biases come into play and every program views these differently. If a top east coast program interviews and highly ranks a disproportionate number of people with strong west coast affiliations, they may fill much lower than usual, and vice versa. Every program handles this differently, but in general you want to match the best class you can so you have to be strategic about invites. Some programs care about how far they drop on their list and may penalize some applicants even at the rank list stage in order to say they matched in their top-X. Others don't give a flip and just rank based on who they most want to get and let the algorithm sort it out.

While there are probably some unscrupulous people out there, I don't think most people are out to deceive applicants. The overwhelming majority of love letters turn out to be true or moot (applicant ranks another program higher and matches). If someone gets a ranked to match letter and doesn't actually match, I would personally interpret that to mean the ranked me highly but filled higher than they expected. It's a bit of a jump to infer darker motives.

I think being a PD is somewhat of a thankless job. Of all the attendings I know personally who have become chairmen recently, not one of them was a PD first. It doesn't seem to be a sure-fire route to bigger and better things. It probably does come with a modest salary bump to compensate for the additional workload, but I would wager it's peanuts compared to what any academic attending could pull in private practice and probably not even near enough to compensate for all the BS they have to deal with. Whenever I read about a problem resident, my heart goes out to the poor PD whose work life is being consumed by some a--hole who can't be a normal human being and play well in the sandbox with other kids. No, I think most of those people do it because they honestly care about educating residents and enjoy that aspect of academic medicine.

I suppose the tone of my post implied a bit more of a nefarious nature than I would have liked. Really it just comes down to the difference in goals for the program and applicant. The program is out to make sure that the most highly-qualified applicants rank their program highly, whereas the student is in for the same thing, but at the end of the day can only go to one program. This leads to a situation where a student can (falsely or not) believe a program likes them, and they might indeed like them, but not as much as their 1-5 ranked individuals. Its just a difficult situation for a student to be in because you don't know if a program likes you enough to the point you're on their short list, or likes you that you'd be in the 2nd or 3rd tier on their list. This shouldn't necessarily inform a student's rank list, but I can imagine that if the faculty and residents at a program seem as though they like you you'd be much more interested in attending that institution. Students just need to be fairly cautious in getting overly attached to the kind words they hear on the interview trail.

 

[operaman]

Students just need to be fairly cautious in getting overly attached to the kind words they hear on the interview trail.

Well said. The match algorithm really does put the power in the applicant's hands despite how it may feel.

I think the best thing any applicant can do is let your top choices know DURING the interview day how much you like the program based on what you've seen thusfar. For my current program, I made it clear during my interviews that if I had to submit a rank list that day, I would rank them number 1. Obviously I had more interviews so if I liked a future program better I'm not bound that statement any more than they're bound to me when they meet a better set of applicants the next day.

For us and many other similar programs, that rank list is done ASAP once applicants leave, so the interview is your best shot to express interest. I think this does carry some weight as I've definitely noticed which applicants have seemed truly interested in the program and which ones took the interview because it's a top program but maybe aren't so jazzed about coming here. Our rank meetings are probably like most others and can be contentious with passionate opinions all around, but people are generally more willing to fight for someone who really wants to come there.

 

[libertyyne]

Well said. The match algorithm really does put the power in the applicant's hands despite how it may feel.

I think the best thing any applicant can do is let your top choices know DURING the interview day how much you like the program based on what you've seen thusfar. For my current program, I made it clear during my interviews that if I had to submit a rank list that day, I would rank them number 1. Obviously I had more interviews so if I liked a future program better I'm not bound that statement any more than they're bound to me when they meet a better set of applicants the next day.

For us and many other similar programs, that rank list is done ASAP once applicants leave, so the interview is your best shot to express interest. I think this does carry some weight as I've definitely noticed which applicants have seemed truly interested in the program and which ones took the interview because it's a top program but maybe aren't so jazzed about coming here. Our rank meetings are probably like most others and can be contentious with passionate opinions all around, but people are generally more willing to fight for someone who really wants to come there.

This is kind of a funny set up, I would probably retort with If I had to submit rank order the same day you would be Number 1.

What is your opinion on PDs talking to each other about ranking applicants. Seems like a step that undermines the way the process was designed.

 

[Forte de Agua]

Thanks guys! Very insightful discourse here. I love the ideas, and I hope more programs would discourage love letters and such.

However, can we address the elephant in this forum: the discriminatory selection (race, sex, religion, geography) of candidates accepted into any program.

Thoughts?

 

[libertyyne]

Thanks guys! Very insightful discourse here. I love the ideas, and I hope more programs would discourage love letters and such.

However, can we address the elephant in this forum: the discriminatory selection (race, sex, religion, geography) of candidates accepted into any program.

Thoughts?

That is a very difficult beast to prove. A large portion of what you think is racism could be because those other applicants were from the area or close by and PDs do like applicants who have lived closer, have ties with the state etc.

 

[Forte de Agua]

Which is why I brought it up, 🙂

 

[libertyyne]

Which is why I brought it up, 🙂

Making decision on ties to utah is not racism , sexism or anything you are claiming.

 

[Forte de Agua]

But it's nevertheless discriminatory which is what the acgme forbids

 

[libertyyne]

But it's nevertheless discriminatory which is what the acgme forbids

could you please point to the rules where ACGME prevents regional preference for selecting applicants.

 

[libertyyne]

Are you and FMG, IMG? any other red flags that would prevent you from obtaining a residency?

 

[Forte de Agua]

"The ACGME expects that participants in the greater graduate medical education community will be able to work and study in an atmosphere that discourages discrimination and harassment by colleagues, supervisors, teachers, peers, other staff members, and patients. This principle applies in all areas of graduate medical education, including employment and training."

No red flags or IMG

 

[libertyyne]

"The ACGME expects that participants in the greater graduate medical education community will be able to work and study in an atmosphere that discourages discrimination and harassment by colleagues, supervisors, teachers, peers, other staff members, and patients. This principle applies in all areas of graduate medical education, including employment and training."

No red flags or IMG

Regional selection or preference does not fall under discrimination. It is literally in the mission statement of many schools and organizations.

 

[Forte de Agua]

Mission to help the state in which organizations are located and regional selection/preference are two different things. An Alabama resident could enter Utah and still fulfill the mission objective.

 

[libertyyne]

Mission to help the state in which organizations are located and regional selection/preference are two different things. An Alabama resident could enter Utah and still fulfill the mission objective.

There are many instate schools that select a majority of their classes from instate residents. Would you consider that discrimination as well?

 

[Matthew9Thirtyfive]

"The ACGME expects that participants in the greater graduate medical education community will be able to work and study in an atmosphere that discourages discrimination and harassment by colleagues, supervisors, teachers, peers, other staff members, and patients. This principle applies in all areas of graduate medical education, including employment and training."

No red flags or IMG

It also says on the ACGME website that they recommend contacting the EEOC if you feel you have been the victim of discrimination. On the EEOC website, they list discrimination as being "person's race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age (40 or older), disability or genetic information." The only thing that comes close to discrimination is national origin, and that is the prohibition of employers from preferentially hiring candidates based on which country they are from.

If having an in-state bias was prohibited, universities and medical schools would not be allowed to have in-state preferences or provide discounted tuition for in-state students. Since both of those things are given the rubber stamp by the government, it is obviously not an illegal form of discrimination.

 

[operaman]

This is kind of a funny set up, I would probably retort with If I had to submit rank order the same day you would be Number 1.

What is your opinion on PDs talking to each other about ranking applicants. Seems like a step that undermines the way the process was designed.

It’s more than just PDs - residents and other faculty do it too. I don’t know how much we share actual ranks, but certainly people will talk about applicants they like. Usually it’s more of “yeah we all really liked him/her here and hope we can get them here.”

I don’t think it undermines the process at all because we already know where everyone else is interviewing and what other programs are going to be in their top 5-10. No we don’t have official data but it’s not hard to guess since we see where all our applicants matched each year. It’s also not hard to figure out where our applicants land in other rank lists since we are all looking for similar things.

I don’t think much blackballing happens at the PD level unless someone was truly egregious and friends are warning other friends about a serious problem. It definitely happens at the faculty/resident/student level. We all do some serious due diligence on people we like - often this means contacting faculty/residents/students we know personally who worked with them. Yeah those people who kiss up to the docs but are douches to classmates may get found out.

 

[Forte de Agua]

It also says on the ACGME website that they recommend contacting the EEOC if you feel you have been the victim of discrimination. On the EEOC website, they list discrimination as being "person's race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age (40 or older), disability or genetic information." The only thing that comes close to discrimination is national origin, and that is the prohibition of employers from preferentially hiring candidates based on which country they are from.

If having an in-state bias was prohibited, universities and medical schools would not be allowed to have in-state preferences or provide discounted tuition for in-state students. Since both of those things are given the rubber stamp by the government, it is obviously not an illegal form of discrimination.

Just because it commonly happens doesn't mean it's not illegal. It's possible people turned a blind eye to bias. There's just not enough people to protest a common trend.
On paper it sounds great, but on closer inspection of resident lists, it's clear discrimination is going on some level or another.

As far as instate tuition benefits and acceptances, some universities are funded by their own state tax dollars. Hence they would want to provide benefits to taxpayers and their kids. However, we're talking about the ACGME here and its rules as agreed by all programs. Obviously there's two opposing--if not more--forces competing for each own's interest.

 

[Stagg737]

Just because it commonly happens doesn't mean it's not illegal. It's possible people turned a blind eye to bias. There's just not enough people to protest a common trend.
On paper it sounds great, but on closer inspection of resident lists, it's clear discrimination is going on some level or another.

As far as instate tuition benefits and acceptances, some universities are funded by their own state tax dollars. Hence they would want to provide benefits to taxpayers and their kids. However, we're talking about the ACGME here and its rules as agreed by all programs. Obviously there's two opposing--if not more--forces competing for each own's interest.

Find the law that specifically states hiring based on geographic residence is illegal. Until you can do that, your argument is moot from a legal standpoint. From an ethical standpoint it's also shaky at best. If you hire someone with strong ties to an area then there is a better chance they will settle down in that area than someone who has no ties and will just be moving there for residency for the first time. So if your mission statement is specifically to hire people who will stay and practice in the area, are you going to hire someone with ties to the area or a complete stranger? That's just common sense (which is also backed by actual studies).

 

[charterihateyou]

Having been on the other side of this now for 5+ years, I have to admit, I tend to take bigger issue with the applicants than the programs. People tend to hear what they want to hear. "Shoe in", "Promised a spot" was actually a program saying, "We really liked you and hope you will consider us!" Unless a PD explicitly tells you, "We are ranking you in our top X where X is less than the number of spots in the program", there really isn't an issue.

This is exactly what I have heard. People take some nice pleasantries and get waaay to excited.

 

[Forte de Agua]

Find the law that specifically states hiring based on geographic residence is illegal. Until you can do that, your argument is moot from a legal standpoint. From an ethical standpoint it's also shaky at best. If you hire someone with strong ties to an area then there is a better chance they will settle down in that area than someone who has no ties and will just be moving there for residency for the first time. So if your mission statement is specifically to hire people who will stay and practice in the area, are you going to hire someone with ties to the area or a complete stranger? That's just common sense (which is also backed by actual studies).

I would check your superiority complex if I were you. This is a friendly debate, not intended to rouse emotions.

EEOC posted:
"National origin discrimination involves treating people (applicants or employees) unfavorably because they are from a particular country or part of the world...Discrimination can occur when the victim and the person who inflicted the discrimination are the same national origin."


To put it simply, I would assume we all want equal treatment from anywhere in the US, which is supposedly the ACGME and EEOC's intentions. Of course on a practical standpoint, employers would want to choose someone with ties in the state where he resides over a random person looking for a job. But the point I'm arguing is not what one would do, but what one should do based on the contract programs signed with ACGME.

 

[Stagg737]

I would check your superiority complex if I were you. This is a friendly debate, not intended to rouse emotions. Common sense...why don't you find some pubmed articles for me?

EEOC posted:
"National origin discrimination involves treating people (applicants or employees) unfavorably because they are from a particular country or part of the world...Discrimination can occur when the victim and the person who inflicted the discrimination are the same national origin."


To put it simply, I would assume we all want equal treatment from anywhere in the US, which is supposedly the ACGME and EEOC's intentions. Of course on a practical standpoint, employers would want to choose someone with ties in the state where he resides over a random person looking for a job. But the point I'm arguing is not what one would do, but what one should do based on the contract programs signed with ACGME.

Not being emotional or superior at all, you just made a claim that was incorrect.

I'm not making any statements about national origin, I'm saying that individuals with ties to a specific geographic location are more likely to settle there permanently and practice there. It's why state schools with missions to train physicians who will stay in-state prefer to accept individuals from that state. Same thing with many residency programs (especially ones at state-run/funded institutions). I'm not going to post articles on this because they're extremely easy to find on your own and I don't feel like wasting my time on it right now.

Your post from the EEOC is in regards to national origin, which is a completely different argument (and a far more valid one) from geographic preferences which was the point I was arguing. Again, you're not going to find laws against accepting someone because they have ties to that geographic area and you will actually find laws encouraging it in many cases (ie tuition discounts for in-state residents, loan forgiveness programs, etc).

However, I also disagree that we should be providing equal opportunity for everyone in regards to purely geographic aspects. If a state has a physician shortage, then I think it's actually more likely to be ethically questionable or wrong to accept applicants from other areas of the country who plan on leaving right after residency, as it does nothing to address the physician shortage in that area. Again, this is a completely separate argument from accepting people based on race/national origin, sex/gender, or religion.

 

[Matthew9Thirtyfive]

Just because it commonly happens doesn't mean it's not illegal. It's possible people turned a blind eye to bias. There's just not enough people to protest a common trend.
On paper it sounds great, but on closer inspection of resident lists, it's clear discrimination is going on some level or another.

As far as instate tuition benefits and acceptances, some universities are funded by their own state tax dollars. Hence they would want to provide benefits to taxpayers and their kids. However, we're talking about the ACGME here and its rules as agreed by all programs. Obviously there's two opposing--if not more--forces competing for each own's interest.

Um, yes. If it were illegal, it would not be sanctioned by the government. There are literally schools where you have to be from that state or the surrounding states to be admitted, and these programs are promoted by the government. There is no law against this.

 

[DocWinter]

OP seems to be getting a taste of the real world and the disappointment of not getting what you want, which does not equal discrimination or illicit handling.

 

[nlax30]

There very clearly spelled out “protected groups” legally when it comes to discrimination..... ties to a particular part of the county is not one of them.

 

[slurpy15]

Life isn’t, and will never be, fair. Not all people are equal candidates for every place. People will always choose those they feel they can get along with best.


Sent from my iPhone using SDN mobile

That's a completely lame answer. If people hadn't fought against discrimination, my guess is that you wouldn't have your job (I believe that you are female, no?) Nothing more disgusting than someone who rests on the hard work of others fighting yet contributing nothin to the fight themselves. You may be an ortho trauma MD, but there are plenty of poorer and less educated who are braver than you.

 

[DocWinter]

That's a completely lame answer. If people hadn't fought against discrimination, my guess is that you wouldn't have your job (I believe that you are female, no?) Nothing more disgusting than someone who rests on the hard work of others fighting yet contributing nothin to the fight themselves. You may be an ortho trauma MD, but there are plenty of poorer and less educated who are braver than you.

Easy there. You are coming off slamming someone you know nothing about and how they got where they are.
This entire thread was doomed from the beginning, but it's edging in a dangerous direction. Hope mods shut this down, OP has had his/her vent

 

[slurpy15]

Lmao. I’m sure I’ll cry myself to sleep tonight, keyboard warrior. You have no idea what I do, or don’t, contribute to “the fight,” so kindly f**k off. And by the way, since your reading comprehension is poor, let me say it again: life isn’t fair. Doesn’t matter if I agree or disagree with it, or what I do about it. My opinion is irrelevant to the fact that people will always have their own biases that will trump other things, it’s the way all humans work.


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About what I expected. A more appropriate answer would be yes, this happens, it's terrible, it's an operating flaw in the human race, and here is how we can fight against it. There is nothing more lame than a "successful" person who won't help others, or at least make suggestions or show empathy.

 

[slurpy15]

Easy there. You are coming off slamming someone you know nothing about and how they got where they are.
This entire thread was doomed from the beginning, but it's edging in a dangerous direction. Hope mods shut this down, OP has had his/her vent

Agreed. Because many docs are sheeple. It's sad.

 

[NickNaylor]

You’ll have to forgive us for not whipping out our poster boards and sharpies for the Million Man March to protest discrimination based on state of origin.

The whole thrust of the argument of the OP is silly.

 

[operaman]

Wow some terribly uninformed opinions on federal discrimination law!

No, national origin has zero to do with state of residence. There is exactly zero federal case law surrounding Title VII to this effect. It is always interpreted as a country of origin; you would need to file a suit and get rulings in favor in order to change this. "East coaster" or "southerner" is not a federally protected class. Sorry. We can debate whether or not this is right, but for now the statute and surrounding case law is overwhelmingly clear.

For most programs, the regional bias is exerted at the pre-interview stage with the goal of maximizing yield. No East coast program is going to blow a lot of invites on people whose entire background has been spent on the West coast because everyone knows these people will rank ALL their west coast options first. People who are serious about moving will typically find ways to reach out to programs and inform them of this fact.

As for the OP (sorry this thread got so derailed) -- I would beware reading too much in to the makeup of the class as indicative of anything other than the people who ranked it highly. It's actually a problem that's been discussed in the academic medical literature, especially around programs that inadvertently end up skewing all male or all female; it becomes incredibly difficult to get the opposite sex applicants to rank the program high enough. I've heard faculty at other programs saying pre-match they thought they would get their first all-female/male resident class based on how the rank list ended up, only to match the exact opposite. People tend to go where they feel they fit in, so if the program already has a fairly homogenous makeup, it's not unreasonable that similar people will continue to match there of their own accord.

 

[slurpy15]

Oh gosh, I didn’t realize I needed you to tell me what an “appropriate answer” is. Ahahahaha. I did give an answer, which is more true and accurate than any safe-space BS you call “empathy.” Oh my god. [emoji23][emoji23][emoji23]


Sent from my iPhone using SDN mobile

But wouldn't helpful advice be more useful that just stating how things are? I think we all know how things are! But stating it doesn't help anyone, does it?

 

[operaman]

Oh gosh, I didn’t realize I needed you to tell me what an “appropriate answer” is. Ahahahaha. I did give an answer, which is more true and accurate than any safe-space BS you call “empathy.” Oh my god. [emoji23][emoji23][emoji23]


Sent from my iPhone using SDN mobile

The fragility of some students is truly astounding.

I don't know when the whole safe-space and trigger warning thing started but it can't have been that long. Looks like we're seeing more of those students now filtering into medical schools - I know I've had a couple instances recently where I've run into this in real life and I keep coming back to the idea of fragility. Probably deserves its own thread, but I do wonder how those of us who did not come up in that era can learn to effectively deal with these students who are seemingly ill-equipped to interface with the real world and lack the coping mechanisms to process constructive feedback.

 

[gyngyn]

Civil disagreement, please.

 

[Forte de Agua]

Civil disagreement, please.

Thank you! 🙂

Operaman et al: You can't help but feel more sensitive on online posts because several nuances in a face to face conversation are missing. These include facial expressions, tone, etc. Sure you could detect tone through wording, but even that can be misinterpreted, which I confess I may have done so. Also, fragility is part of human nature; you see it in patients ALL THE TIME...even amongst colleagues. If you can't tolerate fragility, then maybe you're in the wrong profession.

Wow some terribly uninformed opinions on federal discrimination law!

No, national origin has zero to do with state of residence. There is exactly zero federal case law surrounding Title VII to this effect. It is always interpreted as a country of origin; you would need to file a suit and get rulings in favor in order to change this. "East coaster" or "southerner" is not a federally protected class. Sorry. We can debate whether or not this is right, but for now the statute and surrounding case law is overwhelmingly clear.

For most programs, the regional bias is exerted at the pre-interview stage with the goal of maximizing yield. No East coast program is going to blow a lot of invites on people whose entire background has been spent on the West coast because everyone knows these people will rank ALL their west coast options first. People who are serious about moving will typically find ways to reach out to programs and inform them of this fact.

As for the OP (sorry this thread got so derailed) -- I would beware reading too much in to the makeup of the class as indicative of anything other than the people who ranked it highly. It's actually a problem that's been discussed in the academic medical literature, especially around programs that inadvertently end up skewing all male or all female; it becomes incredibly difficult to get the opposite sex applicants to rank the program high enough. I've heard faculty at other programs saying pre-match they thought they would get their first all-female/male resident class based on how the rank list ended up, only to match the exact opposite. People tend to go where they feel they fit in, so if the program already has a fairly homogenous makeup, it's not unreasonable that similar people will continue to match there of their own accord.

I personally don't like your answer, but I have to admit it's merited. Chance can't be ruled out, but also people could say one thing and truly did the other during ranking. We just don't know for sure. Based on what I know of the historical residents match list, it appears to me there's bias that seem--we're not in law school!--to violate ACGME principles. That's why I wanted to bring this up because I'm wondering if anyone else felt victimized.

Anyway, thanks for all the responses!

 

[Matthew9Thirtyfive]

Thank you! 🙂

Operaman et al: You can't help but feel more sensitive on online posts because several nuances in a person to person conversation are missing. This includes facial expressions, tone, etc. Sure you could detect tone through wording, but even that can be misinterpreted, which I confess I may have done so. Also, fragility is part of human nature; you see it in patients ALL THE TIME...even amongst colleagues. If you can't tolerate fragility, then maybe you're in the wrong profession.

If you (general you) can’t tolerate being given a dose of reality, you really are in the wrong profession.

I personally don't like your answer, but I have to admit it's merited. Chance can't be ruled out, but also people could say one thing and truly did the other during ranking. We just don't know for sure. Based on what I know of the historical residents match list, it appears to me there's bias that seem--we're not in law school!--to violate ACGME principles. That's why I wanted to bring this up because I'm wondering if anyone else felt victimized.

Anyway, thanks for all the responses!

No, it doesn’t. You don’t have to be in law school to be able to read. It is very clear that there is no prohibition against regional bias, and the ACGME discusses discrimination wrt the protected classes outlined by statute and elucidated on the EEOC website. You may not like it, but that doesn’t make it illegal or in violation of ACGME principles.

 

[jw3600]

Civil disagreement, please.

Civil disagreement with a delusional poster is a unicorn.