Second Match..What's your opinion?

[Faebinder]

---

Members do not see this ad.

what does everyone here think of that 2005 proposal for the second match? Frankly, I think the elimination of the need to scramble is a rather excellent stress eliminator.

 

[person2006]

what does everyone here think of that 2005 proposal for the second match? Frankly, I think the elimination of the need to scramble is a rather excellent stress eliminator.

No, I think the match should be eliminated. It hides your results from you until it's too late to do anything about it. Some of us (like me) get totally f'ed by the match. If we had normal job applications and weren't hired, we could just apply for more jobs. The g.d. match guarantees that you won't know you are in trouble until it's too late to do anything about it. Sure there's the scramble or second match, but by then it's too late; almost all of the jobs that we might have been able to get are now filled. We've already been screwed.

It's corrupt anyway- programs take illegal phone calls and make illegal hints to those they like most or those with connections calling on their behalf. It makes it all a game to arrange things under the table, but those of us without anyone helping arrange our jobs under the table get f'ed.

Anyway, my point is don't try to put perfume on a pile of s. Flush it.

 

[neutropenic]

Maybe we should follow the Canadian model:

http://www.carms.ca/jsp/main.jsp?path=../content/applying/eligibility

 

[turtle md]

Maybe we should follow the Canadian model:

http://www.carms.ca/jsp/main.jsp?path=../content/applying/eligibility

After just a quick glance, it looks similar. Someone w/ more time and nothing else to do, please explain the difference... 🙂

 

[neutropenic]

After just a quick glance, it looks similar. Someone w/ more time and nothing else to do, please explain the difference... 🙂

In short (and it's not this simple you'll have to read thie website):

Canadian allo MD seniors: 1st round
everyone else: 2nd round

 

[PatrickBateman]

It's corrupt anyway- programs take illegal phone calls and make illegal hints to those they like most or those with connections calling on their behalf. It makes it all a game to arrange things under the table, but those of us without anyone helping arrange our jobs under the table get f'ed.

You'd be even more f'ed if it was a free-for-all. Regulation makes the process less corrupt, not more.

BTW, I matched at my number one program without any connections or arangments "under the table".

 

[PatrickBateman]

In short (and it's not this simple you'll have to read thie website):

Canadian allo MD seniors: 1st round
everyone else: 2nd round

That seems like a pretty good method. 👍

 

[person2006]

You'd be even more f'ed if it was a free-for-all. Regulation makes the process less corrupt, not more.

BTW, I matched at my number one program without any connections or arangments "under the table".

No communication after the interview about preferences or rank list?
No phone calls from your home PD or other faculty helping make it happen?
Well good job. I don't know how many people do well without these things, but they happen a lot.

I was told flat out that that's what I was lacking by the one program I knew someone in who could let me know. I can only assume it was a problem at other programs too. (That and many places I interviewed filled almost entirely with their own students. That'd be good to know too before it's too late to apply elsewhere.)

It's true that a free for all would still be corrupt, but at least those of us who are currently getting f'ed could still apply for jobs that are actually freely available.

 

[Orange Julius]

No communication after the interview about preferences or rank list?
No phone calls from your home PD or other faculty helping make it happen?
Well good job. I don't know how many people do well without these things, but they happen a lot.

Huh? Telling a program that you're interested in them isn't "corrupt". It's completely within the rules. Why on earth would you not do that? If you didn't, it would be very reasonable for them to assume that you weren't interested.

It's true that a free for all would still be corrupt, but at least those of us who are currently getting f'ed could still apply for jobs that are actually freely available.

How would that be? What are you talking about? If there were no match, the process would be pure chaos. I don't see how that would help anyone.

 

[PatrickBateman]

No communication after the interview about preferences or rank list?
No phone calls from your home PD or other faculty helping make it happen?
Well good job. I don't know how many people do well without these things, but they happen a lot.

I sent an email telling them that I'd be ranking them and that I was very interested. That's not illegal. There were quite a few threads on SDN about that sort of thing at the time. That's all. No calls from PD's or other faculty. No secret hints. I had no clue untill match day.

I was told flat out that that's what I was lacking by the one program I knew someone in who could let me know.

They told you that what exactly was lacking? A letter from your PD?? A letter of intent? what?

BTW the way "regular job interviews" work is that an employer interviews tons of applicants and generally takes a long time coming to a decision. Then they offer the position to one applicant, then another, until they fill their positions. They don't tell you you're not in the running until they're secure that all positions are filled. Given the size of the pool this would take longer than the match and you wouldn't be "in the know" untill it was too late anyway. Besides, the calls from faculty and PD's that you're complaining about would be just as much (or as little) a part of it as they are now. Just accept it and reapply. Good luck.

 

[neutropenic]

No communication after the interview about preferences or rank list?
No phone calls from your home PD or other faculty helping make it happen?
Well good job. I don't know how many people do well without these things, but they happen a lot.

I did not have anyone call on my behalf as my school has no department in the field I was applying for.

Sent thank you notes to all the people who interviewed me.

No "#1" notes or anything of the sort.

Still matched my #3.

Did get some phone calls and handwritten notes from PDs saying they "would love to have me" but not from programs #1-3.

 

[spalatin]

BTW the way "regular job interviews" work is that an employer interviews tons of applicants and generally takes a long time coming to a decision. Then they offer the position to one applicant, then another, until they fill their positions. They don't tell you you're not in the running until they're secure that all positions are filled. Given the size of the pool this would take longer than the match and you wouldn't be "in the know" untill it was too late anyway. Besides, the calls from faculty and PD's that you're complaining about would be just as much (or as little) a part of it as they are now. Just accept it and reapply. Good luck.[/QUOTE]

Regular job interviews where interviewees are competing for the best jobs and interviewers are competing for the best candidates seem to me to be the American way. Free and open competition. Do you really think nine months is an inadequate amount of time? The match was concocted to make it easy for programs to fill their quotas. They don't have to recruit, there is no incentive for bad programs to improve, there is no incentive for good programs to remain good. Usually you have a very limited amount of information available about a program, while the program knows everything about you from the time you were in kindergarten to the day you show up on their doorstep. You do not have the ability to ask the program director important questions lest you jeopardize the rank order list.

If timing were truly a concern then this could be solved by opening the application season in August, allowing candidates to apply to programs, and giving programs two weeks from the application to decide to offer an interview. If the candidate is a good one, a job offer could be made on the spot, and the candidate given an opportunity to accept, either immediately or within a week or so, which is standard practice in most industries. In the case of a good candidate with an interview from a prestige place, but no offer, yet, and a solid offer that they have from a community hospital with an acceptance deadline, it would be an additional bargaining chip to force the prestige hospital to make a decision or risk losing a candidate.

I can't see how anyone loses if the match is eliminated, except for the hospitals who would have to consider cleaning up their respective acts and start being competitive.

Another thought. Why not have a central residency credentialling agency similar to the Federation of State Medical Boards where programs would quarterly report their resident's evaluations and send copies of their credentialling documents. This would make it easier for residents to switch programs and for programs wanting a new resident since all the documentation would be in one place. As a bonus this credentialling agency would make it more difficult for a malignant program to screw a resident by threatening to alter prior training records.

 

[Gut Shot]

Regular job interviews where interviewees are competing for the best jobs and interviewers are competing for the best candidates seem to me to be the American way. Free and open competition. Do you really think nine months is an inadequate amount of time? The match was concocted to make it easy for programs to fill their quotas. They don't have to recruit, there is no incentive for bad programs to improve, there is no incentive for good programs to remain good. Usually you have a very limited amount of information available about a program, while the program knows everything about you from the time you were in kindergarten to the day you show up on their doorstep. You do not have the ability to ask the program director important questions lest you jeopardize the rank order list.

If timing were truly a concern then this could be solved by opening the application season in August, allowing candidates to apply to programs, and giving programs two weeks from the application to decide to offer an interview. If the candidate is a good one, a job offer could be made on the spot, and the candidate given an opportunity to accept, either immediately or within a week or so, which is standard practice in most industries. In the case of a good candidate with an interview from a prestige place, but no offer, yet, and a solid offer that they have from a community hospital with an acceptance deadline, it would be an additional bargaining chip to force the prestige hospital to make a decision or risk losing a candidate.

I can't see how anyone loses if the match is eliminated, except for the hospitals who would have to consider cleaning up their respective acts and start being competitive.

From speaking with old schoolers the pre-match era actually sounded quite miserable. The recurrent theme was "utter chaos." Programs would pressure the Hell out of students to accept appointments as early as M3 year.

On the interview trail a practice known as the "exploding offer" was quite common, where an offer would be made on the spot but it would expire after 24-48 hours. How'd you like to be interviewing at a program you're lukewarm about and get one of those? Do you take it? Do you hold out for something better that might not come?

Every year people get bitter about the match, but it's like getting bitter about vaccines; if you weren't around to experience the alternative then try not to bitch too much. What did you have to do, exacty? Fill out an application? Go on some interviews? Make a list and then kick back? Jesus, someone call 9-1-1.

 

[spalatin]

From speaking with old schoolers the pre-match era actually sounded quite miserable. The recurrent theme was "utter chaos." Programs would pressure the Hell out of students to accept appointments as early as M3 year.

On the interview trail a practice known as the "exploding offer" was quite common, where an offer would be made on the spot but it would expire after 24-48 hours. How'd you like to be interviewing at a program you're lukewarm about and get one of those? Do you take it? Do you hold out for something better that might not come?

Every year people get bitter about the match, but it's like getting bitter about vaccines; if you weren't around to experience the alternative then try not to bitch too much. What did you have to do, exacty? Fill out an application? Go on some interviews? Make a list and then kick back? Jesus, someone call 9-1-1.

From the '60s, "The times they are a changing..."
Before medical school, I was an engineering manager at a very large and successful manufacturing firm. Cal Tech is a highly respected engineering school. We had firms from all over come to us with recruiters to convince us that we should go there for post docs. Other schools like Stanford, UCLA, MIT, Harvard and Michigan had the same. I did get "exploding offers." People need people who are willing to make a decision. Most offers I got gave me a week to decide. But the choice of which offer I accepted was mine and mine alone. I was not at the whim of a dozen programs. They had business decisions to make too. They needed to fill positions. When I was a hiring manager with open engineering positions, I did the same. I would advertise the opening and credentials I was looking for, wait for two weeks to see who responded, sort the resumes and if there weren't any that I liked well enough, I would re-advertise. Once I had enough to fill my position(s), I'd schedule interviews, either make offers at the time of interview if there was a good fit or a group of engineers would get together and discuss the candidates and make a decision after a week. Candidates got 1-2 weeks tops to make a decision. During that time, skilled candidates who had offers on the table were able to call me, negotiate salaries, fringe benefits, project responsibilities and there was generally a give and take. I had to be competetive or my best candidates would go to work for McDonnell or EADS. If I couldn't compete, and sometimes that happened, I'd take the second choices, but the process was concluded within a month.

Programs that feel the need to do a high pressure sales job are exactly like the car dealership I just visited. When I decided the deal wasn't good enough, they came up with fifty reasons why I was screwing myself by not overpaying for the car I just drove. I walked away because there are other car dealerships and other cars.

I'm not sure you can compare the "bad old prematch" days with our environment today. In those days you could complete an intern year and go into practice, if you wanted. You didn't get a salary or any kind of living wage, you lived in the hospital, they had rules against being married, having family or any outside balance. But, at the end of a year you could make a choice. Today, you are stuck at a place for 3-8 years. You can't practice without board certification.

To answer your questions specifically, if you are a good candidate, with excellent credentials, and good prospects, and you are willing to risk a little for potentially good returns, then yes, you do turn down an offer that isn't what you really want, or where you really want to be. If you were a marginal candidate and your prospects weren't good then you take it. There is always risk in life, my friend, and if you are risk averse, you minimize your risks, but you also minimize the potential rewards.

If you are a mediocre student, mediocre grades, low board scores from an off shore school and you get only one interview at the worst derm program in the country and they offer you a position but you have to say yes right this minute, then you would probably say where do I sign? On the other hand if you're Stanford, top 1-2% in your class you might want to wait until you have seen all 10 programs that are interviewing you. So, the answer is yes.

It makes no sense to quote program directors common and well rehearsed response, as you did above, because not only were we not there then, but I don't think anyone who is breathing today thinks that the training and practice environment in the US is the same in 2006 as it was in 1956. So, we have a different game, different referees and different rules today. Also we do have technology that was not available then, such as this very internet.

As far as the work involved, the central application system is useful, but it's far more expensive than it should be, and why the graduated fee system that costs progressively more as you apply to more programs? My reasoning? Population control. The programs do not want a deluge of applicants, so they make it progressively more expensive. It makes far more work for the program directors, so they limit it. Med students are getting smarter, and realize that after dropping a couple of hundred thousand for med school, that an extra 10k for applying to all programs in competitive specialties is worth the risk. With a modern computer, a good printer and a scanned photo, you can produce a CD or paper document that anyone can read for about two bucks each. You can post-mail them for another two bucks. With electronic transmission even cheaper. Figure $1/program. So, why does ERAS charge thousands for applying to a hundred programs?

How many interviews did you pay for yourself? I'll be most of them, if not all of them. When I recruited engineers, I paid. I bought their plane tickets, I rented their cars, paid for the hotels and meals and even paid for a second look interview.

So, you're right. The present system is perfect. The hospitals/ERAS/NRMP channel you through an expensive conduit, limiting access, and thus competition, paying nothing for the recruitment of good people, capitalizing on their labor, while paying wages and working conditions to residents they can't even get nurses to put up with. Excellent system. If you are a hospital administrator, that is.

And I'm not sure what to make of your last statement. It seems a non-sequitor. 911 and religion have very little to do with the topic at hand, unless your present habit is to curse as part of your normal discourse.

 

[Faebinder]

From the '60s, "The times they are a changing..."
Before medical school, I was an engineering manager at a very large and successful manufacturing firm. Cal Tech is a highly respected engineering school. We had firms from all over come to us with recruiters to convince us that we should go there for post docs. Other schools like Stanford, UCLA, MIT, Harvard and Michigan had the same. I did get "exploding offers." People need people who are willing to make a decision. Most offers I got gave me a week to decide. But the choice of which offer I accepted was mine and mine alone. I was not at the whim of a dozen programs. They had business decisions to make too. They needed to fill positions. When I was a hiring manager with open engineering positions, I did the same. I would advertise the opening and credentials I was looking for, wait for two weeks to see who responded, sort the resumes and if there weren't any that I liked well enough, I would re-advertise. Once I had enough to fill my position(s), I'd schedule interviews, either make offers at the time of interview if there was a good fit or a group of engineers would get together and discuss the candidates and make a decision after a week. Candidates got 1-2 weeks tops to make a decision. During that time, skilled candidates who had offers on the table were able to call me, negotiate salaries, fringe benefits, project responsibilities and there was generally a give and take. I had to be competetive or my best candidates would go to work for McDonnell or EADS. If I couldn't compete, and sometimes that happened, I'd take the second choices, but the process was concluded within a month.

Programs that feel the need to do a high pressure sales job are exactly like the car dealership I just visited. When I decided the deal wasn't good enough, they came up with fifty reasons why I was screwing myself by not overpaying for the car I just drove. I walked away because there are other car dealerships and other cars.

I'm not sure you can compare the "bad old prematch" days with our environment today. In those days you could complete an intern year and go into practice, if you wanted. You didn't get a salary or any kind of living wage, you lived in the hospital, they had rules against being married, having family or any outside balance. But, at the end of a year you could make a choice. Today, you are stuck at a place for 3-8 years. You can't practice without board certification.

To answer your questions specifically, if you are a good candidate, with excellent credentials, and good prospects, and you are willing to risk a little for potentially good returns, then yes, you do turn down an offer that isn't what you really want, or where you really want to be. If you were a marginal candidate and your prospects weren't good then you take it. There is always risk in life, my friend, and if you are risk averse, you minimize your risks, but you also minimize the potential rewards.

If you are a mediocre student, mediocre grades, low board scores from an off shore school and you get only one interview at the worst derm program in the country and they offer you a position but you have to say yes right this minute, then you would probably say where do I sign? On the other hand if you're Stanford, top 1-2% in your class you might want to wait until you have seen all 10 programs that are interviewing you. So, the answer is yes.

It makes no sense to quote program directors common and well rehearsed response, as you did above, because not only were we not there then, but I don't think anyone who is breathing today thinks that the training and practice environment in the US is the same in 2006 as it was in 1956. So, we have a different game, different referees and different rules today. Also we do have technology that was not available then, such as this very internet.

As far as the work involved, the central application system is useful, but it's far more expensive than it should be, and why the graduated fee system that costs progressively more as you apply to more programs? My reasoning? Population control. The programs do not want a deluge of applicants, so they make it progressively more expensive. It makes far more work for the program directors, so they limit it. Med students are getting smarter, and realize that after dropping a couple of hundred thousand for med school, that an extra 10k for applying to all programs in competitive specialties is worth the risk. With a modern computer, a good printer and a scanned photo, you can produce a CD or paper document that anyone can read for about two bucks each. You can post-mail them for another two bucks. With electronic transmission even cheaper. Figure $1/program. So, why does ERAS charge thousands for applying to a hundred programs?

How many interviews did you pay for yourself? I'll be most of them, if not all of them. When I recruited engineers, I paid. I bought their plane tickets, I rented their cars, paid for the hotels and meals and even paid for a second look interview.

So, you're right. The present system is perfect. The hospitals/ERAS/NRMP channel you through an expensive conduit, limiting access, and thus competition, paying nothing for the recruitment of good people, capitalizing on their labor, while paying wages and working conditions to residents they can't even get nurses to put up with. Excellent system. If you are a hospital administrator, that is.

And I'm not sure what to make of your last statement. It seems a non-sequitor. 911 and religion have very little to do with the topic at hand, unless your present habit is to curse as part of your normal discourse.

Wow.. I couldn't have said this better if I tried to. 👍

 

[Gut Shot]

From the '60s, "The times they are a changing..."
Before medical school, I was an engineering manager at a very large and successful manufacturing firm. Cal Tech is a highly respected engineering school. We had firms from all over come to us with recruiters to convince us that we should go there for post docs. Other schools like Stanford, UCLA, MIT, Harvard and Michigan had the same. I did get "exploding offers." People need people who are willing to make a decision. Most offers I got gave me a week to decide. But the choice of which offer I accepted was mine and mine alone. I was not at the whim of a dozen programs. They had business decisions to make too. They needed to fill positions. When I was a hiring manager with open engineering positions, I did the same. I would advertise the opening and credentials I was looking for, wait for two weeks to see who responded, sort the resumes and if there weren't any that I liked well enough, I would re-advertise. Once I had enough to fill my position(s), I'd schedule interviews, either make offers at the time of interview if there was a good fit or a group of engineers would get together and discuss the candidates and make a decision after a week. Candidates got 1-2 weeks tops to make a decision. During that time, skilled candidates who had offers on the table were able to call me, negotiate salaries, fringe benefits, project responsibilities and there was generally a give and take. I had to be competetive or my best candidates would go to work for McDonnell or EADS. If I couldn't compete, and sometimes that happened, I'd take the second choices, but the process was concluded within a month.

Good for you, but look at the scale of the respective tasks. You're hiring a single manager. In 2006 the NRMP match dealt with 26,715 active applicants jockeying for 24,085 available PGY-1 and PGY-2 spots.

Programs that feel the need to do a high pressure sales job are exactly like the car dealership I just visited. When I decided the deal wasn't good enough, they came up with fifty reasons why I was screwing myself by not overpaying for the car I just drove. I walked away because there are other car dealerships and other cars.

Uuuuuuuuuh, you do the same thing in the match when you either 1. rank a program low on your list or 2. don't rank it at all.

I'm not sure you can compare the "bad old prematch" days with our environment today. In those days you could complete an intern year and go into practice, if you wanted. You didn't get a salary or any kind of living wage, you lived in the hospital, they had rules against being married, having family or any outside balance. But, at the end of a year you could make a choice. Today, you are stuck at a place for 3-8 years. You can't practice without board certification.

And how is this relevant? Yes, much has changed, but that doesn't diminish the problems of transitioning thousands of grads into thousands of residency programs.

Bye the bye, people come and go from programs all the time. They switch specialties, move, quit, etc. constantly. The fear of getting stuck in a lousy place for 3-8 years doesn't change based on hiring practices. They can still slather you with BS and you're still free to move on if it doesn't suit you. Just ask Panda Bear.

To answer your questions specifically, if you are a good candidate, with excellent credentials, and good prospects, and you are willing to risk a little for potentially good returns, then yes, you do turn down an offer that isn't what you really want, or where you really want to be. If you were a marginal candidate and your prospects weren't good then you take it. There is always risk in life, my friend, and if you are risk averse, you minimize your risks, but you also minimize the potential rewards.

If you are a mediocre student, mediocre grades, low board scores from an off shore school and you get only one interview at the worst derm program in the country and they offer you a position but you have to say yes right this minute, then you would probably say where do I sign? On the other hand if you're Stanford, top 1-2% in your class you might want to wait until you have seen all 10 programs that are interviewing you. So, the answer is yes.

Thanks for the sermon, but I'm still waiting to hear how dissolving the match would help matters. Top candidates will still end up heading to whatever programs they desire. Everyone else will end up at the best program (according to their respective wishes) that they can get into.

Hmmm, come to think of it, there is a system in place that resembles what you're so fond of. It's the process of getting into medical school. Remember that? Wasn't that fun? The top candidates get bombarded with offers and the remaining 97% are left to stew in their own juices for weeks or months on end. Wow, that sure beats the heck out of matching.

It makes no sense to quote program directors common and well rehearsed response, as you did above,

It does if there's some truth to it.

because not only were we not there then, but I don't think anyone who is breathing today thinks that the training and practice environment in the US is the same in 2006 as it was in 1956. So, we have a different game, different referees and different rules today. Also we do have technology that was not available then, such as this very internet.

As I alluded to earlier, this isn't about the training environment (which is quite peripheral), this is about sticking 26,000 people into 24,000 holes in the best way possible. There is no perfect way to go about this, but I advocate a relative order and you advocate a process which would make the deck officers of the Titanic blush with envy.

As far as the work involved, the central application system is useful, but it's far more expensive than it should be, and why the graduated fee system that costs progressively more as you apply to more programs? My reasoning? Population control. The programs do not want a deluge of applicants, so they make it progressively more expensive. It makes far more work for the program directors, so they limit it. Med students are getting smarter, and realize that after dropping a couple of hundred thousand for med school, that an extra 10k for applying to all programs in competitive specialties is worth the risk. With a modern computer, a good printer and a scanned photo, you can produce a CD or paper document that anyone can read for about two bucks each. You can post-mail them for another two bucks. With electronic transmission even cheaper. Figure $1/program. So, why does ERAS charge thousands for applying to a hundred programs?

You're going to have to work this tangent out on your own.

How many interviews did you pay for yourself? I'll be most of them, if not all of them. When I recruited engineers, I paid. I bought their plane tickets, I rented their cars, paid for the hotels and meals and even paid for a second look interview.

So, you're right. The present system is perfect. The hospitals/ERAS/NRMP channel you through an expensive conduit, limiting access, and thus competition, paying nothing for the recruitment of good people, capitalizing on their labor, while paying wages and working conditions to residents they can't even get nurses to put up with. Excellent system. If you are a hospital administrator, that is.

Not sure what planet you're writing this on. I just witnessed my first match cycle as a resident, and I can't begin to tell you how wrong you are. Programs are in a constant battle to attract and match top candidates. I did indeed pay for most of my travel expenses, but that's medicine, for ya: a seller's market up until licensure.

And I'm not sure what to make of your last statement. It seems a non-sequitor. 911 and religion have very little to do with the topic at hand, unless your present habit is to curse as part of your normal discourse.

It's as normal a part of my discourse as being a stuffy and verbose is to others.

 

[Gut Shot]

Excellent system. If you are a hospital administrator, that is.

One more thing. Could you explain to me how the match algorithm works? I ask because I'm not convinced that you get it.

 

[glorfindel]

Spalatin, you make some interesting points, but I admit that your post confuses me. I get the bit at the end about the expense of ERAS -- it's an expensive proposition, especially for marginal candidates who feel that they need to apply everywhere.

I'm not sure, though, what your point is in the first half of your post. Your point that life is risky is well-taken. But I'm not sure what that has to do with the comparison between the Match and the pre-match system. Both systems, surely, are risky. In the former, you send in your ROL and risk matching at #9 or not matching at all. In the latter, you have to deal with the risks of exploding offers. Once we accept that life is risky, as you suggest, how are we any closer to deciding whether the Match is any better than what preceded it?

 

[PatrickBateman]

Regular job interviews where interviewees are competing for the best jobs and interviewers are competing for the best candidates seem to me to be the American way. Free and open competition. Do you really think nine months is an inadequate amount of time? The match was concocted to make it easy for programs to fill their quotas. They don't have to recruit, there is no incentive for bad programs to improve, there is no incentive for good programs to remain good. Usually you have a very limited amount of information available about a program, while the program knows everything about you from the time you were in kindergarten to the day you show up on their doorstep. You do not have the ability to ask the program director important questions lest you jeopardize the rank order list.

And how would any of that be different in "real" job interviews? There's still more demand than supply. If you ask a ton of sensitive questions at any job interview, chances are you won't get hired. The interviews you go on during the match process are as real as any job interview out there.

Another thought. Why not have a central residency credentialling agency similar to the Federation of State Medical Boards where programs would quarterly report their resident's evaluations and send copies of their credentialling documents. This would make it easier for residents to switch programs and for programs wanting a new resident since all the documentation would be in one place. As a bonus this credentialling agency would make it more difficult for a malignant program to screw a resident by threatening to alter prior training records.

And this powerful centralized bureaucracy would be the american way?? You can dream about this benevolant semi-state body all you wish but it's not going to happen.

And what's wrong with programs having our educational transcripts anyway? We've been working on them all our lives for exactly that purpose after all.

 

[PatrickBateman]

From the '60s, "The times they are a changing..."
Before medical school, I was an engineering manager at a very large and successful manufacturing firm. Cal Tech is a highly respected engineering school. We had firms from all over come to us with recruiters to convince us that we should go there for post docs. Other schools like Stanford, UCLA, MIT, Harvard and Michigan had the same. I did get "exploding offers." People need people who are willing to make a decision. Most offers I got gave me a week to decide. But the choice of which offer I accepted was mine and mine alone. I was not at the whim of a dozen programs. They had business decisions to make too. They needed to fill positions. When I was a hiring manager with open engineering positions, I did the same. I would advertise the opening and credentials I was looking for, wait for two weeks to see who responded, sort the resumes and if there weren't any that I liked well enough, I would re-advertise. Once I had enough to fill my position(s), I'd schedule interviews, either make offers at the time of interview if there was a good fit or a group of engineers would get together and discuss the candidates and make a decision after a week. Candidates got 1-2 weeks tops to make a decision. During that time, skilled candidates who had offers on the table were able to call me, negotiate salaries, fringe benefits, project responsibilities and there was generally a give and take. I had to be competetive or my best candidates would go to work for McDonnell or EADS. If I couldn't compete, and sometimes that happened, I'd take the second choices, but the process was concluded within a month.

Medicine is very diferent to engineering. You're talking about hiring trained candidates to work as in the field they have already trained for. The situation is somewhat like that of soon-to-be medical attendings applying for work after residency. In fact that process is not unlike that which you describe for engineers. Residency, on the other hand is an educational program. It's not practicable to have candidates join up at any time of the year. Coordinating the process is essential to providing a structured graduated standard educational progression. To abandon the match and turn to a chaotic approach would make organizing the flow of trainee physicians from M4 to PGY1 extremely difficult. No one's going to opt for a messier, more chaotic system.

No one want's the process to go on longer or to be less organized than it already is. You're the only person I've ever heard who'd like to start the season earlier and have it go on longer.

I agree with you point about the expence of the process. It's outrageously expensive. Almost as bad as the USMLE. After charging me $1000 for their crap-ass Step II extravaganza I found out today that they want another $50 from me to send my scores on to my program. Yes, it's all overpriced.

 

[asdfaa]

From the '60s, "The times they are a changing..."
Before medical school, I was an engineering manager at a very large and successful manufacturing firm. Cal Tech is a highly respected engineering school. We had firms from all over come to us with recruiters to convince us that we should go there for post docs. Other schools like Stanford, UCLA, MIT, Harvard and Michigan had the same. I did get "exploding offers." People need people who are willing to make a decision. Most offers I got gave me a week to decide. But the choice of which offer I accepted was mine and mine alone. I was not at the whim of a dozen programs. They had business decisions to make too. They needed to fill positions. When I was a hiring manager with open engineering positions, I did the same. I would advertise the opening and credentials I was looking for, wait for two weeks to see who responded, sort the resumes and if there weren't any that I liked well enough, I would re-advertise. Once I had enough to fill my position(s), I'd schedule interviews, either make offers at the time of interview if there was a good fit or a group of engineers would get together and discuss the candidates and make a decision after a week. Candidates got 1-2 weeks tops to make a decision. During that time, skilled candidates who had offers on the table were able to call me, negotiate salaries, fringe benefits, project responsibilities and there was generally a give and take. I had to be competetive or my best candidates would go to work for McDonnell or EADS. If I couldn't compete, and sometimes that happened, I'd take the second choices, but the process was concluded within a month.

Programs that feel the need to do a high pressure sales job are exactly like the car dealership I just visited. When I decided the deal wasn't good enough, they came up with fifty reasons why I was screwing myself by not overpaying for the car I just drove. I walked away because there are other car dealerships and other cars.

I'm not sure you can compare the "bad old prematch" days with our environment today. In those days you could complete an intern year and go into practice, if you wanted. You didn't get a salary or any kind of living wage, you lived in the hospital, they had rules against being married, having family or any outside balance. But, at the end of a year you could make a choice. Today, you are stuck at a place for 3-8 years. You can't practice without board certification.

To answer your questions specifically, if you are a good candidate, with excellent credentials, and good prospects, and you are willing to risk a little for potentially good returns, then yes, you do turn down an offer that isn't what you really want, or where you really want to be. If you were a marginal candidate and your prospects weren't good then you take it. There is always risk in life, my friend, and if you are risk averse, you minimize your risks, but you also minimize the potential rewards.

If you are a mediocre student, mediocre grades, low board scores from an off shore school and you get only one interview at the worst derm program in the country and they offer you a position but you have to say yes right this minute, then you would probably say where do I sign? On the other hand if you're Stanford, top 1-2% in your class you might want to wait until you have seen all 10 programs that are interviewing you. So, the answer is yes.

It makes no sense to quote program directors common and well rehearsed response, as you did above, because not only were we not there then, but I don't think anyone who is breathing today thinks that the training and practice environment in the US is the same in 2006 as it was in 1956. So, we have a different game, different referees and different rules today. Also we do have technology that was not available then, such as this very internet.

As far as the work involved, the central application system is useful, but it's far more expensive than it should be, and why the graduated fee system that costs progressively more as you apply to more programs? My reasoning? Population control. The programs do not want a deluge of applicants, so they make it progressively more expensive. It makes far more work for the program directors, so they limit it. Med students are getting smarter, and realize that after dropping a couple of hundred thousand for med school, that an extra 10k for applying to all programs in competitive specialties is worth the risk. With a modern computer, a good printer and a scanned photo, you can produce a CD or paper document that anyone can read for about two bucks each. You can post-mail them for another two bucks. With electronic transmission even cheaper. Figure $1/program. So, why does ERAS charge thousands for applying to a hundred programs?

How many interviews did you pay for yourself? I'll be most of them, if not all of them. When I recruited engineers, I paid. I bought their plane tickets, I rented their cars, paid for the hotels and meals and even paid for a second look interview.

So, you're right. The present system is perfect. The hospitals/ERAS/NRMP channel you through an expensive conduit, limiting access, and thus competition, paying nothing for the recruitment of good people, capitalizing on their labor, while paying wages and working conditions to residents they can't even get nurses to put up with. Excellent system. If you are a hospital administrator, that is.

And I'm not sure what to make of your last statement. It seems a non-sequitor. 911 and religion have very little to do with the topic at hand, unless your present habit is to curse as part of your normal discourse.

Wow, an ex engineer, now in medicine having just gone through the match. Who does that remind me of? Not sacrament by any chance 😱 The writing style is also eerily identical. What a strange coincidence!!

 

[spalatin]

Good for you, but look at the scale of the respective tasks. You're hiring a single manager. In 2006 the NRMP match dealt with 26,715 active applicants jockeying for 24,085 available PGY-1 and PGY-2 spots.

Hmmm. According to the National Science Foundation, there were 765,000 engineering graduates in 1999-2000. They all graduated in April/May timeframe and they all needed a job, and no, they are NOT fully qualified prospective engineers. They need two years experience to take the EIT exams, then an additional year after that to be a full fledged Professional Engineer. Less, if they do the MS or PhD, but they still need mentoring before they can be trusted to design important devices and structures upon which many lives depend.

They also jockey for availalbe positions. Companies such as the one I worked for hold about half a dozen positions per year for new graduates. There are more engineering firms than there are hospitals, so the potential applicants have more to choose from for first year positions.

So, thirty times more grads looking for first year positions, maybe 20 times more employers.

I fail to see the difference. I again assert that you have taken an anecdote built around legends of two generations ago and apply it without a.) considering its relevance, and b.) considering how it has skewed graduate medical education. I suggest a prospective randomized controlled study in which half the positions and half the medical schools do not participate in the NRMP and in about 8 years we'll be able to assess appropriately the applicability and relevance of a 5 decade old wive's tale, in light of quantum leaps in technology.

It's as normal a part of my discourse as being a stuffy and verbose is to others.

Ahhh. Potty mouths. One of the last true refuges of the underinformed, immature and uneloquent.

 

[spalatin]

Wow, an ex engineer, now in medicine having just gone through the match. Who does that remind me of? Not sacrament by any chance 😱 The writing style is also eerily identical. What a strange coincidence!!

No, who is scarament? I'd probably get along with him. Affirmation is good for the soul. I went through the match 5 years ago. I be dun soon! 😉

 

[spalatin]

And how would any of that be different in "real" job interviews? There's still more demand than supply. If you ask a ton of sensitive questions at any job interview, chances are you won't get hired. The interviews you go on during the match process are as real as any job interview out there.

Agreed.

And this powerful centralized bureaucracy would be the american way?? You can dream about this benevolant semi-state body all you wish but it's not going to happen.

And what's wrong with programs having our educational transcripts anyway? We've been working on them all our lives for exactly that purpose after all.

I am not in favor of centralized bureaucracies. So, I agree with you and retract the thought. Thanks for pointing it out. I do not particularly like the FCVS and prefer to send my credentials directly to the state boards myself, but several states and hospitals now require the FCVS.

With residency programs, there are numerous anecdotal accounts of less than forthright programs who are less than honest in reporting residents accomplishments, especially when a resident tries to jump ship and move to a new program.

One of the key principles of audits is that if only one person has access to important data, then it is easy for that person to alter that data. If there are copies under independent control, preferably by a disinterested third party, then there is less likelihood of hanky-panky. I'm not saying that medicine is 100% populated by John Lay, but perhaps there may be a few bad apples and having an independent data repository gives those who do wish to change programs independent access to their data, which should give the programs a bit more incentive to treat their people a little better. There is another alternative: insist on copies of your evals when it is eval time and then take 'em home and have them date stamped and notorized. Then we don't need a centralized bureacracy which costs somebody money.

The reason I thought about this is that some of the specialty boards get a summarized version of these transcripts on an annual basis. My thinking was (and is not, now, due to your insight), that a central repository would cover all the boards. I stand corrected. Thank you.

 

[RxnMan]

...They all graduated in April/May timeframe and they all needed a job, and no, they are NOT fully qualified prospective engineers. They need two years experience to take the EIT exams, then an additional year after that to be a full fledged Professional Engineer. Less, if they do the MS or PhD, but they still need mentoring before they can be trusted to design important devices and structures upon which many lives depend...

Engineering licensure rules change from state to state, but in Colorado, you need at least 4 years of ABET-accredited engineering education (a B.S.) to sit for the EIT/FE. Then you need 8 years of relevant engineering work experience to sit for the P.E. licensure exam. An M.S. or Ph.D. program can count towards those 8 years, but that's still very different than what you have written.

But civils are generally the only ones who get these, as they usually aren't required (and are sometimes a liability) in other engineering disciplines. Granted, they cannot call themselves a licensed professional engineer (with the legal power to sign off and approve plans and schematics), but not having licensure is not a barrier to being employed as an engineer.

 

[spalatin]

Engineering licensure rules change from state to state, but in Colorado, you need at least 4 years of ABET-accredited engineering education (a B.S.) to sit for the EIT/FE. Then you need 8 years of relevant engineering work experience to sit for the P.E. licensure exam. An M.S. or Ph.D. program can count towards those 8 years, but that's still very different than what you have written.

But civils are generally the only ones who get these, as they usually aren't required (and are sometimes a liability) in other engineering disciplines. Granted, they cannot call themselves a licensed professional engineer (with the legal power to sign off and approve plans and schematics), but not having licensure is not a barrier to being employed as an engineer.

I misspoke. Sometimes the fingers go faster than the brain. EIT in my state requires 2 years post PhD, 3 Post MSE, 4 years post BSE. EEs and MEs and the feds do want it in the aerospace industry for those "responsible." Calif wants 3 years education to sit for the EIT and 6 total for the PE (including the BSE 3 year credit) for non-structural, non-geological engineers. But we are off topic. I don't think the academic/experiential credentials are such worlds apart that conceptually there aren't significant overlaps. Not having licensure is not necessarily a barrier to being employed in the medical profession either. But it is if you want to be the "doctor" and make the hard decisions with the legal power to approve care plans and prescribe drugs and tests and operate.

 

[RxnMan]

I am an EI, I work for a BioEng PE, my father is a Civil PE, and I've proctored the FE - my experience forced me to speak out. It's good to see engineers in medicine.

In engineering, if all training positions aren't filled, then maybe that industry takes a bit of a hit. In medicine, if all of the training positions aren't filled, then the US standard of care goes down. To what extent is up for debate, but people are very sensitive when it comes to health care and that's when they call their congressperson (high-quality free healthcare is a human right, right?). Program Directors are under huge pressure to fill all slots (% filled, length of ROL also go into rankings, which are also stressed).

Now step back a second. Those kids in the Pre-Allo forum think being a doc is all Hollywood and making a million dollars. Imagine one of those kids on the wards for the first time and confronting clincal reality for the first time. Along comes a PD saying 'sign now for this residency spot and it's your's.' The kid doesn't even know how to do a physical and this PD wants them to commit to a speciality for 5 years. Then they graduate and that PD tells them that their contract was traded to BFE Alaska for some guy with better stats.

The Match makes the most people the most happy, and in general, protects students by removing this sort of corruption as a disinterested third party.

 

[Gut Shot]

Hmmm. According to the National Science Foundation, there were 765,000 engineering graduates in 1999-2000. They all graduated in April/May timeframe and they all needed a job, and no, they are NOT fully qualified prospective engineers. They need two years experience to take the EIT exams, then an additional year after that to be a full fledged Professional Engineer. Less, if they do the MS or PhD, but they still need mentoring before they can be trusted to design important devices and structures upon which many lives depend.

They also jockey for availalbe positions. Companies such as the one I worked for hold about half a dozen positions per year for new graduates. There are more engineering firms than there are hospitals, so the potential applicants have more to choose from for first year positions.

So, thirty times more grads looking for first year positions, maybe 20 times more employers.

Hmmm, 765,000 graduates, eh? So you're telling me that in 1999-2000 one in every 368 people in this country was a fresh engineering graduate.

My numbers are a little different. According to Gereddi and Wadhwa in 2004 the breakdown was like this:

Total: 222,335

Bachelors: 137,437
Engineering (excluding CS, electrical, IT): 52,520
Computer science, electrical, IT: 84,917

Subbaccalaureate: 84,898
Engineering: 39, 652
CS and IT: 45,246

I fail to see the difference.

Really? You honestly can't see the difference between 24,000 people with (roughly) equivalent MD training entering into a limited number of defined specialties through uniformly accredited (ACGME) training programs versus engineering grads coming from multiple training backgrounds (chemical, mechanical, civil, petroleum, mining, chemical, electrical, etc.) who are looking for positions in graduate school, numerous government agencies, and countless private firms and corporations.

Yes, you're right. They're practically the same process.

I again assert that you have taken an anecdote built around legends of two generations ago and apply it without a.) considering its relevance, and b.) considering how it has skewed graduate medical education.

Funny, you keep repeating that it has skewed graduate medical education, but you haven't really demonstrated how this has occurred, or even what has occurred.

I suggest a prospective randomized controlled study in which half the positions and half the medical schools do not participate in the NRMP and in about 8 years we'll be able to assess appropriately the applicability and relevance of a 5 decade old wive's tale, in light of quantum leaps in technology.

I'm sure the powers that be will get right no that one. The match is imperfect and annoying at times, but when all is said and done it accomplishes something that the old way does not: virtually everyone matches at the best program (as defined by their preferences) that they can get into.

Ahhh. Potty mouths. One of the last true refuges of the underinformed, immature and uneloquent.

You left out the fact that it turns on a mom or two.

 

[person2006]

From my point of view, a key factor in favor of just applying for jobs like engineers is this: If a chemical engineer doesn't have a job in March, he'll apply for other chemical engineering jobs in April, May, etc. not scramble about applying for jobs in computer or industrial engineering for 1-2 days to work at for a year before any chemical engineering jobs are available again the following March. The problem with the match isn't that it's followed by the scramble. It's that all the jobs dissappear on the same day.

 

[Gut Shot]

From my point of view, a key factor in favor of just applying for jobs like engineers is this: If a chemical engineer doesn't have a job in March, he'll apply for other chemical engineering jobs in April, May, etc. not scramble about applying for jobs in computer or industrial engineering for 1-2 days to work at for a year before any chemical engineering jobs are available again the following March. The problem with the match isn't that it's followed by the scramble. It's that all the jobs dissappear on the same day.

That's why one has to approach the match in a sensible fashion: apply to enough programs, interview at enough programs, and rank enough programs. If you do those three things the chances of a good candidate not matching are quite small. The vasts majority of the people who scramble are those who have failed to perform all of the above steps. I can recall six people from my class who didn't match, and while anecdotal, here were their situations and outcomes (as of last year):

Peds - ranked three programs (scrambled into good peds program)
Plastic surgery - marginal candidate, few interviews (scrambled into prelim surgery)
Urology - marginal candidate, few interviews (matched into general surgery in main match)
ENT (2) - marginal candidates, few interviews (research years)
Derm (1) - decent candidate, not enough interviews (situation undecided)

You'll notice that with the exception of the peds person (who must have been high), the remaining unmatched folks were all attempting to get into highly competitive fields as fair to middling applicants. In other words, it was no big surprise.

One last thing: you say the jobs all disappear on one day, but the jobs start disappearing the moment applicants and programs begin composing their ROL's. The chips start falling well before match day, all the algorithm does is show the participants where they lay.

 

[person2006]

I understand what you are saying Havarti666, but I didn't really have those problems.

I applied to many programs. I was invited to 18 and could afford to attend 14 interviews. I was a strong enough applicant that my interviews included strong programs such as Cornell, MGH, Wash U, UTSW as well as several midrange an a few relatively non-competitive programs. From what I can gather, what happend in the match is: 1) I didn't get any of the top programs which I can understand and didn't necessarily expect. 2) the other programs filled most of their positions with either their own students or with students who had done electives there. 3) I never got to interview at any other programs because by the time 1&2 were apparent, every job in the country was gone. This is my problem with the match. I was definately a better applicant than many people who matched at other places, but I had no way of knowing that I needed to apply to those places until it was too late. I wasn't a bad applicant. I didn't apply to too few programs. My interviews mostly went well bases on my impression and based on feedback from my interviewers during several of my interviews. I was f'ed in the match though. Now I get to waste a year of my life working in the wrong specialty before matching next year. It's sucks. It's all I can do, but you can see why not everyone thinks the match is a good thing.

 

[Gut Shot]

I understand what you are saying Havarti666, but I didn't really have those problems.

I applied to many programs. I was invited to 18 and could afford to attend 14 interviews. I was a strong enough applicant that my interviews included strong programs such as Cornell, MGH, Wash U, UTSW as well as several midrange an a few relatively non-competitive programs. From what I can gather, what happend in the match is: 1) I didn't get any of the top programs which I can understand and didn't necessarily expect. 2) the other programs filled most of their positions with either their own students or with students who had done electives there. 3) I never got to interview at any other programs because by the time 1&2 were apparent, every job in the country was gone. This is my problem with the match. I was definately a better applicant than many people who matched at other places, but I had no way of knowing that I needed to apply to those places until it was too late. I wasn't a bad applicant. I didn't apply to too few programs. My interviews mostly went well bases on my impression and based on feedback from my interviewers during several of my interviews. I was f'ed in the match though. Now I get to waste a year of my life working in the wrong specialty before matching next year. It's sucks. It's all I can do, but you can see why not everyone thinks the match is a good thing.

Sounds like you got the bone. My med school dean informed me that every year there was one poor bastard who did everything right and still got shafted. It's cold comfort, I know, but qualified people are going to get stiffed in competitive specialties every year (and with 97.6% of gas spots filling in the match, competition this year was pretty fierce). My brother graduated in the top third of his class at Wash U and almost fell off the end of his rank list (all 4-year rads programs, back when they had 4-year rads programs).

So yes, it sucks to be an unfortunate statistic... at least you didn't waste six years of your life like I did getting a PhD.

 

[8744]

Engineering licensure rules change from state to state, but in Colorado, you need at least 4 years of ABET-accredited engineering education (a B.S.) to sit for the EIT/FE. Then you need 8 years of relevant engineering work experience to sit for the P.E. licensure exam. An M.S. or Ph.D. program can count towards those 8 years, but that's still very different than what you have written.

But civils are generally the only ones who get these, as they usually aren't required (and are sometimes a liability) in other engineering disciplines. Granted, they cannot call themselves a licensed professional engineer (with the legal power to sign off and approve plans and schematics), but not having licensure is not a barrier to being employed as an engineer.

In Louisiana it is five year of engineering work to sit for the PE exam. I passed it the first time and would put "PE" after my ID badge but "MD, PE" would confuse people.

In most states, you can't work for yourself or be the principle of an engineering firm (offering engineering services ot the public) unless you are licensed.

 

[Faebinder]

In Louisiana it is five year of engineering work to sit for the PE exam. I passed it the first time and would put "PE" after my ID badge but "MD, PE" would confuse people.

In most states, you can't work for yourself or be the principle of an engineering firm (offering engineering services ot the public) unless you are licensed.

In Florida it is also 5 years... the exam was a joke to me. I don't put PE either... one day I put MSBE (Masters of Science in Biomedical Engineering) behind my name for an article to publish and I confused every single person it encountered.... Ever since then it's just straight MD. 🙄

 

[RxnMan]

In Louisiana it is five year of engineering work to sit for the PE exam. I passed it the first time and would put "PE" after my ID badge but "MD, PE" would confuse people.

In most states, you can't work for yourself or be the principle of an engineering firm (offering engineering services ot the public) unless you are licensed.

Yeah, you can't hang out your shingle until you've got the PE.

I work for a guy who's got "PhD, PE," on his badge and he's never had any questions about it from the patients. My impression was that patients feel that more letters = better doctor. Do you think "MD, MS" would be confusing?