What are the alternatives to the Match? What do you think would happen if it were abolished?

[Lem0nz]

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I'm interested in the opinions raised in the other thread. For all the jaded med students and residents - go wild. Explain to me why you think the match should go away but more importantly, explain what you think the process should be and what you think the ramifications of getting rid of the match will be.

For the elders, I can only guess what life was like pre-match and it was alluded to gently in the other thread. How bad was it really, and why?

I'll start. I think everyone saying the match is violating anti-trust laws and artificially lowering wages is just flat out wrong. I think its the absolute opposite. We have more applicants than we do residency spots - whether you agree with MD vs. DO vs. Carrib vs. IMG - whatever, there are more people than spots. If the match vanished programs would have zero incentive to suddenly increase wages to be more competitive. Quite the opposite, you'll see that the highly sought after academic places will do what they are already doing with attending salaries - they'll be 1/3 to 1/2 lower because you 'get the privilege of working at the world's best _________'. And your rural community program struggling to recruit applicants already is not suddenly going to pay residents more money - if they had those kind of resources, they wouldn't be a third tier bottom of the list choice to begin with.

I think instead of one month of anxiety followed by one week of panic and absolute hell you'll get an entire year or two worth of hell. People will be forced into specialties 1-2 years into medical school. I see none of the perceived benefits of abolishing the match actually materializing, even if you force programs to have rules like you can only offer interviews in September and only interview in January and only have 30 days to offer a job.

And quite frankly, if you abolish the match, I see zero incentive for any residency program to try to follow whatever rules you would replace it with.

Hoping for a spirited discussion and eager to hear other's viewpoints.

 

[Dral]

An option is rolling acceptances. That’s how my fellowship app cycle worked. It seemed to favor the programs over the applicant.

A modified rolling process like med skool acceptances is possible, but not sure how well it would work.

 

[SunBakedTrash]

Some fellowships don’t have matches. The whole cycle leaves you scrambling and having to make promises you don’t feel comfortable making just to make sure you aren’t the only one standing when the music stops. This is even worse if you’re not competitive or geographically restricted. The match might not be perfect but it’s security for most. Never underestimate the politics involved in filling positions.

 

[whataschool_classof24]

I think what you're seeing here on this forum is just the human nature of wanting to complain about things

 

[GoSpursGo]

An option is rolling acceptances. That’s how my fellowship app cycle worked. It seemed to favor the programs over the applicant.

A modified rolling process like med skool acceptances is possible, but not sure how well it would work.

Some fellowships don’t have matches. The whole cycle leaves you scrambling and having to make promises you don’t feel comfortable making just to make sure you aren’t the only one standing when the music stops. This is even worse if you’re not competitive or geographically restricted. The match might not be perfect but it’s security for most. Never underestimate the politics involved in filling positions.

Just throwing this out there, this is also exactly how it works when you're on the actual job market. And it absolutely favors the program/job because they can put you on a timeline where you can't really fully consider (or even receive) all of your options before you have to make a decision.

 

[SunBakedTrash]

You have more recourse when looking for post-training work. It’s not hard for some vengeful PD on a power trip to ruin your career because you waffled and then took another spot.

 

[slowthai]

Net-net, the match is better than the alternative for most students. I mean, all the politics and bullcrap post-interview communication going on now? Imagine that but 100000x worse

But cut out all the BS. No more playing games on either side. No more empty promises. No more lying to programs. Just ban all of it.

 

[aldol16]

I don't know if there's a better process out there. Since the match favors applicants as opposed to programs, it's probably as close you can get to an efficient process from the perspective of applicants as possible.

 

[sloop]

Forensic psychiatry does not use the match. I wound up accepting an offer for fellowship in the spring of 2020 . . . for a position that starts July 2021.

Point being that without the match or some unified system of application, programs just try to fill their spots earlier and earlier. In the case of forensic psychiatry, that kind of sucks for the applicant if your program happens to expose you to forensics later in your residency and you decide you like it. You could be left either scrambling for open spots or completely out of luck for a position directly after residency.

This could also pose a problem because the applications generally require you to submit multiple clinical writing samples, preferably redacted forensic reports. If you haven’t completed a forensic rotation by around the middle of PGY-3 (which is very possible at many psych programs) you may not actually have any relevant reports to submit with your application.

It can also put you in the position where you have X days to accept an offer, meanwhile you’re waiting to see if someone else might offer a position.

I mean, it worked out okay for me but applying outside of the match is definitely not optimal. Applying to residency (through the match) was definitely a better system.

On the other hand, I don’t think the match is responsible for trainee wages being what they are. Even in my field which does not use the match, it’s not like you get to negotiate your salary. As a forensics fellow, you’re generally just going to be paid whatever a PGY-5 is paid at that institution. They’re not going to offer you a different contract to entice you.

Also, if a place was going to do that, there’s no stopping them from doing it for positions in the match as well. They could just offer more money and advertise this on their interview days in hopes that they would entice more people high on their rank list. The reason they don’t do this has nothing to do with the match but with the entire concept of medical training itself. These programs hold the keys to the kingdom of specialty practice, which is highly desired by graduating medical students. They simply don’t have to pay you “what you’re worth” because they’re banking on the value of making you eligible for specialty board certification.

 

[YCAGA]

There are alternatives. They are just worse

 

[SurfingDoctor]

You could become a senator from Kentucky...

Or... Dr. Nick...

 

[operaman]

Every time I hear people talk about getting rid of the match, I’m reminded of Churchill’s famous quote about democracy:

“democracy is the worst form of Government except for all those other forms that have been tried from time to time.…”

I think the same can be said of the Match.

 

[Lawpy]

Keep the match but impose application caps and ban all post interview communication

 

[Matthew9Thirtyfive]

But cut out all the BS. No more playing games on either side. No more empty promises. No more lying to programs. Just ban all of it.

The logistics of the game theory involved make it completely pointless for applicants to lie, but programs can benefit by doing so. Good luck getting them to stop.

 

[slowthai]

The logistics of the game theory involved make it completely pointless for applicants to lie, but programs can benefit by doing so. Good luck getting them to stop.

Of course, but I was really talking about how the match could be improved hypothetically.

 

[qwerty89]

Keep the match but impose application caps and ban all post interview communication

Application caps create new problems.

If you are applying Derm with 235/245 do you even bother applying to some high tier places knowing its a long shot even though its your dream? Or do you pack your list with only bottom tier programs to maximize your chance of matching at the expense of the opportunity of matching at a better program?

 

[NotAProgDirector]

NRMP Match: Good, bad or ugly? | Student Doctor Network

Similar thread from 2019. Interesting to compare the theoretical question of whether residencies could do virtual interviews to what happened this year.

 

[Lawpy]

Application caps create new problems.

If you are applying Derm with 235/245 do you even bother applying to some high tier places knowing its a long shot even though its your dream? Or do you pack your list with only bottom tier programs to maximize your chance of matching at the expense of the opportunity of matching at a better program?

I think that depends on the cap being set. Something like 70 i think would be reasonable but an exact number really depends on looking at the trends over several years.

 

[Lucca]

the match algorithm and process is not the problem. The problem is the gamification of the residency selection process. Lots of people complain about program empty words, but the fix to that is incredibly simple: dont believe them. If your advisors arent telling you that, they are doing you a disservice.

 

[Lawpy]

the match algorithm and process is not the problem. The problem is the gamification of the residency selection process. Lots of people complain about program empty words, but the fix to that is incredibly simple: dont believe them. If your advisors arent telling you that, they are doing you a disservice.

The gamification arose from overapplication imo. Fix the problem of overapplication by imposing caps and the issues will be resolved. For all of SDN's obsession with top programs and matching highly, a cap set at 50-70 is reasonable

 

[Lawpy]

Oh yeah another big change.

Stop forcing MS4s to accept interview invites immediately (and thus forcing them to ditch rotations/aways/sub Is halfway to go to their phones or suddenly stop on side of road or other stressful, potentially dangerous situations). That is effectively the most idiotic thing i have ever seen.

Give them the entire day to accept the invite and guarantee that interview slot is held for them.

 

[VA Hopeful Dr]

Every time I hear people talk about getting rid of the match, I’m reminded of Churchill’s famous quote about democracy:

“democracy is the worst form of Government except for all those other forms that have been tried from time to time.…”

I think the same can be said of the Match.

To paraphrase: the Match is the worst way to decide who goes where for residency except for every other way that's been tried.

 

[ArdorAyurveda]

Application caps create new problems.

If you are applying Derm with 235/245 do you even bother applying to some high tier places knowing its a long shot even though its your dream? Or do you pack your list with only bottom tier programs to maximize your chance of matching at the expense of the opportunity of matching at a better program?

If the applicants dream is to go to top tier derm, then they should have gotten higher step scores.

So in this case, if application caps were involved, this theoretical derm applicant with the 235/245 step scores should temper his/her expectations and apply to bottom tier derm programs...he/she can always move to that dream derm program as an attending.

Application caps are a reasonable, easily implementable solution to the problem of over-application, and it will encourage applicants to be more selective about where they send applications to.

 

[kopftonmd]

Oh yeah another big change.

Stop forcing MS4s to accept interview invites immediately (and thus forcing them to ditch rotations/aways/sub Is halfway to go to their phones or suddenly stop on side of road or other stressful, potentially dangerous situations). That is effectively the most idiotic thing i have ever seen.

Give them the entire day to accept the invite and guarantee that interview slot is held for them.

This x1000000000. I also like the option of reducing the number of apps.

This all said, some of the angst seems to be brought on by us students ourselves - for many stronger applicants, the issue comes from the shift of perspective from "pls let me match anywhere!!!!" to "I want to go to XYZ fancy-pants program." If you just want to match anywhere at all (in a specialty), you can estimate your chances pretty well based on the NRMP data.

 

[ohmanwaddup]

Oh yeah another big change.

Stop forcing MS4s to accept interview invites immediately (and thus forcing them to ditch rotations/aways/sub Is halfway to go to their phones or suddenly stop on side of road or other stressful, potentially dangerous situations). That is effectively the most idiotic thing i have ever seen.

Give them the entire day to accept the invite and guarantee that interview slot is held for them.

This. I'm more nervous about missing an interview slot at my top spot then I am for the actual interview

 

[srirachamayonnaise]

I don’t see the point of reinventing the wheel when the match actually generally works for most of the candidates. The problem is that people apply to too many places and that flood of applications make evaluation of candidates impossible and hence the programs are overloaded with fake listings, like online apartment listings on Craigslist. The simple solution is everyone is limited to 30 applications. That will force all of us to only apply to programs you are genuinely interested in. And that will give programs ample time to review all the applications so that some great applicants don’t just get screened out due to some technicality. By limiting application numbers, the overall match rate will not change but the optimization of the outcome will be much higher. It will save all stakeholders money and time.

 

[7331poas]

That will force all of us to only apply to programs you are genuinely interested in

Not really true. I am genuinely interested in MGH internal medicine. I wouldn't apply to it even with top scores if there were application caps. Why would I play with fire by applying somewhere competitive?

 

[srirachamayonnaise]

Not really true. I am genuinely interested in MGH internal medicine. I wouldn't apply to it even with top scores if there were application caps. Why would I play with fire by applying somewhere competitive?

Well within your reach as well I shall add

 

[Lawpy]

Not really true. I am genuinely interested in MGH internal medicine. I wouldn't apply to it even with top scores if there were application caps. Why would I play with fire by applying somewhere competitive?

If the cap is set at 50 and you are truly a top tier applicant, there's no reason not to apply to MGH.

 

[Med Ed]

If the cap is set at 50 and you are truly a top tier applicant, there's no reason not to apply to MGH.

Premedical students seem to have little trouble with the concept of applying to a blend of target, safety, and reach schools.

 

[operaman]

Great minds!

I’m probably one of the dinosaurs that thinks the match is actually a fabulous system. It’s stressful sure, but so is medicine. I don’t think stress alone is reason enough to revamp anything. Eliminating unnecessary stress is a good thing, but in the end there are aspects of career advancement and even medicine itself that are inherently stressful. Unfortunately the Gen Z group has started rebranding stressful as abusive or unsafe and using these new terms to push for change (though to what nobody knows).

 

[SunBakedTrash]

Great minds!

I’m probably one of the dinosaurs that thinks the match is actually a fabulous system. It’s stressful sure, but so is medicine. I don’t think stress alone is reason enough to revamp anything. Eliminating unnecessary stress is a good thing, but in the end there are aspects of career advancement and even medicine itself that are inherently stressful. Unfortunately the Gen Z group has started rebranding stressful as abusive or unsafe and using these new terms to push for change (though to what nobody knows).

Everyone is an expert in everything and everyone should get what they want unless it conflicts with what I want. Not sure this is limited to Gen Z though. Boomers are some of the worst.

 

[Gilakend]

Premedical students seem to have little trouble with the concept of applying to a blend of target, safety, and reach schools.

This is something that has recently surprised me that it seems some people don't do in the match? Maybe I'm just naive to the match process.

For example, in another thread when wondering why the couples matching rate was higher than individual, someone said "Maybe they apply to more realistic or lower ranked programs?" which was astounding to me. I always assumed the goal was the literally match anywhere > nowhere, but it seems like, especially good applicants, have VERY top-heavy lists compared to what would be common advice for a top applicant applying to med school, which as you said would be very blended still.

 

[YCAGA]

This is something that has recently surprised me that it seems some people don't do in the match? Maybe I'm just naive to the match process.

For example, in another thread when wondering why the couples matching rate was higher than individual, someone said "Maybe they apply to more realistic or lower ranked programs?" which was astounding to me. I always assumed the goal was the literally match anywhere > nowhere, but it seems like, especially good applicants, have VERY top-heavy lists compared to what would be common advice for a top applicant applying to med school, which as you said would be very blended still.

I thought applying with the goal of matching ANYWHERE was the standard logic too, but I have heard of people applying to a handful of CT and vascular programs when there are only like 30-80 spots in the entire country and way more applicants than spots. I think some people are so delusional about location and not living in a “crappy city” that they will risk going unmatched. Or they are so arrogant that they don’t think it’s a realistic risk for them.

 

[YCAGA]

I have met people who have said they only want to match in the California and/or the Northeast and will only apply to those locations. Because they “can’t be happy without real culture.” You know what is worse than doing residency in Detroit or Minneapolis? Being chronically underemployed and unemployed for the next 40 years when you don’t match.

 

[operaman]

Everyone is an expert in everything and everyone should get what they want unless it conflicts with what I want. Not sure this is limited to Gen Z though. Boomers are some of the worst.

This is true. I think the anger at the match is simply misdirected though. The real underlying issue is that there are more applicants than positions for many specialties and this is gradually getting worse each year. There’s simply no way to retool the application process to alter this underlying fact.

I’m generally against anything that disempowers the applicants and things like application caps or getting rid of the match entirely would take substantial power from students. The only thing I’ve thought might be helpful would be to have the more competitive fields all do an early match like Ophtho or urology or the entire military system already do. Have it timed out such that applicants who failed to match could decide if they wanted to reapply in those fields or look for another position in the main match. Maybe some kind of cutoff if your field drops below X match rate for Y number of years then you have to go to the earlier match date.

 

[YCAGA]

This is true. I think the anger at the match is simply misdirected though. The real underlying issue is that there are more applicants than positions for many specialties and this is gradually getting worse each year. There’s simply no way to retool the application process to alter this underlying fact.

I’m generally against anything that disempowers the applicants and things like application caps or getting rid of the match entirely would take substantial power from students. The only thing I’ve thought might be helpful would be to have the more competitive fields all do an early match like Ophtho or urology or the entire military system already do. Have it timed out such that applicants who failed to match could decide if they wanted to reapply in those fields or look for another position in the main match. Maybe some kind of cutoff if your field drops below X match rate for Y number of years then you have to go to the earlier match date.

An early match would be especially ideal for the integrated residencies for specialties that are also accessible through a general surgery fellowship (plastics, vascular, thoracic). It would be a win-win for general surgery programs and applicants in my mind. Applicants would not be forced to dual apply until after they failed to match the integrated program. General surgery programs would know that anyone applying to them was not and could not rank 20 vascular programs before a single GS program. There still is the issue that people might think you "don't want to be there" if you have a heavy sub-specialist resume, but did the generations of surgeons who went through general surgery before fellowship face that bias? Not to my knowledge.

 

[7331poas]

Premedical students seem to have little trouble with the concept of applying to a blend of target, safety, and reach schools.

The data suggests you are wrong, especially considering applications per applicant is ballooning. But continue with the boomer arguments.

 

[VA Hopeful Dr]

Great minds!

I’m probably one of the dinosaurs that thinks the match is actually a fabulous system. It’s stressful sure, but so is medicine. I don’t think stress alone is reason enough to revamp anything. Eliminating unnecessary stress is a good thing, but in the end there are aspects of career advancement and even medicine itself that are inherently stressful. Unfortunately the Gen Z group has started rebranding stressful as abusive or unsafe and using these new terms to push for change (though to what nobody knows).

I had no issue with the Match and I was a very weak medical student.

As I've said before, I do think that SOAP is miles better than the old scramble system (not sure if you're enough of a dinosaur to remember that). I'm sure there are ways that it could be improved and I'm sure it's being looked at fairly regularly.

 

[Med Ed]

The data suggests you are wrong, especially considering applications per applicant is ballooning. But continue with the boomer arguments.

Number of AMCAS applications per applicant:
2011: 14
2020: 17

Number of ERAS applications per applicant (2020):
Total: 95.0
UMGs: 69.6
IMGs: 138.5

 

[YCAGA]

Number of AMCAS applications per applicant:
2011: 14
2020: 17

Number of ERAS applications per applicant (2020):
Total: 95.0
UMGs: 69.6
IMGs: 138.5

I am not following the significance of these numbers. It is an order of magnitude easier to apply to 70 residencies versus 70 medical schools in terms of hours spent. Honestly 10 times more time consuming is probably an understatement. It is also like 1/4 to 1/6th cheaper to apply to additional residencies versus additional medical schools. Very roughly you are looking at $1500 in application fees to apply to 70 residencies and $7000 to apply to 70 medical schools.

 

[Lawpy]

I am not following the significance of these numbers. It is an order of magnitude easier to apply to 70 residencies versus 70 medical schools in terms of hours spent. Honestly 10 times more time consuming is probably an understatement. It is also like 1/4 to 1/6th cheaper to apply to additional residencies versus additional medical schools. Very roughly you are looking at $1500 in application fees to apply to 70 residencies and $7000 to apply to 70 medical schools.

Would a possible solution be to make residency apps a lot more expensive to cut down the volume???

 

[YCAGA]

Would a possible solution be to make residency apps a lot more expensive to cut down the volume???

I would rather people get into competitive specialities somewhat based on merit not the limit on Daddy’s Amex.

 

[Lawpy]

I think the anti-Match sentiment has less to do with the Match itself and more to do with all the problems in the residency app process and overapplication. The Match itself is the best thing possible for applicants.

 

[Lawpy]

I would rather people get into competitive specialities somewhat based on merit not the limit on Daddy’s Amex.

I'm trying to see how to stop the overapplication without caps. From what you outlined, it seems to be either making the apps more expensive or adding more hoops like secondaries. They both suck but allowing apps grow unchecked is not sustainable, and so caps become the necessary and inevitable solution.

 

[YCAGA]

I'm trying to see how to stop the overapplication without caps. From what you outlined, it seems to be either making the apps more expensive or adding more hoops like secondaries. They both suck but allowing apps grow unchecked is not sustainable, and so caps become the necessary and inevitable solution.

Well I don’t think there is much wrong with the current system where people are weeded out by stats and IMG/DO status. That is how a meritocracy works.

I don’t think capping applications will help much. Any number that would let PD’s actually consider every application will be way too low. So then we are left with a watered down solution of like max 40 or 50 applications. That doesn’t seem fair to the top applicants when we know number of programs ranked is the strongest predictor of a successful match in competitive specialities.

 

[Lawpy]

Well I don’t think there is much wrong with the current system where people are weeded out by stats and IMG/DO status. That is how a meritocracy works.

I don’t think capping applications will help much. Any number that would let PD’s actually consider every application will be way too low. So then we are left with a watered down solution of like max 40 or 50 applications. That doesn’t seem fair to the top applicants when we know number of programs ranked is the strongest predictor of a successful match in competitive specialities.

The Charting Outcomes gives plenty of very clear information to help people assess their chances for specialties. The system is increasingly being less meritocratic because the problem of overapplication is leading to metrics being repeatedly abused aggressively (see Step 1 P/F issue, widespread variability in clinical grades, widespread variability in determining AOA, widespread variability in research productivity and letter quality). This makes the metrics less meaningful and school prestige and other subjectives more impactful. That's a major problem.

Capping the apps to 50 is reasonable in that it forces people to prioritize where to apply based on using information from Charting Outcomes. It's definitely possible to apply to reaches because 50 is a big enough number to take that chance. PDs will be less overwhelmed and will take the time to seriously consider more if not most/all applications

 

[Lem0nz]

NRMP Match: Good, bad or ugly? | Student Doctor Network

Similar thread from 2019. Interesting to compare the theoretical question of whether residencies could do virtual interviews to what happened this year.

Took me awhile but this was a great thread to read from start to end. My conclusion is... it probably isn't going to get better than the match no matter what we do.

I think early applications and moving competitive specialties up into their own new bracket that happens before main interviewing and/or matching will destroy the couples match.

I strongly agree with YCAGA that application caps, to be meaningful, would have to be prohibitively low. Think 30 or less.

Increasing cost for applications coupled with supplementary applications making the entire process excruciatingly more painful would probably work for a couple years, and then the arms race would just intensify and the loan money would be increased and we'd be back where we are now, but worse.

I agree that the process is not good enough, but I don't think any of the solutions proposed will have meaningful impacts, at all, unfortunately. The underlying problem is supply and demand and demand is outstripping supply so the arms race on the demand side (applicants) is going to get worse until it simply can't get any worse (everyone applies to every program) and that will be our steady state. That's honestly the only logical conclusion I see here.

 

[Lawpy]

Took me awhile but this was a great thread to read from start to end. My conclusion is... it probably isn't going to get better than the match no matter what we do.

I think early applications and moving competitive specialties up into their own new bracket that happens before main interviewing and/or matching will destroy the couples match.

I strongly agree with YCAGA that application caps, to be meaningful, would have to be prohibitively low. Think 30 or less.

Increasing cost for applications coupled with supplementary applications making the entire process excruciatingly more painful would probably work for a couple years, and then the arms race would just intensify and the loan money would be increased and we'd be back where we are now, but worse.

I agree that the process is not good enough, but I don't think any of the solutions proposed will have meaningful impacts, at all, unfortunately. The underlying problem is supply and demand and demand is outstripping supply so the arms race on the demand side (applicants) is going to get worse until it simply can't get any worse (everyone applies to every program) and that will be our steady state. That's honestly the only logical conclusion I see here.

Why 30 for app caps? The current number is apparently 90 apps/applicant which is way too many but that's exaggerated by IMGs applying hundreds of places

 

[Lem0nz]

Why 30 for app caps? The current number is apparently 90 apps/applicant which is way too many but that's exaggerated by IMGs applying hundreds of places

If your goal is that PDs actually give stronger consideration and more time to each application they receive the number has to be lower than 50 I think. It has to have consequences and weight.

For example, 40-50 was the average number of applicants to general surgery a decade ago when I was applying. My program was a middle of the road at best community surgery program and at that time they were still HEAVILY screening on board scores, IMG status, and if they thought you had legitimate interest in going there or you were a Harvard grad gaslighting as a safety school and dumped half the applications in the garbage without looking at them. That was just reality.

I'm great friends with the coordinator and we talk often, and the only thing that has changed is that in the new environment/arms race they've cranked that minimum step score up because they can. Nothing else has changed.

Edit: Your point of application caps is that they demonstrate actual willingness and interest to truly attend the residency if you apply to it. 50 did not achieve that goal in the past. The secondary goal (cost containment of the process) is, for better or worse, not a worth while goal we should be measuring if I'm being perfectly honest. I know (I KNOW) that the extra 2k or 5k or whatever its costing these days is batty and ****ty as a medical student because I was there, I applied to 120 programs out of fear from a low step 1 (216), but it is insignificant over the course of our careers when we get a real paycheck a year later and when our loans evaporate because of attending salary/PSLF combination. It feels fking awful in the moment but any attending can tell you that 10k or 100k is not relevant over the course of your career. This is also why increasing the cost of the applications won't matter. If you crank that cost up and it suddenly costs 50k instead of 10k to apply and interview, it'll hurt like hell in the moment but you'll pay it and ten years later you'll just shrug and move on.