I just don't understand how this organization has obtained such a stranglehold on everything related to obtaining and keeping residency positions.
For all the talk of ethics and professionalism, I have to say that this process has been one of the least ethical and professional things I've ever been associated with professionally in all my 34 years.
From what I understand, if someone matched...and ends up deciding they would rather go in a different direction...and the PD agrees that the individual can look elsewhere, it doesn't matter because the only entity that can null the contract is the NRMP.
That makes no sense.
*disclaimer: I think I'm going to end up getting exactly what I tried for...but it doesn't make me feel any less dirty about this "ethical process".
It's a good question / point.
From the NRMP standpoint, the concern is that if you can back out of a match, it leaves the program's short. So, for example, let's say someone matches into my IM program. The scramble list comes out, and they see an ortho spot is open. They decide they would rather have that and apply and get accepted. Now they contact me and tell me that they are not coming. They ask for my "permission". What exactly am I supposed to do? If I say no, I know I'll get a bitter unhappy resident at best, at worst they will submit their notice on day 1. If I say yes, then I have an open spot to try and fill. What exactly do I do? Call the next person on my rank list, and see if they want to come -- thereby pushing the problem onto someone else?
The opposite is possible too. Let's say I match you, and then the Chairman's son goes unmatched and wants a spot. I call you up, tell you that I don't think it's going to work and I need you to contact the NRMP and give them your permission. If you don't, I make your life hell and make sure you fail out anyway. Sounds crazy, but it could happen.
In a nutshell, the NRMP feels they need to be the final arbiter so that neither programs nor applicants can feel pressured into voiding a match. The price we pay for that is inflexibility. How often these "bad events" would happen is unclear.
Today has not given me a lot of faith in the managed scramble which would only allow interface between programs and applicants via ERAS,
I second this. It will come up at our next national meeting. If no one else stands up to the mic to say it, I will.
I don't think it's the FAULT of technology... it's the lack of human thought about designing a system that incorporates the expected failures of technology. I feel like there needs to be a 2nd round of matching where the people that didn't match can go online and select which remaining programs they want to apply to and do it within 24 hours... and at the end of 24 hours, the programs look at a list of all the applicants who are unmatched but interested in their program and either offer a position or rank them and do another round of matching. NRMP at least needs to make a system that incorporates expectations for technology failures and that is more fair for both the applicants and the programs. If I was a PD and wasn't getting applications from a good candidate because of an ERAS/NRMP issues or a applicant's internet issues, I'd be upset.
Of note, what you're describing is SOAP which is planned to replace the scramble next year. Agreed on tech backup plans. As I mentioned on a different thread, I think the bigger problem is going to be ERAS. trying to deliver 1000's of applications in a short period of time, with each application being several megabytes large, is a huge challenge. ERAS could migrate to a cloud based system -- apps aren't sent to programs but instead can be seen by clicking on links -- but that equally has problems associated with it and can be attacked with a DoS attack.
The fact that you and your employer don't have the "right" to void the contract without a waiver from NRMP.
Addressed above
The fact that they have so much control over people's rights to obtain said job.
Not completely certain what you are referring to here. I agree that some reforms are needed. Banning people from the match should not be the NRMP's sole decision, or a reasonable and affordable (for applicants) review / appeal process is needed.
The fact that if you are looking at dually accredited programs, you really have to choose which match to go into...is total crap...and I will work to end this policy in my time on earth. This could EASILY be worked around.
No arguments here. The ideal would be to have the MD and DO matches integrated. I get the sense that the major force preventing that is the AOA. I expect they worry that many DO students would favor the MD match, and they won't want to make it easier for them. Note that this is based solely on my gut -- I know nothing about the inner workings of the AOA.
The fact that after all the money these people rake in from people who are often times using BORROWED MONEY at 6-8% interest to pay said fees...only to completely botch things and screw things up, is completing unacceptable and unprofessional.
The fact that students have to borrow large amounts of money to attend medical schools is not the fault of the NRMP or ERAS.
NRMP and ERAS for everyone that matched worked just fine. I agree that the scramble this year was, so far, a fiasco. And, the NRMP and ERAS certainly share some/much of the blame. It's unacceptable. Whether it's unprofessional is unclear. We don't know if ERAS/NRMP were simply underprepared, the target of a DoS attack, whether the failure was in their network provider / routers, etc. Given the circumstances, they may have done the best that they could. That doesn't excuse it, but it's not unprofessional which suggests that they either purposely did this, or failed to try their best to fix it.
And what is the point of not being able to find out where you matched? That just flat stupid, and a power trip.
Another good question. The answer is tradition, and "face saving" for those US grads who have to scramble. Allowing them to scramble before the match results are released allows them to open an envelope like everyone else and fake surprise. Whether that's "worth it" is an interesting question to ask.
Tradition is hard to break.
What cracked me up the most was that the process of filling out the ACGME ROL was completely archaic when compared to the AOA ROL.
I would love to know more about this. Post or PM me.
