An effort to reduce the stress of the post-match scramble may become reality for the class of 2006 if the National Resident Matching Program Board of Directors approves a proposed second round for the process. The decision could come during the board's meeting in May.
The proposal, one of a number considered over several years by the NRMP Committee on the Unmatched Applicant, grew from concern about "the pressure to make uninformed decisions during the chaotic 24-hour period after applicants learned whether they had matched," says an NRMP proposal for a second match.
National Resident Matching Program Ponders Need for Second Match
By Leslie Champlin
2/1/2005
This story first appeared in the February 2005 FP Report.
Before the second match, students who didn't place in the first match would be notified. They would apply for unfilled positions through NRMP's Electronic Residency Application Service. Students and programs would submit rankings. The NRMP would verify match results, post them to its Web site and send them via e-mail according to the current match schedule. Results of the first and second matches would be announced concurrently.
A recent NRMP survey found 70 percent of U.S. medical school seniors and 85 percent of independent applicants favored a second match.
A recent NRMP survey found 70 percent of U.S. medical school seniors and 85 percent of independent applicants favored a second match.
Jenny Butler, M.D.:
"The current scramble system often forces people to make rash decisions in fear that they will miss out."
"The current scramble system often forces people to make rash decisions in fear that they will miss out."
"I think everyone's goal for a second match system would be to lessen the anxiety and stress placed on applicants, program directors and medical school officials who must participate in the current scramble," said Gretchen Dickson of Pittsburgh, student member of the AAFP Board of Directors. "A second match system could create a better fit between applicants and programs than the current scramble system."
Jenny Butler, M.D., of Ankeny, Iowa, resident representative to the AAFP Committee on Chapter Affairs, agreed. A second match "gives both residency programs and students additional time to make big decisions," she said. "I think the current scramble method is insufficient. I like the idea of having a designated period for unmatched students and unfilled programs to find each other before match day."
Moreover, a second match would give unmatched students a greater sense of control over their ultimate residency placement, said Dickson.
"A second match system with an opportunity to rank programs would lessen the panic associated with the scramble," she said.
Butler agreed. "Students who don't match will be allowed more time to explore their other options," she said. "The current scramble system often forces people to make rash decisions in fear that they will miss out."
Jenny Butler, M.D., of Ankeny, Iowa, resident representative to the AAFP Committee on Chapter Affairs, agreed. A second match "gives both residency programs and students additional time to make big decisions," she said. "I think the current scramble method is insufficient. I like the idea of having a designated period for unmatched students and unfilled programs to find each other before match day."
Moreover, a second match would give unmatched students a greater sense of control over their ultimate residency placement, said Dickson.
"A second match system with an opportunity to rank programs would lessen the panic associated with the scramble," she said.
Butler agreed. "Students who don't match will be allowed more time to explore their other options," she said. "The current scramble system often forces people to make rash decisions in fear that they will miss out."
Peter Nalin, M.D.:
"For the vast majority of applicants, the match works very well. It's difficult to address the fitness of a second match as a 'solution' because the 'problem' hasn't been well described yet. Why complicate what works well? "
"For the vast majority of applicants, the match works very well. It's difficult to address the fitness of a second match as a 'solution' because the 'problem' hasn't been well described yet. Why complicate what works well? "
Equally important, a second match may be of benefit to family medicine, said Michael King, M.D., of Lexington, Ky., resident member of the AAFP Board.
"I think there is some benefit of a second match for family medicine in general because of the fill rates over the last few years," he said. "Last year, family medicine filled 78.8 percent of their slots in March, but, as usual, increased it to 93.5 percent by July. By having the second match by the NRMP, applicants and programs would be bound to NRMP rules, which would provide security that people would fulfill their commitments, unlike some situations that can occur during the scramble process, where people keep fielding offers or simply do not come to the program as they said they would."
The idea does have challenges. Program directors and medical school officials aren't as keen on the idea. Only 44 percent of them favor it, according to the NRMP survey. The officials suggest the NRMP proposal is a solution searching for a problem and, if implemented, could place more burden on the majority of matched students than it would resolve issues for unmatched students.
"Ever since the match was introduced, a few students have not matched annually," said Peter Nalin, M.D., president of the Association of Family Medicine Residency Directors. "Yet for the vast majority of applicants, the match works very well. It's difficult to address the fitness of a second match as a ‘solution' because the ‘problem' hasn't been well described yet. Why complicate what works well?"
Moreover, residency directors question the wisdom of discouraging interviews during a second match. An applicant's ability to communicate and demonstrate professionalism and preparation are important, and an interview helps identify those who offer those skills, they say.
"I think there is some benefit of a second match for family medicine in general because of the fill rates over the last few years," he said. "Last year, family medicine filled 78.8 percent of their slots in March, but, as usual, increased it to 93.5 percent by July. By having the second match by the NRMP, applicants and programs would be bound to NRMP rules, which would provide security that people would fulfill their commitments, unlike some situations that can occur during the scramble process, where people keep fielding offers or simply do not come to the program as they said they would."
The idea does have challenges. Program directors and medical school officials aren't as keen on the idea. Only 44 percent of them favor it, according to the NRMP survey. The officials suggest the NRMP proposal is a solution searching for a problem and, if implemented, could place more burden on the majority of matched students than it would resolve issues for unmatched students.
"Ever since the match was introduced, a few students have not matched annually," said Peter Nalin, M.D., president of the Association of Family Medicine Residency Directors. "Yet for the vast majority of applicants, the match works very well. It's difficult to address the fitness of a second match as a ‘solution' because the ‘problem' hasn't been well described yet. Why complicate what works well?"
Moreover, residency directors question the wisdom of discouraging interviews during a second match. An applicant's ability to communicate and demonstrate professionalism and preparation are important, and an interview helps identify those who offer those skills, they say.
How a second match would work
"Selecting residents without interviews deletes those important attributes from the local selection process," said Nalin. "Why exclude onsite interviews from the unmatched group? This group deserves and requires comparable attention and scrutiny in the selection process."
Officials, students and residents all express some concern about the effect of delaying announcement of match results until the end of the second phase. Such a delay is envisioned in the NRMP proposal (see box to the right).
A second phase would mean applicants who matched in the first round would not know the name of their residency programs until the second phase was completed, according to King. "Uncertainty about where you're going would be very stressful. Clearly, unmatched applicants and programs would benefit by a second match, but it would certainly be at the emotional and psychological expense of those who matched initially," he said.
The NRMP acknowledges timing issues in its proposal, noting that the schedule for ranking deadlines could pose problems for osteopathic students. If the deadline for the NRMP phase one preceded the American Osteopathic Association match results, osteopathic students couldn't participate in the NRMP. Likewise, dually accredited programs may not be able to place unfilled AOA positions in the NRMP.
Moreover, though unmatched students and unfilled programs could be "required" to participate in a second match, monitoring compliance would be difficult, according to the NRMP.
"It is likely that some participating applicants and programs would reach agreements in the period between the first and second matches or that programs would offer their unfilled positions to applicants who had not participated in the match at all," the proposal says.
Not all students would match in the second phase. Nor would all positions fill. The end of the second phase still would mark the beginning of a scramble.
Of greatest concern: Students might shorten their ranking list and wait for the second match to list their "safety" programs. That, says the NRMP, would mean "many positions may be filled in phase one by independent applicants, leaving more unmatched seniors at the conclusion of phase two."
Officials, students and residents all express some concern about the effect of delaying announcement of match results until the end of the second phase. Such a delay is envisioned in the NRMP proposal (see box to the right).
A second phase would mean applicants who matched in the first round would not know the name of their residency programs until the second phase was completed, according to King. "Uncertainty about where you're going would be very stressful. Clearly, unmatched applicants and programs would benefit by a second match, but it would certainly be at the emotional and psychological expense of those who matched initially," he said.
The NRMP acknowledges timing issues in its proposal, noting that the schedule for ranking deadlines could pose problems for osteopathic students. If the deadline for the NRMP phase one preceded the American Osteopathic Association match results, osteopathic students couldn't participate in the NRMP. Likewise, dually accredited programs may not be able to place unfilled AOA positions in the NRMP.
Moreover, though unmatched students and unfilled programs could be "required" to participate in a second match, monitoring compliance would be difficult, according to the NRMP.
"It is likely that some participating applicants and programs would reach agreements in the period between the first and second matches or that programs would offer their unfilled positions to applicants who had not participated in the match at all," the proposal says.
Not all students would match in the second phase. Nor would all positions fill. The end of the second phase still would mark the beginning of a scramble.
Of greatest concern: Students might shorten their ranking list and wait for the second match to list their "safety" programs. That, says the NRMP, would mean "many positions may be filled in phase one by independent applicants, leaving more unmatched seniors at the conclusion of phase two."
