How The National Residency Matching Program ("The Match") Works

Every spring, graduating medical students in the United States stress out in the middle of March over the results of the the National Residency Matching Program (NRMP), generally celebrated by medical school as "Match Day." No other profession operates like this. Lawyers after law school, PhDs after graduate school, MBAs after business school - all enter a competitive job market. Medicine instead has a nationalized system that ostensibly relies on de jure collusion between residency programs to assure a reasonable allocation of residents to programs on a predictable schedule. How did this come to be?

The History of The Match

In the United States prior to 1952, medical students found residency positions much like their colleagues in other fields, through a decentralized, competitive market. However, as residency programs wanted the best residents, they often competed to offer spots earlier and earlier to the brightest candidates, causing undue stress. As Sara Robinson writes:

Medical internships were introduced around the turn of the last century as an optional form of postgraduate education. Because interns were a source of cheap labor for hospitals, Roth explains, slots soon outnumbered applicants and competition for interns was fierce. Salaries and working conditions of the internships were specified ahead of time, even then, and there was no negotiation in the process. Thus, the competition manifested itself in timing rather than price: Hospitals began to insist that their offers be finalized before those of their competitors. The average date for finalizing an internship gradually crept from the end to the beginning of the senior year. By the mid-1940s, internships were being finalized at the beginning of the junior year of medical school, and some inquiries came even during the sophomore year. 

Recognizing that the situation was out of hand, the Association of American Medical Colleges adopted a resolution prohibiting medical schools from disseminating student transcripts or reference letters before a certain date during the senior year. This fixed the advancing-date problem but created a new one: Students tended to hold onto offers as long as possible, hoping for offers from better schools. The hospitals were unhappy with this situation; if a student rejected an offer at the last moment, the hospital might have trouble filling the slot with a desirable applicant. So the hospitals, still battling fiercely for residents, passed a series of resolutions shortening the time a student could sit on an offer. At one point, hospitals had telegrams offering residency positions delivered at precisely 12:01 A.M. on the earliest allowed day; the students were forced to accept or reject these offers within hours. 

In response to this clearly unsustainable situation, all parties decided, in the early 1950s, that it was time for drastic changes in the procedure. The centralized system created as a result had students and hospitals communicating with each other as before, but it replaced the rounds of offers by ranking lists, submitted by both sides to a central authority. Following a standard procedure, the central authority then matched students with residency programs. Such was the inception of the residency-matching algorithm, although it took some fiddling (trial and error) to get a procedure that worked.

The situation improved, although economists and game theorists argued that the situation favored the hospitals.

The NRMP Algorithm

In general, the problem of matching residents to programs is one of two-sided matching, or more amusingly called the "Stable Marriage Problem."  The basic problem is stated as:

Imagine a set of n boys and n girls. Each boy B ranks each girl G, and vice versa. The first boy goes to his preferred girl and proposes. If he is on the top of her list, she says 'Maybe' (for now); otherwise, she says 'No.' If she says no, he goes on to his next choice, until he finally gets to a 'maybe.' Then, the next boy repeats the same process with the remaining girls, which goes on until all the boys have paired off with all the girls.

The original research showed that while this produces a stable set of pairs such that no improvements can be made by any couple re-pairing (ie, no cheating), it was also shown that this process favors the boys (the ones asking) over the girls. Another implication was that the girls could game the system by lying about their true preferences. Economist Alvin Roth and others showed that the original NRMP algorithm was equivalent to the stable marriage problem and that it favored the hospitals. In the 1990s, Roth was recruited by the NRMP to revise its algorithm as well as make it more equitable for couples entering the match.

Despite these changes, several medical students filed an anti-trust lawsuit against the NRMP in 2002, accusing it of abetting medical schools in colluding to keep wages low. The suit was unsuccessful, but the lobbying efforts of the NRMP fared better: President Bush signed a pension law that had an attached rider specifically granting immunity to the NRMP from such claims in 2004.

Navigating the Match

In an ideal world, simply putting down your true preferences and having the residency programs do the same would lead to optimal outcomes. In reality, the process entails much subjectivity as programs want not only qualified applicants but also want to claim they did not have to go very far down their list to fill their spots. This is more an issue of vanity than practicality, but it impacts how programs structure their rank lists. Awareness of this social reality behooves the applicant to clearly state their desires for programs they are interested in during the interview process, despite not having fully considered all their options. It also necessitates clear communication with programs of interest after the formal interviews in order to ascertain if the feeling is mutual. While the degree of communication between applicants and programs is restricted per the NRMP guidelines, if any programs or applicants deviate, it is in the best interests of each applicant to also deviate (to understand this better, check out the prisoner's dilemma). Ultimately, the applicant should take whatever steps necessary to clarify his preferences with programs of interest.

If you are interested in learning more about how to navigate the match, check out:

   

References:

• Robinson, Sara. "Are Medical Students Meeting Their (Best Possible) Match?" SIAM News, Volume 36, Number 3, April 2003
• Antitrust Lawsuit Over Medical Residency System Is Dismissed - New York Times
• National Resident Matching Program - Wikipedia

Can A Social Media Profile Be A Resume?

Thinking about applying for medical school? Residency? A scholarship, perhaps? Your online reputation may precede you. This guest post by Dr. Gregory Mackay explains some of the do's and don'ts of maintaining an online social media profile as a healthcare student and professional.

Social networking has become an inevitable part of our daily lives and although social media and healthcare privacy are not exactly two sides of the same coin, you need to be very careful about how you socialize because social behavior on social networking websites could have a significant contribution to make towards shaping your future career.

Source: FredCavazza.net

These social networking websites have grown by leaps and bounds (the code of conduct has also changed tremendously) over the last couple of years but so have the medical schools and universities who have already embraced social networking and made it a part of the learning curve. Most medical schools and universities have already got a defined set of guidelines that they expect their students to follow while socializing online.

Now, why is it important for medical students to “behave” themselves while socializing online? Social networking, as it used to be some 5to 7 years back, isn't only about having an online presence - it is now seriously considered as an identity replica by the corporate world which does not have enough time to go through background check reports and small details in a curriculum vitae - the only option they are left with is to take people on face value and that is what calls for “socially responsible behavior” on social networking websites. So, that actually translates to medical schools and universities creating a set of social media policies that can help inexperienced students have better profiles and the behavioral patterns on social media websites. Just warning them is not going to do the job because everyone would interpret the instructions differently - only a written set of guidelines is going to help them.

As a matter of fact the popularity of social media policies has also grown by leaps and bounds. More and more people have realized the benefits. But the million dollar question is “what needs to go into those policies”? Some of the key things that need to be integrated in social media policies include:

• The student should be selective about where he establishes a profile. His online presence should mirror his professional responsibilities and interests - he should never go overboard. 
• A student should remember that having profiles on online social networking websites does not make him a different person - he is the same professional and his behavior should match his professional profile. 
• He should be very selective about what he makes public and what information he keeps under wraps. 
• Students should understand that every online behavior can be recorded and monitored. It's best to think twice before displaying certain characters online. His behavior should in no way be able to tarnish his professional reputation. 
• A medical student also needs to understand that deceit and pretence are not supposed to be considered positive traits in health professionals and he should steer clear of such things while socializing online.

This actually needs to be taken very seriously because a study that was conducted in 2010 has clearly pointed to the fact that not less than 20% of residency pharmacy directors (employers) completely trust social media behavior while recruiting candidates. As a matter of fact, 89% of them also strongly agreed to the fact that the behavioral patterns of social media websites clearly define the identity and character of a candidate and that speaks volumes about the kind of professionalism that they have and also the kind of attitudes that they would display towards others.

There is another huge benefit offered by social media policies. A set of written guidelines is also going to make sure that the privacy of the patients remains intact and that does not jeopardize the careers of young medical professionals. It was found out in a study in 2010 that medical students not having a “respectable” social media behavioral pattern are more prone to diagnosing patient information on social media websites. That could be a dangerous thing and could seriously jeopardize the careers of young medical professionals.


Dr. Gregory J. Mackay is a board certified atlanta cosmetic surgeon by the 'American Board of Surgery' who practices for “The beauty of knowledge”

3 Ways To Improve Your Personal Statement

This guest post by Lauren Bailey describes some key ways you can spruce up your personal statement as you apply for medical school, residency, fellowship, and beyond. As your stare at that blank Word document, or even as you are about to hit 'Submit' on ERAS, keep these points in mind.

3 Story Telling Elements that Can Instantly Improve Your Personal Statement

Every year medical school admission officers get hundreds of the same type of "formulaic" personal statements from their applicants—the statements typically lead with a mere, "I want to become a doctor because of x,y,z" and are usually dry throughout the entire piece. While yes it's true that admission officers favor clean and simple writing and usually pass on applicants that sound too pompous (or those that already write in "doctor-speak"), that doesn’t mean that they want personal statements that are boring. If your statement sounds like the rest, it will get thrown in the rejection pile. But by simply incorporating some traditional story telling elements to create a narrative, you can help your statement stand out. To learn how to do this effectively, continue reading below.

Start with a Personal Anecdote
Your introduction is the make it or break it point. From the very beginning you need to draw-in your reader. Otherwise, he or she may toss out your application almost instantly. One of the easiest ways to captivate your audience is to lead with an anecdote—a personal story that describes why you want to be a doctor or what brought forth your passion for medicine. There has to be some "aha!" moment or epiphany you experienced that made you think, "This is the profession for me, this is my true calling." Paint a narrative that helps re-enact that epiphany moment and then carefully tie it into a strong thesis. For example, maybe you wanted to become a doctor after someone in your family got severely ill. You could start it off like this: I was 8-years-old and cancer was a term I'd never heard of before. As my grandmother rested in the hospital bed, frail and hairless, I wanted nothing more than to have the power to heal her. How desperately I wanted the power to be able to heal everyone around world. At that moment, I realized that I wanted nothing more than to become a doctor. I feel attending [blank] medical school will not only help me accomplish my childhood dreams, but will also help me become the best possible healthcare provider possible.

Focus on Character Development
Your main objective when writing your statement is to come off as likable—admission officers must like you, otherwise you will get denied. Like in any story, there is always a main character. In this case, it's you. You want to make sure that when describing your strengths and weaknesses for example, you don't come off as arrogant, a know-it-all, or have any traits that some people might be turned-off by. For example, a popular "weakness" that applicants like to state is the fact that they're a perfectionist which can be both a blessing and a curse. While it's extremely generic, it's still a valid point. However, if you try to demonstrate that this by saying, "One semester I got a B and I was really hard on myself for a whole week" you might rub admission officers the wrong way. They already get plenty of applicants with pristine grade point averages. And who's to say that someone who makes 100's on written exams can translate those skills to real world scenarios? Instead, if perfectionism is truly a weakness then at least explain a scenario where it affected something that directly relates to healthcare—perhaps when volunteering at the local hospital or health care facility for example.

Be Careful with Language Choice
Last but not least, you need to use your power of language. That's not to say that you need to take out a thesaurus and use "fancy" words to help you sound intelligent. The admission officers already have your transcripts and records, they know you're intelligent. Instead, use this opportunity to sound like a "real" person—someone they'd like to meet in real life and interview. Your best way to accomplish this is to write using your natural voice; steer away from sounding too formal.

Personal statements don't have to be so cut and dry. But figuring out a way to incorporate the story telling elements mentioned above, you should give your statement that added spice that will persuade admission officers you deserve an interview.

This guest post is contributed by Lauren Bailey, who regularly writes for online colleges. She welcomes your comments at her email Id: blauren99 @gmail.com.

Residency Application Personal Statements

The following is a guest post by Jedd H. regarding how to approach the dreaded 'personal statement' when you start ERAS and apply for residency programs. 

The medical profession is one of the most sought careers by many people. In fact, there are universities that specialize in providing medical education. In the United Kingdom, leading medical schools include the universities of Cambridge and Oxford. But medical training does not end after a person has  graduated from a medical school. The tertiary-level education offered at a medical college is not enough for those intending to pursue this career to a greater extent.

Since medical training in schools is not enough to make a person expert in handling medical situations, education at this level is only considered an entry-level. Additional training could be obtained by a medical school graduate from a hospital or any medical institution that offers residency program. But before one could become an intern on one of these medical institutions,  the medical student must  convince the hospital’s residency directors to offer him as slot to become a resident.

Residency directors most likely have already read an applicant’s credentials from his transcript or from his curriculum vitae. They may already have a grasp of what the applicant is intellectual-wise and skill-wise. However, there might be information about the applicant that cannot be read or inferred by just reading the transcript or the CV, like the candidate’s motivations, interest, skills, relevant experiences and other interesting details. Thus, residency directors often require applicants or candidates to submit their personal statements.

The residency applicant’s personal statement is his best opportunity to convince the residency directors that he is qualified to become a medical intern. It allows an applicant to stand out from other candidates, especially if has submitted a well-written and very persuasive statement. A good application should be coupled with a first class statement to ensure that a candidate would be able to stand out from others.

Basically, a well-written personal statement should be able to answer two key questions. The first question refers to the applicant’s choice of expertise or specialization: Why is the candidate applying for the specialization? The applicant should be able to show his motivation for applying for the residency. The candidate must be able to present the reason why the medical specialization has drawn his interest. The candidate should be able to show that he knows what he is applying for and he fully understands the sacrifices required to master the certain specialization.

The second question refers to the applicant’s suitability to the medical specialty he has chosen: Why is the candidate suitable to become a medical resident? The candidate must be able to show that he is well-qualified to undergo residency. The applicant must showcase certain skills, experiences and personal qualifies that he believes would help during his residency years. The applicant could highlight his clinical skills as well research skills. The applicant could also highlight his patient or teaching experiences.

If the applicant’s personal statement contains the answers to these questions, then he has a high chance of being accepted a resident in a medical institution.

Jedd H. is a freelance writer with years of experience consulting with students on writing and personal statement drafting. 

Comparing Residency Match Systems

This is a repost of an article by Ishani Ganguli, a 5th year medical student at Harvard Medical School, regarding how the U.S. residency match system compares to the UK system. 

On my weekend travels exploring Guatemala’s gorgeous natural offerings (Caves! Volcanoes! Giant lakes! Smaller pools!), I’ve gotten to meet a mix of international medical students on their own final-year electives.

Residency applications aren’t the first topic of conversation, but they come up eventually. Which is how I heard that this is a big two weeks for the Brits. On Monday Oct 11, students applying to foundation programmes (the British equivalent of residency) learned the questions they must answer for 60 percent of their ranking score. They had until today to submit their responses.
Later this year, they’ll be ranked within their medical school based solely on their graded 200-word answers to each of those five questions and class grades (40 percent). These ranks determine if they get their first, or 20th, choice of foundation programme.

The Brit students I’ve talked to bemoan the seemingly arbitrary quantification of their ability to wax eloquent and the paucity of data points on which they’re judged -- especially in a competitive year.

In the States, in contrast, our application files are quite a bit thicker -- in addition to grades and the personal statement, they include a curriculum vitae, three or four letters of recommendation, a summative Dean’s Letter, and (for the selected few) interviews.

I like that our British counterparts are forced to think of personal and observed examples of multi-disciplinary teamwork and cultural sensitivity -- topics that certainly merit attention when selecting doctors. Our personal statement prompts, in comparison, are quite vague.

But I must say that I’m comforted by US programs’ proclivity for information, both as an applicant and as a patient in our health system. Knowing more about the doctors we train, from multiple angles, can only help ensure that they (we) are both competent and genuine.

The article was originally posted here and is being reposted here with permission from the author. The post from Short White Coat, a blog about learning to be a doctor, which is a part of White Coat Notes on boston.com. You can contact Ishani at shortwhitecoat@gmail.com.

Gifts For Medical Students On Match Day

According to the National Residency Matching Program, Match Day is the day when U.S. medical school soon-to-be graduates will find out what internship and residency programs they have "matched" to, after the several months long interview and ranking process. While graduation is the formal and ceremonial completion of medical training that leads to the conferring of a medical degree, in many ways, the match day is the functional culmination of four years of hard work, or in many cases, a lifelong effort. Friends and family often take part in Match Day ceremonies put on by medical schools to celebrate this major transition point with their loved ones. To help celebrate, here are a few gift ideas for the lucky matchee:

1. A tablet

As technology becomes ever more integrated into medicine, having a tablet is becoming an essential device for staying up-to-date with the latest medical knowledge. Many hospitals now provide free Wifi for their staff, making these tools a highly useful as well as stylish "pocket brain." Tablets can also be utilized for performing clinical calculations or even in evaluating patients in the clinic with the use of specialized apps. In many ways, starting internship or residency is almost like going back to school again... except you are getting paid and likely working harder. Still, might as well be prepared like all the other 'students', right? 

 2. A Little Leisure Reading

             

As well as medical school can prepare a student intellectually for being a practicing physician, there's no substitute for the real thing. All three books above are excellent and describe how the authors made that critical transition in their respective specialties. In fact, the House of God has become so well known that some of the terms coined within entered the general medical lexicon, although usually as kind of an inside joke. 

 3. Or Perhaps Something More Inspirational?

            

When the doldrums of intern year hit (usually around January/February when the novelty has worn off but the light at the end of the tunnel is still somewhat dim, the two books above both provide a big picture look of why we as doctors do what we do. Whether caring for patients in underserved communities in far flung corners of the world or working to turn the arc of a deadly disease, these doctors have made a difference and show us how our daily work is part of the larger whole. Yes, cliche, but sometimes you need those "Hallmark moments" to push you forward as an intern. 

Haha, and if you really want to impress them, buy the Kindle above and preload it with all these titles! That way they can read the book during downtime even at work! 

 4. Something To Make Them Smile

   

And when all else fails, why not try something cuddly? Take it into work and put a smile on the faces of your colleagues and patients!

Looking more ideas? Check out some Match Day gift ideas from years past!


Updated 2015-12-25