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Hospital Express Concern Over Further IME Cuts Malpractice Insurance Is a Growing Concern for Academic Medical Centers
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NRMP Turns 50
In 1952, medical school seniors seeking residency training programs were a hot commodity for program directors anxious to fill empty slots. With 5,800 graduating students competing for nearly 10,500 hospital internships and no organized system to match them, hospitals began trying to lure students into specific programs long before they graduated. The ensuing confusion was a catalyst for the establishment of a nationwide, equitable matching program. Before the establishment of such a program, students were often pressured to make early commitments without knowing whether a more desirable position would be offered later. Last-minute scrambles for graduating seniors who had not yet chosen residencies required students to respond quickly to telegraphed offers from hospitals unfamiliar to them. "I've heard of programs trying to recruit medical students as early as the second year of medical school," says Liz Lostumbo, director of the National Resident Matching Program (NRMP) in the AAMC Section for Student Services. "This was long before students were into their clinical clerkships and before they had any idea of what specialty they wanted to go into," she says. Bob Beran, Ph.D., executive director of the NRMP, says that medical students nearing graduation were responsible for initiating the idea of a program that would lend some order to the annual scramble for open residencies and provide a common time for the fulfillment of available slots. "The students didn't like the chaotic system of selecting residents that existed before 1952," affirms Dr. Beran. "The idea for the Match originated with them." Dr. Beran says that a number of hospital associations joined forces to respond to students' concerns, resulting in the establishment of the National Interassociation Committee on Internships (NICI). This predecessor to the modern NRMP consisted of representatives from the AAMC, the American Hospital Association (AHA), the American Protestant Hospital Association, the Catholic Hospital Association, the Council on Medical Education and Hospitals of the American Medical Association, and liaison officers from federal services offering what were then called "internships." F.J. Mullin, M.D., dean of what was then the Chicago Medical School, served as the first chair of NICI. Dr. Mullin orchestrated a trial run of what came to be known as the "matching plan" (today more commonly termed "the Match") in 1950-1951. Although the new plan found some favor in hospitals, it was severely criticized by students, who found the original algorithm unfair to both themselves and residency programs. Student leaders from 43 of the nation's then-79 medical schools met at Columbia University on Oct. 21, 1951, to express their opposition to the original plan and to offer what they considered a more fair method. Among the student complaints reported in a New York Times article the following day were that students were not sufficiently consulted, that the algorithm limited their freedom of choice, and that it simply "could not work." One Howard University delegate voiced his concern that the plan would enable local authorities who discriminate against minorities to shift the blame for such discrimination to the plan rather than "keeping it where it belonged." Students formed the National Student Internship Committee and suggested the implementation on a national scale of an effective match program already in place, the "Boston Pool Plan." NICI delegates agreed to adopt the Boston plan, whose algorithm for matching students and hospitals has changed little over the past 50 years. In that first Match half a century ago, 5,564 students out of 5,581 applicants (each charged a $2 administration fee) were matched successfully, 84 percent with their first-choice program. Hospitals were matched with 74 percent of their first-choice students. To conduct the Match, officials used IBM machines in which they inserted punch cards indicating the students' and hospitals' choices. In the 1980s, the dawn of the computer age had students entering their choices onto disks that were then sent to the AAMC for processing. In 1999, the Match became completely Web-based, a transition Lostumbo says was relatively smooth. "We now successfully operate a completely paper-free program," she says. Now sponsored jointly by the AAMC, the American Board of Medical Specialties, the AMA, the AHA, and the Council of Medical Specialty Societies, the NRMP has grown exponentially over the years. Besides undergoing a series of name changes, Lostumbo says one of the biggest changes the program has seen over the past 50 years is the increase in the number of participants who are not U.S. seniors. In 1952, 11 of the Match's participants were from schools outside the United States and Canada. In the 2002 Match, 61 percent of the 23,459 applicants were U.S. medical school seniors, the others being "independent applicants" - international medical school graduates, U.S. students who have studied in foreign schools, and graduates of osteopathic medical schools. "In general, the Match isn't that much different from the one devised 50 years ago," says Dr. Beran. "The basic process has sustained tremendous changes in medical education, a testament to the forethought of its founders." |
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