AAMC Reporter: June 2005

Proposed Second Match Defeated

Following a year-long evaluation, the National Resident Matching Program (NRMP) board of directors voted unanimously in May against offering a second match for applicants who do not obtain positions.

The rejected proposal for an additional phase to give unmatched candidates another opportunity to pair with a program would have pushed Match Day back two weeks into April.

Although the second match would have given more students the opportunity to pair with a residency program before the Scramble, a 48-hour period during which students apply for unfilled positions on a secure NRMP Web site, the board saw too many problems with instituting a second round.

For example, the second match guidelines would have required that all specific matching information be withheld until both the first and second match were completed. Students placed in the first match would have known if they had matched, but not where. All options, including reversions, second-year positions and couples applications would have been preserved, and all unmatched students would have been required to participate.

"Many board members felt the change would push Match Day too late," said Mona Signer, AAMC assistant vice president for the NRMP. "And few agreed with holding the Phase 1 results until after Phase 2 finished. If we didn't want to preserve the Match Day tradition, matches could have been revealed at the end of Phase 1, and that might have been a little more attractive."

An April Match Day would also be problematic for schools, Signer said. Not only would it truncate the timeframe for processing paperwork on new residents, but a tighter schedule would also make it more difficult to ensure that visas held by international medical graduates are current.

Both students and schools opposed revealing match information at a later date. Representatives from the American Medical Student Association (AMSA) and the AAMC's Organization for Student Representatives (OSR) voted against the measure because it would not allow students enough time to make moving arrangements if their residency program was on another coast or if they had a spouse to consider. Initially, students indicated strong support for a second match in an NRMP survey.

"Students in general were originally positive about a second match, but a student's time is tight on the Match Day schedule," said Ben Rudd, a fourth-year medical student at SUNY-Upstate Medical University and OSR liaison to the NRMP. "Sometimes you have quick turnaround times to get forms in or you have to get a temporary license, and a tighter Match Day schedule really gave us pause." AMSA supported the second match proposal from the time it was first introduced because it would have reduced the number of students who parti-cipate in the Scramble, according to Leana Wen, the organization's president.

"The Scramble is such a chaotic process, and students are forced to make decisions in a high pressure situation," she said. "They're in a vulnerable position, and a second match would have alleviated some of that tension."

Wen said AMSA would continue to work with NRMP to find ways to streamline the Match process and limit the number of students affected by the Scramble. In the past two years the number of U.S. senior students who were unmatched totaled 1,037 in 2004 and 921 in 2005.

Match results from a second round were not expected to be as high as the first phase. Approximately 20 percent of total applicants and 10 percent of available positions would have been included. The success rate for U.S. seniors was anticipated to be much better than for independent candidates.

In recent years, the NRMP, at the request of students, has made several improvements to the Match Day process. The board added 24 hours to the Scramble, doubling the amount of time students have to contact programs about available openings, and it supported Internet technology improvements that shortened the time between the rank order list deadline and Match Day by a week. Signer said the board agreed to investigate additional techniques that could improve the process in future years.

—Whitney L.J. Howell, whowell@aamc.org

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