NRMP Consider Two-Part Match In lieu of SOAP

[SooConfused]

So other countries can practice protectionism but we can't?????

Sure we can, if we think it's in our best interest to do so. Israel is a great example, since they just shut the door on foreign medical students because they want the seats for people who are going to practice in Israel. The thing is, anyone applying for a residency in the US wants to practice in the US, so that's not really a concern or the issue here.

Americans, especially those attending school in the US, already have HUGE built-in systemic advantages, and there are more residency slots than US grads. The question is whether it would benefit programs or patients to practice protectionism to the point of prioritizing the very bottom of the US pool over FMGs who have overcome long odds to outperform them under whatever metrics PDs use to judge.

To date, Congress and the people running the hospitals have decided that the answer is a resounding no. Maybe that will change at some point as the population of US grads continues to grow at a rate greater than residency slots. But my sense is that they will always have an advantage over IMGs and FMGs, so protectionism won't be necessary.

The fact that everyone who wants ortho can't get it sucks. OTOH, if everyone could get it, it would be FM or peds, and then a lot of the gunners wouldn't want it. No amount of protectionism will fix this.

Pretty much every American attending med school in the US who wants a residency and who does not have a big red flag can have one. Maybe not the one they want, or where they want, but they can have one. If people with high scores and lots of research who are unloved by plastics, neurosurgery or ortho PDs cannot lower themselves to take an EM or FM residency in the middle of nowhere because they worked too damn hard for that, there isn't a lot protectionism can do to address that.

It's difficult to shed tears for IMGs who chose the Caribbean over patiently taking the time to make their applications good enough to be accepted to an American school, and who then lose out to a superior FMG. Remember, it is a very tiny subset of US grads who neither match nor SOAP, and that is almost always because they either over reached or have a huge red flag. Either way, protectionism wouldn't help them.

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[Mr.Smile12]

The latest word: no two phase match

Decision of the NRMP® Board of Directors Regarding the Proposal for a Two-Phase Match

On August 2, 2022, the NRMP published a proposal for a Two-Phase Match to replace the current Match® and Supplemental Offer and Acceptance Program® (SOAP®) processes, known as Match Week…

www.nrmp.org

 

[Rapsidy]

Not a shock when the only risk they listed was “ Does not address more primary concerns including high application numbers”

Aka we have 100 million reasons why to keep people over applying, and we aren’t taxed on any of those reasons.

 

[Med Ed]

Glad this happened.

The powers that be keep trying to fix the UME-to-GME transition with patches and half measures. Someone just needs to sit down with a blank sheet and redesign the entire thing from scratch.

 

[voxveritatisetlucis]

The latest word: no two phase match

Decision of the NRMP® Board of Directors Regarding the Proposal for a Two-Phase Match

On August 2, 2022, the NRMP published a proposal for a Two-Phase Match to replace the current Match® and Supplemental Offer and Acceptance Program® (SOAP®) processes, known as Match Week…

www.nrmp.org

Sad! Sounded like a good idea to me. One match for applicants to apply their dream another to be more pragmatic

 

[DrZoidbergDO]

Glad this happened.

The powers that be keep trying to fix the UME-to-GME transition with patches and half measures. Someone just needs to sit down with a blank sheet and redesign the entire thing from scratch.

It's a bad system, but is there really a better one? I haven't seen any proposals that are better than the match. Certainly it's better than how it was before

 

[Med Ed]

It's a bad system, but is there really a better one? I haven't seen any proposals that are better than the match. Certainly it's better than how it was before

I'm not saying a new version of this process would dissolve the match, but it's past time to think outside this decrepit, dysfunctional box we find ourselves in.

I haven't seen a winning idea yet, either, because I don't think it has been conceived of or put forth.

 

[DrZoidbergDO]

I'm not saying a new version of this process would dissolve the match, but it's past time to think outside this decrepit, dysfunctional box we find ourselves in.

I haven't seen a winning idea yet, either, because I don't think it has been conceived of or put forth.

reformation to the match seems like the most likely outcome to me, which i personally think is also the way to go.

 

[Captain_Falcon]

reformation to the match seems like the most likely outcome to me, which i personally think is also the way to go.

Any particular tweaks that should be made? As a current M4 applying, I would love the idea of an initial match where students apply to only 5-10 programs, interview, and see if they match. This would occur in like October only, find out results early November, all unmatched and unfilled positions go on to what would be a normal interview season

 

[DrZoidbergDO]

Any particular tweaks that should be made? As a current M4 applying, I would love the idea of an initial match where students apply to only 5-10 programs, interview, and see if they match. This would occur in like October only, find out results early November, all unmatched and unfilled positions go on to what would be a normal interview season

Yeah the 2 phase match system with app caps seems to be an improvement over the current system

 

[NotAProgDirector]

There are multiple old threads on this worth reading:

NRMP Match: Good, bad or ugly?

This discussion started in another thread, with this post: Gotta love how PDs try to see the match as being something good. The match forces students to spend big bucks doing multiple interviews. Compare this to my fellowship where there was no match and I went on one interview and got the job...

forums.studentdoctor.net

What are the alternatives to the Match? What do you think would happen if it were abolished?

I'm interested in the opinions raised in the other thread. For all the jaded med students and residents - go wild. Explain to me why you think the match should go away but more importantly, explain what you think the process should be and what you think the ramifications of getting rid of the...

forums.studentdoctor.net

No system is perfect. Since the vast majority of US MD's and DO's get spots in the current system, any change may shuffle whom gets which spot (which is hard to decide whether it's "better" or not). So ideally, to me, better = less applications.

I think I now favor a three phase match. An early round with limited spots, the main round with all the spots, and a final round to replace SOAP. Simpler would be an app cap, but I don't think that will pass legal muster. We will see how signaling goes - which is a "soft app cap".

 

[aldol16]

It's not what I had favored -- which was an "early decision" type early round to get 30% of the spots filled.

How would you fill 30% of the spots only in the first round using a match algorithm that programs would actually adopt? All programs want the top applicants. If you run a match algorithm limiting your spots to only 30% of the spots at each program, then the top applicants will fill those and then in the next round, the top programs have to fill their remaining 70% of spots with applicants who would have been lower on their rank list had there only been 1 round.

 

[NotAProgDirector]

I think that's unlikely to happen. The top candidates aren't going to be willing to take an early round spot "just anywhere". And community programs will be filling their 30% early slots with the usual candidates they get. There will be plenty of great candidates in the main match round. There will just be 30% less of them. Plus anyone who applied to the early round but didn't get any spot, would likely get a close look from the program for the main round (similar to current signals).

But there is no perfect solution. I'm looking for a solution that decreases the numbers of apps that programs are flooded with. This might help. Or might not -- possible that people who don't match in the early round will panic and send 50% more apps in the main round. In fact, that seems very likely now that I think about it. So maybe there's no good solution.

 

[Putkernerinthehall]

What's wrong with the current process ?

 

[Med Ed]

What's wrong with the current process ?

Massive overapplication.

 

[Mr.Smile12]

I think that's unlikely to happen. The top candidates aren't going to be willing to take an early round spot "just anywhere". And community programs will be filling their 30% early slots with the usual candidates they get. There will be plenty of great candidates in the main match round. There will just be 30% less of them. Plus anyone who applied to the early round but didn't get any spot, would likely get a close look from the program for the main round (similar to current signals).

But there is no perfect solution. I'm looking for a solution that decreases the numbers of apps that programs are flooded with. This might help. Or might not -- possible that people who don't match in the early round will panic and send 50% more apps in the main round. In fact, that seems very likely now that I think about it. So maybe there's no good solution.

I presume that unlike college admissions, the applicants are NOT charged for the number of applications they send? That's the usual route available for admissions (raise those secondary fees... we need a new Keurig machine!).

 

[NotAProgDirector]

Not sure if that's sarcasm or not. Of course ERAS charges fees for applications. If serious, in my plan each applicant would get a very limited number of early apps - one could make an argument between 1 and 3. I'd simply include that in ERAS's baseline of 12 (or whatever it is) -- 3 early and 9 regular for example. Remembering that all of the early apps are considered in the main match -- so no one loses anything.

Note that the early round doesn't need to be a match at all. Programs can just offer spots, applicants can consider all offers, and then there's some date by which applicants need to finalize their decisions - but they can do so at any time. Any spot not filled in the early round simply becomes available in the main match. Programs would have a much smaller group of applications to consider for their early spots.

 

[Putkernerinthehall]

Not sure if that's sarcasm or not. Of course ERAS charges fees for applications. If serious, in my plan each applicant would get a very limited number of early apps - one could make an argument between 1 and 3. I'd simply include that in ERAS's baseline of 12 (or whatever it is) -- 3 early and 9 regular for example. Remembering that all of the early apps are considered in the main match -- so no one loses anything.

Note that the early round doesn't need to be a match at all. Programs can just offer spots, applicants can consider all offers, and then there's some date by which applicants need to finalize their decisions - but they can do so at any time. Any spot not filled in the early round simply becomes available in the main match. Programs would have a much smaller group of applications to consider for their early spots.

Why is this ERAS over application such a difficult problem ? I mean some popular medical schools get 15,000-18,000 applicants and they manage to sort through them using all kinds of screens, filters / algorithms and teams of reviewers. Residencies get what, at most maybe 2,500 - 3,000 on average for a popular specialty like IM ? I understand the review process is different from medical school admissions but it still seems reasonably manageable for most specialties.

I admit, I'm no expert....just curious why the fuss? Is it super expensive to apply thru ERAS? Can't be as costly as those med school secondaries, right?

 

[Rapsidy]

Why is this ERAS over application such a difficult problem ? I mean some popular medical schools get 15,000-18,000 applicants and they manage to sort through them using all kinds of screens, filters / algorithms and teams of reviewers. Residencies get what, at most maybe 2,500 - 3,000 on average for a popular specialty like IM ? I understand the review process is different from medical school admissions but it still seems reasonably manageable for most specialties.

I admit, I'm no expert....just curious why the fuss? Is it super expensive to apply thru ERAS? Can't be as costly as those med school secondaries, right?

ERAS made nearly 100 million dollars off of applications for the match alone in the last year or so.

You are comparing medical schools abilities to handle applications which have far more staff and resources to read applications than many program directors do.

Would highly recommend listening to the 6 part series linked below from the sherif of sodium on the match in order to understand what is so flawed about the matching system and the issue with over application.

https://m.youtube.com/channel/UCb1FduhfPiV4jGuFPohRwnQ/videos

 

[Med Ed]

Why is this ERAS over application such a difficult problem ? I mean some popular medical schools get 15,000-18,000 applicants and they manage to sort through them using all kinds of screens, filters / algorithms and teams of reviewers. Residencies get what, at most maybe 2,500 - 3,000 on average for a popular specialty like IM ? I understand the review process is different from medical school admissions but it still seems reasonably manageable for most specialties.

I admit, I'm no expert....just curious why the fuss? Is it super expensive to apply thru ERAS? Can't be as costly as those med school secondaries, right?

Applicants to medical school have the MSAR, which gives them very good data on how competitive they are at any given school. This allows for a degree of self-selection that is difficult to come by in the residency application process. Medical schools also have entire offices dedicated to admissions, and during the summer and fall their people spend countless hours reviewing and whittling down application pools to reasonable numbers. Even then it's a burden.

To use your example, contrast this to a popular IM program that receives several thousand applications. There is usually no dedicated staff to review them, just a group of people (like the program director) who have competing job responsibilities. Like being doctors, directing the residency program, and/or providing other types of administrative support. To get some idea of what this is like, buy 40 decks of cards and flip through them all at a rate of one every 5 minutes.

From the applicant standpoint, there is no GME equivalent of the MSAR. Students apply to many programs without any clear idea of whether or not they are competitive. Furthermore, since the cost of not matching is so high, students will hedge their bets by over-applying, including to many programs they have little knowledge of or genuine interest in.

So we end up in a situation where students apply to many programs they don't care about, and programs receive hundreds or thousands of applications with little idea about each applicant's true motivations (and insufficient staff to consider them all). The only winner in all this is ERAS.

Ultimately this is what led to Step 1 being converted to a P/F exam, but that's another story.

 

[throwaway123342]

ERAS made nearly 100 million dollars off of applications for the match alone in the last year or so.

How much money did AMCAS make? How much money do medical schools make?

 

[DOVinciRobot]

Why is this ERAS over application such a difficult problem ? I mean some popular medical schools get 15,000-18,000 applicants and they manage to sort through them using all kinds of screens, filters / algorithms and teams of reviewers. Residencies get what, at most maybe 2,500 - 3,000 on average for a popular specialty like IM ? I understand the review process is different from medical school admissions but it still seems reasonably manageable for most specialties.

I admit, I'm no expert....just curious why the fuss? Is it super expensive to apply thru ERAS? Can't be as costly as those med school secondaries, right?

For starters because residency isn’t school, it’s literally a job. Getting people that actually fit is a much bigger deal. Med schools also have dedicated admissions committees whose job it is to do nothing but admissions, for reference my residency program (mid sized academic surgery program) has a handful of attendings, and the program coordinator, that are tasked with interviews, filtering applications, etc. these are clinically active people with full clinical surgical practices and other administrative responsibilities.

And then people complained when programs filtered by Step 1 score. (Guess what, now it’s just Step 2. I can tell you 100% that’s what we used to filter this year).

 

[Rapsidy]

How much money did AMCAS make? How much money do medical schools make?

 

[Mr.Smile12]

Sorry... I was being sarcastic about it. I just wasn’t sure if raising the cost of application would be appropriate as an approach. I commiserate with the one person I knew who was in charge of managing the graduate residency process for five (?) dental residency programs. I helped whenever I could or was mandated to.

 

[Putkernerinthehall]

Furthermore, since the cost of not matching is so high, students will hedge their bets by over-applying, including to many programs they have little knowledge of or genuine interest in.

I think you hit the nail on the head. Students don't have much choice other than to over apply. Program Directors should work with medical schools to eliminate the oversupply of med students relative to residency slots. And maybe an MSAR-like tool should be developed. Doesn't the Residency Explorer tool provide students an indication where they are and aren't competitive ?

 

[Med Ed]

I think you hit the nail on the head. Students don't have much choice other than to over apply. Program Directors should work with medical schools to eliminate the oversupply of med students relative to residency slots.

That's not the issue. The real issue is described here. In 2007 the average USMG applied to ~32 programs, in 2020 that number was ~70. Likewise, in 2017 the average IMG applied to 79 programs, in 2020 that number was 139. The increased applications only exacerbate the underlying structural problems with the process, so it has become a positive feedback loop of dysfunction.

And maybe an MSAR-like tool should be developed. Doesn't the Residency Explorer tool provide students an indication where they are and aren't competitive ?

Program directors have resisted the creation of a GME MSAR, in part because many programs are quite small, which limits the utility of descriptive statistics (i.e., there can be a lot of fluctuation from year-to-year). They also don't seem to be too keen on showing the world who the actually match.

 

[NotAProgDirector]

Residency programs currently get none of the fees collected by ERAS. As mentioned above, we don't have a huge team of people to review applications. There's no secondaries with fees (except perhaps for a few programs, and I've never heard of a fee).

The timeline is also much shorter than medical school apps. We get apps in early October, and many programs start interviewing in November.

Would an MSAR for residency programs really change anything? I have my doubts. Programs are also resistant to creating one because it will create the same problem medical schools face -- a ranking system. Plus, there's no GPA for medical students. So in the end it will come down to USMLE scores, # research (which no one can agree upon how to measure), and AOA/GHHS.

 

[throwaway123342]

That's not the issue. The real issue is described here. In 2007 the average USMG applied to ~32 programs, in 2020 that number was ~70. Likewise, in 2017 the average IMG applied to 79 programs, in 2020 that number was 139. The increased applications only exacerbate the underlying structural problems with the process, so it has become a positive feedback loop of dysfunction.

I see no issue here. Applicants should do what is best for them and that is over applying. That is what is best. Why would I run the risk of a bad match or losing out on good interviews by trying to save a couple thousand dollars. In the grand scheme of things that is nothing.

The problem is residency programs which are lazy and do not want to take the time to review applications.

 

[VA Hopeful Dr]

I see no issue here. Applicants should do what is best for them and that is over applying. That is what is best. Why would I run the risk of a bad match or losing out on good interviews by trying to save a couple thousand dollars. In the grand scheme of things that is nothing.

The problem is residency programs which are lazy and do not want to take the time to review applications.

Your first paragraph is exactly the issue. You are correct in that for the applicant, more applications increases the chance of a match. What's a few grand versus either a 1 year delay in finishing residency and the loss of 6 figures of income (SOAP into a transition year then match whatever specialty) or possibly not ending up anywhere at all.

Your second paragraph shows a shocking amount of ignorance in what residency programs are stuck with. Based on what @NotAProgDirector has said, your average IM program gets 100 applications per spot. The nearest IM program to me has 12 spots per year. That's 1200 applications. Let's say you are shocking fast at reviewing applications and take 5 minutes per application. That's 100 hours just reviewing applications. Programs don't have anyone whose only job is doing that so you have to add work to people who have other jobs as well. So if you have a teaching attending who already works 40 hours per week, even if we spread this across 4 weeks that means they are now doing a month of 65 hour weeks (and likely more since most teaching attendings work more than 40 hours at baseline).

 

[throwaway123342]

Your second paragraph shows a shocking amount of ignorance in what residency programs are stuck with. Based on what @NotAProgDirector has said, your average IM program gets 100 applications per spot. The nearest IM program to me has 12 spots per year. That's 1200 applications. Let's say you are shocking fast at reviewing applications and take 5 minutes per application. That's 100 hours just reviewing applications. Programs don't have anyone whose only job is doing that so you have to add work to people who have other jobs as well. So if you have a teaching attending who already works 40 hours per week, even if we spread this across 4 weeks that means they are now doing a month of 65 hour weeks (and likely more since most teaching attendings work more than 40 hours at baseline).

Then perhaps they should hire staff. These hospitals (and doctors!) are swimming in money. The blame is squarely on the programs. Don't go around talking about "application fever" when the real problem is "penny pinching GME".

 

[DrZoidbergDO]

Your first paragraph is exactly the issue. You are correct in that for the applicant, more applications increases the chance of a match. What's a few grand versus either a 1 year delay in finishing residency and the loss of 6 figures of income (SOAP into a transition year then match whatever specialty) or possibly not ending up anywhere at all.

Your second paragraph shows a shocking amount of ignorance in what residency programs are stuck with. Based on what @NotAProgDirector has said, your average IM program gets 100 applications per spot. The nearest IM program to me has 12 spots per year. That's 1200 applications. Let's say you are shocking fast at reviewing applications and take 5 minutes per application. That's 100 hours just reviewing applications. Programs don't have anyone whose only job is doing that so you have to add work to people who have other jobs as well. So if you have a teaching attending who already works 40 hours per week, even if we spread this across 4 weeks that means they are now doing a month of 65 hour weeks (and likely more since most teaching attendings work more than 40 hours at baseline).

app 👏 caps 👏 asap 👏

 

[DOVinciRobot]

Then perhaps they should hire staff. These hospitals (and doctors!) are swimming in money. The blame is squarely on the programs. Don't go around talking about "application fever" when the real problem is "penny pinching GME".

Tell me you have no idea how any of this works without telling me you have no idea how this works

 

[throwaway123342]

Tell me you have no idea how any of this works without telling me you have no idea how this works

Youre right. There is absolutely nothing programs can do to solve the problems that are inherent to the Match. My bad

 

[VA Hopeful Dr]

Then perhaps they should hire staff. These hospitals (and doctors!) are swimming in money. The blame is squarely on the programs. Don't go around talking about "application fever" when the real problem is "penny pinching GME".

No, most of them really aren't

 

[Med Ed]

I see no issue here.

Of course you don't.

 

[Putkernerinthehall]

Program directors have resisted the creation of a GME MSAR, in part because many programs are quite small, which limits the utility of descriptive statistics (i.e., there can be a lot of fluctuation from year-to-year). They also don't seem to be too keen on showing the world who the actually match.

Well then, they can accept the flood of applications without complaining. An MSAR tool would likely reduce the number of applications as med students would have a better feel as to where they are / aren't competitive. Residency programs need to help themselves some.

 

[Putkernerinthehall]

Your first paragraph is exactly the issue. You are correct in that for the applicant, more applications increases the chance of a match. What's a few grand versus either a 1 year delay in finishing residency and the loss of 6 figures of income (SOAP into a transition year then match whatever specialty) or possibly not ending up anywhere at all.

Your second paragraph shows a shocking amount of ignorance in what residency programs are stuck with. Based on what @NotAProgDirector has said, your average IM program gets 100 applications per spot. The nearest IM program to me has 12 spots per year. That's 1200 applications. Let's say you are shocking fast at reviewing applications and take 5 minutes per application. That's 100 hours just reviewing applications. Programs don't have anyone whose only job is doing that so you have to add work to people who have other jobs as well. So if you have a teaching attending who already works 40 hours per week, even if we spread this across 4 weeks that means they are now doing a month of 65 hour weeks (and likely more since most teaching attendings work more than 40 hours at baseline).

How about the residency programs hire some qualified staff ?

 

[Putkernerinthehall]

Tell me you have no idea how any of this works without telling me you have no idea how this works

Not the target of your comment but, hey, every other hiring organization in the world pays people to review applications and interview. Why are residency programs any different ? Hire some staff to get the job done and quit complaining. My goodness. Engineering managers review resumes and interview people all the time. Same with attorneys, accountants, etc. Successful companies hire small staff to help if warranted.

 

[Putkernerinthehall]

That's not the issue. The real issue is described here. In 2007 the average USMG applied to ~32 programs, in 2020 that number was ~70. Likewise, in 2017 the average IMG applied to 79 programs, in 2020 that number was 139. The increased applications only exacerbate the underlying structural problems with the process, so it has become a positive feedback loop of dysfunction.

It sure is part of the issue. If there were more slots than students, people would have less tendency to over apply. Some programs would still get inundated, sure, but overall the number of applications would come down.

 

[Med Ed]

Well then, they can accept the flood of applications without complaining. An MSAR tool would likely reduce the number of applications as med students would have a better feel as to where they are / aren't competitive. Residency programs need to help themselves some.

They are now trying to do this by developing preference signaling systems.

 

[Med Ed]

It sure is part of the issue. If there were more slots than students, people would have less tendency to over apply. Some programs would still get inundated, sure, but overall the number of applications would come down.

2022 Main Match Report, page 15, Figure 3. There are more positions in the match per MD seniors (1.82) than in any time in history.

MD seniors - 19,092
DO applicants - 7,303
Total PGY-1 positions - 36,277

Even when you take out the dead-end prelim positions there is enough room for all domestic graduates.

I believe Dr. Carmody's assessment is correct: this is a self-perpetuating psychology that is "rational but harmful."

 

[VA Hopeful Dr]

How about the residency programs hire some qualified staff ?

That's an option of course, but you have to get approval for that which is much harder than you may realize.

As for this one:

Not the target of your comment but, hey, every other hiring organization in the world pays people to review applications and interview. Why are residency programs any different ? Hire some staff to get the job done and quit complaining. My goodness. Engineering managers review resumes and interview people all the time. Same with attorneys, accountants, etc. Successful companies hire small staff to help if warranted.

Residency is different because the hiring takes place all at once during a fairly short time span. Larger companies that have full time recruiters or whatever don't typically have that problem.

 

[Putkernerinthehall]

Even when you take out the dead-end prelim positions there is enough room for all domestic graduates.

Right, US MD is not an issue in terms of slots. Isn't the issue of over-application coming from all the IMG / FMG applicants? Maybe you put a cap on those since they typically are the ones applying to 100+ programs. I imagine there would be a cry of foul / lack of fairness.

 

[Med Ed]

Right, US MD is not an issue in terms of slots. Isn't the issue of over-application coming from all the IMG / FMG applicants? Maybe you put a cap on those since they typically are the ones applying to 100+ programs. I imagine there would be a cry of foul / lack of fairness.

There would be more than a cry, there would be lawsuits. That's why an application cap, the simplest and most straightforward solution, has not been implemented. Even if successful, it would result in years of litigation over restriction of free trade.

At some point you may want to consider that the people who have been dealing with this for years are all saying the same thing: it's a serious problem, it hasn't always existed, and there isn't some quick fix that has been overlooked by everybody.

 

[NotAProgDirector]

Well then, they can accept the flood of applications without complaining. An MSAR tool would likely reduce the number of applications as med students would have a better feel as to where they are / aren't competitive. Residency programs need to help themselves some.

I agree with some of your points / thoughts. It is perhaps true that if residency programs were more transparent about chances of getting a spot, we might see less applications. But perhaps not - even with data, people may simply decide to "toss in an application and see what happens".

Regarding comparisons to other fields, there are some unique issues. We hire an entire class every year (i.e. replace 1/3 - 1/5 of the workforce). The hiring timeline happens all at once in a small period of time.

You seem to be under the assumption that we have lots of money to spend. Residency programs do not. Perhaps you're looking at all those GME dollars that flow from CMS -- all that money is taken by the institution, and relatively small amounts are doled out to programs. If you're argument is "that's wrong, you should get more" I don't disagree, but it is what it is. Interestingly, the ACGME is starting to recognize this and the new requirements now start to require funding for APD's and core faculty -- so going forward we may have more people who can look at applications.

We could also take a page from the Medical School Application Playbook, and charge secondary fees. If we collected $20 per application, first it might cut down on applications as some people who had low interest might simply not bother. Second, it would create an income stream with which to fund some people to review applications. But it would increase the costs to applicants by quite a bit.

But, let's ignore all that. Sure, some of those ideas above are solutions to the problem. The concern being raised is the problem itself: application inflation.

Not that long ago, people applied to less programs. Because programs received less applications, they offered interviews to a greater percentage of people who applied. From the applicant viewpoint, the chance of getting any interview from an application was higher. In IM (as an example), people applied to 30 programs, got 15 interviews, ranked 13-15, and matched somewhere. Now, people are applying to 70+ programs. Programs are overwhelmed with applications, and reject more people because there just isn't enough space. Programs can't tell whom is "really interested" and whom is just scattershot applying. Some really good and interested candidates might get passed by. In the end, the match continues to be equally successful -- most spots fill, most US candidates get spots. But because of the inflation, it's a ton more work -- for no benefit to anyone. in fact, the one metric that has gotten worse over time is the number of people matching to their top ranks.

That's the issue being discussed. It's the classic Prisoner's Dilemma. If all students were to agree to decrease their number of applications, then it would be a huge win for everyone -- cheaper for students, better app review by programs, possibly a "better" match with people getting the spots they want. But if any student "defects" and over applies, it's a win for them. They get more interviews and a longer rank list (although not necessarily a better match). So what tends to happen is a drift towards everybody defecting. It's likely not as diabolical as that -- if I was applying and was told that the average applicant submitted 20 applications, I would submit 22 or so -- submitting less than the average seems like a bad idea. If enough people feel like that, the average becomes 22 the next year, and the creep continues.

Perhaps there's no solution. But app inflation seems to have created a bunch of waste.

 

[Rapsidy]

There would be more than a cry, there would be lawsuits. That's why an application cap, the simplest and most straightforward solution, has not been implemented. Even if successful, it would result in years of litigation over restriction of free trade.

At some point you may want to consider that the people who have been dealing with this for years are all saying the same thing: it's a serious problem, it hasn't always existed, and there isn't some quick fix that has been overlooked by everybody.

I imagine that they could easily do an application cap considering they lobbied congress to be exempt from antitrust laws and therefore would likely win any lawsuit brought against them. They just have little interest or incentive in fixing the problem because they make 100 million tax free dollars a year on medical students.

Jung v. Association of American Medical Colleges - Wikipedia

en.m.wikipedia.org

I don’t really blame them, why would any organization want to cut their bottom dollar. I do think signaling is at least a step in the right direction and hopefully with some data in the years to come we can see how much impact signaling has, but I’m not holding my breath they’ll make any big sweeping changes anytime soon.

 

[Mr.Smile12]

By chance, discovered the following 2021 article. Discuss.

The Residency Match is Broken

The National Resident Matching Program (Match), the program to align med school applicants with their preferred residency program, is broken and filled with disincentives. The fix might be easy.

sciencebasedmedicine.org

 

[NotAProgDirector]

The description of the problem is accurate.

The solution is complicated. He is correct that if the AAMC won't do what we want, programs would need to work around it. The legality of a token based system is unclear -- although I would love application caps, I remain concerned that it's illegal to tell job applicants that they can only apply for 30 positions. What if we made that true for medical school -- you're only allowed to apply to 10 of them? I doubt people would be very happy with that. But if tokens were optional, some programs used them and perhaps others didn't, then maybe it would pass muster?

Completely missing the point is the author's claim that signaling won't solve the problem. What's the difference between signals and tokens? Nothing -- they are the same thing. If we gave every applicant 30 signals, then programs could just discard all apps without a signal.

 

[Med Ed]

I imagine that they could easily do an application cap considering they lobbied congress to be exempt from antitrust laws and therefore would likely win any lawsuit brought against them.

I'm reluctant to prognosticate on any particular legal outcome, particularly since the match was not "saved" by the judicial system. It does appear that if caps are every used, it will only be after every other possible solution has been tried and discarded.

They just have little interest or incentive in fixing the problem because they make 100 million tax free dollars a year on medical students.

No argument here.