Waiver Reviews and Violation Investigations
Case Summaries
Below are examples of waiver reviews and violation investigations
conducted by the NRMP. They are intended to help Match participants understand
the NRMP's policies and procedures and to highlight relevant sections
of Match Participation Agreements that govern the Specialties
Matching ServiceSM
(SMSSM).
These examples are illustrative only and are not meant to be an exhaustive
list of the types of reviews and investigations conducted by the NRMP.
Participants should review the terms and conditions of the Match
Participation Agreement.
WAIVER:
I. Waiver Granted - Applicant
Description
After the 2011 Surgical Critical Care Fellowship Match, Dr. Jason Bourne
wrote to the NRMP and requested a waiver of his Match commitment to the
National Medical Center. Dr. Bourne wanted to change his specialty to
Colon and Rectal Surgery, and he notified the NRMP of his intentions in
November 2011, one month after release of Match results. The NRMP initiated
a waiver review and requested information from the director of the fellowship
program to which Dr. Bourne had matched and from his current residency
program director. After reviewing all pertinent information, the NRMP
granted Dr. Bourne a waiver of his Match commitment.
Policy
Sections 2.4
of the Specialties Matching
Service Match Participation Agreement states that the NRMP may grant
a waiver of the binding Match commitment if an applicant has elected to
change specialties provided the waiver is requested no later than the
January 15 prior to the start of training. Once a party has matched,
a waiver may be obtained only from the NRMP; applicants and programs are
not authorized to release each other. Moreover, applicants may not apply
for, discuss, interview for, or accept a position in another program until
the NRMP has approved a waiver request. All waivers must be submitted
to the NRMP in writing, with a copy to the program to which the applicant
matched. The NRMP solicits information from all relevant parties prior
to deciding whether to grant the waiver. If the waiver is granted, the
applicant may accept a position in another program and participate in
future NRMP Matches.
II. Waiver Granted - Program
Description
After the 2011 Pediatric Specialties Spring Match, the Pediatric Pulmonology
program director at American General Hospital wrote to the NRMP requesting
a waiver of his program's Match commitment to Dr. Jean Grey. Dr. Grey's
visa application had been delayed by her home country, and she had asked
the program to postpone her July 2012 start date to allow additional time
for the application to be approved. The NRMP initiated a waiver review
and requested information from Dr. Grey regarding the status of her visa
application. Dr. Grey confirmed that her application had been delayed,
and the NRMP granted the Pediatric Pulmonology program a waiver of its
Match commitment.
Policy
Section
2.1 of the Specialties
Matching Service Match Participation Agreement states that an applicant
must meet all of the requirements for entry into graduate medication education
prior to the scheduled start date of the matched position. The requirements
include those imposed by the institution and program as well as those
prescribed by the Accreditation Council for Graduate Medical Education
("ACGME") in Section II of the ACGME Institutional Requirements,
Residents. Programs are not obligated to offer, nor will the NRMP require,
a delayed start date for training.
Section 3.4
authorizes the NRMP to grant a waiver of the binding Match commitment
to a program if honoring the Match outcome would cause serious and extreme
hardship. Once a party has matched, a waiver may be obtained only from
the NRMP; applicants and programs are not authorized to release each other.
Moreover, programs may not discuss, interview for, or offer the matched
position to another candidate prior to or during the course of a waiver
investigation. All waivers must be submitted to the NRMP in writing, with
a copy to each applicant named in the request. The NRMP solicits information
from all relevant parties prior to deciding whether to grant the waiver.
If the waiver is granted, the program may recruit another qualified candidate
for the vacant position.
Section
5.1 states that a Match commitment is subject to the official policies
of the appointing institution in effect on the date the program submits
its rank order list and is contingent upon the matching applicant meeting
all eligibility requirements imposed by those policies.
III. Waiver Denied- Applicant
Description
After the 2011 Medical Genetics Fellowship Match, Dr. Jack Traven requested
a waiver of his Match commitment to the American Medical Institution.
During his residency training, he had entered into a serious relationship
and now planned to be married. Dr. Traven did not want to be separated
from his fiancée for the duration of his fellowship. The NRMP denied
Dr. Traven's request and informed him of his obligation to honor the Match
commitment. When Dr. Traven declined his matched position, the NRMP initiated
a violation investigation of his actions.
Policy
Section
2.4 of the Specialties
Matching Service Match Participation Agreement authorizes the NRMP
to grant a waiver of the binding Match commitment to an applicant if honoring
the Match outcome would cause serious and extreme hardship. If the NRMP
denies the waiver request, the applicant is expected to accept the matched
position. If the applicant fails to do so, the NRMP will initiate an investigation
to determine whether the applicant has violated the terms of the SMS
Match Participation Agreement. Moreover, any applicant whose waiver request
is denied and who does not accept the matched position may be barred from
accepting or starting a position in any program sponsored by an NRMP Match-participating
institution for one year from the date of the NRMP's final decision to
deny the waiver. Any program at a Match-participating institution that
offers a position to that applicant to commence training during the one-year
period is in breach of the Agreement, and the NRMP will initiate a violation
investigation of that program.
Section
5.1 states that the listing of an applicant by a program on its certified
rank order list or of a program by an applicant on the applicant's certified
rank order list establishes a binding commitment to offer or to accept
an appointment if a match results and to start training in good faith
(i.e., with the intent to complete the program) on the date specified
in the appointment contract. Failure to honor that commitment is a breach
of the Agreement and may result in penalties to the program or applicant.
In addition, applicants who terminate or resign their positions within
45 days of the date specified in their appointment contracts will be presumed
to have breached the Agreement and will be subject to a violation investigation.
IV. Waiver Denied-Program
Description
After the 2011 Abdominal Transplant Surgery Fellowship Match, the program
director at American Hospital wrote to the NRMP and requested a waiver
of its Match commitment to Dr. Lara Croft. After Match Day, the program
director had obtained additional information about Dr. Croft's residency
training, and she no longer was comfortable offering Dr. Croft a position.
The NRMP initiated a waiver review and learned that Dr. Croft had no prior
record of misconduct. Moreover, the information on which the program had
based its request for a waiver had been available to the program prior
to the rank order list deadline,
when the program could have deleted the Dr. Croft from its rank order
list. The NRMP denied the program's request for a waiver.
Policy
Section 5.1
states that the listing of an applicant by a program on its certified
rank order list or of a program by an applicant on the applicant's certified
rank order list establishes a binding commitment to offer or to accept
an appointment if a Match results and to start training in good faith
(i.e., with the intent to complete the program) on the date specified
in the appointment contract. Failure to honor that commitment is a breach
of the Agreement and may result in penalties to the program or applicant.
VIOLATION:
I. Violation - Applicant
Description
In the 2011 Radiology Fellowship Match, Dr. Peter Parker matched to the
Interventional Radiology program at National Medical Center for a July
2012 start date. In May 2012, the NRMP learned from the program director
that Dr. Parker had not returned his confirmation letter and had not responded
to the program director's repeated requests for information to complete
the appointment process. The NRMP contacted Dr. Parker and informed him
of the NRMP's requirement to request a waiver of his Match commitment
if he did not plan to honor his match. During the waiver review, the NRMP
learned that Dr. Parker was undecided about whether to accept the matched
position. He was completing an occupation outside the field of medicine,
and he was unsure what course of action to take. The NRMP denied the waiver,
noting that Dr. Parker could have withdrawn from the Radiology Fellowship
Match prior to the rank order list deadline if he had wished to pursue
a different career. When Dr. Parker failed to honor his Match commitment,
he was barred for one year from accepting or starting a position in any
program sponsored by an NRMP Match-participating institution, barred from
future NRMP Matches for two years, and flagged as a Match violator in
the NRMP's Registration,
Ranking, and ResultsSM
(R3SM)
system for two years.
Policy
Section
2.4 states that waiver requests for change of specialty must be submitted
no later than the January 15 prior to the start of training. If
the NRMP denies the waiver request, the applicant is expected to accept
the matched position. If the applicant fails to do so, the NRMP will initiate
an investigation to determine whether the applicant has violated the terms
of the Agreement. Moreover, any applicant whose waiver request is denied
and who does not accept the matched position may be barred from accepting
or starting a position in any program sponsored by an NRMP Match-participating
institution for one year from the date of the NRMP's final decision to
deny the waiver. Any program at a Match-participating institution, regardless
of the program's Match participation status, that offers a position to
that applicant to commence training during the one-year period is in breach
of the Agreement, and the NRMP will initiate a violation investigation
of the program or the institution. Section 5.1 states that the listing
of an applicant by a program on its certified rank order list or of a
program by an applicant on the applicant's certified rank order list establishes
a binding commitment to offer or to accept an appointment if a Match results
and to start training in good faith (i.e., with the intent to complete
the program) on the date specified in the appointment contract. Failure
to honor that commitment is a breach of the Agreement and may result in
penalties to the program or applicant. In addition, applicants who terminate
or resign their positions within 45 days of the date specified in their
appointment contracts will be presumed to have breached the Agreement
and will be subject to a violation investigation.
II. Violation - Applicant
Description
In the 2011 Thoracic Surgery Fellowship Match, Dr. Diana Prince matched
to the American General Hospital. After the Match, the fellowship program
director informed the NRMP that Dr. Prince had failed to disclose on her
ERAS application a prior issue with her medical license. The NRMP initiated
a violation investigation, collected information from relevant parties
including information from the state medical board where Dr. Prince was
completing her core residency training, and determined that Dr. Prince
had failed to disclose a former suspension of her medical license. The
NRMP barred Dr. Prince for one year from accepting or starting a position
in any program sponsored by an NRMP Match-participating institution, barred
her from participation in future NRMP Matches for three years, identified
her as a Match violator in the R3 system for three years,
and sent a copy of the Final Report to the American Board of Medical Specialties.
Policy
Section
4.4 of the Specialties
Matching Services Match Participation Agreement states that applicants
are responsible for the completeness, timeliness, and accuracy of the
information provided to programs. The submission of information by an
applicant during the interview and/or matching process that is false,
misleading, incomplete, or plagiarized from another source is a violation
of the Agreement. If the NRMP believes it has received credible evidence
that the applicant or program has violated the terms of the Agreement,
the NRMP is authorized to take appropriate action.
Section
7.2 outlines for applicants and programs the consequences of a confirmed
violation of the Agreement. Applicants may be barred from subsequent NRMP
Matches and/or identified as a Match violator to participating programs
for up to three years or permanently, as determined by the NRMP.
III. Violation - Applicant and Program
Description
In the 2011 Sleep Medicine Fellowship Match, Dr. James Kirk matched to
the Sleep Medicine program at American Medical Institution. In June 2012,
Dr. Kirk notified the program that he would not honor his binding Match
commitment because he had decided to accept a position in a Sleep Medicine
program that was closer to his family. The program director at the American
Medical Institution informed the NRMP of Dr. Kirk's actions, and the NRMP
initiated a violation investigation of Dr. Kirk. After learning that the
second Sleep Medicine program also was an NRMP Match-participating program,
the NRMP initiated a separate violation investigation of the program.
The NRMP conducted the investigations according to the NRMP
Policies and Procedures for the Reporting, Investigation, and Disposition
of Violations of NRMP Agreements. The program director at the second
Sleep Medicine program reported to the NRMP that he was unaware of Dr.
Kirk's existing Match commitment; however, the NRMP concluded that a breach
of the Agreement had occurred. Dr. Kirk was barred for one year from accepting
or starting a position in any program sponsored by an NRMP Match-participating
institution, flagged as a Match violator in the R3 system
for two years, and barred from future NRMP matches for two years. In addition,
the second Sleep Medicine program was flagged as a Match violator for
two years.
Policy
Section 3.4
of the Specialties Matching
Services Match Participation Agreement states that programs shall
use the Applicant Match History in the Match Site to determine the Match
status of any applicant considered for appointment to the program.
Section
5.1 states that the listing of an applicant by a program on its certified
rank order list or of a program by an applicant on the applicant's certified
rank order list establishes a binding commitment to offer or to accept
an appointment if a Match results and to start training in good faith
(i.e., with the intent to complete the program) on the date specified
in the appointment contract. Failure to honor that commitment is a breach
of the Agreement and may result in penalties to the program or applicant.
Section
5.1 also states that any program that discusses or offers a position
to an applicant who matched to a concurrent year position in another program
and who has not been granted a waiver by the NRMP will be in breach of
the Agreement. Programs shall not interview or discuss with an applicant
any potential position unless the program has first determined that the
applicant is eligible for appointment. Programs shall determine the applicant's
eligibility by verifying the applicant's Match status in the Applicant
Match History that is available in the Match Site and/or by calling the
NRMP to obtain that information.
IV. Institution
Description
After the 2011 Primary Care and Sports Medicine Fellowship Match, the
program director at National University College of Medicine contacted
the NRMP about an applicant who had declined her matched position for
July 2012. The applicant had informed the program director that she was
declining the position because she wished to pursue another core residency
in Family Medicine and had accepted a position in a non NRMP Match-participating
program for July 2012. The NRMP initiated a violation investigation of
the applicant. After learning that the core Family Medicine program was
affiliated with a Match-participating institution, the NRMP initiated
a separate violation investigation of the institution. The NRMP conducted
the investigations according to the NRMP
Policies and Procedures for the Reporting, Investigation, and Disposition
of Violations of NRMP Agreements. Although the Family Medicine program
did not participate in the NRMP Main
Residency MatchSM, the NRMP concluded that the institution
had breached the Agreement. The applicant was barred for one year from
accepting or starting a position in any program sponsored by an NRMP Match-participating
institution, flagged as a Match violator in the R3 system
for two years, and barred from future NRMP Matches for two years. In addition,
the institution was listed as a Match violator in the Institution and
Program Violations Report in the R3 system.
Policy:
Section
2.2.6 of the Match
Participation Agreement for Institutions requires institutional officials
to ensure that none of the programs sponsored by the institution, regardless
of Matching Program participation status, discusses, interviews for, or
offers a position to an applicant who has matched to a concurrent year
position through the Matching Program. An institution will be in breach
of the Match Participation Agreement if any program sponsored by the institution
discusses, interviews for, or offers a position to an applicant who has
matched to a concurrent year position in another program.
Section
9.2 of the Match Participation Agreement for Institutions outlines
for applicants, programs, and institutions the consequences of a confirmed
violation of the Agreement.
Updated
08/29/2012
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