Waiver Reviews and Violation Investigations

Case Summaries

Below are examples of the types of waiver reviews and violation investigations conducted by the NRMP. They are intended to help match participants understand the policies and procedures governing waiver reviews and violation investigations and to highlight relevant sections of the Specialties Matching Service Match Participation Agreement. 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. Review the terms and conditions of the Match Participation Agreement.

WAIVER:

Waiver Granted - Applicant

Description
After the 2007 Radiology Fellowship Match, Dr. Jane Doe wrote to the NRMP and requested a waiver of her match commitment to the National Medical Center. Dr. Doe wanted to change her specialty from Interventional Radiology to Abdominal Radiology, and she notified the NRMP of her intentions less than one month after the release of the Match results. The NRMP initiated a waiver review and requested information from the director of the fellowship program to which Dr. Doe had matched and from her current residency program director. After reviewing all pertinent information, the NRMP granted Dr. Doe a waiver of her 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 and the waiver is requested no later than the January 15 prior to the start of training. Waivers must be requested from, and can be granted only by, the NRMP; applicants and programs are not authorized to release each other. Moreover, applicants may not negotiate for appointment to 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 or participate in future NRMP matches.

Waiver Granted - Program

Description
After the 2007 Obstetrics and Gynecology Fellowship Match, the Gynecologic Oncology program at American General Hospital wrote to the NRMP, requesting a waiver of its match commitment to Dr. John Smith. Dr. Smith's visa application had been delayed, and he had asked the program to postpone his start date in order to allow additional time for the application to be approved. The NRMP initiated a waiver review and requested confirmation from Dr. Smith regarding the status of his visa application. Dr. Smith confirmed that his application had been delayed, and the NRMP granted the Gynecologic Oncology 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. Those requirements are prescribed by the Accreditation Council for Graduate Medical Education ("ACGME") in Section II of the ACGME Institutional Requirements, Residents, and are incorporated into the Match Participation Agreement by reference.

Section 3.3 authorizes the NRMP to grant a waiver of the binding match commitment to a program if honoring the match would cause serious hardship. Waivers must be requested from, and can be granted only by, the NRMP; applicants and programs are not authorized to release each other. Moreover, programs may not negotiate with 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.

Waiver Denied- Applicant

Description
After the 2007 Vascular Surgery Fellowship Match, Dr. Lucy McGilicutty requested a waiver of her match commitment to the American Medical Institution. While completing her residency training, she entered into a serious relationship and now planned to be married. She did not want to be separated from her fiancé for the duration of her fellowship. The NRMP denied Dr. McGilicutty's request and informed her of her obligation to honor the match commitment. When Dr. McGilicutty notified the NRMP that she would not accept the matched position, the NRMP initiated a violation investigation of her 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 would cause serious hardship. The burden falls on the applicant to demonstrate why honoring the match would be a 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 Agreement. Moreover, any applicant whose waiver request is denied and who does not accept the matched position cannot accept a position in another NRMP match-participating program for one year from the date of the NRMP's decision. Any program 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. Failure to honor that commitment is a breach of the Agreement and may result in penalties to the program or applicant.

Waiver Denied-Program

Description
After the 2007 Medical Specialties Matching Program, the Infectious Disease program at American Hospital wrote to the NRMP and requested a waiver of its match commitment to Dr. Christopher Robin. After Match Day, the program director realized that he had listed an incorrect quota of positions in the NRMP's Registration, Ranking, and Results (R3) System, and he did not have the funding to support Dr. Robin. The NRMP initiated a waiver review and investigated the program's log-in history within the System. Although the program director had made several changes to his rank order list prior to the certified rank order list deadline, he had never modified his program quota prior to the quota change deadline. The NRMP denied the Infectious Disease program director's request for a waiver.

Policy
Section 3.2 of the Specialties Matching Services Match Participation Agreement allows programs to withdraw entirely from an SMS Match or withdraw positions prior to the quota change deadline for the Match. However, programs may not withdraw from, or change the number of positions offered, in any SMS Match after the quota change deadline except for situations beyond the control of the program, as determined by the NRMP.

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. 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 2007 Pediatric Cardiology Match, Dr. Jane Doe matched to the program at National Medical Center. In March 2007, the NRMP learned from the program director that Dr. Doe had not returned her confirmation letter and had not responded to his repeated requests for information to complete the appointment process. The NRMP contacted Dr. Doe and informed her of her of the NRMP's requirement to request a waiver of her match commitment. During the waiver review, the NRMP learned that she was undecided about whether to accept the matched position because her ultimate goal was to obtain a position in a Pediatric Surgery program. Although she had matched in Pediatric Cardiology, she also had obtained a position in a non match-participating specialty at another institution that would better position her for a fellowship in Pediatric Surgery. The NRMP denied the waiver and when Dr. Doe failed to honor her match commitment, she was barred from NRMP match-participating programs for one year, barred from future NRMP matches for two years, and flagged as a match violator in the NRMP's Registration, Ranking, and Results (R3) System for two years.

Policy
Section 2.3 of the Specialties Matching Services Match Participation Agreement allows applicants to withdraw from the SMS Matching Program under certain conditions prior to the applicable rank order list certification deadline. Applicants who have accepted a position through any other national matching service or by agreement outside the SMS Matching Program must withdraw from the Matching Program. Failure to withdraw in a timely manner is a breach of the Agreement.

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 in the fellowship program. 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 cannot accept a position in another NRMP match-participating program for one year from the date of the NRMP's decision. Any program 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. Failure to honor that commitment is a material breach of the Agreement and may result in penalties to the program or applicant.

II. Violation - Applicant

Description
In the 2007 Thoracic Surgery Fellowship Match, Dr. Holly Golightly matched to the American General Hospital. After the Match, the program informed the NRMP that Dr. Golightly had forged her letters of recommendation. The NRMP initiated a violation investigation, collected information from relevant parties including the individuals who purportedly had signed the letters of recommendation, and determined that Dr. Golightly had forged the letters. The NRMP permanently identified Dr. Golightly as a match violator in the NRMP's Registration, Ranking and Results (R3) System, permanently barred her from participation in future NRMP matches, sent a copy of the Final Report to the American Board of Medical Specialties and the Federation of State Medical Boards, and barred her from NRMP match-participating programs for one year.

Policy
Section 4.3 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 considered 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.

Violation - Applicant and Program

Description
In the 2007 Child and Adolescent Psychiatry Fellowship Match, Dr. John Doe matched to the program at the American Medical Institution. In June 2007, Dr. Doe notified the program that he would not honor his binding match commitment because he had decided to accept a position in another Child and Adolescent Psychiatry program with a July 2007 start date. The program at the American Medical Institution informed the NRMP of Dr. Doe's actions, and the NRMP initiated a violation investigation of Dr. Doe. After learning that the second Child and Adolescent Psychiatry program also was an NRMP match-participating program, the NRMP initiated a separate violation investigation of the program. The NRMP conducted both investigations according to the NRMP Policies and Procedures for the Reporting, Investigation, and Disposition of Violations of NRMP Agreements and although the program director at the second Child and Adolescent Psychiatry program did not know of Dr. Doe's existing match commitment, the NRMP concluded that a breach of the Agreement had occurred. Dr. Doe was barred from match-participating programs for one year, flagged as a match violator in the NRMP's Registration, Ranking, and Results (R3) System for two years, and barred from future NRMP matches for two years. In addition, the second Child and Adolescent Psychiatry program was flagged as a match violator for two years.

Policy
Section 3.3 of the Specialties Matching Services Match Participation Agreement states that programs are expected to 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. Failure to honor that commitment is a breach of the Agreement and may result in penalties to the program or applicant. In addition, any program that offers a position to an applicant who matched to a concurrent year position in another program is in breach of the Agreement.

Updated 08/14/2007