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 Service. 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:

I. Waiver Granted - Applicant

Description
After the 2010 Thoracic Surgery Fellowship Match, Dr. John Doe wrote to the NRMP and requested a waiver of his match commitment to the National Medical Center. Dr. Doe wanted to change his specialty to Vascular Surgery, and he notified the NRMP of his intentions one month after 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 his current residency program director. After reviewing all pertinent information, the NRMP granted Dr. Doe 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 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 2010 Medical Specialties Matching Program, the Cardiovascular Disease program director at American General Hospital wrote to the NRMP requesting a waiver of his program's match commitment to Dr. Ethel Murtz. Dr. Murtz's visa application had been delayed by her home country, and she had asked the program to postpone her July 2011 start date to allow additional time for the application to be approved. The NRMP initiated a waiver review and requested confirmation from Dr. Murtz regarding the status of her visa application. Dr. Murtz confirmed that her application had been delayed, and the NRMP granted the Gastroenterology 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 3.3 authorizes the NRMP to grant a waiver of the binding match commitment to a program if honoring the match 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 2010 Pediatric Surgery Fellowship Match, Dr. Lucy McGilicutty requested a waiver of her match commitment to the American Medical Institution. During her residency training, she had 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 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 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 2010 Radiology Fellowship Match, the Interventional Radiology program director at American Hospital wrote to the NRMP and requested a waiver of its match commitment to Dr. Jane Doe. After Match Day, the program director had obtained additional information about Dr. Doe's residency training, and she no longer felt comfortable offering Dr. Doe a position. The NRMP initiated a waiver review and learned that Dr. Doe 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 certified rank order list deadline, when the program could have deleted the Dr. Doe's name from its rank order list. The NRMP denied the Interventional Radiology 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 2010 Pediatric Specialties Spring Match (PSSM), Dr. Robert E. Lee matched to the Pediatric Gastroenterology program at National Medical Center for a July 2011 start date. In May 2011, the NRMP learned from the program director that Dr. Lee 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. Lee 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. Lee was undecided about whether to accept the matched position. He was completing a separate fellowship in Pediatric Hematology/Oncology, and he was unsure whether he wished to pursue a career in that specialty. The NRMP denied the waiver, noting that Dr. Lee could have withdrawn from the PSSM prior to the rank order list deadline if he had wished to pursue a career in Pediatric Hematology/Oncology. When Dr. Lee 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 Results (R3) System for two years.

Policy
Section 2.3.1 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 accept a concurrent year position outside the SMS Matching Program or through any other national matching service shall withdraw from the Matching Program. Withdrawal from the SMS Matching Program must be completed prior to the rank order list certification deadline. Failure to withdraw is a breach of the Agreement. Applicants in the Matching Program also are prohibited from discussing, Interviewing for, or accepting a position through any other national matching service or by agreement outside the Matching Program after the rank order list certification deadline.

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 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.

II. Violation - Applicant

Description
In the 2011 Child and Adolescent Psychiatry Fellowship Match, Dr. Holly Golightly matched to the American General Hospital. After the Match, the fellowship program director informed the NRMP that Dr. Golightly had forged a letter of reference from her residency program director. The NRMP initiated a violation investigation, collected information from relevant parties, including the program director who purportedly had written the letter of reference, and determined that Dr. Golightly had forged the letter. The NRMP barred Dr. Golightly for one year from accepting or starting a position in any program sponsored by an NRMP match-participating institution, permanently identified her as a match violator in the NRMP's Registration, Ranking, and Results (R3) System, permanently barred her from participation in future NRMP matches, and sent a copy of the Final Report to the American Board of Medical Specialties and the Federation of State Medical Boards.

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 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 2010 Allergy and Immunology Fellowship Match, Dr. John Doe matched to the A/I program at American Medical Institution. In June 2011, Dr. Doe notified the program that he would not honor his binding match commitment because he had decided to accept a position in another Allergy and Immunology program with a July 2011 start date. The program director 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 Allergy and Immunology 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. Although the program director at the second Allergy and Immunology 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 for one year from accepting or starting any program sponsored by an NRMP match-participating institution, 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 Allergy and Immunology 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 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 Combined Musculoskeletal Matching Program, the director of the Orthopedic Hand Surgery program at National University College of Medicine contacted the NRMP about an applicant who had declined her matched position for July 2011. The applicant had informed the program director that she had accepted a position in a non-NRMP-match-participating Plastic Surgery program at another institution beginning July 2011. The NRMP initiated a violation investigation of the applicant. After learning that the Plastic Surgery 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 Plastic Surgery program did not participate in the Specialties Matching Service, 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 NRMP's Registration, Ranking, and Results (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 NRMP Registration, Ranking, and Results (R3) System.

Policy:
Section 2.2.5 of the Match Participation Agreement for Institutions requires institution 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 considered 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 08/31/2011