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^SM (SMS^SM). 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 Results^SM (R3^SM) 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 Match^SM, 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