Policies and Procedures for Waiver Requests

Purpose

The National Resident Matching Program (NRMP) assumes responsibility for instituting measures to protect the integrity of the matching process by requiring all match participants to behave ethically and responsibly during the matching process.

Policy

It is the policy of the NRMP to require each match participant to enter into an NRMP Match Participation Agreement and for the NRMP to conduct a review of all waiver requests submitted by participants. Under the terms of the Agreement signed by all Match participants, 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 begin training on the date specified in the appointment contract. The binding commitment may be released only through the procedures set forth in this policy.

The NRMP reserves the right to grant to an applicant or a program a waiver of the binding commitment; applicants and programs are not authorized to release each other from their binding match commitment. The determination to grant or deny a waiver request lies in the sole discretion of the NRMP and is not subject to arbitration.

A. Request for Waiver

1. Applicants, program directors, or institutional officials may contact the NRMP to request a waiver. The NRMP will not initiate a waiver review until it has received a written or electronic request. The request must include the name(s) of the matched applicant(s) and program(s).
   
   
2. Waiver requests must be sent in writing to:

Mona M. Signer, Executive Director
National Resident Matching Program
2450 N Street, NW
Washington, DC 20037-1127
FAX (202) 828-4797
nrmp@aamc.org

B. Confirmation and Examination Procedures

Following receipt of the waiver request, the NRMP will ask the requestor to confirm in writing that he/she/it wishes the NRMP to process the waiver. After receiving written confirmation, the NRMP will contact the party or parties (applicant, program director, and/or institutional official) identified in the request and any other person(s) with knowledge of the circumstances surrounding the request. All parties contacted will be asked to provide the NRMP with a written statement within five business days from the date of the NRMP's request.

1. All waiver requests will receive a full examination and evaluation by the NRMP. The NRMP is authorized to contact other individuals/institutions in the course of acquiring information
   
   
2. Applicants who have matched to a program shall not discuss, interview for, or accept a concurrent year position in another program prior to the NRMP issuing its decision as to whether to grant the requested waiver. In addition, programs shall not discuss, interview for, or offer the position to any other candidate until either: (a) the matched applicant has informed the NRMP that he/she will not accept the matched position if/when the NRMP denies the waiver and the program has been so notified by the NRMP; or (b) the NRMP grants the waiver.
   
   
3. An applicant or program may request a waiver if he/she/it believes the fulfillment of the commitment to the results of the Matching Program would cause serious and extreme hardship. The burden shall be on the requestor to demonstrate serious and extreme hardship. For purposes of the waiver process, the term serious and extreme hardship means the significant adversity that honoring the match would bear upon the requestor's case.
   
   
4. An applicant who matched to an advanced or fellowship position also may request a waiver if he/she has elected to change specialties, provided the waiver is requested no later than the January 15 prior to the start of training in the advanced or fellowship program.
   
   
5. If at any time during the course of a waiver review the applicant or program notifies the NRMP in writing that he/she/it will not honor the match commitment if the waiver is denied, the NRMP may grant an immediate waiver to the other party.

C. Consequences of Waiver Review Process

1. At the conclusion of the examination and evaluation, the NRMP will decide whether to grant or deny the waiver request.

   a. If a waiver is granted, the matched applicant may accept another position or participate in future matches, and the NRMP will not pursue the matter as a violation of the Match Participation Agreement signed during registration. In addition, the matched program will be free to recruit another candidate for the vacant position.

   b. If a waiver is not granted, the matched applicant and program will be expected to honor the match commitment. Both parties will have five business days from receipt of the NRMP's decision to inform the NRMP whether the applicant will begin training in the program. Failure to honor the match commitment is a breach of the Match Participation Agreement and grounds for a violation investigation. All investigations are conducted in accordance with the Policies and Procedures for Reporting, Investigation, and Disposition of Violations of NRMP Agreements. The NRMP recommends that each applicant and program read that document carefully.

2. If a waiver is not granted and the applicant does not agree to honor the match commitment, he/she may be barred from accepting a position in any program sponsored by an institution that participates in the Matching Program if the position has a start date within one year from the date of the NRMP's final decision to deny the waiver. Further, an institution that participates in the Matching Program is prohibited from offering a position in any program sponsored by the institution, regardless of Matching Program participation status, to any applicant who is ineligible to accept a position as the result of a denied waiver. Programs shall not discuss, interview for, or offer 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. If any of the programs sponsored by the institution discusses, interviews for, or offers a position to that applicant to commence training during the one-year period or if the applicant accepts such a position, the NRMP will initiate an investigation to determine whether the applicant, the program, or the institution has violated the terms of the Match Agreement.
   
   
3. If a waiver is not granted and the applicant does not agree to honor the match commitment, the applicant may be subject to a violation investigation for failure to honor his/her binding match commitment. As a consequence of a confirmed violation, the applicant may be:

   (1) barred from future NRMP matches for a period of one to three years or permanently, as determined by the NRMP.

   (2) identified as a match violator to participating programs for a period of one to three years or permanently, as determined by the NRMP.

   (3) barred from accepting or starting a position in another NRMP match-participating program that has a start date within one year from the date of the NRMP's issuance of the Final Report of the investigation.

   In addition, the applicant's medical school will be notified of the confirmed violation, with a request that it become part of the applicant's permanent file.
   
   
4. If a program is denied a waiver of its match commitment by the NRMP and does not agree to offer the matched position to the matched applicant, the program may be subject to a violation investigation for failure to honor its binding match commitment. As a consequence of a confirmed violation, the program may be:

   (1) barred from future NRMP matches for one to three years or permanently, as determined by the NRMP.

   (2) identified as a match violator to participating applicants for one to three years or permanently, as determined by the NRMP.

   In addition, the NRMP will notify the ACGME and appropriate residency review committee and the program director association.
   
   
5. If any program sponsored by an institution that participates in the Matching Program, regardless of the program's Matching Program participation status, offers a position to an applicant who has matched to a concurrent year position and who has not been granted a waiver by the NRMP, the institution may be subject to a violation investigation for failure to comply with the Participation Agreement.

D. Reconsideration of Initial NRMP Decision

A party whose request for a waiver has been denied may request reconsideration of the determination. The party will have five business days from receipt of the initial adverse decision to request reconsideration. The request for reconsideration should state the basis for reconsideration and explain why the initial decision of the NRMP is unreasonable under the circumstances. The decision following reconsideration is final and not subject to arbitration.

Upon completion of the reconsideration process, if any, the NRMP will issue a letter indicating the final decision regarding the waiver request. Unless otherwise determined by the NRMP, the effective date of the final decision will be the date of the letter that transmits the final decision to the party(ies).

E. Match Violations

If the NRMP initiates a violation investigation to determine whether an applicant or program has violated the terms of the Match Participation Agreement, the investigation and any confirmed violation will be handled in accordance with the terms of the relevant Agreement and the NRMP Policies and Procedures for Reporting, Investigation, and Disposition of Violations of NRMP Agreements.

Updated July 2009