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 NRMP's policies and procedures and to highlight relevant sections of the 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

I. Waiver Granted - Applicant

Description
After the 2007 Main Residency Match, Dr. Jane Doe wrote to the NRMP and requested a waiver of her match commitment to the Anesthesiology program at American Hospital. Dr. Doe informed the NRMP that her child had recently been diagnosed with a medical condition that required her immediate attention. The NRMP initiated a waiver review and requested information from the director of the program to which Dr. Doe had matched. Because Dr. Doe was completing her PGY-1 year at the time she requested the waiver, the NRMP also wrote to her current program director to request information. After reviewing all pertinent information, the NRMP granted Dr. Doe a waiver of her match commitment.

Policy
Sections 2.5 and 3.4 of the Match Participation Agreement for Applicants and Programs authorizes the NRMP to grant a waiver of the binding match commitment 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, 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.

II. Waiver Granted - Program

Description
After the 2007 Main Residency Match, the Neurology program at National Medical Center wrote to the NRMP, requesting a waiver of its match commitment to Dr. James Smith. Dr. Smith had informed the program that he failed to obtain a PGY-1 position and thus would not be eligible for a July 1, 2008 start date in the Neurology program. The NRMP initiated a waiver review and contacted Dr. Smith, who confirmed he had not matched to a PGY-1 position and was unable to obtain one during the Scramble. The NRMP granted the Neurology program a waiver of its match commitment.

Policy
Section 2.1 of the Match Participation Agreement for Applicants and Programs 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 3.4 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 the 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 begin to recruit another qualified candidate for the vacant position.

Section 5.1 states that a match commitment is subject to the official policies of the appointment 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 2007 Main Residency Match, Dr. Lucy McGilicutty wrote to the NRMP and requested a waiver of her match commitment to the Radiology-Diagnostic program at the American Medical Institution. While completing her PGY-1 year, she entered into a serious relationship and now planned to be married. She did not want to be separated from her fiancé for three years. 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 2.5 of the Match Participation Agreement for Applicants and Programs 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.

IV. Waiver Denied - Program

Description
After the 2006 Main Residency Match, the Pathology program at National Medical Center in Maryland wrote to the NRMP requesting a waiver of its match commitment to Dr. James Baker. After the rank order list deadline, the program director obtained additional information about Dr. Baker's prior residency training, and she no longer felt comfortable offering him a position. The NRMP initiated a waiver review and learned that Dr. Baker had a pre-existing licensing issue with the state of California but that the issue would not affect his ability to obtain a license in Maryland. Moreover, the new information obtained by the program had been available prior to the ranking deadline, when the program could have deleted the applicant's name from its rank order list. The NRMP denied the Pathology program's request for a waiver.

Policy
Section 5.1 of the Match Participation Agreement for Applicants and Programs 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.

VIOLATION

I. Violation - Applicant

Description
In the 2007 Main Residency Match, Dr. Scarlet O'Hara matched to the Family Practice program at American General Hospital. After the Match, the program informed the NRMP that Dr. O'Hara 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. O'Hara had forged the letters. The NRMP permanently identified Dr. O'Hara 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 Match Participation Agreement for Applicants and Programs sstates 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 an 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.

II. Violation - Program

Description
During the 2007 Main Residency Match, Match applicant Robert E. Lee informed the NRMP that the General Surgery program at National Medical Center had pressured students to reveal their ranking preferences during the application process. The NRMP initiated a violation investigation, solicited information from applicants who had interviewed with the program, and determined that a breach of the Agreement had occurred. The General Surgery program was flagged as a match violator in the NRMP's Registration, Ranking, and Results (R3) System for three years.

Policy
Section 6.0 of the Match Participation Agreement for Applicants and Programs prohibits applicants and programs from requesting ranking information. Applicants and programs may express interest in each other but may not solicit statements implying a commitment. Although applicants and programs may volunteer how they plan to rank each other, it is a breach of the Agreement to request such information.

III. Violation - Applicant and Program

Description
In the 2007 Main Residency Match, Dr. Jim Doe matched to the Internal Medicine program at American General Hospital. 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 a Psychiatry program at another institution. The Internal Medicine program director informed the NRMP of Dr. Doe's actions, and the NRMP initiated a violation investigation of Dr. Doe. After learning that the 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 Psychiatry program director 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 Psychiatry program was flagged as a match violator for two years.

Policy
Section 3.4 of the Match Participation Agreement for Applicants and Programs 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.

IV. Medical School

Description
In the 2007 Main Residency Match, the student affairs office at National University College of Medicine provided the List of Unfilled Programs to one of its prior graduates, Dr. Holly Golightly, in an effort to help her scramble into a PGY-1 position. Dr. Golightly had not registered for the 2007 Main Match and thus was ineligible to receive the List of Unfilled Programs.

Policy:
Section 6.3 of the Match Participation Agreement for Medical Schools states that it is a violation for any medical school official to share the List of Unfilled Programs with any individual who is not registered for the Main Residency Match or allow an individual who is not registered for the Match to use the registrant's unique code number and password to access the secure web site to obtain information about unfilled positions.

Updated 08/14/2007