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 Match Participation Agreements that govern the Main Residency Match. 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 2009 Main Residency Match, Dr. John Smith wrote to the NRMP and requested a waiver of his match commitment to the Internal Medicine program at National Hospital. Dr. Smith informed the NRMP that his wife had been diagnosed with a serious illness after release of the match results, and he wished to remain near his extended family for their care and assistance. The NRMP initiated a waiver review and requested medical information from Dr. Smith along with information from the director of the program to which Dr. Smith had matched. Because Dr. Smith was a medical student, the NRMP also wrote to his school official to request information. After reviewing all pertinent information, the NRMP granted Dr. Smith a waiver of his match commitment.

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 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, 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 or participate in future NRMP matches.

II. Waiver Granted - Program

Description
After the 2009 Main Residency Match, the Dermatology program at American Medical Center wrote to the NRMP, requesting a waiver of its match commitment to Dr. Holly Golightly. The start date for training had passed, and Dr. Golightly had not yet obtained the necessary visa to begin training in the program. The NRMP initiated a waiver review and contacted Dr. Golightly. Dr. Golightly confirmed that she did not yet have her visa, but she asked the NRMP not to grant a waiver because her visa would be approved soon. After reviewing all pertinent information, the NRMP granted the Dermatology 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. 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 would cause serious and extreme hardship. Once a party has matched, a waiver of the binding commitment 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 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.

III. Waiver Denied - Applicant

Description
After the 2008 Main Residency Match, Dr. Lucy McGilicutty wrote to the NRMP and requested a waiver of her match commitment to the Radiology program at the American Medical Institution for July 1, 2009. During the spring of her PGY-1 year, she had decided that she wanted a career involving direct patient care, and she wished to change her specialty to Internal Medicine. The NRMP denied Dr. McGilicutty's request because her request for a waiver based on change of specialty was not timely. The NRMP 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 who has elected to change specialty provided the waiver is requested 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 a position in another NRMP match-participating program for one year from the date of the NRMP's final decision to deny the waiver. 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 2009 Main Residency Match, the General Surgery program at National Medical Center wrote to the NRMP requesting a waiver of its match commitment to Dr. Christopher Robin. After the rank order list deadline, the program director obtained additional information about Dr. Robin's prior residency training, and he no longer felt comfortable offering Dr. Robin a position. The NRMP initiated a waiver review and learned that Dr. Robin had no prior record of misconduct. Moreover, the information obtained by the program had been available prior to the ranking deadline, and the program could have deleted the applicant's name from its rank order list had he contacted Dr. Robin's former program director prior to the rank order list deadline. The NRMP denied the Psychiatry 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 breach of the Agreement and may result in penalties to the program or applicant.

VIOLATION

I. Violation - Applicant

Description
In the 2009 Main Residency Match, Dr. Robert E. Lee matched to the Family Medicine program at American General Hospital. After the Match, the program informed the NRMP that Dr. Lee could not qualify for a medical training license because he had failed to disclose on his application that he was on probation for a license he had held in another state. The NRMP initiated a violation investigation, collected information from relevant parties, and determined that Dr. Lee had misrepresented himself on his training license application. The NRMP permanently identified Dr. Lee as a match violator in the NRMP's Registration, Ranking, and Results (R3) System and permanently barred him from participation in future NRMP matches. The NRMP also barred Dr. Lee from accepting a position in an NRMP match-participating program for one year.

Policy:
Section 4.3 of the Match Participation Agreement for Applicants and Programs 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.

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 one to three years or permanently, as determined by the NRMP.

II. Violation - Program

Description
During the 2009 Main Residency Match, applicant Scarlett O'Hara informed the NRMP that the Neurology program at National Medical Center had required her to identify the programs with which she had or planned to interview and to give the name of the program in which she was most interested. The NRMP initiated a violation investigation of the program and solicited information from other applicants who had interviewed with the program. Other applicants confirmed that similar questions had been asked of them, and the NRMP determined that a breach of the Agreement had occurred. The Neurology 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 soliciting verbal or written statements implying a commitment. In addition, it is a breach of NRMP policy for programs to request information about applicants' ranking preferences, for applicants or programs to suggest or inform the other that placement on a rank order list is contingent upon submission of a verbal or written statement indicating ranking preferences, or for a program to require applicants to reveal the names or identities of programs to which they have or may apply.

III. Violation - Applicant and Program

Description
In the 2008 Main Residency Match, Dr. Jim Doe matched to the Physical Medicine and Rehabilitation (PMR) program at American General Hospital. In June 2009, Dr. Doe notified the program that he would not honor his binding match commitment because he had decided to accept a position offered by an Orthopaedic Surgery program at another institution. The PMR program director informed the NRMP of Dr. Doe's actions, and the NRMP initiated a violation investigation of Dr. Doe. After learning that the Orthopaedic Surgery 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 Orthopaedic Surgery 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 Orthopaedic Surgery 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 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. 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.

Section 5.1 also states that any program that discusses or offers a position to an applicant who has 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 Match Agreement. Programs are prohibited from interviewing or discussing 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. Medical School

Description
In the 2009 Main Residency Match, the student affairs office at National University College of Medicine contacted an unfilled program prior to 12:00 noon eastern time on Tuesday of Match Week in an effort to assist student who had not obtained a PGY-1 position.

Policy:
Section 8.0 of the Match Participation Agreement for Medical Schools states that it is a violation for any medical school to pursue positions for the school's unmatched senior students and graduates prior to 12:00 noon eastern time on Tuesday of Match Week. Schools also must agree not to assist any matched senior student or graduate to find an alternative position. It also is considered a violation of the Match Agreement for the NRMP school official, the NRMP school administrator, or the designee of either to make any communication with respect to an alternative position for any matched senior student or graduate who has not received a waiver of his or her match commitment from the NRMP.

V. Institution

Description
After the 2009 Main Residency Match, the student affairs dean at National University College of Medicine contacted the NRMP about a senior who had failed to match to a PGY1 position. The senior, who had participated in another national matching plan for her specialty training and matched to the Child Neurology program at National Medical Center, had been informed by the Medicine-Preliminary program at National Medical Center that she did not need to participate in the 2009 Main Residency Match for her PGY1 position. At the advice of her school, the student registered for the 2009 Main Residency Match and submitted a rank order list, but the Medicine-Preliminary program already had agreed to provide her with a PGY1 position based on her match to Child Neurology and did not place her position in the Match.

Policy:
Section 2.2.4 of the Match Participation Agreement for Institutions requires institution officials to ensure that prior to the release of the results of the Matching Program, all of the programs sponsored by the institution, regardless of Matching Program participation status, offer positions to U.S. allopathic senior students only through the Matching Program or another national matching plan. If any of the programs sponsored by the institution offers a position to a US allopathic senior outside the Matching Program or another national matching plan, including a preliminary position for a program that participates in another national matching plan, the institution will be in breach of the Match Agreement.

Updated 08/14/2009