On August 2, 2022, the NRMP published a proposal for a Two-Phase Match to replace the current Match® and Supplemental Offer and Acceptance Program® (SOAP®) processes, known as Match Week, and issued a call for public comment to evaluate the feasibility of that proposal. Following the call for public comment, the NRMP invited testimony from national medical education and student organizations of which 12 presented the perspectives of their constituency. In addition, NRMP leadership attended several meetings requested by AAMC constituency groups, specialty organizations, and sponsoring institutions. This letter summarizes those efforts and the ultimate deliberation of the NRMP Board of Directors. The NRMP deeply appreciates the input from the community and discussions with partner organizations and institutions about ways in which we might continue to contribute to improvements in the transition to residency.
Background and Purpose: Since 1952, the mission of the NRMP (“The Match®”) has been in part to provide a matching process that is fair, equitable, efficient, transparent, and reliable for all participants through the use of a mathematical algorithm that matches the preferences of applicants with the preferences of programs in order to obtain a residency training program. In 2012, the Supplemental Offer and Acceptance Program® (SOAP®) was established to address instability and inequity during the post-Match period known as the “Scramble,” an ungoverned period during Match Week whereby unmatched or partially matched applicants attempted to obtain unfilled positions through an “open market.”
While SOAP has objectively improved the process for obtaining unfilled positions, the process relies on a highly compressed timeline, complex rules, and program-preferenced offers to applicants. Increasing numbers of applicants, broad variation in recruitment methodologies by programs, community demand for improvement across the whole of the transition to residency, and increasing stress among applicants and programs, led the NRMP to consider possible solutions to alleviate some of the stressors. The proposed Two-phase Match prioritized:
- Providing the opportunity for applicants to rank their true preferences in each phase of the Match and incorporating the matching algorithm across the whole of the Match cycle;
- Reducing the stressors of SOAP including complicated rules, confusion, and scarcity mindset that may inhibit good decision-making;
- Incorporating more time between matching events, thus creating opportunity for contact with programs and for more thoughtful career development decision-making; and
- Facilitating a program’s ability to utilize holistic review and gauge alignment of applicant characteristics more thoroughly with program aims and mission.
Outcome of the Call for Public Comment: The call for public comment was solicited between August 2 and September 2 via a survey and distributed through multiple channels. The survey yielded a total of 8,258 responses (5,297 with complete and 2,961 with partial data). As seen in the figure below, nearly two-thirds of respondents were students, residents, or fellows.
Respondents reported on whether the Two-Phase Match would be advantageous or disadvantageous, and among responses received, 60 percent viewed a Two-Phase Match as modestly (30.6%) or significantly (30.2%) advantageous, 20 percent viewed it as modestly (9.8%) or significantly (10.6%) disadvantageous, and an additional 19 percent viewed it as neither advantageous nor disadvantageous in its impact on Main Residency Match participants. Of those who viewed the proposal as advantageous, the most frequently cited positive impacts included
- More thoughtful decision-making and career planning by encouraging proactive rather than reactive recruitment behaviors and strategies by applicants and programs (67.2% of learners, 74.2% of GME personnel, and 75.1% of medical school personnel);
- Greater participant wellness through reduction of stressors accompanying the current Match Week (60.3% of learners, 55.0% of GME personnel, and 49.3% of medical school personnel);
- Enhanced applicant agency by allowing applicants more control and input throughout the matching process over decisions that affect their training (57.0% of learners, 45.0% of GME personnel, and 57.3% of medical school personnel).
Through free-text fields, respondents reflected on other positive impacts, including improved life logistics such as more time to make plans post-match and improved Match outcomes.
Of those who viewed the proposal as disadvantageous, the most frequently cited negative impacts included
- Introduction of application and/or interview behaviors that could create more stress and burden on applicants and programs (78.9% of learners, 69.1% of GME personnel, and 68.3% of medical school personnel);
- Potential identification of partially matched or unmatched applicants, which could lead to bias and stigmatization (52.4% of learners, 56.7% of GME personnel, and 69.5% of medical school personnel);
- Extended time to be engaged in matching process for partially matched or unmatched applicants (45.1% of learners, 44.4% of GME personnel, and 55.7% of medical school personnel).
Through free-text fields, respondents reflected on other negative impacts, including cost concerns, difficulty for programs to engage in holistic review or for students to complete the MS4 year, and increased focus on “gaming” the Match system.
Summary of Public Testimony and Invited Meetings: On September 16, members of the NRMP Board and senior leadership engaged in a period of public testimony with 12 medical education and student organizations. Those organizations brought the perspectives of their constituencies to the NRMP to reflect on perceived benefits and risks of the proposal for the community. Many themes that emerged during those discussions were similar to those reported through the public comment survey, including more time for strategic and deliberative decision-making, reducing stress, and promoting transparency as positives and increased anxiety, increased stigmatization, and higher costs as negatives. Organizations did touch on benefits and concerns that had not previously been referenced, including
- Utilization of the matching algorithm for both groups
- Supporting international medical graduates though increases/sustained use of virtual platforms
- Does not address more primary concerns including high application numbers
Decision: After taking into consideration the public comments, testimony, and requested meetings, the NRMP Board of Directors decided to not move forward with the proposal as written. Although the benefits/advantages articulated by the community are significant, the risks/disadvantages are considered of greater consequence. The Board of Directors and NRMP leadership are committed to its pursuit of innovative ways to contribute to improvement in the transition to residency and the matching processes and will continue working to identify ways in which the Match can reduce stressors on applicants and programs and increase equity through use of the matching algorithm throughout the matching cycle. The NRMP will use the next year to engage with the community (e.g., focus groups, workshops at national meetings, additional public comment) to socialize ideas and solutions that could improve the Match Week experience for all constituents. On behalf of the NRMP Board of Directors and NRMP Staff, we thank you for your time and input regarding this important discussion.
Donna D. Elliott, MD, EdD
Chair, NRMP Board of Directors
Donna L. Lamb, DHSc, MBA, BSN
NRMP President, Chief Executive Officer