With Soaring Costs, We Need to Re-Evaluate The Current Matching System For Medical Students and Residencies
Established in 1952, the match system was designed to cater to a high demand for doctors, and served the healthcare industry well on both ends – doctors could choose and pursue their specialties of choice, and patients received treatment from happier and more fulfilled professionals. At that time, it was decided that residency program terms were non negotiable – but again, back then, who would question an opportunity of that nature, especially after considering the socioeconomic landscape in the U.S. following the Great Depression?
“This system is highly wasteful. It incurs massive costs for hospitals and students through the interview process, precludes contract negotiations that could optimize value for both parties and results in depressed wages for young physicians.” states Amy Ho, member of the M.D. Class of 2014 at the University of Texas Southwestern Medical School in a recent article in Forbes.
Perhaps a deeper look into the matching process of can help identify some of the challenges faced by students.
After finishing college and two years of classroom-based training, students jump right into clinical training, which is based off of predetermined core rotations. Let’s hope that your choice of specialty happens to be a “core” rotation in your third year, because if not, then there is a good chance you won’t even rotate in your specialty of choice, according to Amy.
“In the spring of their third year, students must decide on their career specialty, often without rotating in their chosen specialty yet if it was not a “core” rotation of third year.” adds Amy Ho.
During their fourth year, students spend their next three months completing ‘away rotations’ at potential residencies. By mid-September, students students hedge their bets by applying to every residency program of interests to ensure a match, incurring fees for each application. The interview process begins in October and typically takes three to four months. If a student must travel all over the country to interview, travel costs can pile up quickly, putting a financial strain on parents, and causing students to miss much of their senior year, all to meet the demand to match.
By late February, once all is said and done, students rank their top choice programs and programs rank their top choice students and submit a “rank list” for the NRMP algorithm to optimize.
This is what medical students must face in order to make it to the finish line in becoming a medical doctor. The passion of a future doctor’s passion in their desired specialty can be thwarted even before he or she reaches the finish line, due to the red tape standing in their way.
“This year, 5.6% of US allopathic (MD) seniors did not match, and 22.3% of US osteopathic (DO) seniors did not match. On the whole, 25.0% of applicants in the NRMP Match did not match – with a 25% unemployment rate,” as noted by Amy Ho.
Today’s medical professional demand is higher than ever, yet the residency opportunities are scarce, as programs are unable to grant residencies to every qualified applicant. This has created a world full of medical professionals who can’t practice what they want, amidst a healthcare industry ladened with physician shortages, slippery compliance, ever changing laws, political changes in policy, and a growing nation of underserved patients.
“The misbalance between residencies and students is no longer; and resources are tighter than ever, yet the archaic Match system continues to waste time and funds of students and applicants alike in the name of ‘tradition’.” adds Amy Ho.
Can we admit that the current method of matching may be an outdated model? Once we can get past that, a conversation needs to be had among institutions, healthcare professionals, industry thought leaders, and more to begin to redesign a method that considers today’s healthcare agenda and the cultivation of the doctors of tomorrow.
Read more on Amy Ho’s perspective in Forbes.