Contributed by: Ross Lenhart
Senior Vice President, Stein Communications

Recently for The Scoop, I have written reviews about two books that I admired, both of which dealt with student selectivity — College Unranked and The Price of Admission. Both involved the nuances of student selectivity — one dealing with the influence that a faulty ranking system has on the public; and the other, with the swaying power that wealth, alumni, and political clout exerts on the college admission selection process. I suppose I am somewhat of a college admission junky. This is completely understandable seeing that as a student, I first started giving college tours and answering questions of prospects and families in 1964; and then commenced with a profession involving the selection of the college a student plans to attend and why, and also the selection of whom a college accepts and why. The selection process has always been a source of great fascination to me. You have to admit — it’s a rather simple process — the student researches, visits, applies, and waits. The college recruits, gathers information, makes a decision, and informs the student of that decision. For over forty years in my professional life, this is the way it has been. For me, it has been the only way of making such a match.

I thought I knew it all, but by being an interested party in the future plans of my son and daughter-in-law, I have stumbled on a whole new system of student selection. It’s a match that happens annually in March. Not a tennis match, not a soccer match, this is another form of institutional people matching — a people match like none other. I became interested by watching my daughter-in-law, armed with her new M.D. degree from Emory, as she embarked on her journey to find her place as a resident in a teaching hospital — not unlike a high school senior in search of a college. As admission officers talk often and proudly about their medical school acceptance rates, they might want to follow their students a bit more closely after their college graduation and watch the process that confronts them in the fourth year of medical school as they head towards residency and internships. It’s a fascinating process of student selection of which I was never aware — a matching process that is actually called The Match.

You know the drill — in the early part of the 20th century, hospitals offered internships with short deadlines to medical students, who were forced to make decisions without knowing what other offers might be forthcoming. Sounds familiar, doesn’t it? On the other hand, hospitals were being left out to dry because students rejected their offers, and it was too late for the hospital to approach the next preferred candidate, as he or she had already decided on another hospital. And don’t forget about the salary consideration here. After four years of college and four years of med school, these offers from hospitals aren’t quite the same financially, as say, six-figure top offers from law firms graduating law students after only three years. Realistically, it’s more like an offer of financial aid somewhat like a flat salary. Hospitals didn’t have a system of a Candidate’s Reply Date and then relying on a waiting list, or a system of rolling admission that we know in undergraduate college admission today. It was a lose-lose situation. Not good for the student; not good for the hospital.

Thus, in 1952, the National Resident Matching Program (NRMP) was established; and since that time, medical students have applied to hospitals in their disciplines, whether it be family practice, pediatrics, or internal medicine, through the NRMP as a clearinghouse. Imagine how hard it was to get everyone to cooperate in order to get this system underway? But a week ago, approximately 15,000 medical school students found out through this year’s residency match where they will spend the next several years — some in far away places or in places they never really wanted to go.

This is where is gets hazy for me, and pardon me if I don’t get too detailed — but basically, The Match is a system that relies heavily on the process of algorithms for matching interns and residents with hospitals. In other words, and very simply put in my own elementary terminology — The Match uses a computer program to make an effective match of a resident with a teaching hospital through a nationwide system that honors the individual student choices of where he or she may want to spend his or her residency, and matches those choices together with the student recruitment desires and needs of the hospital. Rather confusing, but they do it, and it seems to work. Here again, amazing how all those hospitals and all those resident candidates can cooperate.

The Match works like clockwork. It’s set up on a system of firm dates and mandatory responses. In her search for her match for a residency in ophthalmology, my daughter-in-law flew at her own expense to eleven cities from Miami to Philadelphia to Charleston to Austin to others in order to have a personal interview. These trips served to personally set her own numerical priorities for The Match as well as to satisfy the match priorities of the hospital.

One might question the total financial outlay of the resident candidate when considering that the hospital also benefits in getting their match priorities in order. In the last few years, The Match has recently endured a challenge by a group of physicians through a class action lawsuit alleging that The Match has violated antitrust laws by claiming that NRMP practices encouraged lower-than-competitive wages and imposed exhausting working conditions on residents.

As gender enrollment patterns changed in medical schools so have the accommodation considerations of The Match. In 1952, when The Match was launched, only two out of every ten medical school graduates were females. When my daughter-in-law graduated from Emory Medical School, the gender ratio in her class was fifty-fifty. Also consider the marriages, engagements, or partnerships that are bound to happen for some med students after four years of working and studying together intensely. Not wanting to split these relationships geographically, the NRMP also has developed a system of a Couples Match, allowing those who are married, engaged, or partnered to be selected or matched to the same teaching hospital together.

Once the medical specialty is selected, the multiple interview trips around the country taken, the different paperwork steps followed minutely and on time, the fourth year med student waits until a seemingly never-ending drum roll takes him or her to the nail biting date of March 20th. Last week at exactly 1:00 p.m. Eastern Standard Daylight Time, 15,000 students ripped open envelopes all at the same time and learned where they will train as doctors for the next several years.

Is it a sane method of compatible student selectivity, or just plain March Madness? For the answer, you might just want to consult your physician.

Sources:
The Journal of The American Medical Association, February 19, 2003.
The New England Journal of Medicine, January 23, 2003.

This entry was posted on Wednesday, April 2nd, 2008 at 10:45 am and is filed under Admissions, Recruitment.