Phillips R. Recent Changes to the National Residency Matching Program. JAMA. 2000;283(22):2997. doi:10.1001/jama.283.22.2997
Prepared by Ashish Bajaj, Department of Resident
and Fellow Services, American Medical Association.
For nearly half a century, the National Residency Matching Program (NRMP)
has operated as an impartial and confidential venue for matching applicants'
and residency programs' preferences for each other. In the past few years,
the NRMP has instituted several changes to improve the residency match process
for applicants and residency programs.
The NRMP is sponsored by 5 organizations: the American Medical Association,
the American Board of Medical Specialties, the Association of American Medical
Colleges, the American Hospital Association, and the Council of Medical Specialty
Societies. Its board of directors also includes student representatives from
4 different organizations. Although the NRMP is not the only organization
to conduct a match, it is the largest. In the 2000 Match, the NRMP served
3769 residency programs, offered 22,722 positions, and processed 33,528 applicants.
The NRMP has a single cardinal rule for both programs and applicants:
neither must ask the other to make a prior commitment as to how each will
rank the other. This rule is intended to ensure a fair process by which applicants
and programs can rank one another after fully weighing their options, and
thus avoid pressure to accept one another on the spot. For the Match to work
optimally requires broad participation by programs and applicants, who must
act in good faith and promise to abide by the Match results.
The NRMP has actively worked to improve its services. Two years ago,
the Match algorithm was changed to favor the preferences of applicants over
those of programs. Although the new algorithm only changed the results for
16 applicants in the first year it was tested, the change was probably significant
to those individuals. This past year, the NRMP successfully converted the
Match to an Internet-based process for both applicants and programs. This
year also marked the first time that programs were asked to list their final
Match quotas prior to the close of the rank-order list process so that students
and the NRMP could monitor the availability of positions in the Match.
Because the Match process requires broad participation to work well
for everyone involved, the NRMP will be working closely with specialty societies
to ensure adequate participation by programs in the Specialty Match. Beginning
this year, if a specialty cannot commit at least 75% of programs and 75% of
positions to the Match, it will not be able to fill its positions through
the NRMP. The NRMP is exploring other mechanisms to enhance participation
and professional behavior in the main Match. These include building more effective
communication with program director organizations and developing a common
professional ethics language with accreditation and board certification organizations.
The NRMP is also actively exploring collaboration with the Association of
American Medical Colleges' Electronic Residency Application Services to assist
unfilled programs and unmatched applicants in finding one another.
It has been encouraging to see how well the sponsoring organizations
work together to improve this important service. More substantial improvements
will likely require better monitoring and inducement to participate. The NRMP
is hopeful that increased cooperation from specialty and program director
organizations as well as accreditation and board certification bodies will
make this possible.