In Reply Drs Kirsch and Drolet misapprehend the nature of the matching process and the procedures used by the NRMP. Match procedures allow applicants and program directors to assess each other through applications and interviews and to make training selection decisions based on their own preferences and the criteria important to each.
Kirsch and Drolet propose allowing applicants to receive multiple offers simultaneously—exactly the problem a matching program is designed to rectify. Prior to creation of the NRMP, an applicant could receive multiple concurrent offers and hold those offers indefinitely, to the detriment of other applicants who might have no offers at all. In other cases, an applicant could receive an offer with a short deadline for acceptance and feel compelled to act on it before knowing whether other, more desirable, offers would be extended. In contrast to such chaos, the NRMP allows applicants and program directors to consider all options simultaneously and to rank those options in order of preference. The Match yields a best result because no applicant or program could achieve a better outcome than the one produced by the matching algorithm. The binding nature of the NRMP match commitment is essential to ensuring the integrity of the process, because an applicant’s failure to honor that commitment disadvantages not only the matched program that is left with a vacant position but also other applicants who might have matched to a less-preferred program or not matched at all.
Signer MM, Curtin LS. The National Resident Matching Program and Competition for Employment—Reply. JAMA. 2018;319(17):1824. doi:10.1001/jama.2018.1485
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