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January 23, 2020

Improving the Residency Application and Selection Process: An Optional Early Result Acceptance Program

Author Affiliations
  • 1University of Michigan Medical School, Ann Arbor
  • 2American Medical Association, Chicago, Illinois
JAMA. 2020;323(6):503-504. doi:10.1001/jama.2019.21212

The process of securing a residency position following medical school has become increasingly arduous and complicated. The mean number of applications per applicant for US and Canadian medical school graduates has increased across all specialties in the last decade, with several specialties seeing a doubling in number of applications. For instance, from 2011 to 2019, applications per applicant increased from 15.2 to 34.8 for family medicine, from 30.5 to 61.3 for obstetrics and gynecology, and from 21.6 to 51.9 for psychiatry.1 Similarly, the number of applications received by each program also has increased across all specialties, some by more than 200%. For example, from 2011 to 2019, the mean number of applications received by family medicine programs increased from 76 to 251 and received by psychiatry programs increased from 115 to 446.1

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1 Comment for this article
Improving the Residency Application and Selection Process
Robert Blacklow, AB, MD, D.Sci (hc) | Harvard Medical School
I am responding as a past member of the NRMP Board of Directors (1993-2013), its President for two terms, and Treasurer for one. During my terms on the Board, we made several changes which improved the process: streamlined the couples match; changed the algorithm from a hospital match to a student match with the help of Alan Roth, a subsequent Nobel Prize winner; developed better processes for advanced specialty matches; and instituted a "second match" for those unmatched. The dual problems of excessive applications by medical students and the burdens it placed on the hospital programs were often discussed, many ideas were floated, but no acceptable solutions were found. These problems have continued and according to this article, have become even more burdensome.

But the solution proposed here is not only unworkable and will create many more problems than it proposes to solve, but it is actually a step backwards to the time that there was no matching program. It proposes now an extra "early acceptance" match, similar to that at many undergraduate colleges. This will now create two cohorts of students in their last year of medical school: those who got in early, and those who did not. An already frenetic fourth year will be even more so, and reliance on grades, scores on required exams even more important and for the elite programs, "the rich will get even richer". Their burdens will greatly decrease--after all, half of their slots will already be filled.

What is another option? Residency programs can become more transparent, listing their general requirements and the general characteristics, score levels and competencies of the last 3-5 cohorts they have accepted. This will help guide students and their faculty advisors in the selection process. But the Programs do not want to display their closely guarded secrets lest their competitors find out. Look closely: the fault lies not in our stars but in ourselves.