The Match

The Match is an odd system of determining residency employment, and I'm not sure if there are any equivalent employment processes for any other fields. After a standard application and interview process, no letters of acceptance or rejection are sent. Instead, each applicant makes a "rank order list" of all the programs she likes in the order of preference. Each program makes a list of all the applicants they like in the order of preference. These lists are processed by a central computer algorithm that then generates a "match list" of the optimal pairings between applicant preferences and program preferences.

It's an interesting system that was historically borne from unequal and unfair residency job offers. In the past, there was little standardization of how to go about obtaining a residency position or how programs were to recruit residents. This led to confusion and apprehension by residency applicants which ultimately may have contributed to applicants accepting suboptimal residency offers. For example, if a mediocre residency offered a position, it might be better just to take that definite job than wait for the better residencies to reply. Now with the Match system, the timeline is standardized and applicants and programs make their decisions with more information.

That being said, I don't know if it's an optimal process. For applicants, it feels as though we've lost an element of control. In the past, rolling admissions have allowed us to accumulate acceptances and/or rejections, giving us a sense of how we were doing and allowing us to "hold on" to an acceptance while we see if we get accepted to higher-desired programs. Here, applicants don't have any certainties and go into the match with a risk of not matching anywhere (leading to a more frantic process called the scramble). This uncertainty in a population of medical students who like assurance can lead to unnecessary costs. We end up applying to more programs than necessary to assure that we will match somewhere. Whereas when applying to medical school, I may cancel a "safety" school once I got in somewhere else, in the Match process, I don't have any acceptances and must keep those safety programs in the case that I don't match at the "harder" institutions.

Furthermore, this process may hamstring job negotiation power. In the past, lawsuits have brought up this issue (but have not been successful). Without knowing if I've gotten into any programs, I have no negotiating power or leverage prior to securing the job. Since I must sign the contract for the program that I match into, I have no negotiating power after the match. This may not be all that important, but it's something absent that is common in other fields.

Overall, we want a method of determining residency positions in a fair, equitable way for both applicants and programs. We want applicants to strive for optimal programs, and we want programs to fill their slots with optimal candidates. A Match process may facilitate that, but whether its optimal, I'm not convinced. Nevertheless, it is here to stay.