December 21st, 2016
It is obvious to all of us here at Academic Medical Center that you are an outstanding residency applicant, and we would be delighted if you matched with us and would be proud to play a role in your professional development. We have ranked you “to match” in our program and encourage you to contact us to express any specific interest you may have in our program.
Academic Medical Center Program Director
You read the email in disbelief and think you are set. Academic Medical Center is your top choice program. You hit the reply button to say that you will be ranking Academic Medical Center #1 on your list and submit your rank list with confidence.
To your shock on match day, you do not match with Academic Medical Center but instead match with your #11 choice. You feel a little cheated and wonder why the program director at Academic Medical Center sent you this misleading email. You start to think that this communication from Academic Medical Center may have been a violation of the Match Participation Agreement (MPA).
In my work with residency applicants from a variety of schools applying for different specialties, I am often surprised that some of the correspondence and communication from programs is remarkably similar to the example above from the fictitious Academic Medical Center. I am even more surprised when applicants receive overwhelmingly positive feedback from programs where they don’t match.
The MPA is designed to make the match fair for everyone involved. Item 6.0 of the MPA, Restrictions on Persuasion of the MPA, specifically states: “One of the purposes of the Matching Program is to allow both applicants and programs to make selection decisions on a uniform schedule and without coercion or undue or unwarranted pressure. Both applicants and programs may express their interest in each other; however, they shall not solicit verbal or written statements implying a commitment. Applicants shall at all times be free to keep confidential the names or identities of programs to which they have or may apply.”
I find that many interviewers and program directors may violate the terms of this agreement, sometimes unwittingly. Interviewers often casually ask applicants during interviews, “So, where else did you apply?” or suggest, “If you are really interested in matching here, please be sure to let us know.” Other programs routinely call applicants who are within “matching range” to recruit them after they interview. Does this constitute persuasion or pressure? The 2014 NRMP Program Director Survey suggests that post-interview contact does not have a great impact on ranking, but is this really true? Earlier research on this topic, cited in an article entitled Manipulation and the Match in JAMA in which the author reflects on his own experience as a residency applicant going through the match, suggests otherwise.
These subtle and not so subtle manipulations place applicants in difficult positions. Applicants are often confused, and these recruitment efforts on the part of program directors create an atmosphere of distrust and suspicion. Applicants are in a subordinate position during these interactions; they feel vulnerable and anxious. Of course, they often feel obligated to tell a program what it wants to hear by saying, “I loved your program and I will be ranking you really highly.” Or, applicants may feel pressured to tell a program that they will be ranking it #1, even if that’s a white lie. Sometimes applicants are so nervous about matching that institutions’ recruitment efforts may influence the way they rank programs.
So, how should applicants deal with these situations? If you receive a residency match “love letter,” take its sincerity and truthfulness with a grain of salt. You certainly will want to respond graciously, but do not say you are ranking the program first if that is not your intention. As for fielding questions or comments that may violate the MPA, I suggest being diplomatic and somewhat vague without confronting or offending your interviewer. For example, if the interviewer asks where else you are applying or interviewing, it is acceptable to answer, “I am applying to and interviewing at a variety of programs, mostly on the West Coast” or whatever situation applies to you. If pressured to express specific interest in a program, it is fair to say, “I am very interested in this program and have not yet decided on my final rank order, but I will be ranking your program highly.” As with the “love letter,” do not tell a program that you will be ranking it first if this is not true.
Although some programs do indeed violate MPA standards, most programs behave ethically in the match, and it is the obligation of all program directors and everyone who interviews applicants to uphold MPA tenets. Values and ideals start at the top so, if those in positions of power do not demonstrate ethical behavior, applicants are also encouraged to be insincere. Such behavior not only violates the MPA but also corrodes some fundamentals of our profession: honesty, good will and professionalism.
JESSICA FREEDMAN, M.D., is president of MedEdits Medical Admissions and author of the MedEdits Guide to Medical Admissions and The Medical School Interview. Follow Dr. Freedman and MedEdits on Facebook and Twitter.