Is a Second Match Coming?
This summer, a committee appointed by the National Residency Matching Program (NRMP) delivered its report on the issues surrounding the annual "scramble" process which follows the annual announcement of the match results. The committee compared the extent to which the scramble affects US students versus international medical graduates, as well as whether the NRMP should attempt to lessen the chaotic scramble process by offering, in effect, a secondary matching process to better oversee the process by which unmatched applicants attempt to find positions.

Currently, the scramble process allows unmatched applicants to contact programs during a 24-hour period before matched applicants learn where they matched. Typically, phone interviews occur during which positions are offered, forcing the unmatched applicants to make quick decisions about whether to accept or not, without having the pre-match opportunity to visit the program or fully investigate what the program offers because any delay in accepting an offer at this stage will likely result in the position being offered and accepted by another unmatched applicant.

The committee considered a host of complex issues that must be dealt with if the NRMP decides to proceed with this concept of a secondary match process. One issue concerned the timing of a second match. There would be little support for a second phase of the matching process if it substantially delayed announcing the results of the primary match. Nor could a secondary match process be allowed to substantially cut into the amount of time currently available for applicants to interview at programs. Thus it is likely that the secondary match would have to be confined to a couple of weeks, since it was determined that the general announcement of match results would not occur until this secondary matching phase was completed.

The preliminary concept being considered would require all unmatched applicants and programs with unfilled positions to participate in the secondary matching phase, although participants on both sides could in fact opt out by failing to submit a rank order list, thus removing them from the matching algorithm, effectively. Obviously the secondary match process, if implemented, would be much smaller than the first, and would likely have a much lower matching rate, since candidates deemed less competitive in the larger match might be found less attractive in the secondary phase as well. If not all positions were filled, then a process similar to the current “scramble” would likely follow the announcement of match results, much reduced in scale but probably similar in nature to what occurs under the current system.

Significant issues remain to be settled before any secondary matching process could be implemented. Among them is the behavior of programs and unmatched applicants in response to the new system. What would prevent a program with unfilled positions from offering jobs to applicants and then opting out of the secondary match by failing to submit rank order lists? How would such a process affect applicants participating in the Canadian first and secondary matches? Osteopathic applicants might also be squeezed out of consideration if the results of the Osteopathic match process occurred later than an earlier rank order list submission deadline for the NRMP match—which might well be necessitated in order to make time for the new, secondary process. Finally, entirely new applicant and program matching strategies might well evolve in reaction to the new process, with both sides listing only the most desirable entities in the initial match, rather than including fall-back or safety programs/applicants in their original rank order lists.

While many questions and issues are yet to be explored before a final decision on this proposed secondary process is made by the NRMP, it is certainly an idea worthy of careful consideration, given the chaos and potential for hasty commitments now seen in the "scramble" process.

We'll keep you posted on further developments.