By Jessica Freedman, MD
President of MedEdits: Medical Admissions
The scramble. Just these words make applicants and program directors anxious. So, what exactly is the scramble, why is it so competitive, and how is it likely to be changed?
The annual “Match Week” is March 16th – 19th 2009, and though I hope no one reading this article will ever need to put the information below to practical use, it seems an ideal time for a brief overview of the scramble — just in case.
A Little Background
The national residency matching program (NRMP) was established in 1952 to create uniformity and a schedule for postgraduate medical education assignments. Every March, the NRMP conducts a residency match to optimize the chances that both programs and applicants match with their most highly ranked choices.
Keep in mind that the NRMP is not an application service; applications are submitted via the electronic residency application service (ERAS). The NRMP is the mechanism for connecting programs and applicants.
After interviewing, applicants submit rank order lists (ROLs) of programs based on their preference, and programs do the same for applicants they have interviewed. Since 1998, the NRMP has used a matching algorithm designed to ensure that both applicants and programs “match” with their most desired choices.
For those applicants that did not match, the scramble is a period of time after the match when these applicants attempt to find, or “scramble”, to try and obtain one of the remaining unfilled positions.
Why is the scramble so competitive and stressful? The numbers tell the story.
In 2008, 4,214 programs participated in the match and a total of 25,066 positions were offered: total applicants were 35,956, 15,692 of whom were from accredited US schools and 20,264 who were independent. How’s that for fierce competition for a match? Of the almost 36,000 applicants, 28,737 submitted rank lists, of whom 20,940 matched.
What happened to the applicants who did not submit rank lists? Some applicants “pre-match” at programs and sign contracts before the match. Others enter the match just to have a list of unfilled positions to enter the scramble. Since some applicants who pre-match do not withdraw their applications, data for the number of applicants who pre-match are not available.
The NRMP estimates that roughly 13,000 applicants, many of whom are non-US citizen international medical graduates (IMGs), registered for the sole goal of competing in the scramble. These applicants competed for only 1,388 unfilled PGY1 and PGY2 positions. Clearly, entering the scramble is not a wise gamble and should be avoided.
What is the Match Week Schedule?
March 16th: At 12 noon EST applicants find out if they matched.
March 17th (Scramble Day!): At 11:30 AM EST individual programs find out if they have filled their positions.
March 17th (Scramble Day!): The race begins. At 12 noon EST the locations of unfilled positions are released, and individuals may start contacting programs to obtain these positions.
March 19th: MATCH DAY! For those who matched, results are posted at 1 PM EST.
How Quickly Do the Unfilled Spots Fill?
The unfilled positions are filled very quickly during the scramble. By 4 PM on scramble day in 2008, more than half of the 1,388 PGY1 and PGY2 open positions were filled. By 6 PM the day after the scramble, only 179 positions remained open.
At many US schools deans are available to help students on scramble day; though this is helpful, the chances of obtaining a spot via the scramble still are slim.
While many individuals send applications to unfilled programs via ERAS, others hire for-profit commercial companies who “fax” materials and email programs on behalf of clients. Jammed fax machines and lines of communication make this process challenging. Only 8,700 individuals submitted applications via ERAS during the 2008 scramble, suggesting that all of the other applicants used commercial services. Some applicants even hire companies and send applications via ERAS.
What Changes Are Ahead?
Recognizing that applicants and programs are forced to make important decisions quickly and that the scramble is disorganized and lacks leadership, the NRMP, together with the Association of American Medical Colleges, is forming a scramble task force to propose changes. The earliest these changes would be implemented is for the 2011 match. Here are some of the major changes being proposed, based on a five-day match week.
- NRMP releases unmatched applicant and unfilled program information simultaneously on the Monday of Match Week.
- Programs may not make offers for 48 hours after this information is released, giving them time to review applications and conduct (phone) interviews.
- Programs submit applicant preference lists on Wednesday (after the 48 hour period).
- The NRMP system emails applicants with offers from Wednesday to Friday; applicants can receive multiple offers.
- Applicants have two hours to consider an offer, after which the offer expires. Offers are sent out every two hours until 6 PM each day (valid until 8 PM).
- Applicants are required to submit only applications via ERAS.
- Programs are required to accept only applications via ERAS.
- Until Friday, program directors can add candidates to their preference list until positions are filled.
- Match Day is moved to Friday.
- This ERAS “scramble mode” ends at 6 PM Friday and remaining unfilled positions are posted.
Managing the Scramble
In an ideal world, avoiding the scramble is the best strategy. But if this is impossible, try to have a leader at your school who can advocate for you and help you through this stressful day.
Every year holds “surprises,” with some great programs not filling that must enter the scramble. Some applicants who thought they didn’t have a shot for a spot at a competitive program or within a competitive specialty may therefore end up with a really desirable position through the scramble. Such good luck is the exception, however.
Match Day is not only a rite of passage but a tremendous accomplishment for everyone in medicine. Every Match Day is accompanied by some tears but more often by happy screams. If your school has a Match Day ceremony, I encourage you to participate.
In my day, we received the news in an envelope and didn’t have the option of finding out our “match” alone, via the internet. Even if you don’t get your number one match, this is a momentous day in which you should participate as a member of your class. Good luck and match well!
For more information on the match and the scramble visit the NRMP website.
Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits Medical Admissions (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. If you want to decrease your chances of having to enter the scramble next year, visit: www.MedEdits.com. Dr. Freedman is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).
Meet Dr. Freedman at the American Medical Student’s Association Meeting in Arlington, Virginia, March 12th- 14th, 2009. Visit us at booth #3 and pick up a free SDN lapel pin and pen.