The Match and the BCS

I appreciate the efforts of BigKingTut... he is fielding his opinion and needs not to be attacked by having a different one.

The match is a less than perfect solution but it is the best one we have so far until a better solution comes along. I do, believe, however that the concept of the match should be challenged periodically, not necessarily to go back to the "old way" but perhaps to advance and/or modify it. Have we asked ourselves if we can come up with a better process today? How can we make it more fair? How can we correct for the "shady" behaviors of some programs and not simply accept it? Etc, etc.

Finally, residency is a job. Every career have a period of on-the-job training- most are obviously not as long as ours. Some might be longer- PhD post-docs for instance. Orthopaedic surgery is the career. This is my opinion. Whatever helps u get thru stuff.

young dr. bigking tut you i don't think you are wrong, you don't understand the history ...

'Those who cannot remember the past are condemned to repeat it.' ... George Santayana

the match is not perfect but it does deal with some problems that happened in the past. the match process does not account for the human factor. the handshake and a wink that may occur between some applicants and programs. there are some programs are very strict and play fair, like the do at Columbia (i do remember this from my interview there in the 90's). others who may bend the rules (hearsay). regardless of what process is in place, the human factor will be in place.

understand bigking tut, there are a lot of applicants to weed through, hundreds. for some programs and specialties, it is like an American Idol cattle call. it is not like your regular human resources application practice.

the process has been evaluated over and over and faired well ...

Christopher Avery, Christine Jolls, Richard A. Posner and Alvin E. Roth, The Market for Federal Judical Law Clerks, 68 Univ. of Chicago Law Review 793 (2001)

Antitrust experts such as Judge Richard Posner of the United States Court of Appeals for the Seventh Circuit and Joel Klein, former Assistant Attorney General for Antitrust at the Department of Justice, have extolled the virtues of the matching process and have sought to apply it in other areas. For example, Judge Posner has proposed adopting a version of the Match for the federal judicial law clerk application process, noting approvingly that the Match "is simply a way of facilitating the parties' expression and achievement of their preferences, an opportunity that is lacking in an unregulated market with timing problems."

David M. Herszenhorn, Revised Admission for High Schools, New York Times (Oct. 3, 2003)

Mr. Klein, now the Chancellor of the New York City school system, recently announced that the New York City Board of Education is implementing a matching system for the close to 100,000 eighth graders who apply each year to New York City high schools. He explained that the City is adopting a system patterned after the Match because it is "the most efficient way of matching students to high schools while distributing opportunities as fairly as possible” and "is recognized by virtually any economist as the welfare-maximizing model.”

so i beg of you young dr. bigking tut ... take a look at the history ... the match may not be the best system, but it is as fair a system as you will see ... unfortunately, it is not within a vacuum and the human factor will always be present ...

fortunately or unfortunately for you bigking tut, you will have to endure the match ... here is the algorithm that you seem to have a problem with ... take a look see if it is reasonable ....

www.nrmp.org/res_match/about_res/algorithms.html

and there are also some rules of professionalism

www.nrmp.org/res_match/policies/professionalism.html

BigKingTut, participater in the "HR" process]

I'd like to respond to several of your points...first in reguards to reading literature about leadership and management, you can only read so much. There is something to be said about real life experiences vs what literature tells you...its one thing to read about it, and another to go out and do it, and like you said at the end of your post, you don't know about it until you go through it.

If you re-read one of my posts, I stated that a good number of employees of my former company come from co-ops and internships....these are people we have seen in action, know what they are about, and actually know how they will fit in. This is not just an engineering thing, as many programs do this such as business, c.s., lawyers etc...I think this is absolutely the best way to find a fit for your position, you don't know what one will do until they are put under fire so to speak. However, this is not an ideal world and we must find others to fill our position that we have not worked with....and an interview process is as you say marginal at best. Anyone can put on a smiling face for a day, and feed you bs (and this works both ways for both interviewer and interviewee)...now look back at the older days of residency, where an internship and residency were not connected, and you basically had your year to show your stuff as a doctor, what was so wrong with that...or even say you went through your one month or maybe even 2 months at a program, they like you, you like them sign up right there....I don't see the problem with that type of a system. I have actually heard several orthopaedist, and other specialist voice their distaste for the current process, as they feel it rewards more book smarts, and pays less attention to showing what you have in a real life situation...nowadays your basically judging your applicants off what they offer in what is a primary care education, with a small fraction dedicated to these specialties....as an outsider looking in, it doesn't make sense to me...and I know that don't judge it until you've been through it, but sometimes an outside opinion is helpful, as motivations are not the same, and there can be some bias from an inside opinion....just my 2 cents worth

One other thing I'd like to say...you state that most don't understand the match when they go through it, and then residents guide them who think they understand it but don't....what is the benefit of that? If as an applicant, you are in a system that is supposed to favor you, yet you don't truly understand it, how at the end of the day does that swing the balance of power in your direction, it just doesn't make sense to me. In theory, the match sounds like a good, maybe not great, but good idea, better suited for fellowships where the communities are smaller and outside influences from individual applicants balance each other out....but there is a big difference b/t theory and real life...

BigKingTut]


Oh, I'm sorry, I should have known better than to disagree with something. I mean all that I've ever been taught in life is that there is only one way to skin a cat, and everything is perfect as it is, so no one should think otherwise. Its just a shame that all of our feces are not odorless as yours.

My retort:
1.) Residency as a job, career, profession, or whatever you want to call it, the match is still a unique process that does not exist in any other form other than residency or fellowship. It doesn't matter about your definition of it as a job, career, profession, education or what not, tell me one profession, career, or education selection process like the match? I mean, if it is such a great process, why not apply it to med school selection, or heck even undergrad....that is my point. And this whole thing about what if your #5 offers you, and you have to decide w/o interviewing for any other top choices, well life is about decisions, and you wouldn't be the first or last to have to make that decision by a long shot. People across the country have the same types of decisions day in and day out, so what makes them different than you? And as for going into something less competitive, if you say so, but do realize that there are many competitive things in life outside of medicine, and many of them are far far far more competitive than the most competitive residencies, yet they function fine w/o a system like the match. Oh and I didn't know that salary impacted on what was classified as a job, and I really didn't know that 40k and some change was just enough to eat....you do know about gluttony right?

2.) Whoosh, the point went right over your head...where did I say that engineering was like orthopaedic surgery? I didn't, I simply went to my experience as an interviewer and interviewee to bring my opinions to the table, wether it be as a lawyer, engineer, education superintendent or what not, many of the principles are very similar....a good engineering education should have taught you that by now, and if not, med school and residency should have as well....just b/c these are two different areas, doesn't mean that some parallels cannot be drawn in this matter now does it.

3.) My opinion is wrong? How do you come about that deduction? I mean is there anything actually factual to make that more than your opinion. I doubt it. My opinion that the match isn't perfect and there could be a better way to go about it....how is that wrong? The match is a good idea, but theory and real life are two different things, if you worked in the field as an engineer you should already know that. In a vacuum, w/o all this second looks, getting letters from the right people, somebody who knows somebody good ole boy network, etc the match would probably be what you make it out to be, and in a smaller community, such as fellowships, these factors don't influence the process as much as a larger community in the residency match...and my decision into specialty really has no relevance to this discussion...I know this, this is a public forum open to anyone, not just medical students or ortho residents, so anyone may make their opinion known, wether it be a lawyer, wall street broker, teacher or a bum that just happens to go to the library and does this for his jollies....

4.) I don't know as much as I think I do...well if you say so...I know this, this, we are debating this on a O/S brought to us by a man who has far less academic credentials than a med school drop out, so just dismissing someone b/c they don't agree with you, or they don't have the right experiences in your book is really rather funny...

Thats fine you don't share my opinion, I really don't care. I just find it funny that you can't admit that other options exist, and are so grandiose as to think its your way or the high way....really short sighted if you ask me.

Just to continue a very interesting discussion from 1 program director's perspective...

If you get an interview at our program you have a chance to match (presuming you don't "implode" during the interview). If we have done our job in pre-screening, then we would be happy to have any of the 50 applicants whom we interview match with us. If there is someone who just isn't the right fit, then they may not make the final match list. In 10 years, we have never changed our match list after the interview day - that may be viewed as silly by some but we don't feel it is important to say that we went to #6 on our list to get our 6 residents. We value the integrity of the match and the process and just let the computer work its magic.

In the end, the algorithm is designed to favor the applicant, not the program, and you have control of your list so it ultimately is a process that works for the majority of the people the majority of the time. As for your friend who "slipped" to his 8th choice, this is much more common than you would think (people aren't always so honest and of course you are savvy enough to realize that everyone who says they got their "1st choice" cannot all be telling the truth).

I'm happy to discuss this with anyone on-line or off-line if you would like.

William N. Levine, MD
Vice Chairman and Associate Professor
Residency Director
Columbia University Medical Center
New York, NY

StewieGriffin,

The saying "Once you make it to the interview, everyone has an equal chance"

i would personally agree with this statement ... i would love to discuss some of these issues ... you can PM me and talk off line .. or i may address some of this issues if i do begin my blog (i am pretty sure i will begin this after the interviewing season)

most will have a ranking of the applicants prior to the interview and the interview will move you up or down that list .... people are different in there interview techniques .... it depends on you style ... and what you feel is important .... the most important part is getting your foot in the door ... then the rest is up to you ...

Agreed.

The story I told is purely based on assumptions made by my friend. I meant to include that in my original post. And what I base my assumptions on are this persons feelings and post-fact ideas - which may be flawed.

Which is why the away rotations are key to matching, IMHO. So how do people move up the rank list? We are so similar. The original application has to come back into play to distinguish applicants who are equally charming.

The saying "Once you make it to the interview, everyone has an equal chance" - in my guess is only half true. What are your feelings on this issue Staff? Since you have seen the behind the scenes discussions at a variety of institutions.

StewieGriffin

you have good points .... but, i would like to state, unless you can prove otherwise, most of what you said about your friend last year is speculation not fact .... hearsay, the lawyers would call it

being on residency selection committees at 3 institutions .... large and small ... it is not as devious as you all may think ... there are some programs that play "games" ... make calls ... send letters ... reposition rank lists to make their numbers look good .... as well as applicants that do the same

truth is that for most programs ... most of you look the same ... blue or black suit (sometime charcoal gray) ... short haircut (occasionally with too much product) ... good grades ... good board scores ... good letters .... how do we separate you ... it is hard ... the more we have face recognition or interaction ... the better or worse chance you have .... that is why people rotate and do second looks ....

the problem of the MATCH is not the actual system or flawed algorithm that is made to match students to programs ... the problem you discuss is a human problem .... and regardless of the system you chose ... the human element will always cause it to be somewhat flawed.

Points to make:

- Match is a better process than the fellowship gig (Almost all of us agree)

- Snoop Doggy Dog needs a Jobby Job Job - To the lay person, ortho is a "job". To us, ortho is life/satisfaction/passion. A job is what you get paid for without having to owe money back. After medical school, you are no longer a "student" - you are now an apprentice to your residency. If someone asks you what you do for a living, do you respond "I'm studying orthopedic surgery" or do you say "I'm an orthopod/resident". It depends on who you are talking to and why. In the end, I think the conversation of job vs. life choice vs. continual education becomes an exercise in futility. Call it what you want - don't get upset over it - and who cares as long as you are an orthopod.

- The issue with the Match is that it does not always favor the applicant. Look for example at the numerous posts about "optional" second looks, phone calls to applicants, programs dropping students in their rank list due to inability to make socials, etc. If a person seems like a good match for the program, they should be ranked without regard to where they may POSSIBLY match. I hear too many programs talking about how they only go down to 8 on their rank list (to fill 6 positions). It seems like more of an ego trip for programs. To an extent this can be helpful because it lets people tell programs they are very very high in their list. It also helps because programs can avoid some people who only want to go there based on name-value. And I suppose i t gives the sense of camaraderie if everyone feels each resident ranked it #1. However, I don't see this always favoring the applicant. My friend last year dropped to number eight on his list last year and was a great applicant. He told his top program they were top, and the rest said he was very interested in. At interviews, he was told "You'll probably match at a better program than us..." but still he responded properly and always showed interest. Somehow, he slipped through his entire middle rank listed schools because they felt he was going to be ranked higher so they didn't rank him as high. Is that the right thing for programs to do???? I think in some instances when it's a small program of 2 or 3 people this is more justified because they want to make a cohesive group of residents that fit together. Still, this makes the match a big game which does not favor the applicant.

BigKingTut, participater in the "HR" process: Your comments make me wonder how much experience you have reading literature on management and leadership. If you had, you would know that anyone's ability to predict how successful or productive or easy-to-get along with an applicant/candidate is marginal at best.

As with many things in medicine, we finally came to a point where we start looking at outcomes. So looking at the outcomes of the hiring process (in a scientific, non-anecdotal way), it has been shown time and time again that the hiring and selection process simply does not produce much better of a result than the flip of a coin, after some basic common sense is employed (e.g. don't hire a marketing person for your legal counsel). So, I truly beg to differ that your experience in whatever industry has taught you any pearls that other users of this forum haven't considered. There are many of us with other "life experiences". And NO, it is not worth my time and hassle to provide you with multiple references on this topic.

That being said, I am glad to hear of more people with experiences working outside of healthcare, as I feel this is a much-needed addition to our diversity. I wish they weren't all engineers (would be nice to have some more designers, artists, bartenders, manual laborers, etc), but nonetheless it is often a nice addition to diversity. I agree with you that the match is a difficult, frustrating process. But wisdom (that of the people who have been through it the other ways and this way) tell us otherwise, so who are we to judge?

To everyone, as for complaining about the cost of one more airline ticket...get over yourselves. Just like any decision anyone makes, you can weigh the cost and benefit of such a purchase. Bottom line is that it increases your chances of making an average of some ridiculous $320,000 / year. So please, please, quit bitching about your 100K in debt that you can pay off with 6 months of salary when you finish.

One last thing BigKingTut - I don't want to play the "you haven't been there yet" card much, but with the residency application, interview, and match process, I believe this principle definitely applies. When going through it, the majority of us really have little idea what we are doing (the rest are in denial), and we are put in situations where we listen to residents give us advice, when in fact, they also had no clue what they were doing when they went through it! Is med school exactly what you thought it would be? Hell, is 3rd year what you thought it would be? OB/GYN? Psych? FP? Anything? Bottom line is that we can't know what it is like until we get there and do it. I'll get off my soap box now.

BigKingTut:

1. Residency is not a job. It is required training for which you luckily get paid enough to eat. Orthopedic Surgery is a career, which you cannot pursue without residency. It is as much a required step along the road of education as undergrad and med school. It is a fact of life. If you do not like it, stop b!tching and go into something less competitive.

2. I don't care if you were an engineer for 16 months or 16 years. You cannot simply extend that experience and apply it to ortho residency. I was an engineer too, and being on the other side, rest assured, being an ortho resident and being an engineer are as different as night and day.

3. You haven't even decided on a specialty and you are coming on an ortho board to b!tch about the match. You have made your opinion known. Understand that your opinion is wrong, and let it go. Come back here in three years when (or if) you have participated in the match and see if you still harbor the same sentiment. I would bet you won't.

4. You don't know nearly as much as you think you do.

oh young jedi night,

i personally try to make my residents not to look at this as a job. it is your profession, your craft. you should take pride in what you do. if you want have a “job” mentality, be a shift worker, go into ER.

you know, the difference between intelligence and wisdom is the intelligence is metal aptitude and wisdom only comes with experience. the match was developed out of wisdom. it was not driven by the competitive specialties. it was developed to assist the student and prevent people from taking advantage of them. it is trying to give every qualified applicant a chance.

brief example, we have young doctor BigKing Tut interviewing, his 1st interview is at the #5 program on his list initial rank list, 2nd with the #6 program, 3rd at his #2 program. The #5 program calls him and says”we like you. we think you will fit in well. We would like to offer you a spot. You have 3 days to respond.” He gets excited, but thinks program #2 is better fit for him. So, he calls program #2 and says “I like your program and would like to be a resident there. I have an offer at #5.” #2 responds” well we still have a few interviews. But, you are definitely in our current top 10 (6 positions).” What do you do? And you still haven’t interviewed at the other programs on your list.

unfortunately, the more competitive the program, the more applicants per position. somehow you have to make a algorithm of how to select applicants to interview. the only thing that is a standardized way of comparing applicants is the USMLE. so, it is therefore used as a guide for the interview process.

yes, and i would agree that applying for residency is like entering the NFL draft. you 40 time = USMLE; vertical jump = number of honors; etc. most of the programs realize from past experience that sometimes you may pick a ryan leaf and pass up on a tom brady. i have tried, in our program, to come up with a system that takes many other things into account. but, it becomes labor intensive.

oh young patowan learner ... be patient with the process .... concentrate on your medical school exams .... do well ... and in the end it will all work itself out

If residency is not a job, then what is? Are you saying just because something involves an educational component, its not a job?
Definition: an activity such as a trade or profession that somebody does regularly for pay, or a paid position doing this

Just because transferring from one ortho residency to another is a difficult task, doesn't make it less of a job, and doesn't mean its unique in that respect. I can name plenty of jobs that you can't jump in and out of. And sometimes people can't just quit their job because they don't like it, sometimes there are reasons in play that keep them at that job, so its just not that simpel...

Lets play devil's advocate for a moment...you lost x number of dollars on your cancelled trips, yet how much more would you have spent to go on those interviews. Think about the average medical student, who could very well be in 6 figures of debt already, to have to spend more to go across the country to interview at every place possible, some just as back up plans that that are not clear top choices but just in case...when they could narrow that down....the match may be better than what was had before (opinion), but is it the best there could be?

I will make my disclaimer, I have not decided on ortho or any other specialty, I am early in my medical education. However, I am not inexperienced in life and interviews, having worked 16 years in engineering, the last five of which I became integral with human resources and interviewed many applicants for highly competitive jobs. I understand what your saying in terms of fellowships, however these are not the same animal, as the numbers are different. In addition medical students do away rotations, a way to show their stuff. Not much different than a co-op or intern type position by a college student in their junior and senior years. Why would it not be possible for an I like you, you like me lets sign the deal during the away. It happens in engineering, as my former employer had hired many fine employees this way, as a known product is better than an unknown. The match has turned competitive specialties into a meat market, where scores are viewed as a premium b/c of the massive numbers of applicants...it eerily reminds me of the NFL combine in some respects. I just think there are better ways to go about the process, and thats my opinion. It's my 2 cents...

Did the sports fellowship process last year. Ended up at a great place but. . . . . . . .

Had to cancel 8 interviews cause I took an early position.

Had to cancel 4 airline tickets, and had to eat about ~$400 dollars for cancellation fees.

The match evens the playing ground. Talk to the "old-timers." In the past a phone call was made from one big name to the next, and the deal was done. That's great if you're from a big name program. Not so great if you're not.

Finally, residency was compared to a "job" in a previous post. Residency is not a "job." It's post-graduate education that you are getting paid for. If you interview for a job, get hired, and don't like it you go find another job. You match in ortho, don't like it. . . . .good luck leaving and finding another ortho "job."

Bone_Jock - President of the "There needs to be a freakin' match for all fellowships" club.

Thanks Dr Levine, that article is a great summary of the reasons why the match became what it is today. Some people may not like it despite all out efforts to persuade them otherwise, but it is still the best/fairest option available to maximize a students chance of going to their top choice

As a Residency and Fellowship Director, I have a vested interest and passion for protecting the well-being of future residents and fellows. Therefore, I can unequivocally tell you that the match is the ONLY way to protect the APPLICANT's potential for matching at the highest program on the list (it is a resident-based algorithm, not a program-based).

I have taken the liberty of attaching a pdf link to a fantastic article that detailed the history of the match and what life is like without it ().

Unfortunately, you don't have to go back in history to recognize what life was like without it. Take a moment to speak to any current PG-4 or PG-5 resident in your own programs. Anyone going into Spine, Sports Medicine, or Total Joints (and ~75% of residents are going into spine and sports right now) has experienced life without a match and it's not pretty.

At Columbia, we had 3 residents this year take a Spine fellowship - 1 on August 15, 1 on August 17, and the last (!) on September 3. The 1st 2 residents interviewed at less than half of the programs to which they were offered interviews. Unfortunately, there are already stories of programs beginning interviews in the PG-3 year. The same thing is happening in Sports Medicine which means that you end up having to know which fellowship you'd like even before you start the process and very likely will not be able to interview at fellowships which you may have preferred, but dare not take the risk of saying no to a "sure thing".

None of this is unique, however, as 2 variables occur with 100% certainty when a match implodes:
1) "Exploding" offers are given in which the applicant is given a defined time limit to accept the offer after which the offer is taken back.
2) Interviews continue to be held earlier and earlier so that programs can gain a competitive advantage on their "colleagues".

As always I wish you all good luck in finding the best possible Orthopaedic Surgery residency position.

William N. Levine, MD
Vice Chairman and Associate Professor
Residency Director
Columbia University Orthopaedic Surgery
New York, NY

I totally agree witht he matching system.. You just can't have that diversity of choices as to where you want to go unless you have a matching system...
Just imagine, you interview at 10 or more programs and rank them versus you interview at the your 10th ranked program first in "your ideal interviewing system" and you are offered a spot but you have to sign in a day or two... Leave getting a spot in your "probably first ranked program", you won't be going there for an interview even. And for the rest of your life, you'll keep wondering if this was the best u cud get or maybe you shud have refused and gone for another interview!!
So, the baseline...
Appreciate the Matching Process and Be Happy!

you now i love reading these forums to see what thoughts are out there about different subjects .... i find it interesting from the recruiting side ...

i am glad there are many people that have set the young doctor BigKingTut straight ... prior to posting the comment, maybe he should have done some research on why the match was started.

it was set up to favor the applicant ... in the past for resident applicants and currently for fellowships ... it was very common for people to not even get to the interview prior to the program filling ... this leads to applicants accepting offers just to have a position.

young doctor BigKingTut, the match is in your favor ... appreciate it ... it would be much more frustrating if you went to an interview and you were told ... i am sorry we have filled all of our spots .... this happened to me years ago when i was interviewing for fellowships ....

appreciate what you now have .... good luck

You need to stop complaining and listen to the people who have already been through the process. I echo the statements by the others on this thread. After going through fellowship interviews I was wishing we still had a match process. The match gives 100% of the advantage to the applicant.

I remember bitching about the match during 4th year, but now I completely see the benefits and how it works out to your advantage. So seriously, embrace it and realize that it's in your best interest that the match exists.

Well...how large is the number of doctors compared to all jobs in America? Obviously its quite small. How come every other profession deals with the same problem, a job that maybe wasn't there first choice offers them after an interview and they have to take it or leave it, probably without the benefit of seeing these other places? In all honesty, whats the difference? I understand the "theory" of the match, just as I understand the theory of what were initially well intentioned ideas in history that have worked like crap. I just find it stupid to leave the next 3-7 years of your life up to a computer algorhythm.....its just my .02 cents, and I think there is a better way to go about it. I don't think it is of benefit to both the program or the applicant. Its turned the whole process in to basically a numbers game, where applicants go to as many interviews as possible, trying to reach that magic number, and programs interview massive amounts of people....it feels like something out of 1984 or Brave New World.....