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Prematching: Soon a thing of the past
Posted on 25. Jan, 2012 by MedEdits Medical Admissions, LLC in Residency Admissions, Residency Match
“I just hope to get a prematch offer so I don’t have to go through the main residency match.”
“What should I do? I got a prematch offer from a great program but it isn’t my number one choice and I think I would rather enter the main residency match. Should I take the prematch offer? Help!”
I hear these types of comments throughout the residency match process from United States and non-United States citizens who are considered “independent applicants.” Many independent applicants hope to receive prematch offers to guarantee they will earn a residency training position which can alleviate stress. For other independent applicants, however, prematch offers actually cause stress since giving up a guaranteed residency training position to enter the main residency match in hopes of matching at a “better” program presents a dilemma.
Under current National Residency Matching Program policy (NRMP), international medical students and graduates, osteopathic medical students and graduates, and past US allopathic medical school graduates, all of whom the NRMP considers “independent applicants,” can accept “prematch” offers from residency programs. What this means is that programs can offer residency positions to independent applicants before the main residency match, which takes place annually in March. However, the NRMP may modify this policy, which would completely change the landscape of the residency match and, based on the opinions of many individuals involved in the process, make it more equitable.
Before exploring the proposed change, let’s consider the history of current prematch policies and review some data regarding how many applicants may obtain prematch residency training positions.
In 2001, the NRMP proposed that “all sponsoring institutions participating in the Main Residency Match must register and attempt to fill all of their positions in the Match except those specialties or programs participating in other national matching programs.” Some specialties historically do not fill any positions outside the match, and they tend to be the more competitive specialties. Many other specialties and programs that traditionally accept independent applicants try to fill some spots outside the match and also fill spots through the main residency match. So, while some programs and specialties adopted this proposal in 2001, others did not.
The main concerns of programs that offer prematches is that non-US citizen international medical graduates (IMGs) might have difficulty obtaining visas by July 1st (which is required to start their training) if they have to wait until March to obtain a match. NRMP determined that 92% of IMGs requiring visas in 2009 received them by July 1st, but the impact that prematching early might have had on this statistic is unknown. Programs that offer prematches were also concerned about “losing” their most desirable independent applicants if those applicants entered the main residnecy match because, in theory, these independent applicants could be ranked highly by more desirable programs where they might ultimately match.
The NRMP reviewed data carefully to ascertain how many applicants actually obtained residency positions outside the match in 2008. Of 28,633 new residents who entered graduate medical education programs, 1,588 withdrew from the residency match. Of these, 791 individuals indicated they had obtained a “non-NRMP” position and 567 indicated they withdrew at “applicant’s request.” It is likely that both of these groups obtained prematch offers. Interestingly, 2,577 residents in NRMP specialties did not participate in the main residency match; it is likely that these individuals also obtained prematch offers. In total, 3,935 individuals probably accepted prematch offers, and only 94 of these individuals were US allopathic medical school graduates in 2008.
Under a new policy to take effect for the 2013 match, the NRMP requires that all institutions participating in the main residency match fill all of their residency training positions through the NRMP residency match or another national residency matching program. In other words, institutions (and not specific programs or specialties) will be held accountable and will not not be allowed to offer prematch offers outside the match. This is why the NRMP is calling this an “All-In” policy; institutions will need to decide if they would enter all of the institution’s residency training positions in the match.
Like the two applicants with divergent views quoted at the beginning of this article, many people will be in favor of instituting change while others won’t be too happy about it.
Note: The data in this article is from the official document published by the NRMP: Proposed NRMP Policy Change: All Positions in the Match.
About MedEdits Medical Admissions, LLC
Dr. Jessica Freedman is president of MedEdits Medical Admissions and author of The MedEdits Guide to Medical School Admissions, The Medical School Interview, and The Residency Interview.Subscribe to News
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The MedEdits team comprises a group of professionals committed to clients’ success. We focus only on medical admissions and therefore have unique expertise. We work hard to help you achieve your goals, putting in long hours and often working evenings and weekends to help you meet deadlines. We define our own success by that of our clients; nothing makes us happier than hearing a client earned an acceptance or match. Each member of the MedEdits team brings a unique perspective and expertise, and we collaborate and draw upon our different strengths to benefit our clients. We all are rigorously trained in our unique disciplines and this work ethic and commitment to excellence is reflected in the work we do.