One afternoon during my PGY3 year, I got a cold call from the director of a well-regarded pulmonary fellowship. I was rounding at the Philadelphia VA, and he caught me off guard. He thought I’d be a great fellow. So, what did I think of their program? Where would I be ranking them? The questions and adoration implied a clear quid pro quo. I had to think quickly, since the program wasn’t my first choice. Since I didn’t want to blow my chances, I told him I’d be thrilled if I matched there. No doubt, he immediately recognized I wasn’t ranking them first, and he moved on to his next call.
Thirty years later, the sketchy communications persist. Last week, a PGY3 shared a dilemma with me. Fellowships were inferring that candidates should follow up at ranking time, implying they should show their interest to secure a safe spot on the rank list. The PGY3 wondered if it would be better strategically to tell her “number two” program that she was ranking them first since she thought her chances were better there. No doubt, other residents are asking the same question.
I could fill this Note with similar stories, particularly regarding fellowship recruitment. Internal medicine residencies tend to discourage these communications, though there are exceptions.
Efforts to manipulate candidates’ and programs’ preferences undermine the Match, making the process less fair and less effective. The match algorithm is designed to maximize the ability of candidates to train at their favorite programs and to help programs match their top candidates. As long as candidates and programs create lists that reflect their preferences, the system works.
The NRMP has long prohibited programs from asking candidates to divulge their choices, but these rules don’t preclude more subtle, manipulative communication. How should a candidate respond when a program director or selection committee member calls, telling them how great it would be to work with them? Is a response expected? What if a program doesn’t communicate? Does it mean they’re not interested, or does it just mean they have a “no communication” policy? On the program side, I’ve heard faculty at rank meetings suggest we move candidates up or down based on whether they’ve expressed interest, as if applying and interviewing weren’t enough.
Thankfully, through an impressive group effort, many internal medicine residencies have moved away from these communications. Several years ago, the Association of Program Directors in Internal Medicine (APDIM) created guidelines to discourage post-interview communications. This year, we’ve joined a group of programs that have signed onto an even more explicit statement of match integrity, promising that we “will not engage in individualized, program-initiated post-interview communication.” All members of our Intern Selection Committee are required to follow this policy. With time, we hope all programs, throughout GME and throughout the country, will adopt this approach. Correspondence intended to answer questions, provide updates, and help candidates make informed decisions is fine. Individualized correspondence intended to influence decisions is not.
For residents working on their rank lists now, I suggest the following: First, note that if a program asks you where you are ranking them, they’re engaging in unethical behavior, designed to manipulate your choices. Second, if a program reaches out to tell you how wonderful you are, remember they are doing this for one reason only, so you will rank them first, regardless of whether it’s the best program for you. Third, don’t misconstrue what it means if a program doesn’t reach out; they may simply be following the rules. If you like them best, rank them number 1.
For those of you on the recruitment side, please think the same way about communication from applicants. There’s no evidence that candidates who communicate will be better trainees or be a better fit for your program. Candidates who don’t reach out may be just as excited to match with you. There’s only one legitimate way for candidates and programs to communicate preference- with their rank lists.
After each interview day, we tell residency candidates that we don’t expect them to communicate with us and that we don’t make rank decisions based on whether they communicate. What we do say is that they should create their lists in their order of preference and choose the program they love most and put it first. We then follow up with a letter explaining our policy, which I’ve attached to this Note.
As educators, it’s our fundamental responsibility help trainees pursue their career goals. The residency and fellowship matches are designed to ensure the process is effective and fair, but it only works if everyone follows the letter and spirit of the rules.
Enjoy your Sunday, everyone. This afternoon, we’re going to River Tavern in Chester for lunch.