The US Residency Match at 70: What Was, What Is, and What Could Be

The National Resident Matching Program: An Outdated Business Model Due for Reform

“…This also leads to increased utilization of screening metrics by programs to filter huge application loads which impedes the program's ability to gauge sincere applicant interest, leading to a distribution of interviews heavily reliant on metrics. 1 To enhance the NRMP business model and relieve some of the burden of congestion from applicants and programs, one approach is to limit the number of interviews an applicant can attend during the match cycle, which can provide more equitable opportunities in the face of increased congestion. Furthermore, with the increase in revenue produced by additional applications, the NRMP may consider allocating a fraction of these funds to lobby for or provide partial funding for additional surgical residency training positions.…”

“…This also leads to increased utilization of screening metrics by programs to filter huge application loads which impedes the program’s ability to gauge sincere applicant interest, leading to a distribution of interviews heavily reliant on metrics. 1…”

“…6 Further recommendations that can improve the effectiveness of the NRMP business model by reducing congestion in the match include providing applicants and programs with avenues to express interest and identify well-suited candidates respectively through continued utilization of newly introduced preference signaling. 1 The incorporation of preference signaling has already shown promising potential, with a recent study finding increased interview rates for Otolaryngology applicants utilizing signaling in the 2021 match cycle. 7 This study is limited by a lack of analysis regarding individual applicant characteristics or program-specific attributes, which may have allowed for the development of more targeted recommendations.…”

“…1 However, in the past 70 years, inflation in applications has led to increased revenue earned by ERAS through rising application costs for students without any notable improvement in the business model of the NRMP for either applicants or programs in response to this application surge. 1 Similar problems have been observed over the past decade in the Canadian Resident Matching System (CaRMS) which is heavily modeled after the NRMP; however, this system continues to adapt with needed quality improvement as the needs of its stakeholders and medical education landscape evolve. 2 While previous studies have examined trends in NRMP, most studies utilized a very short time frame, focused just on 1 specialty when providing solutions, and failed to explore the differences in trends between the non-surgical and surgical specialties.…”

“…The National Resident Matching Program (NRMP) was created in 1952 to protect graduating medical students from predatory hiring practices and to establish a system that would best align the preferences of medical students and residency programs. 1 However, in the past 70 years, inflation in applications has led to increased revenue earned by ERAS through rising application costs for students without any notable improvement in the business model of the NRMP for either applicants or programs in response to this application surge. 1 Similar problems have been observed over the past decade in the Canadian Resident Matching System (CaRMS) which is heavily modeled after the NRMP; however, this system continues to adapt with needed quality improvement as the needs of its stakeholders and medical education landscape evolve.…”