Tuesday, April 06, 2004

DB has a post on this New York Times story about the match and the lawsuit attempting to derail it. DB makes some excellent points:

Popular residencies could (and therefore probably would) decrease their financial stipends. To get a dermatology slot you might work for much less than today.
Less popular residencies (either specialty or location) might increase their stipends to try to attract residents. This could lead to bidding wars - financially helping some residents in the short run.
It follows that considerations other than the quality of training would have a greater influence on residency training
Timing would become a greater issue. Students would start seeking positions in their 3rd year rather than their 4th year. Programs would encourage this trend to insure that they "fill" their positions. However, 3rd year students often change their minds about specialties. Thus, students might reneg on their committments, leaving programs scrambling to find replacements.
The above comment seems absurd - until one examines subspecialty fellowships in internal medicine, which have exactly that problem.
(and they let them get away with it?)
The stresses on applicants would increase without the current standarization

While Dr. Centor diplomatically calls a world without the match as one with "increased chaos", I think it would be akin to anarchy. Imagine the situation described above. Imagine taking calls from headhunters as a third (or second)-year medical student. Imagine getting postcards with the pitch "Consider this postgraduate medical education opportunity in sunny Florida!!!" Those things were annoying enough to get as a resident.
A ranking meeting in a world without a match could certainly be interesting according to a commenter to my Match Day post:

When John got a 240 on his USMLE Step II but he wants 45K, Stephen on the other hand took three times to pass but he only wants 30K. Who should we take?"

Who indeed. Anyway the results for the 2004 match are here. Makes for interesting reading. Of the 1044 categorical surgery spots, 885 were filled by U.S. graduates, up slightly from last year. 2 surgery programs didn't fill, compared to 9 last year. Contrast to the 46 IM, 38 pediatric, and 221 family practice programs that had open slots. And those numbers are better than last year's. Radiology and derm don't seem to have that sort of trouble, however.
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