A Proposal to Address the Increasing Number of Residency Applications

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In their Commentary, Katsufrakis and colleagues1 point out several issues that complicate the residency match process. For programs, the concept of a good “fit” between the program and prospective residents is probably as important as the academic credentials that applicants bring to their residency training. Similarly, applicants should be encouraged to carefully review prospective training programs, trying to identify which programs would best suit their training needs. Unfortunately, the ability of both programs and applicants to spend time focusing on this goodness of fit is compromised by the sheer number of applications that programs receive and the large number of programs to which applicants apply. Data presented by the National Resident Matching Program confirm that positions ranked per applicant have risen nearly 35% over the last 10 years, with a 20% increase in the number of applicants ranked by position per filled program.2 In addition to increasing costs for applicants and programs, this deluge of applications reduces the ability of programs and applicants to fully investigate one another.
While Katsufrakis and colleagues offer some potential solution in their Commentary, one aspect they overlook is that the Match consists of only one phase. Since both programs and applicants have to go “all in” during the Match, this incentivizes applying to as many programs as possible and interviewing as many applicants as possible. Another potential solution would be to conduct a first phase or “early decision” match whereby applicants would be limited to ranking only a small number of programs—say, five—while programs could rank only two or three applicants per available position. This “early decision phase” which could be open in October and November would force applicants to focus only on the programs to which they feel they are best suited and also encourage programs to interview only those applicants who they believe would be at the top of their list. Once the early decision period concludes, all open positions and unmatched students would continue through the regular match with interviews occurring mid-December through January, which is ample time for applicants and programs to move ahead in preparation for the regular match.
While not a perfect solution, an “early decision” phase would allow selected applicants and programs the chance to find that right fit without the noise of a mountain of other applications as well as reduced cost for many applicants and programs.
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