Exclusive Residency Insights From the Head of the NRMP

Ryan Syrek, MA


December 07, 2018

Medscape: A recent study found that programs often ask applicants questions that the NRMP had said they shouldn't ask. That same study also found that post-interview communication is a common source of stress that's not very well regulated. Do you have any plans to address these concerns?

Signer: Our Match Participation Agreement, which is the contract that both applicants and program directors sign when they register for The Match, specifically prohibits certain kinds of questions. It prohibits programs from requiring applicants to tell them where else they have interviewed or applied. It also prohibits program directors from asking for any ranking information, and generally prohibits any kind of coercive behavior. Programs that ask those questions are subject to an investigation. The NRMP will levy sanctions if the program is found in violation.

We strongly encourage applicants to report alleged violations to the NRMP.

But we can only investigate instances where potential violations are reported to us. Applicants are often afraid to report violations because they worry about whether it will have a detrimental effect on their career. That's why we have posted to our public website a form that allows applicants to report alleged violations anonymously. Although it certainly is possible, perhaps even likely, that these violations are underreported, we can only investigate what's reported to us, and so to the extent that that kind of behavior isn't reported, it's allowed to continue.

We strongly encourage applicants to report alleged violations to the NRMP. If the report is anonymous, that's fine because a pattern may emerge. If it happened to one applicant, it likely happened to many applicants who applied to that program.

We do not regulate post-interview communication. Our Code of Conduct discourages post-interview communication, but it is not prohibited in the Match Participation Agreement. The NRMP Board of Directors has considered banning post-interview communication but has declined to do so. That is because directors of programs that may not be very competitive want to be able to contact applicants after the interview and say, "We really liked you. We really hope you'll come here."

I certainly understand why applicants and programs engage in post-interview communication, but applicants and program directors shouldn't create their rank-order list on the basis of post-interview communication from the other party. They ought to create their rank-order list based on their true preferences. Applicants should rank the programs where they want to train in order of preference, not where they think they will match. Program directors should rank applicants in order of preference, not the applicants with whom they think they will match. The matching algorithm works best when Match participants rank each other in order of true preference.

Medscape: What about questions that fall more under general employment issues—questions like, "Are you planning to have children?" or things of that nature?

Signer: The NRMP has no jurisdiction over those kinds of questions. They may be illegal, and certainly applicants should contact their own legal counsel or address it with their medical school advisers if they think they have been asked illegal questions. The NRMP can't regulate what is legal and illegal; that is the province of federal and state laws. We are in the business of regulating the conduct of Match participants.

The NRMP expects all Match participants to behave in an ethical and professional way. If we learn that a program has been asking inappropriate questions, we will send a strongly worded letter to the program director and to the administration in that teaching institution, but it's not a violation of our Match Participation Agreement.


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