In the 2014 Forbes article “How A Nobel Economist Ruined The Residency Matching System For Newly Minted MD’s,” Amy Ho argues the way we place new medical school graduates into residency positions needs to be reassessed. She calculated the cost of applying to residency to be greater than $7,500 when taking into account loans and interest. If you have not participated in the U.S. medical educational industrial complex, this may seem like an astonishingly high number for job-seeker whose salary prospects are about $50,000 per year to expend. Yet, this is the norm in the system we have. And while the Match is indeed an antiquated absurdity that should be reexamined, Ho’s article fails to propose a solution to curtailing the significant financial burden placed on the already debt-laden fourth-year medical student.
The fact is, there is a far more economical way to approach the application process for both applicants and programs, even while working within the constraints of an archaic system. The majority of the cost of applying to residency programs is associated with travel expenses. But what if only one trip was necessary for applicants to interview at all of the programs he or she was invited to? And what if a program’s resources were freed from the chains of the semi-weekly onslaught of a new troop of bushy-tailed interviewees, lunches and pre-interview happy hours?
A week-long, specialty-specific, residency interview conference is a far more efficient and financially palatable solution than the status quo. Programs and applicants could convene in a single city, during a single period. Applicants could interview with multiple programs and save the cost of traversing the nation over the course of months. Programs would free up their faculty’s time over the course of the fall and winter and be able to invest those expensive resources elsewhere. And, perhaps best of all, interview season would cease to be a season at all. One shudders to think of the implications such a change would have on the expensive and misused fourth year of medical school, when nearly four months are dedicated to the interview process.
Such an event gets at the cost and time problem, but would be an interviewing marathon that is not without drawbacks — not the least of which would be the loss of those “gut instincts” one gets while walking within a hospital’s walls or exploring an unknown city. Programs’ cost-savings in time and resources would be partially offset by newly incurred travel expenses of their own.
Is this the ultimate solution? No. But it is a major paradigm shift. And having just participated in the resource-sucking, yearlong process of residency applications, I can say without a doubt I, and many of my colleagues, would welcome a way to defray the outrageous cost of finding a job.
Amy Ho’s argument for scraping the match is certainly not without merit, but it will take some ingenuity to come up with creative solutions to its current problems; and much like any change in medicine, it is likely to be implemented with a graduated approach. Reshaping the interview process is low-hanging fruit that could be the first significant step in revamping the outmoded Match process while at the same time putting some money back in the pockets of indebted U.S. seniors.
Harrison Lobdell IV is an emergency medicine resident.
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