the medical draft

Friday, March 10, 2017

The sun sets on the first day of this year’s NFL free agency as rejoicing, and perhaps mourning, breaks out through the country with each team’s fans praying that this…might…be …the…year!  Hope springs eternal for the next season after seminal events in each sport. Whether it is the NCAA signing period bringing high school stars to campus, or the trade deadline in the NBA and NHL where a final push to the playoffs might be a reality. But there is another draft that is happening now that will likely have a much more tangible effect on people’s lives…literally.

The 2017 National Residency Matching Program (NRMP) releases its results beginning March 13 and the lives of thousands of medical students and millions of patients will be forever changed. In the fall of 2016, at the beginning of their fourth and final year of medical school, more than 40,000 soon to be doctors begin the application process for residency training slots and the start of graduate education. Almost 5,000 teaching hospitals offer more than 30,000 training opportunities in every specialty of medicine, from surgery to ophthalmology, psychiatry to family practice, pathology to whatever other type of medicine you can imagine.

The process is relatively simple. The medical students apply to a residency program (usually more than a few), visit and interview at a couple and then on February 22 send their wish list to the “Match”. Residency program directors, and their staff, sift through the applications, medical school grades and interview performance to decide where they rank the soon to be doctors o their draft board and submit their list as well. NRMP computers do the rest, and next week marriages are announced. There will be some rejoicing, some sadness and some mourning. A few students won’t be matched, but like the NFL, there is a supplemental draft since some programs also don’t fill their positions.

But why should the rest of the world care; it’s not like fans fill a stadium every Sunday and have fantasy resident teams based on how well a new doctor cared for a patient in congestive hear failure or assisted on an operation. Aside from the direct care that the residents provide at a teaching hospital, the results of the Match might alter the landscape of a community for a generation to come. Training can last 3 to 7 years or more and during that time, these new doctors start families, put down roots and often tend to stay in the area where they did their training.

The young fourth year medical student that interviewed at your local hospital might be the surgeon who is emergently operating on you in ten years. She might be coaching your basketball team or he might be running for school board. These are the new young professionals who become the fabric not only of the medical community but also of the community as a whole.

Unfortunately, there is a cloud that hangs over this year’s Match. Because foreign medical graduate students also participate in the Match in search of US quality training, there has been concern raised by the NRMP that travel restrictions for some might affect their ability to begin training on the traditional start date in July. From the NRMP press release:

  • …This uncertainty leaves programs the choice of not ranking qualified applicants or risking empty training slots on their program start date. Even if the ban ends after 90 days, there is concern that the consular interviews that are required prior to obtaining visas will be so slow that affected applicants will not be able to start training on time. There also are concerns about whether residents and fellows who are in the U.S. on visas will be able to remain in their training programs. 
  • The consequences of the Executive Order are far reaching for Match applicants, and the upheaval it is causing is extensive. The affected applicants have worked hard for many years to achieve their goal of becoming physicians, and they should not be denied that opportunity because of a blanket policy that does not consider the individual. Similarly, U.S. training programs should be able to select applicants based on their excellent character and qualifications, without regard to nationality. Both applicants and programs benefit from an orderly process for entry into graduate medical education. The Executive Order disrupts that process very considerably.

As NFL free agency winds down and the hype of their draft begins, teams begin reshaping their team to become more competitive in the coming years. The NRMP  allows hospitals and communities to do the same thing when it comes to the quality of medical care available. Perhaps it might be time to appreciate the medical draft that touches health and welfare of thousands of communities in the US. Knowing that your local hospital has filled their training slots in family medicine and surgery should make you feel a little safer for the next thirty years. Wit hall that is at stake, it is surprising that the Match isn’t must watch reality television. I wonder if ESPN might be interested?


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