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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medical draft day…the match

Monday, April 27, 2015

After months of speculation, the NFL draft of college players will finally happen this week. Fans will celebrate their good fortunes or bemoan their perceived loss as each of the 256 college players picked, are assigned to their new team. Meanwhile, the coaches, scouts and other management personnel may have their career longevity significantly affected depending upon how well the rookies impact the success of their new teams. But it’s not life or death, even if fans may think it is, when a future star wears a different jersey. Interestingly, the draft that has life and death implication concluded a couple of weeks ago, in anonymity, except for the tens of thousands of new doctors who learned their educational fate.

Graduating from medical school is a definite accomplishment, but rather a hollow one. The four years of undergraduate studies and four more years of medical school only qualify the newly minted MDs to open another door to access further training. The MD degree does not allow them to practice medicine; instead, it is the entry requirement for post- graduate training that can last three to seven years or more. This is residency training, so called because historically, the new MDs would literally live in the hospital where they trained. Graduating residency is the ticket to begin the practice of medicine and it all begins with the draft.

 

The National Residency Matching Program is the NFL draft of medical schools. Senior medical students decide upon their hoped for medical career, from primary care (family medicine, internal medicine, family practice) to specialties as diverse as obstetrics to dermatology to psychiatry to surgery. From there, it’s a search for the teaching hospital that has the program they are interested in pursuing, with hopes that the hospital residency program is interested in pursuing them. There are application forms, letters of reference, tours and formal interviews, no different than the NFL pre-draft evaluation process. The difference has to do with the scale of the draft.

There were over 40,000 docs-to-be in the 2015 NRMP draft trying to secure one of about 30,000 slots. The medical students list their preferred programs, the hospitals rank their wish list and a computer does the matching. At the end of March, the fate of each group is decided. The hospitals find out the quality of their new class of residents, while the medical students find out where their new home will be, come July.

 

Most applicants find a place to train, but some do not. The playing field is not necessarily the same for each applicant. More than 22,000 are senior medical or osteopath students who trained in the US. There are 6,000 American students who studied abroad and another 10,000 foreign medical grads. Add about 2,000 who have applied in previous years and the pool of hopefuls is complete. Those who do not get a spot in the first round, scramble to find a place to train. It’s just like an undrafted free agent who goes from team to team asking just for a chance to play. These students want and need a place to complete their medical studies, because without at least a year of postgraduate training, they do not qualify for a medical license, the golden ticket to care for patients.

While fans of the Buccaneers, Titans and Eagles fret about their first round pick and whether it is a Jameis Winston or Marcus Mariota, the NRMP is a real difference maker for communities. More often than not, new docs tend to live near where they train. They are familiar with the hospitals and neighborhoods, they may have started families and settled into the schools and community and have settled into homes. As well, the local doctors and hospitals have had years to assess their potential colleagues, and try to recruit the brightest and best to stay nearby.

The good news for 2015 is that about 13,000 of the 30,000 slot matched into primary care, meaning that 2018 will see a bumper crop of docs ready to cure the world, or at least help people help themselves become healthier. Their careers will span decades and touch the lives of thousands. And yet, those seminal decisions, affecting the lives of many generations, occurred in the obscurity of an NRMP computer program. If only it had the hype of the NFL and the daylight that draft day will bring.

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