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In this video, Nicole Mott, BS, a medical student at the University of Michigan Medical School in Ann Arbor, discusses her in the New England Journal of Medicine, which outlined the issues resulting from misleading Match rate reporting and called for reform of the 70-year-old process.

The following is a transcript of her remarks:

First and most simply to address some of the limitations of the Match rate, is that when we refer to the "Match rate," oftentimes people are referring to the Match rate for the National Resident Matching Program, or NRMP. However, that doesn't include all specialties in all programs. So, some notable exceptions would be ophthalmology, urology, and military training programs.

Second, when we talk about the Match rate, often the Match rate that's publicized in media reports is actually the Match rate for a very specific group of applicants. And that is seniors at U.S. medical schools that grant MD degrees. Those students tend to have the highest Match rates compared to other applicant groups. However, they only comprise less than half of applicants in the NRMP Match. Some other applicant groups include seniors at U.S. medical schools that grant DO degrees, international medical graduates, and previous graduates of MD- or DO-granting medical schools.

The third thing is that the Match rate is actually the proportion of "active applicants" who are successfully placed into a participating residency program in the main residency Match. So, the term "active applicants" is key because an active applicant is someone who registers for the NRMP Match and also submits a rank-order list.

However, about 8% of NRMP registrants either withdraw from the Match or do not submit a rank-order list. Often that means that those students initially apply to programs, but they didn't actually get any interviews and therefore didn't submit a rank-order list. So when we exclude those applicants from the denominator of the Match rate, we're actually underestimating the number of doctors who are unable to obtain residency positions.

Aside from the Match rate, I think there's other pieces of data that we should look into to inform the current state of the Match, both for advisors and for stakeholders involved in the Match process.

Building off the previous point about underestimating the Match rate, there's data that are lacking on applicants who apply to residency programs or register for the NRMP Match, but do not submit a rank-order list. So, we need to display denominators that include all these applicants and identify any characteristics of those applicants who apply to programs, but don't receive any interviews, to uncover possible inequities, and also to inform applicants about their competitiveness and various specialties.

Second, career trajectories and physician workforce contributions of unmatched applicants or applicants who only match into a first-year preliminary PGY1 position are unknown. It's possible that, you know, we have a group of applicants who are "chronically unmatched," and we don't really have good data on those people. So, we need to understand the number and characteristics of unmatched physicians in order to provide guidance for future applicants and also to inform physician workforce pipeline planning.

And then finally, I'll just say, a lot of students don't just care about the overall Match rate, but how the Match rate affects them in the specialty of their choosing. We don't really have good detailed Match outcomes, including specialty-specific matching positions on rank-order lists. So, that information is important because it can help us uncover inefficiencies in the system and inform future policy changes -- things like application or interview caps -- and also just allow applicants to have more realistic expectations for the Match.

As far as declines in first-choice matching, actually the proportion of active U.S. seniors in MD programs matched to their top-ranked program has stably decreased over the past 15 years. Meanwhile, the proportion of those who match to a program that they placed fourth or lower on their rank-order list has increased. The same general trend actually holds true for DO programs as well.

I think this trend is concerning because, at least anecdotally, a lot of students are under this belief that they'll match into one of their top three choices, and as we can see from this trend, that's increasingly not true. Many are surprised to discover where they match, and there might be misalignment in programs and applicants and their first choice and what they actually want and where they actually end up.

I think the demographics of medical schools have changed quite a bit in recent years. Now we have an older cohort of medical students who often have families, and so when they're matched somewhere they don't want to be, it might not just be the program, but also the location, and that affects an entire family. So, I think we need to look into this, one, to have more realistic expectations for applicants, but also to inform possible inefficiencies in the system.

As far as changes and solutions to the Match process, I think there's a lot of different things that have been proposed, and a lot of it still remains debated in the literature, but we do need to try different things out to see how they will work.

I think that the residency selection process right now is extremely over-congested. Applicants are applying to more programs than ever before, and programs on their part are receiving more applications than ever before. When you have that kind of congestion, it creates a bit of chaos and just randomness to the whole process. So, I think we need to consider possible application or interview caps.

However, those types of things don't work in a vacuum. They need to be accompanied by other things such as increased transparency overall in the residency selection process. This includes, for example, programs perhaps being more explicit about their selection criteria, and applicants being more explicit about their desires in terms of where they want to go, which we have seen through signaling programs that have been introduced.

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