500 Cummings Center
Beverly, MA 01915
Tel. (978) 927-8330
Fax: (978) 524-8890
James Whiting, MD
Greetings from Portland! Spring up here, as in much of Northern New England means lengthening days, (slightly) warmer temperatures, unrealistic expectations of what April and May will be like and, of course, lots of mud. It also means Match day and the end of recruitment season. As many of you know, I am not only your secretary, but the Residency Program Director here in Maine.
For those of you either not involved, or only peripherally involved in residency recruiting and this annual rite of spring, there are a number of facts worth noting. First, the popularity of surgery as a career has never been higher. Every spot in the country filled this year, most programs are seeing something in the range of 200-300 applicants per categorical position, the average USMLE scores of students matched to surgery continues to rise, and when you meet these young men and women in person, itís impossible not to be incredibly impressed with their talent, enthusiasm and idealism. Whether lucky or good (or both), we are doing something right.
Thatís not to say that everything is rosy all over. The system used to find and select these young surgeons is badly broken and poorly serving the needs of both applicants and programs. The burgeoning popularity of our specialty and the ease of electronic submissions have created a virtual arms race of applications. Deans are routinely recommending even strong candidates to apply to forty programs, candidates with less than stellar USMLE scores are applying to 60 or 70 and I ran into a few coupleís matching candidates who applied to over 100 programs! Applicants report spending as much as $10,000 on the process. Programs inundated with applications can now no longer read every application and end up overly dependent on computer filtering of candidates by board scores. Even the most gifted medical student who is absolutely born to be a surgeon will struggle mightily to find a spot if their board scores are below average. There is evidence to be presented at Program Directors meeting this spring that the reliance on USMLE filters may be especially harmful to qualified applicants who are underrepresented minorities. Lastly, the stresses caused by this system have been associated with disturbing breakdowns in simple courtesy (read professionalism) by applicants and programs alike. Applicants cancel interviews at the last minute, leaving programs unable to fill their spots. At the same time, applicants report that the majority of programs donít acknowledge receipt of applications or provide any information as to when they have filled all interview slots, thus leaving the students to twist and wonder whatís happening, while preventing them from blocking geographically related interviews together.
So what to do about all this? Itís a big complex problem that involves behemoths like the AAMC where it will take time to address. But we can do something at the local level and we can start with the low hanging fruit of professionalism. Most of us would agree that professionalism is a competency that benefits by modeling and clarity. So letís provide that in New England. Letís provide a code of expectations for applicants and programs alike and hold each other and our applicants responsible. Letís also provide some transparency to the process. There is no downside to clearly stating our criteria for applicants, along with our timetables. If you are faculty and not involved in residency administration, you can still help. Volunteer to interview and read (and abide by) the match agreement ahead of time. Put some time and thought into helping your program select the best candidates through the questions you ask. Itís in all of our best interests.
James Whiting, MD