Disparities in the residency match process.

To the Editor: We are writing to express our concerns with the current residency matching process regarding an apparent loophole that treats sponsored US graduates differently than independent applicants from international medical schools. Allowing international graduates to enter the National Resident Matching Program (NRMP) and then withdraw if offered a pre-Match position, is unfair to US graduates and programs that use the matching process in good faith. Currently, a US graduate must go through the entire interview process and then wait until Match Day to find out which program they have matched with. They may not withdraw from the Match except through the dean of student affairs of their sponsoring medical school. On the other hand, an international graduate could start the NRMP process and then could independently withdraw from the Match if offered a pre-Match position prior to the rank order list certification deadline. From a residency program perspective, one could interview a number of international graduates and not have the opportunity to match any of them if they all withdrew prior to the ranking deadline. A program will spend a lot of time and energy on individuals they are unable to match with. Having an agreement outside of the Match is also risky for applicants. Such loose agreements may lead to applicants refusing to show up or programs refusing to take on an applicant after initially agreeing to terms. The NRMP process, on the other hand, is a legally binding agreement ensuring both parties a successful outcome. We are concerned that this disparity creates an uneven playing field between domestic and international graduates and between programs that strictly use the NRMP process and those who routinely practice pre-matching agreements. We recommend that the NRMP sponsors and board of directors reevaluate the impact these policies have on both applicants and residency programs. John E. vanSchagen, MD Phillip J. Baty, MD Grand Rapids Family Medicine Residency Grand Rapids, Mich