Friday, September 17, 2010

Cleaning up the scramble for medical residents with SOAP

Changes are coming in the scramble that follows the medical resident match run by the National Resident Matching Program (NRMP). A new, semi-centralized, partially computerized Supplemental Offer and Acceptance Program (SOAP) has been announced, for implementation in March 2010.

If I understand the proposal correctly, residency programs with unmatched positions will be able to submit preference lists of match participants who ended up unmatched, and these preferences will be used to make exploding offers, after which the preference lists and positions will be updated to take account of acceptances (e.g. candidates who accept a position will be removed from other program's preference lists), and new exploding offers will be issued. Unlike in the main match (which these days uses the Roth-Peranson algorithm, but which you can think of as a student-proposing deferred acceptance algorithm), applicants will not submit preference lists, but will accept or reject offers as they come in (i.e. they cannot defer acceptances by holding their best offer until they see if any better offers arrive later).

Part of the proposal is to integrate the scramble with the Electronic Residency Application Service (ERAS), which will make some kinds of automatic processing and regulation possible,while some of the proposed regulations may be more challenging to enforce. (Markets that use exploding offers at fixed times have often been subject to cheating of various sorts: here's a paper on the experience of the law clerk market. There are lots of differences in the market culture of doctors and lawyers that may result in different outcomes.)

Here are some of its proposed rules:

• Unmatched applicant and unfilled program information will be released simultaneously.

• There will be a “time out” period during which unmatched applicants can send applications but programs cannot make offers.

Applicants and programs will be required to send and receive applications only through ERAS.

NRMP-participating programs that fill positions during Match Week must do so only through the SOAP.

• New functionality will be added to the R3 System to allow programs to offer unfilled positions on the basis of preference lists submitted by the programs.

Applicants must accept or reject their offer(s) within a specific timeframe; offers not accepted or rejected will expire.

• The R3 System will establish an electronic “handshake” when an applicant accepts a position.

Positions will be deleted from the dynamic List of Unfilled Programs once an offer has been accepted.

A program’s unfilled positions will be offered to applicants in order of preference until all positions are filled or the preference list has been exhausted; programs will be able to add applicants to the bottom of their preference lists throughout Match Week.

• The NRMP Match Participation Agreement will be expanded to include Match Week and SOAP, and sanctions will be imposed for improper behavior.
Eligible NRMP applicants:

• Must be able to enter GME on July 1 in the year of the Match

• Will be able to apply only to unfilled Match-participating programs during Match Week

􀀹 Access to the List of Unfilled Programs will be restricted by match status (preliminary or advanced)

􀀹 Must use ERAS and will be able to select only unfilled Match-participating programs

􀀹 Cannot use phone, fax, email, or other methods

􀀹 Cannot have another individual/entity contact programs on applicant’s behalf

􀀹 Will be able to accept positions only through SOAP during Match Week

• Can apply to non-Match-participating programs after Match Week

Ineligible NRMP applicants:

• Cannot participate in SOAP

􀀹 Cannot apply to Match-participating programs using ERAS, phone, fax, email, or other methods

􀀹 Cannot have another individual/entity contact Match-participating programs on applicant’s behalf

• Can apply to non-Match-participating programs during Match Week

􀀹 Can use ERAS to select non-Match-participating programs

􀀹 Can use phone, fax, email, or other methods

• Can apply to Match-participating programs after Match Week

Unfilled Programs:

Must accept applications only through ERAS during Match Week

􀀹 Cannot use phone, fax, email, or personal contacts

• Must fill positions using SOAP during Match Week

􀀹 Cannot offer positions to ineligible applicants during Match Week

􀀹 Cannot make offers outside SOAP during Match Week

􀀹 Are not required to fill positions during Match Week

• Can add applicants to bottom of preference list

If an applicant rejects an offer or allows an offer to expire, no further offers will be made to that applicant by the same program.

Once an applicant accepts an offer, the applicant will not be able to send additional applications via ERAS.

Once a program has filled all of its positions through SOAP, applicants will be unable to send applications to that program via ERAS.

Offers extended by programs and accepted by applicants during the Match Week Supplemental Offer and Acceptance Program (SOAP) will create a binding commitment. Failure to honor that commitment or failure to adhere to SOAP policies will be a violation of the Match Participation Agreement.

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