A problem for the NRMP that may be growing

I've had correspondence and conversations with a number of residency program directors, about a common problem that may interfere with how safe they feel about rank-ordering residency and fellowship applicants according to their true preferences.

I'll quote from some emails without identifying the senders.

"I oversee the xxx residency match ....

"There is a terrible game that is going on in some surgical fields, though.  Program directors feel that it is prestigious not to go down their lists very far.  A program director may boast to his/her Chair, "This year we only needed to go down to #6 on our list to fill our (3) positions."  This ambition to not go down far on a list, as evidence that a program is highly desirable, is often achieved by pressuring candidates in the following way, "If you want to come here, you really need to let us know," which translates to "tells us we are your #1 and then you will have a chance to match here."  These actual or implied quid pro quos are a shame and pervert the intent of the match and your good work.  I know the NRMP considers them illegal or at least poor practices, but they are common, unfortunately."

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"I work in xxx [non-surgical specialty], which is a specialty that is very competitive for the match.  Although the system that you helped develop should match applicants and residency programs based on the rankings that applicants and programs provide according to their independent preferences, some prestigious residency programs in xxx (and likely other specialties) are being evaluated by hospital presidents or other administrative officials by how far down the rank list they must go to fill their complement of residents.  This in turn has created an environment where some programs are ranking applicants according to the likelihood that the applicant will rank the program in the top slot rather than if they believe that the applicant is truly the best applicant for their program.  While I believe that each residency  program should be able to use whatever criteria they want to for ranking applicants, the problem is that some residency program directors or department chairs are contacting applicants or faculty at which the medical students train to find out if their program is at the top of the applicant’s rank list.  This puts the applicants in an awkward position and in my opinion likely biases the match result to hurt some applicants.

In an ideal world, such behavior by residency programs could be prevented by explaining that it violates the principles of the match.  However, I am afraid that this approach will be unlikely to remove the cause of this problem: pressure that some departments feel from administrators and hospital presidents."
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Perhaps the community (directors and NRMP) could be persuaded that residency directors shouldn’t show their rank order lists to their deans and chairs?