On August 2nd, 2022, the National Resident Matching Program (NRMP), put out a call for public comment regarding consideration of a Two-Phased Main Residency Match. On behalf of its Board of Directors, the NRMP was evaluating the feasibility of this plan to replace the current system of Match® and Supplemental Offer and Acceptance Program® (SOAP®). The period for public comment closed on Friday, September 2nd, 2022. On Friday, September 16th, 2022, several community GME stakeholders and organizations, including the Electronic Residency Application Service (ERAS) and Thalamus, were invited to provide testimony to the workgroup of the NRMP Board of Directors and leadership pertaining to the two-phase match. Thalamus was represented by myself, CEO and Founder, Jason Reminick, MD, MBA, MS. Given the significant discussion amongst our community directed towards the Undergraduate Medical Education (UME) to Graduate Medical Education (GME) transition, we wanted to include our comments publicly in here to continue the conversation at a national level and is presented below.
September 16th, 2022
Donna L. Lamb, DHSc, MBA, BSN
President and Chief Executive Officer
National Resident Matching Program
2121 K Street NW, Suite 1000,
Washington, DC, 20037
Re: NRMP Call for Public Comment Regarding Consideration of a Two-Phased Main Residency Match.
Dear Dr. Lamb,
Thalamus welcomes the opportunity to submit comments to the National Resident Matching Program (NRMP) regarding the consideration of a two-phased Main Residency Match. As our organization provides the most-widely used residency interview management platform, our comments, in strong support of this proposal, focus on the likely effects and benefits of this proposal on the interview season and match process for all applicants, programs and other GME stakeholders. Further, given our research collaboration with your organization, we believe the proposal strongly supports many of the findings of our current collective research projects.
As you are aware, Thalamus is a comprehensive interview management platform for GME applicants and programs with the mission to ensure the right doctors end up in the right hospitals to treat the right patients. Our vision is to ensure doctors achieve their life dream of practicing medicine and to help hospitals serve their mission and their community. These actions ultimately help the broader health care system to improve patient care. Founded in 2013, Thalamus is the fastest-growing residency and fellowship interview scheduling platform in the United States. Currently 90 percent of all residency applicants and more than 2,500 residency and fellowship programs use the platform to manage their interview and recruitment seasons.
Thalamus applauds the NRMP for addressing issues impacting applicant wellness and agency.
The NRMP proposes an improvement to the Match process by replacing SOAP with a two-phased match supported by the Main Match algorithm. Each phase would include submission of rank order lists (ROLs) by both applicants and programs. As proposed, this would provide time between phases for more thorough vetting of programs by applicants, and more time for holistic review of applicants by programs.
This would further allow for increased contact between programs and applicants outside of the “compressed timelines of SOAP.” The resulting outcome would include two Match Days, “Providing the release of the full results to all participants to facilitate transition planning and program planning.” Similarly, newly accredited programs and applicants with an updated eligibility status would have increased opportunity to participate in Phase Two, while fostering “continuity of participation, with outcomes and agreements from Phase One honored throughout Phase Two.”
Thalamus supports this proposal, especially considering the number of programs and applicants our software supports annually during the current compressed SOAP timeline. We believe that both applicants and programs benefit significantly from this timeline, including the opportunity for applicants and programs with a change in eligibility status to participate in the later-phase round.
Thalamus fully supports the proposed timeline of the two-phased match.
The NRMP proposal includes a timeline for the 2024 Match as follows:
- 1/12/24: Quota Change Deadline (Phase 1 Begins)
- 1/15/24: ROL Open
- 2/7/24: ROL Certification Deadline
- 2/19/24: Match Day 1 (Phase 1 Ends)
- 2/22/24: ROL Open (Phase 2 Begins)
- 3/6/24: ROL Certification Deadline
- 3/14/24: Match Day 2 (Phase 2 Ends)
Thalamus believes that the overall effects of an accelerated timeline is beneficial, with minimal costs in regards to either applicants or programs. While historically, interview season broadly (and in some specialties) extends from October through the end of February, the overall number of programs and specialties currently interviewing beyond a February 7th ROL certification deadline is minimal. For the 2022 Match, residency programs using Thalamus conducted and completed only 1% of all residency interviews in February, and only 8.7% of residency interviews occurred after January 15th. The graph below shows cumulative interviews completed by date across all specialties, as a percentage of total interviews completed throughout the season on Thalamus.
While the accelerated timeline will result in all stakeholders submitting rank lists earlier than the current process, programs should be able to accommodate for this new timeline with adequate and early planning. Similarly, we expect the change will be welcomed by applicants matching in the first round, given the earlier notification of a successful match.
Additionally, we believe that those unfilled programs and unmatched applicants participating in the second round will also benefit given a more holistic, thoughtful and compassionate process. While we strongly support the removal of any stigmatization of applicants and programs that need to participate in SOAP, we believe a second phase of the match will likely result in an even more positive experience for these parties. While the period of uncertainty will extend beyond the current week of SOAP, we expect that this will allow applicants more opportunity to explore programs and specialties than with the current process. There will likely need to be some adjustment in Match Day celebrations, although this will likely be much improved from the current experience for those applicants who match during SOAP.
The effects on interview invitation timing and distribution will likely be minimal.
As noted above, for the 2022 Match, only a minimal number of programs (1%) conducted interviews in February. Similarly, the majority (73%) of interview invitations were released through Thalamus over the first 4 weeks of the recruitment season. 93% were released within 8 weeks. The graph below shows cumulative invitations by date across all specialties, as a percentage of total invitations sent throughout the season.
Similarly, Thalamus supports large proportions of programs in specialties offering both standardized and/or common interview releases (as well as those that do not). It is unlikely based on our data that either will be affected based on the two-phased match proposal.
Because Thalamus maintains a robust database of applicant interview choices and preferences throughout recruitment season, we have the ability to see—in real time—how this proposal may affect the residency interview season and would be happy to provide assistance as needed in this regard.
The process should ensure continued integrity of the match, while promoting diversity, equity and inclusion, to the benefit of all applicants and programs.
We believe it is worth noting the fact that in the proposal, as written, the second phase of the match would not require additional registration fees or other costs to applicants. Given that the average applicant spent over $2200 on residency application fees in 2022, we also strongly support the NRMPs decision to decrease match registration fees for this Match 2023 season. Since its inception, Thalamus has remained entirely free and complimentary to applicants navigating the match process. This proposal supports these ideals, which serve as a pillar for the equity of opportunity that should exist for all medical students regardless of socioeconomic status, and which ultimately effects the representativeness of the healthcare workforce and patient outcomes, especially in underserved and rural areas throughout the US.
Thank you for the opportunity to comment on the Two-Phased Main Residency Match Proposal. We believe the process is fair, equitable, holistic and supportive of DEIB in GME. Further, we would be happy to collaborate with the NRMP regarding any modeling of interview season and outcomes data to further support the proposal as it develops. We look forward to engaging with you in the future. If you have any questions, please do not hesitate to contact me.
Jason Reminick, MD, MBA, MS
CEO and Founder