A Eulogy for the Match

Abstract

September 27, 2028.The Match died today. The cause of death was indifference.The Match was born in 1951 to Francis Joseph Mullin and John Marshall Stalnaker.1 Early on, it had several congenital disorders corrected by future pediatric surgeon W. Hardy Hendren III,2 leading to the National Resident Matching Program (NRMP) that we know today.3 In 1998, The Match received care from Drs. Alvin E. Roth and Elliott Peranson, allowing it to accommodate couples, myriad specialties, and DO applicants.4 For his work, Dr. Roth won the 2012 Nobel Prize in Economics.5During its heyday, the Match served nearly 50 000 registrants, boasting decades-long streaks of year-over-year increases in applications and positions. Success came with controversy. In 2003, residents sued the NRMP in a monopoly lawsuit. However, Congress gave the Match antitrust protection akin to that of Major League Baseball.6 Afterwards, the Match consolidated its power, showing swagger with its 2012 all-in policy that required programs to fill every first-year position either exclusively through or outside of it. The Match justified its actions by asserting it was protecting residents and that participation was voluntary.7Then, the Match developed health problems, starting with a severe case of application fever.3,8 As the number of applicants increased, students, institutions, and programs found themselves trapped in a series of prisoner's dilemmas where strategies such as overapplication, obfuscation of performance data, and use of flawed and discriminatory screening heuristics seemed logical.9 Sickness spread as participants suffered from perverse incentives, excessive and progressive costs, inequities, time pressures, waste, and mistrust.10Forces outside the Match began taking shape, including competency-based time-variable education,11 situational judgement testing,12 pass/fail grading,13 resident unions,14 affinity matching,15 virtual interviews,16 and implicit bias training,17 all driven by the desire for high-quality skill development, veracity, fairness, and autonomy. Unfortunately, the Match came to be seen in direct opposition to these important principles and turned ill.Physicians suggested many remedies. Signal preferencing initially showed promise, but students realized that it helped programs more than them,18 and they lobbied for increasing choices until signaling became meaningless. Supplemental applications initially provided more signal than noise,19 but students quickly used AI chatbots to create the perfect essay for each program.20,21 Application caps were thought to be a cure,22 but students rebelled when their choices became limited. Prominent specialists recommended application phases,23 but this increased everyone's workload past capacity, and the idea was abandoned. Ultimately, participants in the Match rejected all remedies despite endless calls for more.24 Unfortunately, treatment for the fever did not cure the infection.9The beginning of the end began outside of organized medicine when Ivy League law schools pulled out of the US News & World Report rankings.25 Once the first school acted, the rest followed. On the surface, law school Deans stated they quit the rankings because of flawed methodology. However, they also calculated that forces beyond their control could lead to unfavorable ranking changes, and they asserted their power to declare themselves elite, etching this judgement in history, impossible to broach.25Important academic physicians also called for the end of formal rankings,26 and just like law schools, medical schools followed.27 These events led residencies to realize they could take back their own power by removing themselves from the Match. Several community programs had been “all out” of the Match for years, shortening interview seasons and offering applicants positions on the spot, thereby gaining advantage over their competitors. Once the first Ivy League residency opted out, others had to follow. Students, frustrated by the inflexibility, inequity, restrictions, and workload of the Match, began opting out to join these programs. Remaining programs saw fewer and fewer candidates, and one by one opted out to compete. Yesterday there were no applications in the Electronic Residency Application Service system, and the Match officially died.The Match, like paper charts, celluloid x-ray film, and analog stethoscopes, will be fondly remembered for being important and effective in its time.It is survived by chaos and remorse.