In Reply.

Abstract

In Reply to Alvin and Magid: In response to the more flexible residency application system that we proposed,1 Alvin and Magid argue that the current Match process is more fair. While we agree that the Match is fair to applicants and programs in terms of clarity of process and access to that process, those elements of fairness could be maintained under a more flexible process via a coordinating entity such as a revamped National Residency Matching Program. Where the current system fails is in its inability to support a range of applicants and programs. A more flexible system would allow the diverse pool of applicants and programs to engage with the process in a variable fashion while receiving ongoing feedback on competitiveness; for example, an applicant with very high interest in a single program (say, because of family) could make a quick commitment while an applicant with fewer constraints could interview widely and proceed through the application process more slowly. Bidirectional feedback between programs and applicants would augment opportunity and support efficiency while the coordinating entity maintained the clarity and accessibility of the current process. Alvin and Magid also identify a number of logistical challenges to a new system: tuition charges, determination of graduation eligibility, salary negotiation, and processes for application and acceptance. True, there are many hurdles to overcome. Yet as a recent report from the Macy Foundation2 outlined, a number of pilots are experimenting with time-variable, competency-based models. The March (2018) supplement of this journal features some of these innovations. While these pilots are demonstrating how best to overcome challenges as we evolve toward a system of competency-based health professions education, the biggest barriers to competency-based education remain structural monoliths like the current Match process. Rethinking the Match supports the move to competency and away from system-created deadlines. The result would be a better-prepared physician workforce that is more equipped to meet the needs of society. And, that’s a fairer deal for all of us. Alan Dow, MD, MSHAAssistant vice president for health sciences for interprofessional education and collaborative care, and Ruth and Seymour Perlin Professor of Internal Medicine and Health Administration, Virginia Commonwealth University, Richmond, Virginia; [email protected]; Twitter: @alan_dow; ORCID: http://orcid.org/0000-0002-9004-7528. Christopher Ray, MDResident, Internal Medicine and Pediatrics, Virginia Commonwealth University, Richmond, Virginia; ORCID: https://orcid.org/0000-0002-5477-9035. Steven Bishop, MDAssistant professor of internal medicine and clerkship director, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-1878-1445.