To the Editor: Reforming the Residency Match Process

We thank Williamson et al¹  for calling for improved charting data standardization outcomes and data sharing to improve the National Resident Matching Program (NRMP). However, when implementing long-term interventions, one may want to remain cognizant of the long-term impacts on Match efficiency and cost-effectiveness for residency programs and applicants. We stress that the Match is only part of a multifaceted residency application process and suggest that conclusions drawn from a single catch-all endpoint (ie, Match data) to restrict the number of interviews are limited in its implementation and depiction of complex issues. Instead, we recommend analyzing each element of the application process from its participants (applicants, program directors, educators, accrediting bodies) to its facilitators (Electronic Residency Application Service [ERAS], NRMP) to guide changes.

For instance, solely contextualizing decreased first-choice matching by referring to longer program and applicant rank lists ignores potential pre-Match contributors, such as objective measure screening and limited transparency regarding program competitiveness, culture, diversity, and overall fit.^1,2  Ideally, institutions prefer to interview and rank students with interest in their program, potentially to avoid matching under the Supplemental Offer and Acceptance Program (SOAP) or at worst holding unmatched positions.³  On the other hand, students face pressure to apply to increasingly more programs given the unfavorable ratio of applicants to available positions¹  and the dilemma of not matching (eg, SOAP).

In this respect, interview matching³  or interest-based screening for interviews and ranking⁴  may be a potential supplement to quantitative screens for reducing financial costs, improving Match satisfaction, and promoting equity. For example, the first steps taken by the 2023 NRMP⁵  in most specialties include geographic preference and program signaling—applicant information that residency programs may use to guide interview and rank decisions. In addition, while the newly implemented meaningful experience narratives may provide another snapshot of an applicant's fit, the writeups may add paperwork to already overburdened programs. Future interventions, grounded in clearer transparent data, must also balance applicant and program interests with the competitive, high-volume reality of the Match.

With the Match being a system involving sets of complex interactions, steps taken to include multilevel stakeholders at different time points may be more efficacious (eg, the newly implemented 2023 ERAS geographic preference and program signaling system). Reformative efforts may do well to focus not only on the destination but also on the journey of everyone involved.