Recruitment and the Match. The two go hand in hand, with the Match being the culmination of the recruitment process. It is a 7-month long journey that involves approximately 30,000 applicants vying for nearly 24,000 positions at one of the 3700 residency training programs in the United States. It stretches from August, when applicants register with the National Resident Matching Program (NRMP), until March, when training programs find out which applicants will make up their next class of residents. What happens in between is often a hectic and stressful, yet rewarding, process.

The NRMP is a private, non-profit corporation that administers the Match through its website (www.nrmp.org). The NRMP provides a central, impartial arena within which applicants and training programs (that must also register) are matched together based upon applicants’ preferences for programs as well as programs’ preferences for applicants (more on this below). Beginning in mid-August and continuing into late Fall, prospective residents compile their application materials and submit them through another system- the Electronic Residency Application Service (ERAS)- then “give” their chosen programs permission to view their applications, which include items such as their CV, personal statement, letters of recommendation, and both their USMLE and medical school transcripts. This is the point at which the residency programs become directly involved.

The Internal Medicine Residency Program here in the Department of Medicine begins to sort through, on a daily basis, the ERAS applications that pour into the office starting in September. Applications are reviewed by a team, composed of Marshall Wolf, M.D., Joel Katz, M.D., and Bruce Levy, M.D., who determine which applicants to invite for an interview. To show you how quickly this large number of applicants gets pared down: of the more than 2,000 ERAS applications received, the Internal Medicine Residency Program will interview approximately 350 people. Of these, only one out of five will make it into the 72 available DOM residency positions the Accreditation Council for Graduate Medical Education (ACGME) has approved.

The interview process here in the Department begins in December and runs all the way through January, with each interviewee coming in for one day (Primary Care applicants get two days, the second day devoted to primary care interviews). During the previously mentioned time span, interview days occur Monday through Thursday and each one brings with it about twenty eager and anxious applicants. Julie Levison, M.D., a first year Primary Care intern who went through the process last year, describes it as “a stressful time,” but also vividly remembers the “warmth of the housestaff, and having a very personalized interview” with a faculty member who had interests similar to her own.

The recruitment process is taxing not only for the applicants, but also for the residency programs that are themselves competing for the following year’s class of interns. Dr. Katz explains that “in order to provide attention to the needs of these applicants, the Education Office staff has been working ‘all-out’ for long hours.” Dr. Levy notes that the Internal Medicine Residency Program meets a “wonderful group of applicants that are extremely talented and could certainly be successful here at BWH as residents.” In addition, Dr. Levy feels that their program faces a tremendous challenge to “identify, out of the 350 well-qualified interviewees, those individuals with outstanding academics, a super collegial personality, and the probability of becoming an impact player in medicine.”

The bulk of this challenge is undertaken during the interviews. These are one-on-one in format, with each applicant meeting with several members of the over 130 faculty who volunteer their time to assist with this process. “Additionally,” note the very grateful Drs. Katz and Levy, “housestaff coordinate applicant dinners before each interview day, slide shows capturing the program’s flavor, and hospital tours for every visiting student.” At the end of January, once the interview process is complete, faculty and housestaff come together as a committee to determine how they will rank the candidates. Here’s where the aforementioned rank order lists come into play.

Each program and each applicant must submit a rank order list to the NRMP by February 23rd. The Internal Medicine Residency program will submit a list of approximately 150 candidates (to ensure 72 in the end), and all candidates will submit their own lists ranking the programs they would like to attend. The Internal Medicine Residency Program “seeks a diverse cohort of interns, in regards to previous training, career goals, ethnicity, and gender- the selection committee looks for candidates who it feels will eventually become significant contributors to society”, explains Dr. Katz.

The rest of the process is in the hands of the Match, and finally everyone gets a chance to catch their breath. Essentially, the Match is accomplished by a computerized algorithm, whereby applicants match into the program listed highest on their list(s) that also ranked the applicant and that did not fill all available positions with applicants that the program preferred (as determined by its rank order list).

Sounds simple? Well perhaps, on the surface. Applicants will be interns at a program they would like to attend as long as that program feels the same way. But things can get complicated. For example, let’s say that ‘Sara’ ranks the Brigham as her #1, and this looks like it will happen because the Brigham also has Sara on its rank list. Sara is tentatively matched with the Brigham. However, the Brigham ranked Sara as #73 on its list, and unfortunately, candidates 1-72 on the Brigham’s list have also all ranked the Brigham on their respective lists. So in the end, Sara will end up elsewhere, only because there are no more open spots at the Brigham, since it filled its allotment with applicants that it preferred more than Sara, based on the rank order list it submitted.

On March 17th of this year, the Internal Medicine Residency Program will find out who its incoming 72 interns will be for next year. Dr. Levy describes the group of candidates that has already come through for interviews as “outstanding, an academically rich and diverse group of applicants.” Dr. Katz adds that, “this year there is a particularly high interest in the new Howard Hiatt Global Health Equity residency training track.” Both Drs. Katz and Levy also emphasize that this is a result of and a credit to the “many members of the department who play key roles in the recruitment process as advisors, interviewers, subcommittee members, special meeting attendees, as well as those who volunteered their time to have lunch with the interviewees.”

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Your Medicine Online would like to acknowledge the contributions that were made to this article by
Drs. Joel Katz, Bruce Levy and Julie Levison, as well as Brandon Johnson, who is the Program Administrator for the Department’s Internal Medicine Residency Program.

Click here learn more about the Department’s Internal Medicine Residency Program.