The Timeline Shift in the Medical Subspecialties Match — A Wolf in Sheep’s Clothing?
Ryan D. Madanick, MD
Assistant Professor of Medicine; Director, University of North Carolina (UNC) Gastroenterology & Hepatology Fellowship Program, UNC School of Medicine, Division of Gastroenterology & Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill
GI fellowship candidates and programs will experience a major change in the Medical Specialties Matching Program. Beginning this year, internal medicine residents have until post-graduate year three (PGY-3) to apply and interview for fellowship programs. This change was put into effect to permit internal medicine residents to make a more informed decision about their career by expanding their opportunities for subspecialty experiences during residency before formally beginning the application process. Internal medicine residents now have greater opportunities to find faculty within GI to provide mentorship and write stronger letters of support for them, instead of scrambling around chaotically during their internship year. For those who needed extra time and could not apply until their PGY-3 year, this change means that they can continue training immediately following residency without needing to take a year off. In short, the new subspecialty Match timeline is intended to represent a significant benefit for our future colleagues.
The new timeline should also benefit GI fellowship programs by decreasing the number of fellows who experience “buyers’ remorse” about their subspecialty selection or specific track during their training. The extra year will give residents a better chance of selecting a field and a career pathway that fits best with their long-term goals. For programs with a research focus, candidates will be able to better explore their motivations to enter a research career without undue time pressure.
Nonetheless, many program directors have concerns about the new timeline. One major problem faced by programs involves the condensed interview cycle. Programs have just under four months, from July 15 until Nov. 14, to review applications, invite and interview candidates, and submit their rank lists. This year, program directors had to compete with summer vacation schedules to ensure an adequate complement of faculty members to interview candidates. Combine vacation schedules with annual meetings of the AGA’s sister groups, and arranging dates for interviews becomes much more difficult.
With fewer dates available for interviewing, strong candidates will surely be faced with overlapping dates or impossible travel schedules. Such conflicts may lead candidates to decline interviews they would have otherwise accepted or even to cancel their interviews at the last minute. Programs located in more isolated or seemingly less desirable areas of the country may find themselves in the unenviable situation of having to scramble just to fill their interview slots.
Further adding to program directors’ worries is the condensed period to apply for state licensure. Until this year, candidates who successfully matched into a fellowship position had more than a year to complete all of this paperwork. Starting this year, new fellows will have approximately six months to obtain their state licenses. Licensing may be a particular problem in states with notoriously slow processes (e.g., California, Texas) or for international medical graduates who may need to obtain visas and/or documentation of their education from other countries. This may skew fellowship applicant selection toward residents who already have a license in that state.
With these issues in mind, program directors and faculty need to be flexible, understanding, and even creative in their approach to the new subspecialty Match timeline. We should not assume that the cancellation of an interview indicates that other programs are taking fellows “outside the subspecialty Match.” We need to work together with the applicants to arrange feasible interview dates for all parties. At DDW®, some program directors suggested scheduling local candidates early and even coordinating interview dates with regional programs. As a last resort, if desired candidates simply cannot travel for the interview, program directors or faculty might have to do phone interviews or video conferencing (e.g., Skype, FaceTime) to accommodate everyone.
Once the subspecialty Match has been completed, program directors need to be extra vigilant about making sure future trainees apply for their state license immediately.1 Programs should contact fellows as soon as possible after the subspecialty Match and provide them with a checklist of documents and deadlines needed to obtain state licensure. This checklist could even be provided at the interview to allow candidates to get documents prepared. Remember that busy residents often need more than one reminder to get their paperwork in!
If your program has major difficulties this year, please do not give up on the subspecialty Match. The subspecialty Match is vital to our profession.2 We should avoid the temptations for a short-term gain by trying to “game the system,” as such manipulations will lead to long-term losses for the GI community as a whole, through a return to the strong-arm tactics of years past. As educators, we need to set the example by forsaking selfishness and exhibiting the altruistic qualities we wish to instill in our own trainees.
Dr. Madanick had no conflicts to disclose.
1. http://www.im.org/AcademicAffairs/match/Pages/AdviceforManagetheNewFellowshipMatch.aspx, accessed July 2, 2012.
2. Proctor DD, DeCross AJ, Willis CE, Jones TN, Pardi DS. The Match: five years later. Gastroenterology 2011;140:15-8.
3. http://www.im.org/AcademicAffairs/match/Pages/MovetheMatch.aspx, accessed July 2, 2012.