Individual applications were completed 18 months to two years in advance of the start date. Each program had its own requirements and deadline. Program directors then sorted the applications and selected applicants for interview. Applicants went on interviews, often interviewing with one program months before another. Program directors then began making offers to selected candidates. Frequently, an applicant was asked to make a decision about an offer before knowing if he or she would receive other offers.
According to Dennis W. Boulware, MD, senior associate dean for academic affairs at the University of Alabama Health System and past president of the Association of Subspecialty Professors, “It was not uncommon to be given an offer and have to make a decision within a day—or even an hour.”
Match Facts and Numbers
- Number of programs that participated in the 2006 match: 94
- Number of training positions available in the 2006 match: 162
- Percentage of training positions filled in the 2006 match: 96%
- Number of applicants who participated in the 2006 match: 378
- Percent increase from the number of applicants in 2005: 18%
Program directors found it disadvantageous to allow an applicant significant time to think over an offer. If the applicant rejected it, their next choice for the position may have already accepted an offer elsewhere. As a result, some program directors began to offer training positions to applicants earlier and earlier in the process.
In reviewing these scenarios, the Committee on Training and Workforce Issues, whose responsibilities include overseeing the application and acceptance of fellows into rheumatology training programs, identified many areas of concern in the pre-match system:
- Each program had its own paper application.
- Each program had its own timetable for receiving applications and conducting interviews.
- The application process started early in the second year of medical residency. This factor may have limited the number of internal medicine residents who would apply for rheumatology fellowships because of lack of contact or experience with this subspecialty.
- Applicants felt pressured to accept positions before receiving all potential offers, causing anxiety and limiting their ability to obtain their first choice.
- Program directors felt pressured to offer positions to multiple applicants simultaneously, as it was unclear who had already accepted a training spot. Occasionally, this led to the worst-case scenario of having to rescind an offer if too many applicants accepted.
- The variable timetable of this process made it difficult for applicants to examine different regions of the county for their subspecialty training. Residents tended to stay “close to home,” and were less likely to seek out a more varied experience at a distant hospital.
Universal Electronic Application
In recognition of these problems, the ACR adopted the match, and also the Electronic Residency Application Service (ERAS) universal application. Since the commencement of these programs, potential rheumatology fellows begin the application process by utilizing ERAS. This service supplies a universal online application and allows applicants to virtually attach transcripts, letters of recommendation, tests scores, and other credentials.