THE NRMP: ALL-IN…AND TESTING THE SOAPY WATERS?
================================================

* Michael Mazzone
* Martin Wieschhaus
* Stoney Abercrombie
* Sneha Chacko
* Joseph Gravel
* Karen Hall
* Grant Hoekzema
* Lisa Maxwell
* Todd Shaffer
* Michael Tuggy

By many accounts this was a banner year for family medicine in the Match. At 2,740 offered positions, we witnessed a 7-year high. Not since 2000 (when 2,603 positions were filled) have we seen this number of matched applicants into family medicine. After being flat at 91% from 2008 to 2010, the fill rate for family medicine programs through the match bumped to 94% in 2011 and 95% this year.1 These numbers certainly are a cause for some optimism.

Behind these promising numbers, however, lurk some stark realities that point to a looming crisis. The positive upticks noted above do not reflect a significant change in the attitudes of US medical school graduates toward primary care. The increases are largely due to: (1) an increase in the number of medical students graduating, particularly from osteopathic institutions,. and (2) a slight increase in the number of family medicine residency positions offered in the Match. Most believe these slots do not represent new positions but are existing ones moved into the Match in anticipation of the All-In policy to be instituted in 2013.

This year the National Resident Mapping Program (NRMP) instituted the Supplemental Offer and Acceptance Program (SOAP). So, did the SOAP program actually help family medicine by allowing unmatched medical students to reexamine or reexplore their specialty choice? Of the 130 family medicine slots available, almost all were filled during the SOAP process. Though the process was successful in filling most of the slots, there were a number of logistical problems. First, United States Medical Licensing Exam (USMLE) scores for applicants were not available on day 1. Secondly, many of the filters one typically uses in the Electronic Residency Application Service (ERAS) were difficult or impossible to implement. Considering that many programs actually received more applications through SOAP than through the general Match, the lack of filters proved frustrating and very troubling. Lastly, the actual SOAP process can be problematic. For example, if a program has 1 slot available and 4 outstanding candidates, only 1 offer for the position can be made at a time making the need to know that candidate’s interest in your program critical. If the candidate is not interested, another offer cannot be made for 2 hours, at which time many of your initial candidates will be gone. Currently the NRMP is seeking active feedback on the SOAP process. For those who participated in the process, your feedback is vital in improving the supplementary Match. Submit this feedback to nrmp{at}aamc.org.

Next year the NRMP will institute the All-In policy. Therefore, a program will have to offer all of its PGY-1 positions through the Match. In 2008, 3.2% of all family medicine residency slots were filled outside the Match with only 3 programs not participating in the Match. Up to one-third of all programs offered at least 1 position outside the Match.2 The change will affect a large number of programs but its exact impact on the specialty is unknown. The actual guidelines for implementing this policy will be discussed and distributed this summer.

As citizens, we need to be concerned. The US medical education system is not producing a sufficient primary care workforce. As our population ages, more and more medical students are choosing specialties with less and less patient contact. Without significant change, a health care crisis of epic proportions cannot be avoided. As the SOAP attempts to cleanse the matching process, let our efforts be All-In when advocating for innovation to stimulate more student interest in family medicine.

*   © 2012 Annals of Family Medicine, Inc.

## References

1.  National Residency Matching Program (NRMP). Data and Reports. Results & Data: 2012 Main Residency Match. [http://www.nrmp.org/data/index.html](http://www.nrmp.org/data/index.html).
    
    

2.  National Residency Matching Program (NRMP). “All-In” Policy Program Participation and Exceptions. [http://www.nrmp.org/allinpolicyexceptionsstatement.pdf](http://www.nrmp.org/allinpolicyexceptionsstatement.pdf).