“ All In (or Out) ” NRMP TIGHTENS THE NOOSE Jay Shapiro, MD Program Director Anesthesiology

NRMP A “ service ” of the AAMC Not-for-profit Est 1952 to provide a uniform date of appointment to positions in GME Became a mechanism for a “ level playing field ” for applicants

Business Potential $60/applicant x 38K applicants= $2.3M $35/ ” track ” x 4427 tracks= $145K $35/match x matches= $940K $200/Institution x Inst= $400K Total = $3.8M* *Does not incl 38 specialty matches

NRMP Controls “ Agreement ”

NRMP Controls “ Agreement ” Program Director Code of Conduct

Program Code of Conduct  Respect applicant’s right to privacy in interview & ranking decisions  Accept responsibility for interview team  Refrain from illegal/coercive questions  Decline to require second visits  Discourage unnecessary post-interview communication From Signer Presentation 11/2012

NRMP Controls “ Agreement ” Program Director Code of Conduct Reports

(7) the American Board of Medical Specialties (8) the applicant's residency program director if the violation occurred in a fellowship match (9) the Federation of State Medical Boards if the applicant is to be permanently identified as a Match violator or permanently barred from future NRMP Matches (10) any parties whom the NRMP has determined are relevant to its investigation. From “ Agreement ” Reports Regarding Applicant Violations

Reports of Violation by Programs (3) the ACGME for distribution to the respective Residency Review Committee (RRC) and the Institutional Review Committee (4) the respective specialty program director association

All In Policy Why History Exceptions Implementation

Benefits Evident in 2013 Match 6% increase in number of positions offered 10% more sponsored applicants 20% more independent applicants WHY

Our Transition Journey Past –8 PGY 1 Positions in the Match –4 PGY 2 Positions-outside match Separate Application Separate Interviews Hire/Accept as we find good candidates Process usually complete by late October

Our Transition-Journey Present (for start 2013) –Letter of Commitment in Nov position –Current Resch Fel-will continue clinical-1 position –Unexpected withdrawal of PGY 1-1 position - Match violator-can interview but not start before 7/13/2013-will start off cycle –1 position in Physician “ R ” Match

Our Transition-Journey Next Year –All positions in “ R ” match? –Separate Interview Program? –How do we select interviewees? ERAS applications Separate application process –What happens to military/career change applicants?????