Is It Time for a Match to Get Into Medical School?

The residency matching system began in 1952. Before that, there were years of challenges regarding graduating physicians and residency programs finding equitable placements. Prior to a residency match, medical students were challenged to decide whether to contract with programs without the insight of offers from other programs, making future offers and discontent from both hospitals and students about the process. With modifications over the years, the residency matches have endured the test of time for over 70 years. Nearly every physician practicing in the United States underwent a matching system (or subsequent scramble).  

I have talked with admissions/enrollment experts at medical schools, other medical school deans, and prospective medical students about the medical school admissions process, and I hear growing frustration with the process from nearly everyone. I would like to know if the time has come for a match to matriculate into medical school.  

I am going into my 20th year of full-time medical education. Much has changed in medical education, but more has stayed the same in terms of the process of admitting students into medical school. Prospective medical students apply through the AACOMAS (for DO schools) or AMCAS (for MD schools). Medical schools receive the application, review the application, interview selected applicants, and choose the interviewees for placement into medical school. An offer of acceptance is extended to the selected applicants, and the applicant has a time designated by the school to accept or deny the offer and enroll (usually involving a deposit).  

One trend that has increased over the recent years is an increase in the “melt,” where an accepted applicant enrolls in a medical school but then accepts another offer-- typically at a medical school that is more desirable to the candidate (e.g., closer to home, lower tuition, etc.) and the medical school enrollment for the position “melts” away (rescinds the acceptance of the offer) from the initially enrolled school. Part of the challenge is that prospective medical students don’t always tell the schools they are melting and have accepted another offer. Oftentimes, it isn’t until late spring when medical schools get a list of their “dual-enrolled” prospective students, and they learn that the class they have filled isn’t actually filled. Schools then reach out to the dual-enrolled prospective students to see if they will keep their positions or need to backfill the position from their waitlists (or interview additional applicants). I have heard of cases where prospective students have had up to six signed enrollment agreements (and deposits) at medical schools, causing five open positions across the country from the one prospective medical student. The additional challenge created by this is that many of the students who are taken from the waitlists of schools to fill these positions often create voids at other medical schools. This creates a scramble at medical schools across the country to fill their open positions or potentially lose a paid seat, resulting in losing four years of tuition and creating budgetary challenges for the entire medical school.  

A match to get into medical school might improve upon our current system with the following considerations:

• It would create a more equitable marketplace. Prospective students would be able to rank their most desired programs, and medical schools would be able to rank their most desired applicants, leading to greater fairness in the marketplace.  
• If it is set up like the residency matching process, it would nearly eliminate melt. However, a scramble process (similar to SOAP) would likely be needed.
• There would likely be fees for both applicants and schools for the process. The current fee schedule for the NRMP Match charges a standard registration fee of $70 per applicant. Without having a vendor prepared to do this, it is unknown how much the fees might be for a medical school match.  
• Applicants who would typically have been placed on a waitlist and waiting to “melt” could potentially have their desired offer through the match.
• Most medical schools would lose forfeited deposits they are receiving under the current system (hundreds of thousands of dollars in some cases).  

As a medical student advocate, I see several potential benefits for prospective medical students:

• It could reduce the stress of medical students deciding whether to enroll (and possibly deposit) in a school before hearing from their most desired medical school. However, a match would create additional needs for education in the process.  
• There could potentially be less deposits to be forfeited and therefore saving prospective medical students money.  
• It could potentially eliminate the “waitlist purgatory” and uncertainty for students as to whether they might be accepted.
• A potentially fairer marketplace for students and their decision-making ability.

There would be several potential challenges in creating a match for medical schools:

• There would be several stakeholders to convince, including medical school deans.  
• Ideally, it would be for osteopathic (DO) and allopathic (MD) medical schools. Convincing both communities would be a challenge.
• An interested vendor(s) would need to be identified.  

Overall, the idea of a match to get into medical school deserves more consideration.