Justice in Residency Placement: Is the Match System an Offense to the Values of Medicine?  

Oleh:

Murphy, Timothy F.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Cambridge Quarterly of Healthcare Ethics (keterangan: ada di Proquest) vol. 12 no. 01 (2003), page 66.

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Perpustakaan FK Nomor Panggil: C01.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Medical residency-specialty training after the completion of medical school-is an essential component of medical education and is required in order to be a licensed, independent medical practitioner in most jurisdictions. As things currently stand in the United States, the match between medical school grad¬uates and residency programs is governed by a match between rank-order lists prepared by candidates and residencies alike. An applicant picks a number of residency programs and ranks them according to order of interest. The resi¬dency program prepares a similar list, ranking the candidates it most wants in its program. A computer program compares the rankings and makes assign¬ments according to a certain algorithm. Using these lists, the match system assigns approximately 24,000 applicants to approximately 21,000 training posi¬tions in pediatrics, obstetrics and gynecology, internal medicine, and the rest. These assignments are then announced to all parties on specific days. The system has been in place since 1952 and is overseen by the National Residency Match Pro~ram (NRMP) , a nonvrofit or~anization. This system has several advantages. First of all, it standardizes the timetable for decisions, and appli¬cants are in no position to tie up offers while waiting to hear from other institutions. Institutions are not held captive, either, in making assignments while waiting to hear from particular parties. There are ethical aspects of the match-both internal and external. One of the most important internal concerns is that some residencies and candidates violate NRMP rules by entering into contractual relationships prior to formal action on rank-order lists.1 Some candidates and residencies try to renege on their choices after the fact. In fact, some residency directors and applicants directly acknowledge dishonesty on their part.2 It is also true that some residency directors and candidates believe the system can unfairly reward personal relationships.3 Some u.s. candidates go unmatched to residencies because graduates of international medical schools displace them. For some, this displacement of domestic medical graduates raises a serious question of equity.4 By contrast, some of the best foreign medical school graduates may find themselves unranked by the most prestigious residency programs, raising

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