Observations from the Phase II Match: Impact on Student Residency Candidates

To the Editor: In the current marketplace, more student pharmacists are choosing to continue their education beyond the doctor of pharmacy (PharmD) degree. A growing disparity between the number of students pursuing postgraduate training and the number of available positions has led to an increase in unmatched candidates and a decrease in unfilled positions.¹ Reflecting back to the 2006 American College of Clinical Pharmacists (ACCP) vision statement that postgraduate training would be a requirement of all graduates by the year 2020, there is certainly ground to make up.²

In response to increased competition for positions, the American Society of Health-System Pharmacists (ASHP) adjusted their Resident Matching Program for the 2016 Match.³ According to published commentary from ASHP, revisions were made to provide more structure to the matching process, with the goal of ultimately yielding more successful matches.⁴ The revised Match features a 2-phase process. Phase I is the same as previous versions of the Match, starting in late December and results being released mid-March. The new Phase II process essentially repeats the steps used in Phase I, but with a significantly abbreviated 3-week timeline.⁵ Following Phase II, remaining unmatched candidates can apply to available programs in a post-Match process similar to the previous “Scramble” process.

Results of the 2016 Match were comparable to data from 2014 and 2015. During the initial phase of the Match, 4609 candidates pursued postgraduate year 1 (PGY1) positions, an increase of roughly 5% from 2015. With 3312 PGY1 positions available to those candidates, the result was a 1.4:1 ratio of applicants to positions in Phase I. This ratio is nearly identical to that seen during 2014 and 2015. During Phase II, the ratio expanded to 4.1:1, with 1162 candidates vying for 282 open PGY1 positions. Finally, the ratio swelled to 68.7:1 during the post-Match process, with 893 unmatched candidates and only 13 open PGY1 positions remaining. Overall, 3309 candidates successfully matched with PGY1 positions for a 68% applicant match rate; 91.9% of those matches occurred during Phase I.¹

While these Match results appear consistent with previous years, we observed that the residency candidate’s experience was not. As faculty members guiding students through this process, it was challenging and frustrating to watch quality students fail to secure positions— more than we had faced in previous years. Bringing structure and order to the Match process makes sense, but at what cost? In our experience, the 2016 Match process resulted in a series of negative consequences for student candidates that require reflection.

The extended Match process places additional time stressors on an already lengthy timeline, and students are faced with additional uncertainty. Should students continue into Phase II, they must wait longer to potentially secure a position and risk delayed entry into a highly competitive job market if unsuccessful. The Phase II process itself has some unnecessary downtime, including delays impacting application submission and during processing of results. An ASHP-sponsored virtual career fair is available after the post-Match process, but job availability is uncertain for the 893 unmatched candidates remaining (18% of the original pool). The timeline is equally lengthy for programs, leading to possible “match fatigue” for all parties involved.

This increase in time is accompanied by increased costs for unmatched candidates. In addition to the cost incurred in the Phase I application process, students are required to pay an additional $40 per program application in Phase II. Based on data published by ASHP on the National Matching Services, Inc. website,¹ the average candidate in Phase II spent a total of $370 on registration and applications alone.

Unlike in the former post-Match Scramble, students no longer drive communication about their interest in a position as the programs now control the majority of the Phase II communication. Many of the students we mentored during Phase II reported hearing nothing from the programs they applied to, leaving them with many unanswered questions. Did programs elect not to respond to students, or was this a result of an extremely short timeline? Regardless of the reasoning, this was an unfortunate outcome of the Phase II process for students who were already feeling vulnerable and lacking confidence.

In some ways, the process adversely equalizes the field for prospective Phase II candidates as an unanticipated consequence. Programs must rescreen large numbers of applicants fairly quickly predominantly using application materials, making it harder to identify candidates with intrinsic characteristics that are difficult to measure, including grit and tenacity.⁶ Abstract data reveal these character traits commonly occur among candidates who secured positions in the old post-Match Scramble and may be a desirable “X factor” that cannot be as easily identified in the new process.⁷

Alternatively, the Phase II process may lead programs to implement strategies that narrow their applicant pool. Many programs require onsite interviews as part of their process, negatively impacting more distant candidates who may be unable to travel. We observed that identifying a local candidate in some cases increased the likelihood of a successful match.

Considering the potential negative implications for Phase II candidates, there is opportunity for schools and colleges of pharmacy to enhance the preparation of residency candidates. Strategies are needed for the successful development of residency-bound students to ensure successful matching in today’s market. Studies outline “residency prep” curricula and strategies,^8,9 and all schools should consider implementing similar programs in a consistent and integrated way. Special consideration should be on guiding students through Phase II and post-Match processes to best set students up for success. Identifying residency-bound candidates earlier in the curriculum may position students to succeed in a competitive field. It is imaginable that students who later decide to pursue residency training may lack certain prioritized traits that programs are seeking.

While efforts to enhance successful matches are vital, many quality candidates will continue to remain unmatched after every cycle simply because positions do not exist. The process, regardless of the described concerns, is not the core of the problem. The number of pharmacy graduates is growing yearly. Thus, the ultimate issue is the need for more quality postgraduate training programs. The profession’s focus should be on enhancing efforts to create more residency positions instead of implementing further revisions to a selection process that may not be broken.