Discussion Topics

Featuring information posted by The Association of Residency Program Directors in Endodontics membership on contemporary topics of concern to our constituency and the various stakeholders within postgraduate endodontics

The Question of Using “The Match” for Endodontics

“The Match” residency applicant process is used to match graduating medical students into residency programs. It is employed across all of the medical specialties and is also known as the National Resident Matching Program (NRMP).

 

Entirely separate from the NRMP is the Postdoctoral Dental Matching Program (NatMatch) that is used for matching dental applicants into the residency programs in advanced general dentistry, as well all of the major dental specialties (as defined by having the largest applicant pool sizes), except for Endodontics. Although distinct from one another, the NRMP and NatMatch programs use similar processes and a proprietary algorithm for matching applicants. Such Match programs have been promoted as arguably offering applicants a more fair, more competitive, more transparent, and more professional approach for residency applicant pairing with Programs. In the least, it may be accurate to say such applicants would be more likely to have been permitted to make fully informed career-impacting Program preference decisions than under a non-Match or rolling admissions scenario as is currently in use.

 

It is important to understand that in order to have a “thick” enough market for a given specialty Match program to be successful, it is not necessarily the number of participating residency programs that is the important variable. Instead, it is the number of available first year residency positions (slots) that must be included in the Match for any given annual application cycle. That minimum number has been suggested to be 70 – 75 slots, but would have to be determined from consultations with the Match system vendor. Importantly, there would be no mandatory requirement for all programs having to participate in a Match. Program Directors not agreeing to have their programs participate could continue on with their own preferred admission protocols.

 

Hypothetically, within any individual dental specialty’s debate and deliberation processes for approving a new applicant Match program, there exist two primary stakeholders: the Program Directors and the applicants. As the education-based entity, Program Directors would be obligated to necessarily serve in a dual capacity role. In addition to representing their Program’s interests, they should also act as a proxy for the unspoken interests of the changing applicant pool. Serving in what amounts to a dual fiduciary role, the Program Directors participating in Match programs would voluntarily agree to put the interests of the applicants above their own.

 

This decision process over the question of The Match would ideally not be driven by politics, minority self-interest, or hidden within a closed committee-cloaked opacity. It would have to be both safe for the participants and completely transparent. In other words, the hypothetical playbook used to implement a Match program (or not) for the specialty would be initiated at the sponsor level. Hypothetically, a new, sponsor-established Special Committee on The Match would be created and administered as a standing (permanent) committee, tasked solely with addressing issues involving The Match. Its membership would be comprised of at least 7 current Program Directors, nominated by a majority of their peers. Such a committee would be beneficial whether a Match is presently in existence, or if one is being considered for the future. The schedule,  agenda, and parliamentary procedures for the announced in-person Match discussion meetings would be set by this special committee and fully disclosed to all Program Directors, in advance. Several exploratory meetings could be necessary to complete the process, but after an appropriate period for fact finding and thorough discussion/debate, the Program Directors would be permitted to vote yes or no on moving forward with implementing The Match. The sponsoring entity’s leadership would have to be willing to allow the Program Directors (in their dual fiduciary role) to decide by a simple majority vote (80% minimum threshold participation, no proxy votes allowed) whether or not a Match program would be advisable to employ for their specialty programs. 

 

If a simple majority of current Program Directors voted in favor of The Match within this hypothetical scenario, they would do so under a stipulation for being contractually required to commit all of their first year resident program slots to the proposed Match. Should a sufficient threshold number of contractually committed first year resident program slots be realized, formal plans for implementing a Match program at a future date could proceed.

 

If those Program Directors currently not in favor of the Match held the majority vote, then the status quo would be maintained for a specified and agreed upon period of time, perhaps three to five years, after which time this same deliberation process would then be revisited in light of additional relevant information and changes in both program and sponsor leadership. 

 

However, should this important matter be effectively hidden by being placed under the auspices of some hypothetical generic education committee, it risks languishing in isolation and into perpetuity, since it could be shelved as being just another issue among the many pressing concerns within academic endodontics today. Whether such a lack of hypothetical generic education committee focus were to occur by neglect or by accident, the outcome for The Match question would be advantageous only for maintaining the status quo (i.e. no Match). Such a hypothetical “death by committee” stagnation fate for The Match question would also prevent the comprehensive analysis and focused attention it deserves from our specialty. This outcome would mean in the best case additional delay, and in the worst case an unfortunate and possibly permanent interment of the question altogether. 

 

 

René Magritte, "Those who cannot remember the past are condemned to repeat it."--George Santayana, The Life of Reason, 1905. Smithsonian American Art Museum

Instructional video series on The Match:

 

Dr. J. Bryan Carmody, aka the “Sheriff of Sodium”, is a pediatric nephrologist physician from Virginia who created a series of compelling YouTube videos (linked below) describing the creation and evolution of Medicine’s residency applicant Match system. From its inception over 70 years ago aimed squarely at combatting the serious and all too familiar problems of “exploding offers” and ever-advancing interview dates, to its present iteration, where in 2024 there were over 50,000 participants, Dr. Carmody offers his unique insights into the pros and cons of The Match.

A simple explanation regarding how the Match computer algorithm works to pair applicants with programs:

Additional Match-related links and information:

 

  1.  Match or Non-Match: At the Crossroads – Allareddy et al 2015
  2. Exploding Offers Can Blow Up in More Than One Way – Lau et al 2010
  3. Applicant Selection Procedures in Endodontic Specialty
    Programs in the United States: Program Director’s
    Perspective – Bell et al 2014 
  4. Cross-Sectional Analysis of National Dental
    Residency Match Data – Prakasam et al 2016
  5. The Origins, History, and Design of the Resident Match – Roth 2003
  6. The Residency Match: Competitive Restraints in an Imperfect
    World – Madison 2005

  7. Prosthodontic Resident Selection by Postdoctoral Dental Matching Program: A National Survey by Participating Program Director – Lee et al 2020

  8. Residents’ Perceptions of the Graduate Endodontic Application Selection Process and Match – Woodmansey et al 2015

  9. American College of Prosthodontists Position Statement on “The Match” – 2023
  10. American Academy of Periodontology Match Support Statement – 2024
  11. The US Residency Match at 70: What Was, What Is, and What Could Be – Williamson, Soane, and Carmody 2022
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Association of Residency Program Directors in Endodontics
Program Director Opinions on The Match - Both Pro and Con

gesture, thumbs up, good

A "Pro-Match" Perspective

Dear Colleagues, 

 

It is that time of year again when we select a new PGY1 class. I don’t know about you but during each annual application and interview cycle I dread the task of ultimately having to extend what have been called “exploding offers” of admission to our selected program applicants. It just feels wrong for me to force such an important decision by pressuring applicants in this manner. The way our overall non-Match admissions system operates today, we program directors are pretty much compelled to proceed alike in this regard.

As you all know, we recently moved up our centralized application deadline again by one month and will in all likelihood be tempted to do so again in the near future, since during the 2024-2025 cycle, I have heard several of us elected to try to get the jump on our colleagues by scheduling our interviews earlier than ever before. This accelerated response is neither new, nor is it surprising. The more recent days of the unwritten and unenforced, voluntary so called “gentleman’s agreements” for program directors agreeing to hold our interview dates to a specified scheduling range, seem far behind us and appear as being somewhat naive, in retrospect.

 

Historically, these kinds of half-measures, and frankly self-serving, driven by competition attempts at securing our desired first year residency classes sooner than our colleagues (efforts that ironically eliminate competition, when you think about it), have been tried before by similar decision makers within other disciplines. Those folks failed then to solve the very same ongoing, human frailty-associated applicant selection problems we continue to struggle with today. Some of us may feel by not joining The Match, we are uniquely expressing our sovereignty as an independent dental specialty. Some could be proud for us to remain a holdout, and some small minority may even believe us to be some kind of a maverick specialty for that reason. Nonsense. What we are by refraining from joining The Match is being silly. In truth, we as program directors, and as a specialty, simply look selfish and provincial. You can ask anyone within academia (who is outside of our specialty) and they will agree. In this respect, endodontics is unfortunately an outlier specialty that is hung up on the past, and continuing to take that same position indefinitely, one that refuses to allow a widespread discussion, does not bode well for our future. 

 

If we were to elect to have our program included in a future Match for endodontics, but other program directors choose not to change from what we are doing now, each of us would be free to proceed under the system we feel is best. That is to say, participation within The Match would be voluntary and no individual program would be forced to participate in it, if endodontics were to join. As things presently stand, we as program directors are provided with no such option to choose a different way forward. We need to change that and I believe we are the only group who are justified in demanding it.

dislike, no, not

A "No-Match" Perspective*

Fellow Program Directors,

 

Having served as a PD for several years, I will initially say to those of you who may be new, that you may not be aware that this same match consideration business for endodontics has already been thoroughly vetted, and quietly reinforced several times in fact, by many highly qualified and seriously dedicated individuals over the years. I’m sure that you fellow professionals on the pro-match side of this question are all well-meaning endodontist PDs. However, you either do not want to appreciate the facts for what they are, or maybe you simply desire to change things for the sake of change alone? So, once again I will try to lay out those facts, and for you this time using simple bullet points. Strap in, because this will be a long letter since I have much to say:

 

  • The rolling admissions system we currently use has successfully worked well for us in endodontics for many years. We are not the only dental specialty that does not use the match process for selecting our residents. Within our present system, applications are made, residents are selected, and most of those dentists successfully progress through our programs to graduate and become practicing endodontists, educators, researchers, etc. This is a win-win arrangement for the programs and for the applicants who get selected. The idea that these so-called “exploding offers” made by PDs to applicants even exist at all is just a big red herring. By demanding quick decisions from our applicants after an offer of acceptance has been made, we are in no way engaging in a form of “regressive bargaining”, as has been said. Personally, I feel no compulsion or requirement for providing such applicants with a valid reason for my having to do so. 
  • An applicant should not apply to our program if they are not prepared to make a quick decision after I have offered them a position, and usually this happens either the same day of their interview, or shortly thereafter. Potential legal issues notwithstanding, I see no need to provide applicants with a disclaimer before they applied to my program stating the fact that they would later be subjected to having to make such a quick decision. It is axiomatic that because of the fact they applied to our program in the first place, and then went an additional step further to attend our interview process, that they have tacitly accepted this possible quick decision deadline. I feel as the PD, I have been empowered with the authority to compel such an applicant into making a yes or no decision on our offer of admission, and as quickly as the needs of our program dictate. 
  • If the applicant does not want to quickly decide to accept the position I have extended to them, within the required timeline, then I feel it is my prerogative to rescind the offer, wish them well,  and to then immediately move on to the next, best candidate who may be better prepared to accept the offer under such a condition. If the applicant turns us down and subsequently decides to take their chances on another program interview, and eventually does not get accepted into any program, well that is indeed unfortunate; but my feeling is that things tend to work out for the best. I cannot recall such a situation ever having happened from previous application cycles. All things considered, the applicant made their choice and can always reapply during the next cycle, as desired. The fact that they may have had attended no prior interviews, or that they have additional pending interviews scheduled after ours, has absolutely no bearing for them having to make a quick decision regarding whether or not to accept our offer for admission.
  • Despite what could be widely assumed to be true, there is no actual 100% parity among all the residency programs. I am not boasting when I state that my program is unique. Beyond that, I believe it to be superior in every way to all the other 50+ endo residency programs. I and my faculty have worked very hard for many years to make it so, and I will therefore exert my authority as the PD to manage it responsibly, and in the manner that we have collectively decided. There are no tangible reasons for us to have to compete for applicants with the other programs, by using some optional matching system, since we fully believe our program is the best one available to the applicant pool. We imagine the top candidates all know this to be true and that is why they consistently apply to our program. We received over 200 applications to our program this cycle, and this is all the proof we need that our program remains in demand and at the top.
  • Because our program is the best possible program for any applicant to choose from, we believe that we should be able to quickly secure the best and brightest applicants from the available pool, without any unnecessary interference that could come from participating a third party match program. This means we will necessarily schedule our program interview dates as early as possible after the cycle window has opened, in an attempt to ensure that this will indeed happen. This year we interviewed early in June, which worked out well for everyone. I can think of no advantage for our program to participate in a match process where our interviews would take place much later in the year, and one that I view to be as unpredictable as a lottery.
  • There are times when we will reserve or hold a slot for a known, targeted future applicant whom we want enrolled within our program. I’d imagine there could also be some PDs who might do the same thing when circumstances dictate the need for doing so. Some of these targeted candidates might not be permitted to participate in a match program, for any number of reasons. Therefore, joining a match system would complicate our ability to dedicate and set aside such first year resident slots to these individuals, since my understanding is that we would have to agree to commit all our first-year resident slots. No way I can see being able to do that consistently, and continue operating at the same level of unrivaled excellence that our program enjoys.
  • My personal opinion is there will likely never be a PD-only group vote scheduled to decide this issue. No disrespect intended, but you are pretty naive if you think that will ever happen without some major outside stimulus, or specialty change in direction. Besides, I constantly have my ear to the ground, and I believe there remain enough PDs who are opposed to the idea of a match, including perhaps those who be willing to consider following the lead of their more senior colleagues, if such a vote were to be taken today. So tell me, why the need for making the time, effort, and expense to prepare and schedule some new, PD-only group vote on this question, if the outcome is likely to be already known in advance? I have faith in the leadership and in the assigned people who decide this issue for us. They have served our interests well, and there are many of us who have been in agreement for some time that a match is just not a good fit for us in endodontics.
  • I realize our program’s participation in a match system is entirely voluntary. The trouble with that notion though is if our program does not agree to participate, we may not have the same access to the best candidates (those applicants whom we desire to enroll first) as we do now, because of their agreement to participate in the match. If most of the programs are participating in a match, such applicants might well feel compelled to sign the match agreement and join it. They could perceive that their chances of being accepted somewhere become enhanced by joining it, instead of opting out in favor of competing for a position within a lesser number of non-match programs.
  • Not that such a thing could ever possibly happen, but what if we were to join the match and our program ended up with a slot that did not match with any applicant? I know there is a post-match option for programs pairing with the unmatched applicants but, honestly, would their credentials be suitable for meeting our program’s high admission standards? We can’t know what applicants will fail to match ahead of the match decision date announcement and we would have to scramble with the other programs having unmatched slots for the remaining group of unmatched applicants. This non-Natmatch regulated process sounds like a gamble at best, something over which we are not willing to risk sacrificing the prestige and reputation of our program. Of course, we could not effectively run our program without a full complement of residents, so under this match system we could be forced to pair with an individual to whom we might not have even opted to extend an interview invitation. 
  • The bottom line from all of this tedious discussion is simply this: my needs and the needs of my program outweigh the needs of the applicants to my program. Although possibly unpleasant and biased when stated in this curt manner, such an impersonal decision must be made, and I feel the result from such a calculation provides for the greater good of all parties concerned. You will just have to yield and trust my experienced judgement on this undeniable fact.
  • If those applicants who end up enrolled in in our program feel slighted or maligned in any way by the abrupt manner in which they were selected, they either do not openly voice it, or they probably get over it quickly after their program time commences. I have no knowledge of any negative discipline-related, interpersonal, financial, or adverse psychological impacts resulting from these prior forced acceptance decisions, and therefore must logically assume none to exist. Even the feedback we receive from our multi-year alumni surveys (we have a great ~60% completion rate), asking questions about overall residency experiences, include no such expressed complaints or associated regrets.
  • As other PDs might have also experienced in their programs from time to time, we have only had a very few infrequent, and occasional residents who once enrolled, later voluntarily resigned from our program, or who were told by me to leave our program, for various reasons. I do not believe even those resident attrition events can be traced back to the earlier forced acceptance decisions they made either. In fact, although we have never formally studied it, I am firmly convinced there can be no possible connection whatsoever between an applicant being forced to make such an admission decision under duress, and adverse events during their residency that negatively impact their personal lives and/or their ability to function effectively as a successful resident within our program. Our program is rigorous, our expectations for residents are demanding, and consequently we do not do a lot of hand holding.
  • This absence of related negative resident experiences tells me what we are doing with our current admission protocols remains the best way to manage our applicant selection process for our program. As I have stated many times before regarding this specific debate, I will personally not be saying yes to any future question that is asked of me for having the match. As far as I and many of my fellow PDs can tell, we have no need of it in endodontics, and it can only serve to complicate matters. The old saying applies here: “If it ain’t broke, don’t try to fix it”.

*Disclaimer: This added “conversation” is anecdotal and fictional, and has been composed from the author’s imagination, informal historical discussions, recollections from various colleague conversations, third party insights, etc. It is intended only for the purpose of describing a hypothetical “Pro-Match” Program Director position, and for adding to a discussion of The Match question among member Program Directors. Any resemblance to actual events, locales, or persons, living or dead, is entirely coincidental. No attribution to any actual individual, either living or deceased, or to any formal or informal body or real entity is intended or implied.

 

Feel free to share your thoughts by joining the ARPDE as a current Program Director, or by using the contact form. Where do you stand on this important question?