When the MedPhys Match (MPM) was launched in its inaugural year for the 2015 medical physics residency application cycle, this move toward standardization of the residency application and selection process provided a unique opportunity to survey the participants in order to examine the process for opportunities for improvement.

Following the model of the National Resident Matching Program (NRMP) for medical residencies, the newly created MPM aimed to address challenges in the existing open system by providing the framework for a fair system for pairing medical physics residency applicants with residencies. Matches between applicants and residencies are optimized according to the preferences of both parties as indicated through rank order lists, which are submitted by a single deadline; and binding results are released on a fixed date — designed to eliminate previously noted issues that prevented both applicants and residencies from having equal opportunities to assess their options [1], [2]. However, as with our physician counterparts who participate in the NRMP, the possibility of "gamesmanship" still exists [3]–[6]. Furthermore, once a negative culture has become entrenched, it can become difficult to change [7].

With the intent of both understanding the current state of the medical physics residency application process and using this information to help inform and improve this step in our profession, we set out to study the MPM with annual surveys sent to all applicants and residency program directors registered in the MPM from the first 2015 match cycle onward. The surveys gather information covering multiple aspects of the MPM and residency application and interview process, including respondent demographics, ethical issues, considerations for interview invitation and acceptance, interview experiences, costs, considerations for ranking, and overall perception of the MPM. Surveys from the second year (2016) onward include questions regarding reapplication, preparation, and success. A full list of the survey questions for both residency applicants and residency program directors is available online in the supplemental information for our paper on "Ethical violations and discriminatory behavior in the MedPhys Match" [8], published in JACMP last year.

To date, we have collected data from the first three match cycles from MPM applicants and medical physics residency directors. In addition to our 2017 article focusing on ethical concerns, earlier results from various aspects of the ongoing study have been presented at AAPM and SDAMPP meetings [9]–[11]. This article highlights a few of our findings across all three years.

Survey Respondent Demographics

Applicant surveys were sent to the email addresses of all applicants who registered in the MedPhys Match. The respondent rate (27-31%) was similar across all three years (Figure 1). Our data represented responses from a higher ratio of matched applicants than reported in the entire registered applicant pool (Figure 2).

Roughly half of all residency program directors responded to the survey (Figure 3).

Figure 1. Survey invitations were sent via email to all registered applicants regardless of whether they did or did not successfully match, participate in interviews, submit rank order lists, or withdraw from the match. Respondents included individuals from all of these groups.

Figure 2. Survey respondents were asked whether they matched, submitted a rank order list, or withdrew from the match. Non-participating applicants are defined as those who either withdrew from the MedPhys Match or did not submit a rank order list. Compared to the overall pool of applicants registered for the MedPhys Match (MPM), our survey respondents (Survey) represent higher percentages of both applicants who participated in the match and applicants who successfully matched to a residency.

Figure 3. Survey invitations were sent to the program directors listed for each residency program participating in the MPM.

Ethical Violations

The match system is meant to circumvent or eliminate previously identified problems with the open free-for-all application process by enforcing the single deadline (no race for early commitments); binding agreements to follow through on matches (no reneging on commitments); and the ability to rank all applicants/programs in your order of preference, knowing that you will be matched with your top choice that has an opening (no second guessing whether you should wait for a better offer).

What happens when it doesn't work? When the letter or spirit of the law — as defined by legally prohibited discriminatory questions [12] and the MPM rules [13] — are not followed, ethical violations can erode and diminish the potential of a fair match system. The problematic behaviors include prohibited questioning, potential for discrimination, pressures to commit prior to rank deadline, efforts to game the system, and dishonest communication such as false ranking pledges.

A selection of survey results is shown in the following figures and tables, revealing problematic ethical violations and other dishonest behaviors.

Figure 4. Applicants who reported being asked about children were asked how comfortable they were in answering these questions. Results include all three years of survey responses for all responding applicants and are further broken down by gender. Female applicants are significantly more uncomfortable answering this question, presumably because of increased potential for discriminatory use of the information.

The MPM rules prohibit asking the other party for rank positioning information (i.e., a specific rank number or range). There should be no additional pressure to influence rankings by asking where else the applicant is interviewing or by being offered incentives such as a future position, and yet each of these behaviors were reported by respondents to the surveys (Table 2).

Figure 5. Applicants who reported the interview experiences in Table 2 were then asked how they felt about answering. Respondents were largely uncomfortable or very uncomfortable answering these questions during interviews.

The Cost of Applying for Residency

The cost of application and interviews — both in terms of time commitment and financial investment — represents a significant burden for residency applicants.

Reported interviewing costs from survey respondents is shown in Figure 6. As could be expected, the financial burden of interviewing scales with the number of interviews attended. It is worth noting, however, that there is an increasing trend in total spending on interviews: in 2017, 76% of respondents reported spending upwards of $1,000 and 38% reported spending upwards of $3,000, up from 59% and 24% in 2015.

Figure 6. Top: Percentage of applicant respondents from 2015-2017 grouped by their reported costs of interviewing, with proportion of matched and unmatched applicants indicated. Bottom: Average number of interviews attended reported for each cost range by year.

The cost of traveling, scheduling conflicts with other interviews, and time constraints due to other commitments were frequently cited as reasons applicants chose to decline interview invitations (Figure 5). While time limitations may be inevitable, traveling costs and scheduling conflicts can be mitigated through voluntary coordination between residencies to schedule regionally-grouped and nonconflicting interview dates.

Figure 7. Financial and time limitations were frequently cited by applicants as reasons for declining interview invitations.

Ongoing Work

In addition to the results highlighted here, the surveys gather data on the primary inclinations and preferences of both applicants and program directors. This should provide valuable guidance for future applicants looking to understand and improve their chances of matching, and for programs to make themselves more appealing to applicants. We have also gathered ongoing data on the satisfaction of both applicants and program directors with the match process as well as their sentiments regarding this aspect of entry into clinical practice in the medical physics profession. The details of these results will be reported in our next journal publication, and we look forward to sharing more of what we have learned with the rest of the community in future reports from this study.