The authors respond to a proposal in this issue of Academic Medicine by Ray, Bishop, and Dow, who recommend adopting a free-market approach to the Match in which applicants and programs negotiate directly with each other to find and fill residency positions year-round. This Invited Commentary examines and responds to the reasons Ray and colleagues give for changing the Match and explores their proposal's implications and likelihood of success.The authors question Ray and colleagues' argument that assumptions underlying the National Resident Matching Program algorithm have been violated. The authors suggest there is insufficient evidence for the "July effect" and that the possibility for improvement in physician supply due to the year-round entry of graduates into the workforce ultimately faces the rate-limiting step of caps on residency positions allocated to programs. Most important, competency-based medical education, on which the free-market proposal depends, is not yet sufficiently developed.Nonetheless, the imbalanced ratio of applicants to positions in the Match is contributing to a rise in the numbers of student applications and program interviews. Although the proposed free-market approach might, as Ray and colleagues envision, curtail applications as well as reduce time and financial resources currently expended on the process, it would require significant changes on the part of applicants, residency programs, medical schools, and other stakeholders.Because the proposed free-market approach could reduce some negative effects of the imbalance of applicants and positions, it merits ongoing discussion along with other more immediate practical solutions to issues with the Match.

译文

:作者回应了Ray,Bishop和Dow在本期《学术医学》中提出的建议,他们建议对比赛采用自由市场的方法,在这种方法中,申请人和计划彼此直接协商以寻找并填补当年的居留职位-圆形的。本受邀评论对Ray和同事提出的更改比赛的原因进行了调查并做出回应,并探讨了其提议的含义和成功的可能性。作者质疑Ray和同事的论点,即违反了《美国国家居民匹配计划》算法的假设。作者认为,“七月效应”没有足够的证据,而且由于毕业生全年进入劳动力队伍而改善医生供应的可能性最终面临着分配给计划的居留职位上限的限速步骤。最重要的是,基于自由市场的建议所依赖的基于能力的医学教育尚未得到充分发展,尽管如此,申请人与比赛中职位的比例失衡导致学生申请和计划面试的人数增加。尽管如雷及其同事所设想的那样,提议的自由市场方法可能会减少申请,并减少目前在该过程中花费的时间和财务资源,但仍需要对申请人,居住计划,医学院和其他方面进行重大更改。由于拟议的自由市场方法可以减少申请人和职位失衡的某些负面影响,因此值得进行中的讨论以及针对Match问题的其他更直接的实际解决方案。

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