A tale of two systems: Pathology resident recruitment in and out of the National Resident Matching Program

The recruitment of most first-year pathology residents currently occurs via 2 systems: the National Resident Matching Program (NRMP), known as the Mat ch, and an underground Out-of-Match process. Out-of-Match recruitment is no t a sanctioned option for American medical school seniors. Recent declines in American seniors choosing pathology has intensified pressures to recruit good international medical graduates (IMGs). Pressures by program on IMGs and by IMGs on programs result in the Out-of-Match recruitment of many IMGs who initially enroll in the NRMP. IMGs may be offered unsolicited Out-of-M atch positions with a decision deadline even though they are still intervie wing. Some are told if they decline an offer, they will not be ranked by th at program in the NRMP process. To enhance apparent recruitment success, pr ograms also feel pressured to participate in the Out-of-Match process, as w ell as offer positions before they have interviewed all applicants. Coercio n of applicants and program contravenes the spirit of the NRMP, compromises the ability of applicants and programs to best match needs, taints constru ctive interactions among program directors, and does not enhance pathology' s image among applicants or in the broader medical community. Hum PATHOL 32 :677-679. Copyright (C) 2001 by W.B. Saunders Company.