The 2020-2021 GME recruitment season was transformative. While it was full of new and old challenges for stakeholders, the impact of the first-ever entirely virtual recruitment season will be substantial and long-lasting.

Before COVID-19, the long-standing process of in-person interviews was considered “sacred” by many. But this system was simply not possible during a global pandemic. In the transition to virtual interviews, applicants saved significant time and expense but the canceling of away rotations, difficulty scheduling USMLE exams, and a delayed start of the application season brought novelty, anxiety, and frustration to an already stressful endeavor.  Specifically, international medical graduates (IMGs) were faced with current and future VISA restrictions combined with an unclear ECFMG verification process, all of which presented additional challenges.

Concerns going into the process

Institutions confronted change in management, technical, and infrastructure challenges in transitioning to virtual interviews. They wondered if they would be able to properly “sell” themselves to applicants without in-person visits. In many cases, faculty and program leadership feared being unable to adjust to a new process.

Similarly, applicants experienced confusion and concern given a lack of data and precedent of a virtual process, and issues of inequity and inequality in the system were brought to the forefront. Ample information exists for having the best in-person interview possible, but there was a lack of insight around best practices for virtual GME interviews. Applicants wondered if they would be able to truly get a sense of a program without being able to visit and if programs would be able to experience the “true me” through video conferences. With limited personal space to conduct interviews and the current digital divide, specifically a significant lack of broadband internet in several areas throughout the US, some applicants were disadvantaged in being able to interview virtually.

The myth of the “match crisis”

Most concerning to applicants and programs was the hypothesis that “interview hoarding” (or few applicants holding onto many interviews) would dilute the available matching pool, resulting in a “Match Crisis” with only “top” applicants successfully matching and a compensatory number of residency programs going unfilled.

In truth, the distribution of interviews amongst applicants and programs was similar to prior years. In fact, on average, both completed more interviews during the 2020-2021 recruitment cycle, building in additional buffers for the Match algorithm. According to NRMP data, the result was a nearly consistent match rate compared to prior years, with 1,927 positions going unfilled in the main match and only 7 positions remaining unfilled after the Supplemental Offer and Acceptance Program (SOAP).

While the overall match rate did decrease from 80.8% (2020) to 78.5% (2021), with the largest drop for non-US-citizen IMGs, this was due to more applicants entering the match than a compensatory rise in available positions.

A hurricane or a pandemic, the system must adapt

I have tremendous empathy for the applicants that were challenged by this season’s interruptions. Hurricane Sandy derailed my own residency interview experience.  Likewise, the resilience and perseverance I have witnessed among applicants this year are inspiring.

In October 2012, the night before my first residency interview, I was in New York City when Hurricane Sandy hit. The subway flooded, lower Manhattan was without power, and the city’s entire infrastructure was crippled, the worst occurring in Staten Island. There was no way in or out of the city. That next morning, the interview was canceled.  But I had already booked all of my other interviews later in the season to attend these interviews in New York.  My whole plan was instantaneously turned upside down.  The bigger issue was that of the three programs I was to interview with, only two could reschedule me.

I felt trapped, frustrated, and afraid of how my GME future would be negatively affected by such a disruption throughout this experience. Similarly, 2020-2021 residency applicants experienced feelings of hopelessness and fear of not matching due to stay-at-home orders, tech challenges, Zoom fatigue, and a lack of data on what a virtual match would mean. Fortunately, it seems that the process will be improved this coming year.

Residency recruitment is ripe for innovation

What should we expect for the 2021-2022 GME recruitment season? In all likelihood, the process will remain entirely virtual, barring a significant decrease in active cases of COVID-19 as a result of the vaccine and interactions with variants. In-person interviews will likely still pose too much risk. While a hybrid approach might be possible (some in-person interviews and some virtual, and/or screening), it would create issues with equity.

Long term, for residency (and fellowship interviews), “all in-person” interviews may be a thing of the past. One scenario is that virtual interviews will be used for initial screenings, and then programs will invite desired applicants for in-person “second-look” interviews on campus. The challenge, which will require discussion, is how to do so in an equitable manner.

While many might be eager to get back to the way things have always been done, this new approach can benefit both applicants and programs. Applicants will save money by cutting out unnecessary travel, and program faculty will save time and cost, enabling faculty to attend to clinical duties.  Either way, virtual is likely here to stay.

The collective resiliency of the medical education community shone through the challenges of the past year. In medicine, physicians must adapt to all situations, and GME is no exception. Even in a pandemic, everyone adjusted as needed. Program coordinators and faculty were flexible and creative, while applicants remained passionate and pushed past roadblocks. It seems that there is no situation to which GME cannot adjust. With the financial and time-saving benefits of an all-virtual and/or hybrid recruitment model on the horizon, applicants and programs can rest assured that, while it will take some getting used to, the residency recruitment process will be changed forever.

Jason Reminick is a physician-entrepreneur.

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