Recruitment is a major component of every residency director’s position. The day-to-day life of faculty and trainees is greatly affected by the number, quality, and morale of residents in each residency. Decisions such as who to recruit and how to recruit are among the most important a residency director makes. Failing to fill all available positions or accepting a trainee who does not fit with the culture and demands of a particular program can create significant and lasting challenges for a training director and his or her program.
For applicants, recruitment frequently occurs in their early thirties, at a time when many are forming families, have or are planning to have young children, and have partners who are involved in building careers or parenting. These phase-of-life concerns make program choices challenging for applicants. Considerations such as location of residency become particularly important.
Some uncertainty is inherent in residency recruitment where residency directors and applicants are both vying to fulfill their needs. Individual control is limited, and all participants, training directors and applicants, must sacrifice some autonomy and collaborate to make solutions successful. This is especially true in situations, such as in child and adolescent psychiatry, where the number of program positions exceeds the number of applicants.
In their article in this issue of Academic Psychiatry, Ascherman and Lamps discuss problems and solutions of the Child and Adolescent Psychiatry Match. No authoritative body, like the Deans of American Medical Schools, currently mandates participation in the Match (the deans require all graduating seniors planning residency training to participate in the PG 1 year Match). The Child and Adolescent Psychiatry Match occurs independently of other Matches, and the rules of the National Residency Match Program are augmented by the collaborative rules of the Child Caucus of the American Association of Directors of Psychiatry Residency Training. The complexity of negotiating multiple guidelines can cause some training directors (especially new training directors) to be uncertain about their expected conduct during recruitment.
Several factors—the importance of a successful recruitment season, the lack of a powerful monitoring force, and the inevitable confusion about existing guidelines—combine to create the situation well described in the article by Ascherman and Lamps. They present the history of child and adolescent psychiatry residency recruitment. And they point out the difficulty of the recruitment process for both applicants and training directors prior to agreement to utilize a Match process.
The Match has clear advantages. By providing a period of time to assess programs and applicants, without the expectation that immediate decisions must be made, both training program and applicants are free to gather as much information as possible to make truly informed decisions on their rank order list. I can personally attest to an increased comfort level for applicants participating in the Match. I was a child and adolescent psychiatry residency director both prior to and after the adoption of the Match and witnessed first-hand the pressure on applicants and programs prior to the inception of the Match. As the field of child and adolescent psychiatry grows, and recruitment into the field becomes both a priority and a national necessity, I believe strongly that a viable and universally utilized Match process is essential.
Ascherman and Lamps also discuss disadvantages or potential problems with the Match, citing 5 specific examples involving both training directors and applicants. They stress the need to consider mandating program participation and developing sanctions for both programs and applicants who do not adhere to both National Resident Matching Program (NRMP) and Child Caucus Match rules. They strongly suggest that the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC) for Psychiatry mandate participation and review adherence to Match rules as an element of program accreditation review. This is certainly one possible method of building participation and adherence.
Poor Match outcome for a particular program can ultimately lead to program review, enhanced resources, and improvement in building enhanced results of future Matches. Should the recruitment initiative lead to greater numbers of applicants, the number of applicants will approach the number of positions available, and program incentives to not participate in the Match will decline.
Other actions to support the Match are possible. All organizations within Psychiatry and Psychiatric education have endorsed the Match and strongly support program and applicant participation. Directors of Divisions of Child and Adolescent Psychiatry could agree to mandate universal participation. The Child Caucus could ensure that NRMP sends Caucus rules and NRMP rules to all applicant participants so that applicant confusion is minimized. The Caucus could also develop a mechanism to learn the names of new training directors from the ACGME (which must be notified of changes in training directors) so that new training directors could be oriented to the Match and informed of all Match rules. The benefits of a Match for applicants, programs and the field could also be stressed to new training directors by experienced residency directors who participate in the Match annually.
A combination of mandates, the possibility of meaningful sanctions, joint action by Psychiatry organizations, possible ACGME involvement and continued consensus about the value of the Match will most likely be necessary to build universal participation. A viable Match requires universal participation; child and adolescent psychiatry training requires a viable Match.