After the completion of another successful Standardized Acceptance Process (SAP), Public Health and General Preventive Medicine (PH/GPM) residency program directors voted convincingly to take the bold and historic step of joining the National Residency Matching Program (NRMP) for the 2024/2025 application cycle. It is hoped this move will benefit our training programs, specialty and the College in several ways. First, and foremost, it is hoped participation in the NRMP will increase the number, quality and diversity of applicants to our specialty. Equally important, is the fact NRMP participation will significantly increase our specialty’s exposure to medical students early in their career decision-making, and it will give them a familiar and trusted gateway into the field of Preventive Medicine. Finally, it will place PH/GPM programs in a more competitive, equitable and controlled matching environment, as we vie with other specialties for the most talented young physicians. All that said, we as program directors also realize that for years, some of our best and brightest physicians have entered Preventive Medicine from mid-career and other nontraditional pathways. The intent is to maintain an open pipeline for those physicians as well, but simply channel them through the NRMP process, instead of the SAP, which has been used for the past several years.

With the assistance of ACPM, the PH/GPM program directors developed and launched the SAP eight years ago, in part as a mechanism to infuse some measure of orderliness to an application process that previously had little to no structure. That, along with the decision of most residency programs to begin using the Association of American Medical College’s (AAMC’s) Electronic Residency Application Service (ERAS), was designed to begin a slow and steady progression to the recent decision to join the NRMP. Initially, the ACPM-SAP was little more than a shared timeline and general guidelines for conducting interviews and extending offers to applicants. Over time, the SAP facilitated the “matching” of programs and applicants who mutually ranked each other first, and later matched applicants to programs that were their first choice, and for whom they were also in the program’s “definite matching range” (e.g. among a program’s top three candidates, where the program was looking to fill three slots). In recent years, the ACPM-SAP evolved into a very “Match-like” process, by which every applicant and program rank list was analyzed, and applicants/programs were matched into their mutually highest ranked counterparts, until all available positions were filled or all possible matches were exhausted. While this “home grown” algorithm and process has worked well, it has also been quite labor-intense, requiring two ACPM staff to manually (and independently) conduct the process, periodically stopping to cross-check each other’s work. Concurrently, an ACPM Fellow would in turn check their manual efforts by processing the rank lists through a computer algorithm. Finally, standing at the ready was a disinterested (i.e. no residency program affiliations) yet committed SAP Oversight Committee, available throughout the “matching/pairing week” in case any unforeseen applicant or program issues arose. Albeit cumbersome, this slow, labor-intense evolutionary process to the SAP is exactly what was needed to bring our residency program directors (including myself) and their programs to a sufficient comfort level with the “matching” process to make the next move, to the NRMP Match.

It should be noted at this juncture that MANY people put in countless hours to developing the SAP and enhancing it to the point where it could be such a logical launch point to the NRMP Match.  Starting in 2016, an initial exploratory committee of PH/GPM Program Directors developed the initial SAP framework. For years, Dr. Johnie Rose served as the Program Directors’ designated SAP Liaison, followed by Dr. Heather O’Hara, until I took those reigns a few years ago. In addition to the initial “SAP Task Force”, the GME Sub-Committee and the Program Director’s Group subsequently spent an extensive amount of time fine-tuning the SAP, and then learning about the NRMP, and then doing a deeper dive to learn even more about the NRMP, bringing us to this point. Most recently, Doctors Joseph Iser, Rick Stahlhut and Keva Kidemu have served in a consultative and oversight capacity to the SAP process. Throughout this process, ACPM staff worked tirelessly facilitating meetings, answering program questions, operationalizing the SAP algorithm, and serving as ACPM’s point of contact with the NRMP. They have since hit the ground running again, and is assembling a NRMP Program Director’s Work Group, whose mission it will be to learn about NRMP processes and resources, and bring that subject matter expertise back to all of our program directors.

As previously noted, this promises to be an exciting next step for our specialty. We will have much greater exposure to medical students. We should have more highly qualified and diverse applicants each year. Finally, this greater number of applicants will be yet another compelling argument for more stable and increased funding for Preventive Medicine residency programs. All of this securing a great pipeline of bright new physicians in our specialty, and members and leaders of our College.

James A. Tacci, MD, JD, MPH, FACPM, FACOEM
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