Nicky Quinlan, MBBChBAO MRCPI, and Conrad Williams IV, MD

Hospice and palliative medicine (HPM) is growing as an accredited specialty, in keeping with the growing need for timely palliative care for the seriously ill population of all ages. Currently, the only route to HPM board certification is through an accredited fellowship. HPM has not yet joined the National Resident Matching Program (NRMP) match process, whereas geriatric medicine will have its inaugural match day in January 2014. We believe it is time for HPM to participate in what has become the gold standard process for fellowship fulfillment. We elicited opinions of and experiences with the current asynchronous “nonmatch” application process from colleagues to assess the pros and cons.

Challenges of Rolling Admission
“My top three programs had interview dates separated by 4 months each, leading to my having missed the deadline for one, being offered a position by one, and then not being able to interview at the third because of the length of time prior to their selection process,” one colleague reported. “In my opinion, we have ‘arrived’ as a subspecialty and we need to act like it, including joining, at a minimum, the timeline of the NRMP. This makes further sense due to the number of programs that are transitioning to using the Electronic Residency Application Service as an application tool.”

Another physician commented on how the rolling fellowship admission process affected her family. “Without a formal match, I watched my husband be forced to make huge career decisions on the information he had at that moment rather than all of the information that could be available. Getting fellowship offers at different times forces people, and families, to act on urges rather than thoughtful, prediscussed plans. When more than one offer comes into play, it turns medicine into a business, and in essence, is no longer a true match. I also find it ironic that my husband and I could couples match in residency and happily live together for 3 years, but when it came to applying for fellowship, this was not a possibility. If palliative medicine became a formal match, it would allow for the possibility of some couples matches if the timelines were the same.”

One of our respondents also suggested how the match program may help the field better compete with other specialties. “I emailed the program director directly and interviewed informally at a medical conference and then later formally with program faculty. Shortly thereafter, I received an offer that overlapped with an offer from a different program at the same institution. It was a tense time to decide which specialty to pursue, but it has worked out well for me. I can see how the match can level the playing field for all involved.”

A Case for Rolling Admission
One physician who benefited from the rolling admission process remarked, “My process worked out well for me because I came to palliative care after all of my fellow classmates went through the match. Palliative care as a service came late to my hospital (during my second resident year) so it was [my] third year by the time I was fully exposed to it and knew I wanted to pursue it as a career. That meant I would have had to wait another year and perhaps [the program] would have been with one less fellow. The nonmatch rolling admission process was a win-win for both me and the program.”

We have reported the experiences of only four fellow candidates, and this by no means represents the entire applicant population. However, we have tried to provide a sample of varying experiences and opinions. Given overlapping and disparate rolling admissions for various programs, it appears many candidates are afraid of shooting themselves in the foot or, worse yet, burning bridges with programs by accepting a position then later rescinding it. The uncertainty and apparent stress inherent in the current application process is palpable in the responses.

AAHPM has met with representatives from NRMP and has made available an informative webinar on the match process targeted to program directors (www.aahpm.org/resources/default/national-resident-matchingprogram-webinar.html). Interest surveys have also been distributed and collected from hospice and palliative medicine fellowship programs.

The AAHPM Board of Directors will consider a recommendation by the Leadership & Workforce Strategic Coordinating Committee and Academic Palliative Medicine Task Force to move forward with the next steps necessary toward Academy involvement in the NRMP match over the next several months. What are your thoughts and opinions?