Leaders in Medical Education: Ms. Mona Signer, President and CEO of the National Resident Matching Program

Mona Signer CroppedMona M. Signer is President and Chief Executive Officer of the National Resident Matching Program, an organization that since 1952 has matched medical students to United States graduate medical education programs. Ms. Signer joined the NRMP in 2002, became Executive Director in 2005, and in 2015 was named President and CEO.

During Ms. Signer’s tenure, the NRMP has significantly expanded its Matching Programs. The Main Residency Match now offers more than 30,000 PGY-1 and PGY-2 positions to over 40,000 applicants, and includes all core specialties except Urology and Ophthalmology. Under the banner of the Specialties Matching Service, the NRMP manages 27 fellowship matches encompassing 60 subspecialties, 7,000 positions, and 9,000 applicants. A wholly-owned subsidiary—National Resident Matching Program International—provides matching services to international clients.

From 1996-2000, Ms. Signer was a member of the Montgomery County Maryland Board of Education, a publicly-elected elected body with a $1.2 billion budget and responsibility for a 140,000-student public school system, the largest in Maryland. During her term on the Board, she chaired its Research and Evaluation Committee. She also is a past member of the Board of Directors of the Maryland Association of Boards of Education and the Federal Relations Network of the National School Boards Association.

Could we begin with you sharing more about your background and how you got to where you are right now?
I have a Master of Public Health, and so I have always worked in the health care field. I began by working for the Illinois Department of Public Health in the 1970s, and then worked for the Council on Dental Health at the American Dental Association. In 1979, I assumed a position at the American Hospital Association with primary responsibility for undergraduate and graduate medical education. After retiring for 15 years to stay at home with my young children, I re-entered the workforce in 2002 as Executive Director of the National Resident Matching Program.

What is The National Resident Matching Program exactly? What are your goals with the organization and what direction would you like to see it go?
matchThe NRMP is a private, non-profit organization that was established in 1952 at the request of medical students to provide an orderly and fair mechanism for the transition from undergraduate to graduate medical education. Over the years, it has become the largest matching program in the world. In addition to the annual Main Residency Match that encompasses more than 42,000 applicants and 30,000 positions, the NRMP conducts Fellowship Matches for more than 60 subspecialties through its Specialties Matching Service. The organization is governed by a 19-member Board of Directors whose membership includes medical school deans, ACGME designated institutional officials, GME program directors, medical students, resident physicians, and one public member.

Because the overwhelming majority of GME positions in U.S. teaching hospitals are “filled” by NRMP, our data can be used to identify physician workforce trends. Our goal is to use the data responsibly not only for that purpose, but also to enhance the matching process for applicants and programs. In addition, NRMP occupies a unique position in the transition from medical school to residency and has become—through its annual stakeholder conference—a facilitator of conversations between medical schools and GME sponsors to identify and address important issues in the transition. Lastly, through NRMP International, we provide matching services to countries outside the U.S. and Canada so that they can benefit from the same fair and efficient process.

What are some of the bigger challenges you currently face regarding the work you do and your current role? What do you enjoy most about your current role?
The biggest challenge is ensuring the NRMP’s policies promote fairness and transparency in the matching process while also acknowledging the inherent imbalance of power between Match applicants and GME program directors. We strive to maintain the highest professional standards in the conduct of our Matching Programs, especially by eliminating undue coercion and promoting honest communication between applicants and programs.

A second challenge relates to creating and maintaining an information technology infrastructure that can support the Matching Program. There is no tolerance for error. The matching process must be 100 percent accurate, and the servers must be capable of supporting an extremely heavy load. As an example, during Match Week for the Main Residency Match, we accommodate almost 100,000 logins and millions of page-views within a one-hour timeframe.

One of the most rewarding aspects of my job is working with the Board of Directors. Over the years, I have been privileged to work with many dedicated individuals, and I have especially enjoyed my relationship with the student and resident members of the Board. I remain in contact with many of them, and am gratified that they share their professional and personal accomplishments with me.

From my understanding, much of matching is done leveraging the Gale-Shapely model. I was wondering if there were any challenges that currently exist with such a system and what improvements you would like to see going forward with the way the matching system is done?
The NRMP matching algorithm is based on the Gale-Shapley deferred acceptance algorithm, also known as the stable marriage algorithm. A Match is “stable” when no party would be individually better off than they are with the party (applicant or program) to which they are currently matched. The NRMP algorithm uses the preferences expressed by applicants to begin the matching process, and cycles through each applicant’s rank order (preference) list multiple times to attempt to match the applicant to a program. When all applicants have been matched or when no match is possible, the matching process is complete. Research on the NRMP matching algorithm was a basis for awarding the 2012 Nobel Prize in Economics to Lloyd Shapley and Alvin Roth.

A unique aspect of the NRMP algorithm is its ability to match couples to pairs of programs that suit their needs, and it is these couples that pose a challenge. Some couples’ rank order lists include more than 1,000 ranks, and some couples rank the same programs—often vying for very competitive slots. Although that is not a “challenge” for the software, it is a challenge for the applicants. Even so, the match rate for couples, most of whom are U.S. allopathic medical students, exceeds 90 percent, which is very close to the match rate for single applicants.

Do you have any tips or advice for graduating medical students as they prepare for a successful match for residencies or fellowships?
My advice is that applicants consult all available data such as “Charting Outcomes in the Match”; listen to their medical school advisors, most of whom have been counseling students for many years; and realistically assess their own competitiveness and that of the specialty to which they are applying. The number of first-year positions in the Match far exceeds the number of graduating U.S. seniors, and the majority match to their preferred specialty.

What is the biggest challenges you currently see in healthcare as a whole (which interests you the most)? Why?
Healthcare is changing even as I respond to this question. We don’t yet know what the new Congress and Administration will do when it comes to replacing the Affordable Care Act, nor whether any of the recommendations put forward in the National Academy of Medicine report “Graduate Medical Education That Meets the Nation’s Health Needs.” The latter would substantially change the way GME is financed in the U.S.

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