Jan 04, 2020
Let’s compare and contrast between the Saudi matching program and the American one. We’ll begin with the Saudi one. The first thing to know is that the matching program here is controlled by the government through the MOH. It uses a point system in order to match the best applicants to their preferred program. This is done through the SCFHS portal system. Applicants create an account on their website, enter all their information (SMLE grades, transcripts, research, extra-curricular activities, etc.) and select their desired specialties and cities (10 in order of decreasing preference). Then a computer system will match the best applicant with their most preferred specialty and city. The matching process is done via a point system, incorporating various elements of application, including academic achievements, research, extra-curricular involvement in medical school, etc. After the matching is done, each applicant will know in what and where they matched (ex. Internal Medicine – Riyadh). Thereafter, the interviews begin (each individual program in that city will interview the applicants) and the ranking process ensues. At the end, the matching occurs when the programs rank their applicants. This process favors the programs, as it provides the best applicants to each program based on a point system. The American way is different. The government only governs who is eligible to apply, which is done through accreditation programs (ECFMG, LCME, OAO, etc.). But they have nothing to do with the actual matching process. Matching is done through the NRMP (National Residency Matching Program) through ERAS (electronic residency application system). Applicants will create an account after purchasing a token and enter all their information. Then they apply to individual programs, regardless of city/state and specialty. An applicant can technically apply to all the programs if they can afford it. After applying to each individual program, the programs themselves will start sending invitations to prospective applicants. Programs don’t use a point system and usually incorporate a wider variety of criteria in selecting these applicants. Also, each program sets its own criteria for selecting applicants for interviews. Some may use USMLE scores, other may use letters of recommendation, and some may want their applicants to have rotated in their department previously. It’s different from each program to the other with no single theme. Also some programs may change these criteria from year to year. Nothing is constant and surprises should be expected. After interviews, applicants rank their programs and programs rank their applicants and the matching commences. This process favors the applicant, allowing each applicant to choose the best program for them. Before we compare and contrast, I want to explain the concept of ranking. After interviews, the ranking step begins. Applicants will rank, or place in order, their preferred program. Say for instance an applicant from Alfaisal is applying to Emergency medicine. They will rank emergency medicine programs at the top of their list obviously. Their first program they rank is the program they want to match in the most. Their second program is the one they want match in if the first program isn’t available and so on. They may choose to rank programs in other specialties in case emergency doesn’t work out. Programs rank applicants in the same way. If a program can only accept 6 applicant, then they will only rank the applicants they are sure will rank them as well. It is highly advised that applicants rank the program that will most likely rank them as well in order to match. This is done to make the matching process as fair as possible and allow equal opportunities for all. While a program cannot exactly say that “we will rank you” they can slip that “if you rank us we will most likely rank you”. When we compare and contrast, we see a remarkable difference between the two processes. The way the Saudi process is done allows the best applicant to be matched into their most available preferred specialty, but this favors the program. This doesn’t allow the programs to see a full list of applicants interested in that particular specialty in that city. The point system can be unreliable, giving points to academic achievements, but doesn’t take into account commitment, hard work and enthusiasm an applicant may have displayed in past rotations at that department. A recent study in the US determined that licensing exam scores (USMLE), GPA, and other academic achievements do not correlate at all with the future success of a resident nor does it provide any information on their future performance. Just depending on these points allows an applicant to cheat the system by knowing what to excel in and what to ignore. In the US, the system allows for a much greater variety of criteria and doesn’t limit the programs to a specific list. They see everyone who applies and they decide who they interview and who they accept at the end. This favors the applicant. An applicant could have average scores in his/her USMLE, an average GPA and few academic achievements yet get the same treatment as the applicant who has a high USMLE score, GPA and many academic achievements. This can be due to a strong recommendation letter from a trusted physician or past experience with that program as a student where they showed a high level of enthusiasm, commitment and worked beautifully in a team. These are the things that programs want to see, how they work, not just academic achievement. And these things are very difficult to add to a point system and thus are usually overlooked. Some will argue that this system is used to make sure no "wasta" can interfere. This is true, a wasta now has very little meaning if you can't actually match into that specialty or that city. And wastas were heavily abused in the past, this is something we cannot ignore. In the US, wastas don’t exist and instead we have connections. Connections usually get you through the door, or in other words, will get you an interview. After that, you're on your own. Connections rarely influence a director’s mind on whom their final list of candidates are. Payment (resident salary) is different in both processes. In the US, you are an employee of the hospital so the hospital will give you a monthly salary (it’s not much but it’s enough to get you by during your residency). In KSA, an applicant will have to acquire a sponsor to pay them on their own. This adds a degree of stress, if they can’t find a sponsor, they end up doing free labor with no pay. The Saudi system has a degree of national preference, leaning towards the national candidates over the expatriates. This is done without any regard to any qualifications whatsoever. All non-nationals will be put into a separate list for ranking later in the spots that were not filled by nationals in the first match. The US completely lacks this approach and instead separates candidates based on location of graduation. In other words, they will favor candidates that graduated from the US first (regardless of nationality), then graduates from Canadian schools (again regardless of nationality), then all the other graduates. And yes, in the NRMP reports, IMGs are separated into US citizens and non-US citizen groups. But as I have previously explained, the only advantage a US IMG has over a non-US IMG is that they can apply to places that do not offer visas. But in places that do offer visas, all bets are off and everyone is treated equally.