A Flawed Process Makes Med School Graduates Scramble

Optimizing a supply chain is always challenging. And when what you’re doing is not working on an existing supply chain, but trying to bring suppliers and customers together, it can be even tougher.

I was thinking about this after reading a recent posting on The Wall Street Journal Health Blog describing the event known as Match Day. That is when thousands of graduating medical students find out where they will do their residences, which is accomplished by use of what the blog refers to as “a great big computer.”

The matches are announced on a Thursday. But lately the supply of graduates exceeds the number of residencies, so three days earlier, on Monday, many students are informed that they weren’t matched with a program.

That leads to a stressful and chaotic event known as the “Scramble.” That means these graduates spend Tuesday rapidly contacting hospitals that still have open slots, sending out applications, making calls and conducting phone interviews. A graduate in the Scramble will usually grab the first offer that results (assuming he or she gets one), even if it is not in their chosen specialty.

What made this item of particular interest to me is that those involved in the process are actually trying to improve it. And they seem to understand at least one lean concept: that the order of steps in a process can be just as important as the steps themselves.

Mona Signer, executive director of the National Resident Matching Program, describes their proposal like this: Instead of the students finding out Monday that they haven’t matched, and the remaining open slots being publicized at noon on Tuesday, both of those steps would take place on Monday. Then, the students would be able to send their applications for open slots on Monday (though that timing is still a bit unclear). They’d have to use an electronic system run by the Association of American Medical Colleges, rather than the multitude of communication means, such as email and faxes, that are used now and that can jam up programs’ systems.

Rather than the very fast mating dance on Tuesday, the programs wouldn’t be able to make offers until Wednesday — which believe it or not, would be significantly more time for them to make decisions. Applicants could receive multiple offers, which would be sent through NRMP’s system. Match Day would be moved from Thursday to Friday…

Signer says the proposal is still under consideration and could change significantly before it’s finalized. The changes wouldn’t happen until 2011.

How would you approach this problem? Value stream mapping? Post your thoughts below.

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