I agree wholeheartedly with the sentiments and many of the arguments put forward in this piece, but felt I should comment on some inaccuracies (in my opinion...

I agree wholeheartedly with the sentiments and many of the arguments put forward in this piece, but felt I should comment on some inaccuracies (in my opinion...) I originally trained in the UK, which had no structured residency programs at the time, and no matching scheme. The result was the so-called 'lost tribe' of doctors: http://careers.bmj.com/careers/advice/bmj.331.7514.s90.xml http://careers.bmj.com/careers/advice/bmj.331.7514.s90.xml Coming to the US, it seemed to me that the match was a massive improvement. The author claims that "Students are then obligated to attend that residency program. They can’t privately negotiate with other programs, as students can for, say, undergrad admissions, or med school admissions—or almost any other normal employment situation." However, the key to the program (the algorithm was discussed on hn a few months ago I think??) is that a medical student can only be matched to a residency that THEY listed as an acceptable choice of employer, and where the residency listed THEM as an acceptable choice of resident. Medical students are also free to try to negotiate with residencies (before the ranking deadline)...and residency programs as just as free to say 'No'. I think it's reasonable for the hospital to promise a set period of residency training, with all pay and conditions specified up front, but only on the condition that the incoming resident makes the commitment to stay for the full program. The resident can leave simply by giving their notice: what they are unlikely to be able to do is find another residency willing to take them on, when they've just broken their previous commitment. In fact, one of my UCLA Emergency Medicine classmates, Andrew Nerlinger, left our program just 6 months before finishing, for a better opportunity elsewhere (http://www.enduraventures.com/about-us http://www.enduraventures.com/about-us).