ON WEDNESDAY of this week, nearly 16,000 envelopes were anxiously opened; their contents spelled the future for the entire graduating class of this nation's medical education system. Celebrations and commiserations began forthwith: the 1979-1980 National Residents Matching Program (NRMP) had come to its long-awaited climax.
Attaining a first-year residency position has become a lengthy project requiring planning, social ingenuity, and, frequently, a fair amount of money. With the exception of some subspecialty programs the days of individual students seeking private agreements with house staff programs ended 28 years ago with the creation of the NRMP. The selection process was computerized to avoid thousands of students trying to gain the early favors of program directors before all desirable house staff positions were filled. The expansion of medical school enrollment during the 1970s and the relative stability in the number of first-year residency positions now exert pressures on the system that make