Fraud and Deception During Residency Application: A Med Student's Worst Nightmare

Although all medical students experience anxiety related to the residency match process, that anxiety rarely involves criminal authorities. In March 2016, Dr Bilal Ahmad endured an ordeal ripped from every student's worst nightmares, one that would involve the police and put his future in doubt. It prompted him and his current residency director at Louisiana State University's Our Lady of the Lake Psychiatry program, Dr Kathleen Crapanzano, to publish a piece about the case in Academic Medicine.



Although specific aspects of the incident may be unique, Ahmad and Crapanzano hope that by sharing their story, students and faculty will become more vigilant about new potential fraudulent behaviors and increased pressures surrounding the Match. We spoke with them to hear what happened, in their own words.

Medscape: Let's just start with a brief overview of exactly what happened.

Crapanzano: We had a resident in our program who let me know that her boyfriend, Billy [Ahmad], was going to be coming through the Match. We had him do a rotation with us. He was a fine applicant. Our committee chose to have him match with us.


About 3 days before the Match list was due, I got an email. It said, "Dr Crapanzano, I want to thank you for everything you've done for me, but I've decided to sign outside of the Match and go to a program in New York." I get one of those emails every year or two, so I didn't think too much of it.

I didn't say anything to his girlfriend, because I figured that was none of my business and that must have been the decision that they had made between the two of them. Perhaps they'd broken up and didn't want to tell me. Whatever their personal circumstances, I didn't think it was any of my business. So, I didn't talk to her. I wrote him back and said, "I wish you well. Glad you found a place you're happy with!" And I took him off the list.

Medscape: But you soon realized that things weren't that simple, right?

Crapanzano: The week before Match week, no changes can be made. I ran into Billy's girlfriend and asked what happened with Billy in the Match. She said, "What are you talking about?" I said, "Him signing in New York." The color left her face. She said, "He didn't even interview in New York." I thought, "Oh dear, they're breaking up, and she doesn't know it." I left the room to let them sort it out. She comes in about 15 minutes later and hands me the phone. Billy gets on and says, "I don't know what this is about."

Medscape: Dr Ahmad, what was going through your mind?

Ahmad: It was shock at first. Dr Crapanzano asked me if had ever sent an email to the program stating that I wanted to withdraw from the Match and pursue another residency program. She read the email address to me, and I said, "I've never had an account with this name before."

Crapanzano: So I said, "Billy, I don't know how to tell you this, but I took your name off the list." I immediately called the person in the medical school that serves over graduate medical education, and he thought I should reach out to the Match, which I did.

Medscape: Just to be clear, you reached out to the National Resident Matching Program (NRMP)?


Crapanzano: Yes, and I got someone on the phone and told them the story. This is the Wednesday before Match week. The woman said, "It's too late. It's all done." When the Match came out, he had matched somewhere else. He had a legally binding contract that he had to go somewhere else. It was a family medicine program, but he wanted to be a psychiatrist. So not only was he not coming here with his girlfriend, he wasn't even going to be in his specialty of choice.

Medscape: So while you were figuring out what comes next in terms of residency, there were now legal concerns.

Ahmad: Correct. I first went to my local police station back in Texas in March of 2016.

Medscape: You contacted the criminal authorities while also sorting things out with the NRMP?

Crapanzano: Yes. We called the NRMP, and they said that because the perpetrator was someone outside of the Match, it was consequently notgrounds for invalidation. So we filed an appeal. We wrote all these letters and explained the whole thing. Whoever this was, he had taken away the ability for Billy to practice in his chosen profession. Thankfully, after we appealed, the NRMP did invalidate the Match, and he was able to start in our program.


Medscape: With that part solved, you switched to trying to track down the perpetrator?

Crapanzano: Billy asked me if I would please email the top five programs that he had put on his rank list, to see whether this had happened anywhere else, because it might help him narrow down who to consider as a target. Another program did receive the same email. The police got the IP address related to the two times this fake email account had been used. One was at a hospital, at a computer terminal where someone had to log in under their own name. The second login was from that person's home address. So we knew who the person was. Billy and I were going to have to go testify, but at the last minute, a plea deal was reached.

Ahmad: It was almost the perfect crime, in the sense that I got lucky that my girlfriend happened to be a member of the program that was my top choice. Had she not been in the program, I don't think anybody would have ever known known what happened.

Medscape: Do you have any sense why this person would do this to you?

Ahmad: It's really, really tough to speculate on motive. I can tell you the guy had a history in applying to the same program, and ultimately he didn't match there. He would have wanted to possibly be at that program. That's all that I can really speculate. It's tough to say.

The individual who is responsible was somebody I had known my entire life, since I was 4 years old. He was already in another program. He was already a resident at the time that he committed the crime.

Medscape: How long did the criminal prosecution take?

Ahmad: By the time that the legal process concluded, the individual responsible actually pleaded guilty to both felony and misdemeanor charges. It was May 2018. It was over 2 years from start to finish. The felony charge was securing execution of a document by deception greater than $150,000, and the misdemeanor was a Class A misdemeanor, which is the highest level of misdemeanor in Texas, and that was for online impersonation.

Medscape: In researching for the piece you wrote, did you come across any other instances of something like this?


Crapanzano: No, I have not. I asked the NRMP, and they had never had anything like this reported. When I talk to applicants, it does strike terror in their hearts to think that someone could sabotage this, when they've worked so hard. I don't have a sense that this is going to turn into a widespread problem.

Medscape: What can we learn from this unique situation?

Ahmad: I've had the opportunity to share my story with some medical students with whom I've had a chance to work as a resident over the past couple of years. I certainly don't want to instill paranoia or heighten anxiety even more than already exists for many of the folks who are going through the Match process. I think that this case may have been an outlier.

So the advice I would give is to be careful until that rank list deadline is finalized. Don't show your hand to most people on how you plan on ranking programs. Maybe be a little bit more guarded about that information until after the rank lists are finalized.

Medscape: Are there any broader concerns that this incident made you think about?

Crapanzano: Applicants are feeling more and more pressure. A recently published study showed that most applicants wish that, after their interview, there was no more communication with the programs. They feel a certain amount of pressure to say such things as they're going to rank a program highly or whatever. They don't want that added pressure.

The NRMP has been a little stricter about limiting postinterview communication. This year, I made a real point of limiting postinterview communication with applicants. I do think that the postinterview communication process should probably be limited on both sides, because it leads both sides to feel the pressure to make promises that aren't fair or accurate.

Ahmad: To prevent something like this from happening again, all communication between applicants and programs should occur through the Electronic Residency Application Service (ERAS) portal. Because in all honesty, it's so easy to make up an email address in somebody's name and start emailing folks, saying that you want to withdraw from a program. Most of the time, folks don't have a relationship with some of the programs that they've interviewed at. So programs may not think twice to either remove them or lower them from their rank list. I think the thing that stood out to me was that all communication should happen through the ERAS portal to minimize the chances of this happening to somebody else.

Crapanzano: Also, this doesn't have anything specifically to do with this situation, but just with the overall Match anxiety: I think that, in the bigger sense, the deans of medical schools need to help cut through some of the hysteria that has built in the applicants. The Association of American Medical Colleges has a really nice new section on their website. On the basis of your STEP scores, they predict how many programs you should apply to, making students aware of that so that they aren't over the top in their application process would be one idea.

In general, I'd like to think that the vast majority of people who end up in medicine by the Match process are ethical. Every once in a while, though, I guess someone gets through.

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