Wednesday, February 22, 2017

Hardy Hendren and the resident match

The journal Surgery has published (early online) an account by Hardy Hendren, recounting the drama at the origin of the resident match:
The 1951 Harvard student uprising against the intern match
Don K. Nakayama, MD, MBAa, , , W. Hardy Hendren III, MD, FRCSb
a Departments of Surgery, Florida International University, Sacred Heart Medical Group, Pensacola, FL
b Harvard Medical School, Massachusetts General Hospital, and Children's Hospital Boston, Boston, MA
Available online 18 January 2017

Here's the first paragraph:
"In the fall of 1951, a group of Harvard medical students led by W. Hardy Hendren, III organized a national movement against the newly instituted match that would assign graduating seniors to hospital internship programs. Before then, hospitals with intern positions to fill rushed to secure commitments from students, who in turn accepted the first decent offer that came their way. Knowing that students could not risk waiting for a better offer, hospitals pushed them into making early commitments. When some students began getting offers in their junior and sophomore years, medical schools, professional groups, and hospitals organized the National Inter-association Committee on Internships to deal with the issue. The intern match was thus organized and scheduled to take place in 1952. When the plan was announced in mid-October 1951, Hendren recognized that the proposed algorithm placed students at a disadvantage if they did not get their first choice of hospitals. Facing resistance at every step from the National Inter-association Committee on Internships and putting his standing at Harvard Medical School at risk, Hendren led a nationwide movement of medical students to change the procedure to one that favored students' choices. Their success [less than] 1 month later established in the inaugural match the fundamental ethic of today's National Resident Matching Program to favor students' preferences at every step of the process."

In my book Who Gets What and Why, I wrote about Hendren and these events in part as follows p138):
"One student who noticed this flaw in the proposed design was Hardy Hendren. He was preparing to graduate from Harvard Medical School in 1952, just as the clearinghouse was getting started. When he told me about it years later over lunch in Cambridge MA, he had already retired (in 1998) from Boston Children’s Hospital, where he had been chief of surgery. (His colleagues had given him the nickname “Hardly Human,” for the long, complicated surgeries he was able to conduct.) Hardy entered the Navy during WWII, in 1943 when he was seventeen, and trained as a pilot before returning to college and medical school. As you can imagine, with that background, as he prepared to seek his first job as a doctor, he wasn’t shy about expressing his concerns that the clearinghouse was unsafe for students.
"Hardy also wasn’t one to wait around for bureaucrats. And so, with a group of fellow students, he formed the National Student Internship Matching Committee, which organized opposition to the proposed algorithm. The Committee recommended that it be replaced with a different way of processing the preference lists to determine a match: it became known as the Boston Pool Plan. This was, in fact, the algorithm that was finally implemented when the clearinghouse was used to match students and positions in 1952."

After some discussion of stability, and the fact that the Boston Pool Plan is equivalent to the hospital proposing deferred acceptance algorithm, I wrote (p141):
"Back in 1952, economists hadn’t yet figured out any of this, which makes Hardy Hendren’s insight and his committee’s grassroots efforts all the more impressive."

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