French medical residents struggle without a way for couples to match together

 Esther Duflo sent me a link to the story below in Le Monde, describing the difficulty facing married doctors in France who wish to match to first jobs in the same city.

If I understand correctly, the old system ranked students by their exam results on the  épreuves classantes nationales (ECN), after which the students  then chose among the jobs available to them in rank order. A couple could decide to choose jobs at the same time, by waiting till the turn of the worse ranked member of the couple.  In this way they could choose two jobs in the same city.  But a new system ranks doctors differently, by specialties, and resolves itself for everyone at the same time. So couples can now have no way to assure themselves of being matched in the same city. 

Here's the article (which I sense isn't completely clear either in English translation or in the original French): 

"We are pawns to be moved": the geographical conundrum of medical intern couples
Since the last reform of medical studies, the algorithm that distributes future interns in the university hospitals of France no longer guarantees their assignment in the same city as their partner.  By Diane Merveilleux 

" Since 2023, the three-day ECNs giving rise to a single national ranking have been replaced by a sixth year punctuated by tests in the form of multiple-choice questions (MCQs) in October, then oral exams in the spring, which make it possible to establish 13 rankings by specialty groups.

"When summer comes, each student makes up to 80 wishes, a wish corresponding to a specialty in a city. Then an algorithm makes it possible to assign each person an assignment according to the ranking of their wishes. This algorithm will run eight times, each time simulating a final result and allowing students to adapt their wishes and review their ambitions. Their final assignment falls at the same time for everyone, at the end of the last round, in September. They are then hired for four to six years of boarding in the same place, without any possibility of change.

"For young medical couples, this is where the problem lies: those who would like to spend these years in the same city have no way of being sure.

...

"Thus, until 2023, the national ranking led students to choose their assignment one after the other – the first, then the second, and so on. In this configuration, the member of the couple who had obtained the highest score could "downgrade" themselves to join their partner's level so that they could make their decision at the same time. "Today, this downgrading is no longer possible, it's the very principle of the algorithm: we have a system that is totally different," says Philippe Touzy."

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It seems that the couples algorithm that they have abandoned is much more primitive than the Roth-Peranson algorithm* now used in the American medical match, which allows couples to submit much more expressive joint preferences over pairs of jobs.

As it happens, just a few years ago there was a proposal for a two-part match that would have inadvertently disabled the US couples match.  Itai Ashlagi and I were able to convince the American Medical Association (which had sponsored the proposal) that it was a bad idea.  We ran the match under a variety of conditions.  So Itai  has an efficient implementation of the Roth-Peranson algorithm available if it could be helpful in France.

Here’s a blog post about that…

Friday, April 21, 2023

Transition from medical school to residency: defending the parts that work well (namely the NRMP Resident Match)

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 From     Roth, Alvin E. "What have we learned from market design?" Reprinted with a postscript in The Handbook of Market Design, Nir Vulkan, Alvin E. Roth and Zvika Neeman editors, Oxford University Press, 2013, Chapter 1, 7-50