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
[Update: the published version appears in Volume 161, Issue 6, June 2017, Pages 1728-1734]

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."

Travel bans and rank order lists for the resident match

Residency programs have to submit their rank order lists of applicants by Feb 22. Should they try to match with doctors from countries subject to a possible renewed US travel ban?

Travel Ban Confusion Complicates Match Day Decisions

"UPDATE:  The Trump administration announced February 16 that it would discontinue its legal push in appeals court to reinstate their travel ban, but would instead issue a new, revised immigration order next week. No other details were given.

As medical school students look ahead to Match Day on Friday, March 17, some international students have additional anxiety in light of the uncertainty surrounding President Trump's executive order banning travel for people in seven Muslim-majority countries.

Residency programs also have to decide whether they will hold spots for students from the targeted countries who may not be allowed to come to the United States if legal rulings change.

First comes decision day February 22, when preferences must be ranked by both programs and students.

"Some applicants are concerned that the program directors won't rank them and there's concern from programs on whether the students can begin training on time," Mona Signer, president and CEO of the National Resident Matching Program (NRMP), told Medscape Medical News.

Trump's executive order, issued on January 27, aims to prevent citizens of seven majority-Muslim countries — Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen — from entering the United States for 90 days. It suspended entry of all refugees for 120 days and barred refugees from Syria indefinitely. A federal judge has since imposed an emergency stay, halting the key parts of the executive order.

The administration's next step is unclear, but news sources have reported that Trump may take the fight to the Supreme Court or issue a revised order.

According to the Association of American Medical Colleges (AAMC), 260 medical students have applied to US residency programs from the seven countries the ban covers.

Questions include whether the ban will be reinstated, and, if it is reinstated, whether medical students would be exempted. Some worry the ban could spread to other countries. Last year, 3769 non-US citizens who studied medicine abroad matched into a US residency program, according to the American College of Physicians."

A perfect match--documentary on the medical match by Dr Trisha Pasricha

Here's a description of a forthcoming documentary on the National Resident Matching Program (NRMP), the resident match : A Perfect Match. And here's a piece on the doctor-filmmaker behind it, Dr. Trisha Pasricha, who graduated from Vanderbilt's medical school and went through the 2016 match: The Envelope, Please.

Apparently the film is scheduled for release around the time of the 2017 match, so look for it in March (Match Day will be March 17, 2017).

Match Day for new doctors

Today is Match Day, when graduating medical students find out where they will do their residency.

MAR18

Match Day!

Applicants: Medical school Match Day ceremonies at 12:00 p.m. ET. Learn where you matched in the R3 system and by email at 1:00 p.m. ET.

Programs: Match Results by Ranked Applicant and SOAP Results by Preferred Applicant reports available at 2:00 p.m. ET.

Advance Data Tables available on www.nrmp.org at 1:00 p.m. ET.

Here's an earlier WSJ story by a graduating doctor:
Match Day, the NFL Draft of Medicine
On March 18, thousands of budding doctors find out where they’ll be serving their residencies.
"As you can imagine, it is a day of high anxiety, celebration and disappointment. My classmates and I have spent the past year choosing specialties, filling out applications and interviewing with residency programs. This process has taken us to cities, hospitals and universities around the country. After years of study, we’re about to become physicians. Both our professional and personal lives hinge on the results of this algorithm.

The Match was introduced in 1952 to address many of the uncertainties of residency applications. Before, medical students had to seek residency spots by themselves. But this decentralized system was rife with coercion, favoritism and deceit. Residency programs would demand medical students accept offers before applicants could consider other options. Students and programs betrayed one another by reneging on commitments.

The Match provides structure to the process. Students apply for residency positions through a common application. Strict policies govern communication between programs and applicants, with public reporting of violations. Applicants and programs submit ranking preferences into a centralized system. The Match algorithm couples these rankings and establishes binding contracts for residency positions.

Last year saw record numbers, when nearly 35,000 applicants submitted ranking preferences for roughly 30,000 residency slots. Medical schools host ceremonies to celebrate the event. Researchers Alvin Roth and Lloyd Shapley even won the 2012 Nobel Prize in Economics for their work related to the Match."
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Here's the NRMP page on why it takes 23 days from the time preferences are submitted to announce the match results

What Happens Between Rank Order List Deadline And Match Day?

Between the Rank Order List Certification Deadline and Match Day, the NRMP conducts a rigorous review of Match data, including:

• Assessing and confirming the integrity of the data
• Conducting a final verification of applicants’ credentials
• Withdrawing applicants who are ineligible for the Match
• Transferring the data from the R3 system to the matching algorithm module, rechecking the data, processing the algorithm, and transferring data back into the R3 system
• Verifying the results of a Match and transferring the data into the NRMP databases
• Verifying applicants’ credentials for Main Residency Match SOAP participation
• Preparing 50,000 individual Match Week reports for Main Residency Match applicants, program directors, and medical schools

These steps, all completed in a few weeks, ensure the accuracy of Match results.

Here's a story on the SOAP scramble for unmatched students:https://www.statnews.com/2016/03/17/medical-students-match-day/ 

Maladaptive interviewing culture in some residency matches

Here's a paper that describes the high-pressure interviewing that goes on before the resident match for Radiation Oncology (and proposes that residency directors should behave better):

Taking “the Game” Out of The Match: A Simple Proposal
by Abraham J. Wu MD, Neha Vapiwala MD, Steven J. Chmura MD, PhD, Prajnan Das MD, MS, MPH, Roy H. Decker MD, PhD, Stephanie A. Terezakis MD and Anthony L. Zietman MD
in the International Journal of Radiation Oncology, Biology, Physics, 2015-12-01, Volume 93, Issue 5, Pages 945-948

"Holliday et al  (3)  conducted an anonymous survey in which medical students applying in Radiation Oncology reported experiencing “behaviors that conflict with written NRMP policies, either during or after interviews”  (3)  . Of those who responded, alarmingly high percentages perceived that the system can be “gamed” through actions ranging from a wink and a nod, embellished thank you notes and advocacy phone calls, all the way to overt promises and declarations of interest (the potentially disingenuous nature of which is disturbing in itself). Radiation Oncology is fortunate to attract über-competitive “top-seed” candidates with credentials that confer prestige and promise to our specialty's future  (4)  , but, it being such a competitive field, most candidates are applying to dozens of programs. Both programs and candidates have sought a way through the morass by essentially “prearranging” matches ahead of the Match deadline. Programs seek affirmation that the applicant will rank them first, and applicants, with the stress of an overwhelming process, are tying themselves into knots trying to let all the programs at which they interview feel that they will be ranking them number one. Many candidates have complicated decisions to make about their lives and genuinely do not know their program ranking until the last minute, but the pressure is on to “show their hand”  (5)  . First-year residents, when asked what it was that they found most stressful about the process, describe the subtle pressure that programs put them under “to declare” them as top of the list. The anxiety when applicants are obligated to “play the game” is immense, even cruel. An implicit requirement to declare a first-choice program may have significant practical consequences: an excellent applicant who declared a “first choice,” yet narrowly failed to match at that program, may have plummeted down the rank list of other programs unwilling to “waste” a high slot on him or her. Applicants may not be truthful in their post-interview communications (for example, telling multiple programs they are the first choice)—behavior that can never be condoned, but which the new norms incentivize. The report by Holliday et al confirms what we knew in our hearts: that the pendulum has indeed, insidiously, swung in this direction and that these behaviors are now regarded as the new normal rather than in any way deviant.
...
"From the perspective of the applicants, Jena et al  (10)  surveyed senior medical students at 7 US medical schools regarding post-interview communications with programs and uncovered that more than 85% of respondents reported communicating with programs, with nearly 60% notifying more than one program that they would rank it highly. Furthermore, students reported that programs indicated that they would be “ranked to match,” “ranked highly” (52.8%), or other similar suggestive euphemisms. Most worrisome is that nearly a quarter of applicants admitted that they altered their rank order list on the basis of these programmatic communications, and 1 in 5 who ranked programs according to these promises did not match at that program, despite ranking it first. 

Do participants try to strategize in strategy-proof mechanisms? Alex Rees-Jones surveys medical students about the NRMP.

One of the papers I heard at the recent SITE conference at Stanford was this one, reporting a survey of medical students engaged in the NRMP.

Suboptimal Behavior in Strategy-Proof Mechanisms:Evidence from the Residency Match 
Alex Rees-Jones
The Wharton School, University of Pennsylvania
August 10, 2015

Abstract: Strategy-proof mechanisms eliminate the possibility for gain from strategic misrepresentation of preferences. If market participants respond optimally, these mechanisms permit the observation of true preferences and avoid the implicit punishment of market participants who do not try to “game the system.” Using new data from a flagship application of the matching literature—the medical residency match—I study if these potential benefits are fully realized. I present evidence that some students pursue futile attempts at strategic misrepresentation, and examine the causes and correlates of this behavior. These results inform the assessment of the costs and benefits of strategy-proof mechanisms, and demonstrate broad challenges in mechanism design.

From a survey of graduating medical students: "I find that 17% of students self-assess their preference reporting strategy to be nontruthful, with 5% directly attributing this nontruthful behavior to strategic considerations."

A problem for the NRMP that may be growing

I've had correspondence and conversations with a number of residency program directors, about a common problem that may interfere with how safe they feel about rank-ordering residency and fellowship applicants according to their true preferences.

I'll quote from some emails without identifying the senders.

"I oversee the xxx residency match ....

"There is a terrible game that is going on in some surgical fields, though.  Program directors feel that it is prestigious not to go down their lists very far.  A program director may boast to his/her Chair, "This year we only needed to go down to #6 on our list to fill our (3) positions."  This ambition to not go down far on a list, as evidence that a program is highly desirable, is often achieved by pressuring candidates in the following way, "If you want to come here, you really need to let us know," which translates to "tells us we are your #1 and then you will have a chance to match here."  These actual or implied quid pro quos are a shame and pervert the intent of the match and your good work.  I know the NRMP considers them illegal or at least poor practices, but they are common, unfortunately."

**********

"I work in xxx [non-surgical specialty], which is a specialty that is very competitive for the match.  Although the system that you helped develop should match applicants and residency programs based on the rankings that applicants and programs provide according to their independent preferences, some prestigious residency programs in xxx (and likely other specialties) are being evaluated by hospital presidents or other administrative officials by how far down the rank list they must go to fill their complement of residents.  This in turn has created an environment where some programs are ranking applicants according to the likelihood that the applicant will rank the program in the top slot rather than if they believe that the applicant is truly the best applicant for their program.  While I believe that each residency  program should be able to use whatever criteria they want to for ranking applicants, the problem is that some residency program directors or department chairs are contacting applicants or faculty at which the medical students train to find out if their program is at the top of the applicant’s rank list.  This puts the applicants in an awkward position and in my opinion likely biases the match result to hurt some applicants.

In an ideal world, such behavior by residency programs could be prevented by explaining that it violates the principles of the match.  However, I am afraid that this approach will be unlikely to remove the cause of this problem: pressure that some departments feel from administrators and hospital presidents."
************

Perhaps the community (directors and NRMP) could be persuaded that residency directors shouldn’t show their rank order lists to their deans and chairs?  

Match Day 2015! 1,035 couples participated...

Congratulations to all the new docs!  Today was Match Day for the National Resident Matching Program (NRMP)

Here's a selection of stories that crossed my screen today:

Press Release: 2015 Residency Match Largest On Record With More Than 41,000 Applicants Vying For Over 30,000 Residency Positions In 4,756 Programs
" An all-time high of 1,035 couples participated in the Match, 110 more than last year, with a 94.8 percent match rate."

The fates of thousands of med school students are decided by this Nobel Prize winning algorithm

Match Day: Then & now

Matching Dreams: Students ring in the future of medicine on the first day of spring (Harvard)

Medical students open envelopes and glimpse their futures: A national event that places graduating medical students into residencies, Match Day is both a celebration and a nerve-wracking affair. (Stanford)

The residency match in Otolaryngology

A recent paper looks at the resident match in Otolarygology, in the context of the overall resident match.

State of Otolaryngology Match: Has Competition Increased since the ‘‘Early’’
Match?  by Cristina Cabrera-Muffly, Jeanelle Sheeder, and Mona Abaza, in the journal Otolaryngology--Head Neck Surgert 2015 Feb 24

"Over the past 60 years, the United States residency match process and characteristics of medical students applying to the match have changed considerably. Centralized matching of postgraduate training positions was successfully implemented nationwide in 1952.1 At that time, just over 10,000 positions were offered through the match. In the 2013 match cycle, there were almost 50 different specialties that offer PGY-1 positions through the National Residency Matching Program (NRMP) match and a total of 26,392 positions offered.2

In 2006, in response to concerns about physician shortages, the Association of American Medical Colleges (AAMC) recommended an increase in the number of medical student postions.3 There was an overwhelming response among allopathic programs in both new schools (13 have matriculated their first class since 2006) and larger class sizes in established schools, with rosters expanding 15% to 18%.3,4 Meanwhile, osteopathic medical schools have doubled in number from 15 to 30 over the past 20 years.3 Therefore, the overall number of graduating medical students has increased considerably, reaching an all-time high in 2013.5 This has a direct effect on the quantity of medical students seeking any residency position, including otolaryngology.

The otolaryngology match has also undergone several iterations since its beginnings. In late 1977, otolaryngology and ophthalmology specialties officially separated.6 In 2006, the otolaryngology match transitioned from coordination by the San Francisco match (SF match) to become part of the NRMP. This transition altered the timeline of the application process in otolaryngology and potentially affected the applicant pool. Prior to 2006, the interview season for early match was generally from October to December, with the rank list submission deadline in early January. Match notification occurred in mid-January.7 This allowed applicants who did not match to complete a separate application for other specialties, although interview periods often overlapped. Once the NRMP began coordinating the otolaryngology match in 2006, the interview season was delayed to November through January, with the rank list submission deadline at the end of February. Match notification now occurs in mid-March.8

The change from the SF match to the NRMP match occurred as the required general surgery intern year became integrated with otolaryngology residencies, eliminating the need to separately interview for a preliminary general surgery position.9 Since 2006, otolaryngology programs have an integrated intern year, eliminating the need for a separate match. The early timing of the otolaryngology match allowed for applicants who did not match into otolaryngology to apply for a different specialty during the regular match of the same year through the NRMP. Applicants participating in the couples match during the early match likely found it more difficult to coordinate match cities when one partner applied to otolaryngology and the other to a regular match specialty. It is unclear whether the competitive nature or the couples match situation was considered when the match timing was changed.

...

"Over the past 16 years, we have seen an increase in the number of US seniors applying to residency. Fortunately, during the same time period, the number of first-year residency positions in all NRMP specialties increased as well. This rate of growth of residency positions appears to be consistent with the recommendation by the Council on Graduate Medical Education, who recommended increasing the number of first-year residents to 27,000 per year by 2015.4 In the same time frame, the number of unfilled NRMP residency positions has decreased by 55.8%. These positions are being filled by non–US seniors since the overall rate of applications and matches increased while the rate of US senior applications and matches stayed constant. Non–US seniors include prior US medical school graduates and IMG. IMG includes both US citizens attending medical school outside the United States and citizens of other countries attending international medical schools. Data suggest that the IMG portion of this group is filling the additional residency positions. In 2002, 18.6% of all NRMP positions were filled by IMG, while in 2013, IMG matched into 24.8% of NRMP positions. Meanwhile, the percentage of NRMP positions filled by prior US graduates has remained stable (between 2% and 3%). The decrease in percentage of unfilled positions is also due to increased IMG matching.

...

"The advantages of the otolaryngology conventional match are the elimination of one of the interview processes (since the preliminary general surgery intern year is now included), as well as improved ability for couples to match together."

MIT News reports on a forthcoming paper by Nikhil Agarwal:

An Empirical Model of the Medical Match | Online Appendix
American Economic Review, forthcoming
(NBER Working Paper 20767 - includes analysis of government interventions for rural programs)

Here's the MIT News report:

Is the medical match fair?

Study finds the demand for positions strongly influences medical residents’ salaries.

Peter Dizikes | MIT News Office
January 27, 2015

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COMMENT

When medical-school graduates apply for their residencies, they use a centralized clearinghouse that matches applicants with jobs. This system has sometimes been challenged, such as in a lawsuit several years ago that claimed salaries of residents were reduced by this centralized matching method.

But a forthcoming study by an MIT economist indicates that demand for a limited number of desirable residency positions can keep salaries low — and introduces a new way of assessing that demand despite incomplete data that has previously restricted analysis of the issue.

“Salaries will likely remain low unless residency programs can increase the number of positions,” says Nikhil Agarwal, an assistant professor of economics at MIT, and author of the paper on the subject.

On average, Agarwal’s study finds, salaries of medical residents are lowered by an average of $23,000 due to the demand for slots. As the study puts it, residents are willing to accept an “implicit tuition” in their wages in return for experience and prestige. In the long run, residencies may be a worthwhile tradeoff for doctors establishing themselves in the profession, even with seemingly reduced wages.  

Determining demand

Agarwal’s paper, to be published in the American Economic Review, is based on data from 2003 to 2011 gathered by the National Graduate Medical Education census.

The central clearinghouse — the National Residency Matching Program (NRMP) — matches about 25,000 medical residents annually. Incoming residents rank the positions they would most like to have, and an algorithm matches these choices with the ranked preferences of the medical programs.

A 2002 lawsuit asserted that the residents have limited bargaining power because they are assigned to positions and cannot receive multiple job offers, unfairly lowering their compensation. That suit was eventually dismissed in 2004, a few months after Congress passed an antitrust exemption for the NRMP system.

But that resolution of the lawsuit did not resolve the question of whether or not the clearinghouse does affect residency salaries. As of 2010, residents had a mean salary of about $47,000, compared to $86,000 for physician assistants, who do comparable work. Medical residents also have notably long workweeks and shifts, which themselves are the subject of intermittent public debate.

Agarwal’s study finds a new way of analyzing the compensation issue in the face of limited information. He did not have access to the ranked lists of jobs that applicants submit to the NRMP, nor to the lists of preferred candidates that medical programs submit. Even so, Agarwal was able to study the matched pairs of residents and positions, along with some additional descriptive data, such as geographic location, and determine demand on that basis.

The key to the analysis, Agarwal says, is “the fact that there are multiple residents in the same program. That tells you a lot about the residency program’s preferences for residents. Once you figure out that side of the market, you’re in business.”

For instance, Agarwal adds, “If a program [decides] to hire residents from [highly ranked] medical schools with similar licensing-exam test scores, then everybody it’s matched with will be similar on those characteristics. But if it doesn’t care about prestige of the medical school as much, there might be people from all kinds of medical schools, but their licensing-exam scores will be similar.” Partly by building a picture of those preferences and measuring it against the characteristics of the class of applicants, it is possible to estimate how many qualified applicants are available for residency positions.

An ‘imperfect’ market

An underlying implication of Agarwal’s conclusions is that the idea of a perfectly competitive, uniform market driving salaries does not ultimately hold up to scrutiny when it comes to medical residencies. There appear to be clumps of jobs considered particularly desirable, leading to uneven relationships between supply and demand within the overall residency job market.

“In [my] theory, you get a situation where people are not indifferent” in terms of job preferences, Agarwal notes.

For his part, Agarwal, who focuses on the growing field of market design, believes this method of determining preferences can be applied to other domains as well.  He is continuing to do research in the area of school choice, among other topics.

Maybe I didn't ruin the medical labor market after all

In a recent post I remarked on a Forbes blog post by a medical student at the University of Texas Southwestern Medical School who proposed that it would be better if the medical Match, the NRMP, didn't exist, because then medical students would be able to freely choose the job they wanted. That's how free markets work, as she understands them.

Now, in the same blog, three of her classmates point out that things might not work that way...Why The Residency Matching System For Newly Minted M.D.'s Still Works

And (still in the same Forbes blog) another medical student, Jack DePaolo responds similarly: Sorry, Medical Students, But You're Not Entitled To Your Dream Job

All in all, this subsequent discussion is good news, it means that we economists aren't doing quite as bad a job explaining to the general public (and to medical students) how markets work and what they do, as it might have appeared from that first contribution.

Did I ruin the medical labor market?

Students of economics are sometimes surprised that many of the things they know aren't known by everyone.

So a number of people have emailed me the blog post on the Forbes magazine web site that is headlined How A Nobel Economist Ruined The Residency Matching System For Newly Minted M.D.'s, and subtitled Match Magic: How One Economist Hurt Physicians and Patients.

In it, a graduating medical student who apparently just went through the Match a month ago argues that she would have done much better if there hadn't been a match, since then she could have picked a better job, in a nicer city, at a much higher wage. And she would have been spared the expense and inconvenience of interviewing. Because in a free market you are free to choose the job you want. That's the way economists get their jobs, she concludes.
******

A quick search of the web quickly reveals that other docs have a different view of the match and of markets more generally. Here's a post from a blog site called Skeptical Scalpel, which begins this way

"A blog post entitled "How a Nobel Economist Ruined the Residency Matching System for Newly Minted MDs" appeared on the Forbes website. In it, Amy Ho, the medical student author, lists all the things she considers wrong with the National Resident Matching Program (the "Match").

"I would have commented about this on the site itself except that I have a lot to say, and in order to post a comment, I would have had to agree to allow Forbes to post tweets in my name. No, thanks.

"The title of the post is misleading. As the author noted, the Match as been around since 1952. It was established to make the process of finding a residency position fair for all graduating medical students. Alvin Roth, the economist who shared a Nobel Prize based in part on his work with the Match algorithm, simply refined the process in the 1980s and 1990s to make it even more fair. Roth didn't ruin the Match; he made it better.

"Ms. Ho blames the Match for the fact that 25% of those enrolled in 2014 failed to obtain a residency position. But even if the Match did not exist, there would still have been more than 34,000 people seeking some 26,000 positions, and 8000 doctors would not have found jobs..."
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The NRMP data are here: http://www.nrmp.org/wp-content/uploads/2014/03/2014-NRMP-Main-Residency-Match-Advance-Data-Tables-FINAL.pdf 
94.4% of seniors at U.S. medical schools were matched in the main match. (Table 4).

Today is match day (for medical residents)

Here's the press release: U.S. Medical Students Learn 2014 National Resident Matching Program (NRMP) Main Residency Match Day Results in Ceremonies Today

"In the 2014 NRMP Main Residency Match results released today, more than 16,000 U.S. medical school seniors are among the 25,687 applicants who successfully matched to first-year residency positions. Students receive Match results today at their medical school Match Day ceremonies.

Washington, D.C. (PRWEB) March 20, 2014

Embargoed for release until 1:00 PM EDT, March 21, 2014

The National Resident Matching Program®(NRMP®) 2014 Main Residency Match® results released today show that 16,399 U.S. allopathic medical school seniors have matched to first-year residency positions. U.S. seniors around the country will celebrate these results at Match Day ceremonies being held today. Match Day is an annual rite of passage for U.S. medical school students and other applicants, a day when they learn at which U.S. residency programs they will train for the next three to seven years.

This year, the Match offered 29,761 first- and second-year positions, 500 more than in 2013 and an all-time high. More than half of the additional positions were in the primary care specialties of Internal Medicine and Family Medicine. According to NRMP Executive Director Mona M. Signer, the 2014 numbers continue a steady trend of position growth. In the past five years alone weve seen an increase of more than 4,000 positions, and more than half of those are in Internal Medicine and Family Medicine, Signer said.

Although the total number of registrants increased in 2014, the number of U.S. seniors declined. Eighty-nine fewer seniors registered for the Match and 113 fewer submitted rank order lists of programs. Thats a surprise, said Signer. She added, The good news is that the number of U.S. seniors choosing primary care continued to increase modestly, with 3,167 seniors matching in Internal Medicine and 1,398 in Family Medicine. An additional 1,818 seniors matched in Pediatrics, 19 fewer than last year.

Match Rates for Applicant Groups
This years Match included 40,394 registrants, 59 more than last year; however, 85 fewer applicants submitted rank order lists of programs. With more positions and fewer applicants competing for them, match rates rose for all key applicant groups. The overall match rate to first-year positions was 75 percent, the highest since 2006. The match rate for U.S. seniors was 94.4 percent, 0.7 percentage points higher than last year. Of the applicants who matched, 54 percent of U.S. seniors and almost 50 percent of all other applicants matched to their first choice for training.

Prior-year graduates of U.S. allopathic medical schools, students and graduates of osteopathic (D.O. degree) schools, and students and graduates of international medical schools represent the other key applicant groups who submitted rank order lists of programs:

    1,662 previous graduates of U.S. allopathic medical schools, an increase of 175 over last year; their match rate of 48.0 percent rose 7.2 percentage points
    2,738 osteopathic students/graduates, an increase of 61 over last year; their match rate of 77.7 percent was 2.9 percentage points higher than last year
    5,133 U.S. citizen students/graduates of international medical schools, 38 more than last year; their match rate of 53.0 percent was an increase of 0.2 percentage points
    7,334 non-U.S. citizen students/graduates of international medical schools, 234 fewer than last year; their match rate of 49.5 percent was an increase of 2.5 percentage points
Primary Care Specialty Trends and Position Fill Rates

With the total number of positions reaching an all-time high, increases were noted in the number of primary care programs and positions offered in the Match:

    Internal Medicine programs offered 6,524 positions, 247 more than in 2013; 99.1 percent of positions filled, and 48.5 percent filled with U.S. seniors
    Family Medicine programs offered 3,109 positions, 72 more than in 2013; 95.8 percent of positions filled, and 45 percent filled with U.S. seniors
    Pediatrics programs offered 2,640 positions, 24 more than last year; 99.5 percent of positions filled, and almost 70 percent filled with U.S. seniors
The most competitive specialties were Neurological Surgery, Orthopedic Surgery, Otolaryngology, Plastic Surgery, and Radiation-Oncology, specialties that offered at least 50 positions in the Match and filled at least 90 percent with U.S. seniors.

Applicants who did not match to a residency position participate in the NRMP Supplemental Offer and Acceptance Program (SOAP). During SOAP, the NRMP makes available the locations of unfilled positions so that unmatched applicants can apply for them using the AAMC Electronic Residency Application Service® (ERAS). This year, 1,075 of the 1,181 unfilled positions were offered during SOAP.

Couples in the Match

The NRMP allows any two applicants to participate in the Match as a couple. Participants who enter the Match as a couple agree to have their rank order lists of preferred residency programs linked to each other so they can try to match to a pair of programs that suits their needs. This year, 925 couples participated in the Match and 843 of them matched to their residency program preferences.

Match Day Ceremonies

Match Day ceremonies begin at 12:00 p.m. EDT on Friday, March 21, at U.S medical schools. Contact your local medical school for details and photographs or videos from their Match Day ceremonies.

The NRMP Match
The Match uses a computerized mathematical algorithm to align the preferences of applicants with the preferences of residency program directors in order to fill training positions available at U.S. teaching hospitals. Research on the NRMP algorithm was a basis for awarding The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel in 2012."

MIT news on the couples match for doctors

MIT news does a good job of science reporting (and of celebrating Parag Pathak)...

Doctor, doctor: Why the job market for married couples in medicine works well

New study in the growing ‘market design’ field of economics explains how a job-market algorithm helps land couples in the same locations.

The Algorithm of Happiness...

Elliott Peranson sends me the following note:

The NRMP has redone their web site at www.nrmp.org. Check out their new tagline on the home page. Sounds more appealing than the "Roth-Peranson Algorithm". 

2013 Results and Data Book from NRMP’s Main Residency Match

Here's the press release: 2013 Results and Data Book from NRMP’s Main Residency Match, and here's the data book for the 2013 Match

The data book also reports on the second year of the new SOAP scramble, but not in the same detail as last year's report. Last year I predicted that more of the visible action would move to the first round (reflecting more action before the beginning of the official scramble), but this year's data book doesn't give that information.

Here's the press release, though, which gives a good overview of the data, which seem to reflect a successful match year.

The National Resident Matching Program® (NRMP®) is pleased to announce the publication of its Results and Data 2013 Main Residency Match --- the most comprehensive Match data resource produced annually by the NRMP. The report provides statistics on the most successful Match in NRMP history, in which 28,130 of 29,171 available residency positions were filled.    

Included in the report are statistical tables and data graphs from the Main Residency Match and a state by state breakdown of each participating U.S. residency training program, with the number of positions offered and filled for each. This year, for the first time, the report includes results and charts from the Match Week Supplemental Offer and Acceptance Program® (SOAP®)-- the process used by NRMP for unfilled residency positions.

This year’s Results and Data Book is notable because the 2013 Match was the first to utilize NRMP’s All In Policy, which requires participating programs to register and attempt to fill all their positions through The Match.

NRMP Executive Director Mona M. Signer said, “Readers of the 2013 Results and Data Book will see the overwhelming success of the All In Policy. The 2013 Match produced the highest fill rate in NRMP history, and match rates rose for nearly every applicant group.”

Results and Data 2013 Book Facts

Applicant Numbers (Comparisons to 2012) 

• 40,335 registrants (1,958 more)
• 34,355 active applicants (3,000 more)
• 17,487 U.S. allopathic medical school seniors (960 more)
• 2,677 osteopathic medical school students/graduates (317 more, highest ever)
• 5,095 U.S. citizen international medical school students/graduates (U.S. IMGs) (816 more)
• 7,568 non-U.S. citizen international medical school students/graduates (IMGs) (740 more)

Applicant Match Rates 

• 74.1 percent of all applicants were matched to PGY-1 positions
• 93.7 percent of U.S. allopathic seniors matched to PGY-1 positions; of those, 78.8 percent matched to one of their top three choices
• 53.1 percent of U.S. IMGs were matched to PGY-1 positions, up from 49.1 percent in 2012 and the highest Match rate for this applicant group since 2005
• 47.6 percent PGY-1 Match rate for IMGs, an increase of seven percentage points from 2012

Increased Positions/High Fill Rates
Available residency positions increased to 29,171, 2,399 (9 percent) more than in 2012, when 26,772 positions were offered. The increase is due primarily to implementation of the All In Policy, which resulted in some specialties offering significantly more positions in 2013. Internal Medicine offered 1,000 more positions, Family Medicine offered 297 more, and Pediatrics offered 141 more than the prior year.

The overall position fill rate increased 1.1 percentage points to 96.4 percent, the highest in NRMP history. In 2013, only 1,041 first-year and second-year positions were unfilled; of those, 939 were placed in SOAP, and all but 61 were filled.

Notable Specialties
Often Match results can be an indicator of competitiveness. This year, several specialties and specialty tracks had 100 percent fill rates: 

• Medicine Emergency Medicine
• Pediatrics Primary
• Pediatrics/Psychiatry/Child Psychiatry
• Physical Medicine and Rehabilitation – Post graduate year one (PGY-1)
• Plastic Surgery – Post graduate year two (PGY-2)
• Psychiatry Family Medicine
• Radiation Oncology (PGY-1)
• Thoracic Surgery

The following specialties filled more than 90 percent of positions with U.S. seniors: 

• Plastic Surgery: 95.7 percent
• Otolaryngology: 94.5 percent
• Neurological Surgery: 93.1 percent
• Orthopedic Surgery: 91.8 percent

Couples in the Match
In 2013, a record 1,870 applicants (935 couples) participated in the 2013 Match. They continued to enjoy great success with a match rate of 95.2 percent. Couples have been able to participate together in The Match since 1984. The two partners identify themselves as a couple to the NRMP and submit rank order lists of identical length. The algorithm treats their lists as a unit, matching the couple to the highest linked program choices where both partners match.

SOAP - Supplemental Offer and Acceptance Program
The NRMP launched the Match Week SOAP in 2012 to replace the "Scramble" and to streamline the process for unmatched applicants and the directors of unfilled programs. During SOAP, eligible applicants use ERAS® to apply to programs with unfilled positions and offers are extended to applicants based upon the number of unfilled positions remaining in the program.

U.S. seniors accepted the majority of positions (595 of 878) filled during SOAP. More than 13,808 applicants were SOAP-eligible, 261 more than in 2012. This year, 406 unfilled programs elected to participate in SOAP, offering 939 of the 1,041 positions not filled when the matching algorithm was processed.

A total of 1,327 offers were sent to applicants. By the conclusion of SOAP, 93.5 percent (878 of 939) of the positions had been filled.

How the Match Works
Conducted annually by the NRMP, The Match uses a computerized mathematical algorithm to align the preferences of applicants with the preferences of residency program directors in order to fill the training positions available at U.S. teaching hospitals. Research on the NRMP algorithm was a basis for Dr. Alvin Roth’s receipt of the 2012 Nobel Prize in Economics.

# # #
The National Resident Matching Program® (NRMP®) is a private, non-profit organization established in 1952 at the request of medical students to provide an orderly and fair mechanism for matching the preferences of applicants for U.S. residency positions with the preferences of residency program directors. In addition to the Main Residency Match, the NRMP conducts matches for more than 40 subspecialties. For more information, contact NRMP at 1-866-653-NRMP (6767) or visit http://www.nrmp.org. For interviews, please email cherbert@nrmp.org.

Read more: http://www.digitaljournal.com/pr/1278215#ixzz2V7ttPAqX

Match Day today for new doctors

Good luck to all those matching today!

Here's the Wall Street Journal's anticipatory story: New Doctors Eagerly Await 'Match Day'

"The National Resident Matching Program, the nonprofit group that pairs applicants with openings, expects this year's match to be the largest ever, surpassing last year when 31,355 U.S. and foreign applicants vied for 24,035 first-year residency openings."

Here's the NRMP's press release:

The National Resident Matching Program® (NRMP®) will announce the 2013 medical residency Match results for more than 17,000 United States allopathic medical school seniors and more than 16,000 other applicants on Friday, March 15, 2013 at 1:00 p.m. EDT. Match Day, an annual rite of passage, is when medical school students learn where they will live and train for the next three to seven years at their medical residency programs.

“It’s a wonderful and exciting day,” said Mona M. Signer, executive director of the NRMP. She added, “We are honored to play a small role each year in moving forward the careers of young physicians.”

U. S. senior medical students typically begin the residency application process at the beginning of their final year in medical school. After they apply to programs, programs review applications and invite selected candidates for interviews, which are held in the fall and early winter. Once the interview period is over, both parties create rank-order lists. Programs rank applicants in order of preference, and applicants compile their lists based on their preferred medical specialty and the location of the training programs.

The NRMP matching algorithm pairs the preferences of applicants with the preferences of residency programs, producing a “best result” in order to fill the available training positions at U.S. teaching hospitals. Research about the NRMP algorithm was a basis of Dr. Alvin Roth’s receipt of the 2012 Nobel Prize in Economics.

Students and graduates of international medical schools, osteopathic (D.O. degree) schools, and Canadian candidates also participate in the Match. Last year more than 38, 377 applicants vied for positions, and the NRMP reported a 95% successful NRMP Match result for U. S. seniors.

For more information on this year’s Match results, please visit http://www.nrmp.org after 1:00 p.m. EDT on Friday, March 15, or contact your local medical school for details on their Match Day ceremonies.

Here's the schedule:

March 15, 2013	Match Day! Match results for applicants are posted to Web site at 1:00 p.m. eastern time. Supplemental Offer and Acceptance Program (SOAP) concludes at 5:00 p.m. eastern time.
March 16, 2013	Hospitals begin sending letters of appointment to matched applicants after this date.

First year of the new medical residency scramble, SOAP

I've written before about the new Supplemental Offer and Acceptance Program (SOAP), and the National Resident Matching Program has now released a report on its first year of operation.

There were 1,100 unfilled first year positions at the end of the main match, and 815 unmatched seniors graduating from U.S. medical schools (and many more unmatched applicants when foreign medical schools are included). Most of the unmatched positions were in family medicine and in "preliminary" rotations in surgery and internal medicine.

After the first day of the SOAP exploding offer process (i.e. after two rounds of exploding offers), only 267 positions remained, and 98 of these remained unfilled. So, most of the action happened the first day.

Medical schools complained that students were asked to "commit" to programs prior to receiving an offer, and thought that rounds should be longer. Residency programs thought rounds should be shorter.

In line with the criticisms of the design offered earlier (see here), I anticipate that next year more students will be asked to "commit" before receiving an offer (even though it's against the rules), and that even more of the action will be concentrated in the first day and the first round, with more of the market shifting out of the formal scramble, either officially or de facto, through the offline "commitment" process....

As I was quoted saying last year (see here), "If it's really, really tempting for people on both sides to break the rules," says Roth, "often the rules get broken."


HT: Nikhil Agarwal

NRMP to require participating programs to include all positions in the match

NRMP TO IMPLEMENT "ALL-IN" POLICY

"At its May 16, 2011 meeting, the NRMP Board of Directors voted unanimously to require programs participating in the Main Residency Match to place all positions in the Match. The so-called "All-In" Policy will become effective for the 2013 Match that opens for registration on September 1, 2012. The policy will affect all PGY-1 positions and PGY-2 positions in advanced programs.
The NRMP will continue to accept comments on implementation of the policy, especially as it relates to possible exceptions for residents who enter training off-cycle, GME programs in rural and geographically underserved areas, combined clinical-research programs, and accelerated programs. Final implementation rules will be adopted in May 2012. Read how to submit comments to the NRMP."
**********

The accompanying document includes the following background information, which suggests that at least some positions have matched early (e.g. to the 567 applicants who were withdrawn at "applicant's request"):

HT: Nikhil Agarwal

Medical residency scramble

Dr.  Naveed Saleh, writing in New Physician, describes some of the different prognoses suggested for the new resident scramble (SOAP) which will operate next year: Unscrambling the Match.

"Roth predicts that the rules of the SOAP will be subverted by both programs and applicants eager to match. "If it's really, really tempting for people on both sides to break the rules," says Roth, "often the rules get broken."
Roth suggests that instead of the SOAP, the NRMP and ERAS should institute a properly organized second match during Match Week.
Mona M. Signer, executive director of the NRMP, disagrees with Roth's prediction that decision-making during the SOAP will be strategic. Instead, she predicts that programs and applicants will continue to pursue their best opportunities. Additionally, as with the Match, should a program or applicant violate prescribed rules, sanctions would be imposed.

My previous posts on the residency scramble, and the proposed new rules are here.