When a couple needs two career-track jobs, they face a hard problem of coordination with each other and with their prospective employers. If they are in different industries, they need to find a four-way match, between the two of them and two different employers. If they are academics, they can at least try to find two jobs at the same university, but if they are in different disciplines the negotiations will involve different departments (and maybe different schools, i.e. different deans), and so the search and negotiation process can be complex, and can still involve potentially very different timing of searches and hiring.
The Chronicle of Higher Ed has a first person account of one such struggle, that ended successfully with two tenure-track assistant professorships at the same university: Lessons of a Dual Hire.
The (pseudonymous) author writes:"After three years of job searching for me in the geological sciences, and four years for my husband in engineering, we successfully maneuvered this year to find two tenure-track positions at the same university. Here's how it happened."
The article goes on to explain some of the difficulties that were overcome in the most recent, successful job search.
Here are two earlier related posts, both of which touch on my work on making the clearinghouse for new doctors, the National Resident Matching Program, more friendly to couples.
Job market for couples (which concerns law schools hiring of couples); and
Match Day for new doctors, which is specifically about couples who are both seeking jobs as new doctors.
Even the medical clearinghouse doesn't do much to help doctors whose spouses have non-medical careers (or even doctors whose spouses have medical careers with different years of graduation from medical school). Some years ago, I was asked to respond to an essay from a doctor's spouse which suggested that maybe the market would work better without a match, i.e. without any centralized clearinghouse. That essay, and my reply, were published in an online student edition of JAMA that no longer exists, on web pages that are no longer maintained. However I am linking to them below, on the remarkable internet archive also known as the Wayback Machine.
Mismatch, by Betsy Brody, University of Notre Dame
Response to Betsy Brody's "Mismatch" by Alvin E. Roth (both originally in MSJAMA, April 7, 1999.
Rereading my response, I would have written it a bit differently today, but the basic point still seems right. But two-career searches are tough, no doubt about it.
Showing posts with label doctors. Show all posts
Showing posts with label doctors. Show all posts
Thursday, September 10, 2009
Monday, September 7, 2009
Exploding offers
My favorite exploding offer story is probably this one:
"I received the offer via voicemail while I was in flight to my second interview. The judge actually left three messages. First, to make the offer. Second, to tell me that I should respond soon. Third, to rescind the offer.
It was a 35 minute flight." −2005 applicant for federal judicial clerkships (p448 of "The New Market for Federal Judicial Law Clerks" )
Exploding offers can have a malign effect on market performance. Here's a just-published experimental investigation that focuses on how exploding offers contribute to the unraveling of a market:
Niederle, Muriel, and Alvin E. Roth, “Market Culture: How Rules Governing Exploding Offers Affect Market Performance," American Economic Journal: Microeconomics, 1, 2, August 2009, 199-219.
(In case you were always wondering how lawyers and gastroenterologists are similar, and different, these two papers will give you some clues, at least for when they are looking for jobs...)
Here's the Abstract of the AEJ Micro paper: Many markets encounter difficulty maintaining a thick marketplace because they experience transactions made at dispersed times. To address such problems, many markets try to establish norms concerning when offers can be made, accepted and rejected. Examining such markets suggests it is difficult to establish a thick market at an efficient time if firms can make exploding offers, and workers cannot renege on early commitments. Laboratory experiments allow us to isolate the effects of exploding offers and binding acceptances. In a simple experiment, we find inefficient early contracting when firms can make exploding offers and applicants’ acceptances are binding.
Wednesday, August 12, 2009
British professions
The London Times reports on a British government report on the socioeconomic background of new lawyers, doctors, journalists, and accountants: Top professions 'operate closed shop to exclude the poor'
"Law, medicine and other professions have become more exclusive in the past 30 years, drawing recruits from better off, middle-class families, a government report has found.
Other former trades, such as journalism, have evolved into “modern professions”. They are increasingly colonised by middle-class graduates and offer fewer opportunities for young people with lesser qualifications to get a foot on the ladder.
Barriers to all professions, traditional and modern, have also sprung up — most notably internships — making it even more difficult for children from poor backgrounds with few connections to break in.
The report on access to the professions was commissioned by Gordon Brown and written by Alan Milburn, the former Health Secretary. He said traditional and modern professions had a “closed shop” mentality, blocking mobility and shutting their doors to children from poorer backgrounds."
...
"Professions should also be obliged to report to ministers on how they offered internships. In recent years these unpaid and often lengthy periods of work experience have become the gateway to the best jobs. Mr Milburn said that too often such placements depended on who you knew.
The report revealed that the law is the most exclusive profession. Lawyers who entered the profession in the 1990s typically grew up in families with incomes 64 per cent above average. Those starting out in the 1970s came from homes with incomes 40 per cent above average. Three quarters of judges and two thirds of top barristers are privately educated. “Modern professions”, such as journalism, are not far behind, with degrees and even postgraduate qualifications and an internship now the norm for entry.
Most journalists and broadcasters are from wealthy families and more than half have been privately educated. Forty years ago, only a tiny proportion of journalists were from privileged backgrounds and most worked their way up.
Accountancy is another new preserve of the middle classes. Forty years ago accountants starting work came from families on average incomes but 20 years later in the 1990s, accountants came from families on incomes 40 per cent above average. "
"Law, medicine and other professions have become more exclusive in the past 30 years, drawing recruits from better off, middle-class families, a government report has found.
Other former trades, such as journalism, have evolved into “modern professions”. They are increasingly colonised by middle-class graduates and offer fewer opportunities for young people with lesser qualifications to get a foot on the ladder.
Barriers to all professions, traditional and modern, have also sprung up — most notably internships — making it even more difficult for children from poor backgrounds with few connections to break in.
The report on access to the professions was commissioned by Gordon Brown and written by Alan Milburn, the former Health Secretary. He said traditional and modern professions had a “closed shop” mentality, blocking mobility and shutting their doors to children from poorer backgrounds."
...
"Professions should also be obliged to report to ministers on how they offered internships. In recent years these unpaid and often lengthy periods of work experience have become the gateway to the best jobs. Mr Milburn said that too often such placements depended on who you knew.
The report revealed that the law is the most exclusive profession. Lawyers who entered the profession in the 1990s typically grew up in families with incomes 64 per cent above average. Those starting out in the 1970s came from homes with incomes 40 per cent above average. Three quarters of judges and two thirds of top barristers are privately educated. “Modern professions”, such as journalism, are not far behind, with degrees and even postgraduate qualifications and an internship now the norm for entry.
Most journalists and broadcasters are from wealthy families and more than half have been privately educated. Forty years ago, only a tiny proportion of journalists were from privileged backgrounds and most worked their way up.
Accountancy is another new preserve of the middle classes. Forty years ago accountants starting work came from families on average incomes but 20 years later in the 1990s, accountants came from families on incomes 40 per cent above average. "
Friday, July 10, 2009
Market for doctors: work rules for surgical residents
Surgical residents are young doctors in training, and there is an ongoing conflict playing out between perceptions of their training needs and patient well being and safety. The Boston Globe reports: MGH cited on surgeons' overload, Trainees' hours exceed safety rule; Hospital says it has fixed problem.
"Junior surgeons at Massachusetts General Hospital have been working too many hours, in violation of patient safety rules, according to a national accrediting organization that is threatening to put the hospital’s surgery training program on probation.
The Accreditation Council for Graduate Medical Education cited the hospital because a significant number of its surgeons in training, known as residents, were exceeding hour limits and working seven days straight. The organization believes these workloads contribute to fatigue-related mistakes, and has given the hospital until Aug. 15 to fix the problem."
...
" But five years after the hour restrictions were adopted, Warshaw and other surgeons said frustration is building at the nation’s teaching hospitals, because residents believe the rules interfere with their work and ultimately may harm, rather than help, patients.
The council acknowledged the tension in its April 13 letter to Mass. General, in which reviewers wrote: “The greatest challenge . . . has been getting the culture of the residents to change.’’
..." Dr. Thomas Nasca, head of the accreditation council, lamented in a letter to training programs earlier this year that residents are placed in an “ethical quandary’’ because “we compel them to lie [about their hours] if they do the right thing for their patients.’’
Still, the council is stepping up enforcement, and 5 percent to 10 percent of surgery programs were cited last year, including many of the country’s most prestigious training programs. Beth Israel Deaconess Medical Center was threatened with probation last year, but has since reined in residents’ workloads."
...
"Surgeons are adamantly opposed to tougher limits, saying there is little evidence that sending residents home after a prescribed work shift has improved patient care and that the rules actually may be hurting residents’ education. General surgery residents need to complete at least 750 cases during their five-year training so they are ready to operate on their own once they finish.
Any change would also have financial implications for teaching hospitals, where the nation’s 107,000 residents provide the majority of care."
I haven't done any work related to residents' work rules, but I've done a lot of work related to how residents get hired....
"Junior surgeons at Massachusetts General Hospital have been working too many hours, in violation of patient safety rules, according to a national accrediting organization that is threatening to put the hospital’s surgery training program on probation.
The Accreditation Council for Graduate Medical Education cited the hospital because a significant number of its surgeons in training, known as residents, were exceeding hour limits and working seven days straight. The organization believes these workloads contribute to fatigue-related mistakes, and has given the hospital until Aug. 15 to fix the problem."
...
" But five years after the hour restrictions were adopted, Warshaw and other surgeons said frustration is building at the nation’s teaching hospitals, because residents believe the rules interfere with their work and ultimately may harm, rather than help, patients.
The council acknowledged the tension in its April 13 letter to Mass. General, in which reviewers wrote: “The greatest challenge . . . has been getting the culture of the residents to change.’’
..." Dr. Thomas Nasca, head of the accreditation council, lamented in a letter to training programs earlier this year that residents are placed in an “ethical quandary’’ because “we compel them to lie [about their hours] if they do the right thing for their patients.’’
Still, the council is stepping up enforcement, and 5 percent to 10 percent of surgery programs were cited last year, including many of the country’s most prestigious training programs. Beth Israel Deaconess Medical Center was threatened with probation last year, but has since reined in residents’ workloads."
...
"Surgeons are adamantly opposed to tougher limits, saying there is little evidence that sending residents home after a prescribed work shift has improved patient care and that the rules actually may be hurting residents’ education. General surgery residents need to complete at least 750 cases during their five-year training so they are ready to operate on their own once they finish.
Any change would also have financial implications for teaching hospitals, where the nation’s 107,000 residents provide the majority of care."
I haven't done any work related to residents' work rules, but I've done a lot of work related to how residents get hired....
Wednesday, May 13, 2009
Market for concierge health care
Is it hard to get an appointment with your doctor, who must see patients every fifteen minutes? Perhaps you are in the market for concierge health care (as described in these two stories, one from 2005 and one from this past Sunday):
For a Retainer, Lavish Care by 'Boutique Doctors'
Despite Recession, Personalized Health Care Remains in Demand
"One promise made to patients paying for concierge service is that waiting will not be a part of their health care experience. Patients are guaranteed that phone calls will be returned promptly, appointments will be scheduled on a same-day basis if necessary, and appointment times will be honored. ...
"A relatively simple tradeoff is responsible: the extra fees collected from patients let concierge doctors, who leave regular practice for concierge medicine, slash their caseloads. Before Dr. Kaminetsky became a concierge doctor five years ago he had 2,500 patients in his practice - a standard number for most primary care internists. His list now numbers 600. "
"The practices typically charge at least $1,500 a year, with the most elite services asking $25,000 or more per family. The fees cover a thorough physical exam and enable physicians to limit the number of patients they see so they can provide premier service. "...
"Critics of concierge medicine consider it elitist and say it has widened the already significant class disparities in American medicine. They also say it has exacerbated the shortage of primary care physicians by leaving more patients to be treated by a shrinking pool of doctors.
But advocates counter that the concierge movement reflects deep exasperation with the two-hour waits and 10-minute appointments of conventional primary care. Given the burnout among physicians who must see more than two dozen patients a day, they say the concierge model may sustain doctors who would otherwise hang up their stethoscopes.
Dr. Thomas W. LaGrelius of Torrance, Calif., who leads the Society for Innovative Medical Practice Design, a professional association of concierge physicians, estimated that there were 5,000 such doctors in the United States, out of an estimated 240,000 internal medicine physicians and related subspecialists. "
For a Retainer, Lavish Care by 'Boutique Doctors'
Despite Recession, Personalized Health Care Remains in Demand
"One promise made to patients paying for concierge service is that waiting will not be a part of their health care experience. Patients are guaranteed that phone calls will be returned promptly, appointments will be scheduled on a same-day basis if necessary, and appointment times will be honored. ...
"A relatively simple tradeoff is responsible: the extra fees collected from patients let concierge doctors, who leave regular practice for concierge medicine, slash their caseloads. Before Dr. Kaminetsky became a concierge doctor five years ago he had 2,500 patients in his practice - a standard number for most primary care internists. His list now numbers 600. "
"The practices typically charge at least $1,500 a year, with the most elite services asking $25,000 or more per family. The fees cover a thorough physical exam and enable physicians to limit the number of patients they see so they can provide premier service. "...
"Critics of concierge medicine consider it elitist and say it has widened the already significant class disparities in American medicine. They also say it has exacerbated the shortage of primary care physicians by leaving more patients to be treated by a shrinking pool of doctors.
But advocates counter that the concierge movement reflects deep exasperation with the two-hour waits and 10-minute appointments of conventional primary care. Given the burnout among physicians who must see more than two dozen patients a day, they say the concierge model may sustain doctors who would otherwise hang up their stethoscopes.
Dr. Thomas W. LaGrelius of Torrance, Calif., who leads the Society for Innovative Medical Practice Design, a professional association of concierge physicians, estimated that there were 5,000 such doctors in the United States, out of an estimated 240,000 internal medicine physicians and related subspecialists. "
Wednesday, February 11, 2009
Market for Orthopaedic surgeons
I recently broke an ankle in Maastricht and flew home for surgery in Boston. In both places I visited the emergency room. In both cases the orthopaedic surgery resident who I was treated by in the ER was a young woman.
In Boston, I remarked that, when I was much younger, orthopaedic surgeons were almost all men, and that back then they claimed that orthopaedic surgery had a lot in common with carpentry, and required significant upper body strength. The resident told me that the situation had indeed changed, she had senior mentors who were women.
When she and her colleagues apply for subspecialty fellowships, they will face not only a more gender-integrated market but also a much more orderly market than in the recent past.
A "match" (a centralized clearinghouse) is coming for Orthopaedic surgery subspecialties--see the following preparatory study by two economists (Muriel Niederle and myself) and seven surgeons. (As it happens--small world--the surgeon who put in the many new titanium parts I now am growing new bone around had heard me give an Orthopaedic Surgery Grand Rounds on this subject.)
Harner, Christopher D., Anil S. Ranawat, Muriel Niederle, Alvin E. Roth, Peter J. Stern, Shepard R. Hurwitz, William Levine, G. Paul DeRosa, Serena S. Hu, "Current State of Fellowship Hiring: Is a universal match necessary? Is it possible?," Journal of Bone and Joint Surgery, 90, 2008,1375-1384.
In Boston, I remarked that, when I was much younger, orthopaedic surgeons were almost all men, and that back then they claimed that orthopaedic surgery had a lot in common with carpentry, and required significant upper body strength. The resident told me that the situation had indeed changed, she had senior mentors who were women.
When she and her colleagues apply for subspecialty fellowships, they will face not only a more gender-integrated market but also a much more orderly market than in the recent past.
A "match" (a centralized clearinghouse) is coming for Orthopaedic surgery subspecialties--see the following preparatory study by two economists (Muriel Niederle and myself) and seven surgeons. (As it happens--small world--the surgeon who put in the many new titanium parts I now am growing new bone around had heard me give an Orthopaedic Surgery Grand Rounds on this subject.)
Harner, Christopher D., Anil S. Ranawat, Muriel Niederle, Alvin E. Roth, Peter J. Stern, Shepard R. Hurwitz, William Levine, G. Paul DeRosa, Serena S. Hu, "Current State of Fellowship Hiring: Is a universal match necessary? Is it possible?," Journal of Bone and Joint Surgery, 90, 2008,1375-1384.
Wednesday, December 3, 2008
Medical residents
The Institute of Medicine has issued a report on the training of new doctors: Expert Panel Seeks Changes in Training of Medical Residents (the link is to the NY Times story, the report is at
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety)
The medical residency is the first step on a medical career, and is shaped by competing forces: the desire of the medical profession to limit new entry, the training needs of new docs, and the needs of patients. The latest report focuses on the latter by suggesting that residents should have some scheduled sleep time...
"...the worry is that the huge workload imposed on residents poses a risk to patient safety. The long hours of often unsupervised residents were found to have contributed to the 1984 death of 18-year-old Libby Zion in New York City, a finding that eventually led to a series of changes, including limiting residents to an 80-hour workweek and 30-hour shifts.
But the expert panel said those reforms were not enough. Caps on work hours are often not enforced, and many residents still do not get enough sleep, putting doctors and patients at risk for fatigue-related mistakes. While the new recommendations do not reduce overall working hours for residents, the report says no resident should work longer than a 16-hour shift, which should be followed by a mandatory five-hour nap period.
The committee also called for better supervision of the doctors-in-training; prohibitions against moonlighting, or working extra jobs; mandatory days off each month; and assigning chores like drawing blood to other hospital workers so residents have more time for patient care."
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety)
The medical residency is the first step on a medical career, and is shaped by competing forces: the desire of the medical profession to limit new entry, the training needs of new docs, and the needs of patients. The latest report focuses on the latter by suggesting that residents should have some scheduled sleep time...
"...the worry is that the huge workload imposed on residents poses a risk to patient safety. The long hours of often unsupervised residents were found to have contributed to the 1984 death of 18-year-old Libby Zion in New York City, a finding that eventually led to a series of changes, including limiting residents to an 80-hour workweek and 30-hour shifts.
But the expert panel said those reforms were not enough. Caps on work hours are often not enforced, and many residents still do not get enough sleep, putting doctors and patients at risk for fatigue-related mistakes. While the new recommendations do not reduce overall working hours for residents, the report says no resident should work longer than a 16-hour shift, which should be followed by a mandatory five-hour nap period.
The committee also called for better supervision of the doctors-in-training; prohibitions against moonlighting, or working extra jobs; mandatory days off each month; and assigning chores like drawing blood to other hospital workers so residents have more time for patient care."
Tuesday, November 11, 2008
Market for medical services: time of day
Timing is an important part of many markets: Beth Israel Medical Center in NYC is experimenting with a 24 hour a day clinic for non-emergency services, intended to serve parts of the market that have trouble making appointments during standard doctors' hours: When You Just Have to Get a Flu Shot... at 3 A.M.
Thursday, October 23, 2008
Congestion in the supply chain for new doctors
A new doctor needs not only a place in medical school, but also some clinical rotations in hospitals while still a medical student, and a residency position after graduation. New medical schools, and medical schools that wish to increase their class size, need to find these for their students, which is one of the constraints on increasing the size of US medical school output. The Chronicle of Higher Education describes the situation in Arizona: Shortage of Training Slots Threatens to Stall Influx of New Doctors. (An ungated version will be available for five days at http://chronicle.com/temp/email2.php?id=hVntG8hqVPcppSXRz6qmdkfdQtSZNB5V )
Wednesday, October 1, 2008
Job market; online and offline
A NY Times columnist surveys the uses of different job search technologies, from shoe leather, to the internet, to the social internet: Job Hunting Is, and Isn’t, What It Used to Be
"The big three sites are Monster.com, CareerBuilder.com and Yahoo HotJobs.com. Craigslist is also a popular option, as are those like Indeed.com and SimplyHired.com, which aggregate big and small jobs sites.
"Niche sites are also growing. Doctors can check out PracticeMatch.com; those seeking nonprofit work can go to Idealist.org. TheLadders.com is popular for job seekers looking for executive positions that pay more than $100,000 a year."
"Mr. Challenger suggests limiting yourself to surfing such sites only after dinner. Use the daytime to get out and meet people as much as possible."
"The big three sites are Monster.com, CareerBuilder.com and Yahoo HotJobs.com. Craigslist is also a popular option, as are those like Indeed.com and SimplyHired.com, which aggregate big and small jobs sites.
"Niche sites are also growing. Doctors can check out PracticeMatch.com; those seeking nonprofit work can go to Idealist.org. TheLadders.com is popular for job seekers looking for executive positions that pay more than $100,000 a year."
"Mr. Challenger suggests limiting yourself to surfing such sites only after dinner. Use the daytime to get out and meet people as much as possible."
Tuesday, September 23, 2008
Job market for couples
Two-career households are an important part of the labor force, particularly in academia. Hiring them can be part of a department or school's strategy. See Law Schools Hiring Faculty Couples, from Brian Leiter's Law School Reports.
(Note to students: we'll be covering couples in the medical labor market in either lecture 2 or 3....see
Roth, A.E., "The Evolution of the Labor Market for Medical Interns and Residents: A Case Study in Game Theory," Journal of Political Economy, 92, 1984, 991-1016.
and
Roth, A. E. and Elliott Peranson, "The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design," American Economic Review, 89, 4, September, 1999, 748-780.
(Note to students: we'll be covering couples in the medical labor market in either lecture 2 or 3....see
Roth, A.E., "The Evolution of the Labor Market for Medical Interns and Residents: A Case Study in Game Theory," Journal of Political Economy, 92, 1984, 991-1016.
and
Roth, A. E. and Elliott Peranson, "The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design," American Economic Review, 89, 4, September, 1999, 748-780.
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