Nondirected liver donation in Canada--from the beginning

The Ottawa Citizen has the story:

The Gosling Effect: How one man (and his liver) forever changed Canadian health care. In 2005, Kevin Gosling became the first living Canadian to anonymously donate an organ to a stranger. It set a cascade of kindness into motion.  by Elizabeth Payne 

"It had been a long road for the then-46-year-old from Cornwall, Ont. For months, health officials wouldn’t take him seriously when he offered to donate the organ anonymously. We don’t do that here, he was told. Not only that, it had never been done before anywhere in Canada.

"Some top officials in Canada’s leading liver transplant program were adamantly opposed to Gosling’s proposal. They said it was unethical and immoral. They questioned his motives, even his sanity. But Gosling persisted, so far as to undergo months of physical and psychological testing and preparation.

"After more than a year and a half, everything was set to go.

...

"Gosling didn’t know much about the recipient. He only knew that it was a child.

...

"Gosling’s stubborn altruism and unwavering belief that he could make a life-changing difference to someone in desperate need almost single-handedly changed Canada’s health-care system.

"In the 19 years since that fateful day when transplant surgeons removed part of Gosling’s liver and transplanted it into the body of the very ill child, the Toronto General Hospital has completed more than 137 such operations involving people donating anonymously to strangers – more than any other hospital in the world.

...

"He was a pioneer in an area in which Canada is now a world leader – the act of anonymously donating part of a liver – a phenomenon that continues to be met with disbelief in some parts of the world.

...

"Gosling’s offer was turned down multiple times until he was eventually put in touch with the head of the multi-organ transplant program at University Health Network, one of only two hospitals in the country where living liver transplants are now routinely done. Along the way he met health officials who were adamantly opposed to the idea, even citing the Hippocratic oath. (Later, he was told by one staunch opponent that following Gosling’s case had made him change his mind.)"

HT: Colin Rowat

#############

See also:

Cattral, Mark S., Anand Ghanekar, and Nazia Selzner. "Anonymous living donor liver transplantation: The altruistic strangers." Gastroenterology 165, no. 6 (2023): 1315-1317.

and here are all my posts on nondirected donors: https://marketdesigner.blogspot.com/search/label/nondirected%20donor

Support for hepatitis C human challenge studies, in The Lancet Gastroenterology & Hepatology

 Here's a call for action, in The Lancet Gastroenterology & Hepatology:

Joint statement in support of hepatitis C human challenge studies by Harvey J Alter, Eleanor Barnes, Mia J Biondi, Andrea L Cox, Jake D Eberts, Jordan J Feld, T Jake Liang, Josh Morrison, Charles M Rice, Naglaa H Shoukry, David L Thomas, Jennifer Van Gennip, Charles Weijer, on behalf of other signatories †, Published:September 20, 2023 DOI:https://doi.org/10.1016/S2468-1253(23)00314-X

"We, the 121 undersigned, believe that human challenge studies among adult volunteers will be critical in the development of hepatitis C vaccines.

...

"Despite the advent of safe and highly effective direct-acting antiviral (DAA) treatments, the ongoing toll of hepatitis C remains high among low-income and middle-income countries and vulnerable populations such as people who inject drugs. Millions of new infections occur annually, outpacing cures in some regions,1 with progress further disrupted by the COVID-19 pandemic. Without a change in strategy and the development of new tools, we will not reach the ambitious goal set out by WHO of elimination of viral hepatitis as a public health threat by 2030. This will require an effective hepatitis C vaccine—“the best insurance for the future”, as highlighted by a recent announcement of the White House national hepatitis C elimination programme.2

...

"Human challenge studies for a hepatitis C vaccine could accelerate vaccine development dramatically. The effort to establish the model and test an initial vaccine candidate could take as little as 3 years. If that candidate fails, subsequent studies to test others could provide evidence of efficacy as quickly as 1 year.

"It is only because of the remarkably effective treatments that we can now consider human challenge studies for hepatitis C. With DAAs, cure rates of people without cirrhosis are reliably over 98%, with highly effective salvage regimens for the few who do not respond to a first course of therapy.5,  6 We are confident that in the era of DAAs, human challenge studies can be done in accordance with the highest ethical and safety standards. Healthy volunteers providing fully informed consent would be infected for at most 6 months before treatment and would be free to go about their lives with the right to request treatment and withdrawal from a study at any time. Acute infection causes no or few symptoms in most, and unlike in most challenge studies, where the risk of transmission necessitates quarantine of participants, the risk of passing hepatitis C to others is very low in day-to-day life.

"The impact of a vaccine would be enormous: reducing transmission, preventing cirrhosis, and most importantly, markedly reducing the rate of liver cancer, the world's second-most deadly cancer in terms of total fatalities.7 The global success of hepatitis B vaccine in achieving these goals exemplifies the importance of an effective hepatitis C vaccine. With the prospect of such a significant advance, we have confidence that people will volunteer to participate in hepatitis C challenge studies, and with such a strong team of experts worldwide, we are confident this approach will lead to the development of a successful hepatitis C vaccine."

**********

† Here's the full list of 121 signers of the letter

*********

1Day Sooner has a related web page with some background: https://www.1daysooner.org/hepatitis-c-open-letter

**********

Earlier related posts:

Monday, May 15, 2023

Eliminating Hepatitis C, now that there's a cure (even though it's expensive)

Saturday, August 26, 2023

Challenge trials for a Hepatitis C vaccine

Sunday, November 1, 2020

What do we know about the effects of payments to participants in challenge trials for vaccines, and other public spirited activities?

The market for radiation oncologists

 Dr. Wes Talcott at Yale points me to some contemporary discussion of the labor force in radiation oncology.  As with a number of other medical specialties, there's a tension between the number of staff needed to prep a patient for treatment and the number of new board certified specialists needed to supervise such treatment. Residents fill the first kind of position, and time and training transforms them into the second.

The contemporary discussion seems to focus on proposals that individual residency programs should reduce the number of residency positions they need to fill, in a decentralized manner, either by offering fewer positions in the Match, or declining to fill positions that aren't filled in the main Match. There is a concern that a coordinated reduction in positions would invite antitrust scrutiny, although other specialties (such as gastroenterology*) have managed that.

Here's an article from the International Journal of Radiation Oncology*Biology*Physics:

Chicken Little or Goose-is-Cooked? The State of the US Radiation Oncology Workforce: Workforce Concerns in US Radiation Oncology by Chirag Shah, MD and Trevor J. Royce, MD, MS, MPH, Published:March 11, 2021 DOI: https://doi.org/10.1016/j.ijrobp.2020.11.056  

"oversupply worries have reached a fever pitch among trainees, with the job market being the primary concern and 52% perceiving an increasingly competitive market10; these concerns have manifested in a precipitous decline in student interest, with 14% of RO residency positions unmatched in the 2020 Match (compared with previous rates of near 0%) and worse numbers expected for the 2021 match."

#####################

Here's a reply, suggesting that the current situation presents an opportunity for the RO profession to remake itself in various ways:

When in a Hole, Stop Digging: In Reply, Workforce Concerns in US Radiation Oncology  Louis Potters, MD, FASTRO, FACR,  Published:March 11, 2021, International Journal of Radiation Oncology*Biology*Physics, DOI: https://doi.org/10.1016/j.ijrobp.2020.12.024

#####################

A different kind of reply is that fewer U.S. medical graduates are applying for RO residency positions in the Match:

No Longer a Match: Trends in Radiation Oncology National Resident Matching Program (NRMP) Data from 2010-2020 and Comparison Across Specialties  by Chelain R.GoodmanM.D., Ph.D.aAustinSimM.D., J.D.hElizabeth B.JeansM.Ed, M.D.dJustin D.AndersonM.D.bSarahDooleyM.D.cAnkitAgarwalM.D., M.B.A.gKarenTyeM.D., M.S.eAshleyAlbertM.D.fErin F.GillespieM.D.iRahul D.TendulkarM.D.kClifton D.FullerM.D., Ph.D.aBrian D.KavanaghM.D.jShauna R.CampbellD.O. Available online 11 March 2021,In Press, Journal Pre-proof International Journal of Radiation Oncology*Biology*Physics https://doi.org/10.1016/j.ijrobp.2021.03.006

"In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from 2010-2019 (Median [Interquartile Range],187 [170-192], p<0.001). Across all specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010-2019 in both the number of ERAS applicants from the US and Canada (-31%) as well as the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 65% (n=122) were filled by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, a significant decrease from 2010-2019 (Median=92% [IQR, 88-94%], p=0.002). The percentage of radiation oncology programs and positions unfilled prior to the SOAP was significantly increased in 2020 compared to 2010-2019 (Programs: 29% versus 8% [5-8%], p<0.001; Positions: 19% versus 4% [2-4%], p<0.001). Despite >99% (n=127 of 128) of US senior applicants successfully matching in the 2020 NRMP, 16 of 24 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top utilizer of the 2020 SOAP, filling 15% of total positions versus a median of 0.9% [0.3-2.3%] across all specialties (p<0.001).

Conclusions

Supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole."

##################

*The reduction in gastroenterology residency positions was combined with an increase of a year in required training, and this combination contributed to the unraveling of the gastro Match, which has since been restored. See the background discussion in

McKinney, C. Nicholas, Niederle, Muriel and Alvin E. Roth, "The collapse of a medical labor clearinghouse (and why such failures are rare)," American Economic Review, 95, 3, June, 2005, 878-889.

***************

Update: here's a discussion of the RadOnc situation by the Rad Onc Virtual Visiting Professor Network

Allocating and reallocating scarce medical supplies

An op-ed in USA today points out that shortages of critical hospital supplies are occurring and will continue to occur at different times in different states, allowing for increased efficiencies in sharing (which is hampered by a vacuum in leadership at the Federal level).

One of the authors, Dr. Deborah Proctor, is in fact an experienced market designer, who led the (re-)adoption of a fellowship match for gastroenterology fellows.*

National redistribution of hospital supplies could save lives
Taking supplies from less stressed hospitals and sharing them with overwhelmed ones, we could maximize the use of equipment and save more lives.
Diane R. M. Somlo, Dr. Howard P. Forman and Dr. Deborah D. Proctor

"Since we now know more about the predicted peaks in COVID-19 across the U.S., we can see that peak demand will likely occur at different times in different states and cities, starting in early April and extending through May. While some hospitals are already starting to drown, other hospitals that are further from their peak demand have stockpiles of unused equipment lying in wait. 

"What if there was a nation-wide system that allowed hospitals that have equipment but have lower present and predicted demand to lend some reusable (ventilator) and non-reusable equipment (PPE, testing kits) to hospitals that are currently being overwhelmed? Then, as demand in one area rises and the other falls, freed up ventilators could be re-distributed, and manufacturers will have had more time to generate non-reusable equipment for hospitals that lent their equipment. By taking from stockpiles of less stressed hospitals and sharing it with currently overwhelmed ones, we could maximize the use of our national inventory of equipment and save more lives.
...
" redistribution approaches in other settings have enabled vast functional expansions of limited supplies, including kidney transplants and donated food for food pantries across the U.S. Bottom line: Redistribution has the potential to improve the trajectory of COVID-19 mortality in the U.S. Our country is already on track to employ these measures at a state level or voluntarily, so delaying set up of cross-state exchange only means missing out on the maximal benefit of redistribution. In fact, as of this writing, New York’s Governor Andrew Cuomo has just signed an executive order enabling redistribution of medical supplies to struggling hospitals within New York state and Oregon has sent ventilators to New York.

"In these coming trying times, our healthcare system is facing an unprecedented, deadly burden, and we need to make supplies available where they are needed most —independent of state lines. Now is the time to start making the changes, to call on the federal government, national leaders, and private partnerships to coordinate our efforts as a nation, so we can provide the best care possible with our limited supplies. Lives depend on it."

****************

* Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, ''The Gastroenterology Fellowship Match: The First Two Years,'' Gastroenterology , 135, 2 (August), 344-346, 2008.

Lovely short film about the resident match by Dr. Trisha Pasricha

Here's a charming and insightful 11 minute video by the remarkable physician-filmmaker Dr. Trisha Pasricha, about the experience of going through the residency match run each year by the National Residency Matching Program (NRMP). It includes some bits of an interview that Dr. Pasricha conducted with me.


: 

A PERFECT MATCH: The Selection Ritual to Become A Doctor from Trisha Pasricha on Vimeo.


Here's a link on the NRMP web page:
Documentary “A Perfect Match” Follows Student Through The Match Process
"Directed by Dr. Trisha Pasricha (Massachusetts General Hospital) and produced by Dr. Michael Pilla (Vanderbilt University School of Medicine), A Perfect Match: The Selection Ritual to Become a Doctor follows a Vanderbilt University School of Medicine student as he experiences the medical residency match process. The 12 minute film was a finalist at the Nashville Film Festival,

Dr. Pasricha graduated from Harvard University with a B.A. in film production and went on to study at Vanderbilt University School of Medicine. She completed an internal medicine residency at Johns Hopkins and is currently a first-year gastroenterology fellow at Massachusetts General Hospital.."

And here's the direct link on vimeo.
******
Even short films can take a long time to produce; here's my earlier post:

Friday, September 2, 2016

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

*********
Perhaps I'll get a chance to chat with Dr. Pasricha again after she goes through the gastroenterology match.

The match for larygology fellowships

In The Laryngoscope"

Perceptions of the laryngology Match: A survey of program directors and recent trainees

Eric J. Formeister, Mark S. Courey and Katherine C. Yung

Version of Record online: 7 AUG 2017 | DOI: 10.1002/lary.26761

• Abstract
• Article
• PDF(182K)
• References

"The Match for laryngology fellowship training was instituted for the 2012/2013 application cycle on a voluntary basis and has been operational since. Twenty-three laryngology fellowship programs are now participating in the Match for the 2017/2018 application cycle.
...
"the Match was created to allow applicants the opportunity to review all programs they were interested in prior to feeling pressure to select a program. This early selection pressure has been referred to as “early and exploding offers” by Niederle and Roth, who cite this as the principal motivating factor that influenced the adoption of a gastroenterology fellowship Match.[2] It also allows program directors time to interview more applicants while mitigating the pressure to provide early offers to the most desirable candidates. In a free-market system without a Match, these pressures tend to create earlier and earlier applicant selection. A match with uniform deadlines allow interview seasons to begin later in the course of a residency program, theoretically increasing the number of interested applicants.[1]
...
"42% of pre-Match trainees interviewed prior to their PGY4 year, compared to 22% in the post-Match cohort. There were statistically significant differences between the number of programs applied to, interview offers received, and interviews attended between the pre-2012 and post-2012 cohort. Trainees in the post-Match cohort applied to, on average, 6.9 programs, received interview offers at 6.5 programs, and attended 5.3 interviews, compared to an average number of 4.2 applications, 3.3 interview offers, and 3.5 interviews attended in those applying prior to institution of the Match
...
"Our results indicate that both applicants and program directors believe that the Match is a positive development for laryngology. However, fellowship directors appear to be more guarded in their support, as evidenced by only one-third agreeing or strongly agreeing that the Match improves their ability to procure the best fellows. Perhaps this is due to cases in which there has been internal selection of excellent candidates via the Match who would have been selected regardless of whether or not a Match program existed. This is supported by the free-text response from one anonymous fellowship director, who stated that a distinct disadvantage of the Match is an inability to internally select a candidate early and then mentor them in laryngology during residency. It is also noteworthy that trainees who applied before adoption of the Match were significantly more likely to support the notion that the Match is a positive development for the specialty (89%), versus only 56% of those who applied after the Match agreeing with this statement. This difference could be reflective of the reported frustrations that accompany the Match process (e.g., more interviews demanding more time and money from applicant to maximize their perceived chances of matching), compared to the theoretical benefits perceived by those earlier trainees who did not apply via this standardized process.

Undoubtedly, a laryngology Match increases the consumption of time, resources, and cost for both fellowship directors and candidates, as the average number of applicants interviewed at each program from pre-Match to post-Match doubled from approximately three to approximately six, and the number of programs applied to, interview offers received, and interviews attended by applicants all increased significantly compared to prior to the Match. Although there is an obvious advantage inherent in the ability to sample more programs (72% of applicants cite this as an advantage) or to interview more applicants (55% of program directors report this as an advantage) prior to deciding, the Match does have the potential to unnecessarily inflate the number of applications and interviews at each program. This is especially true in the case of internally selected candidates, where applying via the Match essentially becomes a formality."

The gastroenterology fellowship match is thriving

The journal of Digestive Diseases and Sciences reports that the state of the Gastro match is good:

The Gastroenterology Fellowship Match: A Decade Later 

• Robert J. Huang
  • 1
• George Triadafilopoulos
  • 1
• David Limsui
  • 1

1. 1.Gastroenterology and Hepatology Stanford University Medical Center  

Fellows and Young Gis Section

First Online: 

04 May 2017

DOI: 10.1007/s10620-017-4593-z

Cite this article as:

Huang, R.J., Triadafilopoulos, G. & Limsui, D. Dig Dis Sci (2017). doi:10.1007/s10620-017-4593-z

Abstract: Following a period of uncertainty and disorganization, the gastroenterology (GI) national leadership decided to reinstitute the fellowship match (the Match) under the auspices of the National Residency Matching Program (NRMP) in 2006. Although it has now been a decade since the rebirth of the Match, there have been limited data published regarding progress made. In this piece, we discuss reasons for the original collapse of the GI Match, including most notably a perceived oversupply of GI physicians and a poor job market. We discuss the negative impacts the absence of the Match had on programs and on applicants, as well as the impetus to reorganize the Match under the NRMP. We then utilize data published annually by the NRMP to demonstrate that in the decade since its rebirth, the GI Match has been remarkably successful in terms of attracting the participation of applicants and programs. We show that previous misguided concerns of an oversupply of GI physicians were not realized, and that GI fellowship positions remain highly competitive for internal medicine applicants. Finally, we discuss possible implications of recent changes in the healthcare landscape on the GI Match.

Update on the Gastroenterology match

Dr Debbie Proctor at Yale, who was instrumental in re-starting the match for gastroenterology fellows, sends this update:

"The GI match is alive and well. The main concerns are still about "research" positions being offered outside the match, but when actually investigated, the evidence is slim to none that this happens and always with a good reason. That being said, I am sure there are some offers outside the match, but I estimate less than 10%.

We now match in Nov/Dec for people to start in July - 6-7 months later. The residents now interview in the middle of their 3rd year, which makes a huge difference. Remember, we used to interview them and make offers at the beginning of their 2nd year - right after completing internship? What a different 18 months makes in the careers of these young folks!"
******************

For those of you who haven't been following along for decades, here are links to some of the papers around the re-design and restart of the gastro match:

• Niederle, Muriel and Alvin E. Roth, "Unraveling reduces mobility in a labor market: Gastroenterology with and without a centralized match," Journal of Political Economy, 1. 111, no. 6, December 2003, 1342-1352. .
• Niederle, Muriel and Alvin E. Roth, "The Gastroenterology Fellowship Match: How it failed, and why it could succeed once again," Gastroenterology, 127, 2, August 2004, 658-666.
• McKinney, C. Nicholas, Niederle, Muriel and Alvin E. Roth, "The collapse of a medical labor clearinghouse (and why such failures are rare)," American Economic Review, 95, 3, June, 2005, 878-889.
• Niederle, Muriel and Alvin E. Roth, "The Gastroenterology Fellowship Market: Should there be a Match?," American Economic Review, Papers and Proceedings, 95,2, May, 2005, 372-375.
• Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, â€œWhat will be needed for the new GI fellowship match to succeed?,Gastroenterology, 130, January 2006, 218-224.
• Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, ''The Gastroenterology Fellowship Match: The First Two Years,''Gastroenterology , 135, 2 (August), 344-346, 2008.
• Niederle, Muriel, and Alvin E. Roth,''The Effects of a Central Clearinghouse on Job placement, Wages, and Hiring Practice'', inLabor Market Intermediation, David Autor, Editor, The University of Chicago Press, 2009, 273-306. 

D47. Market Design is now officially a field of study

I returned last night from Philadelphia where the American Economic Association’s annual meeting was held. While I was there, my Pittsburgh colleague Asatoshi Maeshiro informed me that Market Design has arrived. In particular, the AEA publishes the Journal of Economic Literature, which classifies articles according to what field they are in. And the newest JEL Classification Codes include market design, under the overall heading of Market Structure and Pricing.  We’re D47.

•        D4          Market Structure and Pricing

•        D40        General

•        D41        Perfect Competition

•        D42        Monopoly

•        D43        Oligopoly and Other Forms of Market Imperfection

•        D44        Auctions

•        D45        Rationing; Licensing

•        D46        Value Theory

•        D47 Market Design

•        D49        Other

When you click on microeconomics, followed by market structure, followed by market design on the JEL classification webpage, you get to this description of the new field, with example (which are clickable on the web page, but don't seem to be when I copy them...:

D470 Market Design

Guideline: Covers studies concerning the design and evolution of economic institutions, the design of mechanisms for economic transactions (such as price determination and dispute resolution), and the interplay between a market�s size and complexity and the information available to agents in such an environment.

Keywords: Markets, Microeconomic Engineering, Price Formation, Quasi-markets

Caveats: Purely theoretical studies concerning mechanism design should be classified in D82. Purely empirical studies concerning market structure should be classified in the appropriate category under L1.

Examples:

• Investment Incentives and Electricity Market Design: The British Experience
• The Economist as Engineer: Game Theory, Experimentation, and Computation as Tools for Design Economics
• Unraveling Reduces Mobility in a Labor Market: Gastroenterology with and without a Centralized Match

Gibson Lecture at Queen's University in Kingston Ontario

I'll be speaking today at Queen's University in Kingston

What have we learned from market design? 

Tuesday, September 17, 2013
4:30 PM 

Grant Hall, Queen's University
43 University Avenue, Kingston, ON

**Light refreshments to follow:  Room 145 Robert Sutherland Hall, 138 Union Street

ALL ARE WELCOME

---

2012 Nobel Laureate
Alvin Roth

Alvin Roth is the Craig and Susan McCaw Professor of Economics at Stanford University. Roth has made important contributions in many fields of economics, including axiomatic bargaining theory and experimental economics, but his contributions in matching and market design have been especially highly regarded, as exemplified by the Nobel Prize in 2012, which was awarded to him together with Lloyd Shapley. Prof. Roth has been involved in the design of the National Resident Matching Program for U.S. doctors, school choice systems in New York City and Boston, the New England Program for Kidney Exchange and the Market for Gastroenterology Fellows. He is a Sloan fellow, a Guggenheim fellow, a fellow of the American Academy of Arts and Sciences, a fellow of the Econometric Society and a faculty research fellow at the National Bureau of Economic Research.  

Abstract:

The talk will address recent developments in market design, focusing particularly on kidney exchange, which has begun to flourish in Canada as well as the United States. It will also cover some general lessons that market design teaches us about markets and marketplaces. Finally, the talk will address how some transactions (like selling organs for transplantation) are regarded as repugnant, despite the fact that there are people willing to engage in them.

The American Gastroenterological Association takes note of the Nobel for market design

The redesign of the match for Gastroenterology fellows is one of the projects mentioned in the Nobel documentation on p23), and the AGA takes note of that: Al Roth Wins Nobel Prize and AGA Recognized in Announcement. (Two key names on that project are Debbie Proctor and Muriel Niederle.)

I speak about kidney exchange at Harvard Medical School

As the seminar announcement makes clear, part of the attraction (at least to third year students) is the free food:)

John Warren Surgical Society at Harvard Medical School
presents

Alvin E. Roth, Ph.D
 George Gund Professor of Economics and Business Administration in the Department of Economics 

at Harvard University and in the Harvard Business School.

for a discussion of

"Market Design, Kidney Exchange, and Repugnance"

 Monday, October 17th
 12:30 pm, TMEC 250

Food will be served.

Al Roth's research, teaching, and consulting interests are in game theory, experimental economics, and market design. The best known market he has designed (or, in this case, redesigned) is the National Resident Matching Program, which matches approximately twenty thousand doctors a year with their residency program at American hospitals. He has recently been involved in the reorganization of the market for Gastroenterology fellows, which started using a clearinghouse in 2006 for positions beginning in 2007. Other markets he has helped design include the high school matching system used in New York City to match approximately ninety thousand students to high schools each year, starting with students entering high school in the Fall of 2004; The matching system used in Boston Public Schools, adopted for students starting school in September 2006; And the New England Program for Kidney Exchange, for incompatible patient-donor pairs. He is the chair of the American Economic Association's Ad Hoc Committee on the Job Market, which has designed a number of recent changes in the market for new Ph.D. economists. He is a Fellow of the American Academy of Arts and Sciences and the Econometric Society, and has been a Guggenheim and Sloan fellow. He received his Ph.D at Stanford University, and came to Harvard from the University of Pittsburgh, where he was the Andrew Mellon Professor of Economics.

High Yield Information:  

First years:  Al Roth is awesome.  You get to ask him questions.  Also attendees will get early access to joining the HMS Transplant Pager Program where you will likely be able to observe the a paired kidney donation first hand.  
Second years: Relive great memories of last year while we talk about kidneys, residency, policy, and ethics.
Third Years: There will be free food.
Fourth Years: Al Roth designed the National Resident Matching Program. I'm sure he'd be happy to answer a reasonable number of questions.  

We look forward to seeing you there!

The job market in gastrointestinal endoscopy

After completing a 3 year subspecialty match in gastroenterology, doctors wishing to specialize further can do a fellowship in advanced endoscopy. The American Society for Gastrointestinal Endoscopy is trying to organize that job market, and, at least for this year, they are doing something quite different from a standard medical match. Aside from a system of prescribed dates (First date to offer an interview: 4/1/2011; First date to offer a position 7/15/2011: Fellowship start date: 7/1/2012), the process is described to applicants (in a letter) as follows:

******
"At 12pm EDT on July 15th, all program directors will send out an email to their top
choice. The fellow will then have 1 hour to decide if they wish to take that position or
wait for other offers. Please send a return email confirming that you got the offer.
You may respond at any time during that hour, ideally as soon as you make your
decision. If you do not respond within that hour, the program director may move on to
their second choice, so please respond within the hour.


"One of 2 things will then happen once you respond:


1. If you have chosen the offer, and send an affirmative email, the program
director will then send an email ASAP to all of its other applicants to
alert them that the spot has been filled, so that other applicants will be
aware that that position at that particular institution is no longer
available.


2. If you chose to reject the offer, please alert the program director via email
ASAP, so that the program director can then make an offer to the next
applicant on the list.


"If after the 15th (and the weekend of the 16th-17th) you do not have a position, please
go to the ASGE AEF website, and a list of programs with open positions will be
posted so that you may contact any of them if you like.


"I know that this non-electronic “match” is not ideal, but until we adopt an electronic
match (hopefully next year) we hope this format works without too many glitches."
******


Note that this is a system of "exploding offers", so one can expect some communication between participants before the appointed hour... (See also the discussion of similar problems I anticipate in the proposed new rules for the residency scramble (SOAP)).

Gastroenterology fellowships enjoy a successful match, so it seems reasonable to speculate that the fellowship in advanced endoscopy will turn to one after trying this.

The gastro fellowship match after five years

A recent article takes stock of the Gastroenterology fellowship match, five years after it was reinstated with some new design rules (about exploding offers):
The Match: Five Years Later, by Deborah D. Proctor et al., Gastroenterology 2011;140:15–18

Proctor et al. report considerable progress, although they continue to monitor violations of market policy. There seems to be a particular issue with respect to research positions.

"...the NRMP/SMS was uniquely set up for our many diverse program offerings. Four tracks were created—Clinical, Clinical Investigator Research, Basic Science Research, and Research—and a reversion process was implemented for the 4 tracks, such that unfilled slots from 1 track could revert to open slots in another track. The GI Match successfully reopened in January 2006 with a match day in June 2006 for fellowship positions starting in July 2007."
...
"However, we must recognize that not all programs are eager or willing to participate in the Match process."
...

"The number of fellowship applicants genuinely committed to an academic research career has been
slowly declining. Simultaneously, competition has stiffened for the grant dollars that pay for these research training positions, and the criteria to renew grant support has become more demanding.
Needless to say, the competition for these increasingly scarce, well-qualified, research-track applicants has become fierce, and the authors are aware of several examples during the last application cycle of candidates interested in research being offered fellowship positions outside the Match.

...
"Although the statistics continue to demonstrate that Match participation is robust, healthy, and gradually increasing, there is also a growing desire to close the loopholes in Match rules that allow a small minority of programs to take unfair advantage of applicants and colleagues."

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To summarize the overall encouraging statistics, in the (2006) Match for 2007 positions, 283 positions were offered and 585 applicants applied, of whom 276 were matched. In the Match for 2011 positions, 383 positions were offered to 642 applicants, of whom 362 were matched.

Here are some papers reporting various elements of the Gastroenterology market design.
The match offers programs the ability to have unfilled positions of one kind (e.g. research positions) revert to other kinds of positions via the Roth-Peranson algorithm (see
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.)