How much compensation for U.S. kidney donors would end the kidney transplant shortage?

 Here's a paper with a forbidding title but an important message (and an eye-catching first paragraph...:)

McCormick, Frank, Philip J. Held, Glenn M. Chertow, Thomas G. Peters, and John P. Roberts. "Projecting the economic impact of compensating living kidney donors in the United States: cost-benefit analysis demonstrates substantial patient and societal gains." Value in Health Volume 25, Issue 12, December 2022, Pages 2028-2033

"Abstract:

Objectives: The aim of this study was to show how the US government could save approximately 47 000 patients with chronic kidney failure each year from suffering on dialysis and premature death by compensating living kidney donors enough to completely end the kidney shortage.

Methods: Supply and demand analysis was used to estimate the number of donated kidneys needed to end the kidney shortage and the level of compensation required to encourage this number of donations. These results were then input into a detailed cost-benefit analysis to estimate the economic value of kidney transplantation to (1) the average kidney recipient and their caregiver, (2) taxpayers, and (3) society in general.

Results: We estimate half of patients diagnosed with kidney failure each year—approximately 62 000 patients—could be saved from suffering on dialysis and premature death if they could receive an average of 1½ kidney transplants. However, currently there are only enough donated kidneys to save approximately 15 000 patients. To encourage sufficient donations to save the other 47 000 patients, the government would have to compensate living kidney donors approximately $77 000 (±50%) per donor. The value of transplantation to an average kidney recipient (and caregiver) would be approximately $1.5 million, and the savings from the recipient not needing expensive dialysis treatments would be approximately $1.2 million.

Conclusions: This analysis reveals the huge benefit that compensating living kidney donors would provide to patients with kidney failure and their caregivers and, conversely, the huge cost that is being imposed on these patients and their families by the current legal prohibition against such compensation."

and here's the first paragraph:

"Economics Nobel Laureate Alvin Roth has played a crucial role in developing paired kidney donation, which is currently saving >1100 US patients with kidney failure per year from suffering on dialysis and dying prematurely. Nevertheless, Professor Roth often points out that this is a victory in a war that we are losing.1 The number of patients diagnosed with kidney failure each year in the United States is not only much greater than the number who receive kidney transplants; it is rising at a faster rate.2,3 Thus, the number of patients diagnosed with kidney failure who are fated to suffer on dialysis for an average of 4 to 5 years while their health steadily deteriorates until they die prematurely has trended upward and is now >100 000 per year."

Guns and gun control

 In the U.S., gun sales are both a protected transaction and a repugnant one. The right to bear arms is protected by the 2nd Amendment to the Constitution, but as school shootings and other mass casualty attacks on innocents have become a staple of the news, there have been periodic attempts to curb sales, particularly of automatic weapons.  The state of Washington is the latest to ban the sale of certain particular automatic weapons, which are legally available in other states, and already very widely distributed.

The NYT has the story:

Selling AR-15-Style Rifles Is Now Banned in 9 States  By Mike Baker and Nicholas Bogel-Burroughs

"Washington State approved a package of gun control measures on Tuesday that includes a ban on the sale of military-style semiautomatic weapons, making it the ninth state to join efforts to prevent the distribution of AR-15s and other powerful rifles often used in mass shootings.

"The new laws put Washington in the ranks of states with the strongest gun control measures in the nation. They include a 10-day waiting period on gun purchases, gun safety training requirements and a provision allowing the state attorney general and consumers to sue gun manufacturers or dealers under public nuisance laws if they negligently allow their guns to fall into the hands of minors or “dangerous individuals.”

"Gun rights proponents swiftly filed a lawsuit to challenge the semiautomatic rifle ban, saying it infringed on Second Amendment rights.

"Washington is among a series of states, largely led by Democrats, that have advanced gun legislation this year as the nation continues to grapple with repeated mass shootings. Republicans have moved in the opposite direction, with lawmakers in several states introducing legislation to expand the ability to carry concealed weapons without a permit and eliminate such things as gun-free zones, background checks and red-flag laws, which allow the removal of guns from people deemed to be at high risk of violence or self-harm.

...

"All of the bans currently in place allow people to keep weapons previously purchased, but states vary on how those so-called legacy weapons are regulated, according to the Giffords Law Center to Prevent Gun Violence."

**********

Earlier:

Sunday, April 16, 2023

The (American) market for assault rifles

Supervised drug use sites to be banned in Pennsylvania

 Statnews has the story:

Pennsylvania set to ban supervised drug use sites, in setback for harm reduction  By Lev Facher

"Pennsylvania lawmakers are set to pass a new ban on supervised drug consumption, effectively ending a Philadelphia nonprofit’s long-running effort to offer a sanctioned substance-use site meant to prevent overdose and death.

"A bill outlawing sites that “knowingly” provide a space for drug consumption passed a committee vote by a wide margin on Tuesday. It now advances to the full state senate, where it is also expected to pass. Gov. Josh Shapiro, a Democrat, has expressed strong opposition to supervised injection sites in the past, and is expected to sign the legislation.

...

"While the Biden administration has expressed unprecedented support for harm reduction, many Americans remain hostile to the approach.

"Some harm-reduction tools, like syringe exchanges and fentanyl test strips, have gained a degree of acceptance, but supervised consumption is still largely taboo. Pennsylvania advocates had high hopes for a planned site in Philadelphia, however, and say the legislation would deal a demoralizing blow to local efforts to avert overdoses and save lives.

...

"Offering medical supervision as people consume drugs that can cause overdose, like heroin and fentanyl, is among the most controversial tactics employed to prevent overdoses. But in recent years, as U.S. drug deaths have surpassed 100,000 annually, the strategy has gained support among some public health advocates. While critics argue that supervised injection condones drug use, studies from cities including Vancouver and Barcelona show that offering the service can lead to a marked reduction in overdose deaths.

...

"Currently, only a few supervised consumption sites are in operation around the U.S. — and none have formally received the federal government’s blessing. Most notably, the nonprofit OnPoint NYC opened two supervised consumption sites in Manhattan late last year. Rhode Island has legalized supervised consumption sites as well, though it’s unclear when a planned site in Providence will open. "

Wild coffee and climate change

 Climate change is threatening coffee crops. But there are some wild variants that show signs of robustness:)

The NYT has the story:

What Climate Change Could Mean for the Coffee You Drink  By Somini Sengupta

"The two types of coffee that most of us drink — Arabica and robusta — are at grave risk in the era of climate change.

"Now the good news. Farmers in one of Africa’s biggest coffee exporting countries are growing a whole other variety that better withstands the heat, drought and disease supersized by global warming.

"For years, they’ve just been mixing it into bags of low-priced robusta. This year, they’re trying to sell it to the world under its own true name: Liberica excelsa.

...

"If it works, it could hold important lessons for smallholder coffee farmers elsewhere, demonstrating the importance of wild coffee varieties in a warming world. Liberica excelsa is native to tropical Central Africa. 

...

"While Arabica and robusta are the two widely cultivated species of coffee, more than 100 species grow in the wild."

New York doesn't ban Menthol cigarettes, amid controversy

 The NYT has the stories, first about the proposed ban, and then about the budget compromise that defeated it:

Black Smokers at Center of New York Fight to Ban Menthol Cigarettes. A proposal to make New York the third state to ban menthol cigarettes has created a furious and expensive lobbying war, and has divided Black leaders. By Luis Ferré-Sadurní

"A push by Gov. Kathy Hochul to ban menthol-flavored cigarettes in New York has become the focal point of a fierce and expensive lobbying fight, pitting Big Tobacco against the medical community.

"Caught in the middle are Black smokers, who smoke menthol cigarettes at higher rates than white smokers, and are the main group the ban is meant to help. Decades of aggressive marketing by tobacco companies have caused Black smokers to consume menthol cigarettes, whose cooling sensation on the throat makes them more appealing and addictive.

...

 "Well intentioned as the ban may be, it has angered some Black leaders, including a group of ministers who have rallied against Ms. Hochul’s proposal because they worry it could increase encounters between Black people and the police if menthol cigarettes were to go underground and authorities crack down on sellers.

"Other Black opponents of the ban suggest it may be discriminatory, a heavy-handed crackdown on the preferred nicotine fix of Black smokers, even if African American men have the highest rates of lung cancer, according to the Centers for Disease Control and Prevention. 

...

"Although lawmakers have signaled their support for the tax increase, the menthol ban’s prospects are far less certain, according to four officials familiar with the negotiations.

The issue has divided Black lawmakers, leaving the measure hanging by a thread in the State Capitol "and potentially forcing Ms. Hochul to weigh how much political capital she should expend on the ban, as opposed to other policy priorities."

********

And here's a story saying that the governor abandoned the proposed ban in a set of budget compromises:

New York Would Change Minimum Wage and Bail in $229 Billion Budget Deal. After weeks of dissension, leaders in Albany reached a handshake agreement on a budget that saw Gov. Kathy Hochul fall short on some of her key objectives. By Luis Ferré-Sadurní and Grace Ashford

"Lawmakers managed to knock down other divisive ideas, including ... a ban on the sale of menthol cigarettes that was opposed by Big Tobacco and had divided Black leaders. Lawmakers did agree, however, to raise taxes on cigarettes to $5.35 a pack, up from $4.35."

**********

All posts so far on menthol

It's hard to dis-intermediate insurance salespeople

 The WSJ has the story:

How Life Insurance Agents Beat Back a Tech Onslaught. Startups tried to bypass salespeople but now embrace them.  By Leslie Scism

"A decade ago, technology startups were planning to steamroll the stodgy life-insurance industry.

"They thought the glad-handing life-insurance agent who cornered customers at Little League games and closed deals at the kitchen table was a relic. Snazzy websites and sophisticated analytics would replace the one-on-one sales pitches and tedious application process that often involved a medical exam.

"The agents won the battle, and now the tech firms are courting them. Of seven startups that together raised more than $1.2 billion to sell life insurance directly to consumers, at least five now promote services to help agents sell policies, according to Coverager.com, which tracks so-called insurtech activity. One of the startups, five-year-old Sproutt, last month bought an insurance brokerage.

...

"Many of the tech firms now better appreciate an old industry adage: Life insurance is sold, not bought.

...

"Glenn Williams, president of life-insurance and financial-services firm Primerica Inc., said his company’s more than 135,000 full- and part-time agents are in people’s homes, “drinking your coffee, eating your brownies…getting the sale done.” 

Market Design at the Max Planck Institute: Axel Ockenfels will become a Director, of ‘Economic Design & Behavior’

 Here's the announcement from the Max Planck Institutes:

Axel Ockenfels Appointed New Director at the Max Planck Institute for Research on Collective Goods in Bonn

"University of Cologne economist and expert in market design will establish the research department ‘Economic Design & Behavior’ at the MPI in addition to his work at the University of Cologne

"Axel Ockenfels, professor at the University of Cologne, will become a new director at the Max Planck Institute for Research on Collective Goods in Bonn in August 2023. He will establish a new department there, to be called ‘Economic Design & Behavior’. Its aim will be to design market, incentive, and decision architectures, based on modern behavioral research. Professor Dr. Ockenfels will thus complement the departments of Professor Dr. Matthias Sutter and Professor Dr. Christoph Engel at the institute, which focus on behavioral research from an economic and legal perspective. He will continue to teach and conduct research at the University of Cologne.

"As a faculty member of the University of Cologne, Professor Ockenfels heads the Cologne Laboratory for Economic Research and coordinates both the ‘Center for Social and Economic Behavior’ and the research division ‘Market Design & Behavior’ of the Cologne-Bonn Cluster of Excellence, ECONtribute. His appointment to the MPI in Bonn will further intensify the cooperation between the Faculty of Management, Economics and Social Sciences at the University of Cologne and the MPI in Bonn, a cooperation that has already contributed to the creation of a prestigious research center for economic behavior and design research in recent years.

...

"The new department at the Bonn MPI will also investigate ethical aspects of institutions and behavior as well as the opportunities and risks of modern computer technology for new markets. Most recently, Ockenfels has contributed to crisis management, for example with proposals for a market design to secure the supply of vaccines, to avoid supply disruptions in the energy sector, and to reduce energy consumption.

...

"Brief CV Axel Ockenfels

"Axel Ockenfels studied economics at the University of Bonn until 1994. He received his doctorate and habilitation from the University of Magdeburg, with periods abroad at Penn State University and Harvard University. Subsequently, he was Emmy-Noether Junior Research Group Leader at the Max Planck Institute for Economics in Jena. In 2003, he became Professor of Economics at the University of Cologne. Research periods have taken him to Stanford University and, currently, to the University of California in San Diego, among other places.

"In 2005, Ockenfels became the first economist in 17 years to be awarded the Gottfried Wilhelm Leibniz Prize of the German Research Foundation (DFG). He is a member of the National Academy of Sciences Leopoldina, the Berlin-Brandenburg Academy of Sciences and Humanities, the North Rhine-Westphalian Academy of Sciences and Arts, and the National Academy of Science and Engineering (acatech). He also sits at the Economists’ Round Table in the Federal Chancellery and on the Scientific Advisory Board at the Federal Ministry of Economics and Climate Protection (BMWK)."

Payment to college athletes: Name, Image and Likeness (NIL) Deals

 The recent changes in what college athletes can be paid for  (and in their ability to transfer freely between schools) has made it profitable for some football players who are eligible for the NFL draft to remain in school.  The NYT has the story:

How transfer, NIL rules thinned out NFL draft QB class: ‘It’s an anemic quarterback class’ by Kalyn Kahler

"the reason for the mid-to-late-round quarterback mass desertion has a lot to do with the growth of the transfer portal and name, image and likeness (NIL) deals.

"In April 2021, the NCAA changed its rules to allow transfers without sitting out a season. A little more than two months later, the NCAA announced its first-ever NIL policy, allowing college athletes to take deals with individual companies, like Bose, and sign deals with collectives affiliated with their schools.

"Collectives are generally made up of donor funds, and they offer contracts to athletes in return for services like autograph signings or event appearances. And in the second season of NIL, collectives are succeeding at incentivizing players at all positions to return to school, and most of all the most important position on the team.

“You’re not necessarily allowed to pay players to return. Like, that can’t be the reason,” said an executive for a collective affiliated with a West Coast university who, like others in this story, was granted anonymity in order to openly discuss details of the hush-hush world of NIL. “But you can talk about their potential when they come back, you’ll have significantly more NIL opportunities than maybe you had the prior year.

...

"You’re not exactly allowed to disclose what people are making,” said the West Coast collective executive. “It has not been laid out from the NCAA and a lot of schools on exactly what you can and can’t talk about. It’s very unclear in a lot of situations, so people naturally get uncomfortable because they don’t know the rules, especially coaches.”

"A veteran NFL agent who represented two draft-eligible Power 5 quarterbacks for their NIL deals said that one transferred to a new program this offseason with the understanding he would make a million-plus through that school’s collective. The agent said the other turned down an offer of more than a million in favor of a transfer to the best football situation, where he’s been promised an amount comparable to an NFL practice-squad salary (in the $200,000 range)."

***********

Related posts on (previously repugnant) payments to student athletes here.

Jerusalem summer school in Economic Theory: Imperfect Cognition and Economic Behaviour: June 26-July 5

 Here's the announcement and call for applications:

The 33rd Advanced School in Economic Theory: Imperfect Cognition and Economic Behaviour

Mon, 26/06/2023 to Wed, 05/07/2023

GENERAL DIRECTOR: Eric Maskin, Harvard University

ORGANIZERS: Elchanan Ben-Porath, The Hebrew University of Jerusalem, Michael Woodford, Columbia University

SPEAKERS:

Robert Aumann, The Hebrew University of Jerusalem

Rava Azeredo da Silveira, ENS Paris & University of Basel

Ido Erev, Technion - Institute of Technology

Itzhak Gilboa, Tel Aviv University & HEC Paris

Tom Griffiths, Princeton University

Eric Maskin, Harvard University

Ariel Rubinstein, Tel Aviv University & New York University

Ran Spiegler, Tel Aviv University & UCL

Jakub Steiner, University of Zurich

Luminita Stevens, University of Maryland

Tomasz Strzalecki, Harvard University

Michael Woodford, Columbia University

Noga Zaslavsky, MIT

ABSTRACT: While economic analysis typically assumes that people reliably choose the available action that is best suited to their current circumstances, experimental psychology has instead emphasized the imprecision of both perceptions and recollections of the objective features of one's environment. This summer school explores whether the kind of cognitive imprecision that is well-documented in sensory domains may also limit the accuracy of economic decisions, and help to account for experimentally documented anomalies for normative models of decision making.

Statement of Policy Principles and Solutions: Living Organ Donation, from the American Association of Kidney Patients (AAKP), the American Society of Transplant Surgeons (ASTS), and the American Society of Transplantation (AST)

 Here's a joint statement about living-donor kidney transplantation from the American Association of Kidney Patients (AAKP), the American Society of Transplant Surgeons (ASTS), and the American Society of Transplantation (AST). The statement opposes rethinking the ban on compensation for donors, suggests that other policies should be evidence-based, and opposes increased bureaucratization and cumbersome regulation of the transplant process.

Statement of Policy Principles and Solutions:  Living Organ Donation

"We stand together in our conviction that any policy changes impacting living organ donation, including those aimed at improving access to living donor transplantation and increasing the survival of already transplanted patients, must begin with principled and transparent dialogue with patients and the expert transplant teams who care for them.  

...

"The United States ranks in the top tier of nations in terms of living donor transplant rates,[1] meaning the current system for living donation works. However, disparities in access to living donor transplantation remain, and we must continue to improve and expand living donor transplantation for those in need.  As such, we support policy changes that are patient-centric, fiscally realistic, and ethically and legally sound. 

"Over the past decade some well-intended organizations and advocates have advanced ideas to increase access to living donor transplantation, including direct payments for or large financial incentives for organ transplants, that may appear expedient but can result in serious adverse consequences for transplantation and for patients. Many of these proposals pose serious unintended negative consequences to both donors and to public trust in organ donation. We fundamentally reject efforts to model changes to the current US system based on research or organ transplant practices in nations such as China and Iran whose governments fail to meet or ignore high international and US standards for ethical medical research and basic human rights.

...

"AAKP, ASTS, and AST strongly support the elimination of disincentives to transplantation and adamantly oppose coercive financial incentives to donate.

...

"AAKP, ASTS, and AST believe that improvements to the transplant system can best be made through ethically and legally sound, evidence-based, data driven policies informed and guided by patients and transplant professionals rather than by overhauling the entire transplant system.

"The transplantation system is a public-private partnership between the federal government and the transplant community and is designed, in part, to prevent overt political influence or other governmental interference in shared patient-physician decision making and clinical judgement. The relationship between patients, including living organ donors, and the doctors and medical institutions they choose to care for them must be protected and respected, as should the ability of individual transplant professionals to make clinical decisions in the best interest of those patients.

"Transplantation is heavily regulated by multiple federal agencies, including the Centers for Medicare and Medicaid Services (CMS), the Health Resources Services Administration (HRSA), and two HRSA contractors (the Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR)).  Transplant centers are subject to duplicative (and often conflicting) requirements and surveys imposed by CMS and the OPTN. Living donor transplant programs are subject to additional scrutiny to ensure that donors are not pressured, coerced, or intimidated into donating an organ.  All living donor transplant programs are required to have independent living donor advocates that ensure that donors’ full and informed consent is given with a full understanding of the procedure and its potential risks and consequences.

"Into this existing and complex regulatory framework, some organizations are proposing policy and legislative changes that would either expand federal control over transplant by inserting yet another federal agency into the process or overhauling the entire transplant system to give federal agencies, as well as political appointees and politicians, greater authority to regulate living donor transplantation. Exposing the living organ donation system to such political influence and putting decision-making in the hands of non-transplant experts is a mistake with dangerous consequences for patient health, public trust, and donor and patient confidence.

"These proposals raise the possibility that the federal government would mandate a “one-size fits all approach” to an incredibly complex set of clinical problems. Such an approach would likely result in fewer innovations and fewer opportunities to reduce barriers to transplantation, especially for historically underserved communities. There are many potential reforms to the transplant system that can be effective, have been suggested by the wider transplant community over the past decade, and should be adopted by Congress and federal agencies. However, any policy or legislative proposal that seeks to amend or replace the existing system with an even larger federal bureaucratic reach with the potential for federal interference in decisions made among organ donors and patients and the doctors and medical institutions they choose to receive care from should be viewed with skepticism.

"We oppose policy efforts that seek to place any governmental entity in the position of determining clinical criteria for living donor transplantation or otherwise interfering with the relationship between and among potential recipients, potential donors, and their caregivers.

*******

As a reader of many such joint statements, I wonder if the phrase  "coercive financial incentives" resulted from a compromise between those who believe that all financial incentives are coercive, and those who wish to leave the door open in the future to ordinary, non-coercive financial incentives, of the kinds that attach to so many human activities, and have done so much to relieve other kinds of shortages.

HT: Laurie Lee via Frank McCormick

Resident match video from the NRMP

 Different labor markets are organized differently. One difference between the market for new doctors and the markets for new Ph.D.s is that doctors use a centralized clearinghouse, so a lot of things happen at the same time.  Here's a video from the National Resident Matching Program that gives some idea about that.

Interesting development in the transition from medical school to residency: connecting applications and interviews

 The market for new doctors has been suffering from congestion in applications and interviews, in the runup to the resident Match (see recent post with a diagram). The American Association of Medical Colleges runs the main application server, ERAS. A private company called Thalamus runs a growing interview scheduling service. Now they are looking to collaborate.

 Here's  yesterday's press release from Thalamus:

AAMC, Thalamus Announce New Collaboration to Improve Transition to Residency

April 27, 2023 by Team Thalamus

Collaboration will increase transparency and make the residency process easier for applicants and programs  

Washington, D.C., April 27, 2023—Today the AAMC (Association of American Medical Colleges) and Thalamus announced a strategic collaboration to accelerate innovation and ease the transition to residency for medical students, medical schools, and residency programs. The collaboration will combine the AAMC’s long-established leadership in innovation along the continuum from medical school to residency training and continuing medical education with Thalamus’ market-leading product and software development expertise. 

“The transition from undergraduate medical education to graduate medical education is a critical period in any learner’s journey to becoming a physician,” said David J. Skorton, MD, AAMC president and CEO. “We know the community is seeking enhanced tools and integrated services that better support application and recruitment processes. We listened, we have made improvements, and, with Thalamus, we are excited to make this vision a reality.” 

The organizations will collaborate to leverage their data, technology, and expertise to transform the medical residency and fellowship recruitment processes for applicants and programs. Their efforts will focus on increasing transparency, supporting equity through holistic review, and improving the learner experience by consolidating the fragmented interview management process. 

“We are thrilled to be collaborating with the AAMC to provide a comprehensive solution that will streamline graduate medical education recruitment processes,” said Jason Reminick, MD, MBA, MS, CEO and founder of Thalamus. “But even more, we are looking forward to building new and innovative tools that improve the experience, are cost-effective, and leverage data for the benefit of the medical education community and the advancement of our collective missions.” Dr. Reminick applied to residency in 2012 during an eventful recruitment season disrupted by Hurricane Sandy. “I’m particularly excited to provide applicants with a comprehensive platform to manage their interview season.” 

The collaboration between the AAMC and Thalamus will enable data-sharing and innovative research that will benefit the undergraduate to graduate medical education community and advance both organizations’ missions. The initiative also demonstrates the commitment of both organizations to addressing the concepts and themes outlined in the 2021 report from the Coalition for Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee.

In recent years, the AAMC has completed significant in-depth research and upgraded technology to enhance the Electronic Residency Application Service® (ERAS®) suite of application and selection tools, such as updating the MyERAS® application content, building analytics tools for institutions, and partnering on collaborative research initiatives. Thalamus has completed unique research related to the physician workforce, including how geography influences The Match® and specialty-specific interview practices. The Thalamus technology will continue the upgrade of the ERAS suite of application and selection tools. The AAMC and Thalamus remain committed to future innovations that will enable the ERAS program to continue to evolve faster and better. 

Beginning in June 2023, all ERAS residency and fellowship programs will receive complimentary access to Thalamus’ leading interview management platform, Thalamus Core and Itinerary Wizard, as well as Cerebellum, a novel data and analytics dashboard to assess recruitment outcomes, specifically from a diversity, equity, inclusion, and geographic perspective. Programs may also elect to purchase Thalamus’ video interview platform and Cortex, its technology-assisted holistic application review and screening platform. 

According to AAMC data, the U.S. is expected to experience a shortage of up to 124,000 physicians by 2034. Given the burnout and other challenges to the health care system caused by the COVID-19 pandemic, the AAMC and Thalamus look to use their collective expertise to promote a diverse and representative workforce that will enhance health care and patient outcomes. 

The data and research the AAMC and Thalamus have amassed to identify resident, fellow, and physician recruitment trends can potentially have a major impact on diversity in medicine and begin to address several well-established and longstanding systemic challenges. These efforts will support not only the application and selection processes in graduate medical education but also aim to improve the experiences of the U.S. physician workforce over the long term. 

Related Resources 

• Frequently Asked Questions 
• AAMC ERAS Collaboration Page
• Thalamus Collaboration Page

###

Note for editors: Leaders from the AAMC and Thalamus are available to speak with media about this new collaboration and what it means for residency programs and applicants. 

The AAMC (Association of American Medical Colleges) is a nonprofit association dedicated to improving the health of people everywhere through medical education, health care, medical research, and community collaborations. Its members are all 157 U.S. medical schools accredited by the Liaison Committee on Medical Education; 13 accredited Canadian medical schools; approximately 400 teaching hospitals and health systems, including Department of Veterans Affairs medical centers; and more than 70 academic societies. Through these institutions and organizations, the AAMC leads and serves America’s medical schools and teaching hospitals and the millions of individuals across academic medicine, including more than 193,000 full-time faculty members, 96,000 medical students, 153,000 resident physicians, and 60,000 graduate students and postdoctoral researchers in the biomedical sciences. Following a 2022 merger, the Alliance of Academic Health Centers and the Alliance of Academic Health Centers International broadened the AAMC’s U.S. membership and expanded its reach to international academic health centers. Learn more at aamc.org. 

Thalamus is the premier, cloud-based interview management platform designed specifically for application to Graduate Medical Education (GME) training programs. The software streamlines communication by eliminating unnecessary phone calls/emails allowing applicants to book interviews in real-time, while acting as a comprehensive applicant tracking system for residency and fellowship programs. Thalamus provides comprehensive online interview scheduling and travel coordination via a real-time scheduling system, video interview platform, AI application screening/review tool (Cortex) providing technology-assisted holistic review, and first-in-class DEI-focused analytics dashboard (Cerebellum). Featured nationally at over 300+ institutions and used by >90% of applicants, Thalamus is the most comprehensive solution in GME interview management. For more information on Thalamus, please visit https://thalamusgme.com or connect with us on LinkedIn, Facebook, Instagram, Twitter, or YouTube. 

More anti-gay legislation in Uganda

 The NY Times has the story about new anti-gay legislation awaiting signature by Uganda's president:

We Will Hunt You’: Ugandans Flee Ahead of Harsh Anti-Gay Law. The bill, passed last month, calls for life in prison for anyone engaging in same-sex relations. President Yoweri Museveni congratulated lawmakers for their “strong stand” against L.G.B.T.Q. people.  By Abdi Latif Dahir

"Uganda’s Parliament passed a sweeping anti-gay bill in late March that threatens punishment as severe as death for some perceived offenses, and calls for life in prison for anyone engaging in same-sex relations.

...

"The bill, which passed 387 to 2, punishes anyone who leases property to gay people and calls for the “rehabilitation” of those convicted of being gay. President Yoweri Museveni, who has commended the bill, sent it back to Parliament on Thursday for “improvement,” his party said in a statement.

"The president congratulated lawmakers and religious leaders on what he called their “strong stand” against L.G.B.T.Q. people. “It is good that you rejected the pressure from the imperials,” he said, a reference to Western countries, in footage released by the public broadcaster. He spoke hours after the European Parliament denounced the bill.

"The legislation follows a groundswell of anti-gay rhetoric that has swept African countries in recent years, including in Ghana, Zambia and Kenya. Last month, lawmakers from more than a dozen African countries gathered in Uganda and promised to introduce or pass measures in their own countries that they said would protect the sanctity of the family and children against “the sin of homosexuality.”

...

"The latest move to target L.G.B.T.Q. people in Uganda has drawn support from local Christian and Muslim groups, and for years the financial and logistical backing o"f some conservative evangelical groups in the United States." 

Banned books

 The LA Times has the story:

Book bans are soaring in U.S. schools, fueled largely by new laws in Republican-led states by  ALEXANDRA E. PETRI

"Fearing criminal penalties, public schools throughout Missouri removed hundreds of books from their libraries after state lawmakers last year made it illegal to provide students with “sexually explicit” material — a new law that carried punishment of up to a year in prison.

"The dangers are playing out in public school districts and campus libraries across the United States, First Amendment advocates warn: Book bans, gassed up by state legislation pushed by conservative officials and groups, are stacking up at an alarming rate.

"In a report published Thursday by PEN America, the nonprofit free speech organization found 1,477 instances of books being prohibited during the first half of the 2022-23 academic year, up 28.5% from 1,149 cases in the previous semester. Overall, the organization has recorded more than 4,000 instances of banned books since it started tracking cases in July 2021.

"At issue is more than “a single book being removed in a single district,” said Kasey Meehan, the Freedom to Read program director at PEN America and a lead author of the report.

“It’s a set of ideas, it’s themes, it’s identities, it’s knowledge on the history of our country — these are the kind of bigger buckets of what is being removed, restricted, suppressed in public schools and public school libraries,” Meehan said."

It's against the law in North Korea to use South Korean words

 From Radio Free Asia:

North Korea sentences 20 young athletes for ‘speaking like South Koreans’. Skaters and skiers were caught on video using banned words while playing a game during training.  By Jieun Kim for RFA Korean

"About 20 aspiring North Korean winter athletes were abruptly sentenced to three to five years of hard labor in prison camps after they were found to have used South Korean vocabulary and slang while playing a word game, sources in the country say.

"It’s the latest example of authorities imposing draconian punishments to try to stamp out use of the “puppet language” and “capitalist” influences in daily life – despite the flood of illegal South Korean dramas and songs that many North Koreans secretly watch after obtaining them on thumb drives smuggled into the country.

"The ice skaters and skiers, all high school graduates under the age of 25 from Ryanggang province, were publicly disgraced at a square in Hyesan on April 3, a resident in the city on the Chinese border told Radio Free Asia’s Korean Service on condition of anonymity for security reasons.

“Residents think that it is excessive that they were sentenced between three and five years” of hard labor, another source in the city said. “It would be impossible to count how many hundreds or thousands of South Korean movies and dramas are easily available to us.”

...

"Apparently, one of the athletes took a video of the young people playing a word game called mal kkori itgi, where the object is to make a sentence that starts with the final word of the previous player’s sentence, and some of the athletes used vocabulary that was distinctly South Korean, a second source from the same province said.

"The video was found on the phone of one of the female athletes during a random inspection raid by police of her home – a frequent occurrence in North Korea when police look for contraband – and was reported to authorities. It wasn’t clear if she had taken the video or if it was sent to her, the first source said.

...

"The North Korean government recently passed the Pyongyang Cultural Language Protection Act, which underscores that the Pyongyang dialect is the standard language, and doles out severe punishments for speaking like a South Korean, or the death penalty for teaching others how to."

Michigan Senate seeks to repeal 1931 ban on unmarried cohabitation

 Michigan now has a more liberal senate than in 1931.  The Guardian has the story, about how even fossil repugnance dies hard:

Michigan Republicans fight effort to repeal ban on unmarried cohabitation. Law signed in 1931 is rarely enforced but carries penalty of prison time and $1,000 fine. by Erum Salam

"An attempt to repeal a Michigan law that punishes unmarried couples who live together is being thwarted by Republicans in the state legislature.

"The law, which dates to 1931, targets “any man or woman, not being married to each other, who lewdly and lasciviously associates and cohabits together”.

"It is rarely enforced but violations carry a penalty of up to a year in prison and a $1,000 fine.

"Senate Bill 56, which seeks to repeal the law, attracted support from all state senate Democrats and half of Republicans. But nine Republicans voted against.

...

"The bill now moves to the statehouse."

*********

Michigan Senate Bill 56: "Crimes: other; lewd and lascivious cohabitation; repeal prohibition. Amends sec. 335 of 1931 PA 328 (MCL 750.335)."

Medical aid in dying: access for children, and for mental illness

Two recent articles discuss whether there should be categorical limits on medical aid in dying (MAID).  In the Netherlands, the law now permits euthanasia for children in certain horrific situations, and in Canada, a debate continues about the status of patients with mental illness.

 From The Conversation:

Dutch government to expand euthanasia law to include children aged one to 12 – an ethicist’s view  by Dominic Wilkinson

"Ernst Kuipers, the Dutch health minister, recently announced that regulations were being modified to allow doctors to actively end the lives of children aged one to 12 years who were terminally ill and suffering unbearably.

"Previously, assisted dying was an option in the Netherlands in rare cases in younger children (under one year) and in some older teenagers who requested voluntary euthanasia. Until now, Belgium was the only country in the world to allow assisted dying in children under 12.

...

"Dutch paediatricians and parents had reported that in a small number of cases, children and families were experiencing distressing suffering at the end of life despite being provided with palliative care.

"That included, for example, children with untreatable brain tumours who developed relentless vomiting, screaming, and seizures in their dying phase. Or children with epilepsy resistant to all treatment with tens to hundreds of seizures a day.

"The study recommended improvements in access to palliative care for children, as well as altering regulation to provide the option of assisted dying in these extreme cases.

"It has been suggested that five to ten children a year might be eligible for this option in the Netherlands.

*********

From the NYT, an opinion piece:

Medical Assistance in Dying Should Not Exclude Mental Illness By Clancy Martin

"I am a Canadian, where eligible adults have had the legal right to request medical assistance in dying (MAID) since June 2016. Acceptance of MAID has been spreading, and it is now legal in almost a dozen countries and 10 U.S. states and Washington, D.C. To my mind, this is moral progress: When a person is in unbearable physical agony, suffering from a terminal disease, and death is near, surely it is compassionate to help end the pain, if the person so chooses.

"But a debate has arisen in Canada because the law was written to include those living with severe, incurable mental illness. This part of the law was meant to take effect this year but was recently postponed until 2024."

Strategy-proofness in Berlin in July

 "The WZB is planning an international conference on matching markets “Matching Market Design: Strategy-Proofness and Beyond” held as a two-day workshop on July 13–14, 2023, at the WZB Berlin Social Science Center, Germany. The conference will be organized by Dorothea Kübler (WZB), Christian Basteck (WZB/FU) and Vincent Meisner (TU)."

Here's the full announcement

Matching Market Design: Strategy-Proofness and Beyond  13. - 14. Juli 2023

"In the design of matching markets, it is important to elicit the privately known preferences of participants. Therefore, economists have focused on strategy-proof mechanisms which incentivize the truthful revelation of preferences and rule out any incentives to strategically misreport them. Unfortunately, as a growing body of evidence documents, strategy-proofness by itself is not sufficient to elicit truthful information on preferences.

"The workshop will bring together leading international researchers from North America, Europe, and Asia to present their latest research on this central design objective, including its limitations. In particular, we aim to discuss theoretical contributions on axiomatic characterizations, complexity notions, behavioral biases, and non-standard constraints, as well as applied work that incorporates experimental and field data."

Here's the preliminary program.

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

This post is about a recently published paper concerning the design of the market for new doctors in the U.S.  But it will require some background for most readers of this blog.   The short summary is that the market is experiencing problems related to congestion, and one of the proposals to address these problems was deeply flawed, and would have reduced market thickness and caused substantial direct harm to participants if implemented, and created instabilities that would likely have caused indirect harms to the match process in subsequent years. But this needed to be explained in the medical community, since that proposal was being  very actively advocated.

For those of you already steeped in the background, you can go straight to the paper, here.

Itai Ashlagi, Ephy Love, Jason I. Reminick, Alvin E. Roth; Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021. J Grad Med Educ 1 April 2023; 15 (2): 219–227. doi: https://doi.org/10.4300/JGME-D-22-00177.1

If the title doesn't remind you of the vigorous advocacy for an early match for select positions, here is some of the relevant back story.

The market for new doctors--i.e. the transition from medical school to residency--is experiencing growing pains as the number of applications and interviews has grown, which imposes costs on both applicants and residency programs.  

Below is a schematic of that process, which begins with applicants submitting applications electronically, which makes it easy to submit many.  This is followed by residency programs inviting some of their applicants to interview. The movement to Zoom interviews has made it easier to have many interviews also (although interviews were multiplying even before they moved to Zoom).  

After interviews, programs and applicants participate in the famous centralized clearinghouse called The Match, run by the NRMP. Programs and applicants each submit rank order lists (ROLs) ranking those with whom they interviewed, and a deferred acceptance algorithm (the Roth-Peranson algorithm) produces a stable matching, which is publicly announced on Match Day. (Unmatched people and positions are invited into a now computer-mediated scramble, called SOAP, and these matches too are announced on Match  Day.)

The Match had its origins as a way to control the "unraveling" of the market into inefficient bilateral contracts, in which employment contracts were made long before employment would commence, via exploding offers that left most applicants with very little ability to compare options.  This kind of market failure afflicted not only the market for new physicians (residents), but also the market for later specialization (as fellows). Consequently, over the years, many specialties have turned to matching for their fellowship positions as well.

  The boxes in brown in the schematic are those that constitute "The Match:" the formulation and submission of the ROLs, and the processing of these into a stable matching of programs to residents.  Congestion is bedeviling the parts in blue.

The boxes colored brown are 'The Match' in which participants formulate and submit rank order lists (ROLs), after which a deferred acceptance algorithm produces a stable matching of applicants to programs, which is accepted by programs and applicants on Match Day. The boxes in blue, the applications and interviews that precede the Match, are presently suffering from some congestion.  Some specialties have been experimenting with signals (loosely modeled on those in the market for new Economics PhDs, but implemented differently by different medical specialties).

The proposal in question was to divide the match into two matches, run sequentially, with the first match only allowing half of the available positions to be filled.  The particular proposal was to do this first for the OB-GYN specialty, thus separating that from the other specialties in an early match, with only half of the OB-GYN positions available early.

This proposal came out of a study funded by the American Medical Association, and it was claimed, without any evidence being offered, that it would solve the current problems facing the transition to residency.  Our paper was written to provide some evidence of the likely effects, by simulating the proposed process using the preferences (ROLs) submitted in previous years.  

The results show that the proposal would largely harm OB-GYN applicants by giving them less preferred positions than they could get in a traditional single match, and that it would create instabilities that would encourage strategic behavior that would likely undermine the successful operation of the match in subsequent years.

Itai Ashlagi, Ephy Love, Jason I. Reminick, Alvin E. Roth; Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021. J Grad Med Educ 1 April 2023; 15 (2): 219–227. doi: https://doi.org/10.4300/JGME-D-22-00177.1

Abstract:

"Background--An Early Result Acceptance Program (ERAP) has been proposed for obstetrics and gynecology (OB/GYN) to address challenges in the transition to residency. However, there are no available data-driven analyses on the effects of ERAP on the residency transition.

"Objective--We used National Resident Matching Program (NRMP) data to simulate the outcomes of ERAP and compare those to what occurred in the Match historically.

"Methods--We simulated ERAP outcomes in OB/GYN, using the de-identified applicant and program rank order lists from 2014 to 2021, and compared them to the actual NRMP Match outcomes. We report outcomes and sensitivity analyses and consider likely behavioral adaptations.

"Results--Fourteen percent of applicants receive a less preferred match under ERAP, while only 8% of applicants receive a more preferred match. Less preferred matches disproportionately affect DOs and international medical graduates (IMGs) compared to US MD seniors. Forty-one percent of programs fill with more preferred sets of applicants, while 24% fill with less preferred sets of applicants. Twelve percent of applicants and 52% of programs are in mutually dissatisfied applicant-program pairs (a pair in which both prefer each other to the match each received). Seventy percent of applicants who receive less preferred matches are part of a mutually dissatisfied pair. In 75% of programs with more preferred outcomes, at least one assigned applicant is part of a mutually dissatisfied pair.

"Conclusions--In this simulation, ERAP fills most OB/GYN positions, but many applicants and programs receive less preferred matches, and disparities increase for DOs and IMGs. ERAP creates mutually dissatisfied applicant-program pairs and problems for mixed-specialty couples, which provides incentives for gamesmanship."

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

I'm hopeful this paper will effectively contribute to the ongoing discussion of how, and how not, to modify the design of the whole process of transition to residency with an aim to fixing the parts that need fixing, without damaging the parts that work well, i.e. while doing no harm. 

(Signaling will likely continue to play a role in this.)

Workshop on Experimental Economics and Entrepreneurship: call for papers

 Nico Lacetera writes:

We are happy to announce the Third Workshop on Experimental Economics and Entrepreneurship, sponsored by the Belk College of Business of the University of North Carolina at Charlotte.

The workshop is organized by David J. Cooper (University of Iowa), Florian Englmaier (Ludwig Maximilian University of Munich), Nicola Lacetera (University of Toronto), Krista Saral (University of North Carolina at Charlotte) and Artie Zillante (University of North Carolina at Charlotte). It will take place in Charlotte, NC on October 18-19, 2023, immediately preceding the North American Annual Meeting of the Economic Science Association, in the same location.

The workshop is meant to promote partnerships between economic experimenters and scholars studying entrepreneurship, and to expose graduate students and recent PhD graduates in Economics and Management to the benefits and challenges of research at the intersection of experimental economics and entrepreneurship. The workshop will include a mixture of presentations by senior scholars in entrepreneurship and experimental economics, talks by more junior scholars, and presentations by graduate students. The conference is designed to encourage participants to interact and hopefully discuss ideas for future projects.

This is an open call for submissions for doctoral students, post-doctoral researchers, and faculty who obtained their doctoral degrees in 2019 or later. If you are interested in participating and presenting your research, please apply by submitting the following material to esaconference@uncc.edu by June 1, 2013:      

•    A cover letter including contact information.
•    An extended abstract of the paper you plan to present.  This should not be more than a page long.  If a paper is available, this can be submitted as well, but this is not required for consideration.

 The decision about accepted applications will be communicated not later than June 20, 2023. Each accepted and confirmed applicant will have two hotel nights covered as well as normal travel expenses.  

In addition to the selected workshop presentations, here is the current list of invited speakers who will be attending:

 

Jennifer Brown (University of Utah)

Jana Gallus (UCLA)

Orsola Garofalo (Copenhagen Business School)

Rem Koning (Harvard Business School)

Ronnie Chaterjee (Duke University)

Tim Salmon (Southern Methodist University)

We look forward to receiving your applications!

David, Florian, Nico, Krista, Artie