Medical residency scramble

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

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

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

Comment on the proposed NRMP scramble following the resident match

The NRMP website asked for comments on the NRMP's new plan for organizing the post-match scramble, and some of my young colleagues and I were moved to send one in:

Comment on the NRMP’s “Supplemental Offer and Acceptance Program” Proposed to Replace the Post-Match Scramble by Peter A. Coles, Clayton R. Featherstone, John William Hatfield, Fuhito Kojima, Scott Duke Kominers, Muriel Niederle, Parag A. Pathak, and Alvin E. Roth.

Executive Summary: "Historical precedent and economic principles suggest that the Supplemental Offer and Acceptance Program (SOAP) proposed for the NRMP Scramble will lead to unsatisfactory outcomes by forcing participants to make unnecessarily difficult decisions and giving them strong incentives to break the rules laid out in the SOAP proposal. We suggest, as an alternative Scramble mechanism, that the NRMP run a “Second Match” for the Scramble participants using rules similar to those of the Main Match."


Here's my previous post: Cleaning up the scramble for medical residents with SOAP

Cleaning up the scramble for medical residents with SOAP

Changes are coming in the scramble that follows the medical resident match run by the National Resident Matching Program (NRMP). A new, semi-centralized, partially computerized Supplemental Offer and Acceptance Program (SOAP) has been announced, for implementation in March 2010.

If I understand the proposal correctly, residency programs with unmatched positions will be able to submit preference lists of match participants who ended up unmatched, and these preferences will be used to make exploding offers, after which the preference lists and positions will be updated to take account of acceptances (e.g. candidates who accept a position will be removed from other program's preference lists), and new exploding offers will be issued. Unlike in the main match (which these days uses the Roth-Peranson algorithm, but which you can think of as a student-proposing deferred acceptance algorithm), applicants will not submit preference lists, but will accept or reject offers as they come in (i.e. they cannot defer acceptances by holding their best offer until they see if any better offers arrive later).

Part of the proposal is to integrate the scramble with the Electronic Residency Application Service (ERAS), which will make some kinds of automatic processing and regulation possible,while some of the proposed regulations may be more challenging to enforce. (Markets that use exploding offers at fixed times have often been subject to cheating of various sorts: here's a paper on the experience of the law clerk market. There are lots of differences in the market culture of doctors and lawyers that may result in different outcomes.)

Here are some of its proposed rules:

• Unmatched applicant and unfilled program information will be released simultaneously.

• There will be a “time out” period during which unmatched applicants can send applications but programs cannot make offers.

• Applicants and programs will be required to send and receive applications only through ERAS.

• NRMP-participating programs that fill positions during Match Week must do so only through the SOAP.

• New functionality will be added to the R3 System to allow programs to offer unfilled positions on the basis of preference lists submitted by the programs.

• Applicants must accept or reject their offer(s) within a specific timeframe; offers not accepted or rejected will expire.

• The R3 System will establish an electronic “handshake” when an applicant accepts a position.

• Positions will be deleted from the dynamic List of Unfilled Programs once an offer has been accepted.

• A program’s unfilled positions will be offered to applicants in order of preference until all positions are filled or the preference list has been exhausted; programs will be able to add applicants to the bottom of their preference lists throughout Match Week.

• The NRMP Match Participation Agreement will be expanded to include Match Week and SOAP, and sanctions will be imposed for improper behavior.
...
Eligible NRMP applicants:


• Must be able to enter GME on July 1 in the year of the Match

• Will be able to apply only to unfilled Match-participating programs during Match Week

􀀹 Access to the List of Unfilled Programs will be restricted by match status (preliminary or advanced)

􀀹 Must use ERAS and will be able to select only unfilled Match-participating programs

􀀹 Cannot use phone, fax, email, or other methods

􀀹 Cannot have another individual/entity contact programs on applicant’s behalf

􀀹 Will be able to accept positions only through SOAP during Match Week

• Can apply to non-Match-participating programs after Match Week

Ineligible NRMP applicants:

• Cannot participate in SOAP

􀀹 Cannot apply to Match-participating programs using ERAS, phone, fax, email, or other methods

􀀹 Cannot have another individual/entity contact Match-participating programs on applicant’s behalf

• Can apply to non-Match-participating programs during Match Week

􀀹 Can use ERAS to select non-Match-participating programs

􀀹 Can use phone, fax, email, or other methods

• Can apply to Match-participating programs after Match Week

Unfilled Programs:

• Must accept applications only through ERAS during Match Week

􀀹 Cannot use phone, fax, email, or personal contacts

• Must fill positions using SOAP during Match Week

􀀹 Cannot offer positions to ineligible applicants during Match Week

􀀹 Cannot make offers outside SOAP during Match Week

􀀹 Are not required to fill positions during Match Week

• Can add applicants to bottom of preference list

If an applicant rejects an offer or allows an offer to expire, no further offers will be made to that applicant by the same program.

Once an applicant accepts an offer, the applicant will not be able to send additional applications via ERAS.

Once a program has filled all of its positions through SOAP, applicants will be unable to send applications to that program via ERAS.

Offers extended by programs and accepted by applicants during the Match Week Supplemental Offer and Acceptance Program (SOAP) will create a binding commitment. Failure to honor that commitment or failure to adhere to SOAP policies will be a violation of the Match Participation Agreement.

Repugnant transactions in Saudi Arabia

I call a transaction 'repugnant' if some people want to engage in it, but others don't want them to. In Saudi Arabia these often involve religious views.
The NY Times report that the Turkish soap opera Noor is very popular among Saudi women, but not among clerics: Arab TV Tests Societies’ Limits With Depictions of Sex and Equality .
"That divided response was apparent this month when Sheik Luhaidan, the Saudi cleric, made his comment about killing the owners of satellite TV stations that broadcast indecent material.
His comments were quickly rebroadcast, and an uproar ensued. Critics across the ideological spectrum, including some hard-line Saudis, berated him as having crossed the line. Some of the television networks Sheik Luhaidan appeared to be referring to are owned, after all, by members of the Saudi royal family.
Sheik Luhaidan, who is chief justice of Saudi Arabia’s highest legal authority, the Supreme Judicial Council, is said to have been surprised by all the controversy.
A few days later, apparently under pressure from senior figures in the Saudi government, he appeared on state television to explain. He said he had not meant to encourage or condone the murder of station owners. Assuming other penalties do not deter them, he said, the owners should first be brought to trial and sentenced to death — and then they could be executed."

For some other, related examples, see
Saudi Arabia bans sale of dogs, cats in capital, and
Saudi Arabia bans all things red ahead of Valentine's Day.

However, as elsewhere, what transactions are repugnant can change over time, in both directions, and things formerly repugnant can become less so:
Saudi Women Can Now Stay in Hotels Alone