Thursday, October 15, 2009

Interviewing for the medical match

A recent article* in the Journal of the American Medical Association talks about the strategic behavior that precedes the submission of rank order preference lists to the medical match. The author was a student member of the NRMP board of directors who then participated in the match, and he describes the ways in which residency directors skirted the Match rules against soliciting information or commitments about how students would rank them. He also describes the kinds of signaling and information exchange that might not be unusual in other job markets, but which might have less consequence than in a centralized clearinghouse.

"I was startled when my first interview with an assistant program director abruptly turned from an easygoing chat to an unfriendly challenge:“Why would you ever come here?” Throughout the rest of the season, other interviewers often pushed the MPA’s boundaries, asking me,“How seriously are you considering our program?” or similar questions. Such inquiries are not violations, strictly speaking, but they still suggested that I had to make a commitment to be competitive. Worse, several interviewers did commit unambiguous violations: “If you want to match here, you have to let us know,” or “If we had a position for you, would you come here?”

" The atmosphere of gamesmanship extended beyond interviews. Some programs offered me formal “revisits” while others left it to me to request them. I wondered if it was necessary to travel to programs to improve my chances there. Soon after, program directors, faculty, or even residents I had met in passing started making recruitment calls, sometimes weekly.
No matter how friendly these callers were, their overtures always seemed to end with awkward pauses inviting me to make a commitment. After each one finished, I gave my standard reply, which soon became rote: “I loved visiting your program and would be honored to train there.” "

..."(Another program director inveighed against gamesmanship on the morning of a visit, but later that day, an interviewer stated outright that in order to match there I had to make a commitment to them.)... As the ranking deadline approached, I felt compelled to tell my top-ranked program that it was first, and painstakingly crafted enthusiastic e-mails to others. Many of the other applicants I know did the same.
Most of us applicants were rewarded for participating in these courtship rituals. I was told I was “ranked to match” by a number of programs, and it was public knowledge that other students were receiving similar commitments. That said, whatever relief these assurances gave us was tempered by horror stories from years past.One student had been sent real estate clippings from his top-choice program, covered with breathless Post-it notes: “Looking forward to seeing you here!” Weeks later, he was shocked to match at a different program."

*(Fisher, Carl Erik, 2009, "Manipulation and the Match," JAMA, 302,12 (Oct 1), 1266-7.)


dWj said...

Is this a function of their not understanding the incentive compatibility characteristics of the match, or is it something else -- simple ego, or a theory that someone who came to their seventh choice program would be a "morale problem" or some such?

Where some strategy seems inevitable is in decide whom to interview; the match is great in a world of full information, but if a mid-tier program is incurring costs to even determine its preferences, I can imagine it wishing to direct those resources toward applicants with whom it has a chance of matching.

Kari Parks said...

Mr. Roth,

I apologize if you've covered this before, but given all the posts lately on matching, have you ever looked into how Panhellenic Sorority Recruitment works?

There is a national protocol by which all colleges' Panhellenic Associations are supposed to abide. In a nutshell, Recruitment is spread out over 4-5 days; on the first day, all Potential New Members (PNMs) visit every single sorority. At the end of the night, the PNMs rank the houses they visited, and each sorority spends hours debating all the women and ranking them, as well. Panhellenic calls this the "Mutual Selection" process and requires that neither PNMs nor sororities give any indication to the other party regarding their likelihood of admissions. (Although all schools have the same rules, this process seems to exhibit varying levels of integrity depending on the campus -- it seems that the bigger of a deal the Greek system is, the more likely that there will be common rule-breaking without severe penalties. My alma mater, UCSD, or UC Socially Dead, seems to have a fairly clean Recruitment process every year.)

The process continues, with PNMs visiting a fewer number of chapters each night, until Pref Night, when the PNM must rank her final order. Per Panhellenic Rules, PNMs must rank every house they visited on Pref Night and sign a contract agreeing to accept a bid from whichever sorority that offers one; if she does not choose to become initiated, the PNM locks herself out of joining any sorority for one calendar year.

Al Roth said...

Hi: I couldn't figure out how to respond directly to Ms. Parks' very interesting comment, so I'll post one myself. The late Sue Mongell and I wrote a paper on sorority matching, and I wonder if it's still up to date. Here's the reference:
Mongell, S. and Roth, A.E., "Sorority Rush as a Two-Sided Matching Mechanism," American Economic Review, vol. 81, June 1991, 441-464, and here's a version on the web:

Al Roth said...

the last part of that url should be