NRMP Match Day, 2019

Today is match day, when imminent medical grads find out where they'll be starting residencies in July.

Here's the NRMP's press release:
Thousands Of Resident Physician Applicants Celebrate NRMP Match Results
2019 Main Residency Match is largest on record with 44,600 registered applicants and more than 35,000 positions offered

Here are some data tables, including this one on couples:

Here's an article in Stat reflecting on some current issues of marketplace maintenence, related to what certainly seems to have become excessive pre-match interviewing:

Ideas for easing medical students’ Match Day ‘frenzy’
By ALISON VOLPE HOLMES and MONA M. ABAZA MARCH 15, 2019

"The National Residency Matching Program is an admirable invention. Now more than 30 years old, it is the system through which medical students get their first paid, professional positions. It corrected past abuses that took advantage of students, often pressuring them to accept binding offers within 24 hours of a residency interview. The Match is sufficiently noteworthy that its creator, Alvin Ross, won a Nobel Prize in economics for his work on matching theory. His algorithm continues to place half of U.S. medical school graduates in their first-choice programs. Other professions and selection processes could be improved by using a similar matching system.

Yet the Match and what leads up to it are having growing pains. Medical students are applying to increasing numbers of residency programs, sometimes to all of the programs in a field. Residency program directors are flooded with applications, and have trouble identifying which students are truly interested.

...

"Otolaryngology (also known as ear, nose, and throat) offers a telling illustration of this problem, and a potential solution that failed. In 2010, the average student interested in an otolaryngology residency applied to 47 programs, and the average residency program received 200 applications from U.S. medical students — to fill just two to six positions. By 2015, this increased to 64 applications per student and 275 applications per program.

"The program directors attempted to exert some control over application inflation by asking students to write a paragraph about their interest in the program they were applying for. This reduced applications, but also backfired. In 2017, the number of applications fell back to 200 per program, but 10 programsfailed to get the number of residents they needed. The otolaryngology program directors removed the supplemental requirement and applications jumped back up to 278.

...

"The Match was once a brilliant solution that everyone in medicine was proud of. There are still lessons to be learned from it for other selection processes, including undergraduate admissions. But if we — students, advising deans, and residency program directors — do not come together and work on solutions, we risk losing the Match’s great many advantages."

Congestion in resident and fellowship applications and interviews: Plastic Surgery

Medical graduates can enter plastic surgery through a residency immediately upon graduating.  As in many other specialties, there is lots of applying and interviewing before the residency or fellowship Match.  Here's a proposal to limit the number of applications:

Solving Congestion in the Plastic Surgery Match
Molina Burbano, Felipe, B.A.; Yao, Amy, B.S.; Burish, Nikki, M.D.; Ingargiola, Michael, M.D.; Freeman, Matthew, M.D.; Stock, Jeffrey, M.D.; Taub, Peter J., M.D.
Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 634–639

"Summary: Plastic and reconstructive surgery is among the most competitive specialties in the residency match. Applicants seeking to maximize their chances of a successful match often submit numerous applications to the National Residency Matching Program. It is not uncommon for those applying to plastic and reconstructive surgery to apply to every program. The high application volume imparts significant time and financial burden for applicants and programs alike. Furthermore, it makes distinguishing between applicants with a genuine interest in a specific program and those who are merely hoping to improve their chances vastly more difficult. The authors sought to characterize trends in the match rate, as the number of integrated plastic and reconstructive surgery programs continues to increase. Furthermore, they reviewed the literature on game theory for possible solutions to residency application congestion. The authors propose the use of the game theory model to explain the observed results and show why an application limit is the most reasonable approach to address this issue.
...
"it is not uncommon for those applying to plastic and reconstructive surgery to apply to every program. In fact, of a total of 73 available training programs in the 2017 season, senior U.S. applicants applied to a median of 70 programs

"Such a high application volume imparts significant time and financial burden for all parties involved. Applicants spend an average of $6073 and up to $15,000 on applications and interview travel.3 Residency program directors, in turn, must review a greater number of applications and conduct additional interview dates. Furthermore, distinguishing between applicants with a genuine interest in a specific program, versus those who are merely hoping to improve their chances, has become vastly more difficult, with some preferred applicants possibly getting overlooked in the process.4

"Weissbart et al. observed the same trend in the urology match and other competitive specialties.
...
"Introducing an application limit would guide applicants to apply to programs based on fit (i.e., where they felt they were viable applicants). Similarly, the reduction in applications would allow programs to focus more carefully on reviewing all received applications. A more thoughtful application process, with increased focus on each individual, will likely produce “better” matches. Further research would need to be conducted on the correct application limit and the possibility that less competitive students could be left unmatched if not allowed to apply as widely.
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Plastic surgery was also attractive at Hogwarts, although not to Harry:

Harry Potter and the Resident Match | ZDoggMD.com

Are there too many interviews for medical residencies and fellowships? Should there be an interview Match?

A recent article in JAMA considers the question in the title of this post:

September 21, 2018
Matching for Fellowship Interviews
Marc L. Melcher, MD, PhD; Itai Ashlagi, PhD; Irene Wapnir, MD

"Most surgical training programs interview many candidates because the consequences of not matching harms the reputation of the program and affects the work force of their services.5 Surveys of pediatric surgery program directors in 2011, 2012, and 2014 revealed that they interviewed a median of 24 to 30 candidates per year. However, the median rank at which the programs matched was less than 4, and programs never matched beyond their 12th choice, suggesting that they did not need to interview as many residents as they did.
...
"instituting an interview match may be one approach to help improve the interview selection process by reducing the large numbers of unfruitful and costly fellowship interviews. For example, Ashlagi et al7 found in a theoretical matching model that when candidates and programs each have highly heterogeneous preferences, limiting the number of interviews improved the efficiency of the matching process. Thus, fellowship interview matches represent an opportunity to reduce the excessive number of interviews and optimize the selection of applicants.

"A practical strategy that may achieve this goal is an interview match that precedes the existing match. After applications are submitted, candidates and programs submit rank lists that could be used to fill limited interview slots. Mechanisms that enable applicants and training programs to signal interest in each other have been proposed.4,7 By ranking candidates and programs highly, both essentially are respectively signaling their strong preference for each other.4 Therefore, fewer interviews might be sufficient for candidates and programs to identify mutually desirable matches and reduce the number and costs of interviews. If the program and candidate interview slots remain unfilled, a secondary match could be performed to fill unmatched interview slots.
...
"n conclusion, a well-designed interview match may help reduce excessive costly interviews while more efficiently pairing candidates and programs, so that both achieve as many highly ranked choices as possible. This strategy could be applied broadly to matching programs in other medical specialties and may be attractive at earlier career stages such as residency interviews."
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And here's a related news story on the Stanford Medical School site:

The current fellowship interview process is cumbersome — Stanford researchers have a better idea

"In their fourth and fifth years, surgical residents are busy: They're caring for patients, assisting junior trainees and fulfilling their own training requirements. And that's not all: About 75 percent of these residents are scrambling to squeeze in interviews for fellowships across the country, often packing in between 6 and 15 interviews to ensure they secure a spot, Stanford transplant surgeon Marc Melcher, MD, PhD, told me.

"Fellowship program directors, including Stanford surgeon Irene Wapnir, MD, who directs the breast surgical fellowship, are similarly harried. To fill typically one position, the directors can interview 20 or more doctors to find a quality candidate whose interests match their program.

"The process is also expensive and time-consuming. When experienced residents leave, their coworkers need to cover for them, and the residents must pay their own way to travel to interviews, Melcher said.

...

"Melcher and Wapnir reached out to their Stanford Engineering colleague Itai Ashlagi, PhD, who specializes in the design and analysis of marketplaces, such as matching kidney donors with recipients.  Together with Alvin Roth, PhD, a Stanford economist, they're proposing a new fellowship interview matching system. Their concept appears in JAMA.

"The researchers propose two key changes. First, applicants and programs would signal their preferences for each other — before making travel arrangements and setting aside days of valuable physician time. In addition, the number of interviews for each fellowship program would be capped, as would the number of interviews for each candidate, Melcher said."

Welfare effects of limiting the number of interviews by Beyhaghi and Tardos

Here's a new paper on a subject that is coming up in a number of the markets that I keep an eye on:

Effect of Limited Number of Interviews onMatching Markets
by Hedyeh Beyhaghi and Eva Tardos

Abstract. We study outcome of two-sided matching between prospective medical residents who can only apply to a limited number of positions and hospitals who can interview only a limited number of applicants and show non-intuitive effects in the matching outcomes. We study matching size as our notion of efficiency, and show when the number of interviews is limited, a market with limited number of applications achieves a higher efficiency compared to a market with no limit. Also we find that a system of treating all applicants equally (setting the same limit for their number of applications), is more efficient rather than allowing a small set to apply to one more/less position. This comparison results in a scallop-shape figure 2 that shows expected size of matching with respect to expected number of applications. Finally we show that limiting number of interviews does not always hurt efficiency of matching markets and can improve social welfare in certain cases. 

AEA interviews: the video

Going to the AEA to interview for a job?  Here's a video in which various already-employed economists reflect on the process of becoming employed...

Here's the webpage: Interviewing at AEA? Watch this first.  Laughs, Scares, and Wisdom from AEAs Past!

Interviewing in matching markets by Robin Lee and Michael Schwarz

We still know too little about interviewing as a part of matching markets, but here's a paper (that has been around for a while but is now published) that takes an interesting approach.

Interviewing in two-sided matching markets

By:Lee, RS (Lee, Robin S.); Schwarz, M (Schwarz, Michael)

RAND JOURNAL OF ECONOMICS

Volume: 48   

Issue: 3  

Pages: 835-855

DOI: 10.1111/1756-2171.12193

Abstract

We introduce the interview assignment problem, which generalizes classic one-to-one matching models by introducing a stage of costly information acquisition. Firms learn preferences over workers via costly interviews. Even if all firms and workers conduct the same number of interviews, realized unemployment depends also on the extent to which agents share common interviewing partners. We introduce the concept of overlap that captures this notion and prove that unemployment is minimized with perfect overlap: that is, if two firms interview any common worker, they interview the exact same set of workers.

Maladaptive interviewing culture in some residency matches

Here's a paper that describes the high-pressure interviewing that goes on before the resident match for Radiation Oncology (and proposes that residency directors should behave better):

Taking “the Game” Out of The Match: A Simple Proposal
by Abraham J. Wu MD, Neha Vapiwala MD, Steven J. Chmura MD, PhD, Prajnan Das MD, MS, MPH, Roy H. Decker MD, PhD, Stephanie A. Terezakis MD and Anthony L. Zietman MD
in the International Journal of Radiation Oncology, Biology, Physics, 2015-12-01, Volume 93, Issue 5, Pages 945-948

"Holliday et al  (3)  conducted an anonymous survey in which medical students applying in Radiation Oncology reported experiencing “behaviors that conflict with written NRMP policies, either during or after interviews”  (3)  . Of those who responded, alarmingly high percentages perceived that the system can be “gamed” through actions ranging from a wink and a nod, embellished thank you notes and advocacy phone calls, all the way to overt promises and declarations of interest (the potentially disingenuous nature of which is disturbing in itself). Radiation Oncology is fortunate to attract über-competitive “top-seed” candidates with credentials that confer prestige and promise to our specialty's future  (4)  , but, it being such a competitive field, most candidates are applying to dozens of programs. Both programs and candidates have sought a way through the morass by essentially “prearranging” matches ahead of the Match deadline. Programs seek affirmation that the applicant will rank them first, and applicants, with the stress of an overwhelming process, are tying themselves into knots trying to let all the programs at which they interview feel that they will be ranking them number one. Many candidates have complicated decisions to make about their lives and genuinely do not know their program ranking until the last minute, but the pressure is on to “show their hand”  (5)  . First-year residents, when asked what it was that they found most stressful about the process, describe the subtle pressure that programs put them under “to declare” them as top of the list. The anxiety when applicants are obligated to “play the game” is immense, even cruel. An implicit requirement to declare a first-choice program may have significant practical consequences: an excellent applicant who declared a “first choice,” yet narrowly failed to match at that program, may have plummeted down the rank list of other programs unwilling to “waste” a high slot on him or her. Applicants may not be truthful in their post-interview communications (for example, telling multiple programs they are the first choice)—behavior that can never be condoned, but which the new norms incentivize. The report by Holliday et al confirms what we knew in our hearts: that the pendulum has indeed, insidiously, swung in this direction and that these behaviors are now regarded as the new normal rather than in any way deviant.
...
"From the perspective of the applicants, Jena et al  (10)  surveyed senior medical students at 7 US medical schools regarding post-interview communications with programs and uncovered that more than 85% of respondents reported communicating with programs, with nearly 60% notifying more than one program that they would rank it highly. Furthermore, students reported that programs indicated that they would be “ranked to match,” “ranked highly” (52.8%), or other similar suggestive euphemisms. Most worrisome is that nearly a quarter of applicants admitted that they altered their rank order list on the basis of these programmatic communications, and 1 in 5 who ranked programs according to these promises did not match at that program, despite ranking it first. 

Cheating in China on (American) college admissions

Inside Higher Ed has the story: In China, No Choice But to Cheat?

July 9, 2015 By

Elizabeth Redden

"EUGENE, Ore. -- Is the admission process broken for Chinese applicants to American colleges?

Variations of that question came up again and again during sessions on Wednesday at the Overseas Association for College Admission Counseling [OACAC] conference. Persistent concerns about standardized test fraud, doctored transcripts and fake admission letters -- and the role of agents in helping to "pollute" the application process (as one session description put it) -- are causing some to worry that Chinese students might think cheating is their only choice.

"We need to make it [the application process] safe for honest applicants," said Terry Crawford, the chief executive officer and co-founder of InitialView, a video interviewing company based in Beijing.

"There's a perception in China that the system is rigged, that if you pay enough money you're going to get the results that you want," Crawford said. He cited a recent China Newsweek article laying out the process and prices for cheating on the Test of English as a Foreign Language (TOEFL) as just one example of the type of story that feeds into this perception (the reporter received test answers during the exam via a small, wireless-enabled watch)."

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Interestingly, Initial View, the company that Terry Crawford and Gloria Chyou founded in China, was initially founded to address the problem of fraud in English language tests, by offering applicants the opportunity to make a video of an unscripted interview that they conduct, to be sent to colleges, who can then confirm the fluency of the speaker, and later verify that the student who enrolls is the one who took the interview.