Match Day for new doctors

 The 2024 Match for new American doctors was announced yesterday by the NRMP, the National Resident Matching Program. Congratulations to all!

Here are some links:

Advance Data Tables
Match By the Numbers
Press Release

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.

"It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program," say its leaders

 The current appointment process for interventional cardiology fellows is early and congested, and programs feel obliged to make exploding offers, often to internal candidates, without much opportunity for external candidates and programs to become acquainted. In short, they are facing the problems with decentralized hiring that have led many medical specialties to use a centralized match to organize the labor market for residencies and fellowships.  Here's a proposal that this fellowship program should join the Match in order to have a more orderly, better informed process.

Vallabhajosyula, Saraschandra, Sabeeda Kadavath, Alexander G. Truesdell, Michael N. Young, Wayne B. Batchelor, Frederick G. Welt, Ajay J. Kirtane, Anna E. Bortnick, and ACC Interventional Section Leadership Council. "It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program." Cardiovascular Interventions 15, no. 17 (2022): 1762-1767.

"In this perspective article, which is a summation of the deliberations of the American College of Cardiology Interventional Section Leadership Council, we describe the current process of interventional cardiology fellowship candidate selection and opportunities for improvement by joining the Match.

...

"Current Application Process

...

"the date for program review of applications starts on December 1st (1½ years before the start of the interventional cardiology training program to which applicants are applying), although programs are free to offer spots earlier. At the time applications are submitted, cardiovascular medicine fellows in traditional 3-year programs have variable exposure to the cardiac catheterization laboratory. In our experience, for many applicants, the timing of the application process precludes an adequate diagnostic catheterization laboratory experience in order to inform decision-making. ... program leadership is heavily reliant on candidate performance in the interview and on subjective evaluation through letters of recommendation from faculty mentors who have typically had a single year of exposure to applicants.

Concerns about remote interviewing for the surgery match

 I don't doubt that every year people are nervous about the residency Match, and worries this year are related to the special situation of the Covid pandemic, in which interviews will be remote.

Irene Wapnir forwards the following:

From the AM College of Surgeons Bulletin: Interview crisis:

It May Be Too Late toAvoid a Crisis in the Surgery Match This Year

Ronald J. Weigel, MD, PhD, FACS; Steven C. Stain, MD, FACS; and L. Scott Levin, MD, FACS, FAOA

Are you hearing that outstanding medical students applying for surgical residencies are being wait-listed for an interview at top training programs? The problem may be yet another unfortunate consequence of the COVID-19 pandemic.

In normal years, programs have cancellations because there is a physical limitation for how many interviews a student can do. This year, the pandemic forced programs to go to virtual interviews, and a small group of top students nationally appear to be filling all the interview slots for the top programs. If this is true, then many of those programs may go unfilled in the match.

For example, if the average number of interviews offered by a program is 100, and these programs are all competing for the same pool of 100 intern applicants, the pool of top students interviewed may be too small to fill all the slots in these programs. Additionally, the current interview process may create disadvantages for minority applicants and students from schools that are not considered "top tier."

With virtual interviews allowing students to interview at a larger number of programs, we may need a different system nationally for the allocation of interview slots, such as rolling acceptances for interviews with students being required to commit only to a set number of programs, which would allow additional students the opportunity to be interviewed. The solution will require program directors and surgical leaders nationally to discuss this issue. It may be too late to avoid a crisis in the match this year.

Surgery Match: Considerations and Possible Solutions

In their article, "It May Be Too Late to Avoid a Crisis in the Surgery Match," Drs. Weigel, Stain and Levin highlight challenges with this year's surgery match. Regarding this, the ACS proposes that program directors, deans and chairs, as well as candidates, consider the following to ensure as fair and equitable a process as possible during this extraordinary time:

Program Directors, Deans, Chairs

• Review the consequences that oversubscribing to slots has to programs and other candidates with students
• Don't offer slots to more candidates until those offered have a reasonable time to respond
• Make lists of candidates of interest who are not interviewed to ensure slots are offered when available

Candidates

• Consider limiting the number of interviews scheduled to a reasonable amount. Consider the impact on your colleagues of taking up too many interview slots—be fair to other applicants
• Release interview slots if you know you will not use them
• Release slots when you have completed enough interviews and experienced reciprocal interest that you are confident you have a well-prepared rank list

 

NRMP Match Day (and corona virus precautions)

Today, Friday, is Match Day, the day when new American medical school graduates and others find out the residency programs to which they have been matched by the National Resident Matching Program (NRMP).

In a usual Match Day, the graduates of most American med schools would gather together, to learn all together where they would be heading later this summer.  However this year, many of us are working from home, with large gatherings discouraged if not banned, to prevent the spread of corona virus.

The AAMC put out this announcement earlier this week:

The Match®: 10 things to know as the day draws nigh
...

"A two-stage reveal: On Monday, students learned if they have been matched to a residency via emails that were sent out at 11 a.m. ET. On Friday, they learn specifically where their residencies will be during the Match Day ceremonies (either in-person or online), which start at noon ET across the country, or by emails from the National Resident Matching Program® that go out at 1 p.m. ET. Students can also learn about both results through a mobile device.

"Coronavirus impact: Many schools have made or are weighing changes to Match Day celebrations as the status of the virus outbreak changes in various regions of the country."

Why aren't clearinghouses used in college admissions?

I recently had an email from  Professor Deepak Hegde, at NYU's Stern School who asked me a question that led to the following exchange (edited for brevity and reproduced with his permission):

"Why are admission decisions in a broader set of settings (e.g., Phd applicants-programs, MBA applicants-to-business schools and so on)  not cleared through matching programs as is done with medical schools and residency applicants (or in some cases public schools matching)?   Are there a general set of conditions that one could develop to understand the contexts in which the matching algorithm that have helped advance could be implemented effectively?"

I replied as follows:

"I certainly don’t have a complete answer, but one obvious piece is that setting up a centralized clearinghouse for a whole market involves getting a lot of parties to coordinate and cooperate.  So I would guess that MBA admissions have a better chance of getting organized than, say Ph.D. admissions, since MBA programs are more alike one another than are Ph.D. programs (e.g. in Physics and Philosophy, or Chemistry and Chinese).

"And since wide scale cooperation is hard, I think it mostly happens in market in which people are very dis-satisfied with the existing system, and not just somewhat irritated.

"Is it your sense that MBA admissions is in a crisis of some sort?"

His reply: "In my assessment ... MBA admissions is not facing such a crisis, yet."

So...I think the MBA Match isn't something we'll hear about in the near future.

Match Day for medical residents--NRMP results announced

Today is Match Day: later today, graduating American medical students, and quite a number of other young doctors will learn where they will work next year.

Here's one description: The Final Countdown: Match Day 2018.

Here's another:
NRMP Match Week will Reveal Future for Thousands of Resident Physician Applicants
NRMP Main Residency Match continues to grow, with 2018 Match expected to be largest in history.

And here's my all time favorite, courtesy of Hogwarts.

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.

Match Day for new doctors

Today is Match Day, when graduating medical students find out where they will do their residency.

MAR18

Match Day!

Applicants: Medical school Match Day ceremonies at 12:00 p.m. ET. Learn where you matched in the R3 system and by email at 1:00 p.m. ET.

Programs: Match Results by Ranked Applicant and SOAP Results by Preferred Applicant reports available at 2:00 p.m. ET.

Advance Data Tables available on www.nrmp.org at 1:00 p.m. ET.

Here's an earlier WSJ story by a graduating doctor:
Match Day, the NFL Draft of Medicine
On March 18, thousands of budding doctors find out where they’ll be serving their residencies.
"As you can imagine, it is a day of high anxiety, celebration and disappointment. My classmates and I have spent the past year choosing specialties, filling out applications and interviewing with residency programs. This process has taken us to cities, hospitals and universities around the country. After years of study, we’re about to become physicians. Both our professional and personal lives hinge on the results of this algorithm.

The Match was introduced in 1952 to address many of the uncertainties of residency applications. Before, medical students had to seek residency spots by themselves. But this decentralized system was rife with coercion, favoritism and deceit. Residency programs would demand medical students accept offers before applicants could consider other options. Students and programs betrayed one another by reneging on commitments.

The Match provides structure to the process. Students apply for residency positions through a common application. Strict policies govern communication between programs and applicants, with public reporting of violations. Applicants and programs submit ranking preferences into a centralized system. The Match algorithm couples these rankings and establishes binding contracts for residency positions.

Last year saw record numbers, when nearly 35,000 applicants submitted ranking preferences for roughly 30,000 residency slots. Medical schools host ceremonies to celebrate the event. Researchers Alvin Roth and Lloyd Shapley even won the 2012 Nobel Prize in Economics for their work related to the Match."
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Here's the NRMP page on why it takes 23 days from the time preferences are submitted to announce the match results

What Happens Between Rank Order List Deadline And Match Day?

Between the Rank Order List Certification Deadline and Match Day, the NRMP conducts a rigorous review of Match data, including:

• Assessing and confirming the integrity of the data
• Conducting a final verification of applicants’ credentials
• Withdrawing applicants who are ineligible for the Match
• Transferring the data from the R3 system to the matching algorithm module, rechecking the data, processing the algorithm, and transferring data back into the R3 system
• Verifying the results of a Match and transferring the data into the NRMP databases
• Verifying applicants’ credentials for Main Residency Match SOAP participation
• Preparing 50,000 individual Match Week reports for Main Residency Match applicants, program directors, and medical schools

These steps, all completed in a few weeks, ensure the accuracy of Match results.

Here's a story on the SOAP scramble for unmatched students:https://www.statnews.com/2016/03/17/medical-students-match-day/ 

Should there be a residency match for medical physics?

The Journal of Medical Physics has published a debate on the resolution: Medical physics residents should be placed using a matching program

Stephen Sapareto, X. Ronald Zhu and Colin G. Orton, Moderator
Med. Phys. 41, 060601 (2014); http://dx.doi.org/10.1118/1.4871039

Arguing for the Proposition is Stephen Sapareto, Ph.D., arguing against the Proposition is X. Ronald Zhu, Ph.D.

Medical physicists get Board certification following a residency, but they are Ph.D.s and not M.D.'s, so they finish their degree only after writing a dissertation.

Briefly, the position in favor of a match is that graduates are facing a chaotic unraveled market that resembles the one for medical residents prior to the institution of a match.  And the position against a match rests on the observation that medical physicists don't all finish at the same time of year, and that the present rules on timing would be sufficient if only they could be enforced...

Here's an explanation of what medical physicists do, from the American Association of Physicists in Medicine.

Maybe I didn't ruin the medical labor market after all

In a recent post I remarked on a Forbes blog post by a medical student at the University of Texas Southwestern Medical School who proposed that it would be better if the medical Match, the NRMP, didn't exist, because then medical students would be able to freely choose the job they wanted. That's how free markets work, as she understands them.

Now, in the same blog, three of her classmates point out that things might not work that way...Why The Residency Matching System For Newly Minted M.D.'s Still Works

And (still in the same Forbes blog) another medical student, Jack DePaolo responds similarly: Sorry, Medical Students, But You're Not Entitled To Your Dream Job

All in all, this subsequent discussion is good news, it means that we economists aren't doing quite as bad a job explaining to the general public (and to medical students) how markets work and what they do, as it might have appeared from that first contribution.

Did I ruin the medical labor market?

Students of economics are sometimes surprised that many of the things they know aren't known by everyone.

So a number of people have emailed me the blog post on the Forbes magazine web site that is headlined How A Nobel Economist Ruined The Residency Matching System For Newly Minted M.D.'s, and subtitled Match Magic: How One Economist Hurt Physicians and Patients.

In it, a graduating medical student who apparently just went through the Match a month ago argues that she would have done much better if there hadn't been a match, since then she could have picked a better job, in a nicer city, at a much higher wage. And she would have been spared the expense and inconvenience of interviewing. Because in a free market you are free to choose the job you want. That's the way economists get their jobs, she concludes.
******

A quick search of the web quickly reveals that other docs have a different view of the match and of markets more generally. Here's a post from a blog site called Skeptical Scalpel, which begins this way

"A blog post entitled "How a Nobel Economist Ruined the Residency Matching System for Newly Minted MDs" appeared on the Forbes website. In it, Amy Ho, the medical student author, lists all the things she considers wrong with the National Resident Matching Program (the "Match").

"I would have commented about this on the site itself except that I have a lot to say, and in order to post a comment, I would have had to agree to allow Forbes to post tweets in my name. No, thanks.

"The title of the post is misleading. As the author noted, the Match as been around since 1952. It was established to make the process of finding a residency position fair for all graduating medical students. Alvin Roth, the economist who shared a Nobel Prize based in part on his work with the Match algorithm, simply refined the process in the 1980s and 1990s to make it even more fair. Roth didn't ruin the Match; he made it better.

"Ms. Ho blames the Match for the fact that 25% of those enrolled in 2014 failed to obtain a residency position. But even if the Match did not exist, there would still have been more than 34,000 people seeking some 26,000 positions, and 8000 doctors would not have found jobs..."
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The NRMP data are here: http://www.nrmp.org/wp-content/uploads/2014/03/2014-NRMP-Main-Residency-Match-Advance-Data-Tables-FINAL.pdf 
94.4% of seniors at U.S. medical schools were matched in the main match. (Table 4).