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."

The labor force that is the Army

The Army Times has this story:

Choose your job: Army offers soldiers career agency to bolster retention
Kyle Rempfer

"Assignment Interactive Module 2.0 offers a virtual conduit through which units can advertise jobs; soldiers can attract hiring units by highlighting their life experiences, degrees and extracurricular pursuits; and the Army can gather large amounts of data on all of it.

"The marketplace has been open for the past four assignment cycles, but the latest iteration that closed this winter was the first where all positions were viewable to the entire moving population and the process was guided by the Army Talent Alignment Process rules, which more heavily weigh a soldier’s personal desires.

“This is the first time that we allowed complete transparency and also had set it up so the decisions that came out of this process were going to have the preference of the individual officer prioritized over any other consideration,” said Maj. Gen. J.P. McGee, director of the Army’s Talent Management Task Force.

"Officers participating in the first assignment cycle had roughly two months to contact the unit and ask questions, such as about the command climate and the training calendar. Officers could also speak directly to unit leadership, make a value proposition to them and learn what the unit offers in return.

"And while the Assignment Interactive Module 2.0 is currently only available for officers, an enlisted virtual marketplace is expected to deploy in January 2021.
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The Armed Forces News has this one:
Army Tests New Enlisted Assignment System
Published: March 12, 2020
"Spurred by the success of a similar program for officers, the Army will begin a pilot plan to implement a marketplace-style assignment system for enlisted soldiers, the Association of the U.S. Army reported. Beginning this summer, soldiers and non-commissioned officers in armor, military intelligence and quartermaster military occupational specialties (MOSs) will take part in testing of the Assignment Satisfaction Key-Enlisted Marketplace, AUSA reported, citing an Army press release. By the beginning of next year, the Army expects to have the system in place for the entire force.

"The plan calls for soldiers to be able to view a complete list of available positions from which to choose. They would then be able to rank their preference for new assignments based on personal and family needs, AUSA reported."

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and the WSJ has this one:

In Generational Shift, Army Uses a New System to Promote Hundreds of Officers
The Army is revamping its process and adapting private-sector techniques to choose new battalion commanders, a keystone position

"The U.S. Army has initiated the biggest shift since the Vietnam War era in how it selects a key class of officers, drawing on the hiring practices of private-sector organizations and corporations such as the Boston Symphony Orchestra and Google.

"The aim is to move away from techniques used for over 50 years that rely on past military jobs, physical fitness scores and the recommendations of generals to promote officers to the job of battalion commander.

"The new system includes surveys by subordinates, writing tests, psychological assessments, cognitive evaluations and a series of simulated militarylike scenarios in a wooded area on base to gauge leadership and problem-solving abilities.

"It stresses anonymity to eliminate any possible bias. As soon as candidates arrive, they are assigned a number and aren’t known by their names. At an interview, candidates are seated behind a black curtain, and a five-member selection panel is unable to see a candidate’s uniform, with its career-defining ribbons and patches."

Essential and inessential services under corona virus lockdown (guess before reading--coffee, cannabis, etc?)

We're under "shelter in place" orders in Santa Clara County, with everyone hunkering down, except for essential services:

Bay Area orders ‘shelter in place,’ only essential businesses open in 6 counties

"Six Bay Area counties announced “shelter in place” orders for all residents on Monday — the strictest measure of its kind yet in the continental United States — directing everyone to stay inside their homes and away from others as much as possible for the next three weeks in a desperate move to curb the rapid spread of coronavirus across the region.

"The directive was set to begin at 12:01 a.m. Tuesday and involves San Francisco, Santa Clara, San Mateo, Marin, Contra Costa and Alameda counties — a combined population of more than 6.7 million. It is to stay in place until at least April 7.
...
"Businesses that do not provide “essential” services must send workers home. Among those remaining open are grocery stores, pharmacies, restaurants for delivery only and hardware stores. "
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So I was glad to get this email from our local Stanford campus coffeehouse (which I agree is an essential service):

These Coupa Locations are still Open For Take-Out, Curbside-Pickup & Delivery
Today 9:00am - 3:00pm
 Green Library
571 Escondido Mall in Stanford
(nevertheless, our Wednesday morning market design coffee will meet by Zoom, while we shelter in place...)
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Schools are closed (I guess they might be both essential and sources of contagion).  This being California, there are other essential services:
San Francisco: Cannabis deemed as an essential medicine, dispensaries to remain open
"The San Francisco Department of Public Health released a statement on Tuesday letting San Francisco residents know dispensaries will remain open despite having a shelter in place order.

"The Department states cannabis is an essential medicine."

*************
Nevada is different:  Nevada Brothels Requiring Customers To Wear Masks

Germany (where prostitution is also legal) is different in a different way, Stephanie Wang forwarded this shelter in place announcement from Germany:
https://www.land.nrw/de/pressemitteilung/landesregierung-beschliesst-weitere-massnahmen-zur-eindaemmung-der-corona-virus
via Google translate, a list of what is inessential:
"Already on Sunday, the Ministry of Labor, Health and Social Affairs decrees that almost all leisure, sport, entertainment and educational offers in the country will be discontinued. As of Monday, all so-called "entertainment companies" such as bars, clubs, discotheques, arcades, theaters, cinemas and museums have to close. The same regulation applies to prostitution companies."

Intermediation in the wholesale pharmaceutical market, by Alex Chan and Kevin Schulman

Intermediaries called Pharmacy benefit managers (PBMs) play an important, but complicated role in the market for pharmaceutical drugs. Here's an article by Chan and Schulman, explaining why the role of PBM's is so opaque (quick summary: the industry is very concentrated, and is paid by both sides of the transactions that are being intermediated...)

Examining Pharmaceutical Benefits in the United States
Alex Chan,  Kevin Schulman

"...consolidation has resulted in a situation in which the 3 largest PBMs have approximately 80% market share.
...
"One of the largest criticisms of PBMs is the lack of transparency surrounding the structure and scale of payments from manufacturers to the PBM. The current PBM business model is shrouded in secrecy. Descriptions of PBM audits by payers and employers entail visits to PBM sites and examination of paper records under conditions of confidentiality, usually performed by a set of consultants that specialize in this role.5 Only the PBM knows the actual scope of payments from drug manufacturers to the PBM (for example, rebates and other payments, such as service fees). In 2016, for 13 pharmaceutical companies, payments to PBMs and other intermediaries were $100 billion, or 50% of gross sales.2 Without transparency, a PBM might develop formularies that maximize payments to the PBM rather than maximize value to patients. Anthem sued its PBM for $15 billion in 2016 for overpayments on drug pricing.6

"Finally, the issue of who is negotiating on whose behalf in drug markets remains contentious. In other words, the agency of PBMs is not clear. When PBMs depended on service fees from health plans and employers as their main source of revenue, it was clear that they served the payer (ie, the employer or the health plan). Under the rebate model, the role of the PBM has evolved to serving as an agent of both the payer and the manufacturer. In fact, as the prescription drug market has evolved, PBM profits appear to have grown with the growth of rebate dollars and manufacturer payments rather than with the growth of payer fees. It is increasingly hard to disentangle the multiple roles of the PBM and to clarify who PBMs serve as intermediaries."

The Advance Market Commitment for pneumonia vaccine, by Kremer, Levin, and Snyder

Advance Market Commitments: Insights from Theory and Experience
Michael Kremer, Jonathan D. Levin, Christopher M. Snyder
NBER Working Paper No. 26775
Issued in February 2020


Abstract: Ten years ago, donors committed $1.5 billion to a pilot Advance Market Commitment (AMC) to help purchase pneumococcal vaccine for low-income countries. The AMC aimed to encourage the development of such vaccines, ensure distribution to children in low-income countries, and pilot the AMC mechanism for possible future use. Three vaccines have been developed and more than 150 million children immunized, saving an estimated 700,000 lives. This paper reviews the economic logic behind AMCs, the experience with the pilot, and key issues for future AMCs.

And here's their concluding paragraph:

"The AMC moved from theory to practice in its first decade, and we now have a decade of learning from the pneumococcal pilot. While aspects of program evaluation are complicated, the best estimates suggest that the introduction of PCV saved 700,000 lives at a highly favorable cost. Iterations likely could improve AMC design, just as market designs have been refined in settings such as school choice and radio spectrum allocation. Policymakers may wish to consider offering a set of AMCs, perhaps each smaller in scale than the pilot pneumococcus AMC, where potential targets could range beyond health to address agricultural or sustainability problems specific to developing countries."

Hoarding, price gouging, and backlash in the time of corona virus--updated

The NY Times has the story (followed by an update):

He Has 17,700 Bottles of Hand Sanitizer and Nowhere to Sell Them
Amazon cracked down on coronavirus price gouging. Now, some sellers are holding stockpiles of sanitizer and masks.
By Jack Nicas

"On March 1, the day after the first coronavirus death in the United States was announced, brothers Matt and Noah Colvin set out in a silver S.U.V. to pick up some hand sanitizer. Driving around Chattanooga, Tenn., they hit a Dollar Tree, then a Walmart, a Staples and a Home Depot. At each store, they cleaned out the shelves.

"Over the next three days, Noah Colvin took a 1,300-mile road trip across Tennessee and into Kentucky, filling a U-Haul truck with thousands of bottles of hand sanitizer and thousands of packs of antibacterial wipes, mostly from “little hole-in-the-wall dollar stores in the backwoods,” his brother said. “The major metro areas were cleaned out.”

...

"Mr. Colvin said he had posted 300 bottles of hand sanitizer and immediately sold them all for between $8 and $70 each, multiples higher than what he had bought them for. To him, “it was crazy money.” To many others, it was profiteering from a pandemic.

"The next day, Amazon pulled his items and thousands of other listings for sanitizer, wipes and face masks. The company suspended some of the sellers behind the listings and warned many others that if they kept running up prices, they’d lose their accounts. EBay soon followed with even stricter measures, prohibiting any U.S. sales of masks or sanitizer.
**********

And here's the update:

The Man With 17,700 Bottles of Hand Sanitizer Just Donated Them
A Tennessee man had planned to sell his stockpile at marked-up prices online. Now he is under investigation for price gouging.

"On Sunday, Amazon and eBay suspended him as a seller, which is how he has made his living for years. The company where he rented a storage unit kicked him out. And the Tennessee attorney general’s office sent him a cease-and-desist letter and opened an investigation.

“We will not tolerate price gouging in this time of exceptional need, and we will take aggressive action to stop it,” Attorney General Herbert H. Slatery III of Tennessee said in a news release.

"Tennessee’s price-gouging law prohibits charging “grossly excessive” prices for a variety of items, including food, gas and medical supplies, after the governor declares a state of emergency. The state can fine people up to $1,000 a violation."
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Here are all my posts on price gouging

Organizations' security policies in the news

Organizations that deal with large amounts of data have to consider issues of data security involving their own employees, and these issues sometimes conflict with issues of transparency and collegiality.  Here are a few stories about data, data leaks, and data policies.


The NY Times Magazine writes about Google:
The Great Google Revolt
Some of its employees tried to stop their company from doing work they saw as unethical. It blew up in their faces.

Buzzfeed news:
How Saudi Arabia Infiltrated Twitter

The Guardian:
Donald Trump 'offered Julian Assange a pardon if he denied Russia link to hack'
WikiLeaks published emails damaging to Hillary Clinton in 2016
Ex-congressman denies being middleman for US president

The organ as a fictitious commodity, by Nicolas Brisset

Here, in French (and in English via Google Translate) an effort to understand, from writings on the subject, what underlies the widespread repugnance towards compensation for kidney donors, but mostly does not cause objections to kidney exchange.


L’organe comme marchandise fictive, Nicolas Brisset, Dans Actuel Marx 2020/1 (n° 67), pages 167 à 184
The organ as a fictitious commodity, Nicolas Brisset, In Actuel Marx 2020/1 (n ° 67) , pages 167 to 184

From the introduction:

"Finding out in the name of what individuals resist is an inexhaustible source of intuitions and reflections. Not that everything must be accepted as a whole, but understanding these moral systems is a necessary step from the perspective of both a social theory and a normative point of view on societal organization. We find in the history of social sciences several types of proposals in this regard  [5].
Our work will consist in starting from a social choice between two systems proposed to manage the distribution of a specific entity (the organ taken from living donors) in order to infer the moral foundations. In fact, in a 2007 issue of the Journal of Economic Perspective , two purely economic articles proposed very different ways of organizing the distribution of kidneys taken from living donors. On the one hand, Gary Becker and Julio Jorge Elìas proposed what seems at first sight (we will come back to this) to a trading system  On the other, Alvin Roth favored a system centered on organ donation  [7].
However, it turns out that one of these two proposals has been implemented in several countries, while the other seems for the moment to face a strong social rejection. Briefly, the trading system was rejected, while the donation-based system was retained. In this work, we will begin by analyzing the moral system that could have led to the rejection of the market solution in the context of the distribution of organs for the benefit of a system putting donation at the center. What is this rejection based on? We will try to decide between three hypotheses commonly put forward to explain the border between the merchant and the non-merchant. In turn, the use of money, the institution of the market and the problem of coercion were put forward as possible reasons for a refusal to market the organism."

and the Conclusion:
"The objective of this article has been limited, namely to show how the refusal of a method of matching, the organ market, could be understood as supported by a particular moral economy. The heart of the rejection seems to be that nobody would sell their organ if they weren't there obliged. A representation opposed to the idea according to which the prohibition of the markets to the organs would be inherently paternalistic. Here we find the heart of all debates relating to contested goods or activities. Prostitution, blood, gametes, surrogate mothers, the center of debate can be systematically summed up by the question: would these goods and services be produced and sold in the absence of a situation of loss of autonomy? We have seen that this question was also at the heart of Marxist historiography: to build capitalism is to build the political conditions for market efficiency in orienting work towards industrial activity. It seems that the only coherent explanation for the rejection of the market formulas proposed within the framework of the organs is precisely the rejection of such a construction."
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Professor Brisset has examined kidney exchange before--here's an earlier blog post with links to his work:

Wednesday, June 29, 2016

Repugnance and the social acceptance of kidney exchange (in French)

Repugnance and risk perception in paid clinical trials, by Leuker, Samartzidis, Hertwig and Pleskac

In PLOS One, a new paper on repugnance and risk perception:

When money talks: Judging risk and coercion in high-paying clinical trials
Christina Leuker ,Lasare Samartzidis,Ralph Hertwig,Timothy J. Pleskac
Published: January 31, 2020

Abstract
Millions of volunteers take part in clinical trials every year. This is unsurprising, given that clinical trials are often much more lucrative than other types of unskilled work. When clinical trials offer very high pay, however, some people consider them repugnant. To understand why, we asked 1,428 respondents to evaluate a hypothetical medical trial for a new Ebola vaccine offering three different payment amounts. Some respondents (27%) used very high pay (£10,000) as a cue to infer the potential risks the clinical trial posed. These respondents were also concerned that offering £10,000 was coercive— simply too profitable to pass up. Both perceived risk and coercion in high-paying clinical trials shape how people evaluate these trials. This result was robust within and between respondents. The link between risk and repugnance may generalize to other markets in which parties are partially remunerated for the risk they take and contributes to a more complete understanding of why some market transactions appear repugnant.

Compensation for kidney donors? Opt in or opt out? The BBC and The Rift revisit the debates.(featuring Sally Satel and Frank McCormick)

The BBC covers the shortage of transplantable organs, and reviews the debate about compensating living organ donors, among other possibilities. Of particular interest is their discussion of 'opt-in' versus 'opt-out' systems for registering potential deceased donors, given the recent experience with the change in Wales.

Should organ donors be paid? The heavy toll of US kidney shortage
By Henri Astier


"Many countries, notably in continental Europe, have tried boosting the supply of dead donors through a "presumed consent" approach. Such a system, also known as "opt out", automatically places people on a national register of donors unless they choose not to be.

"All US states, by contrast, have "opt-in" laws. Would switching to "opt out" make a big difference? International studies suggest not. Spain, which has presumed consent, is only slightly ahead of the US in the number of transplants relative to its population; France and Belgium, with similar legislation in place, have fewer transplants.

"Wales is currently the only part of the UK with an opt-out system - England is due to follow suit later this year. But the Welsh did not see an increase in organ donations after it changed its law in 2015.
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And here's another forum for the compensation debate, at The Rift (featuring Sally Satel and Frank McCormick [click on his name next to Sally's] on the pro-compensation side...)
SHOULD ORGAN DONORS RECEIVE FINANCIAL COMPENSATION?

Unraveling of finance internships, and a black market for courses

Mallesh Pai points me to this story in Philadelphia Magazine, from the University of Pennsylvania:

Desperate for High-Paying Wall Street Jobs, Penn Students Try Buying Their Way Into the Right Classes--Out-of-control corporate recruiting — and a new black market  by DAVID MURRELL

"...students had been posting in Penn student group chats saying they’d be willing to pay their way into courses they hadn’t been able to get into. There was a simple workaround: These students would offer money to entice another student to drop the class, then swoop in through the online registration portal to take the newly free seat. The going rate looked to be about $50 to $60 for a class.
...
"Five years ago, sophomores like Current might not have been so desperate. Back then, finance companies hired for their all-important junior-year summer internships just a few months ahead of time. But recently, in an attempt to scoop up the best students before anyone else, companies have moved up the timeline. It’s now standard practice for finance firms to recruit sophomores like Current — who has only completed three semesters of college and hasn’t even declared a major — for those same junior-year summer internships a full 18 months in advance.
...
"As it happened, Current’s scheme to buy his way into Corporate Valuation didn’t quite work as planned. He was foiled by the course registration system. His co-conspirator did indeed drop the class, but a spot never opened up. (Current now thinks he failed to account for a wait-list.) But while he came up empty, other students say they know people who have succeeded.

“This is very common,” says junior Valentina Losada, another vet of the corporate recruiting wars. “It’s not even seen as something bad.”
...
"firms have realized they don’t need the university anymore; they can conduct phone and Skype interviews, then bring candidates to New York City for the final round. When deciding whether to recruit on campus at Penn or bypass the school and face no institutional regulation, guess which option the banks have chosen?

"Having granted themselves free rein, many companies are now acting like monopolistic bullies. They move the recruiting cycles ever earlier in a race to reach job applicants first. (Shout-out to the free market!) They don’t give students time to consider other internships, sometimes requiring job commitments just one or two days after the initial offer. Escudero says she’s had friends who received offers only to be told they had to give their answer on the spot — take it or leave it.
...
"The pressure also produces some peculiar unintended consequences, like the underground course-swap marketplace. Both Losada and Bomba say they have friends who have successfully bought or sold classes. "
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Here's a related story in the Daily Pennsylvanian:

Ilyse Reisman | Penn students, please don’t sell your classes | Classes should not be treated like stocks

Paul Milgrom et al. on the incentive auction--two recent papers, and two pictures

Two new papers and two recent pictures on the FCC incentive auction, and the cornucopia of related results (including to auctions as knapsack problems) that Paul Milgrom and his colleagues have developed:

Incentive Auction Design Alternatives: A Simulation Study
KEVIN LEYTON-BROWN, University of British Columbia
PAUL MILGROM, Stanford University
NEIL NEWMAN, University of British Columbia
ILYA SEGAL, Stanford University
February 21, 2020,
Manuscript submitted for review to the 21st ACM Conference on Economics & Computation (EC’20)

Abstract: Over 13 months in 2016–17 the US Federal Communications Commission (FCC) conducted an “incentive auction” to repurpose radio spectrum from broadcast television to wireless internet. This paper revisits from a computational perspective the descending clock “reverse” auction used to procure broadcast rights. We investigate the quantitative significance of various aspects of the design by running extensive simulations, leveraging a reverse auction simulator and realistic models of bidder values.
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Investment Incentives in Near-Optimal Mechanisms
Mohammad Akbarpour, Scott Duke Kominers, Shengwu Li and Paul Milgrom
February 25, 2020

Abstract: In a Vickrey auction, if one bidder has an option to invest to increase his value, the combined mechanism including investments is still fully optimal. In contrast, for any β < 1, we find that there exist monotone allocation rules that guarantee a fraction β of the allocative optimum in the worst case but such that the associated mechanism with investments by one bidder can lead to arbitrarily small fractions of the full optimum being achieved. We show that if a monotone allocation rule satisfies a new property called ARNIE and guarantees a fraction β of the allocative optimum, then in the equilibrium of the threshold auction game with investments, at least a fraction β of the full optimum is achieved. We also establish generalizations and a partial converse, and show that some well-known approximation algorithms satisfy the ARNIE property.

"ARNIE (“avoiding relevant negative investment externalities”)
...
"The definition of ARNIE is as follows: Given any value profile and feasibility constraints, an algorithm outputs some set of packed bidders. Suppose we raise the value of a packed bidder, or lower the value of an unpacked bidder, and then run the algorithm at the new value profile. The algorithm is ARNIE if the new packing, assessed at the new values, yields at least as much welfare as the old packing, assessed at the new values."

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And here are two photos I snapped during a seminar Paul gave two weeks ago...

See my previous posts containing "incentive auction".

Applications and interviews prior to matching in Orthopaedic Surgery

It takes many applications and interviews to match for orthopaedic surgery residencies...

Matching in Orthopaedic Surgery
Chen, Antonia F. MD, MBA; Secrist, Eric S. MD; Scannell, Brian P. MD; Patt, Joshua C. MD, MPH
Journal of the American Academy of Orthopaedic Surgeons: February 15, 2020 - Volume 28 - Issue 4 - p 135-144
doi: 10.5435/JAAOS-D-19-00313

Abstract
In 2016, 1,137 fourth year medical students submitted applications for orthopedic surgery residency positions. Students applied to an average of 79 programs, resulting in in a total of 89,846 applications being submitted for 727 first year residency positions. This ratio of 124 applications per position is two SDs above the mean relative to other medical specialties. The average applicant for orthopaedic surgery residency attends 2.4 away rotations, as attending 2 away rotations increases an applicant's odds of matching, and submits 83 applications. This excessive number of applications overburdens programs, subjects applicants to considerable costs, and diminishes the quality of fit between interviewees and programs. Eighty-three percent of program directors use step 1 United States Medical Licensing Examination scores as a screening tool to decrease the number of applications necessary for review. The average matched applicant attended 11.5 interviews, and Step 1 scores, research productivity, and Alpha Omega Alpha (AOA) status can be used to predict the number of applications necessary to obtain 12 interviews. AOA membership has the strongest influence on interview yield. Applicants report spending an average of approximately $7,000 on the interview process, and 72% borrow money to cover these costs. Post-interview contact, although forbidden by the National Resident Matching Program , has been reported by 60% to 64% of applicants.

Interviews and matching--Echenique, González, Wilson, and Yariv

Interviews are an important feature of many matching markets. Here's a recent paper about that:

Top of the Batch: Interviews and the Match
Federico Echenique* Ruy González† Alistair Wilson‡ Leeat Yariv§ ¶
February 14, 2020

Abstract
Most doctors in the NRMP are matched to one of their most-preferred internship programs. Since various surveys indicate similarities across doctors’ preferences, this suggests a puzzle. How can nearly everyone get a position in a highly-desirable program when positions in each program are scarce? We provide one possible explanation for this puzzle. We show that the patterns observed in the NRMP data may be an artifact of the interview process that precedes the match. Our analysis highlights the importance of interactions occurring outside of a matching clearinghouse for resulting outcomes, and casts doubts on analysis of clearinghouses that take reported preferences at face value.

More proposals for reducing applications and interviews before medical resident matching

If the number of proposals for reform is an indicator of a brewing problem (and I think it is), it's time to think about the various application and interview processes that precede the NRMP resident match.  Here are three more...

J. Bryan Carmody (2020) Applying Smarter: A Critique of the AAMC Apply Smart Tools. Journal of Graduate Medical Education: February 2020, Vol. 12, No. 1, pp. 10-13.
https://doi.org/10.4300/JGME-D-19-00495.1

"Medical students today submit more residency applications than ever before. This trend is costly for students and imposes a substantial burden on program directors. Yet, despite a steady increase in the number of applications submitted per applicant, overall match rates have not improved.1 Put another way, applicants could collectively apply to fewer programs than they do now—and enjoy essentially the same overall match rate.

To assist students in determining the optimal number of residency programs to which they should apply, the Association of American Medical Colleges (AAMC) unveiled Apply Smart in 2016. The website notes that “there is a point where the relationship between the number of applications submitted and the likelihood of entry into a residency changes,” and suggests that students should consider limiting their applications at this point of diminishing returns.2 Responses to Apply Smart have been positive, with deans and program directors praising the tools and encouraging their use in counseling medical students.3–6

At first glance, the Apply Smart analyses seem highly informative. Yet, closer inspection reveals methodologic issues that introduce bias and suggest the need for improvements.
...
"Overapplication is costly, for applicants and programs alike. Given the incentives for medical students to overapply, it is unclear whether informational strategies alone can curtail overapplication. Until graduate medical education leaders are willing to support application caps or a fundamental restructuring of the Match to better allow signaling between applicants and programs,13 it is imperative that informational strategies present unbiased data that can aid students in applying to an appropriate number of programs. We cannot be satisfied for students to Apply Smart—we need to help them apply smarter."

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Joseph G. Monir (2020) Reforming the Match: A Proposal for a New 3-Phase System. Journal of Graduate Medical Education: February 2020, Vol. 12, No. 1, pp. 7-9.
https://doi.org/10.4300/JGME-D-19-00425.1

"The National Resident Matching Program (NRMP) was originally devised in 1952 to bring order to the chaotic residency application process.1 It currently has 2 phases: The Match and the Supplemental Offer and Acceptance Program (SOAP). Applications are submitted through the Electronic Residency Application Service (ERAS). While this is a significantly superior system to its predecessor, it is not flawless. As both residency applicants and positions have become more competitive, the flaws of the current system are becoming increasingly problematic for all involved parties.

"Despite evidence that applying to a greater number of programs does not improve Match rates,2 applicants feel pressured to apply to more and more programs to avoid going unmatched. In 2018, each applicant submitted a mean of 90.6 applications (mean of 60.3 for US graduates and 136.4 for international graduates).3 Applicants feel forced to accept interviews at programs which they have minimal interest in attending, to the detriment of other genuinely interested students. This, in turn, pressures other applicants to do the same lest they be disadvantaged. Whipple et al confirmed this vicious cycle using their computer model for competitive residencies, where they found that applying to the maximum number of programs “led to a poor result for the majority of students when all applicants undertook the strategy.”4

"As a result of this vicious cycle, residency programs are inundated with an average of 996 applications per program5 and have few reliable methods of identifying which of those applicants would seriously consider training there. Interviewing applicants who have no desire to attend that program is a costly endeavor. Gardner and colleagues found that, when accounting for both material and personnel costs, programs spent on average $18,648 ± $13,383 per open position and $1,221 ± $894 per interviewee.6

"Applying so broadly is costly for applicants as well. Fogel et al7 found that 84% of applicants believed residency interviews were too expensive, with 64% of applicants spending at least $2,500, and those entering competitive fields spending considerably more. In a study of orthopedic surgery applicants, for example, interview costs averaged $7,119 (range $2,500–$15,000).8 These figures do not include the cost of the applications themselves or externships, making the total residency application cost significantly higher.

"It is clear that the current system is fraught with inefficiency and that all involved parties would be better served by a system where applicants only apply to the programs they would seriously consider attending.

"The 3-Phase System
Transitioning the Match to a 3-phase process as outlined below could address the aforementioned problems.

"Phase 1
This phase would run from September through December and would function the same as the Match is currently. However, applicants would be limited in the number of positions for which they could apply. The results of Phase 1 would be e-mailed to applicants in the beginning of January. Most interviews already occur within this time frame, so most programs could continue using the systems they have in place. The majority of positions would be anticipated to fill in Phase 1.

"Phase 2
This phase would run from January through March. Those who do not match in Phase 1 would proceed to Phase 2. This would again function like the current Match, with applicants applying to open programs, attending in-person interviews, and submitting a rank list. There would be no cap on the number of Phase 2 applications, allowing applicants to apply broadly. The results of Phase 2 would be e-mailed to applicants in March. The majority of unfilled positions from Phase 1 would be expected to fill in Phase 2.

Phase 3
This phase would be the current SOAP week, with daily rounds of interviews and offers. The number of applicants and positions entering the SOAP would likely decrease significantly."
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Plast Reconstr Surg. 2019 Feb;143(2):634-639. doi: 10.1097/PRS.0000000000005254.
Solving Congestion in the Plastic Surgery Match: A Game Theory Analysis.
Molina Burbano F1, Yao A, Burish N, Ingargiola M, Freeman M, Stock J, Taub PJ.

Abstract
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.

Thomas Toch on school choice and the presidential campaigns

Toch: School Choice Is Here to Stay. But How to Make It Fair and Equitable for All Families? High-Tech Common-Enrollment System Can Help

"The leading Democratic presidential candidates — liberals Elizabeth Warren and Bernie Sanders, but also moderates Joe Biden and Pete Buttigieg — have derided publicly funded charter schools as a threat to traditional public schools. But charter schools and the new, more consumer-oriented public education landscape they represent are here to stay.
...
"In this climate, the policy question is not whether we should have public-sector choice. Instead, we should be asking how to make choice systems in public education efficient and fair for all families. One promising answer: common-enrollment systems that allow families to select traditional public schools or charters through a single, centralized selection process powered by algorithms that match as many students as possible to their top choices.
...
"But taking advantage of expanding public options traditionally meant navigating myriad application timelines and deadlines without information to make clear comparisons.

"It meant oversubscribed schools pulling names out of paper bags, families pitching tents on sidewalks — or paying others to camp out for them — to get to the front of waiting-list lines and schools cherry-picking applicants to get the most attractive students. It was a system favoring the well-educated, the wealthy and the well-connected.

"For schools, that system made planning almost impossible. Many students were admitted to multiple schools but didn’t let schools know their plans, causing thousands of waitlisted students to change schools even after the start of classes, leaving administrators guessing about revenue and staffing, and disrupting instruction.

"But in recent years, the District of Columbia, Denver, New Orleans and a handful of other cities have launched a new way of matching students to schools that addresses these problems."
********

In the manner of journalists with space limitations, Toch goes on to attribute these advances to "Alvin Roth and colleagues."  Of course, prominent among those colleagues are the two leaders in the modern school choice revolution, Atila Abdulkadiroglu and Parag Pathak.

Bangladesh loosens its restrictions on kidney donations

This story appears in New Age: henceforth Authentication Boards may allow a kidney to be donated by someone who is not a near relative, in exceptional circumstances.

High Court sets out guidelines for kidney transplantation

"The verdict said that the Transplantation of Human Organs Act 1999 provided a very narrow definition of donor, ‘that is to say, “near relative”’.

‘The already large gap between demand and supply of kidneys is further increased by this narrow definition of donors leading to kidney patients dying without any transplant,’ the verdict said adding ‘The large gap particularly affects the poor by creating a black market for kidneys where abuses are rampant.’

The verdict said that if the definition of a pool of donors (near relative) was expanded without any restriction whatsoever, ‘that will definitely spur the illegal kidney trade in Bangladesh to an unimaginable extent. So any wholesale expansion of the definition of pool of donors (near relative) cannot be countenanced.’

The verdict said that to determine and verify the authenticity of emotional kidney donation, there should be an inquiry in the light of the guidelines mentioned below.

The verdict said that the exceptional circumstances as in the case of the present petitioner might be determined by the Authentication Board in Bangladesh like the Authorization Committee in India.

The court said that the board must ensure that the near relative or if near relative was not available, any adult person related to the donor by blood or marriage to donate an organ or tissue.

And that case, the authenticity of the link between the donor and the recipient, and the reasons for donation, and any strong views or disagreement or objection of such kin should also be recorded and taken note of, said the verdict.

The board needs to evaluate that there would be no commercial transaction between the recipient and the donor and that no payment has been made to the donor or promised to be made to the donor or any other person.

The board also needs to prepare an explanation of the link between donors and recipients and the circumstances which led to the offer being made."

Can YouTube's recommender engine tone down conspiracy theories?

The NY Times has the story:

Can YouTube Quiet Its Conspiracy Theorists?
A new study examines YouTube’s efforts to limit the spread of conspiracy theories on its site, from videos claiming the end times are near to those questioning climate change. By Jack Nicas

"In January 2019, YouTube said it would limit the spread of videos “that could misinform users in harmful ways.”

"One year later, YouTube recommends conspiracy theories far less than before. But its progress has been uneven and it continues to advance certain types of fabrications, according to a new study from researchers at University of California, Berkeley.

"YouTube’s efforts to curb conspiracy theories pose a major test of Silicon Valley’s ability to combat misinformation, particularly ahead of this year’s elections. The study, which examined eight million recommendations over 15 months, provides one of the clearest pictures yet of that fight, and the mixed findings show how challenging the issue remains for tech companies like Google, Facebook and Twitter."
***********

The paper referred to seems to be this one on Hany Farid's website at Berkeley. It's very recent ("compiled on March 2, 2020," the day of the NY Times story, and e.g. it finds that corona virus conspiracy videos are not being recommended despite being readily available). 

A longitudinal analysis of YouTube’s promotion of conspiracy videos
Marc Faddoul, Guillaume Chaslot, and Hany Farid


Abstract: Conspiracy  theories  have  flourished  on  social  media,  raising  concerns that such content is fueling the spread of disinformation, sup-porting extremist ideologies, and in some cases, leading to violence. Under increased scrutiny and pressure from legislators and the public, YouTube announced efforts to change their recommendation algorithms so that the most egregious conspiracy videos are demoted and demonetized.  To verify this claim, we have developed a classifier for automatically determining if a video is conspiratorial (e.g., the moon landing was faked, the pyramids of Giza were built by aliens, end of the world prophecies, etc.). We coupled this classifier with an emulation of YouTube’s watch-next algorithm on more than a thousand popular informational channels to obtain a year-long picture of the videos actively promoted by YouTube.  We also obtained trends of the so-called filter-bubble effect for conspiracy theories


And here are the concluding paragraphs:

"Summary. The overall reduction of conspiratorial recommendations is an encouraging trend. Nonetheless, this reduction does not make the problem of radicalization on YouTube obsolete nor fictional, as some have claimed (41). Aggregatedata hide very different realities for individuals, and although radicalization is a serious issue, it is only relevant for a fraction of the users. Those with a history of watching conspiratorial content can certainly still experience YouTube as filter-bubble, reinforced by personalized recommendations and channel subscriptions. In general, radicalization is a more complex problem than what an analysis of default recommendations cans cope, for it involves the unique mindset and viewing patternsof a user interacting over time with an opaque multi-layer neural network tasked to pick personalized suggestions from a dynamic and virtually infinite pool of ideas.

"With two billion monthly active users on YouTube, the design of the recommendation algorithm has more impact on the flow of information than the editorial boards of traditional media. The role of this engine is made even more crucial in the light of (1) The increasing use of YouTube as a primary source of information, particularly among the youth (42); (2)The nearly monopolistic position of YouTube on its market;and (3) The ever-growing weaponization of YouTube to spread disinformation and partisan content around the world (43). And yet, the decisions made by the recommendation engine are largely unsupervised and opaque to the public.

"This research is an effort to make the behavior of the algorithm more transparent, in an effort to increase the awarenessof the public and YouTube’s accountability for their statements. We hope it will fuel a public discussion, not about whether YouTube should allow for conspiratorial content on the platform, but about whether such content is appropriate to be part of the baseline recommendations on the informational YouTube.

Kidney exchange at the 34th Advanced HLA Technical Workshop

I'll be speaking tomorrow morning, March 4, at the 34th Advanced HLA Technical Workshop,  at the Omni Rancho Las Palmas Resort in Rancho Mirage, California.  These are the folks who (among other things) figure out if a kidney donor and patient are compatible, so that the patient can be transplanted with a kidney from that donor.

Here is the conference Agenda.

My session is
Advancing Transplantation
9:00 AM-10:00 AM
Moderator:
Cathi Murphey-Half, PhD
Southwest Immunodiagnostics - San Antonio, TX

Speaker:
Kidney Exchange: Past, Present and Possible Future
Alvin E. Roth, PhD
Stanford University - Stanford, CA



When I talk about the detailed compatibility aspects of matching for kidney exchange, I'll be able to describe the current state of the art. Here's my first slide on that:

NSF 70th Anniversary Symposium--the video

I recently attended the celebration of the 70th anniversary of the National Science Foundation, a two-day symposium on Feb. 6-7, 2020. Below is a video of the first day, in which I took part in a session called Science Breakthroughs, which begins at hour 3:45 and goes for an hour. Hear a moderated discussion ranging back and forth over gravity waves, black holes, thermal vents, nanotechnology, and market design (school choice, kidney exchange, repugnant transactions and the fact that both markets and bans on markets require social support to work well).




Science Breakthroughs
Panel featuring NSF-funded science breakthroughs from the last decade. The topics covered in this panel will feature a mix of major breakthroughs, as well as research that has led to significant impacts on society. In addition, the panelists will be a diverse set of researchers, including those earlier in their careers.

Moderator: Amy Harmon, Correspondent, New York Times
Panelists: Jennifer Dionne, 2019 Waterman Award recipient & Associate Professor, Stanford University
Shep Doeleman, 2019 Breakthrough Prize & NSF Diamond Award recipient & Director, EHT at Harvard-Smithsonian Center for Astrophysics
Margaret Leinen, Director, Scripps Institute & Vice Chancellor & Dean, Marine Sciences
Nergis Mavalvala, Professor & Associate Head, Department of Physics, MIT
Alvin Roth, Nobel Prize in Economics 2012 & Professor of Economics, Stanford University