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DOI: 10.1055/s-0041-1735951
Inefficiencies in Residency Matching Associated with Gale–Shapley Algorithms
Funding A.Y.E. reports grants from National Eye Institute, Novartis, Regeneron Santen, Carl Zeiss Meditec, Microsoft, and NVIDIA. He reported personal fees from U.S. Food and Drug Administration, Genentech, Topcon, and Verana Health outside the submitted work. was supported by the Research to Prevent Blindness, University of Washington CoMotion Innovation Fund (NEI/NIH K23EY029246), and supported in part by the Mark J. Daily MD Research Fund Research Fund. C.S.L. reported grants from National Institute on Aging outside the submitted work.![](https://www.thieme-connect.de/media/10.1055-s-00033285/202102/lookinside/thumbnails/10-1055-s-0041-1735951_252ra-1.jpg)
Abstract
Objective This study aimed to investigate emerging trends and increasing costs in the National Residency Matching Program (NRMP) and San Francisco Residency and Fellowship Match Services (SF Match) associated with the current applicant/program Gale–Shapley-type matching algorithms.
Design A longitudinal observational study of behavioral trends in national residency matching systems with modeling of match results with alternative parameters.
Patients and Methods We analyzed publicly available data from the SF Match and NRMP websites from 1985 to 2020 for trends in the total number of applicants and available positions, as well the average number of applications and interviews per applicant for multiple specialties. To understand these trends and the algorithms' effect on the residency programs and applicants, we analyzed anonymized rank list and match data for ophthalmology from the SF Match between 2011 and 2019. Match results using current match parameters, as well as under conditions in which applicant and/or program rank lists were truncated with finalized rank lists, were analyzed.
Results Both the number of applications and length of programs' rank lists have increased steadily throughout residency programs, particularly those with competitive specialties. Capping student rank lists at seven programs, or less than 80% of the average 8.9 programs currently ranked, results in a 0.71% decrease in the total number of positions filled. Similarly, capping program rank lists at seven applicants per spot, or less than 60% of the average 11.5 applicants ranked per spot, results in a 5% decrease in the total number of positions filled.
Conclusion While the number of ophthalmology positions in the United States has increased only modestly, the number of applications under consideration has increased substantially over the past two decades. The current study suggests that both programs and applicants rank more choices than are required for a nearly complete and stable match, creating excess cost and work for both applicants and programs. “Stable-marriage” type algorithms induce applicants and programs to rank as many counterparties as possible to maximize individual chances of optimizing the match.
Note
A.Y.L has received honoraria from Topcon, Genentech, and Verana Health. A.Y.L. works with the U.S. Food and Drug Administration.
* These authors contributed equally and should be considered co-senior authors.
Publikationsverlauf
Eingereicht: 04. Januar 2021
Angenommen: 22. Juni 2021
Artikel online veröffentlicht:
22. November 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 SF Match homepage. SF Match. Accessed 2021 at: https://sfmatch.org/
- 2 2020 Main Residency Match®. NRMP. Accessed 2021 at: www.nrmp.org
- 3 Gale D, Shapley LS. College admissions and the stability of marriage. Am Math Mon 1962; 69 (01) 9-15
- 4 Main Residency Match Data and Reports. . Accessed 2021 at: https://www.nrmp.org/main-residency-match-data/
- 5 Roth AE. The evolution of the labor market for medical interns and residents: a case study in game theory. J Polit Econ 1984; 92 (06) 991-1016
- 6 Turner J. Intern selection: wanted, an orderly plan. Acad Med 1945; 20 (01) 26
- 7 Mullin FJ, Stalnaker JM. The matching plan for internship appointment. J Med Educ 1951; 26 (05) 341-346
- 8 Roth AE. The origins, history, and design of the resident match. JAMA 2003; 289 (07) 909-912
- 9 Roth AE, Peranson E. The redesign of the matching market for american physicians: some engineering aspects of economic design. Am Econ Rev 1999; 89 (04) 748-780
- 10 Internet archive: digital library of free & borrowable books, movies, music & wayback machine. Accessed 2021 at: https://archive.org/
- 11 Moore DB. Not a cheap investment: estimating the cost of the 2017 to 2018 ophthalmology residency match to the applicant and program. J Acad Ophthalmol 2018; 10 (01) e158-e162
- 12 Nash J. Non-cooperative games. Ann Math 1951; 54 (02) 286-295
- 13 Nikonow TN, Lyon TD, Jackman SV, Averch TD. Survey of applicant experience and cost in the urology match: opportunities for reform. J Urol 2015; 194 (04) 1063-1067
- 14 Polacco MA, Lally J, Walls A, Harrold LR, Malekzadeh S, Chen EY. Digging into debt: the financial burden associated with the otolaryngology match. Otolaryngol Head Neck Surg 2017; 156 (06) 1091-1096
- 15 Van Dermark JT, Wald DA, Corker JR, Reid DG. Financial implications of the emergency medicine interview process. AEM Educ Train 2017; 1 (01) 60-69
- 16 Kane L. Medscape physician compensation report 2019. Medscape. Published April 10, 2019. Accessed 2021 at: https://www.medscape.com/slideshow/2019-compensation-overview-6011286
- 17 Weissbart SJ, Hall SJ, Fultz BR, Stock JA. The urology match as a prisoner's dilemma: a game theory perspective. Urology 2013; 82 (04) 791-797
- 18 The United States Medical Licensing Examination. . Accessed 2021 at: https://www.usmle.org/incus/
- 19 Susarla SM, Swanson EW, Slezak S, Lifchez SD, Redett RJ. The perception and costs of the interview process for plastic surgery residency programs: can the process be streamlined?. Plast Reconstr Surg 2017; 139 (01) 302e-309e
- 20 Benjamin DJ, Heffetz O, Kimball MS, Rees-Jones A. Can marginal rates of substitution be inferred from happiness data? Evidence from residency choices. Am Econ Rev 2014; 104 (11) 3498-3528