Advice for Match Day and the 'After-Match': Transitioning to Residency

Roz on Residency

Rosalyn E. Plotzker, MD, MPH

Disclosures

February 20, 2019

The Matrimonial Match Process

Now that you've submitted your rank list, it probably all feels left to the powers of an omnipotent matchmaker. When I was in this phase, I felt like I was about to enter into an arranged marriage. Apparently that isn't a coincidence.

You might know that the algorithm adapted for the National Resident Matching Program (NRMP), the Gale-Shapley algorithm, earned its creators the Nobel Prize in Economic Sciences. Gale and Shapley set out to solve a problem then known as the "stable marriage" problem. Two pools of equal numbers of "elements," initially described as a pool of single men and a pool of single women, were to be paired in a way that achieved the most systemic "stability."

In other words, they tried to establish a situation in which either the Man (M) preferred a Woman (W1) over every other Woman (W2) or, if M preferred W2 and W2 preferred her own partner over him, he was rejected and stayed with his initial match to W1. They also had to satisfy the requirement that no two people preferred each other more than their current partners. While Gale and Shapley sorted through potential stable marriage solutions, the NRMP took shape.

As described by the NRMP, the residency selection process became "dysfunctional" in the early 1940s. Available residency positions exceeded the candidates. This meant that third-year medical students were highly sought and often given only 24-48 hours to decide their future plans in order for institutions to be assured that their slots would be filled. Medical students helped establish the NRMP in the 1950s in order to fix the "disorganized and chaotic methods that had evolved within the residency labor market."

This trend reversed during the 1970s, when the number of applicants finally surpassed the number of residency positions. By 1984, over two decades after the birth of the Gale-Shapley algorithm and three decades after the start of the NRMP, another economist, Alvin E. Roth, adapted the matchmaking process to residency programs. In 1995, it was fine-tuned to give a slightly higher advantage to applicant preference rather than that of residency programs. Voilà—the Match as we know it was formed: a seemingly impartial approach which gives you and everyone else the "best shot."

But I digress...

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