Please explain The Match...

[Peanuts]

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From what I've heard, how programs rank you is more important than how you rank them.

So if you rank a program #12 and they rank you #1, while you rank another program #1 and that program ranks you #2, in the end your #12 program will get you. That's so disturbing to me...

Seems like you'd've been better off not to have ranked program #12, but of course you needed to include enough programs to increase your chances of matching. Furthermore, you failed to predict that program #12 would rank you #1, for example. And now, even though you were so closely compatible with your #1 program, by contract, you must go to the program you ranked #12. How accurate is this?

Anybody feel like explaining The Match process?

 

[b&ierstiefel]

The scenario that you propose is actually far from reality...which is fortunate.

The match is supposed to favor YOU as an applicant. Here's a simple scenario to illustrate:

Program A has interviewed 30 people for 5 spots. It has ranked you #1 out of 30.

Program B has interviewed 20 people for 4 spots. It ranked you #10 out of 20.

You rank Program B #1 and Program A #2.

Situation #1: Let's say that the top 7 applicants from Program B have matched elsewhere or did not rank Program B. That means that you are in line to take the 3rd spot (i.e., the best that Program B can do now is take applicant #8-11 on their rank list). End result: You match at Program B (independent of what Program A's rank list)

Situation #2: Program B only goes down it's top 6 on it's rank list to fill its four spots. End result: You don't match at Program B. You match at your #2 choice which is Program A.

NRMP explains the match algorithm quite thoroughly. The situation they present is a little more complex than the simple scenario above.

http://www.nrmp.org/res_match/about_res/algorithms.html

 

[jeffsleepy]

That's false. I'm sure someone else can link the page with all the details, but the match uses a stable marriage algorithm where the students, not the programs are the ones doing the proposing. Doing it this way actually favors the students, instead of the programs. Basically it looks at what you want and whether the programs will accept you instead of what the programs want and whether you will accept them.

 

[klubguts]

The NRMP website has a good explaination (www.nrmp.org) and this has been discussed ALOT on SDN (you can do a search, which may be more helpful than my post). Your post is inaccurate, as you would match at your highest ranked program which ranked you to match (i.e. ranked you high enough so that you get one of their x number of positions). In the above senario, you would match at your #1 program (not the #12), provided your #1 had more than one position or that the one position was not filled by the applicant which the program ranked #1. In another brief example, if your #1 ranked program ranked you 10 and they have 12 spots, then you would match their irregardless of where you were ranked by any other programs on your rank list. While it can be confusing and this is not a detailed explaination, the motto of the match is to rank 'em as you like 'em.

The match is designed to benefit the applicant....i think people complain about it so much because of the gamesmenship that goes on between programs and applicants in the postinterview period. Some programs will communicate with applicants using alot of vague language (many applicants do the same) which means nothing come match day. Anyway, good luck and hope this helps clarify the issue somewhat.

 

[Peanuts]

Thanks everyone. That was very helpful. I'll check out the nrmp website.

 

[ears]

For me, another reason for all of the complaining is that the NRMP says that their algorithm favors the applicant, but they offer no proof thereof. And there is no independent verification of the results of the match themselves. I presume the long wait between submission of rank lists and Match Day is so they can do their own internal verification process, but we don't even really know if they do that.

In my (not so) humble opinion, the match would benefit tremendously from the following two steps: First, the code that actually runs the match should open source. Let everyone see how it works. If it turns out someone can find a way to game the algorithm, then modify the algorithm. But put all of that stuff out in the open, so we know exactly what we're talking about.

Second, there should be an independent audit of the match results every year. Some external entity which has nothing to do with medical schools should examine the results and the process, and certify that it all worked the way we're told it does.

The match is a pretty high stakes business, and we're asked to take a lot on faith.

 

[surg]

For me, another reason for all of the complaining is that the NRMP says that their algorithm favors the applicant, but they offer no proof thereof. And there is no independent verification of the results of the match themselves. I presume the long wait between submission of rank lists and Match Day is so they can do their own internal verification process, but we don't even really know if they do that.

In my (not so) humble opinion, the match would benefit tremendously from the following two steps: First, the code that actually runs the match should open source. Let everyone see how it works. If it turns out someone can find a way to game the algorithm, then modify the algorithm. But put all of that stuff out in the open, so we know exactly what we're talking about.

Second, there should be an independent audit of the match results every year. Some external entity which has nothing to do with medical schools should examine the results and the process, and certify that it all worked the way we're told it does.

The match is a pretty high stakes business, and we're asked to take a lot on faith.

In fact, there have been independent studies on the match, particularly when the match algorithm was changed. Simulations were done and redone with the actual data and the match works as advertised at least through that time period.

Here is a link http://kuznets.fas.harvard.edu/~aroth/alroth.html#nrmp
that takes you to Al Roth, who is a game theory professor at Harvard Business School who did a lot of the work which contains links to the actual work that is done.

The algorithm is out in the open. If you read the NRMP website, the algorithm that is used is transparent. I doubt that it is essential to read the actual computer code itself, although I agree that open source generally leads to more stable code in general. Independent audits of each year's data would likewise be ideal, but would definitely increase the cost of the match and possibly the time it takes to execute the match.

 

[Strap]

The match is unexplainable. Further, it is inexplicable. Or rather, despicable. Seriously, it is irresponsible. And indefensible. 🙁

 

[Jeff698]

The match is unexplainable. Further, it is inexplicable. Or rather, despicable. Seriously, it is irresponsible. And indefensible. 🙁

Really? Hell, I'm an Aggie and I understood it. What part of it is irresponsible? What part indefensible?

I thought it worked pretty well. Granted, I had serious GI issues during the whole process but I doubt that had anything to do with the match itself and everything to do with the uncertainty involved.

Seriously, what is your problem with it? What would you suggest as a replacement?

Take care,
Jeff

 

[Hawkeye Kid]

The match is unexplainable. Further, it is inexplicable. Or rather, despicable. Seriously, it is irresponsible. And indefensible. 🙁

I'm guessing/hoping that this is a play on Jackie Childs from Seinfeld...Why'd you rank them #1? Did I tell you to rank them #1? Who told you to rank them #1? I didn't tell you to rank them #1.

If not, then I echo most of what Jeff said above. Perfect system? Probably not. But it's better than most solutions I've heard proposed.

 

[NinerNiner999]

Punch yourself in the head, pay your neigbor $500, ask them to kick you in the nuts, then place your head in the toilet and flush it. Visit the nearest Shamen, have him wave a burning chicken over your head and you will recieve an envelope with a piece of paper and tea leaves. Place the tea leaves in a cup full of goat's blood then read your paper that was in the envelope. That's where you matched.

 

[MD'05]

That's false. I'm sure someone else can link the page with all the details, but the match uses a stable marriage algorithm where the students, not the programs are the ones doing the proposing. Doing it this way actually favors the students, instead of the programs. Basically it looks at what you want and whether the programs will accept you instead of what the programs want and whether you will accept them.

Actually, if you are in the top 10 of students desired by all residency programs in a particular specialty, the algorithm favors the student. If you are not, the algorithm favors the residency program.

 

[Seaglass]

Actually, if you are in the top 10 of students desired by all residency programs in a particular specialty, the algorithm favors the student. If you are not, the algorithm favors the residency program.

That is simply not true. YOU get to pick where you go, if you are in the top ten then your pick is guarunteed, if not you are still likely to end up at a place more preferable to you than others on your list. What cannot happen is being "pulled" into a program lower on your list when a program high on your list has a place for you.

 

[Strap]

Really? Hell, I'm an Aggie and I understood it. What part of it is irresponsible? What part indefensible?

I thought it worked pretty well. Granted, I had serious GI issues during the whole process but I doubt that had anything to do with the match itself and everything to do with the uncertainty involved.

Seriously, what is your problem with it? What would you suggest as a replacement?

Take care,
Jeff

In a non-match world, we would be allowed to hit the open market like, oh I don't know . . . EVERY OTHER FIELD, and demand to be paid what we are worth. The match system as it stands is equivalent to indentured servitude, where we are obligated to the institution of which we match, with severe backlash and consequences if we renege (with very little incentive even if we do).

 

[b&ierstiefel]

well, the match algorithm itself is pretty sound. however, it can be manipulated by programs with shenanigans tactics like, "if you don't tell us that we are your #1, you will not be high on our rank list...so what say you? should we keep you on our list?" conversely, we as applicants cannot resort to tactics like this because the programs can easily tell us to piss off. hence, programs potentially have the upper hand.

 

[Jeff698]

In a non-match world, we would be allowed to hit the open market like, oh I don't know . . . EVERY OTHER FIELD, and demand to be paid what we are worth. The match system as it stands is equivalent to indentured servitude, where we are obligated to the institution of which we match, with severe backlash and consequences if we renege (with very little incentive even if we do).

As Andy pointed out in his post, there are some programs that don't exactly play by the rules. They put all sorts of nasty pressure on applicants and engage in childish behaviour. That's WITH the match.

Can you imagine how ugly and chaotic things would be without the match?
I can and I want no part of it. Fortunately, I'm done with it so if everyone wants to play absolute free market from here on out, knock yourselves out. I think you'll regret it, though.

Take care,
Jeff

 

[Strap]

As Andy pointed out in his post, there are some programs that don't exactly play by the rules. They put all sorts of nasty pressure on applicants and engage in childish behaviour. That's WITH the match.

Can you imagine how ugly and chaotic things would be without the match?
I can and I want no part of it. Fortunately, I'm done with it so if everyone wants to play absolute free market from here on out, knock yourselves out. I think you'll regret it, though.

Take care,
Jeff

Atta boy. That's the way to perpetuate the slave mentality. The traditional med student/resident/attending attitude that if "I had to do it then everyone who follows should have to do it, too!"

 

[AJM]

Atta boy. That's the way to perpetuate the slave mentality. The traditional med student/resident/attending attitude that if "I had to do it then everyone who follows should have to do it, too!"

Ummm, Jeff's post had nothing to do with wanting to perpetuate the system. He basically said that he's fine with you guys trying to get rid of the match, but that you'll likely regret it if you are able to change the system. (ie: you'll be in for a nasty surprise if you try out a "free-market" system).

If you want a comparison to how nasty the free market can get, look at the internal medicine subspecialty fellowship application process. GI is basically "free market". They have no match system. Are the applicants able to negotiate for higher salaries and better benefits? No. Are they able to freely look at all the programs they might be interested in? No. The programs have all the power. They can choose to offer an applicant a position after their interview, but the applicant only has about 1-2 days to accept it, not leaving them any time to interview at or evaluate other programs. If they don't give in answer in the designated time period, that offer is rescinded. Not only that, but once they accept the position, they must withdraw their application from all other programs immediately. The applicants are not able to negotiate with the programs about their salaries -- if they tried, the program would simply offer the spot to someone else. Most of my friends applying in GI have had to settle for programs that they did not think would be one of their top choices, more because they weren't sure if they would get other offers down the road. In contrast, Cardiology, which is just as competitive as GI, is a match through the NRMP, and applicants have a much easier time with it -- none of this wheeling and dealing, being forced to withdraw their applications, etc.

But if you want to try doing things the way GI does it, go ahead. I'm also done with the match, so it's no skin off my back if you want to ruin things for yourselves. 🙂

 

[GeneGoddess]

If you want a comparison to how nasty the free market can get, look at the internal medicine subspecialty fellowship application process. GI is basically "free market". They have no match system. Are the applicants able to negotiate for higher salaries and better benefits? No. Are they able to freely look at all the programs they might be interested in? No. The programs have all the power. They can choose to offer an applicant a position after their interview, but the applicant only has about 1-2 days to accept it, not leaving them any time to interview at or evaluate other programs. If they don't give in answer in the designated time period, that offer is rescinded. Not only that, but once they accept the position, they must withdraw their application from all other programs immediately. The applicants are not able to negotiate with the programs about their salaries -- if they tried, the program would simply offer the spot to someone else. Most of my friends applying in GI have had to settle for programs that they did not think would be one of their top choices, more because they weren't sure if they would get other offers down the road.

Medical Genetics has the same problem...

 

[Hawkeye Kid]

Atta boy. That's the way to perpetuate the slave mentality. The traditional med student/resident/attending attitude that if "I had to do it then everyone who follows should have to do it, too!"

Let's keep in mind that the match came into being because programs were making offers to students during the basic science years. Therefore, if I THOUGHT that I MIGHT be interested in surgery (before ever having any experience in surgery) and I was a good basic science student and, say, Hopkins offerred a spot for whatever the going rate was, I could either take it or not. But, if I chose not, I could be pretty sure that the spot would be filled long before I finished medical school. Given that many students sit between third and fourth years unsure of what they want to do, and the fact that basic science accumen clearly does not directly correlate to clinical skill, it seems that this system is probably not where we want to go (again).

Now, does that mean that the match is perfect? Of course not. Does it mean that if the match were dissolved that we'd go back to the scenario above? Not necessarily. But, as it stands, the match works out pretty well for most people that play it correctly. I'd like to make more money as much as the next 200K-in-debt person, but that's not gonna happen, match or no match. The programs ultimately have the power, simply because they have something that we want/need--without a training program and the job that follows, my debt mountain ain't gonna get any shorter. One could argue that they need us, too, which I suppose is true, but given our financial dependence on the system, there will never be enough of an uprising to pry the power from the programs collective hands. And, even if there was, like AJM pointed out, the pay wouldn't go up.

Anyhoo, that's my take. Like Jeff, I would much rather participate in an imperfect match process than take my chances with whatever scheme were to replace it.