Thoughts on residency matching/ interview caps this cycle

[stark4lyfe]

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Some paper came out recently advocating for interview caps for residency matching, TLDR the models shows something like if everyone with >12 interviews accepts all of their interviews, half of applicants might only get one interview which will lead to some real spiciness later on this year. Thoughts? I know its a pretty spicy take using OBGYN candidates as the data pool. Twitter thread is by author.

I'll throw my two cents in. Might be a mess this year. The incentives are absolutely to over interview, for applicants of all kinds.

The Case for Capping Residency Interviews - PMC

To determine 2020 residency cycle application practices and to model potential consequences in the 2021 cycle if (1) applicants scheduled an uncapped number of interviews; (2) applicants were capped to schedule 12 interviews; (3) residency programs ...

www.ncbi.nlm.nih.gov

 

[LutGholein]

What about couples matching? Wouldn’t this necessitate increasing that cap— which would presumably lead to other possible exemptions?

Honestly there aren’t easy answers to this issue.

 

[NotAProgDirector]

It is difficult to predict what might or might not happen this year. This paper makes several assumptions that might not be true:
1. They only had a 30% response rate, projected their findings to the entire applicant pool. Certainly possible that the "overachievers" are more likely to respond and hence over-represented.
2. They assume that those that get lots of interviews will keep them all. Its certainly possible, but going on 30 virtual interviews isn't easy.
3. They also assume that programs won't change their behavior. Sure, programs might increase the number of interviews they offer (per one of their models). But perhaps programs will decide to not invite some of the superstars. If I had a program that offered to a bunch of superstars who all cancel late in the season and then I'm handing out new offers, perhaps I'm smart enough to see this strategy might fail miserably this year and behave differently.
4. If it does come to pass, it's not the end of the world. SOAP will fill all the spots. It won't be fun, but since there's no in-person interviews the difference between a SOAP interview and a normal interview is minimal. And then, for sure, behavior will change the next year.

Any fix to this problem will be certain to help some people, and hurt others. Someone will cap out at 12 interviews and not match. It will be rare, but it will happen.

 

[wanderingorion]

2. They assume that those that get lots of interviews will keep them all. Its certainly possible, but going on 30 virtual interviews isn't easy.

But if there are more interviews, the neurotic M4 might think that 30 interviews are necessary. 30 virtual interviews are tough, but a fraction of the difficulty/cost when virtual. I worry that we all just reassure ourselves that people are rational, but things that determine our future makes us emotional. We want control over an uncontrollable process, and we the consequences of interview hoarding aren't seen by the hoarders. Just the hungry.

 

[slowthai]

Dr Carmody talks about why programs should stop over-inviting applicants:

1. It forces students to be glued to their phones for potential IVs, for fear of losing their spot. Students are doing chill rotations to free up time to be able to answer these emails, using up time that could be spent rotating in their specialty of choice

2. We shouldn't be selecting residents based on who was the quickest to answer their email

3. Programs cite lack of ability to handle interview rescheduling requests and cancellations due to understaffing as reason for over-inviting. Carmody recommends programs use interview scheduling software so that applicants can schedule interviews themselves

4. Some PDs subscribe to the IKEA principle. They believe that applicants are more likely to follow through with attending an interview if they have to "fight" for it. This fails to account for the people that aren't really interested in a program but are afraid to cancel it.

The thought exercise at the end definitely wasn't the greatest, lol. But I agree that the interview invite system as it is is a chaotic mess.

One more thing: If you're doing this, just STOP. Why? Because the Sheriff of Sodium said so

 

[stark4lyfe]

Haha yeah I actually read that blog!!! No way thought I was alone in that.

 

[Neopolymath]

I'm at a loss as to why it has turned into a situation where everyone has to pull off the highway, hold their piss, leave the clinic room etc. to answer a stupid email scheduling something. It's absurd that I've already sent an email to my attending for next block about needing to be glued to my phone lol. Invite the correct number of people in multiple waves over a day or two. It's not that hard but will require the PC to do 10% more work if they are luddites who can't figure out how to schedule emails to send in the future.

 

[Ho0v-man]

I'm at a loss as to why it has turned into a situation where everyone has to pull off the highway, hold their piss, leave the clinic room etc. to answer a stupid email scheduling something. It's absurd that I've already sent an email to my attending for next block about needing to be glued to my phone lol. Invite the correct number of people in multiple waves over a day or two. It's not that hard but will require the PC to do 10% more work if they are luddites who can't figure out how to schedule emails to send in the future.

Administrators doing administrative tasks? GTFOH!

 

[efle]

Been saying since summer, people are underestimating how many programs scared applicants will apply and interview at this year. We were seeing people applying to avg 60+ programs in many specialties before COVID, and there was already a maldistribution with the stronger applicants consuming a disproportionate number of interviews. And compounding this, for the first time, superstars who get dozens of invites will be able to "attend" most of them instead of being limited to their favorite 15-20 by expense and travel issues. For the competitive specialties that de facto required multiple aways/sub-Is to scope out people they'd rank highly, this year will instead be based on who looks best on paper, which I think will make the over-interviewing of the top end apps even worse.

Looks like a recipe for a tragedy of the commons to me. The match only approaches zero-sum after the SOAP corrects for most of the yield issues. Everybody should be doing something like ENT is with their token system or the SOAP is going to be huge this year.

 

[PatchA]

Been saying since summer, people are underestimating how many programs scared applicants will apply and interview at this year. We were seeing people applying to avg 60+ programs in many specialties before COVID, and there was already a maldistribution with the stronger applicants consuming a disproportionate number of interviews. And compounding this, for the first time, superstars who get dozens of invites will be able to "attend" most of them instead of being limited to their favorite 15-20 by expense and travel issues. For the competitive specialties that de facto required multiple aways/sub-Is to scope out people they'd rank highly, this year will instead be based on who looks best on paper, which I think will make the over-interviewing of the top end apps even worse.

Looks like a recipe for a tragedy of the commons to me. The match only approaches zero-sum after the SOAP corrects for most of the yield issues. Everybody should be doing something like ENT is with their token system or the SOAP is going to be huge this year.

Given that this is the lay of the land that those of us applying this year will need to deal with, any advice on how to avoid being part of the disaster?

 

[efle]

Given that this is the lay of the land that those of us applying this year will need to deal with, any advice on how to avoid being part of the disaster?

Be selfish, be part of the problem. Ignore all the societies pleading for people to limit themselves to a normal number of apps. Take the number you'd apply to in a normal year and raise it 1.5x or more. "Attend" all your interviews, even if that means 30 days spent Zoom interviewing. Make sure that includes plenty of places you're highly competitive for.

That's all you really can do, make sure your cows get fed and someone else's go hungry.

 

[NotAProgDirector]

I don't disagree that this year may be a mess for this exact reason. Perhaps a small benefit is that we'll be able to see what happens in ENT and Ortho -- one using a token system and the other not. Not an RCT, but a helpful "natural experiment".

My point is simply that a token system doesn't help everyone. If we consider two applicants -- both apply to 60 programs. One of them gets 30 invites, the other gets 4. The person who gets 30 will probably be fine with a 12 token system, although they will certainly get less invites. The person who gets 4/60 it will really depend upon how wisely they choose which 12 programs to use their tokens. We talk about "applying smart", but I think it can be very hard to know if you're really competitive for programs with the minimal tools at applicants' disposal. Certainly the person who gets no interviews from their 12 tokens is going to wonder if they might have gotten some if they applied differently.

Once you start giving exceptions to couple's, you get a whole new mess. Without an exception, it's a problem also.

We will get a bellweather, but too late to be of much value -- the fellowship match. Will be vert interesting to see if Cardiology and GI all fill, or everyone ranks the same people and 50% of the spots are left open.

 

[Raryn]

I don't disagree that this year may be a mess for this exact reason. Perhaps a small benefit is that we'll be able to see what happens in ENT and Ortho -- one using a token system and the other not. Not an RCT, but a helpful "natural experiment".

My point is simply that a token system doesn't help everyone. If we consider two applicants -- both apply to 60 programs. One of them gets 30 invites, the other gets 4. The person who gets 30 will probably be fine with a 12 token system, although they will certainly get less invites. The person who gets 4/60 it will really depend upon how wisely they choose which 12 programs to use their tokens. We talk about "applying smart", but I think it can be very hard to know if you're really competitive for programs with the minimal tools at applicants' disposal. Certainly the person who gets no interviews from their 12 tokens is going to wonder if they might have gotten some if they applied differently.

Once you start giving exceptions to couple's, you get a whole new mess. Without an exception, it's a problem also.

We will get a bellweather, but too late to be of much value -- the fellowship match. Will be vert interesting to see if Cardiology and GI all fill, or everyone ranks the same people and 50% of the spots are left open.

There are fellowship matches prior to the IM fellowship match in December, though they're smaller. Anesthesia, surgical critical care, and Ob/gyn fellowship matches are 10/14 for example. There's a handful of others on 10/28 (colorectal surgery sleep medicine, spinal cord injury) and 11/18 (adolescent medicine, EM fellowships)

I don't know much about the majority of those fields but I think a good one to watch is going to be the Ob/gyn matches. It's a mix of different competitiveness, including some fields that usually fill everything - like REI and gyn onc. I know a current applicant for REI - they typically have 60-80 applicants for 45-55 spots, so it's a fairly tight nit group where people can get an idea of how folks are interviewing and they can chat with each other. Multiple applicants have apparently complained about the small fee the NRMP adds to people who rank more than 20 programs - which is more than half the programs that have a spot this year, given a number pulled out of the match. Oh, and almost every program has 1 spot this cycle, only a small handful have two.

I wouldn't be at all surprised if given what I've been told, a handful of applicants monopolized enough interview seats that there's a surprising amount of open programs, but we'll see.

 

[FindersFee5]

I'm at a loss as to why it has turned into a situation where everyone has to pull off the highway, hold their piss, leave the clinic room etc. to answer a stupid email scheduling something. It's absurd that I've already sent an email to my attending for next block about needing to be glued to my phone lol. Invite the correct number of people in multiple waves over a day or two. It's not that hard but will require the PC to do 10% more work if they are luddites who can't figure out how to schedule emails to send in the future.

Plastics has actually been doing it kind of like this for a few years - ACAPS dictates a single interview release day where all the programs send their first wave of interviews and applicants have a weekend to plan and respond to those interview invites. Then there's a few other waves and a trickle, as applicants accept or reject the prior invites.

 

[Pinocytosis]

Plastics has actually been doing it kind of like this for a few years - ACAPS dictates a single interview release day where all the programs send their first wave of interviews and applicants have a weekend to plan and respond to those interview invites. Then there's a few other waves and a trickle, as applicants accept or reject the prior invites.

This just makes so much more sense.

 

[Raryn]

This just makes so much more sense.

Several of the ob/gyn fellowships did the same this year as well. May 1 was the deadline for receiving applications, and all the program directors agreed they wouldn't give out interviews until June 5, and couldn't require an answer until June 9. Then after that initial period, every program was required to give every candidate an update on their status - interview, waitlist, or reject - by June 12. After June 12, it was the regular free for all amongst those who were still waitlisted.

It worked well, though rumor has it a number of programs jumped the gun and did at least some of their invitations prior to the initial June 5 date. Would be harder to coordinate with 10-100x as many applicants/programs though. Would almost certainly have to spread it out more.

 

[TrueRenegade]

I wonder of regional bias will become a stronger factor this year. I imagine schools could take more students from their own schools or the schools in the region they normally accept students from. This way they can be more sure that these applicants are serious about ranking.

 

[Pinocytosis]

I wonder of regional bias will become a stronger factor this year. I imagine schools could take more students from their own schools or the schools in the region they normally accept students from. This way they can be more sure that these applicants are serious about ranking.

Perhaps, but I've also heard from friends that some schools are requiring an additional paragraph or two stating why they are interested in their program, similar to secondary essays. I'm not sure how prevalent that is though.

 

[Raryn]

Perhaps, but I've also heard from friends that some schools are requiring an additional paragraph or two stating why they are interested in their program, similar to secondary essays. I'm not sure how prevalent that is though.

ENT programs required that a few years ago. it was just a game of mad-lib.

And I am interested in your program because of my deep desire to be in a [academic/community/mixed academic and community setting]. Living in the [Northeast/Midwest/West/South] has always been my dream due to the excellent culture available in [Cityname], such as the [cold/warm/hot/seasonal] weather. Reviewing your faculty, I'm most interested in working with Dr. [randomname from website with a good research CV] about [topic from pubmed search of randomname].

Etc.

 

[Pinocytosis]

ENT programs required that a few years ago. it was just a game of mad-lib.

And I am interested in your program because of my deep desire to be in a [academic/community/mixed academic and community setting]. Living in the [Northeast/Midwest/West/South] has always been my dream due to the excellent culture available in [Cityname], such as the [cold/warm/hot/seasonal] weather. Reviewing your faculty, I'm most interested in working with Dr. [randomname from website with a good research CV] about [topic from pubmed search of randomname].

Etc.

Watch as this exact verbiage shows up in thousands of personal statements across the nation.

 

[Raryn]

Watch as this exact verbiage shows up in thousands of personal statements across the nation.

I hope not, because it's a silly draft and includes weather as an example of culture.

But just saying, the overwhelming majority of applicants don't know much about the overwhelming majority of programs they apply for other than the location and whether it's academic or community. Most residency program websites suck. Most faculty can tell you about a few places in detail - but no more than a few, and particularly for residency where there's hundreds of programs in each field, good luck getting a clear idea about all of them. Requiring an actual paragraph as to why you want to go to that specific program will just lead to a superficial examination - at most, a pubmed search of a few prominent faculty members.

 

[Raryn]

...We will get a bellweather, but too late to be of much value -- the fellowship match. Will be vert interesting to see if Cardiology and GI all fill, or everyone ranks the same people and 50% of the spots are left open.

I will say of the smaller bellweather that was the ob/gyn fellowship match, they all filled as normal. 327 total positions of which 319 filled (97.6%). Family planning, gyn/onc, REI filled completely. 5 open spots in MFM, 2 in minimally invasive gyn surgery, and 1 in pediatric gyn is a pretty average year - probably even less openings than normal.

 

[efle]

I will say of the smaller bellweather that was the ob/gyn fellowship match, they all filled as normal. 327 total positions of which 319 filled (97.6%). Family planning, gyn/onc, REI filled completely. 5 open spots in MFM, 2 in minimally invasive gyn surgery, and 1 in pediatric gyn is a pretty average year - probably even less openings than normal.

Interesting, do they give any data on number of apps per person this year compared to prior? Did people apply to many more programs than usual

 

[Raryn]

Interesting, do they give any data on number of apps per person this year compared to prior? Did people apply to many more programs than usual

I doubt it, but mostly because these are all small fields and often many applicants apply to every program in the country. I bet that people took more interviews than normal though.