D
deleted947265
I've heard the prisoners dilemma analogy, and I don't think it captures the whole problem.The prisoners dilemma problem implies that if both parties cooperate they will get the optimal outcome but if they don't they will both lose. In this case cooperation isn't in their best interest, both parties are competing with each other for the optimal outcome. It implies that both players are in the same position, all players in the game can communicate, and the two players aren't necessarily going to be harmed no matter what type of strategy they employ, but there can be negative consequences for other people involved.
The thing with overapplication, when I look at it, is that unless you are in the 90th percentile, sending more applications than you need is just too good. It minimizes the risk of the worst possible outcome to the point of non-existence, and it maximizes the chances of the best possible outcome. When everyone does it, you basically have to do it because everyone else overapplying actually makes it hard for you to compete. Overapplication works, it's just a good strategy so you're going to do it because you want to win. Sure it might make it awful for everyone, and you're not happy about it: but it works and that's all that matters.
I would compare overapplication to bottle crowing in Dota 2. 5 people will understand what I'm talking about and you're probably reading this like I'm on drugs, but hear me out. In Dota 2 the map is divided into 3 lanes, the middle lane is generally played as a 1v1 matchup. So back 6-7years ago there was a thing called 'bottle crowing' and it was an absolute scourge. Basically there's an item called the bottle which comes with three charges that give you health and mana, which is enough to give you north of 1/2 your health and mana back. The charges on the bottle can be refilled by returning to base or by getting the rune that spawns every two minutes.
In Dota there's a courier that delivers items to you without you having to return to the main base and missing out on gold and experience and falling behind your opponent. In this particular iteration of the game each team had to share a single courier. Well it turns out there was this really cool thing you could do if you didn't get the rune or were just low without having to leave the base: you could have the courier come to you, put your bottle on it, run it to base it would refill your bottle.
So this was something that was known about for years, and it didn't become a problem overnight. Slowly players began abusing this mechanic more and more and eventually it got to the point that both mid players were doing it non-stop in an even matchup because winning mid is really important. Think about it. If your goal is to bully your opponent out of the lane by killing them or dropping their HP so low they would die if they stayed. Always having more regen than them is a pretty good strategy. So bottle crowing all the time or at least more than your opponent is by extension: not the worst of ideas. Now you might say that's fine because they are using their team's resources, but it has downstream effects on the entire game. Who isn't using the courier while its refilling the bottle for your braindead Magnus for the 12319313817th time? The 4 other players in game, it makes the game less fun because you can't use a feature of the game if you're not playing mid. Worse still it actually just makes the game dumb, what fun is the mid matchup if you can't win or lose unless you are absolutely pounding the other player or getting pounded? It makes everything stupid.
So how does this all tie back to applying to residency? Well they're kind of the same type of interaction if you think about it. There are less ortho slots than applicants so somebody is going to lose out. So if applying to more slots gives you a better chance, applying more than everyone else is the best strategy to ensure you're not going to get shut out regardless of how competitive you are. The less competitive you are, the more over-applying does for you. The more you bottle crow, the more likely you are to win mid. If you're ahead and your opponent wins the lane because they bottle crowed, you lost because you didn't bottle crow. If you got shut out because you didn't send 80 ortho applications this cycle while everyone else did, you got shut out because you didn't send 80 otho applications.
Sure we could give people more information about where to apply but the problem remains that just applying to more residency programs than everyone else is just that good. Not having enough information about residency programs isn't the reason why applicants are sending an increasing of applications every year and giving them more information won't be the reason they'll stop. This ain't a scene, it's an arms race.
I don't think an application cap inherently hurts DO students or IMGs nor does having no application cap benefit them. I mean there's nothing stopping you from applying to a program or two that you aren't as competitive for and just seeing what happens and spending the rest of your applications on places you know your odds are pretty good. That said, it's probably good that there are systems in place that will recommend you places where you should apply based on where you stand and suggest applicants that you want. That should already exist because its just a good idea, it's easy to implement, and everyone can agree they want it. The cynic in me says that it if that if such a system were to reduce applications by a significant amount, the AAMC won't implement it because it would lose them a lot of money. They make 90 million a year from ERAS. I'm not a hotshot sys admin but I really, really doubt it costs more than a few million for servers to run ERAS, if that.
All that said I think the long term solution is to give people options if they don't match into residency. Now, I know I'm not a doctor or in medical school yet. But the idea that a PAs and NPs can go to school for 2 years while and practice in a subordinate role while also having a pathway to independent practice in some states but someone who went to school for 4 years can't do the same is ridiculous and its obvious. Not matching into residency shouldn't be this mark of shame. At the same time we obviously need to have more residency slots but that involves funding them through medicare or some other means and involving a government that is at current, wholly ineffective.
I don't like it because you really shouldn't need to run what is essentially second match. The match should just.... work. Spots are always going to go unmatched. People should be applying to programs they are interested in and are realistic for how competitive they are, period. I think in the first couple of years with an application cap you could potentially have a ton of unmatched slots because everyone is still figuring the match out again. But if its happening too much after like 3-4 years then the application cap just needs to be raised.
Last edited by a moderator:
