The Matching Algorithm & Medical Student Residencies
Resource: https://stanford.edu/~alroth/NAEhealthcareTalk.transcribed.html
The National Resident Matching Program (NRMP) is an organization that is crucial to connecting medical students to their future residencies and fellowships. However, the NRMP was not always an important factor in the lives of medical students; it used to be that medical students followed a process similar to what students in other graduate fields do where they apply for multiple internship positions and choose one out of the offers that they receive. This was the case in the 1920s for medical students and their hospital fellowships as well.
As fellowships became a more crucial part of hospitals and their main pipeline of recruiting doctors, hospitals started to kick off their hiring processes earlier and earlier in an attempt to get a first pick at the future class of doctors. By 1945, hospitals began hiring medical students as early as the end of their sophomore year of medical school. They key issue with this expedited timeline is that it became hard for residency programs to distinguish the best candidates so early in medical school. This prompted medical schools to intervene and withhold student information to push back recruiting.
When the recruiting cycle began, students faced a classic prisoner’s dilemma – each student acted in their best interest and attended several interviews for jobs ranging from their first choice to a safety-choice at the bottom. With students attending more interviews, residency programs would see more candidates, and students were more likely to get an exploding offer that they would be inclined to accept despite it not being their first choice (students had 10 days to respond to an offer). If they chose to wait to find out from their top choice, they risk not receiving an offer at all. The prisoner’s dilemma here is that each applicant was incentivized to attend as many interviews as they could, but they would be better off if all applicants chose to attend fewer interviews, as a more natural match between medical student and residency could happen.
Due to this dilemma, the NRMP had to intervene and create a matching algorithm and restrict the number of interviews that students could attend. The NRMP created an intricate network where the nodes were the medical students and fellowship programs, and edges were present between a student and fellowship node where the student applied to the fellowship and the fellowship accepted the student. The NRMP then conducted a perfect matching in order to create the optimal assignment of students to fellowships so that each student and hospital receives a match that they deep acceptable without needing to expedite the process to a point where students are not prepared to face interviews, and without students and hospitals needing to conduct an unnecessarily high number of interviews.