Showing posts with label residents and fellows. Show all posts
Showing posts with label residents and fellows. Show all posts

Saturday, March 16, 2024

Match Day for new doctors

 The 2024 Match for new American doctors was announced yesterday by the NRMP, the National Resident Matching Program. Congratulations to all!

Here are some links:

Advance Data Tables
Match By the Numbers
Press Release




Tuesday, February 6, 2024

Kidney exchange (and other bits of market design) in the New York Times

 Peter Coy, the veteran New York Times economics columnist, writes about kidney exchange, after an interview/conversation sparked by a recent working paper of mine, Market Design and Maintenance. (He's a rare economic journalist who reads economists' papers.)

Here's his column, published yesterday afternoon:

The Economist Who Helped Patients Get New Kidneys, Feb. 5, 2024, 3:00 p.m. ET, By Peter Coy

He's also a rare interviewer: his column includes the names of more of my coauthors than I can recall in any other interview. In order of appearance: Tayfun Sonmez and Utku Unver, Frank Delmonico, Susan Saidman, Mike Rees (implicitly) when he names Mike's nonprofit Alliance for Paired Kidney Donation, and Elliott Peranson.  Market design is, after all, a team sport.

Here's his concluding paragraph:

"What is it like to straddle the worlds of academia and practice? I asked. “It takes a lot of patience,” he said. “Market design is outward-facing. I learn from trying to persuade people who aren’t economists. It’s a lot of fun also. Sometimes you have to go beyond your completely reliable scientific knowledge.”

########

Earlier post:

Monday, December 11, 2023

Sunday, December 10, 2023

Signaling for residency programs in dermatology, general surgery, and internal medicine

We're starting to see some data from signaling for residency applications.  This paper observes that programs are more likely to interview candidates who send them a signal. (Economists will worry that this reflects which programs are signaled and not just the effect of a signal...)  These three specialties have relatively few signals, more like economics than like Orthopedic Surgery (which has 30 signals).  And the table indicates that more interviews are offered than signals received, so that's another difference from Ortho...)

Rosenblatt, Adena E., Jennifer LaFemina, Lonika Sood, Jennifer Choi, Jennifer Serfin, Bobby Naemi, and Dana Dunleavy. "Impact of Preference Signals on Interview Selection Across Multiple Residency Specialties and Programs." Journal of Graduate Medical Education 15, no. 6 (2023): 702.

"Abstract

"Background Program signaling is an innovation that allows applicants to express interest in specific programs while providing programs the opportunity to review genuinely interested applicants during the interview selection process.

"Objective To examine the influence of program signaling on “selected to interview” status across specialties in the 2022 Electronic Residency Application Service (ERAS) application cycle.

"Methods Dermatology, general surgery-categorical (GS), and internal medicine-categorical (IM-C) programs that participated in the signaling section of the 2022 supplemental ERAS application (SuppApp) were included. Applicant signal data was collected from SuppApp, applicant self-reported characteristics collected from the MyERAS Application for Residency Applicants, and 2020 program characteristics collected from the 2020 GME Track Survey. Applicant probability of being selected for interview was analyzed using logistic regression, determined by the selected to interview status in the ERAS Program Director’s WorkStation.

"Results Dermatology had a 62% participation rate (73 of 117 programs), GS a 75% participation rate (174 of 232 programs), and IM-C an 86% participation rate (309 of 361 programs). In all 3 specialties examined, on average, signaling increased the likelihood of being selected to interview compared to applicants who did not signal. This finding held across gender and underrepresented in medicine (UIM) groups in all 3 specialties, across applicant types (MDs, DOs, international medical graduates) for GS and IM-C, and after controlling for United States Medical Licensing Examination Step 1 scores.

"Conclusions Although there was variability by program, signaling increased likelihood of being selected for interview without negatively affecting any specific gender or UIM group."



Data from future years will be needed to determine how signaling is influencing the distribution of residents to programs.

Wednesday, December 6, 2023

Applying for medical residencies: a consensus statement from Internal Medicine

 The Alliance for Academic Internal Medicine has released a "consensus statement" with many proposals about application and interview caps, and signaling.

Catalanotti, Jillian S., Reeni Abraham, John H. Choe, Kelli A. Corning, Laurel Fick, Kathleen M. Finn, Stacy Higgins et al. "Rethinking the Internal Medicine Residency Application Process to Prioritize the Public Good: A Consensus Statement of the Alliance for Academic Internal Medicine." The American Journal of Medicine (2023).

It also includes a call for data and analysis:

"AAIM proposes increasing internal medicine program preference signals to 15, using tiered signaling with three “gold” and 12 “silver” signals, and setting an interview cap of 15 in the 2024-2025 recruitment season, with participation by all internal medicine programs. The Alliance recommends that all internal medicine programs participate in ACI. AAIM recommends that programs transparently share information about their use of preference signals and other application screening methods and calls for real-time data analysis to explore impact, inform future iterations and identify potential harms.

"The Alliance calls upon ERAS and NRMP as well as Thalamus® and other interview scheduling platforms to transparently share data, to embrace change, and to perform analyses needed to inform this process. For example, recent modeling with eight years of retrospective NRMP data in OBGYN demonstrated that an early match round may increase the number of “mutually dissatisfied applicant-program pairs” and that a multiple-round match process could introduce potential rewards for gamesmanship, a prime factor addressed by the current process.35 AAIM applauds this analysis and hopes that the new collaboration between ERAS and Thalamus® may provide useful interview data to inform this proposal and further interventions."

And here is reference 35 in that last paragraph, about which I've blogged before.

I Ashlagi, E Love, JI Reminick, AE. Roth
Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021
J Grad Med Educ, 15 (2) (Apr 2023), pp. 219-227, 10.4300/JGME-D-22-00177.1

Thursday, October 5, 2023

Transition to residency conference: Oct 5-7

I'll be a panelist at the  the NRMP conference Transition to Residency,  in Boston, Oct 5-7

"The National Resident Matching Program® (NRMP®) will convene its stakeholder conference in Boston this year. The meeting is intended to provide a forum for robust conversation among members of the undergraduate and graduate medical education communities about issues relevant to the transition to residency."

Here's the list of plenary speakers.


Friday, Oct 6, 8:30 – 9:45 AM Plenary I

The Future of the Transition to Residency: Assessing the Impact of Proposed Change

Panelists:

John Combes, MD

Alvin Roth, PhD

Charles (Tom) Thomas, MA, MPhil

Wednesday, September 20, 2023

Mathematics and Computer Science of Market and Mechanism Design: SLMath introductory workshop (videos)

Last week I gave the opening talk of the week long  Introductory Workshop at SLMath, on Mathematics and Computer Science of Market and Mechanism Design.  Some of the video lectures are now online here (consisting mostly of slides and voice).

My talk introduces the general themes of market design by recounting the history and challenges facing the market for new doctors from 1900 through this year.

Berkeley's Simons Laufer Mathematical Sciences Institute (SLMath), formerly known as the Mathematical Sciences Research Institute (MSRI) has a commanding view of the SF Bay.







Friday, September 8, 2023

Signaling for Orthopaedic surgery residencies

 The Journal of Bone and Joint Surgery reports a small survey about signaling behavior among applicants for orthopaedic surgery residencies.

Deckey, David G., Eugenia Lin, Coltin RB Gerhart, Joseph C. Brinkman, Karan A. Patel, and Joshua S. Bingham. "Decoding the Signals: An Analysis of Preference Signaling in the 2023 Orthopaedic Surgery Residency Match." JBJS Open Access 8, no. 3 (2023).

"While previously used in other specialties, the preference signaling program (PSP) was implemented in the 2022 to 2023 orthopaedic surgery residency application process for the first time. The PSP allowed for 30 signaling tokens to be sent by applicants to programs of their choice to indicate particular interest in a program.

...

"An anonymous electronic survey was emailed to all orthopaedic surgery residency applicants who applied to the authors' institution during the 2022 to 2023 application cycle. The survey was sent after match lists were submitted and closed before the release of match results. 

...

"The survey was completed by 101 applicants. Applicants applied to a mean of 90 programs (range: 10-197) and received an average of 12 interview invitations (range: 0-39). Applicants almost uniformly used all 30 signals, with nearly two-thirds signaling their home programs (65%, 49/76), and nearly all applicants sending signals to programs at which they performed away rotations (95.7%, 88/92). Applicants received a mean of 9 invitations from programs they signaled, compared with 2 invitations from programs they did not signal."

#######

Applicants report sending signals to all the programs that would have been expected to automatically give them interviews even in the absence of a signaling mechanism--namely their home programs and those which they have spent time visiting in 'away rotations.'

In the Economics job market, which may have been the first to introduce signaling, we limited applicants to 2 signals, and advised them not to signal jobs in which they already had well established mutual interests, i.e. not to signal jobs which they felt would interview them without signals. One of the ideas behind the Econ signaling mechanism is that there are many ways applicants can send signals of interest within a network to which they are well connected. Since some applicants are better connected than others, we were offering some signals that could be sent out of network.

It will be interesting to understand if signals to Ortho residencies are helping promote out of network interviews, or are largely strengthening the network connections already established by medical schools (home programs) and away rotations.

Tuesday, August 29, 2023

OB-GYN doctors will use a new application system to apply to residency programs (but will continue to go through the NRMP resident match)

 Before new doctors can participate in the resident match (by engaging with the NRMP), they first have to apply to residency programs, and arrange interviews.  This process has been experiencing congestion, and the specialty of Obstetrics and Gynecology has now decided to switch application services. 

However, participation in the NRMP will not change: the Association of Professors of Gynecology and Obstetrics (APGO) FAQ states "Obstetrics and gynecology applicants will use the National Residency Match Program (NRMP) for the Match. This new application does not change how the applicant or programs interact with the NRMP Match system."

Medpage Today has the story:

Ob/Gyn Switching to Independent System for Residency Applications— This is the last year ob/gyn will use ERAS, despite helping to pilot the program  by Rachael Robertson, Enterprise & Investigative Writer, MedPage Today August 25, 2023

"Beginning next year, ob/gyn programs will start using an independent system for processing residency applications, rather than the Electronic Residency Application Service (ERAS).

"The joint decision to switch to the new system was made by the American College of Obstetricians and Gynecologists (ACOG), the Association of Professors of Gynecology and Obstetrics (APGO), and the Council on Resident Education in Obstetrics and Gynecology (CREOG). The new system will be managed by Liaison International, which uses "Centralized Application Service (CAS) technology," according to the company's website.

...

"A joint statement on the APGO website opens in a new tab or window

said that the new system "will be user friendly and efficient, less expensive for applicants, and will directly decrease the burdens faced by program directors, program managers, and applicants alike," and "will incorporate the entirety of interview season functions, from application submission, review, interview offers and interviews, to rank list submission."

ACOG explained that the decision to pull the ERAS stemmed from the Right Resident, Right Program, Ready Day One initiativeopens in a new tab or window, noting that the new system is mobile-friendly and "will include immediate fee reduction," as detailed on their FAQ pageopens in a new tab or window.

In response, the Association of American Medical Colleges (AAMC), which runs ERAS, issued a statementopens in a new tab or window attributed to President and CEO David J. Skorton, MD, and Alison J. Whelan, MD, the chief academic officer, saying they were "surprised and dismayed" by the decision. 

...

"Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, shared information  opens in a new tab or window

about the change on social media, writing on his blogopens in a new tab or window that ob/gyn program directors helped to pilot ERAS when it was first rolled out in the mid-90s.

Carmody told MedPage Today that he anticipates the biggest downsides will fall on applicants, such as those who want to apply to another specialty in addition to ob/gyn.

"Those applicants will have to use one system to apply to ob/gyn and another to their other specialty," he explained. "The same thing applies to applicants who fail to match. They'll have to use ERAS to apply to another specialty during SOAP [Supplemental Offer and Acceptance Program] since few, if any, ob/gyn positions are typically available."

*************

OB-GYN will continue to employ signaling  (very loosely modeled on the signaling used in the Econ PhD job market, but asking applicants to submit 3 "gold" signals and 15 "silver" signals): 

Program Signaling for OBGYN Residency Application Background and FAQs

**************

Earlier:

Friday, April 21, 2023

Saturday, April 29, 2023

Resident match video from the NRMP

 Different labor markets are organized differently. One difference between the market for new doctors and the markets for new Ph.D.s is that doctors use a centralized clearinghouse, so a lot of things happen at the same time.  Here's a video from the National Resident Matching Program that gives some idea about that.


Friday, April 28, 2023

Interesting development in the transition from medical school to residency: connecting applications and interviews

 The market for new doctors has been suffering from congestion in applications and interviews, in the runup to the resident Match (see recent post with a diagram). The American Association of Medical Colleges runs the main application server, ERAS. A private company called Thalamus runs a growing interview scheduling service. Now they are looking to collaborate.

 Here's  yesterday's press release from Thalamus:

AAMC, Thalamus Announce New Collaboration to Improve Transition to Residency

Collaboration will increase transparency and make the residency process easier for applicants and programs  

Washington, D.C., April 27, 2023—Today the AAMC (Association of American Medical Colleges) and Thalamus announced a strategic collaboration to accelerate innovation and ease the transition to residency for medical students, medical schools, and residency programs. The collaboration will combine the AAMC’s long-established leadership in innovation along the continuum from medical school to residency training and continuing medical education with Thalamus’ market-leading product and software development expertise. 

“The transition from undergraduate medical education to graduate medical education is a critical period in any learner’s journey to becoming a physician,” said David J. Skorton, MD, AAMC president and CEO. “We know the community is seeking enhanced tools and integrated services that better support application and recruitment processes. We listened, we have made improvements, and, with Thalamus, we are excited to make this vision a reality.” 

The organizations will collaborate to leverage their data, technology, and expertise to transform the medical residency and fellowship recruitment processes for applicants and programs. Their efforts will focus on increasing transparency, supporting equity through holistic review, and improving the learner experience by consolidating the fragmented interview management process. 

“We are thrilled to be collaborating with the AAMC to provide a comprehensive solution that will streamline graduate medical education recruitment processes,” said Jason Reminick, MD, MBA, MS, CEO and founder of Thalamus. “But even more, we are looking forward to building new and innovative tools that improve the experience, are cost-effective, and leverage data for the benefit of the medical education community and the advancement of our collective missions.” Dr. Reminick applied to residency in 2012 during an eventful recruitment season disrupted by Hurricane Sandy. “I’m particularly excited to provide applicants with a comprehensive platform to manage their interview season.” 

The collaboration between the AAMC and Thalamus will enable data-sharing and innovative research that will benefit the undergraduate to graduate medical education community and advance both organizations’ missions. The initiative also demonstrates the commitment of both organizations to addressing the concepts and themes outlined in the 2021 report from the Coalition for Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee.

In recent years, the AAMC has completed significant in-depth research and upgraded technology to enhance the Electronic Residency Application Service® (ERAS®) suite of application and selection tools, such as updating the MyERAS® application content, building analytics tools for institutions, and partnering on collaborative research initiatives. Thalamus has completed unique research related to the physician workforce, including how geography influences The Match® and specialty-specific interview practices. The Thalamus technology will continue the upgrade of the ERAS suite of application and selection tools. The AAMC and Thalamus remain committed to future innovations that will enable the ERAS program to continue to evolve faster and better. 

Beginning in June 2023, all ERAS residency and fellowship programs will receive complimentary access to Thalamus’ leading interview management platform, Thalamus Core and Itinerary Wizard, as well as Cerebellum, a novel data and analytics dashboard to assess recruitment outcomes, specifically from a diversity, equity, inclusion, and geographic perspective. Programs may also elect to purchase Thalamus’ video interview platform and Cortex, its technology-assisted holistic application review and screening platform. 

According to AAMC data, the U.S. is expected to experience a shortage of up to 124,000 physicians by 2034. Given the burnout and other challenges to the health care system caused by the COVID-19 pandemic, the AAMC and Thalamus look to use their collective expertise to promote a diverse and representative workforce that will enhance health care and patient outcomes. 

The data and research the AAMC and Thalamus have amassed to identify resident, fellow, and physician recruitment trends can potentially have a major impact on diversity in medicine and begin to address several well-established and longstanding systemic challenges. These efforts will support not only the application and selection processes in graduate medical education but also aim to improve the experiences of the U.S. physician workforce over the long term. 

Related Resources 

###

Note for editors: Leaders from the AAMC and Thalamus are available to speak with media about this new collaboration and what it means for residency programs and applicants. 

The AAMC (Association of American Medical Colleges) is a nonprofit association dedicated to improving the health of people everywhere through medical education, health care, medical research, and community collaborations. Its members are all 157 U.S. medical schools accredited by the Liaison Committee on Medical Education; 13 accredited Canadian medical schools; approximately 400 teaching hospitals and health systems, including Department of Veterans Affairs medical centers; and more than 70 academic societies. Through these institutions and organizations, the AAMC leads and serves America’s medical schools and teaching hospitals and the millions of individuals across academic medicine, including more than 193,000 full-time faculty members, 96,000 medical students, 153,000 resident physicians, and 60,000 graduate students and postdoctoral researchers in the biomedical sciences. Following a 2022 merger, the Alliance of Academic Health Centers and the Alliance of Academic Health Centers International broadened the AAMC’s U.S. membership and expanded its reach to international academic health centers. Learn more at aamc.org

Thalamus is the premier, cloud-based interview management platform designed specifically for application to Graduate Medical Education (GME) training programs. The software streamlines communication by eliminating unnecessary phone calls/emails allowing applicants to book interviews in real-time, while acting as a comprehensive applicant tracking system for residency and fellowship programs. Thalamus provides comprehensive online interview scheduling and travel coordination via a real-time scheduling system, video interview platform, AI application screening/review tool (Cortex) providing technology-assisted holistic review, and first-in-class DEI-focused analytics dashboard (Cerebellum). Featured nationally at over 300+ institutions and used by >90% of applicants, Thalamus is the most comprehensive solution in GME interview management. For more information on Thalamus, please visit https://thalamusgme.com or connect with us on LinkedInFacebookInstagramTwitter, or YouTube

Friday, April 21, 2023

Transition from medical school to residency: defending the parts that work well (namely the NRMP Resident Match)

This post is about a recently published paper concerning the design of the market for new doctors in the U.S.  But it will require some background for most readers of this blog.   The short summary is that the market is experiencing problems related to congestion, and one of the proposals to address these problems was deeply flawed, and would have reduced market thickness and caused substantial direct harm to participants if implemented, and created instabilities that would likely have caused indirect harms to the match process in subsequent years. But this needed to be explained in the medical community, since that proposal was being  very actively advocated.

For those of you already steeped in the background, you can go straight to the paper, here.

Itai Ashlagi, Ephy Love, Jason I. Reminick, Alvin E. Roth; Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021. J Grad Med Educ 1 April 2023; 15 (2): 219–227. doi: https://doi.org/10.4300/JGME-D-22-00177.1

If the title doesn't remind you of the vigorous advocacy for an early match for select positions, here is some of the relevant back story.

The market for new doctors--i.e. the transition from medical school to residency--is experiencing growing pains as the number of applications and interviews has grown, which imposes costs on both applicants and residency programs.  

Below is a schematic of that process, which begins with applicants submitting applications electronically, which makes it easy to submit many.  This is followed by residency programs inviting some of their applicants to interview. The movement to Zoom interviews has made it easier to have many interviews also (although interviews were multiplying even before they moved to Zoom).  

After interviews, programs and applicants participate in the famous centralized clearinghouse called The Match, run by the NRMP. Programs and applicants each submit rank order lists (ROLs) ranking those with whom they interviewed, and a deferred acceptance algorithm (the Roth-Peranson algorithm) produces a stable matching, which is publicly announced on Match Day. (Unmatched people and positions are invited into a now computer-mediated scramble, called SOAP, and these matches too are announced on Match  Day.)

The Match had its origins as a way to control the "unraveling" of the market into inefficient bilateral contracts, in which employment contracts were made long before employment would commence, via exploding offers that left most applicants with very little ability to compare options.  This kind of market failure afflicted not only the market for new physicians (residents), but also the market for later specialization (as fellows). Consequently, over the years, many specialties have turned to matching for their fellowship positions as well.

  The boxes in brown in the schematic are those that constitute "The Match:" the formulation and submission of the ROLs, and the processing of these into a stable matching of programs to residents.  Congestion is bedeviling the parts in blue.

The boxes colored brown are 'The Match' in which participants formulate and submit rank order lists (ROLs), after which a deferred acceptance algorithm produces a stable matching of applicants to programs, which is accepted by programs and applicants on Match Day. The boxes in blue, the applications and interviews that precede the Match, are presently suffering from some congestion.  Some specialties have been experimenting with signals (loosely modeled on those in the market for new Economics PhDs, but implemented differently by different medical specialties).

The proposal in question was to divide the match into two matches, run sequentially, with the first match only allowing half of the available positions to be filled.  The particular proposal was to do this first for the OB-GYN specialty, thus separating that from the other specialties in an early match, with only half of the OB-GYN positions available early.

This proposal came out of a study funded by the American Medical Association, and it was claimed, without any evidence being offered, that it would solve the current problems facing the transition to residency.  Our paper was written to provide some evidence of the likely effects, by simulating the proposed process using the preferences (ROLs) submitted in previous years.  

The results show that the proposal would largely harm OB-GYN applicants by giving them less preferred positions than they could get in a traditional single match, and that it would create instabilities that would encourage strategic behavior that would likely undermine the successful operation of the match in subsequent years.

Itai Ashlagi, Ephy Love, Jason I. Reminick, Alvin E. Roth; Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021. J Grad Med Educ 1 April 2023; 15 (2): 219–227. doi: https://doi.org/10.4300/JGME-D-22-00177.1

Abstract:

"Background--An Early Result Acceptance Program (ERAP) has been proposed for obstetrics and gynecology (OB/GYN) to address challenges in the transition to residency. However, there are no available data-driven analyses on the effects of ERAP on the residency transition.

"Objective--We used National Resident Matching Program (NRMP) data to simulate the outcomes of ERAP and compare those to what occurred in the Match historically.

"Methods--We simulated ERAP outcomes in OB/GYN, using the de-identified applicant and program rank order lists from 2014 to 2021, and compared them to the actual NRMP Match outcomes. We report outcomes and sensitivity analyses and consider likely behavioral adaptations.

"Results--Fourteen percent of applicants receive a less preferred match under ERAP, while only 8% of applicants receive a more preferred match. Less preferred matches disproportionately affect DOs and international medical graduates (IMGs) compared to US MD seniors. Forty-one percent of programs fill with more preferred sets of applicants, while 24% fill with less preferred sets of applicants. Twelve percent of applicants and 52% of programs are in mutually dissatisfied applicant-program pairs (a pair in which both prefer each other to the match each received). Seventy percent of applicants who receive less preferred matches are part of a mutually dissatisfied pair. In 75% of programs with more preferred outcomes, at least one assigned applicant is part of a mutually dissatisfied pair.

"Conclusions--In this simulation, ERAP fills most OB/GYN positions, but many applicants and programs receive less preferred matches, and disparities increase for DOs and IMGs. ERAP creates mutually dissatisfied applicant-program pairs and problems for mixed-specialty couples, which provides incentives for gamesmanship."



************
I'm hopeful this paper will effectively contribute to the ongoing discussion of how, and how not, to modify the design of the whole process of transition to residency with an aim to fixing the parts that need fixing, without damaging the parts that work well, i.e. while doing no harm. 

(Signaling will likely continue to play a role in this.)



Tuesday, February 21, 2023

It's hard to navigate the Ophthalmology and Urology labor market without a couples match

The Ophthalmology and Urology matches are earlier than the NRMP resident match, and do not offer a couples match. Based on a survey of Ophthalmology and Urology match participants, the authors outline the need for a couples match.

Navigating the Ophthalmology & Urology Match with a Significant Other by lSamantha S. Massenzio MD *, Tara A. Uhler MD †, Erik M. Massenzio MD †, Emily Sun BS *, Divya Srikumaran MD *, Marisa M. Clifton MD ‡, Laura K. Green MD §, Grace Sun MD ║, Jiangxia Wang MS ¶, Fasika A. Woreta MD, MPH *  https://doi.org/10.1016/j.jsurg.2022.07.026  Journal of Surgical Education, Volume 80, Issue 1, January 2023, Pages 135-142

"Highlights:

• There is an increasing number of couples applying for residency

• Ophthalmology and urology applicants cannot utilize the NRMP Couples Match system

• A Couples Match is highly desired by applicants to these two specialties

• The lack of a Couples Match is a deterrent to these specialties for some applicants

• Systems to aid applicants to these specialties with significant others are needed"

Saturday, January 28, 2023

Signaling in the markets for new doctors

 Signaling of interest is catching on in medical labor markets for residents and fellows.

Here's some material from Thalamus (which describes itself as "Complete GME interview management solution for applicants & programs. Easy, secure, and automated interview scheduling to optimize in-person & virtual recruitment.")

The Ultimate Guide to Preference Signaling for Medical Residency Applicants and Programs 2022-2023.

It all seems to have started with the signaling mechanism we use in Economics.

From Part 1: 

"The Emergence of Preference Signaling:
Preference signaling was first implemented in 2006, as part of the recruitment process for economics graduate students administered through the American Economics Association (AEA). Since then, there have been several useful studies analyzing this process by leading economists at institutions including Harvard and Stanford. These include “Preference Signaling in Matching Markets” and “The Job Market for New Economists: A Market Design Perspective.”

"Of note, one of the authors on the latter article is Dr. Alvin E. Roth, who won the Nobel Prize in Economics for proving certain key attributes of the matching algorithm that is used today by the National Resident Matching Program (NRMP), where Dr. Roth currently serves as a board member. This article has been cited in papers throughout GME that examine preference signaling in specialties including Otolaryngology and Orthopaedic Surgery."
********
Earlier:


Wednesday, January 18, 2023

Collective bargaining by medical residents

 The WSJ has the story:

Medical Residents Unionize Over Pay, Working Conditions. Doctors-in-training say they want to advocate for themselves and patients  By Dominique Mosbergen

"Physicians-in-training at top teaching hospitals across the country are joining unions, demanding higher pay and better working conditions.

"The Committee of Interns and Residents, the largest group representing doctors in residency and fellowship programs, said it added chapters at five teaching hospitals last year and two in 2021, up from a prepandemic pace of roughly one a year. CIR, which is affiliated with the Service Employees International Union, said it represents about 15% of the nation’s 140,000 residents and fellows. 

"The pandemic’s strains spurred residents to organize, said Simranvir Kaur, a fourth-year resident specializing in obstetrics and gynecology at Stanford Medicine, where most of some 1,400 Stanford residents voted to form a union last May. 

...

"Stanford, which is based in Palo Alto, Calif., said it is negotiating a union contract with its residents and declined to comment further.

...

"The American Medical Association’s ethics code advises physician unions not to engage in strikes by withholding essential medical services from patients. 

"CIR said that residents’ first priority is patients and that unionized residents would vote to strike only as a last resort. The last time a CIR union went on strike was in 1981."

Wednesday, January 4, 2023

"It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program," say its leaders

 The current appointment process for interventional cardiology fellows is early and congested, and programs feel obliged to make exploding offers, often to internal candidates, without much opportunity for external candidates and programs to become acquainted. In short, they are facing the problems with decentralized hiring that have led many medical specialties to use a centralized match to organize the labor market for residencies and fellowships.  Here's a proposal that this fellowship program should join the Match in order to have a more orderly, better informed process.

Vallabhajosyula, Saraschandra, Sabeeda Kadavath, Alexander G. Truesdell, Michael N. Young, Wayne B. Batchelor, Frederick G. Welt, Ajay J. Kirtane, Anna E. Bortnick, and ACC Interventional Section Leadership Council. "It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program." Cardiovascular Interventions 15, no. 17 (2022): 1762-1767.

"In this perspective article, which is a summation of the deliberations of the American College of Cardiology Interventional Section Leadership Council, we describe the current process of interventional cardiology fellowship candidate selection and opportunities for improvement by joining the Match.

...

"Current Application Process

...

"the date for program review of applications starts on December 1st (1½ years before the start of the interventional cardiology training program to which applicants are applying), although programs are free to offer spots earlier. At the time applications are submitted, cardiovascular medicine fellows in traditional 3-year programs have variable exposure to the cardiac catheterization laboratory. In our experience, for many applicants, the timing of the application process precludes an adequate diagnostic catheterization laboratory experience in order to inform decision-making. ... program leadership is heavily reliant on candidate performance in the interview and on subjective evaluation through letters of recommendation from faculty mentors who have typically had a single year of exposure to applicants.






Thursday, December 22, 2022

Wilderness Medicine starts a fellowship Match

 "Wilderness medicine" sounds like the sort of medicine you hope you never need as a patient.  But there is a medical fellowship program that draws on a cross-disciplinary group of docs, and their decentralized labor market has run into the usual difficulties. Here's a report on a new centralized clearinghouse, run in-house and partly manually, following a simulated run.

Davis, Christopher A., Stephanie Lareau, Taylor Haston, Arun Ganti, and Susanne J. Spano. "Implementation of a Specialty Society‒Sponsored Wilderness Medicine Fellowship Match." Wilderness & Environmental Medicine (2022, in press).

"Previously, wilderness medicine (WM) fellowships offered spots to applicants using an offer date. Due in part to increases in the number of WM fellowships and applicants, in 2021, the WM program directors (PDs) agreed to conduct the first WM fellowship match through the Wilderness Medical Society graduate medical education committee. This article outlines the process used and demonstrates its feasibility.

...

"Wilderness Medicine (WM) fellowships previously filled positions using an offer-date set by fellowship directors each fall.1 Applicant(s) were called in the order of preference by each director until all available positions were filled. Once called, applicants would have 30 min to accept or decline the offer. Limitations included the potential for verbal, nonbinding offers to influence candidates’ and directors’ actions on the offer day, as well as pressure on candidates to accept initial offers owing to the lack of knowledge regarding potential forthcoming offers. These concerns cast uncertainty on whether participants were placed in a disadvantageous position by the offer-date system.

...

"Formal fellowship matching services are not exclusively managed by the NRMP; other businesses, the military, and professional societies host matching services. The San Francisco match currently provides fellowship matching services to 22 subspecialties.6 The military does not use a computer-generated match list; the selection committee arranges negotiated pairings between programs and applicants, with the ability to place an applicant in a program they did not rank.7 The American Urological Association, in conjunction with the Society of Academic Urologists, has overseen the urology residency match program for >35 y, which includes fellowship matches.

...

"After completion of the simulated trial/test match, all PDs and WMS GME committee members agreed to participate in the proposed inaugural WM match via email or telephone verification. The deadline of October 25, 2021 was set for the submission of all rank lists to the WMS staff member by all participating applicants and programs. Individual emails were sent to both the programs and applicants to encourage timely completion of the process. On October 28, 2021, at 0900 PST/1200 EST, initial emails were sent simultaneously to each applicant and each PD to inform them of either a successful match or eligibility for the secondary match.

...

"A total of 13 programs and 15 applicants completed the match process. After the first round, 11 of 15 applicants had matched, and 2 programs and 4 candidates had the opportunity to complete the secondary match. During the secondary match period, the unfilled programs2 withdrew, obviating the need for the secondary match.

...

"Many PDs noted in 2021 that they had a significant increase in the number of applicants in 2020 and cited this as motivation for moving away from the previous telephone-based offer system and pursuing a match for the subsequent year."

Wednesday, November 23, 2022

Improving the transition to (surgical) residency

The transition from medical school to residency is presently troubled by congestion involving (too) many applications and interviews.  It's a subject of considerable discussion in the medical community, sometimes hampered between the parts of the process that proceed the Match, and the Match itself (which is the clearinghouse run by the NRMP that, after all applications and interviews have been processed, solicits rank order lists and turns them into a matching of doctors to residency programs)..  Here's a paper that focuses sensibly on the runup to the Match, even though its title follows the (unfortunately common) practice of calling the whole process the Match.

Designing the “match of the future”: challenges and proposed solutions in the interview and match phase of the UME–GME transition by Sophia K. McKinley, Maria S. Altieri, Olabisi Sheppard, Kimberly Hendershot, Keneeshia Williams, Brigitte K. Smith on behalf of the ASE Graduate Surgical Education Committee, Global Surgical Education - Journal of the Association for Surgical Education : 17 November

Table 1 Challenges and proposed solutions in the surgical resident selection process (click to embiggen)




Sunday, November 6, 2022

Limiting congestion by limiting applications, or making them costly

 Here's a paper that investigates two alternatives to limiting congestion in college admissions: one is to limit applications, and the other is to add a small cost for each additional application. (This is a current topic of discussion in a number of other applications, including matching of new doctors to residencies.)

Application Costs and Congestion in Matching Markets by YingHua He and Thierry Magnac, The Economic Journal,  https://doi.org/10.1093/ej/ueac038 (online early)

Abstract: "A matching market often requires recruiting agents, or ‘programmes’, to costly screen ‘applicants’, and congestion increases with the number of applicants to be screened. We investigate the role of application costs: higher costs reduce congestion by discouraging applicants from applying to certain programmes; however, they may harm match quality. In a multiple-elicitation experiment conducted in a real-life matching market, we implement variants of the Gale-Shapley deferred-acceptance mechanism with different application costs. Our experimental and structural estimates show that a (low) application cost effectively reduces congestion without harming match quality."

"Our empirical strategy is novel. It begins with a multiple-elicitation field experiment that enables us to directly evaluate the effects of application costs. The experiment involves the real-life matching of 129 applicants to the seven master’s programmes at the Toulouse School of Economics (TSE), and was conducted in May 2013 for admission in the 2013–4 academic year. The experimental market designs are three variants of the Gale-Shapley deferred-acceptance (DA) mechanism encountered in practice: the traditional DA mechanism, under which applicants can apply to all programmes without any cost; the DA mechanism with truncation (DA-T), under which applicants can apply to no more than four programmes (hence, DA-T-4); and the DA mechanism with cost (DA-C), under which applicants must write a motivation letter for each additional application beyond the first three applications. Under each mechanism, every applicant is required to submit a rank-ordered list of programmes (ROL). As applicants are informed that one of the mechanisms will be implemented, they have incentives to behave optimally under each mechanism.

"To evaluate the performance of a matching procedure, we focus on two dimensions of a matching outcome: the congestion and match quality. The former is measured by screening costs and approximated by the number of applicants to screen; the latter is measured by the welfare of both sides, the number of unmatched applicants, as well as the number of blocking pairs. A pair comprising applicant and programme blocks a matching if both would be better off by being matched together after leaving their current matches. The stability of a matching, defined as the absence of any blocking pair, is the key to the success of matching markets (Roth, 1991). Importantly, stability implies Pareto efficiency when both sides are endowed with strict preferences (Abdulkadiroğlu and Sönmez, 2013)."



Friday, October 21, 2022

The past and future of the transition from medical school to residency, in the Journal of Graduate Medical Education, by Williamson, Soane, and Carmody

 The October issue of the Journal of Graduate Medical Education considers the past and future of the transition to residency.

The US Residency Match at 70: What Was, What Is, and What Could Be  by Edwin Williamson, MD; Caroline Soane, BA; J. Bryan Carmody, MD, MPH, J Grad Med Educ (2022) 14 (5): 519–521., https://doi.org/10.4300/JGME-D-22-00248.1

"But while early offers are long gone, the residency selection process now faces a new set of challenges related to the increasing number of applications submitted by contemporary applicants. In 2020 the average US medical school graduate submitted 70 residency applications.9  The average for some specialties is even higher. For instance, in 2022, the average osteopathic medical school applicant in obstetrics and gynecology submitted 85 applications, while US MD applicants in orthopedic surgery submitted 96 applications, and international medical graduates submitted 100 applications each to internal medicine programs.10  This overapplication increases costs for applicants and programs, leads to reliance on convenient screening metrics in applicant evaluation, and does not ultimately improve Match rates.9 "

Wednesday, August 17, 2022

The importance of couples matching for medical residents (it's missed where it's missing)

 One of the successes of the design of the NRMP Match for medical residents is that it accommodates couples, using the Roth-Peranson algorithm*.  Here's an article reflecting on the fact that the Ophthalmology and Urology matches are done outside of the NRMP, and don't have a couples match.

Massenzio, Samantha S., Tara A. Uhler, Erik M. Massenzio, Emily Sun, Divya Srikumaran, Marisa M. Clifton, Laura K. Green, Grace Sun, Jiangxia Wang, and Fasika A. Woreta. "Navigating the Ophthalmology & Urology Match with a Significant Other." Journal of Surgical Education (2022).

"• There is an increasing number of couples applying for residency

• Ophthalmology and urology applicants cannot utilize the NRMP Couples Match system

• A Couples Match is highly desired by applicants to these two specialties

• The lack of a Couples Match is a deterrent to these specialties for some applicants

• Systems to aid applicants to these specialties with significant others are needed"

...

"The Couples Match is currently not offered to applicants to ophthalmology or urology as these specialties utilize separate match systems outside of NRMP - the San Francisco (SF) Match1 and Urology Residency Matching Program,2 respectively. Historically, the NRMP implemented the match starting in 1952 for internship programs (postgraduate year 1) only. Individual specialties later established their own systems for matching to advanced training beyond internship; for ophthalmology this occurred in 1979, and urology in 1985. While other specialties have since merged their match processes with the NRMP, ophthalmology and urology continue to facilitate their own match.3, 4, 5

"Ophthalmology and urology also have an “early match,” with match results released in January or February versus in mid-March for applicants using the NRMP. This was historically advantageous because of the preliminary internship year required for both ophthalmology and urology, allowing applicants to rank their preference for internship year in the NRMP based on the outcome of their specialty match. However, as of 2021 and 2019, ophthalmology6 and urology7 respectively transitioned to an integrated or joint internship model, meaning that an internship position is secured at the same time as the specialty match. Given these changes, it is currently timely to evaluate applicant viewpoints on the Couples Match.

...

"Survey Findings

"107 respondents reported having a significant other in medicine (72 ophthalmology, 35 urology), making up 31% of all respondents. 68 (64%) significant others applied in the same cycle as the survey respondent, 11 (10%) applied before, and 28 (26%) will apply after. If the Couples Match had been available, 78% of respondents with a significant other who applied in the same cycle reported that they would have participated.

...

"The lack of a Couples Match is a deterrent to ophthalmology and urology for over one-fifth of applicants with a significant other. Of applicants’ partners who considered ophthalmology or urology, over one-third reported to have been deterred. These findings suggest that for many students who want to be in the same location as their partner in medicine, ophthalmology and urology are specialty choices that may be less desirable toward this end. It is unclear how this impacts efforts to foster more diversity (in terms of gender, race, and other factors) in these specialties.

"The inability for ophthalmology and urology applicants to use the Couples Match adds significant stress to an already difficult application season with survey respondents commenting on the negative mental health effects. In addition, there is currently no official avenue for ophthalmology and urology applicants to communicate a desire to match in proximity to a significant other. Although applicants found methods to overcome this barrier, such as by mentioning their significant other during interviews, a majority indicated that there were times that they were hesitant to discuss their significant other out of concern that it would negatively affect their chances of matching, with female applicants disproportionately affected.

"Regarding the early match, most applicants liked receiving match designations sooner; however, there are mixed responses as to whether or not this timeline is helpful for individuals with a significant other in medicine. The authors are aware that a benefit of the early match for ophthalmology/urology applicants is that a significant other applying through the regular NRMP match has the opportunity to selectively contact programs in the vicinity of the applicant's matched program to express heightened interest. Disadvantages to the early match include that once the ophthalmology/urology applicant matches, their significant other has a limited number of programs in the vicinity to choose from - this is in contrast to a Couples Match where any pair of programs in any location may be ranked. This may also be exacerbated by recent efforts to limit the number of applications submitted or interviews accepted by each student.16, 17, 18 Further, the early match does not help individuals whose significant other is also applying to ophthalmology or urology as they would not be able to take advantage of the difference in timeline between partners. It is presently very challenging for a couple who both want to apply in the same year to ophthalmology or urology to be able to coordinate their match outcome to the same location."

##########

*Roth, A. E. and Elliott Peranson, "The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design," American Economic Review, 89, 4, September, 1999, 748-780