Is the match algorithm fair?

[TonyV]

O.K. I have a dillema and I'm not sure if I understand the algorithm properly (even though I read it on the nrmp site).

Any input will be a real big help to alleviate some anxiety.

Here is an extreme hypothetical situation:

Lets say Applicant Sally ranks Hospital A as her #1 choice.

Lets say Applicant Mike has interviewed at 35 programs and he considers Hospital A as a "safety school". He really doesn't want to go there but it would be o.k so he ranks Hospital A #33 on his rank order list of 35 programs.

Hospital A has 10 positions and ranks Mike 12th and Sally 13th on their list.

During the match, let's say Hospital A has filled it's 9 positions and has gone down to 11 on it's list.

Let's say Mike did not match at his first 32 programs.

When the algorithm comes down to the 10th position at the hospital, will Mike (ranked by the hospital 12th but he ranked it #33) get it or will Sally (ranked by hospital 13th, but she ranked Hospital A #1) get the position???????????

To the hospital because they are only 1 spot apart, Mike and Sally are not that different of candidates, but Sally really wants to go there and Mike doesn't want to really go there, but he wants to make sure he just matches.

In this situation I think, by the algorithm that Mike will get the spot. Doesn't that seem to favor the hospital over the candidate?If Sally really wants to be there and the 2 candidates are only 1 spot different to the hospital, shouldn't the algorithm weigh her 1st choice more??? or is that not the way it works????

Please correct me if I'm wrong and anyone who definitely knows, please respond.

Should you still always rank according to where you want to go and not where you think you'll get?

Sorry if this example is long-winded.

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[Been there]

"In this situation I think, by the algorithm that Mike will get the spot. Doesn't that seem to favor the hospital over the candidate?If Sally really wants to be there and the 2 candidates are only 1 spot different to the hospital, shouldn't the algorithm weigh her 1st choice more??? or is that not the way it works????

Please correct me if I'm wrong and anyone who definitely knows, please respond.

Should you still always rank according to where you want to go and not where you think you'll get?"

The match process use to work that way in the remote past (over 6-7 years ago). They use to take into consideration on how high you rank a program. The problem is what if program "A' ranks you #1, but you rank it #2, and program "B" ranks you #10, but you rank it #1. From this model of match, your will land in program "A"; eventhough, program "B" had to go match candidate #11 for the program. There lie the disadvantage in the old system.

The new process will match "Mike"; because the advantages goes both way (the candidates and hospitals---just think about it). There are ways the "Sally" may improve her chances over "Mike". She can call the PD or chairman. Get some one from the program to rally for a higher ranking by the program. Most people will only do this for their tops choices and not their safety programs.

 

[dry dre]

Originally posted by TonyV
If Sally really wants to be there and the 2 candidates are only 1 spot different to the hospital, shouldn't the algorithm weigh her 1st choice more??? or is that not the way it works????

First let me say that I don't like the match for several reasons, but I don't agree with you here.

Why should the the hospital have to take people who they perceive to be less-desirable over someone whom they more like? Programs shouldn't be forced to take a less-desirable candidates just because that candidate has a "big heart" and "really really" wants to be in their program. Should Hopkins (and kind) have to take everyone who ranks them #1?

If Sally really wanted to be there, she should have made a better impression by: better scores, better evaluations, more research, better letters of recommendation, better personality etc etc etc

 

[Seaglass]

Yes, it may seem unfair to choose Mike over Sally, it only seems that way. If Mike was ranked higher he was judged to be a better applicant than Sally, no matter how small that difference may be. If Mike ranked it then the spot is his to take, and Sally may go down to her #2. Like other posters said, Sally may have been able to move up the list by expressing interest, having a stronger application, etc.

The match cannot take into account "desires" and "wishes" etc. It has to do the best with objective info it has.

Overall, the match is very fair, placing you at your most preferred program that has a place for you, and allowing programs to have residents they most desire provided they are willing to go there.

Casey

 

[lurkerboy]

This is where the letters of intent come in handy. The program would take into consideration that Sally would have told them that they are her #1 when they would not have heard anything from Mike. If they are otherwise equivelant, the program would likely rank Sally higher.

I also dislike the system but not for this reason. The bottom line is to only rank places you want to be, so I hope Sally wasn't too sad about her #2!

 

[Wrigleyville]

I don't see the problem. If Mike is the theoretical better candidate, why shouldn't he get the spot?

 

[Kalel]

Bleah. I understand the match algorithm about as well as I understood your post OP. My only advise is to not worry about this nonsense and just rank them in the order that you want to get into. You are at no disadvantage if you rank reaches for 1-3 when it comes to matching at number 4, somehow, the system is skewed in our favor. I think that you'd have to be a mathemitician to fully understand the complexities of how the match system works.

 

[lurkerboy]

No, if you read the nrmp's website, its actually very straightforward. You get into the highest choice that had space for you.

 

[WaitingForJuly]

As others have said, yes, that is the way it works and it is the most fair way of doing things. Who would benefit if Sally got the spot? Only Sally. The program would have been forced to take a less desirable candidate and Mike may have been left without a position. As others have said, if Sally really wanted to go to that program she should have done things to make herself more desirable - whether getting better grades and board scores to begin with or sending a letter to the PD explaining in convincing terms why she is the best candidate for the position or getting someone from her school to make a call for her, etc.

The optimal results occur if both the candidates and programs make their rank list according only to their personal preferences without taking into account how likely they think they are to be matched up with any particular applicant/program. Complain about the NRMP and match process all you want but within the system it is set up to be as fair as possible.

 

[GeddyLee]

Well..here's my problem with the scenario described. Say the program interviews 100 candidates. How much difference is there between there #10 and #11 ranked candidates?

I know when I made my rank list, it was kinda broken into big chunks. The programs within any chunk were pretty equivalent and I could have easily reversed the order of my middle 4 programs. Imagine ranking 100 programs!

Unless you're ranking candidates strictly by their board score, it seems like it could come down to pure luck whether you'r number 15 or 16 on the list, yet it could mean either getting or not getting the spot.

How do programs come up with a rank list? If your top 10 candidates are faily equal and you only have 5 spots, what determines who goes where on the list? Whether or not they like your name?

As for the hoakie letters of intent...you'd think selection committees would now be smart enough to realize that medical students lie their arses off to get what they want. This seems pathetically similar to the medical student who tells every attending they work with that the specialty they're rotating on is the specialty they want to pursue, just to get higher evaluations. It also seems vaguely familiar as the "I really want to practice primary care in a rural area" statement that was all the craze a few years ago. And, my new personal favorite, people that apply for two specialties because they can't make up their mind....shouldn't the system favor people who are solidly committed to the specialty they apply for?

At the end of the day, the whole thing is a bit of a crap shoot. Even people who get the nod from the PD saying "we're ranking you number 1" don't know if it's true. It's a scandalous method for everything in medicine...lies, deceit, from the minute you declare yourself a pre-med.

Medicine is a harsh mistress.

 

[Seaglass]

Well..here's my problem with the scenario described. Say the program interviews 100 candidates. How much difference is there between there #10 and #11 ranked candidates?

There is a difference, does it matter how much?

How do programs come up with a rank list? If your top 10 candidates are faily equal and you only have 5 spots, what determines who goes where on the list? Whether or not they like your name?

I'm sure it's more than the attractiveness of your name. Applicants are not that similar IMHO. Personality counts for a lot I think.

And, my new personal favorite, people that apply for two specialties because they can't make up their mind....shouldn't the system favor people who are solidly committed to the specialty they apply for?

If you worked hard in medical school to be a strong applicant then it should favor YOU no matter how many residency programs you apply to.


To take a different tack on your scenario, Mike worked hard, was AOA, has a great personality and great letters. As a result he got most of the interviews at places he applied to. Unfortunately bad BO caused him to go down to #35 on his list, but overall he is an outstanding applicant, need for a shower aside.

Sally was drunk for half the 3rd year, got terrible letters as a result and therefore only got 1 interview at the program in question. Her personality was "scintillating" though and made up for some of her deficits and got her ranked #11.

Unfortunately overall she was not as good an applicant as Mike and he got the spot. Now you are going to try to tell me Sally deserved it more?

IMHO the match is the fairest system we could have, students screwing themselves over not withstanding.

Casey