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Tag Archives: Clinical Specialties

Efficiency vs. distribution in the the medical residents market

24 Thursday Sep 2015

Posted by tjungbau in Auction, National Resident Matching Program, Strategy

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Clinical Specialties, Matching, NRMP, Welfare

In my recent post about medical graduates applying for multiple specialties in the National Resident Matching Program (NRMP) I briefly mentioned sloppily “sub-algorithms” of the main resident match. To be more specific, whereas it is true that all residents are matched by means of a single algorithm, possible placement of students is fairly restricted by their choice of specialty. In fact, among all students who (also) applied for -to stress it once more- Neurology in 2013, the average number of specialties student applied to fell short of two. As discussed, there is contradictory advice to students about the optimal strategy in terms of multiplicity of specialties.

On a slightly different note, there might be some evidence for a trade-off between distributional goals and market efficiency related to the strategic problem of students. Consider the following situation: A neurology and a neurosurgery department each have an open position. They compete for two students, each of which has a certain value as a neurologist and as a neurosurgeon. Assume both students chose a single field according to their comparative advantage, i.e. the field in which they are relatively better than the other student. If the abilities of students in their respective fields do not exorbitantly differ firms will be absolutely pleased with this situation since they should be able to hire their only candidate by offering slightly more than an outside option and reap the majority of the output. Society should also be happy since the allocation would be perfectly efficient. Unhappy campers would only be found among the residents who would start their career on moderate wages. In this particular situation both would be better off to register for both specialties to induce firm bidding which leads to increased wages but decreases market efficiency due to uncertain outcomes. The interesting question is: Does this logic generalize?

Applying to multiple specialties in the medical resident match

20 Sunday Sep 2015

Posted by tjungbau in National Resident Matching Program, Strategy

≈ 1 Comment

Tags

Clinical Specialties, Matching, Medical Residency, NRMP

The main resident match by the clearinghouse NRMP (National Resident Matching Program) is for several reasons far more complicated than portrayed in the media or stylized in academic models. Simplification in many cases is perfectly acceptable and an art by itself. However, one of those complications is the fact that within the program actually various “sub-algorithms” are run due to the vast number of different clinical specialties, exceeding 40 in 2015. What is more, about half of the students tend to apply for more than one specialty, in general two with a very small number ranking residency programs of more than three specialties. Some sources on the internet designed to help students through the match argue that data seems to suggest that students increase their chances of a match the lower the number of specialties they apply for. In fact, in of all applicants to Neurology -a specialty with rather few openings- for instance the 2013 NRMP matched 63% of students applying for a single specialty, 59% of students with 2, 48% with 3 and 29% with four or more. Outcomes appear to be similar for other specialties independent of the number of vacancies. Based on this evidence it is suggested that students optimize by choosing a single specialty. This is outrageous inference since this claim’s validity depends on various circumstances. Without detailed knowledge of the data I am fairly certain that this statistic is merely caused by an endogenous selection problem. Students with a strong background in possession of excellent reference letters by professors relevant in their field will expect to be matched in their preferred specialty and forbear from applying to different specialties to spare themselves and their advisors the need to explain their dedication to one field over the other. Weaker students though, more uncertain whether they make it or not, will diversify their applications as an insurance policy. It would be interesting if someone were to look closely at the data and attempts to analyze whether fewer specialties are beneficial among weaker candidates. In fact, the opposite might hold true. On the other hand, given limited information about students’ qualities, the number of specialties might actually serve as a signal of quality and confidence and the claim might be correct. This, however, would be obsolete if all students were to apply for a single specialty. Concluding, there is certainly no clear answer to this question without a profound analysis.

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