Bryan Carmody Profile picture
Mar 14 4 tweets 2 min read
For those following along as we continue the countdown to #MatchDay2023, it’s now time for Part 4 in our six-part series.

Yesterday, I described how the NRMP did their best to ignore one doctor’s fight to make the matching algorithm applicant-optimal.

Today, I’ll explain why. Screenshot of the opening slide for The Match, Part 4: Unrav
We’ll cover why outside-the-match offers threaten the existence of the match; how the GI fellowship match failed; and why the NRMP fought so hard for their “All In” policy.

It’s all here:

The Match, Part 4: Unraveling and going all in
If you missed yesterday’s thread, it’s here:
And if you missed the earlier videos, let me help you get caught up:

The Match, Part 1: Why do we have a Match?


The Match, Part 2: The battle for the algorithm


The Match, Part 3: On marriages and matching

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More from @jbcarmody

Mar 15
In 1998, a small residency program in Colorado lost its accreditation.

It wasn’t the kind of thing that you’d expect to change the course of academic medicine.

And yet, it *almost* did.

Earlier, I explained how the Match started. Now, I’ll tell you how it nearly collapsed.

🧵 The Rocky Mountain Osteopat...
When the HealthONE family medicine residency shut down, the residents lost their jobs.

And some of them went to see an attorney named Sherman Marek.

marekweisman.com
The stories these residents told about their program were jarring.

They were working almost unlimited hours for meager pay. But since they’d been assigned their position by a match, they’d accepted their contract sight unseen, without any chance to negotiate salary or hours.
Read 22 tweets
Mar 13
I wasn’t done with my rant when I ran out of Tweets in my thread.

But I think this is shameful.
At least say something like, “In response to student concerns that the existing algorithm advantaged programs [Williams reference], the NRMP Board commissioned a study…”

At least honor the man’s courage and perseverance with a single superscript notation of his work!
It wouldn’t diminish the thrust of the article in the least.

In fact, it would provide tangible evidence of the NRMP acting upon concerns from the community, rather than pretending as if the infallible wisdom of their Board simply prevailed and led them to do the right thing.
Read 7 tweets
Mar 13
As we countdown to Match Day, I want you to meet Dr. Kevin Jon Williams.

For nearly 20 years, he fought for - and eventually won - a student-optimal matching algorithm.

It’s one of the great stories of advocacy in Match history… and the NRMP refuses to acknowledge it.

(a 🧵) Graphic of Dr. Kevin Jon Wi...
Lemme explain.

In 1962, mathematicians David Gale and Lloyd Shapley solved the “Stable Marriage Problem.”

By using a deferred acceptance algorithm, you could pair up a set of men and women who each wanted to be married, but had varying preferences among the potential partners. Screenshot of Gale and Shap...
Importantly, Gale & Shapley’s solution resulted in STABLE pairings - meaning that there was no pair of man/woman who *both* wanted to be married to someone other than the partner that the algorithm assigned. An example of the Stable Ma...
Read 26 tweets
Mar 7
Lemme flesh out the argument here since some respondents and QT’ers seem to be missing the point.

It’s not just “greedy insurance companies are making health care expensive!”

It’s that *we built a system that incentivizes insurers to systematically ⬆️ health care costs.*

(🧵)
The issue is the so-called “80/20 rule” of the Affordable Care Act.

The goal was to keep insurance companies from taking excessive profit margins by requiring them to spend at least $0.80 of every premium dollar on paying for health care.

healthcare.gov/health-care-la…
So imagine you start a new insurance company.

You manage to recruit 100,000 customers, and each pays a premium of $1000/y.

That means you take in $100 million a year. Not bad!

But - you’re required to spend at least $80 million paying for actual health care for your customers.
Read 14 tweets
Feb 21
Back to review the ACGME’s proposed pediatric program requirements - this time with a focus on pediatric residents and faculty.

If you missed Part 1, it’s below. Otherwise, well, you know what time it is.

It’s time to break it down, Winners & Losers™️ style.

🧵
WINNER: Patient caps.

The ACGME guidelines stop short of *requiring* patient caps… but the fact that “programs are encouraged” to limit the number of patients a resident can care for at a given time sets the stage for them to make this an accreditation standard in the future. Screenshot from the ACGME’s...
LOSER: Implicit bias.

Look, the devil is always in the details - and how, exactly, programs will mitigate implicit bias in residency evaluation is unclear. But for the first time, they’ll have to at least *try* to do that as part of their ACGME program evaluation. Screenshot from proposed AC...
Read 13 tweets
Feb 21
The ACGME just released new program requirements for pediatrics - some of which may significantly change the way we train future pediatricians.

So who wins - and who loses - under the new requirements?

You guessed it - it’s time to break it down, Winners & Losers™️ style.

🧵 Screenshot of the first pag...
LOSER: Procedural training.

Gone are the requirements for residents to learn specific procedures like bag-mask ventilation or UAC/UVC placement.

Instead, residents need only be able to perform procedures “considered essential for their area of practice.” Screenshot of the program r...Screenshot of the old progr...
LOSER: Pediatric specialists.

In the old days, you couldn’t have a pediatric residency program without certain specialty faculty (in NICU, PICU, EM, adolescent medicine, developmental, and at least five other specialties). Those prescriptive requirements are now gone. Image
Read 12 tweets

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