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.
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.
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.
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.
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 🧵)
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.
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.
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.
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.
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.
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.
🧵
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.”
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.