#145 1952 · NRMP · Medical labour markets
American medicine built one clearing house and the offer wars stopped
the problem
Hospitals poached students with exploding offers
background
By the 1940s hospitals competed to lock in the best medical students earliest, pushing offer dates into the third year of school before students had seen enough of medicine to choose well. A 1945 embargo on releasing student records until an agreed date only compressed the problem: hospitals began issuing "exploding" offers with a reply deadline, which shrank from ten days in 1945 to under twelve hours by 1950 — students deciding over the phone with no time to compare alternatives.
A University of Chicago dean proposed the fix: instead of both sides racing to lock in a deal first, students and hospitals would each submit ranked preference lists to a central clearinghouse, which would compute the matches. In March 1952 the first Match paired 5,564 senior medical students with roughly 10,500 intern positions by an algorithm that, without anyone naming it yet, approximated what mathematicians would formalize nearly a decade later as deferred acceptance.
the move
The US residency Match: a clearing house running what was later proven to be the deferred-acceptance algorithm, redesigned by Alvin Roth in 1998.
the payoff
Killed decades of exploding-offer chaos; still allocates every US resident today.
what came after
The original hospital-proposing algorithm quietly favoured programs over applicants and struggled with dual-physician couples, whom it often split across distant cities — enough of a problem that some couples began negotiating around the Match entirely. The NRMP commissioned Alvin Roth in 1995 to redesign it; his applicant-proposing algorithm with Elliott Peranson, adopted in 1998, fixed the couples problem and shifted the balance toward applicants, though later analysis found the change affected well under 1% of individual matches. The Match still runs every year: in 2022 it placed the large majority of roughly 42,500 applicants into about 36,300 first-year residency positions.
filed under
references
- [1]The US Residency Match at 70: What Was, What Is, and What Could BePMC / National Library of Medicine, 2022pmc.ncbi.nlm.nih.gov
- [2]The Effects of the Change in the NRMP Matching AlgorithmJAMA (via Alvin Roth, Stanford), 1997stanford.edu