Book Review: Match Day by Brian Eule
Stuart Nachbar
June 25, 2009
I am related by marriage to an emergency medical doctor, so with that and my emphasis on education books I took a look at Match Day. The author, Brian Eule, is a journalist who is also married to Stephanie Chou, one of the three doctors profiled in the story. So, it is safe to say that he has first-hand knowledge as an observer to the process that matches medical school graduates to the hospitals where they will do their residencies.
Eule divides this story between the match process and the first year of residency for three doctors: his wife, an aspiring surgeon; Rakhi Barkowski who wants to become an intenist, and Michele LaFonda who is interested in radiology. LaFonda's fiance, Ted, is also in a medical residency while Scott, Rakhi's husband, is a graduate student. There is more in this story about maintaining relationships than about the work involved a medical internship and residency.
But for me, the match process was more interesting, because I knew nothing about it before reading the story.
According to the author, post-graduate medical residencies have been a part of a physician's education since the early 1920's. The first year was, and still is, called an internship. Subsequent years, where a physician delves into a specialty, are called the residency. They are called the residency because aspiring physicians once lived at the hospital. These days, with the work schedules demanded of them, the hospital is still very much their home.
The idea of the Match came about during the 1940's because hospitals rushed to recruit the top medical students as early as their second year in medical school. The Association of Medical Colleges tried to level the playing field by refusing to release transcripts and recommendations until after the third, and next-to-last, year of medical school. But this only reduced the amount of time that the fourth year students were given to consider offers. By the end of the decade, medical students were given only 12 hours to respond.
After a trial run with 1951 medical school graduates, the Match, a computer algorithm, became the process to consider student preferences and medical specialties against the needs of the hospitals. A Harvard economist, Alvin Roth, has refined the algorithm since the 1980s. His academic colleagues called him "Mr. Matching." Roth's algorithms are used for other purposes as well: to place children in classrooms and select compatible kidneys and patients for transplants in a process known as paired donations.
During the early 1980s, Roth determined that the Match's success had to do with stability, meaning that there was no hospital and candidate not already matched to each other in which both parties wished they were. In the early years of the Match, the hospitals "proposed" aka recruited the students, which created a suspicion of hospital bias.
The American Medical Students Association and the Health Research Group-a division of a consumer advocacy group formed by Ralph Nadar-proposed a student-optimal algorithm, hoping that students would earn a spot at an institution they had ranked higher on their list. During the Nineties, Roth successfully proved that changes in the computer algorithm didn't matter. Only one in a thousand medical students would get a better match.
The Match, however, eliminated the free market for employment for medical school graduates. Students were forced to accept the conditions, including the low salaries, of the hospital with which they were matched. And The Match, by act of Congress, cannot be challenged under Federal anti-trust laws.
The Match means that medical students must become conscientious shoppers who must consider not only their academic and professional interests, but also their personal relationships. An unattached physician can work wherever they want, but the attached cannot, which is a major part of Eule's story. All of the doctors he profiles have had to make very complicated choices based on the give and take in their relationships. One or both careers might be sacrificed in some way.
Match Day is an interesting story for anyone considering a medical career, no matter what stage they are at in their pre-medical or medical education. The road to becoming a physician is quite long-for example, a surgical residency is seven years atop college, medical school and the internship-and it has become only more expensive, rising faster than the wages to be earned during internship and residency. And it's gut-wrenching to hope that the Match will go your way.
Stuart Nachbar writes on thought and fiction in education and politics. His new novel, Defending College Heights, is an investigation into the murder of a U.S. Army recruiter within a tumultuous and corrupt college community. Learn more at www.DefendingCollegeHeights.com
Eule divides this story between the match process and the first year of residency for three doctors: his wife, an aspiring surgeon; Rakhi Barkowski who wants to become an intenist, and Michele LaFonda who is interested in radiology. LaFonda's fiance, Ted, is also in a medical residency while Scott, Rakhi's husband, is a graduate student. There is more in this story about maintaining relationships than about the work involved a medical internship and residency.
But for me, the match process was more interesting, because I knew nothing about it before reading the story.
According to the author, post-graduate medical residencies have been a part of a physician's education since the early 1920's. The first year was, and still is, called an internship. Subsequent years, where a physician delves into a specialty, are called the residency. They are called the residency because aspiring physicians once lived at the hospital. These days, with the work schedules demanded of them, the hospital is still very much their home.
The idea of the Match came about during the 1940's because hospitals rushed to recruit the top medical students as early as their second year in medical school. The Association of Medical Colleges tried to level the playing field by refusing to release transcripts and recommendations until after the third, and next-to-last, year of medical school. But this only reduced the amount of time that the fourth year students were given to consider offers. By the end of the decade, medical students were given only 12 hours to respond.
After a trial run with 1951 medical school graduates, the Match, a computer algorithm, became the process to consider student preferences and medical specialties against the needs of the hospitals. A Harvard economist, Alvin Roth, has refined the algorithm since the 1980s. His academic colleagues called him "Mr. Matching." Roth's algorithms are used for other purposes as well: to place children in classrooms and select compatible kidneys and patients for transplants in a process known as paired donations.
During the early 1980s, Roth determined that the Match's success had to do with stability, meaning that there was no hospital and candidate not already matched to each other in which both parties wished they were. In the early years of the Match, the hospitals "proposed" aka recruited the students, which created a suspicion of hospital bias.
The American Medical Students Association and the Health Research Group-a division of a consumer advocacy group formed by Ralph Nadar-proposed a student-optimal algorithm, hoping that students would earn a spot at an institution they had ranked higher on their list. During the Nineties, Roth successfully proved that changes in the computer algorithm didn't matter. Only one in a thousand medical students would get a better match.
The Match, however, eliminated the free market for employment for medical school graduates. Students were forced to accept the conditions, including the low salaries, of the hospital with which they were matched. And The Match, by act of Congress, cannot be challenged under Federal anti-trust laws.
The Match means that medical students must become conscientious shoppers who must consider not only their academic and professional interests, but also their personal relationships. An unattached physician can work wherever they want, but the attached cannot, which is a major part of Eule's story. All of the doctors he profiles have had to make very complicated choices based on the give and take in their relationships. One or both careers might be sacrificed in some way.
Match Day is an interesting story for anyone considering a medical career, no matter what stage they are at in their pre-medical or medical education. The road to becoming a physician is quite long-for example, a surgical residency is seven years atop college, medical school and the internship-and it has become only more expensive, rising faster than the wages to be earned during internship and residency. And it's gut-wrenching to hope that the Match will go your way.
Stuart Nachbar writes on thought and fiction in education and politics. His new novel, Defending College Heights, is an investigation into the murder of a U.S. Army recruiter within a tumultuous and corrupt college community. Learn more at www.DefendingCollegeHeights.com