The National Resident Match Program began in 1952 in response to dissatisfaction with the process and results of matching applicants to residency programs via the decentralized, competitive market. It was initially called the National Intern Matching Program. From shortly after the first residency programs were formally introduced, the hiring process was "characterized by intense competition among hospitals for (an inadequate supply) of interns." In general, hospitals benefited from filling their positions as early as possible, and applicants benefited from delaying acceptance of positions. The combination of these factors led to offers being made for positions up to two years in advance.

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  • The National Resident Match Program began in 1952 in response to dissatisfaction with the process and results of matching applicants to residency programs via the decentralized, competitive market. It was initially called the National Intern Matching Program. From shortly after the first residency programs were formally introduced, the hiring process was "characterized by intense competition among hospitals for (an inadequate supply) of interns." In general, hospitals benefited from filling their positions as early as possible, and applicants benefited from delaying acceptance of positions. The combination of these factors led to offers being made for positions up to two years in advance. In 1945, the medical schools decided not to release any transcripts or permit any letters of recommendation to be written until a particular date. In this way, they managed to move the date back to the fourth year of medical school. However, the competition for residents simply took on another form. Hospitals began to issue offers with a time limit for reply. The time limit rapidly decreased from 10 days in 1945 to less than 12 hours in 1950. Students were being issued exploding offers that required them to make a decision before hanging up the phone. The NRMP was created as a central clearinghouse that would allow both sides of the market to rank their preferences. The matching algorithm would then be run on IBM card sorters. The students in 1951 protested against the originally proposed matching algorithm, and objected to the hospital-optimal nature of the proposed algorithm. The NRMP stated that students from 1951 objected to an algorithm that gave them incentives to misrepresent their true preferences. A publication in 1962 by Gale & Shapley noted that there always exists a stable solution when colleges are matching with students, but that it is possible to favor colleges as a group over applicants as a group (and vice versa). That is, Gale & Shapley found that there is a college-optimal stable match and an applicant-optimal stable match. Lloyd Shapley would go on to win the 2012 Nobel Prize in Economics for his work on stable allocations. Controversy also arose regarding whether the program was susceptible to manipulation or unreasonably fair to employers. Indeed, it was shown that in simple cases (i.e. those that exclude couples, second-year programs, and special cases for handling unfilled slots) that had multiple "stable" matchings, the algorithm would return the solution that was best for the hospitals and worst for the applicants. It was also susceptible to collusion on the part of hospitals: if hospitals were to organize their preference lists properly, the result returned would be completely unaffected by the preference lists of the residents. A correspondence in New England Journal of Medicine in 1981 recognized that the algorithm in use was hospital-optimal for individual applicants, in direct contradiction to the NRMP's published statements. The promotional NRMP literature was revised to remove the detailed, step-by-step description of their algorithm that had been there before. Later researchers, such as Marilda Sotomayor in 1983, Alvin Roth in 1984, and Klaus et al. in 2007, found that when couples are allowed to match together, there may exist no stable matching. A small, independent match for Ophthalmology switched to an updated algorithm as announced in February 1996, and may have served as a prototype and incitement for the NRMP to update the algorithm. Despite many indications for updating the NRMP algorithm, it saw only minor and incremental changes after its institution in 1952 until 1997. However, in the fall of 1995 the Board of Directors of the NRMP commissioned a preliminary research program for the evaluation of the current algorithm and of changes to be considered in its operation and description, and a study comparing a new algorithm with the existing one. The new algorithm was adopted in May 1997 and has been in use since its first application in March 1998, although the study showed that the net effect of the change on actual matches has been minimal. (en)
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  • The National Resident Match Program began in 1952 in response to dissatisfaction with the process and results of matching applicants to residency programs via the decentralized, competitive market. It was initially called the National Intern Matching Program. From shortly after the first residency programs were formally introduced, the hiring process was "characterized by intense competition among hospitals for (an inadequate supply) of interns." In general, hospitals benefited from filling their positions as early as possible, and applicants benefited from delaying acceptance of positions. The combination of these factors led to offers being made for positions up to two years in advance. (en)
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  • National Resident Matching Program (en)
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