
Another 34000 People Are About to Put Their Future in the Hands of an Algorithm - evanb
http://fivethirtyeight.com/features/another-34000-people-are-about-to-put-their-future-in-the-hands-of-an-algorithm/
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cbd1984
An algorithm is still an algorithm if a human is running it. Therefore, humans
put their futures in the hands of algorithms being run by impartial humans all
the time; partiality is only nice when it's acting in your favor, after all,
and we don't want to be at the mercy of people who might not like us for some
undefinable reason.

~~~
Padding
> we don't want to be at the mercy of people who might not like us for some
> undefinable reason

I keep restating this, but people still hate bureaucracy. Go figure.

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diego
This is the kind of title that I would edit. The article is about how the
National Resident Matching Program will use an implementation of the Gale-
Shapley algorithm for matching medical students and residencies. The title
makes it sound much more significant than it is; virtually all of us "put our
future in the hands of an algorithm" countless times every day. Everything we
do that leaves a trace in a database somewhere will affect our future to
varying degrees.

~~~
dj-wonk
The article does not overstate the significance. Have you known people going
through Match? It is quite significant for those 34,000 people.

I don't follow your argument. The match process has very little in common with
people leaving traces of information in a database.

I'll compare the NRMP with something in the same ballpark: a credit score.
There are three services (last I checked) involved there. You might have a
mix-up, but a credit score can be disputed and corrected. To my knowledge, for
all practical purposes, there is little recourse if the Match does not go as
you hoped other than trying again the following year.

One might also compare the NRMP with the standardized tests for college
admissions; that would make for an interesting discussion.

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rrauenza
Numberphile has an episode on the Stable Marriage Problem:
[https://www.youtube.com/watch?v=Qcv1IqHWAzg](https://www.youtube.com/watch?v=Qcv1IqHWAzg)

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jrapdx3
The "matching program" isn't new--goes back to the 60's if not further. Sounds
like the idea hasn't changed even if the "algorithm" is machine-implemented in
recent times, no surprise there.

Used to be the student would put on his/her list the residencies in order of
priority, and so would the institutions rank the candidates. Let the matching
begin!

A thing to note is that not all residencies were in the mix and there were
always a good number of students who weren't selected or maybe didn't even
participate. That left room for students to find vacancies to fill.

AFAIK there weren't any students who couldn't get into a residency somewhere
even if not among their top choices. Besides by the end of the first year of
training there were always plenty of residents shifting to other programs so
"holes" migrated around to an extent.

Chances are the situation is not at all dire for the current crop of
graduating medical students. It tends to all work out.

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trhway
>where the students will do their residencies — three to seven years or more
of supervised training, usually in a hospital. Since you can’t get a license
to practice medicine in the United States without completing a residency, this
is a high-stakes game.

at least in CA (and majority of other states) the requirement is only 1 year
of post-med-school training:

[http://www.mbc.ca.gov/Applicants/Physicians_and_Surgeons/](http://www.mbc.ca.gov/Applicants/Physicians_and_Surgeons/)

" How much training must I complete before I am eligible for licensure?

A US/Can must complete 12 continuous months of training in a single program to
be eligible for licensure. Further, a US/Can must be licensed by the end of
the 24th month of training. "

So going into 3rd year of residency one must already be licensed.

The rest of states:

[http://www.fsmb.org/policy/public-
resources/state_specific](http://www.fsmb.org/policy/public-
resources/state_specific)

Note: That is not to dismiss the importance of residency. As one can see from
the above, its importance goes way beyond of just getting the license.

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harmegido
The last section of the article was really interesting to me. Some points from
it:

1) Students need a residency to become a Doctor. 2) Residencies are funded by
congress. 3) More doctors -> cheaper healthcare

So why don't we fund more residencies? And why is the government the one
funding them?

~~~
mentalhealth
I'm on my way out, so this'll be quick, but a few other restrictions on
supply:

* There can notionally only be as many fill-able residencies as there are graduating medical students -- this number would probably be the most easy to increase (since schools are fine with making more money), but it's actually quite difficult to find enough instructors to teach the students because the job pays so poorly compared to many other avenues a physician can take (and you need a certain instructor/student ratio for both accreditation and to attract students).

* Each residency program can only admit as many students as they are licensed to do, and this licensing generally is tied to the program volume (so a program seeing X patients per year would be granted Y residency spots). This gets tied to the professional organizations for the individual specialties (an oversimplification), who actually have an incentive to restrict the number of residency spots in order to maintain their own job security.

* There are plenty of available residency spots in the fields we need most, such as primary care -- it's just that unless people feel particularly compelled, they don't go into those specialties, because compensation and work/life balance are so poor compared to many specializations.

~~~
sukilot
? Primary care is the easiest work-life balance outside of radiology. 0 stress
28-hr weeks.

~~~
ceejayoz
Zero stress? 28 hour weeks? Where are you getting this from?

[http://medicaleconomics.modernmedicine.com/medical-
economics...](http://medicaleconomics.modernmedicine.com/medical-
economics/content/tags/2013-salary-survey/productivity-primary-care-geared-
revival?page=full)

> Median hours per week remained unchanged from 2011 to 2012 for
> family/general practitioners at 50 hours, though visits per week increased
> slightly from 98 in 2011 to 99 in 2012.

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virulent
Why is this an article anyway? They use matching algorithms here in Canada for
university co-op (intern) jobs as well. Lots of people don't get jobs, but
that's no fault of the matching algorithm.

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dj-wonk
My hunch is that a lot of value could be added -- and perhaps money made -- by
rethinking the resident matching process. This would be much more than an
algorithm redesign.

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Fomite
There are, for the record, often _unfilled_ residencies in infectious
diseases. This specialty tends to end up on the bottom of physician pay scales
however.

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dchichkov
Based on work of "Lloyd Shapley and David Gale". Can somebody explain why is
it better than just solving good old "Assignment Problem"?

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dj-wonk
I'd be interested to know if the algorithm can be audited, and if so, by whom
and why what process.

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dragontamer
A bit click-baity. The "algorithm" is the same vein as the "algorithm" that
runs our voting system. (add up the votes and choose the winner).

I don't think the "matchmaking algorithm" in the blog post actually matches
the colloquial meaning of the word "Algorithm".

~~~
dcowen91
[http://en.wikipedia.org/wiki/Stable_marriage_problem](http://en.wikipedia.org/wiki/Stable_marriage_problem)

Actually a relatively interesting algorithm, but I don't think the author
explains it fully. The men must also rank the females. The key point is that
for a match between people A and B, A has no person ranked higher than B who
also ranks A higher than their current partner. it is optimal for every
participant.

I'm not too familiar with residency- I wonder if hospitals submit a list of
potential students they accept? How does the length of a hospital's acceptable
candidates list compare to the number of hospitals a student will apply to? In
the Stable Marriage Problem, each set member must rank every member of the
other set.

~~~
jdmichal
> I'm not too familiar with residency- I wonder if hospitals submit a list of
> potential students they accept?

The article does mention that, "Med students and hospitals are currently
ranking their top choices from these interviews." I would assume that the
hospital only ranks students they interview and would consider acceptable for
the program.

> Each set member must rank every member of the other set.

I would assume that they just fill in the blanks with some value that prevents
matching. I don't think a hospital or a resident would be very happy with what
would amount to random assignment of the leftovers.

~~~
JasonFruit
Yes, they only rank students they interview. Those students who don't match
before the rankings are exhausted "scramble"; they speed-date programs that
still have openings in the hope of matching, so the leftovers are not randomly
assigned. (Whether the outcome for them is better than random is hard to say.)

