National Resident Matching Program
The National Resident Match Program began in 1952[2] in response to dissatisfaction with the process and results of matching applicants to residency programs via the decentralized, competitive market.[3] 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."[4] 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. While efforts made to delay the start of the application process were somewhat effective, they ultimately resulted in very short deadlines for responses by applicants, and the opportunities for dissatisfaction on the part of both applicants and hospitals remained.[4] The students in 1951 protested against the originally proposed matching algorithm, and objected to the hospital-optimal nature of the proposed algorithm.[5][6][7] 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).[9] That is, Gale & Shapley found that there is a college-optimal stable match and an applicant-optimal stable match. Controversy arose regarding whether the program was susceptible to manipulation or unreasonably fair to employers.[10] 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.[11][12] 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,[13] in direct contradiction to the NRMP's published statements.[14][15] The promotional NRMP literature was revised to remove the detailed, step-by-step description of their algorithm that had been there before.[16]