Match games

The Match, the process by which medical students are placed in hospital residencies, has been accused of anti-trust and artificially lowering doctors' salaries. Proponents argue that it's a simpler, fairer way to connect employees and employers based on mutual preference.

Maybe there's a common ground, according to Sara Robinson in today's New York Times:

Each residency program could offer up to three salary levels. Students would rank each level as if it were a separate program. Hospitals would include each student three times in their ranking lists, once at each level.

Dr. Bulow called Dr. Crawford's proposal "potentially a significant step forward" but said further study was needed to see how well it might work.

Mona Signer, director of the National Resident Matching Program, a private, nonprofit corporation that runs the match, said the board would look at the proposal.

I'm all for more choice, but this opens up some squirmy cans of worms. Instead of the approximately $40,000 salary (given an 80-hr workweek, about $10 / hr), maybe a place like MGH will offer residencies at 30k, 40k, and 50k. Will the salaries of house staff be published? Will people figure out which residents are making more than the others? How will that affect these stressed-out, competitive teams? I can imagine the chaos that will come when deciding on monthly schedules, call time, vacation days.

Also, money-matching would give state school grads, MD/PhDs, and younger single types another advantage at the prestigious hospitals (as if we needed it). Since these applicants would have fewer loans or financial / familial burdens, they'd be more likely to spring for lower salaries at better hospitals.

"The doctors have been wrestling with this; so have the lawyers and even the politicians," Mr. Marek said. "Perhaps the solution rests with the mathematicians."

Satisfaction with a mathematical solution is predicated on the notion that people think and act rationally. This may not be true, even for doctors.