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Related Experiment Video

Updated: Jul 26, 2025

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Inefficiencies in Residency Matching Associated with Gale-Shapley Algorithms.

Yue Wu1, Parisa Taravati1, Ryan T Yanagihara1

  • 1Department of Ophthalmology, University of Washington; 325 9th Ave, Box 359608; Seattle, WA 98104.

Journal of Academic Ophthalmology (2017)
|June 16, 2023
PubMed
Summary

Residency matching algorithms lead to excessive applications and ranked choices, increasing costs for applicants and programs. Limiting ranked lists slightly reduces filled positions but could streamline the matching process.

Keywords:
Gale-ShapleyNash Equilibriumresident matchingstable marriage

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Area of Science:

  • Medical Education
  • Health Services Research
  • Algorithm Analysis

Background:

  • The National Residency Matching Program (NRMP) and San Francisco Residency and Fellowship Match Services (SF Match) utilize Gale-Shapley-type algorithms.
  • Increasing trends in applicant numbers and application volume have been observed in national residency matching systems.
  • Rising costs and administrative burdens are associated with the current matching processes.

Purpose of the Study:

  • To investigate emerging trends in residency matching algorithms.
  • To analyze increasing costs in the NRMP and SF Match.
  • To evaluate the impact of current applicant/program matching algorithms.

Main Methods:

  • Longitudinal observational study of behavioral trends in national residency matching systems (1985-2020).
  • Analysis of publicly available data from SF Match and NRMP websites.
  • Examination of anonymized ophthalmology match data (2011-2019) including rank lists and match results under various parameter conditions.

Main Results:

  • Both applicant numbers and the length of program rank lists have steadily increased, especially in competitive specialties.
  • Capping applicant rank lists to 7 programs resulted in a 0.71% decrease in filled positions.
  • Capping program rank lists to 7 applicants per spot resulted in a 5% decrease in filled positions.

Conclusions:

  • The number of applications has substantially increased relative to available residency positions.
  • Both programs and applicants rank more choices than necessary for a stable match, leading to excess costs and workload.
  • "Stable-marriage" algorithms incentivize ranking numerous options to optimize individual match outcomes.