Society For Clinical Vascular Surgery

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Game Theory in the Vascular Surgery Integrated Residency Match
Katherine McMackin, MD1, Joseph Lombardi1, George Kilzi, JD2, Francis Caputo, MD1.
1Cooper University Hospital, Camden, NJ, USA, 2Cooper Medical School of Rowan University, Camden, NJ, USA.

OBJECTIVES: The purpose of this study is to examine how the mathematical models of game theory can be applied to predict applicant behavior in the vascular surgery integrated residency match and explain inefficiencies in the current system.
METHODS: Data was compiled from both the National Resident Match Program (NRMP) and the Electronic Residency Application Service (ERAS) regarding applicants, applications submitted, residency programs, applications received and rank order lists for US allopathic seniors. ERAS costs were calculated and time spent on review was estimated based on a three-tiered system of review, 5 minutes per application, 10 minutes per application and 15 minutes per application. Applicant behavior regarding the number of applications was analyzed via the Prisonerís Dilemma decision matrix.
RESULTS: From 2013 to 2016, there was an increase in both the number of applications received per program and the number of applications sent by each applicant. This was neither associated with any change in the average number of applicants needed to rank to fill all positions in a program, nor with the mean number of programs ranked by matched US allopathic seniors. This increase in application number led to an increase in both the cost to the applicant and time spent by each residency program on application review (Table 1). While cooperative behavior between applicants to reduce applications sent out would alleviate this problem, the decision matrix of the Prisonerís Dilemma reveals that inevitably, rational individuals will always choose to apply to more programs.
CONCLUSIONS: Applying theories of interactive decision making to the residency match explains why there are multiple inefficiencies in the vascular surgery integrated residency match. The current system results in both loss of time on the part of the integrated programs and loss of money on the part of the applicants. Application limits may help alleviate these burdens without affecting match rate.

US Allopathic Applicants and Vascular Surgery Program Data 2014-2016
YearNumber of Programs Ranked by Matched US ApplicantsNumber of ApplicantsAverage number of Applications per ApplicantAverage Cost of ERAS ApplicationsNumber of ProgramsAverage Number of Ranked Applicants per Position Needed to Fill All PositionsAverage Number of Applications Received per ProgramNumber of Minutes Spent on Application Review 5/10/15 Minutes Per Application
20137021$246.00394.637.7189 / 377 / 566
201412.28318.2$205.60444.032.1161 / 321 / 482
20158426.1$332.70495.143.8219 / 438 / 657
291612.89831.9$448.40483.963.8319 / 638 / 957

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