Justice in residency placement: Is the match system an offense to the values of medicine?

Cambridge Quarterly of Healthcare Ethics

Volumn 12, Issue 1, 2003, Pages 66-77

  Murphy, Timothy F ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ALGORITHM; BIOMEDICINE; CONSULTATION; HAPPINESS; HUMAN; MEDICAL EDUCATION; MEDICAL ETHICS; MEDICAL PROFESSION; MEDICAL SCHOOL; MORALITY; RESIDENCY EDUCATION; REVIEW; TRAINING; ARTICLE; BIOETHICS AND PROFESSIONAL ETHICS; DECISION MAKING; EDUCATION; ETHICS; LEGAL ASPECT; MEDICINE; NON PROFIT ORGANIZATION; PERSONNEL MANAGEMENT; RANDOMIZATION; SOCIAL JUSTICE; SOCIAL PSYCHOLOGY; STANDARD; UNITED STATES;

BIOETHICS AND PROFESSIONAL ETHICS;

CAREER CHOICE; ETHICS, MEDICAL; HUMANS; INTERNSHIP AND RESIDENCY; MORALS; ORGANIZATIONS, NONPROFIT; PERSONNEL SELECTION; RANDOM ALLOCATION; SOCIAL JUSTICE; SOCIAL VALUES; SPECIALTIES, MEDICAL; UNITED STATES;

EID: 0346014876     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0963180103121081     Document Type: Review

References (23)

1. Carek PJ, Anderson K. Residency selection process and the match: does anyone believe anybody? JAMA 2001;285(21):2784-5. See also: Mangan KS. Keeping "the match" honest. Chronicle of Higher Education 7 Dec 2001, A32-3.
2. Carek PJ, Anderson K. Residency selection process and the match: does anyone believe anybody? JAMA 2001;285(21):2784-5. See also: Mangan KS. Keeping "the match" honest. Chronicle of Higher Education 7 Dec 2001, A32-3.
3. Teichman JM, Anderson KD, Dorough MM, Stein CR, Optenberg SA, Thompson IM. The urology residency matching program in practice. Journal of Urology 2000;163:1878-87.
4. See note 1, Carek, Anderson 2001.
5. One recent ethical dispute was resolved when the NRMP shifted their algorithm away from favoring the rankings of the residencies over the rankings of the applicants. In the past, the NRMP had justified this approach by saying that it paralleled "the real-life process in which hospitals make the offers to their potential employees." For some commentators, however, giving this advantage to residency programs undercuts important interests of the candidates, and the system now tries to match applicants to residencies rather than the other way around. See: Williams KJ. A reexamination of the NRMP matching algorithm. Academic Medicine 1995;70:470-6. See also: Williams KJ. Comments on Peranson and Randlett's "The NRMP matching algorithm revisited: theory versus practice." Academic Medicine 1995;70:485-9; Peranson E, Randlett RR. Comments on Williams' "A reexamination of the NRMP matching algorithm." Academic Medicine 1995;70:490-4.
6. One recent ethical dispute was resolved when the NRMP shifted their algorithm away from favoring the rankings of the residencies over the rankings of the applicants. In the past, the NRMP had justified this approach by saying that it paralleled "the real-life process in which hospitals make the offers to their potential employees." For some commentators, however, giving this advantage to residency programs undercuts important interests of the candidates, and the system now tries to match applicants to residencies rather than the other way around. See: Williams KJ. A reexamination of the NRMP matching algorithm. Academic Medicine 1995;70:470-6. See also: Williams KJ. Comments on Peranson and Randlett's "The NRMP matching algorithm revisited: theory versus practice." Academic Medicine 1995;70:485-9; Peranson E, Randlett RR. Comments on Williams' "A reexamination of the NRMP matching algorithm." Academic Medicine 1995;70:490-4.
7. One recent ethical dispute was resolved when the NRMP shifted their algorithm away from favoring the rankings of the residencies over the rankings of the applicants. In the past, the NRMP had justified this approach by saying that it paralleled "the real-life process in which hospitals make the offers to their potential employees." For some commentators, however, giving this advantage to residency programs undercuts important interests of the candidates, and the system now tries to match applicants to residencies rather than the other way around. See: Williams KJ. A reexamination of the NRMP matching algorithm. Academic Medicine 1995;70:470-6. See also: Williams KJ. Comments on Peranson and Randlett's "The NRMP matching algorithm revisited: theory versus practice." Academic Medicine 1995;70:485-9; Peranson E, Randlett RR. Comments on Williams' "A reexamination of the NRMP matching algorithm." Academic Medicine 1995;70:490-4.
8. Peranson E, Randlett RR. The NRMP matching algorithm revisited: theory versus practice. Academic Medicine 1995;70:477-84
9. Liptak A. Medical students sue over residency system. New York Times 7 May 2002:A1.
10. Hester DM. Rethinking the residency matching process and questioning the value of competition in medicine. Academic Medicine 2001;76:345-7.
11. See note 7, Hester 2001:345.
12. See note 7, Hester 2001:346.
13. See note 7, Hester 2001:346.
14. The one possible exception here might be if teams were racially segregated. This is not a problem in contemporary football, though it might be in other sports.
15. Even though the argument goes against a pure lottery, something might be said for introducing an element of chance into lottery assignments in another way. For example, a residency might categorize applicants in one of two categories: (a) acceptable and (b) unacceptable. The final selection might be made at random from the category of acceptable applicants. I owe this insight to Alan Schwartz, but as it is not the issue under discussion, I will not consider its ethical implications further.
16. See note 7, Hester 2001:346.
17. American Medical Association. Code of medical ethics, Principle VI. Available at: http://www.ama-assn.org.
18. Childress J. Who shall live when not all can live? Soundings 1970;53:333-55.
19. Jonsen AR. The New Medicine and the Old Ethics. Cambridge, Mass.: Harvard University Press; 1990.
20. Pence GE. Classic Cases in Medical Ethics. New York: McGraw-Hill; 1990:320-9, at 338.
21. Anderson KD, Jacobs DM, Blue AV. Is match ethics an oxymoron? American Journal of Surgery 1999;177:237-9.
22. See: Elliott RL. Competition, justice, and the match. Academic Medicine 2001;76:1082-3; and also: Blacklow RS, Beran RL. Academic Medicine 2001;76:1083 [letters to the editor].
23. See: Elliott RL. Competition, justice, and the match. Academic Medicine 2001;76:1082-3; and also: Blacklow RS, Beran RL. Academic Medicine 2001;76:1083 [letters to the editor].