Chapter 1: Understanding the Match Day Tradition

Each year, a pivotal algorithm matches medical students with residency programs across the United States. This process, which an anthropologist describes as deeply human, intertwines technology and destiny.

This week, final-year medical students nationwide will congregate, akin to a virtual banquet, anxiously anticipating an envelope that will shape their futures for the next three to seven years. Celebrated on the third Friday of March, Match Day is a profound rite of passage, marking the transition from student-doctor to practicing physician.

The eagerly awaited envelopes (or emails during the pandemic) reveal not only the geographical location of their residency but also the type of physician they will become. Will they specialize as a surgeon in Chicago or an internist in Seattle? This event mirrors the Sorting Hat from the Harry Potter series, which assigns students to their respective Hogwarts houses by uncovering their true nature. Likewise, the Match Day envelope indicates the residency program that aligns best with the student's aspirations. While the matching process hinges on a computerized equation known as the "matching algorithm," many students feel their results reflect more profound truths than mere calculations.

The first video, "Match Day Mailbag, Part 1: Can I game the Match algorithm?" explores the nuances of the Match Day experience and the overarching questions students face.

Chapter 2: The Nuances of the Matching Algorithm

I first encountered the matching algorithm through my partner, a first-year medical resident who, last year, was among over 40,000 medical students eager for their match. The anxiety was palpable, extending beyond just the applicants. As I awaited Match Day, I channeled my curiosity as an anthropology doctoral student examining digital technologies within the medical field. What makes a residency match truly "ideal"?

To understand this, we look at the mechanics: after applying and interviewing at various programs, students rank their preferences based on what economists, like Nobel laureate Alvin Roth, refer to as "true preferences." The algorithm then places each student in the highest-ranked program that reciprocates their preference.

For economists, this algorithm is a streamlined solution to a complex labor market issue: the optimal method for placing new medical graduates in residency programs. However, for students, the Match evolves into something more significant. Leading up to my partner's Match Day, friends and family often reassured us that he would end up "where he was meant to be."

This sentiment reflects a perception of the Match as a mechanism of destiny. A poignant illustration can be found in the Stanford University's Match Day video titled "A Day of Destiny for Medical Students." The video captures the emotional moments when students open their envelopes, revealing matches that seem preordained, as exemplified by two sisters excitedly discovering they will be attending the same prestigious program.

In the second video, "How the NRMP Matching Algorithm Works," the intricate workings of the matching process are detailed, highlighting both its efficiency and the human elements intertwined within.

Chapter 3: The Human Element in the Algorithm

While economists see the matching algorithm as a rational solution, students perceive it as a symbol of fate. This view is further emphasized by the Match's strict rules: if a student declines their assigned program, they forfeit future opportunities in the matching process.

Though the algorithm appears to be a straightforward expression of individual preferences, the reality is much more complex. The decisions made by students and program directors are shaped by a myriad of external factors that extend beyond personal desires.

For instance, in the 1980s, the National Resident Matching Program (NRMP) recognized a decline in participation due to demographic shifts in medical schools, particularly as more couples emerged. Couples often preferred to stay in the same location, prompting many to bypass the Match altogether. This led to the NRMP introducing a Couples Match option in 1984, allowing partners to submit joint preference lists to ensure they could match in the same area.

Students' choices are influenced by their social ties and economic circumstances, including family responsibilities or financial constraints for traveling to interviews. These dynamics reflect broader cultural notions about who qualifies as a "good" doctor, often influenced by stereotypes related to race, gender, and socioeconomic status.

As sociologist Ruha Benjamin points out, it is crucial to examine which individuals are prioritized throughout this process. Questions posed during interviews can inadvertently reflect biases, impacting how candidates are perceived based on seemingly innocuous details about their lives.

Ultimately, understanding the residency matching algorithm requires recognizing that it is not merely a mechanical process but rather a complex interplay of human choices and societal values. As anthropologist Nick Seaver aptly notes, "Press on any algorithmic decision, and you will find many human ones." In essence, it is the human element, not the algorithm itself, that shapes the destinies of aspiring physicians.

Paige Edmiston is a Ph.D. student in cultural anthropology at the University of Colorado, Boulder.

• Originally published at www.sapiens.org on March 16, 2021.