In celebration of everyone who successfully matched today, I wanted to talk about the fascinating history of the Match, from the crazy days of pre-Match chaos and to the unsung heroism of one medical student that changed it all!
In ye olden days...
Back at the turn of the century, residencies were only just in their nascency, and there was no strict requirement of residency in order to practice medicine. Scary thought, considering I didn't know how to order Tylenol let alone practice medicine when I graduated from medical school. In fact, residencies were once called "undergraduate repair shops" in the 1910 Flexner Report (a revolutionary-but-also-definitely-morally-grey-and-racist education reform paper). They became more popular with the rise of medical specialties, where graduates would essentially apprentice until they felt comfortable to practice on their own. However, as more specialties developed, the value of residency rose, and by the 1930s, most hospitals were requiring residency training before completing boards exams.
By the 1940s, competition for residencies grew fierce. Offers were given out increasingly earlier, so much so that they were being extended to students only in their second year of medical school. It got so bad that medical schools were embargoing recommendation letters to prevent the hospital equivalent of cradle-robbing. Soon, competition got so bad that "exploding offers" were being made that had a 12-hour expiration date, leaving many students scrambling to send off telegrams and make phone calls. No bueno STOP
Thus, the first Match system was born.
The Match that never was:
In 1951, the Mullin-Stalnaker algorithm was in works to be implemented in the first ever match process, and it was being championed by the high echelon of medicine including the Dean of Harvard Medical School. Thousands of dollars were being poured into making this event work, and it would be entirely derailed by a maverick medical student named William Hardy Hendren III. A Navy veteran with lots of chutzpah, he noticed the algorithm was flawed in several ways, and even presented his argument on the blackboard with the Dean and entire medical class present.
I won't go into the nitty-gritty of the Mullin-Stalnaker algorithm for sake of brevity, however it's actually super interesting and explained really when in this blog (https://thesheriffofsodium.com/2020/02/03/the-match-part-2-getting-under-the-hood-how-does-the-match-work/). Long story short, this match process penalized students who ranked "reach" programs, and it often produced what we call unstable matches - matches in which more favorable matches existed for both parties and were not considered or passed on. This encourages "elopement" by either party to make deals outside the matching system.
Going back to our story, Mr. Hendren realized this, and despite multiple threats from the Dean about withholding his graduation and that "[the Dean] didn't give a damn if any of [the students] get internships," he persisted in his quest for reform. In the historic frantic following weeks, Hendren led a movement and gathered over half the student leadership of medical schools across the country and created their own algorithm, "The Boston Pool Plan." This new plan assumed a "deferred acceptance" algorithm, in which a student was tentatively assigned to a hospital until or unless they match at a higher ranked place. There was, as suspected, resistance from the powers-that-be, of which Hendren replied:
"If you don't change the plan, it will be the end of it. I have votes from 95% of the students in the country...These same students have said they're going to bolt if you don't change the plan. We're not going to sacrifice our futures because of the errors you all have made in setting up this plan the way that you have."
The leadership deferred to the demands of Hendren and the students, and the following year the Boston Pool Plan was implemented for the first ever match. Hendren went on to become a renown pediatric surgeon, remaining on to serve as emeritus chief of surgery until his death just this past May at the age of 96.