The urology match as a prisoner's dilemma: A game theory perspective

Objective To investigate the potential inefficiency in allowing urology residency applicants the ability to apply to an unlimited number of programs, and to study whether an application limit would lead toward a more efficient urology match. Materials and Methods Eleven-year data from the American Urological Association were assessed to investigate whether an increase in the yearly mean number of submitted applications was associated with an increase in the yearly mean number of interviews attended or yearly match rate. A match model resembling the current match, except for an application limit, was created to assess the financial and time savings of an application limit. Results There was no statistically significant relationship between the mean number of submitted applications per applicant with the mean number of interviews an applicant attends (P =.545), match rate (P =.383), or match rate when adjusted to account for additional positions becoming available (P =.100). The cost and time savings of a urology residency match that features an application limit in our model are substantial (up to $575,000 for applicants collectively and 1639 minutes per program director). Conclusion Allowing urology residency applicants the ability to submit an unlimited number of applications is inefficient. A urology residency match program featuring an application limit would be more financially practical for applicants and engender significant time savings for program directors.