Commentary on the Match, Economics and Radiology: Armchair Spin or Gospel Truth?

Unless you’ve been living under a rock, you’re aware that there have been changes at Twitter in recent months. Some of the more important have impacted what turns up on a given user’s “feed.” I have happily seen a substantial increase in the number of health-care related items that populate my screen.

It’s not all worthwhile stuff. Plenty of idiots and trolls post about health care, just like anything else. Even their nonsense can be entertaining, but for the most part, I get interesting tidbits about things a teleradiologist might otherwise never know.

Last week, a bunch of posts turned up pertaining to this year’s Match. Evidently, a bunch of emergency medicine (EM) residency spots went unfilled, and people were drawing all sorts of conclusions about it.

This is not a new phenomenon. Every year, all kinds of statistics from the Match are watched, dissected, and subjected to prognostication. Conclusions are drawn. Repercussions are theorized (or proclaimed as facts). One can go pretty deep into the rabbit hole if one is so inclined.

It is, of course, how our brains work. Diagnosticians make a living out of this, but people in general tend to look for patterns and build narratives. Just taking in information and doing nothing with it doesn’t come naturally to us. This is especially the case when the subject at hand is emotionally charged. For instance, topics tied to our economic fortunes (or lack thereof) may ignite some lively discussion.

Tweeting EM docs took last week’s Match news badly. They had the understandable reaction that, with so many residency spots going unfilled, their specialty was falling into disfavor. Some took that ball and ran with it to sound off about all the things going wrong in EM that weren’t being addressed. Of course, they explained, nobody wants to enter a field like that. Others spoke of how this would mean a future shortage of docs in EM and drew dire conclusions for health-care workers and patients alike. I got the impression that similar stuff was happening elsewhere in primary care.

I don’t claim immunity from such things. One of the reasons I went into radiology to begin with, back in the late 1990s, was that plenty of spots in our residency match had gone unfilled in previous years. I figured that meant I would be able to stroll in the door to a top-flight program with little competitive effort. Wasn’t this a reasonable conclusion?

I thought this may be the case based on the little bit of information I had used to draw my narrative. Popular wisdom at the time was that folks weren’t applying to the specialty on account of a bad rad job market. I figured, by the time I got out of residency, that might turn around.

It did, of course, but a little sooner than expected. Just as I was applying, new stats revealed that the market had come roaring back for rads. Med students all over the place heard the same thing, and suddenly I was surrounded by a sea of other hopefuls. I considered myself lucky to get a spot at all.

Folks like me might not have been surprised if we had based our narratives on more info. For instance, if we had been keeping closer tabs on the job market, we might have seen that the number of unemployed (or employed but unsatisfied) rads was steadily diminishing. The information was out there. But to get it, you would have to first conceive of its possible existence, moving it from your “unknown unknown” to your “known unknown.” Then you would have to come up with ways to track it down and get a handle on the real facts of the situation.

That’s a lot of outside-the-box thinking, not to mention time and effort for someone who is otherwise busy. For me at the time, I was focused on med school. Rads already in the field may have had little time outside of their actual jobs and personal lives to explore the matter. It’s a lot easier to take one or two factoids or overheard scuttlebutt while sitting in your metaphorical mental armchair and imagine what your incomplete info means.

Many moons ago, I picked up a bit of wisdom from a podcaster. If you size up whatever you know about a situation and can only think of one probable explanation, consider it a warning that you haven’t thought about it enough or that there is more relevant information you are not aware of just yet.

Harking back to a recent blog, that is especially true when dealing with complex systems. With so many intricate layers of information in such systems, you can’t ever really know all of the pertinent details, especially when more than one complex system intersects, like radiology and economics.

Faced with such an overwhelming amount of unknown data (or the project of gathering it all up), there are a handful of ways we tend to cope. We might take the pittance of info we actually have and assume (or hope or pray) that the sum total of everything we don’t might all just cancel itself out. Alternatively, we may capitulate that there is no way to take all factors into account, and “go with our gut.”

Another option is referring to sources we consider smarter than ourselves. We could take their appraisal as the closest we can get to the gospel truth and turn a willfully blind eye to the notion that they are still fallible, not fully informed, and perhaps biased, whether it is with honest intent or a result of having their own axes to grind.