The structural incentives of such a system would encourage not only honesty on the part of programs and applicants but also facilitate decision making that takes into account the needs and priorities of the applicant's family. This alternative is an eminently more humane way to make a major professional and personal decision. Furthermore, it narrows the artificial gap between the medical profession and all other professions. The sad news is that this idealized view of a labor market doesn't apply to any competitive, national market for new professionals that I know of today. To take one example that is similar to medical residencies, consider the plight of law school graduates who want to clerk for a federal appeals court judge.
Many students feel compelled to accept their first offer.
In fact, the origin of the NRMP in the 1940s came about in response to just this kind of chaotic behavior in the market for new physicians. Many other entry-level professional labor markets exhibit problems of this kind. After experiencing for several years the problems of a decentralized market, including many perverse incentives, and being familiar with the experience of their medical colleagues, the Association of Psychology Postdoctoral and Internship Centers voted in May 1998 to institute a centralized match modeled on the medical match. But the key issue is that it is not only the preferences of the applicants, but also the preferences of the employers that matter in a labor market. In fact, one of the big virtues of the NRMP is that it provides reasonably well for couples who are both seeking residencies.