Spam!

The Journal of Orthopaedic Surgery recently sent me an email asking me to review an article on the use of denosumab for aneurysmal bone cysts. Why on Earth would they send that to me? I have a theory. As editor of a dermatology journal, it is just getting harder and harder to find people willing to review articles. (If you are interested in being a reviewer, send me an email!) Editors are sending interview requests to more and more people, all the while less specifically targeted, in the hopes that someone will agree. And the more the editors send out these emails to increasingly wider audiences, the more the audience becomes inundated with requests.

I used to say yes almost always when asked to do a review; now it has become so commonplace to be asked—and asked to review articles I have no business reviewing—that I have become numb to the requests and turn many of them down as quickly as I can, if I do not just delete them altogether. If this sounds to you to be a lot like the annoying spam phone calls we get, you are seeing the same pattern I see. When there are low costs to sending out requests, we get this cycle of sending more and more requests, getting more and more rejections, and creating more and more wasted effort in the process.

Which brings me to this month’s feature article on the dermatology residency application process. We have so many great candidates, but not so many residency spots. Rejection is common. So, what do applicants do? They apply to more places. Then there are even more rejections, then more applications, then more rejections…so many wasted resources with no end in sight. It would be great if students would limit themselves to applying to some small number of programs, but game theory does not encourage that. Program directors would love to come up with a system that not only reduces the extra work, but also lowers applicants’ costs, too.

I once took a class in economics. Perhaps we could solve the spam phone call problem by letting cellphone owners charge a small fee to anyone who calls their phone. Widespread use of such a system would discourage random mass calling while having little impact on people who want to talk with a friend. Paying reviewers a small fee might help solve some of the issues with getting journal articles reviewed (and would discourage journal editors like me from randomly asking 100 reviewers to review an article). But fixing the residency application process is a nut too hard for me to crack. Economic incentives like much higher application fees might work by discouraging too many applications but would disadvantage some students. Dr Aamir N. Hussain tackles the ongoing debates about dermatology residency applications on page 28.

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