After Interviews, The Match

Early in the summer of senior year, medical students enroll in the National Resident Matching Program (NRMP) Match. The NRMP is sponsored by national medical organizations and managed by the Association of American Medical Colleges (AAMC).

The NRMP algorithm is a mechanism to fairly and consistently pair up applicants and training programs. Medical students develop and submit a rank-ordered list of desired programs; training program directors develop and submit a rank-ordered list of candidates. On "match day" each March, the computer generates the results. The NRMP also offers a couples algorithm, which allows two people to enroll in the Match as a unit.

There are over 2,700 categorical pediatrics positions offered by more than 200 programs. Pediatrics continues to have a high overall match rate with over 97% of all applicants matching to categorical pediatrics first-year positions. Specific data on the most recent Match can be found in the NRMP's Main Residency Match Data and Reports page.

It is important to understand the difference between the NRMP and Electronic Residency Application Service® (ERAS®). ERAS is a service through which applicants apply to residency programs, while the NRMP matches applicants to positions in residency and fellowship programs. Registering with ERAS does NOT also register an applicant with the NRMP.

The NRMP utilizes a mathematical algorithm that processes the preferences expressed on rank order lists (ROLs) submitted by applicants and programs. It is important to understand that the algorithm is applicant-proposing, not program-proposing, meaning the algorithm begins with an attempt to place each applicant into his or her most-preferred program. If an applicant cannot be matched to the first-choice program, an attempt is made to place the applicant in the second-ranked program, and so on, until every option on the applicant's rank order list has been considered.

An applicant is tentatively matched to a program if the applicant appears on the program's ROL and the program has an unfilled position—or the program does not have an unfilled position but the applicant is more preferred by the program than another applicant who had been tentatively matched. The process con­tinues until all applicants have been considered, at which point the Match results become final.

Couples in the Match

The NRMP also offers the opportunity for applicants applying in the same year and participating the same Match to link their ROLs and create pairs of program choices that are considered in rank order when the matching algorithm is processed. Applicants can attempt to match to programs in the same specialty or geographic region.

Partners register with the NRMP separately, and each pays an additional nominal fee to participate in the Match as a couple. Each partner ranks his or her interviewed programs in priority order, indicating the partner's (Student Y) preference if the student (Student X) successfully matches at that program. Each partner must have the same number of ranked programs. This is a complex process, so talking with your advisor or student affairs dean is strongly recommended. Couples cannot participate as a pair when one partner is participating in an early Match.

Tips for Making Your Rank Order List

When all interviews are complete and the applicant has determined what features are most important, it is time to construct a ROL of most preferred down to least preferred residency programs. In creating a ROL, consider the following:

1. Rank Programs Without Regard to Your Chances. The mathematical algorithm always begins with the applicants' lists; the programs' lists are secondary. There is no disadvantage in ranking a highly competitive "dream" program first on your list rather than a program that feels like a safer bet or that has offered assurances. The ROL should always list programs where the candidate would most like to train, in decreasing preference.
2. Base rankings on your personal assessments of programs. It is very important that applicants construct their ROLs solely on the basis of their own opinions of programs. Your top choice should be the program that you believe would provide the best training experience.
3. Include more and less competitive programs. The pool of competitors widens dramatically with the Match because applicants compete with equally qualified graduating seniors from medical schools around the country and with international medical school students and graduates. For this reason, it is essential that each applicant's ROL includes programs on a wide competitive spectrum. Even students at the top of the class are at risk if they rank only the top ranked programs in the country.
4. Avoid SOAP at all costs. Unless you would rather take a year off and reapply, it is important to apply to an adequate number of programs, to interview at an adequate number of programs, and to rank all programs at which you would be willing to train—not just where you would prefer to train. It is increasingly difficult to place in a residency program (especially in your preferred specialty) in the Match, and it is not realistic to count on the Supplemental Offer and Acceptance Program (SOAP) as a back-up method. Plan for the worst case by ranking several less competitive programs and/or consider applying to programs in a backup specialty (which would be placed at the end of your ROL).
5. Continue to Seek Guidance. It is a good idea to consult your specialty advisor when making your rank order list. The advisor can counsel you on the number of programs to include on the list, whether your list has enough depth and competitive range, and whether a back-up program or specialty is required to assure a match. For more objective data, consult the most recent NRMP Applicant Survey.

Applicants enter ROLs online via the NRMP's Registration, Ranking, and Results (R3) system in one or more sessions between mid-January and mid-February. After entering their ROLs, applicants are asked to certify their lists. It is possible to change the list after it has been certified but it is important to recertify the ROL each time changes are made. Only the applicant can see his or her list, a copy of which can be printed out at any step during the process. 

Match Week

On Monday of Match week at 11:00 am ET, the NRMP notifies applicants via email and through its R3 system whether they matched to a residency program. At the same time, residency programs learn whether they have any unfilled positions. Students who do not match are strongly encouraged to meet immediately with their student affairs deans and advisors to talk about why they did not achieve a successful match and to come up with good strategies for obtaining an unfilled position. A list of unfilled programs is made available to SOAP-eligible students who do not match. The SOAP process starts Monday afternoon (see below). Match Day is on Friday of Match Week.

Seniors from allopathic or osteopathic US medical schools match at substantially higher rates than US citizen and non-US citizen international medical school students and graduates (IMGs).

Supplemental Offer and Acceptance Program (SOAP)

In 2012, the NRMP started a new process to help unmatched students and unfilled residency programs find each other. When applicants learn on Monday of Match Week that they are unmatched or partially matched, they also have access to a list of unfilled residency programs. Applicants can then apply (or re-apply) to a limited number of unfilled programs through ERAS. Program directors, after receiving these applications, may then contact applicants for phone interviews or to gather additional information. Applicants may not contact programs, nor have anyone contact a program on their behalf until the program has contacted the applicant after receiving the ERAS application. For an up-to-date SOAP schedule, visit the NRMP site.