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Understand the National Residency Matching Program

Understand the National Residency Matching Program

After what feels like an eternity of studying medical textbooks and cadavers, surviving mind-boggling tests, sitting in on lectures, and shadowing physicians in a variety of fields, it’s finally time to learn where you’ll be practicing your first three to six years of medicine — it’s finally time to figure out where you’ll be headed for residency (or fellowship)!

No matter what year of medical school you’re currently in, it’s never a bad time to think about what kind of physician you want to be and which city you’d ultimately like to live in or near. These personal factors — as well as your medical school accolades — will help determine which residency program you’ll be joining.

While determining where you’ll be attending residency does depend on your choices, it also depends on the residency program’s choices — as well as a mathematical algorithm called the “Match.”

The Match itself is the final, formal process of aligning yourself with a particular residency program. After interviews are over, you must decide and rank which program you’d like to attend. Likewise, residency program directors must decide and rank which applicants they’d like to extend an invitation to.

The Match helps align these preferences. It’s like a mutual agreement between an applicant and a residency program that says: “I want to go here” and “we want you to come here.” Attending one program or another, therefore, depends on how you rank them — and how or if they rank you.

Your Rank Order List

To fully understand this process, you should know what and how your Rank Order List (ROL) can affect your future. A Rank Order List is a list of your most-to-least preferred residency programs. At the top should be your first-choice, followed by your second, third, and so on — depending on how many programs you choose to rank (While there’s technically no limit, there are additional fees for ranking beyond the standard limit of programs.)

It’s important that this list be based on your actual preferences — not how you think you’ll match or which residency program you think will rank you — because the algorithm will try to satisfy your choices above all else. According to the National Resident Matching Program (NRMP), the match is “applicant-proposing,” meaning your expressed preferences — not the residency program’s — will initiate placement into a residency program. In essence, the match system will try to match you to your first choice program, followed by your second, third, and so on until either a “tentative” match is made or all of your ranked programs have been exhausted.

You can make changes to your rank order list, but only up until 9:00 p.m. EST on the Rank Order List Deadline. Any changes must be re-certified to be used in a Match. Keep in mind that couples matching has its own rules for rank order lists. You can read more about that here.

Tentative Matches

While your rank list preferences are highly regarded in the Match process, each program also has a rank list — but for applicants.

Programs also have a maximum number of residents they can accept each year, so when you tentatively match a program — meaning you ranked them and they ranked you somewhere on their list — you still may not officially match to that program if a more preferred (than you) applicant also matches to that program and pushes you out of their maximum allotment of accepted applicants.

In that case, the algorithm will try to re-match you with your next-preferred program(s) until another match is made or until your list has been exhausted. This process happens for every applicant.

Final & Binding Matches

Once the system has worked its way through all of the applicant and residency program lists, the Match is considered complete. At this time all tentative matches become final, and the match is considered a binding commitment.

This is why it is imperative to only rank residency programs in which you want to attend. Entering the Match involves signing a Match Participant Agreement. This electronic signature states that you not only agree to attend the matched program, but you intend to, in good faith, complete said training.

Applicants find out if they matched somewhere (but not where) during Match Week and slightly before a day called “Match Day” —  the official day that applicants, as well as residency program directors and coordinators, find out who matched where. The medical Match Day traditionally occurs on the third Friday of March each year.

The Supplemental Offer & Acceptance Program (SOAP)

In some cases, medical school applicants do not match to any residency programs. Likewise, some residency programs do not fill all of their positions. In these cases, eligible applicants who find out they are unmatched or partially matched during Match Week may enter the Supplemental Offer and Acceptance Program® (SOAP), a process that enables applicants to contact unfilled programs.

View How the SOAP Round Works

Here’s To Your Future!

While graduating from medical school, and therefore earning your educational institution’s seal of approval as a physician, the residency match itself creates a variety of questions, but it can also be a simultaneously stressful and exciting time of your life. Naturally so!

The process involves the beginning of a new phase in life and in your education. It’s the realization that you’re saying farewell to the friends, professors, and the city that you’ve relied on for four years.

Overall, it’s the beginning of unknown changes. Rather than let this overwhelm you, remember that you made it! You graduated from medical school! Focus on what you’ve achieved and what you’re still meant to achieve.

We hope that these basic features of the Match have been helpful, but there are plenty more details to consider. Be sure to do more research and check out this FAQ page from the National Resident Matching Program.

We hope that your interview season, as well as your Match Day, go as planned and that your have a fruitful medical career. If you aim to find a hospital job after residency, remember to check back with for the best hospital job postings on the web.

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