The NRMP Match process is unique. It’s unbelievably stressful and at first glance it feels a little mysterious. On the spectrum of admissions processes, it sits somewhere between the NFL draft and the sorting hat from Harry Potter.
The Match utilizes an algorithm that was initially championed by a group of Harvard medical students in 1952. The algorithm was later optimized by game theory economists, winning them a Nobel prize. Its purpose is simple: it pairs graduating fourth year medical students and other applicants with residency programs. Anyone who wants to gain admission to a residency program must participate in “The Match”. There are certain rules and regulations surrounding what applicants and programs can and cannot do during interview season. It’s meant to preserve the integrity of the process. An example would be that a program is not allowed to ask you where you plan on ranking their program. Or ask where else you have interviewed. You are allowed to express your interest in a program or that you intend to rank them first, but the program is not allowed to reciprocate, and you shouldn’t ask where you fall on their list.
The algorithm is “applicant-proposing” which essentially means that it attempts to place applicants with their preferred residency programs according to their “rank order list”. A successful match is made if the preferred residency program also ranks the applicant highly on their list. If not, then the algorithm attempts to place the applicant with the next program on their list. You can imagine that with over 36,000 applicants, some applying to multiple specialties, there are a lot of moving parts to consider. The algorithm favors the applicant’s preferences over those of programs, so if you make it onto residency A and residency B’s rank lists, you will end up at residency A, even if residency B ranked you higher. I won’t cover every scenario here, but you can watch the NRMP’s video to see an animation of how it all works.
In future posts we will cover the individual parts of the residency application and share our tips on how to curate a beautiful and complete application package. For now, the short story is that the application includes your CV, personal statement, USMLE scores, letters of recommendation, MSPE Dean’s letter, summary of activities, and a bunch of other stuff. It takes many painful hours to assemble and represents hundreds of hours spent studying for exams and actually completing the volunteer and research activities. It is often done in the evenings and weekends while completing clerkships during the 3rd and 4th years of medical school. Application season has historically meant completing between 10-14 interviews, which may cost an applicant between $7K-15K depending on flights, application fees, and other costs incurred on the interview trail. COVID changed all that with virtual interviews and I hope we never go back. It cost me less than $3K total.
I share all this information in an attempt to explain the stress and anxiety residency applications produce but the truth is that words could never be enough. If you encounter a 4th year medical student in January or February, and you watch them long enough, eventually you’ll see what I’m talking about. Every few minutes they will stop and sigh very profoundly. An alert from their phone will make them visibly recoil. They may be unseasonably sweaty. It is a lot to deal with. I think it’s all this stress that makes Match Day so exciting. It represents the culmination of so much effort and sacrifice and the stakes are very high.
I want to congratulate all the med students who just matched this past week. I hope it was the outcome of your dreams. I also hope you have some ultra-chill rotations to finish out the year and a vacation planned. I remember my Match Day as one of the few truly satisfying moments I have ever experienced.