For students who learn that they’ve been placed in the program of their choice, Match Day is cause for celebration. For others, the event can result in disappointment.

To reduce the stress of “The MATCH,” it’s important to learn about the complex system that governs residency placement. The better prepared you are for the process, the more likely you will receive good news on Match Day.

What is The Match?

When students graduate from medical school, they earn a medical degree (MD). However, graduates can’t treat patients without supervision until they acquire additional training in a residency program. Residency training is one of the requirements for obtaining a medical license. 

Most residency programs require doctors to train between three and seven years before they can be certified to practice a medical specialty. In the United States, The MATCH, managed by the National Resident Matching Program® (NRMP®), is the main system used to place graduating medical students into residency programs. 

According to the Journal of the American Medical Association, residency programs were first introduced in the early 1900s.  Competition for talented residents became so fierce that by the 1940s, hospitals began scouting medical students early in their training and offering jobs before other institutions could poach them. In 1952, the NRMP was created to make placing medical students in residency training a uniform process. 

How Does the Match Process Work?

The MATCH is a highly complex system that places medical students in residency programs based on students' and programs' preferences. The NRMP uses a complicated algorithm to rank the order of student’s residency preferences with available positions. 

The MATCH process officially begins at the beginning of a medical student’s fourth year. However, students start their path to residency early in their medical training. Throughout medical school, students take part in clinical rotations in different areas of medicine, which helps them determine what specialty or specialties they’d like to pursue. The culmination of this training is The MATCH process, which includes:

  • Submitting applications to residency programs
  • Interviewing with program teams
  • Creating a Rank Order List (ROL) of preferred programs
  • Waiting while the NRMP calculates results and releases them on Match Day

The Match Application Process

The MATCH application process starts on September 15 annually. Fourth-year medical school students submit applications to residency programs through the Electronic Residency Application Service® (ERAS ®). Submission packages include:

ERAS Application

  • Student’s personal statement and photo
  • Letters of recommendation
  • Medical Student Performance Evaluation (MSPE)
  • Medical School Transcript
  • United States Medical Licensing Examination® (USMLE®)/COMLEX-USA transcript

Residents can submit multiple applications to programs to maximize their chances of acceptance. However, the Association of American Medical Colleges (AAMC) warns that submitting too many applications can create a financial burden on students and may not improve acceptance odds. The AAMC offers a free tool that helps students calculate a reasonable number of applications. 

Interview Season and the Ranking Process

Between October and February, residency programs invite promising applicants to interview their institutions. Applicants travel to hospitals, meet with program faculty, and tour the facilities. 

Throughout the interview process, students begin drafting a ROL  to rank their preferences of residency programs. Residency faculty do the same—ranking students to fill open residency slots. The process is like a dating app: If a student’s and a program’s preferences align, it’s called a “Couple’s MATCH.”

The American Academy of Family Physicians offers the following guidelines for the ranking process:

  • Ensure that your ROL includes your highly desired programs: Even if you have doubts that you’ll be accepted into the program, include it on the list. Ranking the desired program won't prevent you from earning a spot in a less-competitive program.
  • Rank program preference accurately:  As you’ll learn in the ranking system algorithm section below, NRMP bases a match on how you prioritize your choices.
  • Don’t limit your list: Submitting a short ROL will not increase your chances of getting placed in one of your top schools, particularly if you seek placement in highly competitive specialties.

R3: The NRMP MATCH System

The NRMP finalizes the ranking lists in mid-February and feeds them into a system called Registration, Ranking, and Results (R3). The R3 system is a secure software program that contains the algorithm used in matching applicants with programs. The NRMP algorithm is a highly complex mathematical formula that was the basis for the 2012 Nobel Prize in Economic Sciences.

The NRMP algorithm favors an applicant's preferences over a residency program's student rankings. However, both parties must favorably rank each other for a "Couple's MATCH" to occur. Additionally, residency programs must have available positions open for a match to take place. 

The algorithm works like this:

  • The R3 system first tries to match each applicant with their first-choice program. If successful, the student is “tentatively” matched. However, if higher ranked candidates match the institution's available positions, a candidate will lose the match.
  • If a candidate's first choice isn't available or a higher-ranking candidate displaces a "tentative" student, R3 will attempt to place them with their second choice. If the second choice isn't available, R3 will move to the student's third choice. R3 will continue this process until it exhausts a student’s preference list.
  • Once R3 finds a secure match, a "tentative" match becomes a "confirmed" match. The confirmed match is where the student will attend residency training. Once R3 completes the ranked-choice process, the Match is final and legally binding. 

Match Week 

Years of medical training and months of applications and interviews lead to Match Week. Held the third week of March annually, Match Week begins with students learning whether they are accepted into a residency program and ends with discovering where they will take their training. Here's how the week plays out:

Match Week Monday

At 11 a.m. EST, the NRMP informs all applicants whether they’ve been placed in a residency program. They don’t know where they’ll be training on Match Monday—only that they’ve been accepted to a program. In 2020, 94.6% of all applicants were placed into residency programs on Match Monday. These students learn on Match Day Friday where they will receive training.

Match Week Monday – Thursday: What Happens if You Don’t Match to a Residency Program?

Applicants who learn they haven't been placed in a residency program on Match Monday are eligible for the Supplemental Offer and Acceptance Program ® (SOAP ®), a supplemental matching process that takes place between Monday and Thursday afternoons. In 2020, about 6%  of applicants didn't receive placements, and almost 2,000 of the available resident program positions were unfilled following the completion of the R3 match process. Most of the unfilled positions were offered through SOAP.

During SOAP, students can apply to residency programs with unfilled positions. Here’s how it works:

  • Students have one hour after discovering they haven’t been accepted to a program to research available positions. At noon EST on Match Monday, students can submit up to 45 applications to the ERAS. 
  • Programs receive applications at 3 p.m. EST and build an interview list.
  • On Match Week Tuesday, programs begin interviewing applicants by phone.
  • During Match Week, there are three rounds of offers during which programs can extend offers through the R3 system, and applicants can accept or reject offers or allow them to expire. Offers take place:
    • Wednesday: 12 p.m. – 2 p.m. EST
    • Wednesday: 3 p.m. – 5 p.m. EST
    • Thursday: 9 a.m. – 11 a.m. EST
  • After 12 p.m. EST on Match Week Thursday, remaining unmatched candidates and programs with open positions can contact each other to negotiate a match.

In 2020, by the end of the SOAP process, 99% of residency positions were filled. 

Match Day

Match Week ends on the third Friday of March with Match Day. It is one of the most memorable and consequential days in the life of a medical student. This milestone is commemorated at almost every U.S. accredited medical school—including Ross University School of Medicine (RUSM).

At 12 p.m. EST, all applicants who have been accepted into a residency program open an envelope to reveal their residency placements. Each school handles the ceremony differently. Some layout envelopes on a table and let students find their names. Others present each student with an envelope and ask them to announce their placement. In 2020, most celebrations were held virtually because of the COVID-19 pandemic.

The majority of applicants have reason to celebrate Match Day. In 2020, 46.3% of applicants matched their first-choice program, and 71.1% matched one of their top three choices, according to NRMP

Of course, some applicants will be disappointed if they don’t get matched with their top choice. When you enroll in the NRMP system, you agree to accept the final match as a binding agreement. However, you can request a waiver under certain conditions. And if you’re dissatisfied with a program, the AMA offers advice on how to transfer to a new program or specialty.

A Successful Match Day Starts at RUSM

Each year, hundreds of RUSM graduates receive the news that they have matched at leading hospitals across the United States and Canada. In 2019-2020, the RUSM level of first-time residency attainment rate was 95.2%. In 2020, 597 RUSM graduates attained residencies in 24 disciplines. 

Get started on your path to Match Day, by applying to RUSM.

Related resources:

In 2020, 91% of RUSM students passed the initial step of the United States Medical Licensing Examination® (USMLE®) on the first attempt. And in 2021-2022, results show yet another strong year for RUSM with a 96% first-time residency attainment rate* thus far. Located on the island of Barbados and with a network of more than 15,000 alumni, RUSM is one of the largest providers of doctors for the U.S. healthcare system. RUSM graduates practice in all 50 states and in Puerto Rico.

*First time residency attainment rate is the percent of students attaining a 2022-23 residency position out of all graduates or expected graduates in 2021-22 who were active applicants in the 2022 NRMP match or who attained a residency position outside the NRMP match.