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What is The Match?

It’s Match Week! This is arguably the most important and meaningful week of your medical education–one that has huge implications on the course of your medical career. This also happens to be MY Match Week, and I’m both incredibly excited and incredibly anxious.

What the heck is this thing called The Match everyone keeps talking about? The Match–short for The National Residency Matching Program–is the process by which senior medical students apply to and are placed in a residency program in their specialty of choice. It’s a process that originated in the 1940s and that has become a unique and defining experience of medical school. On Match Day, the Friday of Match Week, students at US medical schools gather together and receive a sealed envelop containing their residency placement. At 12:00 noon EST exactly, everyone opens their letters and learns where they will begin residency in a few short months.

Let’s back up, though. How do you get here? In the fourth and final year of medical school, students must choose the specialty they want to go into, and begin applying to residency programs all over the country in that specialty. It is certainly possible to apply to more than one specialty if you aren’t sure. The summer and early fall of your senior year are spent writing essays, getting letters of recommendation, and doing everything you have to to make sure your application is as strong as possible. In early to mid-September, you send off your application.

Starting late September and through February, programs send interview invitations to a select group of students they think are a good fit for their program. Timeframes vary slightly according to specialty (for example, the interview “season” for Family Medicine was roughly October through January for me, but General Surgery tends to run around November to February). Interview season is grueling, and most people burn some vacation and elective time so that they can travel across the country for interviews. Personally, I did 17 interviews total in 2-ish months, mostly concentrated on the east coast. It’s exhausting, expensive, and terrifying.

When you finally finish your last interview, you are able to make a rank-order list of all of the programs you interviewed with that you would want to potentially attend. It’s generally recommended that students rank around 10 programs or more, and obviously the liklihood of successfully matching increases with the number of programs ranked. I happened to rank all 17 programs where I interviewed. Each residency program also makes a rank order list of every person they interview…so, if Hospital A interviewed 100 people for 10 slots in their internal medicine residency, they rank every single one of those people from 1 to 100, based on who they want to come to their program the most to the least.

At the end of February, you submit your rank order list through the National Residency Matching Program. At this point, your job is done and all there is left to do is wait…

Here’s where things get a little weird. This isn’t like most other jobs where a person gan get multiple offers and pick their top choice. Part of what makes The Match so unique is the algorithm by which students are matched to programs that want them. The algorithm is called a “stable marriage” algorithm. Basically what happens is that you, the student, makes a rank order list that is input along with every other applicant’s rank order list. Programs also make a rank order list that is input with every other program’s rank order list. Students are then matched based on both parties’ stated preferences. If your first choice of residency program fills up with students they ranked above you, then you will get bumped to your second choice, and on and on down your list. Likewise, if a program ranks a student highly who ranked other programs above theirs, that student may match somewhere else, and the program similarly bumps down to lower raked students.

Whew. Yeah, it’s a lot. By the beginning of Match Week, however, the algorithm has done its job. On Monday of Match Week, everyone who participated in The Match gets an email letting them know if they matched or not (at this point you still don’t know where). Yes, there are some folks who don’t match, and that’s considered one of the hardest and worst things that can happen to you as a medical professional…though there is still hope.

The middle portion of Match Week, for those who did match, is fairly uneventful and simply filled with anxiety about WHERE they’re actually going. For those who did not match, this is when the Supplemental Offer and Acceptance Program (SOAP) takes place. SOAP is designed to match un-matched students into programs that, for a variety of reasons, are not filled after the algorithm is run.

Finally, when we get to Match Day, everyone who will be matched to a residency program has matched. We all open our envelopes, and then we know exactly where we are going, for better or worse, and celebrate or commiserate! Over the last few years, the likllihood of seniors from US medical schools matching by the end of Match Week is in the mid-80%s, though growing numbers of medical students (both US and international) applying to The Match has been increasing while the numbers of residency positions have not quite kept up pace. Given the physician shortage here in the US, the hope is that the number of positions will grow in the coming years to keep up with demand.

As a personal note, I did match on Monday of Match Week this year, and could not be more relieved and excited. I will find out where I’m going to my Family Medicine residency this Friday, March 20!

Image by Arek Socha from Pixabay

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