Matchmaker, Matchmaker Make Me A Match – The NRMP Main Residency Match

Each spring, thousands of medical students across the United States render their fate into one of the most bewildering processes of higher education: the National Resident Matching Program (NRMP). The program was developed in 1952 as a means to “relieve the pressure and inequity of free market recruitment, and to establish a uniform playing field with educational boundaries” with regards to residency training programs. Prior to this, the process of achieving a desirable residency spot was fraught with chaos, with multiple different application forms and processes, not to mention false promises and false information.

Conceptually, the matching procedure seems straightforward: assign medical students to residency programs in a way that streamlines the process and produces the best outcomes for all parties involved. Practically, however, it’s a bit more complicated. Fourth-year medical students apply to residency programs in the specialty (or specialties) of their choosing, usually via the Electronic Residency Application Service (ERAS) which is a standard computerized application form used by most residency programs across all specialties. The programs review these applications, select the candidates they’d like to meet and go through the standard interview process. The students then rank the programs in order of most desired to least desired and submit their lists electronically to the NRMP. The residency programs do a similar ranking of the students they’ve interviewed, and submit their lists as well. Through a complex computer program that possibly only its creators understand, the best “matches” are made in a manner that optimizes both the students’ and programs’ requests. Both students and programs are contractually bound to the outcomes of the match.

This would be a feat unto itself if it was that simple. The matching program also takes into consideration whether the students have registered as a couple, as in the case of married students who want to stay in the same location, whether the student has applied in two different specialties, and whether the specialty to which the student is applying needs a preliminary or transitional year (“internship”) following medical school before entering into their categorical program. The data processing required is mind-boggling.

And yet, somehow it works. So every March crowds of fourth year medical students anxiously await the envelope containing the program’s output that determines their destiny for the next three to seven years. Every March, dreams are realized or ruined with the opening of a single envelope. While it seems somewhat arbitrary that after years of difficult and expensive education the course of someone’s career comes in the form of a computer-generated assignment, for many it’s preferable to the vague and chaotic process of years past.


National Resident Matching Program.

Electronic Residency Application Service. Association of American Medical Colleges (AAMC).

T. A. McNamee, MD

T. A. McNamee, MD, is an associate professor and internal medicine residency program director at Sanford School of Medicine of the University of South Dakota.
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