Match Info and Ranking Residency Programs

What is the National Resident Matching Program (NRMP)?

The NRMP is a program that most residency programs in the United States use to determine their next class of residents. It is a separate system from the Electronic Residency Application Service (ERAS), and therefore you will need to register with the NRMP before January 31. The NRMP website is full of resources and their content is worth exploring. 

Specialties that do not use the NRMP:

Some specialties including Ophthalmology, Urology, and military residencies do not use the NRMP for their application process. Be sure to read the “How to Apply” section of each of your desired residency programs to verify the correct procedure for applying.

What algorithm does the NRMP use to match residents?

The NRMP has a video that explains the match algorithm with illustrations that all participants in the match should view: How the NRMP Matching Algorithm Works. In summary, you should only be ranking programs that you have interviewed with. Additionally, the match algorithm prioritizes YOU, the applicant. Therefore, you should rank programs in the true order of your preference, NOT based on how competitive you may feel you are for a program. 

What is the timeline for the match? 

Exact dates are subject to change. Please check the NRMP website for exact dates and deadlines.

End of January: You must register with the NRMP (www.nrmp.org) prior to the end of January. 

Early February: The match will open and enable you to “certify” a rank list. Once your list is “certified,” you are able to retract, edit, and re-certify your list as often as you may need until the “Rank Order List Due Date”.

Early March: You must have your final “certified” rank list submitted into the system prior to the “Rank Order List Due Date.” After this date, rank lists cannot be edited or resubmitted. The website is notorious for crashing during the few days leading up to the final date, so be sure to have your rank list submitted early just in case!

Mid March: On Monday of Match Week, you will receive an email indicating if you matched or did not match. If you matched, it’s time to celebrate! However, you will not yet know where you matched. If you did not match, you will need to participate in the The Supplemental Offer and Acceptance Program (SOAP) program. SOAP is a topic that will be described in a separate article. At noon on Friday of Match Week, you will be notified of where you matched. You will either be handed a letter during a ceremony at your medical school or receive an email from the NRMP directly.  

Factors to Consider:

Pro Tip: Remember, if questions arise during this process, many programs encourage post-interview communication/questions (unless they have specifically requested no post-interview communication).

Location: Most often, the first variable medical students consider is the location of the residency program. The AMA reports that in some specialties, up to 64.6% of graduating residents go on to practice medicine in the same state as their residency program. This is certainly aided by residents starting to network with physicians in the area of their program while in residency. Additionally, the location of family members, partners, friends, etc. often plays a role. For some specialties, such as Family Medicine, the scope of practice of physicians can vary widely by where they are practicing.  

Electives/Extracurricular Opportunities: As you’ve been exploring residency programs, you’ve likely found that the medical and procedural training at most programs within a certain specialty is mostly the same. All residency programs must meet their respective ACGME requirements. What often differentiates programs is their extra-curricular and elective opportunities. For example, if you are interested in remaining in academic medicine, which residency programs on your list have a curriculum that will help prepare you for that career path? Other extra-curricular areas that may make certain programs stand out are opportunities to gain experience in advocacy, working with homeless populations, quality improvement, health systems sciences, physician wellness/burnout, etc.

Program Culture/Resident Personalities: Each program and institution will have its own personality in regards to attendings, residents, and the relationship between both groups. This is something you may have to rely on the gut feeling you had when speaking with programs throughout the interview and post-interview process. An aspect of this may be characteristics such as the size of the program. Larger programs may have a wider range of people and personalities, however, to some may seem impersonal.

Fellowship Training/History of Matching: If you are interested in a specific fellowship after residency, it may be advantageous to train at an institution that has that fellowship. Many programs prioritize fellowship applicants from their own programs. Additionally, you will likely have access to faculty that will be able to mentor you in preparing a high quality application to other programs. Be sure to ask each program what their history has been with residents matching into fellowships if this is important to you.

Resident Wellness/Support: Wellness programs for residents are quickly evolving and are now almost diffusely present throughout all of graduate medical education. Consider how supported residents feel at their programs or examples, if they gave any, of times when they needed extra time off and how that was accommodated. For this information, it may be helpful to reach out to a resident that was an alumnus of your medical school or one that you can trust to speak freely outside of the interview setting.

Call Schedule: While all residencies will inevitably involve a challenging call schedule, how call responsibilities are distributed among residents varies widely from program to program. Different states also have different laws that may affect how long you are allowed to be on call. While this shouldn’t be your top priority, it may help differentiate two otherwise similar programs.

Prestige/Academic Setting: Depending on your future career aspirations, the prestige of a program may play a role in your rank list. It is important to note that prestige is NOT necessarily related to the quality of a program. Additionally, for specialties that have residencies in both community hospitals and academic centers, it is important to consider the implications of those settings.

How to put it all together:

The analysis of these many variables will ultimately come down to what is most important to you. It is certainly advisable to put together a pros/cons list, or a graph with each of your most important variables listed with a simple breakdown for each program. Most students will then use gut feel to move programs up and down the list. Some students create a point system, weighting certain variables greater than others, then using this to create a numerical score. Depending on how you make decisions, this may be beneficial to you. Additionally, this strategy may have the same effect of flipping a coin. If you feel disappointed when you see the rank of a specific program, that’s your gut telling you to move it up!

How many residency programs should I rank?

The number of programs that you should rank varies widely based on the specialty you are applying into and how competitive of an applicant you are. The AAMC and the professional organizations of each specialty have recommendations for this that you can find on your website. Ultimately, this would be an excellent topic to discuss with a mentor at your medical school that is familiar with your application and that has experience assisting students with the match process in your desired specialty. As a general rule, you should rank every program that you interviewed with that you would rather attend than entering the SOAP (and/or potentially not match).

Seeking advice/other resources:

Your rank list is ultimately confidential to you and only is shared with your medical school, mentors, fellow students, family, friends, etc. if you choose to share it. It is advisable to have a trusted mentor in your specialty at least take a general look at your list, even if the list is not yet finalized. The AAMC has an entire webpage dedicated to assisting medical students with the match process (click here). Most specialty professional groups also have their own web pages with specific recommendations on preparing for the match. 

Post-ranking communication with residency programs:

Once you have identified your #1 program, and you are 100% sure that they will be your #1 program, it is okay to send a Letter of Intent to that program director and coordinator. The letter should be brief, thanking them for their review of your application, your intent to rank them #1, and 1-2 sentences addressing why you would be a good fit for their program. Be sure to only send this letter to your top program and only once you are absolutely sure it will be your top program. Most programs finalize their rank list around mid-February and you should aim to send it around or before this time. It is up to you whether to send emails to your other top programs indicating that you remain interested. Notably, many residency directors feel this does not impact your rank and ultimately will disclose that they are not your top program.

Pro Tip: It is okay for you to voluntarily tell a program where you are ranking them and it is okay for a program to voluntarily tell you where they are ranking you. It is a Match Violation for a program to ask you where you are ranking them or where you are ranking other programs. It is also inappropriate for an applicant to ask a program how they are being ranked. If this occurs, please see the NRMP website for appropriate reporting procedures to protect your participation in the match.

Ultimately, producing your rank list is an exciting time where you can actively have control over your residency application. Remember to breathe and to enjoy each step of the process. If you are feeling nervous or are unsure what to do next, utilize your mentors and online resources. Do your best to avoid online medical student forums. They are addictive and tempting, however, ultimately do not provide any helpful information and will likely only contribute to your anxiety. Once you submit your rank list, take some time to relax and enjoy your final months of medical school – you’ve certainly earned it!