After Interviews, the Match

​After Interviews, the Match

​Early in the summer of senior year, medical students enroll in the National Resident Matching Program (NRMP) Match. The NRMP is sponsored by national medical organizations and managed by the Association of American Medical Colleges (AAMC).

The NRMP algorithm is a mechanism to fairly and consistently pair up applicants and training programs. Medical students develop and submit a rank-ordered list of desired programs; training program directors develop and submit a rank-ordered list of candidates. On "match day" each March, the computer generates the results. (To learn more, go to http://www.nrmp.org.) The NRMP also offers a couples algorithm, which allows two people to enroll in the Match as a unit.

Medical students apply to residency programs by participating in the Main Residency Match, which is managed by the NRMP. In the 2018 Main Residency Match, the NRMP provided services to 43,909 registrants, and a record number (30,232) of PGY-1 positions were offered.

Within that total were 2,768 categorical pediatrics positions offered by 211 programs. Of those, 2,745 positions were filled in the Match – 63.1% by graduating US seniors. Overall, 9.5% of all applicants matched to categorical pediatrics first-year positions. These and other useful data on the most recent Match can be found in the NRMP's Results and Data 2018 Main Residency Match.

It is important to understand the difference between the NRMP and ERAS. ERAS is a service through which applicants apply to residency programs, while the NRMP matches applicants to positions in residency and fellowship programs. Registering with ERAS does NOT also register an applicant with the NRMP.

The NRMP utilizes a mathematical algorithm that processes the preferences expressed on rank order lists (ROLs) submitted by applicants and programs. The algorithm in use was developed by Alvin Roth, co-recipient with Dr. Lloyd Shapley of the 2012 Nobel Prize in Economics for their work in market design and game theory, fields that examine strategic decision making in complex situations. It is important to understand that the algorithm is applicant-proposing, not program-proposing, meaning the algorithm begins with an attempt to place each applicant into his or her most-preferred program. If an applicant cannot be matched to the first-choice program, an attempt is made to place the applicant in the second-ranked program, and so on, until every option on the applicant's rank order list has been considered.

An applicant is tentatively matched to a program if the applicant appears on the program's ROL and the program has an unfilled position -- or the program does not have an unfilled position but the applicant is more preferred by the program than another applicant who had been tentatively matched. The process con­tinues until all applicants have been considered, at which point the Match results become final.

More information on the match process and algorithm in complex situations is available on the NRMP website.

Couples in the Match

The NRMP also offers the opportunity for applicants applying in the same year and participating the same Match to link their ROLs and create pairs of program choices that are considered in rank order when the matching algorithm is processed. Applicants can attempt to match to programs in the same specialty or geographic region.

Partners register with the NRMP separately, and each pays an additional nominal fee to participate in the Match as a couple. Each partner ranks his or her interviewed programs in priority order, indicating the partner's (Student Y) preference if the student (Student X) successfully matches at that program. Each partner must have the same number of ranked programs. This is a complex process, so talking with your advisor or student affairs dean is strongly recommended. Couples cannot participate as a pair when one partner is participating in an early Match.

Tips for Making Your Rank Order List

When all interviews are complete and the applicant has determined what features are most important, it is time to construct a ROL of most preferred down to least preferred residency programs. In creating a ROL, consider the following:

  1. Rank Programs Without Regard to Your Chances. The mathematical algorithm always begins with the applicants' lists; the programs' lists are secondary. There is no disadvantage in ranking a highly competitive "dream" program first on your list rather than a program that feels like a safer bet or that has offered assurances. The ROL should always list programs where the candidate would most like to train, in decreasing preference.

  2. Base rankings on your personal assessments of programs. Program directors often send complimentary notes and messages after interviews. These can create false impressions and misinterpretations about where program directors plan to place applicants on their ROLs. Complimentary comments and correspondence should not affect the ranking for a training program. It is very important that applicants construct their ROLs solely on the basis of their own opinions of programs. Your top choice should be the program that you believe would provide the best training experience.

  3. Include more and less competitive programs. The pool of competitors widens dramatically with the Match because applicants compete with equally qualified graduating seniors from medical schools around the country and with international medical school students and graduates. For this reason, it is essential that each applicant's ROL includes programs on a wide competitive spectrum.

  4. Avoid SOAP at all costs. Unless you would rather take a year off and reapply, it is important to apply to an adequate number of programs, to interview at an adequate number of programs, and to rank all programs at which you would be willing to train -- not just where you would prefer to train. It is increasingly difficult to place in a residency program (especially in your preferred specialty) in the Match, and it is not realistic to count on the Supplemental Offer and Acceptance Program (SOAP) as a back-up method. Plan for the worst case by ranking several less competitive programs and/or consider applying to programs in a backup specialty (which would be placed at the end of your ROL).

  5. Continue to Seek Guidance. It is a good idea to consult your specialty advisor when making your rank order list. The advisor can counsel you on the number of programs to include on the list, whether your list has enough depth and competitive range, and whether a back-up program or specialty is required to assure a match. For more objective data, consult the 2017 NRMP Applicant Survey, which reveals that US Senior pediatric applicants who matched applied to a median number of 27 programs, were invited to 16 interviews, attended 12 interviews, and ranked 12 programs. Unmatched pediatric applicants applied to a median of 38 programs, and were invited to 4 interviews, attended 3 interviews, and ranked 4 programs. 


Applicants enter ROLs online via the NRMP's Registration, Ranking, and Results (R3) system in one or more sessions between mid-January and mid-February. After entering their ROLs, applicants are asked to certify their lists. It is possible to change the list after it has been certified but it is important to recertify the ROL each time changes are made. Only the applicant can see his or her list, a copy of which can be printed out at any step during the process. 

Match Week

On Monday of Match week at 11:00 a.m. Eastern Time (ET), the NRMP notifies applicants via email and through its R3 system whether they matched to a residency program. At the same time, residency programs learn whether they have any unfilled positions. Students who do not match are strongly encouraged to meet immediately with their student affairs deans and advisors to talk about why they did not achieve a successful match and to come up with good strategies for obtaining an unfilled position. A list of unfilled programs is made available to SOAP-eligible students who do not match. The SOAP process starts Monday afternoon (see below). Match Day is on Friday of Match Week.

Seniors from allopathic or osteopathic US medical schools match at substantially higher rates than U.S. citizen and non-U.S. citizen international medical school students and graduates (IMGs). In the 2018 Main Residency Match, approximately 94.3% of seniors from U.S. allopathic schools and 81.7% of osteopathic medical school students and graduates matched successfully to PGY-1 positions, compared to approximately 57.1% of U.S. citizen IMGs and 56.1% of non-U.S. citizen IMGs.

Results for Pediatrics Residency Match

In the 2018 Main Residency Match, there were 14 unmatched U.S. seniors and 237 unmatched independent applicants who ranked Pediatrics categorical positions as their only choice.

There were 57 unfilled categorical pediatric residency positions in 2018, 45 in 2017, and 14 in 2016. This trend should send a clear message to anyone who plans to match in the specialty: never count on finding a position in a pediatric residency program during SOAP!

Some advisors may recommend that a candidate select an additional specialty as an alternate plan, especially if there are any deficiencies in the medical school record. For example, family medicine programs have the largest number of unfilled 3-year positions after the Match and family physicians also care for children as part of their practices. Only preliminary surgery, a 1-year program that would necessitate reapplication for the following year for another program, typically has more unfilled positions than family medicine.

Supplemental Offer and Acceptance Program (SOAP)

In 2012, the NRMP started a new process to help unmatched students and unfilled residency programs find each other. When applicants learn on Monday of Match Week that they are unmatched or partially matched, they also have access to a list of unfilled residency programs. Applicants can then apply (or re-apply) to a limited number of unfilled programs through ERAS. Program directors, after receiving these applications, may then contact applicants for phone interviews or to gather additional information. Applicants may not contact programs, nor have anyone contact a program on their behalf until the program has contacted the applicant after receiving the ERAS application. Starting Wednesday at 12:00 p.m. eastern time (ET), programs extend offers to applicants through the NRMP's R3 system, and applicants have two hours to decide whether or not to accept the offer. Programs that still have unfilled positions after that time are able to see which applicants are still available and can extend offers during the next round of the process, starting at 3:00 p.m. (ET). The process continues through Thursday at 11:00 a.m. EST.

Bottom Lines

Apply to, and interview with, an adequate number of programs. When interpreting published data, individual applicants should bear in mind that the number is a mean or median and does not account for variation in applicant credentials. It is imperative that applicants discuss the number of programs and the choice of programs on their ROLs with their specialty advisor, program director, or chair.

Don't cancel interviews until you have a sufficient number completed. Graduating seniors may be tempted to cancel interviews toward the end of the season. If you are leaning this way, see point one!

Make sure that at each stage (application, interview, and ranking) you have an appropriate range of competitiveness. Even students at the top of the class are at risk if they rank only the top ranked programs in the country.

Avoid "short listing," unless you are willing to risk taking a year off and include each and every program where you interviewed on your ROL. In other words, include less-preferred programs where you would be willing to train rather than risk being unmatched. Short-listing often results from overconfidence based on communications from programs, and geographical constraints on the applicant's Match preference.

Always have a back-up plan – Once again: avoid SOAP – it is NOT a back-up! Your back-up plan might be to include a sufficient number of less competitive programs. It might be to apply to a less desired specialty for either a preliminary or categorical position. Include these programs at the bottom of your rank order list with your preferred pediatrics programs at the top. 

Licensure and Board Certification

The National Board of Medical Examiners® (NBME®) and the Federation of State Medical Boards (FSMB) sponsor the US Medical Licensing Examination™ (USMLE™).

Students and graduates of medical schools in the United States and Canada that are accredited by the Liaison Committee on Medical Education or the American Osteopathic Association Bureau of Professional Education register for the USMLE with the NBME.

Students and graduates of medical schools outside the United States and Canada register for the USMLE with the Educational Commission for Foreign Medical Graduates (ECFMG).

Medical students take the 3-part examination during medical school and residency.

Most medical students take Step 1 of the in-training examination after the second year of medical school, Step 2 during the fourth year of medical school, and Step 3 during the first or second year of residency. After passing all 3 parts, they are eligible to apply for their medical license.

Medical licenses are granted by state boards of medical examiners. Medical students who plan to practice in another state are advised to apply for a medical license with that state's licensing board as early as possible (generally early in the third year of residency). The FSMB posts links to individual state medical boards at (http://www.fsmb.org/directory_smb.html).

This is also the time to apply for a federal Drug Enforcement Administration number, which permits physicians to prescribe controlled substances.

Certification by the American Board of Pediatrics (ABP)

According to the ABP, physicians must complete the following steps to sit for the board certification

Examination:

  • Graduate from a medical school in the United States or Canada accredited by the Liaison, Committee on Medical Education (LCME), the Royal College of Physicians and Surgeons of Canada (RCPSC), or the American Osteopathic Association (AOA).

    • The alternative for graduates of medical schools outside the US or Canada that are not accredited by the LCME, RCPSC, or AOA but are listed by the World Health Organization, is to hold a standard certificate from either the Educational Commission for Foreign Medical Graduates or the Medical Council of Canada.

  • Complete 3 years of training in pediatrics in an accredited residency program.

  • Possess verification of satisfactory completion of residency training.

  • Hold a valid, unrestricted state license to practice medicine.

  • Pass the 1-day written examination for certification.

Board certification in pediatrics must be renewed every 10 years by successfully completing the program for continuing certification in pediatrics, which includes passing a recertification examination.

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