What is the Match for Residency?

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The Match is the name given to both the organisation and program which sees US medical school students placed into residency training programs. The program’s mission includes both US citizens and non-US citizen international medical students, as well as Fellowship matches and in recent years matches in other territories as well. The Main Residency Match had more than 48,000 applicants and 38,000 positions in the latest available data.

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History of the Match

The first residency programs were created in the 1920s and saw intense competition between applicants. Hospitals wanted to fill their positions as soon as they could, whilst applicants wanted to delay accepting positions for as long as possible, in order to ensure the best possible place for themselves. This led to offers for positions being made as much as two years before the start of the actual programs. In 1945, medical schools took a joint decision to not release transcripts or letters of recommendation until a set date, thus ensuring that the date of residency selection was maintained as being in the fourth year of medical school. Programs therefore began to issue offers that had a set time limit, this being as little as 12 hours by 1950, in some cases students were given offers that had to be answered on the spot – in other words, called on the phone, and asked there and then to confirm. The 1950s saw the formation of the National Student Internship Committee, or NSIC, which worked to assess findings of a trial using the Boston Pool Plan method for matching applicants to programs – a modified version of this being used in 1952, and the National Intern Matching Program being created in 1952 as well. Modifications would follow, with students believing that they were being encouraged to misrepresent their true preferences, whilst others found that there were both college-optimal and student-optimal matches possible. Particular problems have arisen with regard to whether the Match is truly returning the best option for students, and with regard to couples – with multiple researchers finding that stable matching is impossible if couples are allowed to match together. However, if the option for couples matching together is removed, the Match becomes program-preferential rather than fair to applicants. It is therefore an incredibly complex logistical undertaking, and indeed work done on the Match and matching algorithms has seen the award of a Nobel Prize, to Lloyd Shapley and Alvin Roth.

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How does the Match Work?

The first point to note, when considering how the Match works, is that it is a matching algorithm which is applicant-proposed. This means that ‘it attempts to place an applicant (Applicant A) into the program indicated as most preferred on Applicant A’s rank order list. If Applicant A cannot be matched to this first choice program (because the program doesn’t also prefer Applicant A), an attempt is then made to place Applicant A into the second choice program, and so on, until Applicant A obtains a tentative match, or all of Applicant A’s choices have been exhausted (meaning Applicant A cannot be tentatively matched to any program on the ROL).’ In other words, the algorithm is designed to read an applicant’s desires first, rather than read from the program’s side first.

A tentative match is when an applicant has ranked program that has also ranked said applicant, and one of the following is true:

  • ‘the program has an unfilled position (making room for the tentative match to Applicant A) or
  • the program is filled but Applicant A is more preferred by the program than another applicant (Applicant B) already tentatively matched. In such a case, Applicant B is “bumped” from the tentative match with the program to make room for Applicant A.’
If an applicant is bumped from their match, they will then return to their list and the algorithm will attempt to match them with their next most preferred position. This will take place in the same manner as we saw above for Applicant A. A tentative match can then become final when all applicants’ rank order lists have been taken into account and the matching algorithm is complete. Note that this will not result in all applicants matching.

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