What is the Match?

Access to residencies in the U.S. is completed through a process known as the Match.  Organized by the NRMP (National Resident Matching Program), each year approximately 16,000 U.S. allopathic medical school seniors and 15,000 graduates of osteopathic, Canadian or foreign medical schools compete for approximately 24,000 residency positions.

How does the Match work?

The NRMP takes Rank Order Lists (RoL) from each residency program and every individual registered for the Match. The Match algorithm then uses rank order lists submitted by applicants and programs to place individuals into positions. Every applicant is attempted to be placed into the program which was ranked first on their RoL. If the applicant cannot be matched to their first choice, they are then attempted to be placed in their second choice, and so on, until the applicant obtains a tentative match, or all choices have been exhausted. An applicant can be tentatively matched to a program if the program also ranks them on their RoL, and: the program has an unfilled position, or the program does not have an unfilled position, but the applicant is ranked higher than another applicant who is tentatively matched there.

Matches are tentative because an applicant who is matched to a program at one point may be removed from the program later to make room for an applicant who was ranked higher by the program. When an applicant is removed, an attempt is made to rematch the applicant, starting from the top of their RoL again. This process is continued until each applicant has either been tentatively matched to their most preferred program, or all choices submitted have been exhausted and the applicant fails to match.

What is a prematch?

Prematch is a way to get residency outside of the Match. This is similar to a job interview and being hired on the spot. You still have to apply through ERAS and be selected to interview, but the program may let you know on the interview day that they offer prematches and may ask if you are interested. There are pro’s and con’s to telling them you are willing to accept a prematch. The pro’s are if they like you, they will offer you a prematch. This is the contract to begin residency in June. Since it is done outside of the NRMP Match, you must withdraw yourself from the Match and you will not submit a RoL. You should then cancel any remaining interviews you have and sit back and relax as you will be beginning residency in June. The con’s are that they now know you are willing to accept a prematch, meaning you might accept one from another program if they offer. Them knowing that may slightly hurt your chance in them ranking you highly. Though not that big of a deal, it’s all a game in the end.

Some people may look those who are willing to accept prematches as desperate, but there is nothing wrong with accepting a prematch if you were planning on ranking that program highly. In the end, a residency position is a residency position, regardless of how you got it! If the program is in your top 3, take the prematch. If it’s at the bottom of your RoL, reconsider. If you consider yourself a strong candidate and truly believe you will match at higher ranked programs through the Match, then don’t accept the prematch. If you have a short list of programs and have a feeling you may end up not matching, take the prematch and your troubles are gone! Some programs may not rank you if you decline their prematch offer, while others still might; it really depends on the program and how interested they are in you. Some programs offer a prematch within a month after your interview. They also give you a few weeks to a month to decide whether you’d like to take it or not. You have the luxury to complete your interviews and then decide where that program stands, or just accept the prematch and not have to deal with traveling and interviewing further.

It is truly up to you if you want to accept the prematch or not. Most prematch spots are given to IMGs as their visa takes a few months to process and they like to get started on it early so that they will be ready to start residency in June. Sometimes visa delays cause first year residents to start late, which really hurts the program missing a crucial intern. Think long and hard before signing a contract, because its extremely difficult to get out of it (if possible at all). Also, the NRMP may be changing the outlook of prematches in the near future, either getting rid of them altogether, or implementing them through the Match (strictly rumors).

Links:

NRMP Match

Step 9: Post Interview