If you’re a medical student or a loved one, you need to understand the most stressful thing a medical student will experience: Match Week.
It is officially known as the National Resident Matching Program (NRMP) Main Residency Match® . Match Day is the fateful day that every medical student finds out simultaneously where they will (or will not) complete their residency training. Without residency, a graduated medical student is considered an M.D. (medical doctor), but not yet a fully licensed physician that can practice in a clinical setting.
Match Day rankings are determined by an algorithm created by Alvin Roth, who won a Nobel Prize for his work on market design and acceptance theory. (1) The Match process is efficient for matching thousands of medical students to thousands of hospitals across America, and is touted by the NRMP as being:
100% objective, 100% accurate, and 100% committed to a fair and transparent process. (2)
There is debate surrounding the matching process as to its emotional upheaval. (3) After the medical student submits their Rank List, the process is devoid of choice and negotiation. It is a legally binding contract between the medical student and the hospital where they Match. Their spouse and children have little choice other than to uproot and join them in their new city, whether it is best for them or not in the long run.
The Match algorithm is not the only thing that contributes to a medical student’s future in residency. There are many factors at play here, including the medical school where the student studied, the Step 1 board exam scores, where the medical student did away rotations, the interview process, and the Rank List of the medical student. There are some strategies you can implement as a 4th year medical student (4) to help you succeed and navigate your way in this stressful time.
As unfair as the Match may seem, the Match algorithm is completely unbiased. Of course, the process of selecting medical students to interview and the process of ranking the interviewers is subject to bias, so many medical students may feel slighted throughout the interview process and feel that their Match result was prejudiced. That very well may be true, but it is not the algorithm itself that is flawed, it is arguably the whole system.
I recommend you watch this video from the NRMP on how the Matching Algorithm works. (5)
Match Week is historically the third week in March, and includes the flagship days colloquially known as Black Monday and Match Friday. (Certain specialties and the Military carry out a separate, earlier Match process.) Black Monday is the Monday prior to Match Friday where a medical student is supplied an email that states whether or not they matched. If they did not Match, they can undergo the Supplemental Offer and Acceptance Program® (SOAP) process and attempt to Match into a different specialty that has openings. Match Friday is when every medical student in the country receives an envelope at noon Eastern Time from their program supplying them with the hospital name and location where they will carry out the next three to seven years of their residency training.
Black Monday – did you Match?
Here are a few generalized scenarios showing you the potential outcomes of Black Monday:
- Candidate A applied only to Orthopedic programs. Black Monday is more significant to them emotionally than Match Friday because of the competitive nature of matching into Ortho programs.
- Candidate B applied to Pediatric programs. While it’s comforting to receive the reinforcement that they matched, they are more emotionally charged for Match Friday to find out where they Matched.
- Candidate C applied to Internal Medicine and Radiology residency programs. They found out they matched, but they are not yet sure which specialty they will end up in, and so Match Friday will be significant to them for location as well as specialty type.
- Candidate D received an email stating they did not Match, and so they are likely emotionally devastated as well as having to go through the SOAP process to figure out their next steps.
As you can see, the outcome of Black Monday widely varies depending on who you talk to, so please be emotionally intelligent as you ask questions of your medical student, as you may unknowingly release deep fears, anxiety, and shame.
SOAP – Do you need to Scramble?
The Supplemental Offer and Acceptance Program® (SOAP) is an important part of Match Week, as there will be unfilled residency positions once the Match algorithm is complete. Students are given the opportunity to Match into open residency programs, either as Categorical or Preliminary residents. SOAP is also unofficially known as “The Scramble.”
Categorical Residents are physicians who have matched into a residency program and are training in their area of specialty. Preliminary residents are doctors working for a hospital with “resident status,” but are not in an official residency program and are only guaranteed employment for one year. The year(s) spent as a Preliminary resident may or may not count toward a future Residency where they Match. There is a strategy where some students who do not Match opt to take a Preliminary or research year so that they can continue their training (and get paid) and reapply for Match the next year to try to get into the specialty of their choice as a Categorical. In other cases, some programs offer Preliminary spots as a sort of “trial period” before they accept the resident as a Categorical. (6) (13)
Students who do not Match at all, either as a Categorical or through SOAP, do have options to continue their career path. There are some great strategies offered by the AMA for such instances. (7)
If someone graduates with their M.D. and does not immediately enter into a residency program or complete their Boards, they can still obtain specific jobs. (8) However, they are unable to practice in a clinical setting, which means they cannot treat patients in the traditional medical setting or prescribe drugs. (9)
A lot of medical students will use the word “Scramble” or SOAP with avid fear or disgust, as to them, it is broadcasting their failure at not having Matched and having to scramble quickly into any program that will take them so that they can continue on with their training and become a fully fledged physician.
You may equate the SOAP process with eating scraps that have fallen off the Match table and onto the floor, like you are some kind of unlucky or unworthy medical student who was not good enough to Match and now must be satisfied with the last pickings of the day. This is an unfair analysis, but it is a common sentiment among medical students and programs, however publicly unstated.
The truth is, it is not statistically possible for all potential medical students to Match into open residency programs for the specialty of their choice. There are far more openings for Internal Medicine than there are for Dermatology; therefore, it is likely that a percentage of medical students that attempted to get into Dermatology will not Match and will have to use the SOAP process to find an open residency position elsewhere.
While one article from the American Medical Association (AMA) breaks down the 2017 Match statistics in a positive light, citing that matches have statistically improved, the author notes this:
Once the initial matching algorithm was processed last spring, 1,279 of the 31,757 positions were unfilled. Of those unfilled spots, 1,177 were placed in the Match Week Supplemental Offer and Acceptance Program (SOAP). At the conclusion of SOAP, all but 101 positions had been filled. (10)
Participating in the SOAP process is not a shameful failure. It is a second opportunity for medical students to continue their training, even if it is not in their preferred specialty. Some specialties do not look kindly on second-time applicants, and so SOAP is preferable to spending a year as Preliminary resident and then attempting to Match into a competitive specialty a second time the next year.
Whether a medical student learned they matched on Black Monday or went through the SOAP process in subsequent days, everyone will find out where they matched on Friday, Match Day at noon Eastern Time.
It differs by program, but a common ritual is provided by many institutions with varying degrees of privacy: the medical student receives an envelope with the name of their hospital and location. Some schools have the student walk up on stage in front of all of their peers to learn the location of their Match. Depending on the outcome, this may be anxiety-inducing, particularly if the student did not Match in their preferred location and must now mask emotions in front of a few hundred people.
It is worth noting that if a medical student attempts to Match into Neurology, Neurosurgery, Ophthalmology, or Urology, they will likely go through the Early Match process, which might be separate from the standard NRMP Match process described here. (11) Your medical student may have learned they Matched via Early Match to their primary specialty weeks prior, but they are still waiting on their Match for their Transitional year.
If a medical student is applying to the Military Match process, this is an entirely different Match process as well. A medical student may opt to apply to both the civilian Match and Military Match. (12)
A Personal Note
It is not possible to adequately explain the stress and fear surrounding Match Week. If you are supporting a medical student emotionally, please be aware that this may be one of the most stressful times for them and their families. It is fraught with uncertainties, self-doubt, and possibly accompanied by shame and devastation. While the majority of medical students do Match, they may be upset by where they Matched (or did not Match). They or their spouse or their children may be upset that their new location is negatively affecting their families and livelihood.
If you are a medical student, please believe me when I say that no matter what happens during Match Week, you are not a failure. You have completed an enormous accomplishment by graduating medical school. I cannot promise the next three to seven years of Residency (or the subsequent years of Fellowship) will get better for you. I cannot promise that you will find career satisfaction. I cannot promise you will not wish you had never taken this path. But there is always a light at the end of the tunnel. There are always choices you can make to get help and find satisfaction, regardless of your Match Week. You are more than your title of M.D.
Good luck to all of you who have the Match coming up today.
Nicole Davis is the wife of an Orthopaedic Surgery resident and frequently finds herself explaining the confusing world of Medicine to non-medical people. If you are a burgeoning medical professional or a significant other of a medical student or resident, consider sending these simplified articles to people in your life who would like to understand your journey.
1 – Catherine Rampell, 2 from U.S. Win Nobel Prize in Economics, NY Times, Oct 15, 2012, https://www.nytimes.com/2012/10/16/business/economy/alvin-roth-and-lloyd-shapley-win-nobel-in-economic-science.html
2 – National Resident Matching Program, About NRMP, http://www.nrmp.org/about-nrmp/
3 – David Whelan, Alvin Roth Receives Economics Nobel for Flawed Residency Match System, Forbes, October 15, 2012, https://www.forbes.com/sites/davidwhelan/2012/10/15/alvin-roth-receives-economics-nobel-for-flawed-residency-match-system/
4 – Nicole Cragin Davis, 20 Practical Tips for Medical Students on Residency Interviews, October 9, 2017, https://shenoted.com/2017/10/09/med-school-interview-trail/
5 – National Resident Matching Program, Matching Algorithm, http://www.nrmp.org/matching-algorithm/
6 – Nicole Cragin Davis, Residency and Match Terminology – The difference in PGY medical training for Categorical, Transitional, Preliminary Residents, September 9, 2018, https://shenoted.com/2018/09/09/pgy-medical-training-dictionary/
7 – Timothy M. Smith, What if you don’t match? 3 things you should do, American Medical Association, March 7, 2019, https://www.ama-assn.org/residents-students/match/what-if-you-don-t-match-3-things-you-should-do
8 – Non-Clinical Doctors, Careers for Physicians without residency, http://www.nonclinicaldoctors.com/careers-for-physicians-without-residency.html
9 – Nicole Cragin Davis, What is medical school? An explanation for pre-meds and non-medical people, August 13, 2018, https://shenoted.com/2018/08/13/what-is-medical-school/
10 – Brendan Murphy, Breaking down the numbers behind the Match process, American Medical Association, January 16, 2018, https://www.ama-assn.org/residents-students/match/breaking-down-numbers-behind-match-process
11 – American Medical Association, Learning about early match programs, https://www.ama-assn.org/residents-students/career-planning-resource/learning-about-early-match-programs
12 – Medicine and the Military, Medical School Timeline, https://www.medicineandthemilitary.com/officer-and-medical-training/medical-school-timeline
13 – Doctors in Training, Figuring Out the Transitional, Preliminary, and Categorical Year for Residency Applications, August 25, 2011, https://www.doctorsintraining.com/blog/figuring-out-the-transitional-preliminary-and-categorical-year-for-residency-application/
Featured image on article was created by the NRMP.