Roadmap to Residency: - AAMC

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Roadmap to Residency: FromApplication to the Match and BeyondV. Matching ProcessesThis section explains the variety ofprocesses involved in obtaining a position inresidency programs in various specialties.Most U.S. medical students and otherapplicants to U.S. GME programs securepositions through a “matching program.”Although the largest matching programis the National Resident MatchingProgram (NRMP, www.nrmp.org),other residency matching programsinclude the San Francisco MatchingProgram (www.sfmatch.org) and thematching programs sponsored by theAmerican Urology Association (AUA,www.auanet.org/residents/resmatch.cfm)and the American Osteopathic Association(www.natmatch.com/aoairp). Inaddition, the various U.S. ArmedServices select applicants participating inmilitary programs at U.S. medicalschools for Armed Forces-sponsoredGME programs. Finally, the CanadianResident Matching Service (CaRMS,www.carms.ca) sponsors a two-phasedmatch for Canadian medical schoolstudents and other applicants.A. The National Resident MatchingProgram (NRMP)The largest of the several matches is theMain Residency Match (the “MainMatch”) sponsored by the NRMP. Eachyear, the Match provides services to morethan 25,000 applicants and 3,900residency training programs, offeringmore than 21,000 first-year (postgraduateyear 1 or PGY-1) and 2,500 secondyear(postgraduate year 2 or PGY-2)positions. More than three-quarters ofall applicants participating in the Matchobtain PGY-1 positions, and more than90 percent of all PGY-1 and PGY-2positions are filled each year. The NRMPannually publishes Match statistics in the“NRMP Results and Data Book,” whichis available for purchase on the AAMCPublications Web site(www.aamc.org/publications).The NRMP matching process uses theWeb-based Registration, Ranking, andResults (R3) System. Applicants andprograms register for the Match, submittheir rank order lists, and obtain theirMatch results using the Internet on theirown computers. Because all informationin the R3 System is in real time, applicantscan modify their rank order listsup until the rank order list submissiondeadline. Applicants and programdirectors must use their unique identificationnumbers to access the R3 System.The NRMP’s public Web site(www.nrmp.org) contains a wealth ofinformation about the Match. All applicantsare advised to review that informationbefore completing the registrationprocess. To register for the Match, clickthe “Register/Log In” link at the top ofthe NRMP home page. It is important tonote that registration for the MainResidency Match does not register anapplicant with the Electronic ResidencyApplication Service (ERAS,www.aamc.org/eras) or vice versa.The NRMP and ERAS are distinct,complementary programs. ERAS is amethod for applying to residencytraining programs, and the NRMP is amethod for matching applicants withavailable positions in those programs.Applicants must register separately forthe NRMP and for ERAS, which is thesystem used by the overwhelmingmajority of residency training programsparticipating in the NRMP. A singleregistration for the Match allows applicantsto rank any match-participatingresidency training program, regardless ofspecialty.The NRMP classifies applicants into twocategories:• “U.S. seniors,” in NRMP parlance, arestudents currently enrolled in U.S.allopathic medical schools. Themedical school “sponsors” thosestudents by verifying their medicaleducation credentials and ensuringthat they are not withdrawn inappropriatelyfrom the Match. A U.S. seniormay be withdrawn from the MainResidency Match only by an official ofhis or her medical school. Institutionsthat participate in the Main ResidencyMatch may offer positions to U.S.allopathic medical school seniors onlythrough the NRMP or anothernational matching program. Thisrequirement includes PGY-1 preliminarypositions for applicants whoobtain their PGY-2 positions throughanother match.• “Independent applicants,” in NRMPparlance, are those participants in theMain Residency Match who are notU.S. allopathic medical school seniors.This applicant category includes priorgraduates of U.S. allopathic medicalschools; osteopathic medical schoolstudents and graduates; Fifth Pathwayprogram participants; Canadianmedical school students and graduates;and students and graduates of internationalmedical schools, regardless ofwhether they are U.S. citizens or7Association of American Medical Colleges, 2005
Roadmap to Residency: FromApplication to the Match and Beyondcitizens of other countries. Thecredentials of international medicalschool students and graduates areverified by the ECFMG. Independentapplicants may be offered positionsthrough the Match or outside of it,and they may withdraw themselvesfrom the Match at any time prior tothe rank order list deadline.Five types of positions are offeredthrough the NRMP Main ResidencyMatch:• Categorical (C) positions: PGY-1positions in programs that provide thetraining required for board certificationin a specialty• Preliminary (P) positions: PGY-1 oneyearpreliminary positions in transitionalinternal medicine or generalsurgery programs.• Categorical (M) positions: PGY-1primary care positions in combinedprograms in internal medicine andpediatrics• Advanced (A) positions: PGY-2positions in specialty programs thatbegin the year after the Match andsubsequent to one or more years ofpreliminary training• Physician (R) positions: Positions inspecialty programs that begin in theyear of the Match for physicians withprior graduate medical education.The NRMP uses a mathematicalalgorithm that employs the preferencesexpressed in the rank order lists submittedby applicants and programs to placeindividuals into positions. The processbegins with an attempt to place anapplicant into the program indicated asmost preferred on that applicant’s list. Ifthe applicant cannot be matched to thefirst-choice program, an attempt is thenmade to place the applicant into thesecond-choice program, and so on untilthe applicant obtains a tentative matchor all the applicant’s choices have beenexhausted. An applicant can be tentativelymatched to a program if theprogram also ranks the applicant on itsrank order list, and either (1) theprogram has an unfilled position or (2)the program does not have an unfilledposition, but the applicant is morepreferred by the program than anotherapplicant who already is tentativelymatched to the program. This process iscarried out for all applicants until eachapplicant has either been tentativelymatched to the most preferred choicepossible or all choices submitted by theapplicant have been exhausted. When allapplicants have been considered, thematching process is complete and alltentative matches become final.The NRMP issues guidelines for applicantsin preparing their rank order lists:• Applicants are advised to include ontheir rank order lists only thoseprograms that represent their truepreferences.• Programs should be ranked insequence, according to the applicant’strue preferences.• Factors to consider in determining thenumber of programs to rank includethe competitiveness of the specialty,the competition for the specificprograms being ranked, and theapplicant’s qualifications. In mostinstances, the issue is not the actualnumber of programs on the rankorder list, but whether to add one ormore additional programs to the list inorder to reduce the likelihood of beingunmatched.• Applicants are advised to rank all ofthe programs deemed acceptable, i.e.,programs in which they would behappy to undertake residency training.Conversely, if an applicant findscertain programs unacceptable and isnot interested in accepting offers fromthose programs, the program(s)should not be included on theapplicant’s rank order list.The NRMP matching algorithm alsoallows couples to link their rank orderlists so they will match to programssuited to their needs. Both partnersenroll individually in the Match andindicate in the NRMP R3 System thatthey want to be in the Match as part of acouple. The NRMP allows couples toform pairs of choices on their rank orderlists, which are then considered in rankorder in the Match. The couple matchesto the most preferred pair of programson their rank order lists where eachpartner has been offered a position.All participants in the Main ResidencyMatch must sign the Match ParticipationAgreement (MPA) during the registrationprocess. The MPA delineates allMatch rules; applicants should review itcarefully before submitting their8Association of American Medical Colleges, 2005
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