How the Match Works
(‘Cause everyone’s been asking, “So did you get a job?”)
I find it best to begin at the beginning.
In your final year of medical school, you have to decide in which specialty you want to train. This could be anything from “Internal Medicine,” where you would become an internist, to “Pediatrics,” where you’d become a pediatrician, to “Urology,” where you’d become a urologist. Radiology, Neurosurgery, Emergency Medicine–it’s all there. (Except some Internal Medicine specialties, like cardiology, endocrinology, which require you to do an internal medicine residency and then another training session called “Fellowship.”) Anyway. You decide your specialty, and then try to figure out where you want to train for residency*.
So while you’re figuring out where you would like to train for residency (based on a number of factors like reputation, location, research opportunities, etc.) you’re preparing an application for these residency programs. It’s a big electronic folder of things like grades (if your school has them), board scores (standardized national exams everyone has to take), letters of recommendation, evaluations from your time working in the hospital, extracurricular activities, research, and a one-page personal statement. So you submit that to a big centralized clearinghouse called ERAS, which charges you a fee based on how many places you apply to
. Depending on how competitive your specialty is (orthopedics, radiology, anesthesia are often at the top), you may end up applying to an insane number of programs. Like 40. This can be $500-$600 just to apply.
You want to get your application in ASAP, because residency programs can start downloading parts of it as soon as you pay, and can start offering you interviews whenever they want. Technically, they don’t have your full application until November 1, when your medical school releases your “Dean’s Letter,” a summary of your performance during medical school and sometimes has a ranking, grade, or keyword (“Graham is a good candidate,” vs “Graham is an outstanding candidate”) to differentiate students at the same medical school. But anywhere between late October and early November you’ve heard from most programs via email as to if or when they’re going to offer you an interview. For some of the more competitive programs, you may only get offered one or two dates (“Please come interview November 28 or 29″). It’s then a scramble to quickly email/call the programs back and confirm the date you want. You’re constantly balancing booking programs with trying to group them regionally, so you’re not flying back and forth across the country all the time. Because yes, you are paying for this yourself.
So you go around to different programs and interview. You’ll usually interview with 3 or 4 faculty or residents (at least in my experience), both for you to get a feel of the program and its faculty, as well as for the program to get to know you. You get a tour, breakfast and lunch, and often there’s a social event the night before to get to meet the residents outside of the hospital environment. They tell you the specifics about the residency program, why the program is unique or special, you get a chance to ask questions. (In fact, often the most common question you’ll hear is, “So, what questions do you have?”) And as I said before, you’re paying for all of this yourself. Airfare, hotel, meals on the road–it’s all on you**. I lucked out and had friends in every city where I interviewed (Thank you Eric, David, Sam, Deepika, Jesse, Eric, Eugene, Ed, Kenji, Dave, Allison, and Mike, I owe you all BIG TIME!) but still the process will end up being expensive for me to fly all over. People trying to match as couples often spend around $5,000 interviewing, depending. This is of course just loan money, so by the time we’ve paid it off it’s tripled in cost. But I don’t have ideas for a better system–you gain a ton by going to the institution and seeing it yourself.
Now to the Match part of it. I explain it this way. By getting an interview, you kind of have a potential job offer. How it works is this: the med student ranks all the places he or she interviews. The residency program ranks all the candidates they interview. Then a big crazy computer program (The NRMP, lovingly known as “The Match”) … matches everyone up. There’s a good explanation of how it works here. The Match favors the resident, so if two programs rank you #1, but you rank program A higher than program B, you go to program A.
Everyone finds out where they match this year on March 20, 2008.*** Technically we’re all supposed to find out at the same time–that is, students on the East Coast would find out at noon their time, and on the West Coast we’d find out at 9am, but often your friends on the East Coast are already calling and texting and emailing their results early, ahem. And then, July 1, or around there, you start your internship.* You are contractually obligated to go where you’re placed, so right now the thousands of medical students about to graduate and I are all anally pouring over our “Rank Order Lists,” to decide how we want to rank places.
And that’s the Match for you!
*Residency is the name of the training process you go through to become a doctor in a certain field. The length of residency depends on the specialty: pediatrics, internal medicine, and family practice are three years, others are four, some like plastic surgery or neurosurgery are seven. Internship is the name of your first year of residency, no matter what specialty. Most of the time you do your internship as part of your residency program, in some specialties like anesthesia, dermatology, ophthalmology, you do your internship separate from the rest of your training.
**There are some programs that will put you up in a hotel, or pay for your airfare, but these are rare. Often programs will have setups so that you can stay with a resident, however.
***There is a terrible thing called “Black Monday,” which happens the Monday before Match Day, where people who didn’t match at any program find out, and then have to enter “The Scramble,” where they quickly try to find an open residency spot somewhere, often not in their chosen field. (Knock on wood this doesn’t happen to anyone.)
[...] for my personal reference: a good overview of how matching into a U.S. medical residency works. This entry was written by Patrick Chan, posted on 2/2/2008 at 12:46 pm, filed under Asides. [...]
Be glad – in the old days before the internet we used the “green book” to find residencies we thought we would like.
We mailed them a letter, and they sent a booklet to us telling us how wonderful the program was.
Then we applied – each program had its own rules (some wanted 2 letters, some wanted 4, some wanted pictures, some didn’t…)
It’s actually better with the computerized system. Still very stressful, still time consuming, but better.
Not sure why you mentioned anesthesia along with orthopedics and radiology. Anesthesiology is typically on the lower-competitive side of things. Dermatology and plastics would be better examples for you.
Anesthesia has gotten much more competitive in the past 3 years. Yes, there are more spots available than Derm or Plastics, but they’re much harder to get now.
Thanks for clearing that up Graham. Here in Australia it’s completely different, and I’ve been wondering what all the US students have been talking about! Here, you go from med school to internship, but you don’t have to be in a specific program, i.e. you don’t have to choose what career path to follow until you’re ready to. By the time I finish med school I’m sure I’ll have a few ideas of what I want to do, but I’ll use my internship (and residency) to clarify everything before applying to a specific program. It seems very stressful (and expensive) in the US – I don’t envy you! Good luck for the match.
I’m a final year med school student, thanks a lot for making stuff clear. Appreciate it.
Graham,
I read this with interest because I have never understood the whole process and the difference of terms. You managed to clear it up and we’ll be thinking good thoughts for you. Good luck (not that you need it!)
Having graduated from Med School, in “the old days” I am not sure the modern system is all that great. We did have to go through a “match program,” for our internships. But residencies were up to us. There wasn’t the necessity to apply to 40 plus programs. I applied to three orthopedic residency programs, one of which I new I had little chance of getting. I didn’t have to fly to Portland, from LA, for an interview because I had graduated form the medical school to which I was applying for the residency.
It is difficult for me to understand the stress and expense of trying to get into a residency nowadays. I really feel sorry for the modern medical school grad in this regard. With the debt load most of them carry, to add the expense of applying to so many residency programs and then to have to fly to a number of them for interviews, really adds to the financial stress faced by these young physicians.
1) anesthesia i NOT competitive
2) I applied to ENT and ended up spending $10,000.00. This is not surprinsing for good-moderately competitive candidates applying to ENT, Derm, plastics and ortho. The entire process sucked and I was tired of smiling and providing routine answers. Im just glad it is over and now I have to rank the interviews. Graham, by the way, I interviewed with an average # of 8 faculty members/interview (range 7-13). Consider yourself lucky…
It is not unusual for good students to apply to all 107 programs in derm.
Not me of course.
Interesting that someone brought ENT up. I never thought I’d be in a more competitive pool in my life (I am an ENT applicant as well). Ten interviews later, I am broke, tired and probably suffering from cardiac stress. All the candidates were supa fly with high board scores(high i.e >235 for median, not mean), great research(typically submitted or published/presented at a national meeting) if you want to be a serious candidate, a majority AOA, and you are just going: what the fK? But the killer is that most ppl are nice but you look across the table and you know 38 of the 40ppl interviewing of the two spots is a potential competition…so, I am glad we have the NRMP computer thing because without it, there would be no level playing ground post-interview (getting to the interviews is not a levelled-playing ground, you have to work your grades, network and letters in competitive fields).
So, Graham, you found a boyfriend yet?
Not yet. Graham is on a bit of a finding-a-boyfriend hiatus until he finds out where he’s matching.
So Graham is headed for EM…I just got slammed by the EM-13patients to admit and I am on the 12th hour of my last call as a subI. One of them coded and took 2hours to stabilize. Fantastic. Still got love for EM though…
In Canada, the match runs more or less the same way, except it seems that we start later and end earlier (match day is march 6). also, we don’t find it if we didn’t match until match day itself.
i also wish i was back in the good ol’ days with the rotating internship after graduation from med school – i would’ve loved an extra year of clinical rotations to decide what i wanted. that year is now incorporated into pretty much all residency programs, adding an extra year to residency. the current argument against bringing back the rotating internship is 1. politics between the colleges 2. it would add an extra year to residency (which makes no sense!)
my 2 cents (which are now par with your 2 cents :P)
1) Graham’s got fans.
2) Graham, are you going to continue this blog after graduation? You should. I’ll pay you $12.00/year.
3)I am actually losing sleep in anticipation of match day. I feel like I am reducing my life expectancy with each hour less of sleep I accomplish. Great. Maybe I should have gone into EM (Im ortho bound).
$12.00 per year? Nice! Do I hear 13?
I’m still trying to decide what to do with the blog as an intern. I’ll need to talk to my future Program Director and see what he or she thinks. And I may just be so busy that blogging will be the last thing on my mind. We’ll see.
I’ll match (no pun intended) that $12.00 to bring it to $24.00
I hope you keep writing. You’ll be busier than you could have imagined, but I still hope you make some time to write.
It would be fun to watch/witness (read) you grow as a physician, much as we have observed your growth (vicariously and voyeuristically) as a med student.
oh, if you get any good leads on where to find a bf, please share the wealth!
Do ER Residencies still require a Transitional year, or is it built in the program now? It’s been a few years since I managed a TY Residency. We always has ER matches.
So, when will you know where you have placed? Like the others I will be sad if you stop blogging but, I do understand you will be extremely busy. Having said that I would like to hear how you are doing even if it is a simple am breathing, good-bye note. Take-care. Sarah
I’ll know March 20 where I’ve matched, Sarah, but probably won’t really know if I want to keep blogging until I start internship!
[...] on February 5, 2008 For those who haven’t yet seen Graham’s fantastic piece on the Match… while you’re figuring out where you would like to train for residency (based on a number [...]
$50.00/year. Cash.
I uI understand what you are saying. OHSU is the fifth largest academic medical center in the country. ( would hate to see 1 -4.) I have gotton very good over the years figuring out who the interns are just by looking at them. They are pie eyed for want of sleep. They all say the internship is part of the process and they know it. Oh, I did have one guy say he went bald his internship year but, that was the least of his worries.
I have learned a lot from your blog. The “phase” you went through, you know the one where you put the disclaimers on the pictures, has gone far to help me decide what I want to do. I am leaning towards infectious disease but have not totally ruled out emerging disease. I figure I will have time to decide.
I hope you get your first choice on where you want to go. Where would that be by the way? Best of luck to you. Sarah
Hi Sarah—I’m guessing you are at OHSU. I am about to rank it #1 for a competitive surgical subspec. Hmm, your post is interesting. U are the second person i 48hrs to make a similar statement although the residents looked all flush and sweet during the interviews (confessions came from an intern later–he is still happy though) Can we talk? I don’t know any student from OHSU but I love the place and my program of choice. I am not sure if Graham would permit me to leave my email on here…I’ll check back to see.
You’re welcome to, MSMS4!
OMG!!!!!! We need to talk. Are you looking at Dr. John Hunter’s department? Dr Hunter is one of the best. Email me at saraiderin@yahoo.com. Now if we just get Graham to come here. How is that for the not so subtle hint. :O)
Match results in the veterinary world are reported at 8 am EST on March 3rd. These next 3 weeks are a killer. And then I’ll have to Match all over again for a residency in another year. sigh…
Graham,
I’d like you to keep blogging, too. I wish that there was something like this during my internship/res if for no other reason to document that first year. Nothing can totally prepare you for it. Think of you first clinical year, only now you are a REAL doctor. No one has to sign off on anything, it’s all you (kinda). Anyway, good luck on the match!
oOh and to add one more thing to your excellent description of the process. In the competitive specialties (and perhaps others as well), some programs insist on completing “away rotations” at their place (again at your expense). Also, at least in Ortho, there is extensive “horse trading” where you really need to call your Number 1 choice to show your interest, while not letting your 2,3,4 choices know that they aren’t number 1. Some programs want applicants who want them, even more than the “super fly” candidates who come through. The thought being that you will be happier (and more productive) at a place that you desire versus a place you fall into.
That puts even more pressure on your Number ! choice, because the subspecialty communities are very small and you REALLY don’t want to tell two programs they are Number 1 (Even Ortho docs can figure out if you lied).
[...] medical students find out if they matched at all. (Just got my email, I did!) If not, they have to go through The Scramble. Good luck to everyone, and if you have to Scramble, hang in there. I’ve been told that [...]
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[...] about the day when we will learn where life’s next adventure will take us. Here’s a little write-up about the residency application and match process that I found on someone’s blog, if you are interested (Dad, this is for you ). Our Match Day [...]