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How the Residency Match Algorithm Works

Ah yes, Match Day. The culmination of almost 4 years of hard work.

The time leading up to Match Day can be incredibly stressful for medical students. The residency interviews, the uncertainty. Wondering if you won’t match because you laughed too hard at a Zoom joke, or maybe you didn’t laugh hard enough??

But before Match Day, residency training programs and applicants submit their rank lists. Then a computer (via the National Residency Matching Program) matches applicants to their programs. Surprisingly, many applicants actually do not know how this process works! This leads to a lot of time spent trying to “game” the list to increase your chances of matching.

You should always rank in the order that YOU want, not trying to guess where the program is ranking you. See the example below to understand why!

Take a look at the rank lists of the 3 applicants and 2 programs (xxxx=a different program, neither Program A nor Program B. Lets say there are 2 spots available at each program.

Mary Bill Sandra Program A Program B
1. Program B 1. Program B 1. xxxx 1. Sandra 1. Mary
2. xxxx 2. Program A 2. xxxx 2. Mary 2. Sandra
3. xxxx 3. xxxx 3. xxxx 3. Bill 3. Bill
4. xxxx 4. xxxx 4. Program B
5. Program A 5. xxxx 5. Program A

The match algorithm will temporarily place Mary and Bill into their first choices (both into Program B).

However, lets say Sandra doesn’t match at any of her choices 1-3. She will then be placed at Program B, which is her 4th choice. Because she is ranked #2 and the program has 2 spots, she is GUARANTEED A SPOT at that program, no matter where she ranks them. She will bump Bill out because she is ranked higher. (Note: Sandra was bumped out of her top 3 programs from students ranked higher than her at those 3 programs).

Mary’s spot at Program B is secure because she is ranked as 1 of the 2 available spots.

Therefore, Mary and Sandra will match at Program B.

Now Bill is temporarily placed into his 2nd choice, Program A. Although he is ranked #3, his spot here is secure because Mary and Sandra already matched at Program B. Nobody will bump him out of Program A, therefore Bill will match at Program A.

This process continues over and over for the thousands of applicants who apply and eventually programs end up with their cohort. This is also how a student can end up unmatched- if a student keeps going lower and lower on their rank list and getting bumped out by those ranked higher until the student doesn’t have anymore programs left, they will not match.

So really, the focus throughout the residency interview season should be trying to get ranked as high as you can at the programs you interview at. After that, you should genuinely rank programs in the order you want. IT DOES NOT HURT YOU to rank as you please.

Hopefully this was helpful and alleviates a lot of the stress associated with rank lists. I know it did for me and many others when they found out that this is actually how it all works!