March 17, 2017 is Match Day for tens of thousands of medical students in the United States. Physicians know Match Day well as the day when graduating medical students find out where they will be headed for residency.

The Residency Match Process

For the non-physician readers of the blog, here’s how the residency application process works, which culminates on Match Day.

In September, fourth-year medical students apply to residency positions at hospitals around the country. Residency applications (not including travel to interviews) can run over $1,000 for students applying to competitive specialties.

From October to February, medical students fly around the country, at their own expense, interviewing with hospitals in the specialty of their choice. Costs for airfares, hotel rooms, and rental cars can run into the thousands of dollars. However, these are not your typical job interviews. Hospitals do not directly offer residency positions to applicants. Instead, applicants rank the programs where they interviewed, and residency programs rank all of the medical students they interviewed.

The current Match Day system was created in the 1950s in response to the prior medical student recruitment system, where hospitals would offer residency positions earlier and earlier in medical school. Hospitals would often pressure medical students into accepting residency positions by giving “exploding” offers that would only be valid for a few days. In order to bring more equity and fairness to the residency application process, the match system was created.

At the end of February, all students and residency programs submit their rank lists, which then get fed into a computer program which matches students with hospitals. The match algorithm determines the optimal allocation of medical students to residency programs. According to the National Resident Matching Program (NRMP) who runs the match, there will be approximately 42,000 applicants this year to fill 30,000 residency positions. This is a gargantuan computer science problem. To complicate the matching problem further, the process allows for couples matching. This is where two people can choose to submit a joint match list. The algorithm for allocating the residents to hospital residency positions is incredibly complicated, and the algorithm used in the match process won the Nobel Prize in Economics in 2012.

Finally, on Match Day (currently the third Friday in March), students find out where they will be headed for residency.

Match Day Around The Country

Match Day is a big event at medical schools around the country. Each medical school has their own traditions for Match Day. At my medical school, each medical student was given a sealed envelope a few minutes before noon on Match Day. Once the clock struck 12:00 noon, everyone would rip open our envelopes and find out where they were going to spend the next 3-7 years of their lives in residency. The match is binding, and you cannot renege on your commitment to the residency program in that envelope. Match Day truly is a life-changing moment in every doctor’s career.

Other medical schools have more elaborate Match Day ceremonies. For example, at Vanderbilt, students go up one by one (in random order) and open their envelopes in front of all of their friends and family. This is the ultimate reality show, as you see dreams made or shattered based on what’s in those envelopes. Imaging opening your college acceptance or rejection letters in front of a crowd of hundreds of people. They even have the webcast of past match days dating back to 2005, so your joy (or tears) will be available for the world to see for years to come.

Transitioning from Medical School to Residency

Needless to say, Match Day is a day that every physician remembers for the rest of their lives. It marks the beginning of the transition from medical school to residency. It’s a professional as well as a financial transition. You go from accumulating debt for four years in medical school to earning a paycheck and beginning to repay that debt. For some medical students, residency may be the first job they have ever held. Medical students are well prepared for the medical aspects of transitioning to residency, but the financial aspects of holding a job may be very new for them.

In the coming months, I plan to write an Intern Financial Survival Guide, a series of articles that will help guide new physicians with the transition from medical school to residency. I hope to cover the following topics:

  1. Refinancing Your Student Loans
  2. Budgeting As A Resident
  3. Buying vs. Renting
  4. Selecting Health Insurance
  5. Choosing Workplace Benefits
  6. Investing in a 401(k)
  7. Life and Disability Insurance for Medical Residents
  8. Optimizing Your Cash Back And Travel Rewards

Conclusion

I expect precisely zero medical students to read this post on Match Day. They should be celebrating their match with their family and friends. But as you wrap up your medical school education, I hope you will return to this blog and read my Intern Financial Survival Guide.

What do you think? Do you have fond (or not so fond) memories of your Match Day? Are there any topics that you would like me to cover in the Intern Financial Survival Guide?

8 COMMENTS

  1. Do they still open paper letters with their match results or is it now via email? My match day was in 2005 so times have surely changed….We spent it in the NBA Grizzlies stadium club and it was a pretty cool spot to have it.

  2. This was interesting, I didn’t know how the American system worked. I recall being very surprised when a young American doc I once met told me she couldn’t work because she didn’t get into a program and had to wait and try apply again, but I never asked about the specifics.

    In South Africa (where I am) internship is a mandatory thing run by the govt and that you will do in a govt hospital (there is a private sector too, but training is only done in the govt sector). You put your choices for hospitals on a form and they pick one for you (for better or worse), it has no bearing on your eventual speciality as internship is a general 2 year program which takes you through all the major domains (medicine, surgery, ob/gyn etc… It’s pretty much the same as the UK system).

    Specialisation comes later and you can spend years working as a medical officer waiting and hoping to get a specialist training post if you are really determined to go into a popular speciality (or get one right away if you choose a less popular speciality). You can also work as a career non-specialist if you choose.

  3. I remember match day fondly. I had a friend open my envelope and tell me. He got confused by the transitional year followed by the anesthesia residency.

    I ripped it out of his hands and read it myself. I was pleasantly surprised to have gotten my top internship and 2nd ranked anesthesia program, which could have easily been my first if it weren’t so far from home.

    It worked out great for me, and there was quite a party that evening.

    Cheers and congrats to all the newly matched future doctors!

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