“Matching” in medical school means being assigned to a residency training program through a national computerized system that pairs graduating medical students with hospitals. It’s the single event that determines where you’ll spend the next three to seven years of your career, and it’s binding for both you and the program. Nearly every physician in the United States goes through this process, run by the National Resident Matching Program (NRMP).
How the Match Actually Works
The Match uses a mathematical method called the Gale-Shapley algorithm. Both sides, applicants and programs, submit ranked preference lists. The algorithm then works through those lists to find stable pairings where no applicant and program would both prefer each other over whoever they were matched with.
Here’s what happens behind the scenes: the algorithm starts with the first applicant and “proposes” to that person’s top-ranked program. If the program has open spots and ranked that applicant, a tentative match forms. If the program’s spots are already full, the algorithm checks whether the program prefers this new applicant over anyone it’s currently paired with. If so, the least-preferred current match gets bumped back into the pool to try again with their next choice. This process repeats until every position is filled. The key takeaway: the system tries to place you at the highest-ranked program possible on your list, so you should always rank programs in your true order of preference, not where you think you’re most likely to get in.
The Application Timeline
The process begins more than a year before you start residency. During your fourth year of medical school, you submit applications through ERAS (the Electronic Residency Application Service). Your application includes a personal statement, letters of recommendation, your Medical Student Performance Evaluation (a standardized letter from your dean’s office), transcripts, and exam scores. Programs review these materials and invite selected applicants for interviews, which typically run from October through January.
After interviews wrap up, you build your rank order list in the NRMP’s online system. You can rank up to 20 programs before extra fees kick in, with an absolute cap of 300. Programs simultaneously create their own rank lists of applicants. Both sides certify their lists by a deadline, and once certified, the lists create a binding commitment: if the algorithm pairs you with a program, you are obligated to train there.
Match Week: What Happens and When
Match Week follows a specific, high-stakes schedule. On the Monday of Match Week (mid-March), at 10:00 a.m. Eastern, you find out whether you matched, but not where. This is the moment that splits the class into two groups: those who matched somewhere and those who didn’t. Programs also learn at the same time whether they filled their spots.
For students who didn’t match, the Supplemental Offer and Acceptance Program (SOAP) begins immediately. SOAP lets unmatched applicants apply to programs that still have open positions. You can apply to up to 45 programs during SOAP, and offers go out in rounds over the following days.
The big reveal comes on Friday. At noon Eastern, matched applicants finally learn which specific program they’ve been assigned to. This is Match Day, and most medical schools hold ceremonies where students open their results simultaneously. It’s one of the most celebrated (and nerve-wracking) traditions in medical education.
Match Rates by Applicant Type
Not everyone who enters the Match gets placed. In the 2024 cycle, 88.4% of U.S. MD seniors matched successfully. U.S. DO (osteopathic) seniors matched at 77.1%. International medical graduates had a 72.4% match rate. These numbers reflect how competitive the process is, particularly for certain specialties like dermatology, orthopedic surgery, and plastic surgery, where the number of applicants far exceeds available spots.
Couples Matching
If you and your partner are both applying for residency, you can link your rank lists through the Couples Match. Instead of ranking programs individually, you submit pairs of choices. The algorithm then looks for the highest-ranked pair where both of you can be placed. You can also use a “No Match” code for one partner on certain pairs, meaning one person would go unmatched if the other gets their preferred program. Both partners must have the same number of ranks on their lists, and the algorithm treats you strictly as a unit. If it can’t find a match for the pair, it won’t try to match either of you individually.
The Binding Commitment
Matching isn’t a suggestion. It’s a contractual obligation. Once the algorithm pairs you with a program, both sides must honor that result. Programs must offer you a training position, and you must accept it. Neither party can back out without requesting a formal waiver from the NRMP. If either side walks away without approval, it’s considered a violation of the Match Participation Agreement. For applicants, the binding commitment lasts through the first 45 calendar days after your training start date. Resigning or being terminated within that window without an NRMP waiver counts as a violation, which can affect your ability to participate in future Matches.
What Happens After You Match
Once you know your result, the onboarding process starts quickly. You’ll sign and return a letter of acceptance and an appointment contract. Most programs require you to apply for a medical training license in their state, complete background checks, and pass drug screenings. If you’re an international graduate on a visa, you’ll need to stay in close contact with the Educational Commission for Foreign Medical Graduates to manage your visa status. All of this needs to be wrapped up before your residency start date, typically July 1.
What SOAP Looks Like for Unmatched Applicants
Learning you didn’t match is one of the hardest moments in medical training, but the process moves fast and there’s a structured path forward. SOAP opens at 10:00 a.m. on the Monday of Match Week, the same moment you learn your status. By 11:00 a.m., you can start preparing applications for programs with unfilled positions. You’re allowed to apply to up to 45 programs total during SOAP, and you can reapply to programs you originally applied to earlier in the season as long as they have open spots. There’s no separate registration required. Programs begin reviewing SOAP applications the following morning, and offers go out in rounds over the next few days. Not every unmatched applicant finds a spot through SOAP, but it gives you a real chance to secure a position before the week ends.