Match Simulation. In 2019, proposals were presented to the GME community calling for changes to the transition to residency, including changes to the Match. One such proposal called for an “Early Match”. In response, the NRMP activated a comprehensive, data-based study to examine potential benefits and consequences for applicants and programs should the structure of the Match be changed.  At the heart of the study was the simulation of the Early Match proposal that incorporated the following conditions into its design:

+ Launch the early Match in July

+ Restrict the number of applications per applicant to three

+ Limit the number of positions available to up to 50 percent of a program’s quota

+ Make participation optional for applicants

+ Launch the standard Match in September

+Consider unmatched applicants from the early Match, and all other applicants, as part of the standard Match

Importantly, while the early Match proposal encumbered applicants with multiple restrictions, there were no such restrictions extended to programs, causing the NRMP to have concerns about fairness and equity for applicants.

The simulation of an early Match was compared to a simulation of the traditional single Match to understand changes in Match outcomes.  The study relied on eight years of ranking and matching data and found that the early Match, as proposed, could harm applicants, namely osteopathic and international students and graduates, and programs while also generating dissatisfaction with outcomes. Perhaps more importantly, the study determined that an early Match would compromise several of the fundamental principles on which a stable and effective matching market is based:

+ Reduce the thick market needed to ensure participants have many options from which to freely choose

+ Restrict true preferencing because participants could be driven to create rank lists based that ensured a positive outcome

+ Compromise the stability of the Match because participants could match to less preferred options since all available potions would not be in the early Match

In summer and fall 2021, the NRMP communicated with the GME community about its concerns with an early Match as proposed and how the modeling study had identified adverse impacts on applicants and programs that could alter the Match in ways that would be disadvantageous and negatively impact the transition and training experiences.

Exploration of a Two-Phase Match.  As part of its commitment to providing a Matching Program that is fair, equitable, efficient, transparent, and reliable, the NRMP began in 2021 to examine whether improvements could be made to the Match that would foster greater applicant wellness and agency, greater capacity for thoughtful decision-making, and a more wide-spread holistic approach to the application and interview processes. For 70 years, the NRMP has proudly served as the steward of a system that continuously evolves to meet the changing needs of applicants, programs, institutions, and medical schools through improved Match processes, offerings, and resources.

In summer 2022, a proposal outlining a two-phase Match was presented to the GME community that outlined why the time was ripe for the consideration and how participants could benefit from the change in Match structure. Although the Supplemental Offer and Acceptance Program® (SOAP®) has objectively improved on the chaos and instability surrounding the post-Match “Scramble” since it was implemented in 2012, it lacks equity for applicants and encourages reactive rather than proactive training decisions that increase stress on all participants. 

The transition to residency has had to shoulder increasing numbers of applicants, broad variation in recruitment methodologies by programs, and increasing stress among applicants and programs.  A two-phase Match could, at minimum, address stress levels while fostering greater parity of experience for all by 

+ Requiring submission of rank order lists by both applicants and programs at each phase

+ Utilizing the matching algorithm (applicant-proposing) for each phase

+ Providing time for applicants to research and vet program choices

+ Providing time for programs to engage in a more holistic review

+ Increasing time for contact between programs and applicants

+ Including two Match Days that would provide the release of the full results to all participants

The NRMP built the concept of a two-phase Match using the existing Main Residency Match timeline to ensure stakeholders were not burdened with radical changes in preparation, selection, and onboarding.  The NRMP has solicited public comment from the GME community and will invite organizations and other interested parties to participate in a period of public testimony. Findings from the public comment and engagement period will be analyzed and shared with the community.