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Resident Physician Forum
June 14, 2000

Recent Changes to the National Residency Matching Program

Author Affiliations

Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.

JAMA. 2000;283(22):2997. doi:10.1001/jama.283.22.2997

For nearly half a century, the National Residency Matching Program (NRMP) has operated as an impartial and confidential venue for matching applicants' and residency programs' preferences for each other. In the past few years, the NRMP has instituted several changes to improve the residency match process for applicants and residency programs.

The NRMP is sponsored by 5 organizations: the American Medical Association, the American Board of Medical Specialties, the Association of American Medical Colleges, the American Hospital Association, and the Council of Medical Specialty Societies. Its board of directors also includes student representatives from 4 different organizations. Although the NRMP is not the only organization to conduct a match, it is the largest. In the 2000 Match, the NRMP served 3769 residency programs, offered 22,722 positions, and processed 33,528 applicants.

The NRMP has a single cardinal rule for both programs and applicants: neither must ask the other to make a prior commitment as to how each will rank the other. This rule is intended to ensure a fair process by which applicants and programs can rank one another after fully weighing their options, and thus avoid pressure to accept one another on the spot. For the Match to work optimally requires broad participation by programs and applicants, who must act in good faith and promise to abide by the Match results.

The NRMP has actively worked to improve its services. Two years ago, the Match algorithm was changed to favor the preferences of applicants over those of programs. Although the new algorithm only changed the results for 16 applicants in the first year it was tested, the change was probably significant to those individuals. This past year, the NRMP successfully converted the Match to an Internet-based process for both applicants and programs. This year also marked the first time that programs were asked to list their final Match quotas prior to the close of the rank-order list process so that students and the NRMP could monitor the availability of positions in the Match.

Because the Match process requires broad participation to work well for everyone involved, the NRMP will be working closely with specialty societies to ensure adequate participation by programs in the Specialty Match. Beginning this year, if a specialty cannot commit at least 75% of programs and 75% of positions to the Match, it will not be able to fill its positions through the NRMP. The NRMP is exploring other mechanisms to enhance participation and professional behavior in the main Match. These include building more effective communication with program director organizations and developing a common professional ethics language with accreditation and board certification organizations. The NRMP is also actively exploring collaboration with the Association of American Medical Colleges' Electronic Residency Application Services to assist unfilled programs and unmatched applicants in finding one another.

It has been encouraging to see how well the sponsoring organizations work together to improve this important service. More substantial improvements will likely require better monitoring and inducement to participate. The NRMP is hopeful that increased cooperation from specialty and program director organizations as well as accreditation and board certification bodies will make this possible.