the Match : what is it?

Since I am frequently (usually more than once by the same person) asked, and with one week to go before we have the "did we or didn't we" question answered, I figured it was a good time to write an explanation for what exactly this thing, the "Match", I keep referring to, is.

NRMP:  National Residency Matching Program
aka: The Match.
aka: what my husband has been working hard towards for the past 4 years.

The Match program was developed in 1952 to help students find placement in their future residency programs.  Before this point, there had been dissatisfaction with the old method of competition where the hospitals benefited by filling positions early and students from holding out to the last minute.  That sounds like a lot on a student's plate... not only are they traveling and having to continue rotations (like is still done today), but they are also playing hardball with programs, waiting for the best offer but hoping not to wait too long before all positions are filled at "safer" locations, all while not being sure whether what you are waiting for or passing up is really your best possible fit for your personality or family.  And in a lot of cases, it wasn't (wiki).

The decisions that the Match makes is run by a computer using a special algorithm.  This algorithm is based upon a mathematical idea called the Stable Marriage Problem (wiki).  The Stable Marriage Problem is often defined by:

"Given n men and n women, where each person has ranked all members of the opposite sex with a unique number between 1 and n in order of preference, marry the men and women together such that there are no two people of opposite sex who would both rather have each other than their current partners. If there are no such people, all the marriages are "stable"."

If you insert the word "programs" for "men", "applicants" for "women", "match" for "marry", "group" for "sex", you have a pretty good outline for what is happening for all of the 4th year medical students right now:

Given n programs and n applicants, where each person has ranked all members of the opposite group with a unique number between 1 and n in order of preference, match the programs and applicants together such that there are no two pairs of opposite groups who would both rather have each other than their current partners. If there are no such people, all the matches are "stable".

More of a visual learner?  Me too:

image source

So how should a student make their rank list?

As honestly as possible.

Dreaming of going to that prestigious hospital that you interviewed at, but don't think you have the scores to really make it?  Put it at #1!!!!!!  Don't chicken out.  Putting a long shot that you are in love with in your #1 doesn't hurt you!  The only thing at the top of your list that hurts you, is not ranking in order of what you REALLY WANT.  Maybe its a long shot, or maybe they liked your personality more than your scores... not putting them first would be the only thing that ruins your chances with them if they really like you too. 

The bottom of the list was the trickiest for us.  The programs we aren't too excited about but would be "okay" with...the "better than nothing" portion.  We really had to get "nitty gritty" with our details to decide where to rank things on the bottom half of our list... when you aren't all that excited but still want to rank them, that extra cafeteria spending money may be the only thing that helps you decide spot9 from spot10... so don't forget your notebook of details!

What should you do with that program you interviewed at that you just had bad vibes from?  That place you REALLY don't want to go to?  DON'T PUT IT ON THE LIST.  Nothing says you have to put it on there...  Just because you spend a lot of money making it to the interview, or they sent you letters saying how much they LOVED you?  NO.  It is not worth your misery if you were to match with them.

Really the only 2 things that will hurt you if you are a good candidate are:  to not be honest with your ranking, and to put something on the list where you don't want to go.

Because, well, this is a binding contract.

On Match Day, if you open that envelope, it is mathematically your best pairing between places that wanted you and places YOU ranked.  If you don't like your location... well tough luck.  By placing them on your list, you are saying that whether you match to your #1, or your #25, you will go.  You move yourself/your family to that new place, and you will show up to work in the summer.

So be honest with yourself.  Rank the long shot.  Don't rank where you will hate to be.

The inbetween reasons for where you put what program are completely up to you.  And there are many reasons to place things in certain orders:
Fun locations, closer to family, further from family, love the program, love the city, liked the residents, better perks, better pay, housing markets... the list goes on and on and on... but make sure it is what you (and your spouse) want.  Not what your extended family preferes, not what your current friends prefer.  What YOU want.  Because you are the one that has to live the crazy life of residency firsthand.

So how am I feeling right now about next week? 

Truth:  I'm FREAKING OUT.  About 40% nervousness/anxiety, 60% anticipatory excitement.  I just want to know that everything is okay!  I want to stop worrying that the outcome is going to be bad.  I want to get the ball rolling so I can do some REAL house hunting!  And begin the arduous task of sorting and packing.

Thanks to my friend Laura for this reminder:
verse of the day:
"For I know the plans I have for you,” says the Lord. “They are plans for good and not for disaster, to give you a future and a hope."  Jeremiah 29:11 (NLT)

Good luck to all the 4th years in next week's Match.  You aren't alone in your excitement or anxiety!

Today I am participating in the Medical Mondays Blog Hop!  Anyone have anything to add to this?

For more on parts of our med school story and advice, you can read:
rank order list: our dice throw 
before residency: interviews
the beginning of a new normal

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