How the Residency Match Works for Future Doctors

What the Residency Match Is

The Main Residency Match is the process that places graduating medical students, both MD and DO, into residency training positions across the country. The National Resident Matching Program (NRMP) runs it, using an algorithm that pairs applicant preferences against program preferences to produce one nationwide result on a single day each spring.

You cannot negotiate or accept a residency offer outside the Match if you are participating in it.

Every applicant and every program submits a ranked list in advance, and the algorithm decides placements all at once. This system exists so no program can pressure an applicant into an early yes and no applicant loses a spot to someone who accepted faster.

Step One: ERAS Applications

You apply to residency programs through the Electronic Residency Application Service (ERAS), run by the AAMC. Applicants typically start building their application, including personal statement and letters of recommendation, over the summer before their final year of medical school. Programs begin receiving applications in September, and most applicants submit to dozens of programs across their chosen specialty to build a realistic pool of interview invitations.

Your ERAS application includes your USMLE or COMLEX scores, medical school transcript, letters of recommendation, a personal statement, and your Medical Student Performance Evaluation (MSPE), a standardized summary letter your school writes on your behalf. Programs use these materials to decide who gets an interview.

Step Two: Interviews

Interview season runs roughly from October through January. Most programs now conduct interviews virtually or with a mix of virtual and in-person formats. Applicants often complete 10 to 15 interviews across their specialty, though this varies enormously by how competitive the specialty is and how strong an individual application is.

Step Three: Rank Order Lists

After interviews wrap up, both applicants and programs submit a Rank Order List (ROL) to NRMP, ranking each other in order of preference. Applicants rank programs and programs rank applicants.

Neither side sees the other's list. The ranking deadline typically falls in late February, ahead of Match Week in March.

Rank your list purely on where you actually want to train. The algorithm rewards honesty: ranking a backup program higher than your true preference in hopes of seeming interested cannot help you and can only hurt you, because of how the matching algorithm resolves preferences.

How the Algorithm Works

NRMP uses an applicant-proposing deferred acceptance algorithm. In simple terms, the algorithm tentatively matches each applicant to their most preferred program, then checks whether that program prefers this applicant over anyone else tentatively holding a spot. If a program would rather take a different applicant, the lower-preference applicant gets bumped to their next choice on their list, and the process repeats until everyone is placed as well as possible given the two-sided rankings.

The key protection for applicants: once you are matched to a program, you cannot be displaced by that program later ranking someone else higher. The algorithm is applicant-optimal within the constraints of both sides' actual rankings.

Match Week and SOAP

Results release in stages during Match Week. Early in the week, unmatched and partially matched applicants learn their status and can enter the Supplemental Offer and Acceptance Program (SOAP), a scramble process that fills unfilled positions with unmatched applicants over a few days. Match Day itself, when matched applicants learn exactly which program they matched to, falls on a Friday in mid-March.

Recent Match Numbers

The 2026 Main Residency Match was the largest in NRMP history. A total of 38,354 applicants matched to PGY-1 positions, an increase of 687 (1.8%) over 2025, and the Match filled 41,482 positions total across PGY-1 and PGY-2 combined, according to NRMP's 2026 results release . US MD seniors matched at a 93.5% PGY-1 rate, and US DO seniors matched at 93.2%, their highest rate ever.

Growth in the Match tracks growth in the number of active applicants and the number of accredited residency positions each year, so competitiveness in any single specialty depends more on the ratio of applicants to open spots in that specialty than on the overall Match size.