Let’s say it’s next week (match week). You get an email on Monday from the NRMP. And . . . you’ve matched! But even as you exhale in relief, as the stress is leaving your body, a whole new set of anxieties begins to move in. A cavalcade of dystopian possibilities, all centered around the unanswered question:

Where will I match?

Imagined Alternatives

If you are like me, your #1 choice was clear. In your mind, there’s no contest, and you may even fantasize about it. Still . . . you may not get #1. Your rank order list (ROL) spreadsheet comes back to haunt you. You start second-guessing yourself . . . all of your rank criteria band together in endless permutations to make you think of all the things you’ll have to say no to, once you find out where you’ll be going. What if my match is a bad fit? What if I actually do match in Wisconsin? They have winter there, like… every year. Whose desires and needs drove my weighting of the criteria? Did I choose so I could please myself? My spouse? A mentor? Was I trying to impress my friends by aiming high? (And correlatively, did I leave no stone unturned in my studying and applications? What if someone else gets “my spot”?) Did I leave off some programs that, in retrospect, seem like a really good fit? When I interviewed, did I ask the right questions, and was I paying attention to the People in the programs, the schools’ Philosophies, and to their likelihood to advance my Passion” (See “It’s Not the Spreadsheet: Rank Order Lists Done Right”)?

Even if our ROL was well thought out, we face the plague of “imagined alternatives.” This means that as the number of options increases, our satisfaction upon obtaining any one of them decreases. We just can’t help thinking about what might have been. Barry Schwartz sums up the situation nicely: when we have to choose between two pairs of jeans, dissatisfaction with our choice can be blamed on the universe—we didn’t find the perfect pair, because it didn’t exist. But when we choose from among 100 pairs of jeans, any dissatisfaction is our fault, because surely we could have found something better if only we had looked harder. NRMP statistics show that match rate and length of ROL are directly correlated, with longer ROLs being associated with higher match rates.

So if the very things that help us are also the sources of our Match Week fears, what can we do? Take a deep breath, and remember that the well-crafted ROL is an insurance policy against lasting disappointment. The second-guessing and imagined alternatives will come . . . but they will also go away again. Everyone who reaches this point knows that they matched, and everyone with a sturdy, thoughtful, and complete ROL can take solace in the fact that any match on their list will be a good fit for them. This is a situation where second place is not “first loser.”

The Match Process

The Match process begins with the due date for submitting one’s rank order list. In 2019, this is February 20. This is also the date by which residency programs need to submit their lists of applicants they would like to admit to their incoming class. Then the algorithm runs . . .

The algorithm is the great leveler—it treats everyone the same, plays no favorites, is immune to bribery, has no agenda of its own. It simply looks at what everyone wants (applicants, programs) and generates a list that gives it to them, matching applicants with residency programs where there is a mutually indicated desire for a match. It’s like online dating that actually works—if you’ve matched, you’re guaranteed a long-term relationship (with your residency program)!

The algorithm favors the students over the programs—matches are initiated based on the applicants’ ROL, and not the programs’ lists. The algorithm checks each applicant’s ROL preferences against all the programs who also ranked him or her. If the applicant and program mutually rank each other as their first choice, it’s settled—there’s a match. But if the applicant’s #1 choice ranked him or her as their #3 choice, there is a good chance that two other people will be matched to that program before the applicant gets a chance. Depending on the number of slots available at a given program in a given specialty, it becomes obvious why people with longer ROLs match at a higher rate.

A Match Is a Match

In addition to the neutrality of the matching algorithm, you benefit from the anonymity and confidentiality of the system. Programs don’t know where you ranked them, so when you get matched to your #2, they don’t know they were your #2. Ergo, no vendettas or hurt feelings when you start your training there. Likewise, you don’t know where you were ranked by them. This means that, from both perspectives, a match is a match. (The hierarchies and favoritism will come soon enough—just not in the matching process!)

And that is really the thing that will keep you sane in the days and hours leading up to the big reveal on Match Day. If you did your homework, you won’t need to worry about where you will match, because wherever you go, there you will belong.