The Integrity of the NRMP Match

The Process

Beginning in the early fall of each year, residency training candidates undertake the challenging task of seeking the program where they will begin their residency training the following July. Concurrently, graduate medical education program directors begin to review applications and to interview and evaluate candidates for their available residency positions.

What is the Match?

The NRMP Main Residency Match was created to allow program directors and applicants to consider all their options for graduate medical education training without undue or unwarranted pressure, and to establish a uniform date and time for the announcement of residency position appointments. After completing their respective evaluations, programs and applicants each prepare a final, confidential listing of their choices in preference order, which are then used by The Match to place applicants into residency training positions. The success of The Match depends on a high level of trust among all participants in the Matching Program.

What is a "Match Violation"?

The NRMP has established principles and policies to guide participants (sponsoring institutions, residency programs, medical schools, and applicants) through The Match application and rank ordering process. The policies are the foundation of a fair, open, and orderly process. The failure of a Match participant to comply with one or more of the policies is called a Match violation. The NRMP's Policy and Procedures for the Reporting, Investigation, and Disposition of Violations of NRMP Agreements governs the NRMP's handling of Match violations.

Match violations negatively affect all participants in The Match. For example, the consequences of Match violations can result in:

• An applicant being pressured by a program director to reveal the program's place on the applicant's rank order list or to identify the names of other programs with which the applicant has interviewed.
• A program director being notified that a matched applicant will be a "no show" and finding that no other suitable candidates are available.
• An international medical graduate being pressured by (or pressuring) a program director to sign a contract before Match Day.
• A student affairs dean counseling an unmatched student who believed a program director's "promise" that he/she would be ranked first.
• A matched applicant who could have matched to a more preferred program because that program now has an open position because another applicant was a "no show".

Some Match violations are committed with full awareness of the fact that the action is a violation; however, in many cases the violation occurs because the participants are unaware of what constitutes a violation of the Match Participation Agreement.

NRMP Statement on Professionalism

The National Resident Matching Program maintains the highest professional standards in the conduct of The Match and in its interactions with all Match participants: applicants, program directors, institutional officials, and student affairs deans. The NRMP expects all Match participants to conduct their affairs related to The Match in an ethical and professionally responsible manner. All Match participants are urged to read the NRMP Statement on Professionalism.

Applicants are expected to adhere to the terms of the Match Participation Agreement in their search for a residency position. Program directors, institutional officials, and deans of student affairs must honor the conditions of their Agreement with the NRMP and also respect the right of applicants to freely investigate program options prior to submission of a final rank order list.

How Do I Avoid Engaging in a Match Violation?

The policies and procedures of the NRMP Match process are available on the NRMP web site in the Match Participation Agreement. When registering for The Match, all participants agree to conduct their Match-related affairs in a manner consistent with those policies. Participants can avoid engaging in a Match violation through the observance of practices that respect the right of programs and applicants to determine their selections in the absence of unwarranted pressure and to adhere to the highest ethical principles in all interactions with other Match participants.

Match Communications

Applicants and program directors may express their interest in each other; however, they shall not solicit verbal or written statements implying a commitment. Applicants shall at all times be free to keep confidential the names or identities of programs to which they have or may apply. In addition, it is a breach of the applicable Match Participation Agreement for a program to request applicants to reveal ranking preferences or for either party to suggest or inform the other that placement on a rank order list is contingent upon submission of a verbal or written statement indicating ranking preferences. Program directors and applicants frequently engage in the practice of sending letters following the applicant's interview with the program. Those letters often contain statements that can be misinterpreted by either party. Match participants must understand that such letters are not binding and have no standing when final rank order lists are submitted.

Examples of Violations

NOTE: The examples of Match violations noted below are not intended to be all-inclusive. Any additional questions or clarifications about Match violations should be directed to the NRMP.

Agreements Made by Match Participants Before The Match

• A program accepts and signs an agreement with a senior student in a U.S. allopathic medical school before Match Day.
• An applicant requests a contract before the announcement of Match results
• An applicant commits to a concurrent year training position outside The Match and does not withdraw from The Match. (This includes an applicant who matches to a concurrent year PGY-1 position in another match that precedes The Match.)
• A program director "guarantees" an applicant that he/she will rank the applicant within the program's quota, but only if the applicant will rank the program first on his/her rank order list.
• An applicant "guarantees" a program director that he/she will rank the program first on their rank order list, but only if the program director will rank the applicant within the program's quota.

Examples of Violations During Match Week

• An unmatched applicant contacts a program to seek a position before 2:00 p.m. eastern time on Monday of Match Week, or uses a method other than ERAS to apply to programs.
• A program director, anticipating that the program will not fill all of its positions, contacts a student affairs dean prior to 2:00 p.m. eastern time on Monday of Match Week to find out which students did not match.
• A student affairs dean consults with the directors of unfilled programs, faculty, and/or other colleagues about possible openings before the beginning of the Match Week Supplemental Offer and Acceptance Program^SM (SOAP^SM).
• A student affairs dean consults with students about their Match status prior to the release of applicants' Match results at 12:00 noon on Monday of Match Week.
• An applicant or program distributes or posts proprietary Match information to a web site or non- NRMP-related matching service.

Not Honoring Results of Match

• An applicant who matched to a position or who accepted a position during SOAP decides not to honor the binding commitment and does not seek a waiver from the NRMP.
• An applicant who matched to a position or who accepted a position during SOAP accepts a concurrent year position in another program.
• An institution adds new appointment requirements that were not communicated to applicants prior to the rank order list deadline or during SOAP.
• A program director interviews an applicant who matched to or accepted a concurrent year position in another program and who has not obtained a waiver from the NRMP.
• A program director approaches an applicant who has a concurrent year binding commitment to explore the possibility of having the applicant switch programs.
• A program decides not to honor its binding commitment to an applicant who matched to or accepted a position during SOAP and who satisfies all the appointment requirements.
• A program involved in a waiver investigation fills the position prior to the NRMP approving the waiver request.
• A program offers a position to an applicant whose waiver request was denied, and training commences during the applicant's one-year prohibition from accepting or starting a position in any program sponsored by an NRMP Match-participating institution.

The Match Participation Agreement stipulates that programs and applicants can receive a waiver from their commitments when there is a "serious and extreme hardship." Programs and applicants are not authorized to release each other from their binding commitment. Once a party has matched or a position has been offered and accepted during SOAP, a waiver of the binding commitment may be obtained only from the NRMP. "Serious and extreme hardship" refers to the occurrence of a highly unusual, unexpected, and unpredictable situation or circumstance that renders the fulfillment of The Match obligation impossible or would result in irreparable harm to any one of the committed Match participants. Examples of "serious and extreme hardship" include an applicant who failed to graduate on time; the closing of a program or institution; the death or serious illness of a family member that requires the applicant to alter the choice of residency location; or the loss of accreditation by a program or institution.

"Serious and extreme hardship" does not include taking advantage of a more "desirable" program or applicant after rank order lists are submitted.

What Do I Do When a Violation Occurs?

All participants in The Match affirm their commitment to conduct their match-related affairs within terms of the Match Participation Agreement. Participants should contact the NRMP with any knowledge or suspicion of a violation as soon as possible. The cooperation of peers is an important step toward ensuring a fair and equitable matching process.

Confirmed violations by an applicant are reported by the NRMP to the applicant's medical school, the American Board of Medical Specialties, the Educational Commission for Foreign Medical Graduates if the applicant is a student/graduate of an international medical school, and other appropriate individuals and organizations. In addition, applicant violators may be barred from future NRMP matches and/or identified as a match violator for one to three years or permanently, and may be precluded for one year from accepting or starting a position in any program sponsored by an NRMP match-participating institution. Applicants who are barred permanently from the NRMP also are reported to the Federation of State Medical Boards.

Confirmed violations by a program are reported to the Accreditation Council for Graduate Medical Education (ACGME) and the respective Review Committee, the appropriate program director association, and other appropriate individuals and organizations. In addition, program violators may be barred from future Matches and/or identified as a Match violator for one to three years, or permanently.

Updated 02/07/2012