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 Match was created to allow program directors and applicants to consider all their options before making final commitments, 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 listing of their choices in preference order, which are then used by the Match to place applicants into residency 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 (programs and applicants) through the Match application and rank ordering process. Those policies are the foundation of a fair, open, and orderly process. The failure of a Match participant to comply with one or more of those 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.
• 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 a high degree of interest in each other and try to influence decisions in their favor, but must not make statements implying a commitment. Although the Match Participation Agreement does not prohibit either an applicant or program director from volunteering how one plans to rank the other, it is a violation to request such information. 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 NRMP Match and does not withdraw from the NRMP Match. (This includes an applicant who matches to a concurrent year PGY-1 position in another match that precedes the NRMP 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.

Violations During Match Week

• An unmatched applicant contacts a program in the Match to seek a position before noon eastern time on Tuesday of Match Week
• A program director, anticipating that the program will not fill all of its positions, contacts a student affairs dean on Monday of Match Week to find out which students did not match.
• A student affairs dean consults with faculty and other colleagues about possible openings before the beginning of the Scramble period.
• A student affairs dean consults with students about their match status prior to the release of applicants' Match results on Monday of Match Week.

Not Honoring Results of Match

• An applicant decides not to honor the commitment to his/her matched program and does not seek a waiver.
• A matched applicant accepts a position in another program.
• An institution adds new appointment requirements that were not communicated to applicants prior to the rank order list deadline.
• A program director approaches an applicant who is matched elsewhere to explore the possibility of having the matched applicant switch programs.
• A program decides not to honor its commitment to a matched applicant who satisfies all the appointment requirements.
• A program seeks a waiver from a commitment to a matched applicant in order to offer the position to another applicant.
• 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 a position in any NRMP match-participating program.

The Match Participation Agreement stipulates that programs and applicants can receive a waiver from their commitments when there is a "serious hardship." Waivers must be requested from, and can be granted only by, the NRMP.

"Serious 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 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 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. In many instances, immediate notification allows time to prevent the violation. The NRMP will work with all participants to rectify difficult situations. 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 up to three years or permanently, and may be precluded from accepting a position in any NRMP match-participating program for one year. 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 Residency 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 up to three years or permanently.

Updated 11/16/2006