The National Resident Matching Program (NRMP), also called The Match, is a United States–based private non-profit non-governmental organization created in 1952 to place U.S. medical school students into residency training programs located in United States teaching hospitals. Its mission has since expanded to include the placement of U.S. citizen and non-U.S. citizen international medical school students and graduates into residency and fellowship training programs. In addition to the annual Main Residency Match that in 2021 encompassed more than 48,000 applicants and 38,000 positions, the NRMP conducts Fellowship Matches for more than 60 subspecialties through its Specialties Matching Service (SMS). The NRMP is sponsored by a board of directors that includes medical school deans, teaching hospital executives, graduate medical education program directors, medical students and residents, and one public member. NRMP International, a subsidiary of the National Resident Matching Program, was established in 2010 to provide medical matching services outside the United States and Canada.
History From shortly after the first residency programs were formally introduced in the 1920s, the hiring process was "characterized by intense competition among hospitals for (an inadequate supply) of interns." In general, hospitals benefited from filling their positions as early as possible, and applicants benefited from delaying acceptance of positions. The combination of those factors led to offers being made for positions up to two years in advance of the start of postgraduate training. In 1945, medical schools decided not to release any transcripts or permit any letters of recommendation to be written until a particular date. In that way, they managed to move the date of residency selection back to the fourth year of medical school. However, the competition for residents simply took on another form. Programs began to issue offers with a time limit for reply. The time limit rapidly decreased from 10 days in 1945 to less than 12 hours in 1950. Students were being issued "exploding" offers that required them to make a decision about training before hanging up the telephone. In the early 1950s, the National Interassociation Committee on Internships (NICI) examined existing matching plans and chose the Boston Pool Plan, utilized at the time by Boston-area programs, as the model for a trial run of a new centralized system. In October 1951, student representatives from 79 medical schools formed the National Student Internship Committee (NSIC) to discuss the findings of the NICI trial Match and consider an NICI proposal to replicate the Boston Pool Plan at the national level. NSIC petitioned to have the algorithm modified to more equitably represent applicants, and the modified algorithm was adopted and used for the first Match on 1952. That Match was a success, and the NICI recommended the creation of an organization to administer and oversee the running of the Match. The organization, known as the National Intern Matching Program (NIMP), was established in 1952 at the request of medical students. Modifications to the algorithm proposed by students in 1951 were based on concerns that the matching process favored hospitals over applicants. The students believed the algorithm gave them incentives to misrepresent their true preferences. A publication in 1962 by David Gale & Lloyd Shapley noted that there always exists a stable solution when colleges are matching with students, but that it is possible to favor colleges as a group over applicants as a group (and vice versa). That is, Gale and Shapley found that there is a college-optimal stable match and an applicant-optimal stable match. Lloyd Shapley along with Alvin Roth, would go on to win the 2012 Nobel Prize in Economics for their work on stable allocations. A debate arose regarding whether the matching program was susceptible to manipulation or unreasonably fair to programs. Indeed, it was shown that in simple cases (i.e. those that exclude couples, second-year programs, and special cases for handling unfilled slots) that had multiple "stable" matchings, the algorithm would return the solution that preferred the preferences of programs over applicants. A correspondence in New England Journal of Medicine in 1981 recognized that the algorithm in use was program-optimal for individual applicants. Later researchers, such as Marilda Sotomayor in 1983, Alvin Roth in 1984, and Klaus et al. in 2007, found that when couples are allowed to match together, there may exist no stable matching. However, Fuhito Kojima and Parag Pathak in 2009 demonstrated that if the market is large and the fraction of couples is small, then a stable matching exists with high probability. The NRMP algorithm saw only minor and incremental changes after its institution in 1952. However, in the fall of 1995 the NRMP Board of Directors commissioned a preliminary research study to evaluate the current algorithm and recommend changes to be considered in its operation and description, as well as a study comparing a new algorithm with the existing one. A new applicant-proposing algorithm was adopted in May 1997 and has been in use since its first application in March 1998, although the study showed that the net effect of the change on actual matches has been minimal.
Matching algorithm Matching applicants to programs is a generalization of the stable marriage problem; as a result, the solutions are very similar. A simplified version of the algorithm that is used to perform the matching process is described below and on the NRMP website. However, this description does not include the handling of couples (pairs of applicants who participate in a Match together, perhaps to stay in the same geographic location), second-year positions, or special handling of residency positions that remain unfilled. The full algorithm is described in Roth & Peranson 1999.
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