Ask the expert: How does the NRMP work?

Residency Program Insider, June 29, 2010

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The NRMP ranking system is based on two rank order lists: (1) The candidates’ list of programs where they would like to do their training; and (2) the program’s list of candidates they would like to employ. The NRMP considers the candidates’ preferences first by trying to match them with their first choices. As the NRMP moves down the list of a candidate’s choices, the organization also takes into account where the program ranked the applicant. Those candidates who ranked the program first will match to the program in order of the program’s listing.

For example, a training program fills five positions during the Match. Program staff members interview 30 candidates and put 25 on their final ranking list. Of the 30 candidates, seven put the training program first on their list. Those seven are reordered according to where they appeared on the program’s list. The first five who match to the program’s list would enter that program. The remaining two candidates go back into the Match for their second or third choice. At that point, the program’s positions are filled, and the NRMP removes them from the Match. Programs sign a contract with the NRMP that states that they cannot offer a position to a candidate prior to the Match, nor can they tell the candidate where they are ranked on their list.

Violations of this contract result in the Match barring the program for up to three years, or permanently. The candidate also signs a contract with NRMP indicating that they will abide by the Match and the NRMP’s rules.

Candidates or programs may resign from the Match at any time prior to the final deadline, which the NRMP states on its website. However, a candidate shows unprofessional behavior if he or she resigns without reasonable cause from a program to which the candidate has been matched.

This week’s question and answer are from The Complete Residency Program Management Guide by Ruth H. Nawotniak, MS, C-TAGME.

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