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Let the Match Do its Work

October 29, 2023

Program directors and other recruitment team members may freely express their interest in a candidate, but they must not request an applicant disclose ranking preferences, ranking intentions, or the specialty or locations of other programs to which the applicant has applied or may apply.

-NRMP Match Code of Conduct

Hi everyone,

On interview days, here’s what I tell residency applicants: You don’t need to write to us after today, and we won’t consider whether you wrote when we construct our rank lists. We won’t send messages to convey enthusiasm or imply where you stand on our list. Just rank the programs you love first and let the match do its work.


That’s how it should be. The match algorithm is designed to send applicants where they belong. The process is meant to be confidential. Programs that push candidates to reveal their preferences are violating the rules and hurting applicants (see attached):

Most internal medicine programs follow these rules, but, unfortunately, I know from speaking to residents that certain fellowships do not, implying or even stating explicitly that if candidates want to match with them, they should “let them know.” The motivation for fellowships is obvious: by pushing candidates to commit, they’re trying to build an incoming class without having to rely on the match algorithm. In many cases, the commitment is not bidirectional; programs may express enthusiasm, but enthusiasm is not a promise.

The pressure to commit puts candidates in an awkward position, compelling them to engage in a quid pro quo: if you want to match here, you need to tell us. This raises a quandary for applicants. Should I commit to my favorite program or a program where I believe I’m more likely to match? What if anything should I tell other programs? If I don’t communicate, am I blowing my chances?

Fellowship applicants regularly ask me for help navigating this terrain. Here’s what I tell them: First, if a program asks you to commit, they’re violating ethics rules. Consider what this says about the way they treat fellows. Second, understand that when programs convey enthusiasm, they’re trying to get you to place them higher on your list. Programs that don’t write are likely just as enthusiastic, though less manipulative.

It’s important to know that while you are free to express your interest in a program, it’s also an NRMP violation for you to try to influence programs’ decisions (see attached). It’s also important to understand how programs interpret letters. When candidates say they’re ranking a program “first” or “#1,” it’s considered a commitment. When candidates say they’re ranking a program “highly” or “at the top of their list,” it’s interpreted as a way of saying another program is number one. It’s more compelling (and ethical) to convey your interest by explaining why a program would be a good fit, professionally and/or personally.

Unfortunately, we will continue to confront these issues until all programs commit to ending post-interview communications. Until then, if you need advice, let me know.

A final word: as a group, our residents always do well in the fellowship match (see attached), not because they send letters but because they’re brilliant clinicians, educators, leaders, and scholars. This will undoubtedly be true this year too. I advise all of you to follow the advice I give residency applicants: just rank the programs you love first and let the match do its work.

Enjoy your Sunday, everyone. Hopefully, the rain will end so I can hike up East Rock before diving into another batch of residency applications.


Submitted by Mark David Siegel on October 29, 2023