Match madness is approaching, and fourth-year medical students are about to face one of the most exciting — and stressful — times of their lives.

With a January 30 registration deadline, it’s time for almost-doctors to complete paperwork and begin ranking residency preferences for Match Day, March 20. 

While there are other mechanisms for some medical students — those in urology or ophthalmology, for example — to select their residencies, Match Day is by far the largest, last year placing about 47,000 medical students to residencies. “The Match,” overseen by the National Resident Matching Program (NRMP), uses a computer algorithm to match up newly graduated doctors to residency programs across the country so the doctors can continue to learn, train, and conduct research. 

For tens of thousands of medical students, it’s a milestone that marks the end of years of hard work and the beginning of their career practicing medicine.

“It’s exciting to know I’ll be a doctor and doing the work I love to do,” said Aliya Redd, a fourth-year student at the University of Florida in Gainesville, and she can’t wait to get to work.

“I really love working with kids,” she said. “I’ll be getting to do what I’ve always wanted to do.”

And yet, there’s also anxiety associated with the process: Will you get the residency you want? And, beyond that, an even heavier question weighs: Will you match at all? While numbers vary each year, not matching is inevitable for some.

“It’s incredibly stressful, unlike typical job interviews, where you interview, you get an offer, you accept and then it’s done,” said Hilit Mechaber, MD, senior associate dean of student affairs at the University of Miami’s Miller School of Medicine. 

For the past 70 years, the NRMP has brought a method to what was previously an extremely chaotic process. Some students received several offers before the official deadline and held onto them, waiting to weigh other options. That meant other students could not get offers. Some programs pressured extremely promising students, urging them to commit before other offers came in.

In addition to the computer algorithm, Match Day brought consistent rules and deadlines that everyone agrees to follow.

After registering, students will begin to rank the programs on February 2. They have several weeks to consider a wide range of variables — from what they think they can best learn from the program and the mentorship they may receive.

“What they really need to do is to ask [themselves] how well a program fits in with their personal values, how they want to practice,” said Jeanette Calli, chief of match operations at NRMP. “If a program doesn’t align with their goals, they shouldn’t rank it.”

The next big deadline is March 4, when rank order lists are due. After these are certified on March 4, students cannot make changes, Calli stressed. 

“We do get calls on March 5, with someone saying I want to change my No. 3 to No. 1, and the answer is always going to be no,” she said.

After the March 4 deadline, the NRMP runs the rankings through its proprietary algorithm that matches residents to a program. Calli said it’s an intense 2 weeks for NRMP because there’s also a lot of data checking, confirmation of eligibility, and other details.

Aisha Jimenez, MD, now a resident in psychiatry at Meharry Medical College in Nashville, said that proximity to family is important to consider. And if a residency isn’t available in a town close to family, consider whether the residency is in a city close to an airport, she said. 

“Being around loved ones, being near an airport — these are definitely things to consider,” Jimenez said.

It’s also important to ask programs about relocation expenses, vacation days, and whether they have wellness programs, Jimenez said. Finding out about small things such as cellphone reimbursement and parking are also important, Jimenez and Redd said. 

All of these considerations add to the stress of the match process, so they urge medical students to rely on their support systems during the process.

And the University of Miami’s Mechaber urged students to turn to their current program’s advisers. 

“We spend a lot of time helping them think about ways they can prioritize their goals and values,” she said. “They are really coming to the final steps, and we encourage them to dig deep into resources that can help.”

That includes meeting with specialty advisers at their schools, attending any open houses that might still be offered, and utilizing tools and tips on the NRMP website.

Brian Hou, MD, an orthopedic surgery resident at Vanderbilt University Medical Center in Nashville, recommended trying your best to relax after the rank order list is finalized. 

“There’s definite anxiety, but I realized I literally could not do anything else, so I turned my attention elsewhere,” Hou said.

That included training for a Half Ironman triathlon, upping his cooking skills, and playing new board games.

And at the same time students are preparing to find out their residency destination, they also must be prepared to not match. On March 16, students learn whether they match, just not with which specific program.

Each year, many students — the number varies — end up without a match. Not matching can be devastating. Jimenez knows that first-hand.

“It hurt my soul,” she said. “You never think it will happen to you.”

Jimenez went through the supplemental program and landed on her feet.

Mechaber said it is important for students to understand that not matching is a possibility even among the best of students. 

“Not matching is incredibly disappointing, and it happens no matter how talented, how smart a student is,” she said. Advisers at the University of Miami spend a good deal of time preparing students for not matching to lessen the blow.

“We think it’s important to normalize it, because it does happen. We want them to feel like they are not a failure,” Mechaber said.

Hou said that not matching was in the back of his mind, too.

“There’s always, just by the numbers, the chance that you won’t match,” Hou said. “But keep your head up. No one’s in the process alone. You’ve got your family, friends and mentors — lean on them.” 

During the week of March 16, those who did not match should seek help from their school advisers for the Supplemental Offer and Acceptance Program. SOAP, as it is known, is a complicated process in itself, and it’s important to get help.

Janice Cousin, MD, a psychiatry resident at the University of Chicago Medical School who matched with her first choice, urges students who did match to be prepared to emotionally support those who did not. 

“When you don’t match you don’t have time to grieve, you don’t know what to do,” she said. “It’s hard to watch.”

Reaching out and reminding them of your friendship and support can go a long way, Cousin said.