“Match Day” occurs annually in March. This year’s edition has already occurred and has left us with some questions and concerns.
“Match Day” is the day 4th year medical students learn which residency program at which institution they have matched. It’s the day they learn where the next phase of their medical career is headed. It is the exciting day that sets the stage for training in the specialty of your choice, and the final phase of your medical education before entering private practice.
The whole program has been successfully and effectively run by the National Resident Matching Program (RNMP) for over 70 years. Students apply and interview for the programs then rank them in order of preference. Institutions also rank applicants in the order of their suitability and desirability for the program, then, the NRMP uses a computer algorithm to “match” individuals and institutions. Most participants receive their first or second choices. Recently, the NRMP has been the target of those who think it is monopolistic and anticompetitive. More about that later.
According to the American Academy of Family Physicians (AAFP), a large number of family medicine slots went unfilled this year. While the total number of applicants for family medicine residencies increased, 16% of the 5491 FM residency positions were left unfilled. And just under one third of the slots were filled with US med school graduates. That means over two thirds of new FM residents will be Doctors of Osteopathy (DO’s), or FMG’s, foreign med school graduates. I don’t know what this data portends for the future, but I know it will have an impact on the availability and quality of care.
Primary care specialties—internal medicine, med-peds, pediatrics, and family medicine—which make up the largest portion of available positions, had a 92% fill rate, a 1.4% decline from last year. The concern is there seems to be declining interest in a career in family medicine. Medical schools aren’t placing emphasis on students entering family medicine, and the responsibility for training family physicians has fallen to schools of osteopathy.
For over 70 years, the NRMP has been a successful matching program, taking 4th year med students and matching them with the residency program of their choice. Since 2004, the program has been accused of being a monopoly (it’s the only matching program in the country) and “shielded from scrutiny by government protectionism.” The program is “protected by….an antitrust exemption, the Pension Fund Equity Act.” This led the House of Representatives of the U.S. Congress to investigate the program for causing detrimental effects on early career physicians in regard to salary negotiations, work hours, and job duties. Allegedly, the match prevents residents from negotiating employment terms and restricts career flexibility.
Of course, my experience with the NRMP was literally 57 years ago so there probably have been a lot of changes in that time. It was an easy process and I didn’t feel cheated or oppressed in the least. I was ecstatic I got my first choice. In 1969, there were no salary negotiations. You made what the hospital paid, but hospital meals were free and some programs provided low cost housing. You were there to learn and gain experience, not to get rich.
It seems like this is an “if it ain’t broke…” situation. I know, though, when the government gets involved in breaking up a “monopoly” or threatens anti-trust litigation, it never turns out well for the accused party. There may be factors or incidents I don’t know about that have warranted further scrutiny of NRMP.
But for now, why mess with something that doesn’t seem broken. In today’s world, though, there could be all sorts of issues that no one considered a problem 57 years ago.
References: Ault A. Match Day 2026: Is Family Medicine Half-Full or Half-Empty? Medscape 2026 March 20.
The Big Story. Choi J. “House Judiciary Committee calls out ’monopoly’ on medical resident matching.” The Hill 2026 March 27.
