By | April 17, 2016


This article originally appeared on The Wealthy Physician Blog.

In June 2015 Freakonomics Radio released the episode “Make Me a Match”. It highlighted the idea of “matching markets” developed by Stanford professor of economics and Nobel prize winner in economics in 2012 Al Roth. The idea was further detailed in his book Who Gets What—and Why: The New Economics of Matchmaking and Market Design published in 2012.

To say it is worth listening to this episode of Freakonomics is a huge understatement. If you have any desire to understand how the residency match works – as you absolutely should if you’re a medical student – then it should be on the top of your short list of things to do soon.


In short, Al Roth helped create the residency match. He has done tremendous work throughout his storied career to help match subjects together in a market in which they would otherwise not come together. Of course, this is the case for medical students and residency programs when it comes to the residency match.

Historically, medical students were struggling to take positions they really wanted and residency programs were struggling to find appropriate applicants for their available positions. Al Roth changed all that by creating the residency match. A couple decades later some tweaks were made to improve it, such as helping couples applying the same year match in the same location.


However, another couple decades later the process of matching medical students into residency programs is at a crossroads again. To say it is a failure would be unfair and wouldn’t do justice to all the good that still comes out of the residency match.

Nonetheless, a new struggle has presented itself. This time around the shear force of numbers applying to residency programs makes it nearly impossible for enough good outcomes to come from it. This is a complicated issues with many variables involved but the shift is already happening and must be addressed before any more harm is done.

The shift I’m referring to is the severe shortage of residency spots available to the medical students who apply each year to the residency match. More than forty thousand applicants participate in the residency match each year now, but just over thirty thousand residency spots are available to match into.

The days of more residency students than applicants is way behind us. Instead, the opposite situation exists, but the residency match process remains exactly the same.


In fact, more medical schools are opening each year so that there are more applicants who participate in the match process but no new residency spots are being created. Although many medical students end up with an ideal match outcome many more do not end up matching at all. This often leaves these medical students in serious debt with little hope for the future.

Medical students feel more and more pressure each year as coveted residency spots become more competitive to match into. Stress mounts and lives are forever altered but the topic is hardly even addressed during medical school. I know because I was a medical student not too long ago.

I’ve seen first hand how the perils of the residency match can destroy dreams. Willful blindness only serves to perpetuate the problem. Not only that, but there are also no significant programs established to provide medical students with advice and strategies for how to succeed in the residency match.

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