By Daniel Giang ’83

Imagine It’s 1951…

You’re on the verge of graduating from medical school. After countless hours typing out 20 applications and carefully crafting personal statements, you’ve completed interviews at several hospitals. You’re hoping—really hoping—to match at Ivy University, near your fiancé’s hometown. But so far, no offer.

Then comes a lifeline: Frostbite Falls Hospital (FFH) extends you an internship offer—but with a catch. They need your decision today. You scramble, sending a desperate telegram to Ivy U: Any chance? Please, just a hint?

Silence.

With no better option and the deadline ticking down, you sign the contract with FFH. One week later—of course—Ivy U offers you the position you wanted all along.

What do you do?

What you didn’t know was that FFH’s program director was under immense pressure, fielding urgent letters and calls from other qualified applicants. And the Ivy U director? You were next on her list—but she was waiting on another student’s decision.

Now, multiply this chaos by thousands of students and hundreds of programs across the country. You can see why everyone was thinking, We’ve split the atom—can’t we figure out a better way to match interns to hospitals?

The Answer: The Match

In 1952, using the “Boston Pool algorithm” that had been piloted in Massachusetts, a national match was conducted. The lists were originally matched by hand! The underlying algorithm, developed by David Gale and Lloyd Shapley, became a foundation in economic theory.^1,2 In fact, Shapley and Alvin Roth were awarded the Nobel Prize in Economic Sciences in 2012 for the theory of stable allocations.³ This still undergirds the Match.⁴

The Match allowed both applicants and programs to be able to “take a flyer” on their most desired match while simultaneously having the confidence they would be satisfied with their lowest rank. As one might say: keep the bird in hand while still hoping for two in the bush. This proved so successful that in 1953, the National Residency Matching Program (NRMP) was born.

More Than a Process—A Pillar of Stability

Over the decades, the NRMP has evolved to serve the needs of a growing, diversifying physician workforce. It now includes couples matching, accommodates both osteopathic and allopathic applicants, and replaced the frenzied faxing of “Scramble” with the web-based Supplemental Offer and Acceptance Program (SOAP).

The Match has proved so successful, many physicians consider it a mysterious relic of medical training. But in reality, it is one of the most stress-relieving processes in a high-stress profession. It minimizes chaos. It adds fairness. And it gives both students and programs a reliable system in an otherwise uncertain time.

So the next time you reflect on your own Match Day—whether it ended in cheers or tears—remember this: it could have been telegrams, soul-searching, and second-guesses. 

Endnotes

1. Gale D., & Shapley LS. “College Admissions and the Stability of Marriage.” The American Mathematical Monthly, 1962;69(1), 9–15.
2. Roth AE. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909–912.
3. Nobel Foundation. “Nobel Prize in Economics 2012: Stable Allocations—from Theory to Practice.” ScienceDaily. ScienceDaily, 15 October 2012.
4. Roth AE. Ibid.