Residency and the Match (NRMP)

In the USA, graduating from medical school, whether at home or abroad, is not enough to practise independently. Doctors complete residency, a paid training programme in a specialty, which starts at PGY-1 (postgraduate year 1). State medical boards require a period of US graduate medical education for state licensure.

Most residency places are filled through the Main Residency Match, run by the National Resident Matching Program (NRMP). Applicants apply to programmes, interview, and then each side submits a ranked list. An algorithm matches applicants to programmes, and the result is binding under the Match Participation Agreement.

The NRMP states that international medical graduates (IMGs) must have completed the medical science examination, clinical skills and communication skills requirements for ECFMG certification by the rank order list certification deadline, which for the 2027 Match is 3 March 2027. In practice this means passing the required USMLE exams and meeting the other ECFMG requirements in good time. Non-US citizens also need a visa that allows residency training, most often the J-1 sponsored by ECFMG, or an H-1B where a programme offers it. Our ECFMG overview and USMLE guide cover these steps.

1. Register with the NRMP from 15 September 2026. The standard registration deadline is 29 January 2027; registering later costs an extra $50.
2. Apply and interview. Applications to programmes are made separately from NRMP registration.
3. Rank programmes. Ranking opens on 1 February 2027 and the rank order list must be certified by 9 p.m. ET on 3 March 2027.
4. Match Week. On 15 March 2027 applicants learn whether they matched, and unmatched eligible applicants can take part in the Supplemental Offer and Acceptance Program (SOAP).
5. Match Day is 19 March 2027, when results are released at 12 p.m. ET.

The NRMP registration fee is $85, which covers up to 20 programmes on the primary rank list. Each additional programme costs $30, up to 300 ranks.

The NRMP reports that the 2026 Main Residency Match had more than 53,000 registered applicants and over 44,000 positions, with 93.5 percent filled. Among non-US citizen IMGs, 11,944 were active applicants and the PGY-1 match rate was 56.4 percent. For US citizen IMGs the PGY-1 match rate rose to 70 percent. Through SOAP, 2,581 positions were offered.

• ECFMG requirements not complete by the rank order list deadline. The NRMP runs weekly data exchanges with ECFMG to check IMG eligibility, and applicants who have not met the requirements cannot be matched.
• Breaking the Match agreement, for example by accepting another offer after matching. The NRMP says the agreement is binding and its obligations run until 45 days after the start of training.
• Ranking too few programmes, or ranking programmes you would not attend, which the agreement does not allow.
• Leaving visa planning late. Programmes differ on which visas they sponsor, so check before you rank them.