It is that time of year again for March Madness, but I am not talking about college basketball. I am referring to the other March tradition that is maddening for graduating medical students and patients across the nation. I am referring to the National Residency Matching Program (Match), when nearly 50,000 medical students discover where and in what field they will complete their training. Whichever residency program they match determines their career trajectory.
Match Day is usually the third Friday in March. Fourth year medical students will have spent four years in college studying science, asking for references from professors, volunteering to boost their applications, and applying for medical school. Next comes four years of studying medicine, cultivating the favor of professors (for future references), and finally interviewing and applying for coveted residency programs across the country. A computer algorithm weighs each candidate’s preferences and compares it to residency program committee preferences and matches candidates to programs. A few residency programs do not fill all slots, while many candidates do not match to any residency program slot.
Residency is required to practice medicine. Even physicians who were trained abroad and went through a residency abroad must go through a 3-to-7-year residency training program in the United States before they can practice. The type of residency also determines which area of medicine you will likely spend the rest of your life practicing. Some specialties are more sought after than others. Suppose you wanted to study plastic surgery in Southern California with average annual compensation between $500,000 and $800,000 a year. But you were only offered a public health/preventive medicine slot at a rural medicine residency in the middle of nowhere where pay is less than $200,000. That is an enormous difference in lifetime pay and prestige, but it could be worse.
Here is the catch. Not only are the more lucrative residencies highly competitive, but there are also not nearly enough residency program slots for all who apply. Back in 1997 the American Medical Association lobbied Congress to cap the number of residency slots that Medicare funds. Their argument was that there would soon be too many physicians, which would drive unnecessary medical spending. This theory is called physician induced demand. As a result, there is now a physician shortage that could grow to 86,000 doctors within 10 years. There are many other reasons for the shortage, but age and burnout are two important ones. About one-in-five doctors are already over the age of 65. More than one-third of physicians surveyed reported hoping to leave their current role in the next five years, while more than half of those (60%) would like to leave clinical practice entirely.
The average delay in getting in to see a primary care physician is about 30 days. Despite the growing shortage of physicians, the United States has only increased funding for residency slots by a small margin. A limited number of residency slots means thousands of medical school graduates cannot finish their training and will likely never practice medicine.
Just over 93% of U.S. medical school graduates matched to a residency program this year. Some of those who failed to match had extremely specific criteria and will try again next year. Some likely went through the supplemental match (SOAP) and were able to match over the weekend. U.S. citizens who train abroad are less likely to match to a residency program. In many cases their training is considered inferior or at least there is a stigma that they are less qualified. About 70% of U.S. citizens who trained abroad match to a program, whereas only about 56% of noncitizen medical school graduates trained abroad who applied match to a residency. All told, 48,050 medical school graduates applied for a residency in 2026, while there were only 44,344 slots available. That does not tell the whole story, however. Thousands more did not apply because they knew the odds were stacked against them. Untold thousands gave up because they failed to match in previous years and the odds of matching falls each year they fail to match. There are literally thousands of would-be doctors who will never practice medicine because they were unable to complete their training. Most of those are likely to be immigrants or Americans who trained abroad. In some years up to 10,000 medical school graduates are turned away, in what is essentially a game of musical chairs. Many will never get their chance to practice medicine even though we could use them.
Read more at: Results for 2026 Main Residency Match