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BCMS – TOGETHER
WE STAND

“The Match”- A Brief History of

Training Physicians in the US

By Mark Andrew Tobias

O ne day after the drafting of this article, September 27, which means that all the pairs are as happy as possible with their part-

2022, roughly 47,675 medical school seniors will have
ners given all of their preferences and how they were matched up. This
submitted their applications to about 36,627 US PGY-1
where instead of two groups being matched to a member of the oppo-
residency positions through the National Resident Matching Program algorithm is not to be confused with the “Stable Roommates Problem,”
1
(NRMP), also called “The Match.” This year marks the 70th anniver- site group, there is instead one group matched within themselves by
2
sary of the Match in the US and as of 2022, will have generated around order of preference to each other. So, how did we end up using this al-
6.5 million dollars a year for the NRMP from student application fees gorithm to play cupid between medical student and residency, in order
alone. This process is one of the most important annual events in mod- to explain the birth of the match we must travel far back in time.
ern medicine in the US. It’s the source of pride, excitement, fear, dis- Let us begin in the ancient times where there was no such thing as
appointment and many other emotions for medical students across the the Match, medical school or even acetaminophen! During these times
world, but what exactly is “The Match,” what did we do before? and “physicians,” if one could call them that, were usually men, who de-
how did we get to this point? clared themselves pupils to the philosophy of medicine, anatomy and
“The Match” process itself is a real-life example of the “Stable Mar- illness. Notable figures included Hippocrates of Kos, Alcmaeon of Cro-
riage Problem” in mathematics. It is defined as “the problem of finding ton and Charaka of ancient India and others. This style of “physician-
a stable matching between two equally sized sets of elements given an hood” continued for many years until during the renaissance, religious
ordering of preferences for each element.” Another example of this type control of the profession decreased, medical discovery was more evi-
of algorithm would be a speed dating event with two equal numbered dence based and most physicians took up apprenticeships under estab-
groups, split by attraction to the other group, all getting matched with lished physicians to learn the trade. Fast forward to 1765 when the first
a date by the end of the night. Additionally, the Stable Marriage Prob- medical school in the US, the College of Philadelphia, was founded by
lem is called stable, because “there does not exist any pair (A, B) which John Morgan and Willian Shippen after they finished learning and
both prefer each other to their current partner under the matching,” teaching medicine abroad. By 1813, Yale School of Medicine was

24 SAN ANTONIO MEDICINE • January 2023