For senior medical students all across the nation, there is no day that is more highly anticipated and dreaded as Match Day, when each soon-to-be doctor will find out where they will be placed for residency training. Despite four years of sleepless nights, endless work and enormous debts, the fates of these medical students are ultimately decided by a giant supercomputer and a math algorithm whose outcome is anyone's guess.

The process begins in mid-August, when senior medical students begin applying to the residency programs of their choice. Program directors examine the applications and invite students of interest for interviews. Afterwards, applicants and program directors create a Rank Order List (ROL), preferentially ranking program choices and desired students, respectively. To help with this process, the National Residency Matching Program (NRMP), which coordinates the actual matching, puts forth a directory, listing residency programs and the number of positions available that participate in the matching program. Each program is also given a code, which is used by applicants when preparing their ROLs. The number of ranked programs chosen by an applicant often varies depending on the competitiveness of the specialty, the competition for the specific programs, and the applicant's qualifications. However, applicants must take care when choosing particular programs because listing any residency on an ROL is a binding agreement; should a match occur, the both the applicant and program must accept and commit to it. Generally, matched applicants and filled programs have longer ROLs than unmatched applicants and unfilled programs.

Once the ROLs have been submitted, which usually takes place by the end of February, the actual NRMP matching process begins. Based on the preferences expressed by the ROLs of applicants, the NRMP uses a math algorithm to match individuals. Each program is also given a code, which is used by applicants when preparing their ROLs. The number of ranked programs chosen by an applicant often varies depending on the competitiveness of the specialty, the competition for the specific programs, and the applicant's qualifications. However, applicants must take care when choosing particular programs because listing any residency on an ROL is a binding agreement; should a match occur, the both the applicant and program must accept and commit to it. Generally, matched applicants and filled programs have longer ROLs than unmatched applicants and unfilled programs.

Once the ROLs have been submitted, which usually takes place by the end of February, the actual NRMP matching process begins. Based on the preferences expressed by the ROLs of applicants, the NRMP uses a math algorithm to match individuals with their future destination. However, with 16,000 U.S. medical school seniors and 15,000 graduates of osteopathic, Canadian, or foreign medical schools vying for about 23,000 positions each year, it is much like a gigantic game of musical chairs, in which many are going to be left behind.

The NRMP begins by matching an applicant to his or her most preferred program. If the applicant cannot be matched to the first choice, an attempt is made to place the applicant into the second-choice program, and so forth until all the applicant's choices have been tried or a tentative match has been made. An applicant can be tentatively matched to a program only if the program also ranks the applicant on its ROL, if the program has an unfilled position, or if another applicant is more desirable to the program than one who has already been tentatively matched. Thus, the preferred applicant bumps the less preferred applicant out of the spot, and the bumped applicant is re-matched starting from the beginning of his or her list again. The tentative matches become finalized only after all applicants have been considered.

For students who are couples and wish to stay together, the NRMP has devised a similar matching process. Couples first create an ROL by listing pairs of choices. Each partner must have the same number of ranks, and they will be matched at the most preferred pair of programs where each has been offered a place. In creating their ROLs, couples may combine specialties, program types, and geographic locations to suit their needs. It is important to note, however, that couples are treated by the matching algorithm solely as a couple, so if they are not matched together, the individual ROL lists will not be re-checked to match each partner elsewhere. If one partner decides to withdraw from the match, the other ROL will still be used as an individual candidate. Also, if one partner is willing to be unmatched as long as the other gets a particular spot, that may be designated by a special code on the ROL list.

The results of the match are released over a four-day period during what is referred to as Match Week, which usually occurs in the end of March. E-mails are sent out on the Monday of that week, informing students whether they have matched or not. For those who did not match, they must resort to "scrambling," a nightmarish two-day process of last minute telephone interviews and begging for available positions. Thus, a student who scrambles may end up in any specialty, anywhere. A list of unfilled programs is sent to those unmatched applicants that Tuesday of Match Week in order to aid them during the scramble. The match results finally become available on the web at 1 P.M. on Thursday of Match Week, otherwise known as the infamous Match Day. Prior to this day, programs are not allowed to contact students in order to confirm or deny a match.

For some students, Match Day ends in elation and relief. For others, it closes with disappointment and frustration. Still, for most students, it is the beginning of a brand new chapter of their lives as official M.D.'s. No matter where a student may end up, a residency program is still a residency program - even if it is in Fargo, North Dakota.

Mindy is a second-year pre-medical student. She is double majoring in Biology and Spanish and aspires to enter the field of pediatrics.