Ranking a Long Shot First Never Costs You: How the Residency Match Works for IMGs (2027)

Published 31 October 2026 · Luke, co-founder of OET BANK and USMLE BANK · 10 min read

Many applicants treat their rank order list as a bet: put a long shot first and you might lose a safer place further down. In the NRMP's Main Residency Match it does not work that way. The algorithm starts from your list, and ranking a program higher never costs you a place lower down. What decides most outcomes happens earlier: whether your exams and Pathway are done by the deadline, which programs you apply to, and which specialty you choose. In internal medicine, four in ten residents graduated from a medical school abroad. In orthopaedic surgery, about one in seventy. This article explains how the 2027 Match works for doctors trained outside the US and Canada, step by step.

1. What the Match is

The National Resident Matching Program (NRMP) runs the Main Residency Match once a year. Applicants rank the programs where they interviewed, programs rank the applicants they interviewed, and a computer algorithm turns the two sets of lists into placements. Everyone learns the result in the same week in March, and training starts on 1 July. The NRMP's Program Directory lists more than 6,000 PGY-1 and PGY-2 programs taking part.

The Match is not the application. You apply to programs through a separate service, usually the AAMC's ERAS, and you register for the Match with the NRMP. You need both.

2. The 2027 calendar

Interviews take place after programs start reviewing applications and before the rank list deadline. 3 March is also the last day you can register late or withdraw: after it, you cannot leave the Match.

3. What an IMG needs, and by when

For graduates of schools outside the US and Canada, there are two separate deadlines.

• By the rank order list deadline (3 March 2027): pass Step 1 and Step 2 CK, and meet every requirement of your Pathway, including OET Medicine. The NRMP sends ECFMG its list of registered IMGs every week, and ECFMG reports back whether you have met these requirements. If you have not by the deadline, you cannot take part in the Match. You also cannot use SOAP, because SOAP is only for applicants verified as eligible to start on 1 July.
• By the start of training (1 July 2027): hold the ECFMG certificate itself, which also needs your final diploma and transcript verified. The ACGME's rules require a valid ECFMG certificate (or a full US licence) before you are appointed.

In practice the first deadline comes sooner than it looks. ECFMG advises taking OET by its last test date in December 2026 for the 2027 Match, with your Pathway application and OET score reaching ECFMG by 31 January 2027. A Step 2 CK result can take up to eight weeks. Our articles on ECFMG Certification and Step 2 CK work through both timelines.

4. Applying: ERAS and program signals

Most programs take applications through ERAS. Emergency medicine and obstetrics and gynaecology use a different service, ResidencyCAS. What applying costs, including the ERAS fee that rises after the 30th program in a specialty, is in our article on the cost of the USMLE path.

Many specialties also let you send program signals: a small number of flags that tell a program it is one of your top choices. For the 2027 season every residency applicant could use them, IMGs included, and the AAMC suggests signalling the programs you are most interested in. The number depends on the specialty:

Not every program in a specialty takes part: for the 2027 season the AAMC published the list of participating programs in August 2026. Where the table shows gold and silver, that specialty splits its signals into two tiers.

5. How the algorithm works

The NRMP describes its algorithm as applicant-proposing. In plain terms:

1. It starts with your first choice

   The algorithm tries to place you in the program at the top of your list.

2. A tentative match needs the program to rank you too

   You are placed there tentatively if the program ranked you and either has an open position or prefers you to someone already placed there.

3. Bumped applicants move down their own list

   If someone the program prefers comes along later, you are bumped and the algorithm tries your next choice, then the next, until you hold a place or your list runs out.

4. Everything becomes final at once

   When every list has been worked through, all tentative matches become final and binding.

Two consequences follow. First, a program ranks you without knowing where you ranked it: your ranking preferences are confidential, and the Match Participation Agreement does not allow programs to ask you to reveal them. So a long shot at the top takes nothing away from the programs below it; if it does not work out, the algorithm simply moves on. Second, a match needs both sides: you can only match where you ranked the program and it ranked you.

6. Building your rank order list

The NRMP's own advice is short:

• Rank in order of true preference, not in order of where you think you will match.
• Rank every program where you interviewed and would accept a position, and no program where you would not train. Each rank is a commitment if it produces a match.
• Do not rank programs where you did not interview. Programs do not rank candidates they have not interviewed, so no match will occur.
• In a competitive specialty, consider also ranking your preferred programs in an alternative specialty.
• If you need a visa, the Match Participation Agreement makes it your responsibility to confirm that each institution will sponsor the visa type you intend before you certify your list.

In some specialties training starts at PGY-2, after a first year of broad clinical training: dermatology, for example, and some programs in anaesthesiology, neurology and radiology. For these you rank the advanced PGY-2 programs on your primary list and can add a supplemental list of one-year preliminary PGY-1 programs to go with them. A categorical program covers the whole training from PGY-1.

A list can hold up to 300 ranks; the registration fee covers 20. Edits are allowed until the deadline, but every change has to be certified again, and once the deadline passes a certified list cannot be uncertified.

7. A match is binding

When you register, you sign the NRMP's Match Participation Agreement. Under it, a match is a binding commitment: the program must offer you the position and you must accept it. Neither side can release the other; only the NRMP can, by granting a waiver. A position accepted in SOAP is binding in the same way.

The NRMP's All In Policy has a second consequence for IMGs. A program that takes part in the Match must fill all its positions through the Match, and the NRMP states that it does not approve exceptions for IMGs who need visas. So a program in the Match cannot offer you a position outside it.

8. Match Week and SOAP

• Monday, 10 a.m. You learn whether you matched, fully, partially or not at all, but not where.
• Monday to Thursday: SOAP. The Supplemental Offer and Acceptance Program lets programs with unfilled positions offer them to eligible unmatched and partially matched applicants. You can start preparing applications on Monday, through ERAS or the service the program uses; programs start reviewing them on Tuesday morning. In 2027, offers come on Thursday 18 March in four rounds (9 a.m., noon, 3 p.m. and 6 p.m.), with two hours to accept or reject each one.
• No contact first. During SOAP you may not contact a program until it contacts you, and only after you have applied to it.
• Friday, noon. Match Day: everyone learns where they matched.

SOAP is not a second Match. It is a short series of offers, and an offer you accept binds you like a match does. When SOAP ends on Thursday evening, the NRMP posts its final list of unfilled programs and you may contact them freely.

9. Where IMGs train, and for how many years

The ACGME, which accredits US residencies, counts every resident by where they went to medical school. In the 2024–2025 academic year, 24.1% of all 167,083 residents and fellows had graduated from a medical school outside the US and Canada. The share varies widely by specialty. The table also shows how long each training takes under the ACGME's requirements for 2026.

* Including a first year of broad clinical training, which some programs build in and others ask you to complete beforehand (a preliminary year, as in section 6, or a transitional year). "Graduated abroad" counts US citizens who studied abroad as well.

These are shares of residents already in training, not match rates, but the pattern is clear: internal medicine, pathology, family medicine and neurology have taken many graduates from abroad, while orthopaedics, dermatology and obstetrics and gynaecology have taken few. The NRMP publishes match rates by applicant type and specialty every March, and Intealth (ECFMG) summarises the results for IMGs. Read them by specialty, not as one overall number.

One more rule matters if you have trained at home. Under the ACGME's rules, any first year of clinical training that a specialty requires before entry must be done in an ACGME-accredited program (or a recognised Canadian or ACGME-International one). An internship in your own country counts as that year only if its program holds one of those accreditations.

Frequently asked questions

When is Match Day 2027?

Friday 19 March 2027, at noon US Eastern, when applicants learn where they matched. On Monday 15 March at 10 a.m. they learn whether they matched. Rank order lists must be certified by 3 March 2027 at 9 p.m., and residency starts on 1 July 2027.

How does the NRMP matching algorithm work?

It is applicant-proposing: it tries to place you in your first-choice program, then your second, and so on. You hold a place tentatively if the program ranked you and has room, or prefers you to someone already placed. When every list has been processed, all tentative matches become final and binding.

What do international medical graduates need to enter the Match?

By the rank order list deadline (3 March 2027) you must have passed USMLE Step 1 and Step 2 CK and met every requirement of an ECFMG Pathway, including OET Medicine. ECFMG reports this to the NRMP. To start training on 1 July you also need the ECFMG certificate itself.

What happens if I don't match?

If you are unmatched or partially matched and eligible to start training on 1 July, you can take part in SOAP during Match Week. In 2027, offers come in four rounds on Thursday 18 March. An accepted SOAP offer is binding. After SOAP ends, you may contact remaining unfilled programs directly.

How many years is residency in the US?

It depends on the specialty. Internal medicine, family medicine and paediatrics take three years; psychiatry, neurology, obstetrics and gynaecology and anaesthesiology four; and general surgery and orthopaedic surgery five. Some specialties count a first year of broad clinical training within that total.