The Evolution of Match Day

The system’s algorithm matches applicants with programs based on student preferences. Changes in recent years were designed to create a more equitable matching process and to encourage programs to consider student applications holistically.

“The NRMP match tries to even the playing field by assuring that all applicants follow the same rules and adhere to the same deadlines throughout the match process,” explains Gwen McIntosh, MD ’96, MPH, associate dean for students. “The addition of tools such as program signals and geographic preferencing help reduce the total number of applications a student will submit, which in turn reduces the cost of the residency application process.”

McIntosh is fond of saying “it takes a village” to assist medical students, and that village can include faculty advisors, educators, letter writers, and mentors throughout SMPH and its Statewide Academic Campus. Beyond the school, it includes residency program directors.

“The level of complexity might shock some of our alumni,” says Sara Brask, MS, director of career advising at SMPH.

The Association of American Medical College’s (AAMC) Electronic Residency Application Service® (ERAS®) is just one of four residency application platforms and three matching platforms used by various specialties around the United States. Each specialty may use a different application system, and the list of systems is continually evolving.

From Scramble to SOAP

What many SMPH alumni may know as the match “scramble” was replaced in 2011 with the Supplemental Offer and Acceptance Program (SOAP)®. The latter is an electronic, systematic process for unmatched and partially matched applicants to submit new applications, and to interview and receive offers in several rounds. At SMPH, the intensive, four-day SOAP process offers a great deal of support.

“Not every medical school does [SOAP] the way we do. We have boots on the ground ready to give students one-on-one assistance with making quick decisions and prepping applications,” explains Brask. “It is stressful for students, but it is a beautiful week. It is so great to see everyone come together to support these students. The SOAP process allows students to continue following their dreams.”

For SMPH medical students, dreams most often become reality. In 2025, 99.4 percent of graduating students matched. Initial matches and those made through the SOAP process are announced on Match Day, so the entire medical school class celebrates at the same time.

New Signaling Strategies

With the increasing use of technology, the volume of residency applications has increased exponentially. It is common for a program to receive 5,000 applications for 20 open spots. In response, ERAS® introduced electronic signaling — a helpful application-management process that is perhaps the most dramatic change in recent years — beginning with a pilot in 2022 and launching before the 2024 match season.

Each specialty has a national committee of residency program directors that determines the number of signals each applicant will receive for that specialty. Applicants allocate their signals to the programs they find most desirable.

Extending a coveted signal, which medical students use as a way to express interest in programs when submitting residency applications, helps increase the student’s chance of getting an interview. According to the AAMC, 71 percent of program directors say the signals help them identify applications they otherwise may have overlooked. Of the 2024 SMPH medical school graduates who sent a signal with their residency applications, a median of 42 percent received interview offers, compared to a median rate of 2 percent among those who did not send a signal.

Students also may indicate up to three preferred geographic regions, and the highest rate of conversion from application to interview happens when program signals and geographic preferences overlap.

Because strategies are critical, faculty mentors in SMPH departments provide students with valuable guidance related to their specialties. National data from the previous year’s match — including the percentage of students accepted from out of state — provide clues about program preferences and ways to succeed.

MD Student and Alum Reflections

About his journey through the match process at SMPH, fourth-year medical student Ronnie AlRamahi says, “There are so many moving parts, and it is daunting. But our school hosts multiple online meetings with representatives from Student Services and the Wisconsin Medical Alumni Association (WMAA) to provide coaching on how to navigate the system. Every Friday, we have access to drop-in academic advising so we can ask questions. Also, every student has a house mentor who provides professional expertise. These offerings have been super helpful.”

With a wedding planned for May 2025, AlRamahi adds that being part of a couples match with his fiancé, Takwa Salem, added complexity for both of them.

“I may have had one of the most complex match algorithms in my class. I had several factors in my rank list; I tried to match to a preliminary position in the same city as Takwa’s match; and we also did the couples match for residencies in the same city. My mentors helped me dial it back. I used six gold signals and six silver signals,” says AlRamahi, adding that Salem used three gold and 12 silver signals.

“I loved how my house mentor and my fiancé’s house mentor worked together. The process was not as bad as I thought it would be because we had a lot of support,” he says. “Without Student Services, the Dean’s office, and WMAA, I cannot imagine how stressed I would have been.”

In March 2025, AlRamahi and Salem matched to residencies in diagnostic radiology and internal medicine, respectively, at University of Wisconsin Hospitals and Clinics.

SMPH medical alum Hannah Cress, MD ’24 — who is doing a rural-track obstetrics and gynecology residency at the University of Iowa Hospitals and Clinics, Iowa City — also appreciates the guidance she received at SMPH.

“Even if you have no idea where your path in medicine is going to lead — if you may want to try urban or rural medicine, or pursue research — the doors aren’t just opened for you, they are held wide open by others willing to take you with them,” she says. “Looking back, that is all I could have asked for. The UW School of Medicine and Public Health was a wonderful place to attend medical school.”