The 2021 Residency Match was the largest on record. What did it take to make the Match work? And how did international medical graduates (IMGs) fare? Those questions were covered on a recent episode of the “AMA COVID-19 Update.”

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Here are some key takeaways from the experts on what was learned in the 2021 Residency Match.

The Supplemental Offer and Acceptance Program (SOAP) is a vehicle through which eligible unmatched applicants in the Main Residency Match apply for, and are offered, positions that were not filled when the matching algorithm was initially processed. 

Since the 2017 Match, SOAP has included three offer rounds. For the 2021 Match, a fourth round was added, but, interestingly, in a year when Match rates saw a slight dip, there were fewer positions available through SOAP.

“We actually had fewer positions in SOAP this year than we had in the prior year,” said Donna L. Lamb, president and CEO of National Resident Matching Program (NRMP). “So again, not a substantial number, but it was if I recall correctly, it was around 100 less positions available in SOAP. So again, not a lot of changes and not a lot of trends that we saw that we felt like were substantial to the Match itself.”

In spite of a smaller SOAP pool, Dr. Lamb said the extra round helped.

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“The final round—that addition of the fourth round of SOAP—was helpful,” she said. “There were 49 offers made in that final round of SOAP and 42 of those were accepted. So clearly there's a benefit to those candidates in those programs.”

Learn how med ed made the disrupted Match cycle work for students and programs.


The most substantial change in Match rates during the 2021 cycle was for non-U.S. citizen IMGs, who matched at a 54.8% rate, which was a drop from 61.1% last year.

According to an NRMP statement, “the unavailability of medical licensure examinations in the early stages of the pandemic coupled with permanent changes to the scoring and administration of those examinations by the end of 2020 created significant challenges for IMGs this year and likely contributed to the decline.”

The Match rate also was likely impacted by the fact that there was close to a 15% increase in non-US citizen IMGs in the applicant pool.

“Percentage wise, it isn't as high as recent years, but in terms of actual numbers and from an interest perspective, it really was very, very good,” said William W. Pinsky, MD, president and CEO of the Educational Commission for Foreign Medical Graduates.

Beyond increased competition, a disrupted Match cycle may have affected IMGs more severely than other applicants.

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2021 Match hits record highs despite pandemic’s disruptions

“The issue of no away rotations, the tryouts that have occurred in other years, the doing no in-person interviews, I think was even a greater challenge for the international medical graduates,” Dr. Pinsky said. “And probably, a big thing was the fact that the clinical skills exam was suspended and then canceled. And a large number—probably a third of the people who ended up in the Match—had not yet taken their clinical skills exam. And that caused a lot of anxiety.”

Learn more: If you’re among those who matched this year, the AMA offers great advice and resources on the next steps to get ready for your transition to residency.

Find out the AMA Resident and Fellow and IMG Sections give voice to, and advocates for, the issues that affect resident and fellow physicians and trainees who have graduated from international medical schools.

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