Every third Friday in March, the American medical establishment celebrates Match Day. There are media walls emblazoned with school logos, clusters of balloons, and an unseen algorithm that calculates the perfect distribution of thousands of medical students among hospital programs that will, for the next three to seven years, hold immense power over their lives. Unlike a conventional job application process, a law clerkship, or a PhD program, the pairings announced on Match Day are, essentially, binding precontracts that strip workers of their negotiating power. Quitting later or even attempting to negotiate terms is treated as a professional breach of contract, punishable by a systemic, industry-wide freeze-out.

Medical students who aspire to practice have little choice but to enroll in a medical school that registers with the National Resident Matching Program (NRMP), a nonprofit organization that has overseen nearly every accredited residency placement since 1952. Over the summer and fall before Match Week, medical students apply and interview for programs where they wish to train; afterward students and programs submit a ranked list of their preferred partners to the NRMP and its algorithm, which purportedly exists “to make the best possible match for all participants.”

Once matched, residents enter a liminal period of their lives, during which they might work eighty-hour workweeks but are still considered trainees rather than full-time workers. Because of that assigned status, programs often feel justified in offering poor compensation without overtime pay, while residents burn themselves out in the hope of being rewarded with a stable, well-paying, and respected job in the future.