Pre-Match Offers for IMGs: NRMP Rules and Replies

Pre-Match Offers for IMGs: NRMP Rules and Replies

A program in the NRMP Match may not offer you a contract before the List of Unfilled Programs is released during Match Week. A program outside the Match can. If you accept an outside offer, you must withdraw from the Match in the R3 system before 9 p.m. ET on Wednesday, March 3, 2027.

The phrase "pre-match" covers two very different emails. One is a rule problem dressed as an opportunity. The other is a real decision with one hard deadline. This page shows how to tell them apart, how to check a program, four constructed replies, and what to do if a Match program pressures you.

Every NRMP and TMDSAS page quoted below was checked on November 7, 2026, against the 2027 Main Residency Match documents.

The rule in two sentences

The binding text is in the two 2027 Match Participation Agreements (MPAs). The 2027 MPA for programs says:

"Programs participating in the Match agree to register and attempt to fill all positions through the Match or another national matching plan."

And §6.5 of the 2027 MPA for applicants lists, among the things programs are not authorized to do:

"6. Make any written, electronic, or verbal offer or contract for appointment to a concurrent year residency or fellowship position before the release of the List of Unfilled Programs"

The List of Unfilled Programs opens to SOAP-eligible applicants at 10 a.m. ET on Monday, March 15, 2027, under the 2027 Match Week and SOAP calendar. So a Match-participating program that offers you a July 2027 position in November 2026 is doing something the agreement does not authorize.

NRMP's All In Policy exception page states the policy: "Under the terms of the NRMP All In Policy, any program participating in the Main Residency Match must attempt to fill all positions through the Match or another national matching plan. In rare instances, exceptions to the All In Policy may be granted." The examples it lists are rural scholars programs, family medicine accelerated programs that "graduate students in 3 years", and innovative programs that differ from "traditional undergraduate medical education curricula". All three describe a school's own students, and the program applies to NRMP for the exception. None describes an offer to an IMG. If a Match program tells you it has an exception, ask it to put that in writing and check with NRMP before you rely on it.

One more detail from the applicant MPA: the word "pre-match" appears in §6.6, which covers students in a three-year medical curriculum. Those students may not "Enter into an agreement for 'conditional acceptance,' 'pre-match,' or a 'matched' position(s) to a residency training program(s) outside of the Match". That section is not about IMGs, but it shows how NRMP treats the idea.

Which kind of offer is this?

Our view: treat every "pre-match" offer as unverified until you know which row it belongs to. A verbal promise from a Match program has no standing under the agreement. A written contract from a non-Match program is real, and accepting it ends your Match.

The countercase: if a non-Match program is where you want to train, with a written contract and confirmed visa sponsorship, taking it before March 3 can be the right call. Waiting for a Match that may place you lower on your own list, or not at all, is not automatically safer. In 2026, 56.4% of non-U.S. citizen IMGs who submitted rank order lists matched to a PGY-1 position (NRMP 2026 Results and Data, Table 4A).

How to check whether a program is in the Match

1. Search the NRMP Program Directory. The Program Directory describes itself as covering "the over 6,000 PGY-1 and PGY-2 programs participating in the NRMP's Main Residency Match (MRM)" and says "The program directory is updated daily." Its search tips suggest searching "by NRMP or ACGME program codes". Search the exact program name and track.
2. Ask the program in writing. One question: is this position in the 2027 NRMP Main Residency Match? Keep the reply.
3. Match the track, not the hospital. A hospital can run one program in the Match and another position outside it. The offer letter should name the exact program, PGY level and start date.
4. Check the visa type in writing. For positions in the Match, MPA §7.2 says: "Non-U.S. citizen applicants requiring a visa are responsible for confirming the institution's willingness to sponsor the visa-type intended by the applicant before certifying their rank order list." Apply the same standard to an outside offer: the visa type belongs in the written offer. For the program-by-program visa check, see IMG residency: check visas before applying.

Should you accept? A decision procedure

Run checks 1 to 5 in order and stop at the first "no". Step 6 is what you do once all five are yes.

1. Is the program outside the Match? If it is in the Match, the program is not authorized to make that offer before Match Week (§6.5). Go to "Red flags and reporting".
2. Is there a written contract naming the program, PGY level, start date and salary? If not, ask for one before you decide.
3. Is the visa type confirmed in writing, with the institution named as sponsor? If not, ask.
4. Would you rank this program first? If you would rank a Match program above it, accepting gives up that chance.
5. Can you decide before 9 p.m. ET on March 3, 2027? After that you cannot withdraw (see the next section). If the program's deadline is earlier than March 3, ask for time in writing (template below).
6. Accept in writing, then withdraw from the Match the same day, and tell your advisor and letter writers. NRMP does not require the last part; they wrote for a Match application.

If you accept: withdraw from the Match in R3

IMGs are "independent applicants" under MPA §3.2. Section 8.2.1 is the rule:

"Independent applicants who accept a concurrent year residency or fellowship position outside the Match or through any other national matching plan must:

1. Withdraw from the Match through the R3 system; and

2. Withdraw before the Rank Order List Certification Deadline."

Withdrawal is an action in R3, not a letter to NRMP or to programs. Three dates frame it, all from the 2027 Main Residency Match calendar:

After March 3 the window closes. MPA §8.0: "Applicants may not withdraw themselves from the Main Residency Match after the Rank Order List Certification Deadline." And §7.5.1, between that deadline and Match status: "Applicants may not apply for, discuss, interview for, or accept any position that would run concurrent with positions offered in the Match." If you match, the result is binding, and only NRMP can release you; see backing out of the Match.

Then cancel your remaining interviews. MPA §6.2 asks applicants to give "reasonable measures of notification (e.g., one-to-two weeks' notice)" when cancelling. After you have signed elsewhere, cancel the same day. The full cancellation email is in residency interview cancellation email.

Reply templates

Four constructed examples, written by us, not real applicant emails. Square brackets mark what you fill in.

Constructed example: accepting an offer from a non-Match program

Constructed example, written by us, not a real applicant email.

Dear Dr. [Surname],

Thank you for the offer of a PGY-1 position in [exact program name], starting [date]. I accept. I have signed the contract dated [date], which confirms [visa type] sponsorship by [institution], and I will withdraw from the NRMP Main Residency Match in R3 today.

Sincerely, [Your name], AAMC ID [number]

Constructed example: asking for time

Constructed example, written by us, not a real applicant email.

Dear Dr. [Surname],

Thank you for the offer. Before I decide, could you confirm in writing that this position is not part of the 2027 NRMP Main Residency Match, and the visa type the institution will sponsor? I would be grateful for a decision date of [date], which is before the NRMP withdrawal deadline of March 3, 2027.

Best regards, [Your name], AAMC ID [number]

Constructed example: declining

Constructed example, written by us, not a real applicant email.

Dear Dr. [Surname],

Thank you for the offer and for the time your team spent with me. I have decided to remain in the NRMP Match, so I must decline. I appreciate your consideration.

Sincerely, [Your name]

The same reply works when a Match program makes an offer it is not authorized to make. Do not say yes to a verbal offer, and do not argue the rule in the email.

Constructed example: cancelling remaining interviews after accepting

Constructed example, written by us, not a real applicant email.

Dear [Coordinator's name],

I am writing to cancel my interview with [Program name] on [date]. I have accepted a position elsewhere and have withdrawn from the Match, so I want to free the slot for another applicant. Thank you for the invitation.

Best regards, [Your name], AAMC ID [number]

Red flags and reporting

• A Match program offers a position, or a promised rank, before Match Week. Section 6.5 does not authorize an offer; a promise to rank you binds no one.
• A Match program asks you to withdraw or to stop interviewing in exchange for a position. It cannot offer that position before Match Week (§6.5, item 6), so there is nothing to exchange. Section 6.5 also bars telling you that placement on its rank list depends on a statement of your preference.
• A program asks where you will rank it. That is §6.5, item 4. Handling it is covered in the residency still interested email page.

Reporting: MPA §7.5 says "Violations of any policies pertaining to communication between programs and applicants must be reported to the NRMP at policy@nrmp.org." Section 12.0 says reports "may be made anonymously."

Residency pre-match vs TMDSAS pre-match

If your search turned up "pre-match offers" with dates in October to January, you may be reading about medical school admission in Texas. The TMDSAS after-submitting guide says: "Prior to the match, medical schools may extend offers of acceptance to Texas residents for a period between October 15, 2026 (12:01 am CT) and January 29, 2027 (11:59 pm CT)". That system is explained in how the TMDSAS match works and TMDSAS pre-match offer: hold, decline, or reply. Nothing in it applies to residency.

Questions about residency pre-match offers

Is a pre-match offer allowed under NRMP rules?

Not from a program in the Match. Section 6.5 of the 2027 applicant MPA says Match programs are not authorized to make "any written, electronic, or verbal offer or contract" for a concurrent-year position before the List of Unfilled Programs is released. Programs outside the Match are not bound by that agreement.

How do I withdraw from the Match after accepting an outside position?

In the R3 system, before 9 p.m. ET on March 3, 2027. Section 8.2.1 requires both. A letter to NRMP is not a withdrawal.

Can I accept a non-Match offer after March 3, 2027?

Not before Match status is released. Section 7.5.1 bars accepting a concurrent position between the certification deadline and Match status, and §8.0 bars withdrawing after the deadline. If you are unmatched and SOAP-eligible, §9.1 lets you apply only to SOAP programs until SOAP ends. See SOAP for IMGs.

Should I tell other programs I received a pre-match offer?

No. If you decline it, nothing changes. If you accept it, cancel your interviews and withdraw. Using an offer to press a Match program for a ranking statement is the conversation §6.4 and §6.5 rule out.

Review the writing you send next

If you stay in the Match, the next document is a letter of intent to the one program you will rank first: get a free Quick Review of your letter of intent against GradPilot's residency letter of intent rubric. If you are planning for next cycle instead, the residency personal statement rubric reads how your statement shows why this specialty and your readiness for residency work.

More rank-season guides for IMGs:

• IMG rank order list for 2027: how many to rank and the visa check before you certify.
• Residency letter of intent: 2027 NRMP rules: what the agreement lets you say.
• ERAS 2027 timeline: the full season, month by month.
• Medical school and residency essay guides: every residency writing guide in one place.

Sources

Retrieved November 7, 2026, except where noted.

• National Resident Matching Program, 2027 Main Residency Match Participation Agreement for Programs (2027 Match): programs "register and attempt to fill all positions through the Match or another national matching plan."
• National Resident Matching Program, 2027 Main Residency Match Participation Agreement for Applicants (2027 Match): §3.2 independent applicants, §6.2 notice, §6.4–6.6, §7.2 visa confirmation, §7.5 and §7.5.1, §8.0 and §8.2.1 withdrawal, §9.1, §12.0.
• National Resident Matching Program, All In Policy Exception Criteria and Request Form (linked from nrmp.org/policies/all-in-policy/, which redirects to the form page; no cycle year stated): policy sentence and exception examples.
• National Resident Matching Program, Program Directory: participating programs, daily updates, program-code search.
• National Resident Matching Program, 2027 Main Residency Match Calendar and 2027 Match Week and SOAP Calendar: February 1, March 3 and March 15, 2027 times.
• National Resident Matching Program, Results and Data: 2026 Main Residency Match (2026 Match): non-U.S. IMG PGY-1 match rate 56.4% (Table 4A).
• Texas Medical and Dental Schools Application Service, After Submitting (2026-2027 cycle): pre-match offer window.