Not all programs participate in the NRMP Match, nor is any program required to offer all its positions through the Match.
Some medical specialities have their own limited matching programs separate from the NRMP and applicants seeking entry into those residency programs would need to separately enter those match programs. In other cases, program directors may opt to offer all or some of their positions outside of the NRMP Match and instead directly offer contracts to applicants.
These offers may be made at any time, but if offered and accepted before the submission date for the final Rank Order List to the NRMP, then the applicant is no longer eligible to participate in the NRMP Match. The residency program is similarly bound and cannot put those positions into the Match, provided that the applicant is qualified and available on the residency program start date.
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