Students often wonder how many residency programs they should apply to. The short answer is that there is no magic number. A longer answer is more than one and probably less than twenty. However, it depends on many factors and you will need to take both your own competitiveness AND the competiveness of the programs you are applying to into account. Additionally, you may have extenuating personal circumstances (such as a partner in school in a particular city who can’t leave) that may make you feel you need to limit your search to that geographical area.

There are two ways of thinking about programs that will help you determine how many you should apply to. The first is to work backwards from how many programs you want to include on your rank list. The second is to categorize the programs based on how easy you think it will be for you to match into.

Reviewing data for US seniors from the 2011 match can help you know how many programs you should rank. In 2011, essentially all family medicine applicants that listed more than 11 programs matched. Students ranking only one program did not match 20% of the time and 16% of the time for those who ranked only two. The percentage of unmatched students drops for students ranking 3 or more programs. Although overall only 3% of US seniors did not match, those that matched ranked an average of 8 programs compared to the 4.7 programs for those that did not match. The take-home points from all this is that the longer the list the less likely you are to go unmatched. For the average student, ranking 10-12 programs will likely ensure a match. Work backwards from this number to account for attrition of programs during the application and interview process. Most students have 1-2 programs they do NOT want to attend after the interview and some students will probably not get offered interviews at every program they apply to. Furthermore, some students will get interviews but may decide not to attend them from a variety of reasons. Therefore, an average student would need to apply to about 15 programs to account for not getting interviewed at 1-2 programs and not liking 1-2 programs after interviews to be able to have a rank list that is 10-12 long. For this average student the application process may look like this:

  • Applies to 15 programs
  • Offered interviews at 14 programs
  • Interviews at 13 programs
  • Ranks 11 programs

Using three broad categories (stretch, likely, and slam-dunk) of programs can also help you build a list. Stretch programs are those that are more competitive programs than you are an applicant. It may be a stretch for you to match to them but could happen. Likely programs are those that their competitiveness and your competitiveness match up and you feel a match will likely occur. Slam-dunk programs should be seen as a safety harness so you don’t go unmatched. These are programs for which you are a very competitive applicant and you should have no difficulty matching. The concept of these categories does not obviate the need for good fit. You should not rank a stretch program just because it is more competitive if it is not a good fit for your training needs. Likewise, slam-dunk programs should also be those that fit your needs.

Stretch: The program is more competitive than you.
Likely: You and the program are about equal.
Slam Dunk: You are more competitive than the residency

How many programs from each category? Again it depends on your competiveness. An average student may have 2-3 stretch programs, 3-4 likely programs, and 2-3 slam-dunk programs. Students that have faced difficulty in school and are less competitive may need a longer rank list with more likely and slam-dunk programs. Highly competitive students may be able to get away with less than the average student, however it is important to remember that the fewer number of programs ranked the more likely you are to go unmatched – this is true for all students.

In prior years, going unmatched was less concerning because the number of unfilled positions was gigantic compared to the number of unmatched US seniors. In 2007, 13 US seniors were unmatched and could scramble into 304 open slots; in 2009 23 unmatched US seniors could scramble into 224 unfilled slots. In 2011, 29 US seniors were unmatched but only 153 slots were open. If you go unmatched and need to scramble you will likely face a smaller pool of choices then in years past. A further complicating factor for this year’s match is that the traditional scramble was replaced with a more organized application and matching process. Since this if the first year this more controlled process will be used, no one knows exactly what it will be like for students that go unmatched. Not being able to scramble into a program can be very dangerous. For all students that fail to make an initial match or scramble and then attempt matches in subsequent years, the match rate is has hovered around 45% across all specialties since 2007. This means that less than half of US grads will go on to make a match in later years if they fail to do so when the year they graduate.

So what do you do if you have circumstances that make you want to limit your match to a single geographically area or to a few programs? If family is involved talk to them honestly about what you think the chances are to match in your coveted area/programs. Discuss long-term ramifications if you don’t match (scramble to a place you weren’t expecting or go unmatched which probably makes you less competitive the second time around.) Keep in mind that residency in only 3 years long and that you are choosing a specialty that will let your work anywhere when you are done.


References
i) National Resident Matching Program and Association of American Medical Colleges. (2011). Family Medicine. Charting Outcomes in the Match: Characteristics of Applicants Who Matched to their Preferred Specialty in the 2011 Main Residency Match, Fourth Edition. 74-86. Retrieved fromhttp://www.nrmp.org/data/
ii) National Resident Matching Program, Results and Data. (2011). 2011 Main Residency Match. National
Resident Matching Program. Retrieved from http://www.nrmp.org/data/