Applying to a medical residency through the match process is a tedious process that requires plenty of forethought and planning. The key to applying and matching well starts by understanding the process by which medical students apply to residency, and how they match. This guide will help you through many of the following questions!
Table of Contents
Before we jump into the entire process of how you apply to residency and how the matching process works, it’s worth first discussing how to choose a specialty or specialties to apply to. There are a few basic principles in tackling this fundamental question.
Thinking about big picture ideas of practice will help narrow down your choices. For some people, the kind of medicine is most important, and for others the lifestyle that practice comes with is more important. Take time to think deeply about these choices and spend time during your pre-clinical and clinical years observing doctors in these fields to get an eyes-wide-open view of what it truly looks like. On that note, make sure you spend time with residents as well as attendings to see the full scope.
Suggested Read: The 10 Most Popular Residency Specialities
Most residency positions are offered through the Electronic Residency Application Service, or ERAS. The timeline each year varies, but generally follows the same month structure that starts in June and culminates with “The Match” in March of the following year. You can reference the 2019 timeline to prepare for your own application cycle.
While exact dates change from year to year, here is a general timeline for the ERAS application:
ERAS Begins – Applicants can register on MyERAS and begin working on their application. Visit: apps.aamc.org/account.
Applicants start applying to ACGME-accredited residency programs only.
MSPEs released to residency programs.
National Residency Match Program (NRMP) main residency match results are available. Visit nrmp.org.
Programs typically will start reviewing applications at the end of September into early October. Interviews happen from October through February of any given year.
While most programs operate in this way there are several programs that operate outside of this structure or alongside it:
It is important to understand that the application process and the matching process are two separate entities. You’ll need to register for both systems for most residency applications in order to match. ERAS allows you to package your application and get it to programs which in turn will offer you interviews. NRMP allows you to rank those programs in order from most to least desirable, then submit that ranking so their algorithm can match you into a program. The NRMP publishes calendars each year with deadlines for the process which can be found here<. In general, NRMP opens in September, the registration deadline is in November, and rank order lists are due in February.
The Match is basically an algorithm that takes rank order lists of applicants’ programs and compares them to the rank order lists developed by programs that rank the applicants. The algorithm attempts to pair these together as best possible taking into consideration every applicant at the same time.
To learn more about how the matching algorithm works from the NRMP, check out this helpful video: nrmp.org/matching-algorithm
Applicants often wonder why you don’t just apply, interview, and get acceptances to programs like you did for medical school. If you’re interested, read on for some history and rationale!
This algorithm-driven process was invented to solve a very specific situation. Before the match, hospitals were under a great deal of pressure to try to fill their programs, which meant as time went on, hospitals would reach out and extend offers to medical students sooner and sooner – often in their 2nd and 3rd years. Students would snatch up these offers and hospitals would start filling their programs early to secure their futures.
As the process became more competitive, it also became less fair, with students and hospitals accepting and filling programs at will through the year. To standardize this, the powers that be invented this matching algorithm to pair up applicants and programs at one point-in-time in the 4th year – to even the playing field. Interestingly enough, the research used to create this algorithm even won a Nobel prize!
Before the actual application process begins, a successful bid for residency requires careful planning of the second half of third-year and the first half of fourth-year. The important parts here are away rotations and use of electives.
Away rotations are particularly useful for you to find out more about a program, while at the same time, showcasing your talents. These are essentially working interviews, or audition rotations. For this reason, away rotations should be chosen based on your interest of matching into one of these locations. Plus, you can use them as a required rotation. For instance, when using an away rotation as an elective or a Sub-Internship rotation, you’ll also get a free interview out of the rotation without having to travel back for another visit.
Do keep in mind that nearly every medical school has set-aside time for you to do interviews in your fourth year, so you don’t need to feel compelled to get all your interviews done through away rotations.
In general, it is not wise to do your first core rotation as an away rotation at a program you’re interested in. So, if you haven’t done Internal Medicine yet, don’t show up to an audition rotation for internal medicine. Sure, you’ll learn a ton about the program, but you won’t make much of a strong impression. You want to show up to audition rotations looking strong, so usually this means doing a Sub-I or just an elective in that specialty late in your third-year or early in your fourth year.
Regarding timing, there is no right time to do your audition rotation, just a wrong time. One wrong time is early in your third year when you’re not strong clinically. The other wrong time would be too close to your rank order list being due in February. That makes the ideal time anywhere from late Spring of your third year through the end of that calendar year.
Practically speaking, you cannot use all your electives and away time to do audition rotations. Your school will have limitations, but also you also don’t want to spend your whole fourth year just doing the same rotations at different hospitals. You’d be shortchanging your clinical education. Most applicants can afford to do one or two of these, and the rest of exposure to these programs will come from interviews. Every school is different, so make sure you sit down with your deans to find out how many aways you can do, when you can do them, what specialties you can do them with, and how much time is set aside for electives.
Just as it is wise to start prepping your medical school application in advance of the season, applicants should prepare their application well before ERAS opens in the beginning of June.
Start by preparing a comprehensive CV (curriculum vitae) to structure your experiences. You will take that CV and expand on each topic to write small paragraphs for each section of research, volunteer activity, clinical activities, and employment. Since the application assumes you have completed your entire medical curriculum (or will) it is not beneficial to write about rotations unless they were particularly meaningful. If you decide to write about a rotation, pick just one.
ERAS allows for a personal statement about five pages long. You should aim for just about a page and a paragraph. You should not need five pages, nor do admissions committees want to read that much. Describe why you want to pursue your residency of choice and what will make you exceptional at it.
Now review the format for both the Activities and Personal Statement sections.
To begin the Dean’s letter, you’ll need to start by talking to your Dean. Each school has different policies on how this is conducted, but the school will notify the applicant and ultimately generate the letter and upload it to ERAS.
Most schools will automate this and there will be set deadlines from your Dean. Your school will likely require you to attend a meeting before writing the Dean’s Letter/MSPE and will require you to present three noteworthy characteristics.
Dean’s Letter/MSPE Instructions Example
The medical school transcript must be uploaded to ERAS directly from the medical school.
If an applicant has 2-3 Letters of Recommendation (LORs), this should satisfy most program’s requirements. Do not wait until right before the application process to request letters. If you connect with an attending and perform well, ask them if they would be willing to write a letter about 75% of the way through the rotation. Then ask them for the letter at the end of the rotation.
Collect your letters right away through a 3rd party service like Interfolio so you can store them ahead of time and then upload them when the application process opens.
To use ERAS to request letters, you’ll need to wait until the service opens in June. The applicant has to enter the LOR writer’s name and information and then can generate a letter request form to be sent to the letter writer.
After this step, the applicant must confirm the letter of recommendation.
Once the letter is received in ERAS, then they can assign it to the program of choice.
For extended information on letters, the AAMC has details about the format of the letter (https://www.aamc.org/services/eras-for-institutions/lor-portal), and this UCSF has great information on what the letter should include (https://meded.ucsf.edu/md-program/current-students/student-services/advising-career-development/letters-recommendation).
Applicants should start writing their personal statement far in advance of the application. If you know you want to be a general surgeon halfway through your 2nd year, go ahead and start then. Do not wait until the application season to start your personal statement. Applicants are allotted 28,000 characters with spaces.
If you will be applying to more than one specialty, you’ll need a separate personal statement for each program. Technically, you could write a different personal statement for every program, but this is not necessary. You will have the option to assign a specific personal statement to each program.
Writing a strong personal statement starts with structure. A clear format breaks the essay into manageable pieces for the reader to read and for you to write:
“I began my family medicine clerkship in a community clinic dedicated to the less fortunate. There I found a group of family physicians, each with their own niche, working together to form an incredibly comprehensive team. One physician in particular specialized in the behavioral sciences, amongst other things. He saw the kinds of patients I found so fulfilling to treat on my psychiatry rotation, but he also saw just about everything else under the sun. From depression, to skin cancer, to a well-woman exam, I found the pace and surprise of the daily schedule invigorating. What truly impressed me was how he applied the same principles of the one-on-one real, personal connection required in mental-health to every patient. He laughed, he joked, he hugged, he spoke with authority, and to me it seemed like every patient was a member of his own extended family. To me this is what family medicine really means and I will strive to make every patient leave feeling as though they were listened to, understood, and given the best possible medical care available.”
WARNING: Try to weave description and content together. Most applicants use a paragraph to tell a story and then use a sentence or two at the end to reflect on it (which is perfect for a work/activities section, but not for a personal statement). When I see this as an admissions committee member, I just start skipping the story and reading the last sentence of each paragraph.
Don’t think activities. Think THEMES. Think YOU. Here’s some questions to get you thinking:
The applicant can enter as many experiences as they would like to. Be sure to aim for quality, not quantity.
Should you write out your description in bullet form or paragraph form? If you go with bullets, don’t make each bullet a paragraph. If you go with paragraph form, you need to use complete sentences.
I prefer the paragraph form because you can be more reflective. Consider that most applicants will have many similar activities – like participating in an interest group for example. Let’s look at two approaches to illustrate a few advantages of the paragraph form.
Notice there’s just so much more you can say with a paragraph. Suppose both applicants had the exact same resume and both chose bullet form. How would the program director decide which was a better applicant? Choosing to write in paragraph form allows you to identify and highlight all the unique aspects and attributes of your application to help you stand out.
The experience format is as follows:
Due to the vast number of programs offered for each specialty, we are not able to offer detailed program list selection help. The applicant should start by entering their information into residencyexplorer.org. This site will give an idea of where the applicant is competitive based on multiple factors, and they can filter the results based on location and program type. Your adviser will help you to determine which programs are a best fit for you in broader strokes.
Residency Explorer is to residency applications what the MSAR (medical school application requirements) is to medical school applications. It has vast amounts of data on each individual program. Everything from average step scores to the total number of residents and which schools they come from.
Note that you can only enter your scores in Residency Explorer three times, so applicants should not “play around” with different score scenarios, otherwise they will lock out the account – you can still access the information, you just can’t change the numbers.
There are several different tools to help you understand and navigate the residency application process.
Interviews typically start rolling in around late Fall and early Winter. Aim to interview at as many programs as you can afford to attend. Preparing for interviews should start with becoming familiar with typical interview questions. You can expect to find these questions and prompts in a typical interview:
General tips on interview day:
It is helpful to review exactly how the matching algorithm works in order to understand how to create a rank list and how programs are creating their own lists. According to the National Resident Matching Program:
The NRMP uses a mathematical algorithm to place applicants into residency and fellowship positions. Research on the algorithm was the basis for awarding the 2012 Nobel Prize in Economic Sciences. To make the matching algorithm work best for you, create your rank order list in order of your true preferences, not how you think you will match.
Creating a rank order list is stressful but is actually very straight forward. The AAMC specifically states that you should order your programs in the order YOU value the program, not how you think the program will rank you. While this is sound advice, it also stands to reason that you should not highly rank a program you love that you don’t have a realistic shot at attending. If you are listing a program at Harvard that you did not rotate at or interview with, you should not rank that as your number 1 program.
The final rank order list is due at the end of February to prepare for the match in March.
Some applicants are not 100% sure on what specialty they are ready to enter, and others may include ‘backup specialties’ to fill their list. There are certain benefits and drawbacks to creating non-contiguous lists. The term ‘contiguous ranks’ refers to the number of specialties that appear in a row. For example:
Notice that both applicants have three Derm programs and two family med programs. Applicant A has three contiguous ranks for Derm and two contiguous ranks for Family Med. Applicant B has no contiguous ranks.
The number of contiguous ranks is very important, and there is data in Charting Outcomes in The Match (nrmp.org/main-residency-match-data) that provides more detail. For example, of the derm applicants in 2019 that had one contiguous rank for Derm, 30% matched. Of the derm applicants with 12+ contiguous ranks, 100% matched. How you organize your rank list is clearly very important.
That doesn’t mean that you can’t rank multiple specialties though. That is a separate piece of data. In 2019, of the derm applicants that ranked one specialty, 89% matched, while 80% of those that ranked three specialties matched. This is true of other specialties, but not all. In the case of orthopedics, there was an 87% match rate for applicants with one specialty, but that number drops down to 52% with two specialties. Having backup specialties is neither good nor bad across the board, it is specialty specific, and should be a carefully researched decision based on your specialty of choice.
The main ERAS application consists of the personal statement and the activities, but there are also now supplemental applications for residency. In 2022/23, there are now 16 specialties that utilize the ERAS® supplemental application. These questions are very short, and free to fill out, and are utilized to help applicants share more information about themselves with programs that they maybe interested in.
Related Read: Our Guide to the ERAS Supplemental Application
The Match occurs over the process of one week in March – Match Week – and culminates on Match Day, which is on a Friday.
Applicants are notified the Monday of that week to let them know if they matched or not, but there are no specifics on where they match.
If you match, you get to participate in a big ceremony at your medical school where typically students walk to the front of a crowd, open up a sealed envelope, and announce their match. If you find out on Monday that you did NOT match, there’s more work to be done. You’ll need to work through the Supplemental Offer and Acceptance Program (SOAP).
The SOAP program is designed to fill in the gaps left by the algorithm. If you didn’t get paired up, this is the chance to remedy that. The Friday before Match Week kicks off, applicants are notified if they are eligible for the SOAP. This has nothing to do with whether you matched or not. To be eligible for SOAP, you must be registered in the main match through NRMP, be available to start residency in June, and be unmatched. (You find that out the Monday of Match Week).
SOAP works in a completely different way than the NRMP. There is no algorithm this time. If you find out you don’t match on Monday, you obtain access to a list of all unmatched programs through the NRMP website. Through that website, you can select and apply to as many as 45 programs. Now the ball is in the programs’ court. You are not allowed to contact programs at this time. You must wait for them to contact you. They will call and interview you over the phone over the next several days.
SOAP offers are extended in three rounds which start that Wednesday. There are two rounds on Wednesday morning and one round on Thursday. Most positions are filled in that first round. Programs extend offers during those rounds which are valid for only two hours. If you do not respond in those two hours, any acceptances in that round are forfeited and will not be extended to you in other rounds. So, you can either accept, reject, or do nothing. If you reject an offer, it is the same as letting it expire – you can’t come back to it in other rounds.
On Thursday afternoon, the SOAP offers end. If you still have not matched at this point, you still have access to that updated list of unfilled programs and now the rules change. At this point, you can contact the programs on that list and ask for interviews. If they like you, they can extend an offer to you at any time. This process is available from that Thursday during Match Week until May 1st.
International medical graduates are inherently at a disadvantage compared to American Medical Graduates (AMGs) for multiple reasons. Broadly speaking, this is because most program directors are familiar with and confident about the medical education AMGs receive. Since IMGs are somewhat of an unknown to many programs, and because there is a large pool of applicants applying for a smaller group of positions, IMGs always need to have more competitive stats. That means higher USMLE scores, more research, and more volunteer activities. This helps give them the edge with applying.
All the same principles for a successful application apply to the IMG whether you’re from the U.S. or not. One note that is particularly important is selecting IMG “friendly” states. For instance, if you were an IMG interested in Anesthesiology and applied to all programs in Alabama, you simply will not be successful. Why? The reason is that the data shows (for 2019) that no IMGs were matched into any Anesthesiology positions in the state. This data is available in the SAP Crystal Report. Using this report should be the first step in identifying programs to apply to as an IMG.
Once you’ve identified which states match IMGs into the specialty of your choice, the next step is to look at the Residency Explorer app to specifically find out how many IMGs match into specific programs.
The residency application process is a long road requiring a well-planned out approach. From carefully selected audition rotations all the way until Match day, staying ahead of the curve by being prepared is the key to success!
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