The memory of selecting your medical specialty and winnowing your initial list of residencies to interview with now feels distant. You’re mentally and physically exhausted after multiple daylong residency interviews — perhaps dozens, if your first choice of specialty is competitive. All you want to do is crawl under the covers and sleep for a week.
Not just yet. Now that your final residency interview is in the books, you’ve got one last task ahead of you: ranking your options ahead of Match Day.
For my wife, who’s now a practicing family physician safely removed from her training, the Match was the most enjoyable part of the marathon process of transitioning from medical school to residency. That’s not to say it was easy or stress-free. And without extensive guidance and moral support from her medical school’s support staff, colleagues, and family, it would have been far more difficult to manage.
As an aspiring physician, you likely have some understanding of how the Match works and what happens after. But it’s just as likely that you’ve yet to go over the details or consider the key factors that could and should influence your residency rank order. Use the following as a guide to making sense of your choices and deciding what to do in the event that you don’t match with a residency the first time around.
The Match Process
The National Resident Matching Program (NRMP) uses a sophisticated algorithm to match applicants with residency programs. Applicants and residency programs both compile Rank Order Lists (ROLs) ranking their preferred programs and applicants, respectively, in order of preference. At the standard Main Residency Match registration fee of $85, an applicant may rank no more than 20 programs. Each additional rank costs $30, up to a hard limit of 300 unique programs, and additional fees apply to lists longer than 100 programs.
If you’re applying to an advanced program that begins in your second year of residency (PGY-2), you’ll need to create a Supplemental Rank Order List (SROL) to rank your first-year (preliminary) choices. The same limits apply to your SROL. Some residency programs offer joint preliminary-advanced ranks; be sure to ask program directors if you’re pursuing this track.
Ranking Your Residency Options
As you compile your rank list, you’ll revisit the factors that initially attracted you to each program in light of your interview experience. In addition to considerations like the program’s strength in subspecialties that interest you, residency cohort size, and the appeal of the community where the residency is located, you’ll want to consider:
1. Faculty Feedback
Although residency faculty aren’t allowed to tell applicants exactly how they’ll rank, they can drop heavy hints, usually via post-interview letters or emails gushing about the experience. Because it’s in their interest to garner high applicant ranks, you’ll want to take such feedback with a grain of salt, but you shouldn’t discount it either.
2. Internal Culture
When push comes to shove, you want to be happy in the job you’ve agreed to hold for the next few years. This was a big consideration for my wife, whose rank list was a referendum on the social vibe she got from the residents she met while visiting each program.
3. Spouse and Family Support
Tied-down residency applicants can’t neglect their better halves — to say nothing of their children and other live-in relatives, like the kids’ grandparents — unless they don’t mind tension at home. My wife was fortunate that I was location-independent and my career and social life wouldn’t suffer too much from an interstate move. Some of her med school peers’ spouses worried about the transition’s impact on their career prospects and personal well-being. These peers tended to gravitate toward residencies with close-knit cohorts in which spouses were willing to put in a good word with local employers and organize family-friendly social outings.
4. Future Employment
It’s not too early to think about life after residency. After graduation, can you see yourself accepting a faculty position with any of your top-rated programs? Late-residency job seeking is stressful. Knowing that you have a fallback option — if your program director will have you — takes some of the edge off.
5. True Preference
If you haven’t already, prepare to hear plenty about “outsmarting the Match,” or gaming the algorithm to sneak into a more competitive residency than your academic profile might indicate.
Don’t buy this hype. All else being equal, the best way to approach the Match is simply to rank programs according to your true preference: your top choice first, your last choice last, and the rest in between.
What Happens If You Don’t Match?
Most U.S. allopathic (MD) med school seniors match. According to the American Medical Association, 94.3% of all U.S. allopathic seniors matched into residency in 2018, with about 77% landing one of their top three ranks. Match rates are higher in selective specialties because they’re more popular with graduating seniors, although less-competitive applicants often miss their top targets and wind up matching into less-selective programs.
Match rates are lower for osteopathic (DO) seniors, although most still do match. It’s wise to keep your options open, especially if you know you’re not among the most competitive applicants. Chances are high that you will eventually match, although you may have to defer your ambitions for a year or two.
Many applicants who fail the initial match immediately try again. The NRMP Match Week Supplemental Offer and Acceptance Program® (SOAP), colloquially known as the “scramble,” matches unmatched applicants into unfilled residency positions. In 2018, SOAP made 1,177 of 1,279 unfilled residency positions available. It’s common for applicants who didn’t match into selective specialty programs (dermatology, surgery) to match into less-selective programs (pediatrics, internal medicine) through SOAP.
If you don’t match through SOAP or don’t want to try to match again right away, talk to your academic advisor about possible next steps. Students who don’t match right away often take a year or more off to work on research — which residency program directors like to see — or pursue a certification that complements their medical degree, such as an MBA or Master of Public Health degree. The least-preferable course of action is to do nothing at all with your time off.
My wife is all settled in at her first post-residency job. It’s tough work. Some days, she’s overscheduled — seeing 20 patients or more, with barely enough time to gather her thoughts between appointments. But she’s more than able to shoulder the burden, thanks in no small part to the excellent training she received at her residency. If you worry about life after residency, take after her and choose a program you’re confident will prepare you for what’s next.
Are you preparing for the Match process for medical residencies? What’s your biggest worry?