Nearly 39,000 medical students and other applicants were matched with residency positions in the 2024 Main Residency Match, an impressive feat of matchmaking. But not every match is made to last. If, from an individual resident’s perspective, your residency position starts to feel like a mismatch instead, a move may be possible—but you should know that switching residencies will be a different experience than the Match.
Residents may have a change of heart about the specialty in which they wish to train. Personal circumstances may prompt a resident to consider relocating. Or, the program and the resident may not be a good fit for one another. Regardless of the motivation, transfers between programs are a fact of life in graduate medical education.
The numbers, however, tend to be small in relation to the total number of residency positions and care must be taken when trying to apply them to your situation. Around 1,000 residents transfer from one residency program to another each year, according to the Accreditation Council for Graduate Medical Education. Here are a few things to keep in mind when considering a transfer to a new residency.
Be sure a switch makes sense
Residency has a bruising reputation for a reason; it is, in every respect, very difficult. Stress and burnout are common, and given that context, it is doubly important to be clear-headed about a transfer decision.
Is your interest in transferring residency programs in response to a temporary situation—one that might not be all that much different in another setting—or a firm conviction that a change in setting or specialty is essential? If a transfer is indicated, research your transfer options and seek advice from trusted colleagues and mentors early in the process.
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, and handling medical school student loan debt along with other essential tips about succeeding in graduate medical training.
Transfer seekers largely on their own
Transferring involves paperwork, planning, interviewing and often travel, to secure a position, but without the framework of the Match process expressly designed to move things along.
After two years of a residency program in which he was happy, AMA member David Savage MD, PhD, made the decision to pursue a transfer because his wife was accepted into a graduate program on the other side of the country in San Diego. Upon beginning the process, he was struck by how unstructured it was compared to the Match process.
“It's a totally different process entirely,” said Dr. Savage during an episode of the “AMA Making the Rounds” podcast. “Even two years into my program, I was still bound by the NRMP [National Resident Matching Program] Match agreement. When I reached out to the program in San Diego … I got a response from the program director pretty quickly. But I remember the first thing she said was, we do have a spot we are willing to talk with you, but before we can even talk further, you need to talk with your program director, get her buy-in on this and make sure she's okay with us talking about a transfer.”
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It’s like looking for a new job
Networking, reaching out to residency directors and searching online are commonly cited approaches to making the switch.
If you’re happy with your training location but want to switch specialties, starting at the hospital or institution where you are already training can make for a smooth transition. Certainly, the transfer-seeking resident will be motivated, but there is also pressure on residency directors to fill vacancies and preserve clinical service capacity.
Funding can be a complication. The number of funded slots at an institution is limited. And the Medicare program bases payment for residents on the duration of the program to which they originally match. This can be an institutional consideration when switching specialties although it is rarely a deciding factor.
Like looking for a job, it helps to use your network. Dr. Savage—a member of the AMA Council on Medical Education—spoke to a friend who recommend he reach out to the San Diego internal medicine program where he eventually ended up.
f you are comfortable asking for help, the program director from the institution might also be a resource.
“The program directors speak to each other through mailing lists, and they might be advertising vacancies that they're trying to fill,” said Dr. Savage, an AMA member. “So, it might save you a lot of time and effort if you talk to your home person first and that person puts you in touch with programs that are looking for transfers.”
Transfers move fast, logistics take time
Unlike job hoppers in other industries, many of whom quietly find a new position, give two weeks’ notice and leave, that won’t happen in transferring residencies. Before a transfer can be finalized, paperwork documenting your experience in your initial residency must be provided to the new program, along with all of your performance data from residency, and any other materials the receiving program may require.
The receiving residency program director will communicate with the director at your current program. The reasons for a departure and your progress in the program will be part of that discussion. It’s best to clarify how these matters will be discussed in an open conversation with your program director before that contact is made.
When an opportunity is identified, it’s best to move quickly.
“In my case, start to finish between sending my initial email of inquiry to getting an offer was about three weeks,” said Dr. Savage, now an assistant professor and melanoma and sarcoma specialist in New Mexico.
“The real difficult part was the transition because I found out that I was accepted early April and then I needed to be in San Diego over 2,000 miles away to start in this new program less than three months later.”
There are resources that can help
FREIDA™, the AMA Residency & Fellowship Database®, is a place where open postings are listed. Check individual programs’ websites for residency program transfer policies.
The Match is principally designed to place residents starting with first-year positions, as is the Supplemental Offer and Acceptance Program. The Match does have subcategories such as Physician-R—meaning, reserved for doctors with previous residency experience—and Advanced, which places residents into PGY-2 positions. These positions may present an avenue to transfer through the Match. It is important to know where those opportunities exist and be familiar with timelines for application and matching.
