Preparing for Residency

Which factors do applicants weigh most when picking residency programs?

Brendan Murphy , Senior News Writer

Medicine is a calling, many people feel. You don’t choose it. It chooses you. As far as which programs physicians train in, that comes down to a rank-order list.

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What factors do medical students consider most—and least—when choosing residency programs? Recent data released by the National Resident Matching Program (NRMP) shed some light on that question.

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Among the data, reports and research produced by the NRMP is a survey that aims to weigh the factors to which applicants give strongest consideration when applying to and ranking programs. The 2023 version of the survey featured responses from about 8,000 applicants, representing roughly 20% of the applicant pool in the most recent residency-selection cycle.  

NRMP asked survey respondents to list the factors that influenced both application and ranking choices and the relative importance of each of those factors on a scale of one to five. These factors may be worth keeping on a medical student’s radar in advance of the Feb. 28 deadline for fourth-year medical students to submit their Match rank-order list.

Among active U.S. allopathic senior medical students ranking residency programs across all specialties, these were the top five considerations.

  • Overall goodness of fit—cited by 78%.
  • Interview day experience—75%.
  • Desired geographic location—75%.
  • Work/life balance—64%.
  • Quality of residents in program—64%.

For both groups of applicants, the percentage ranking interview-day experience as a key factor took on increased importance; that hadn’t been ranked among the top five factors the previous year. . During this past residency-selection cycle—like all that preceded it since the pandemic—interviews were largely virtual. The interview-day experience taking on increased importance in ranking decisions could represent that programs are becoming more adept at the process, however.

For MD applicants, reputation of the program was a factor that dropped out of the five most important criteria. For DO applicants, the quality of program director criteria dropped out of the top five factors.

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The survey results “indicate that applicants’ consideration of program characteristics in decision-making about application and ranking is likely based in part on preferred specialty and what applicants perceive as important to those specialties,” says the NRMP report, which draws a comparison between residency applicants preferring psychiatry and orthopaedic surgery.

While 70% of U.S. MD seniors who preferred psychiatry “considering program flexibility to pursue electives and interests in deciding where to apply,” says the report, just 42% of those preferring orthopedic surgery said they considered that factor.

Here are some other interesting nuggets from the survey.

U.S. MD seniors most commonly ranked the programs in order of their preference, with 94% citing that as a strategy for ranking programs, compared with 91% for U.S. DO seniors. Of U.S. MD seniors ranked, 77% ranked all the programs they were willing to attend (69% for DOs), and 74% ranked all programs with which they interviewed, regardless of preference. A smaller share of DO applicants, 64%, ranked all the programs with which they interviewed.   

The median number of applications submitted by U.S. seniors who matched was 40, down from 45 last year. The median number of interviews offered to matched U.S. seniors was 16, with those applicants attending a median of 14 interviews. Matched U.S. seniors typically ranked 14 programs.

Matched DO applicants applied to more programs, with a median of 54—down from 60 in 2022. Their median number of interview invitations was 17, with those applicants attending 14 interviews and ranking 14  programs.

The median number of applications submitted by U.S. MD seniors who did not match was 57, down from 80 last year. The median number of interviews offered to applicants who did not match was 14, with those applicants typically attending 13 interviews and ranking a median of 13 programs. 

The median number of applications submitted by unmatched DO applicants was 71 programs, up one from 2022. Those applicants received a median of 13 interview invitations and typically attended 12 interviews and ranked that many programs. Notably, interview offers and attendance rose starkly from prior year numbers for unmatched DO and MD applicants.

The top five factors listed by applicants who were active U.S. osteopathic senior medical students ranking programs—on their final Match rank-order list—were as follows: 

Overall goodness of fit—70%. Desired geographic location—66%.  Interview day experience—64%.  Work-life balance—60%. Quality of residents in program—56%.