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.

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.

FREIDA™, the AMA’s comprehensive residency and fellowship database, includes more than 12,000 Accreditation Council for Graduate Medical Education-accredited residency programs and offers a streamlined user experience.  

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. Of those applicants who completed a rank-order list, more than 11,300 responded to the 2022 survey.

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 March 1 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.

• Desired geographic location—cited by 88%. 
• Perceived goodness of fit—87%. 
• Reputation of program—82%. 
• Work-life balance—74%.
• Quality of residents in the program—73%.

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: 

• Perceived goodness of fit—86%.
• Desired geographic location—84%. 
• Work-life balance—78%.
• Quality of residents in program—75%. 
• Quality of program director—69%.

For both groups of applicants, the percentage ranking work-life balance highly as a factor rose since last year. For MD applicants, that the program they applied to was in an academic medical center dropped out of the five most important criteria. For DO applicants, the quality of program director criteria was a new addition to the top five. Interview-day experience—likely due to programs moving interviews online—and the reputation of the program dropped out.

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 family medicine with those preferring general surgery.

While 73% of U.S. MD seniors who preferred family medicine reported “considering program flexibility to pursue electives and interests in deciding where to apply,” says the report, just 56% of those preferring general surgery said they considered that factor.

And while 43% of U.S. DO seniors who preferred family medicine said they looked at the career paths of recent program graduates when selecting where to apply, 65% preferring general surgery examined 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. Nearly 75% ranked all the programs they were willing to attend (72% for DOs), and 75% ranked all programs with which they interviewed, regardless of preference. A smaller share of DO applicants, 68%, ranked all the programs with which they interviewed.   

The median number of applications submitted by U.S. seniors who matched was 45, up from 33 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 60—up from 49 in 2021. But their median number of interview invitations was 15, with those applicants attending 13 interviews and ranking 13 programs.

The median number of applications submitted by U.S. MD seniors who did not match was 80, up from 45 last year. The median number of interviews offered to applicants who did not match was seven, with those applicants typically attending seven interviews and ranking a median of six programs. 

The median number of applications submitted by unmatched DO applicants was 70 programs, up nine from 2021. Those applicants received a median of six interview invitations and typically attended six interviews and ranked that many programs.