A Guide to Swapping Residency Programs

The first time I heard that swapping or vacating your residency position was possible, I was dumbfounded. I thought, then what is the point of the Match?! Well, before the Match, residents had less collective bargaining power. The Match was created to ensure that each resident was paired with their top program, assuming that the program also wanted that resident, and to (theoretically) advocate for residents’ workers’ rights. Criticisms of the Match aside, it’s paired many residents with their top programs. While it’s an imperfect system (believe me… as someone who SOAPed, re-applied, and matched at my top pediatrics program the next year, I know), it works for the majority. So, what do residents do when they need to switch programs or specialties? Fortunately, systems and businesses exist to help residents make that transition. 

Before we begin, I’d like to offer a word of warning… Residency swaps typically occur outside the match. That means if you are considering swapping your residency program, you may not necessarily receive the same treatment as the residents in that program who participated in the NRMP Match. Before you swap, be extra sure that you will get the same rights, pay, and protections as your new co-residents. If you’re not comfortable with this risk, then you will need to re-apply for the Match and either Match or SOAP into an open spot.

Full disclosure: I have not switched/swapped spots. I was inspired to write this guide after realizing just how many of my colleagues’ switch/vacate their residency spots. I am thrilled to be a pediatrician! 

General Advice for Those Considering Swapping Residency Programs

First and foremost, make sure you have a good reason to leave your current program (e.g., family, health, or financial reasons). I can’t tell you how many people I’ve met who’ve ended up loving their residency experience even though they didn’t match at their #1 on match day. Even if you think you won’t enjoy your time with your #8 spot, give it a chance. It might surprise you. Most residencies will train you well. Strongly consider why you want to switch before you begin this process. 

Next, be a stellar resident. Show up to your program early and leave late. Your focus should be on making a great impression, not making enemies, being professional, and – above all else – being a decent human being. 

The process of swapping a residency program should ideally be done in the fall/winter. It takes time to prepare your transfer application, establish rapport with your program, obtain letters of recommendation, and earn a letter of good standing from your program director (a program letter is essential). That being said, people will leave programs at all times of the year for any number of reasons. Programs can have openings at all times of the year. 

Lastly, the chances of successfully swapping residency programs are low. The chances you’ll transfer into a program with a higher ranking than your current program are even lower. You will most likely transfer to a program at or “below” the quality of your current program. For those individuals who hope to “climb the ladder” by transferring residencies, set realistic expectations regarding switching programs before you start the process.

Steps to Swapping Residency Programs

1. Research. There’s no point in applying for a transfer if there are no open spots available. Do your due diligence to try and find potential open residency spots. 
2. Prepare. Write a general email template to send to prospective programs. Include your name, your program, why you want to transfer, a thank you, etc. In this email, include your CV and your letter of good standing with your program (you’ll get this later). Keep this email concise. 
3. Communicate your desire to transfer with your program. After a few months, speak with your program director about your desire to transfer. Be forthcoming. Do not try and transfer behind your program’s back! Your chances of transferring are catastrophically low without your program director’s (PD’s) support. Be prepared to speak to your program leadership about why you want to transfer (e.g., family, health, finances) and have a good reason about why you want to transfer. Be ready to discuss why and how long you’ve been considering the switch. Don’t be surprised if they try to talk you into staying. 
4. Obtain letters of recommendation and a letter of good standing. Assuming your program and program director are supportive of your decision, start asking for letters of recommendation and ask your program director to write you a letter of good standing. Make sure to follow up with your program director about this letter! It’s essential. 
5. Reach out to programs. Send your templated emails with your letter of good standing, letters of recommendation, and CV attached. Don’t be surprised by silence or rejections. It’s almost certainly not personal.

Resources for Residents Interested in Swapping/Vacating Residency Spots

Student Doctor Network

Student Doctor Network, or SDN, is an online forum for medical students, residents, and attendings to talk about anything and everything regarding medicine. I primarily used it to find out information about programs, find away rotations, and commiserate with other medical students. 

Pros:

• Reportedly more reliable for positions that have opened up
• Well-known

Cons: 

• Poor organization. 
• You have to do your own research

ResidencySwap

ResidencySwap is an online organization that exists to help residents fill unfilled residency vacancies or swap spots with other residents. 

Pros:

• Researches programs for you
• Of the resources I could find that help residents swap, this has the most testimonials

Cons: 

• Cost ($60 per month)
• You depend on another resident following through with the swap
• Reportedly not always reliable

FindAResident

FindAResident is the AAMC’s online service to connect program directors and residents. On FindAResident, programs share information about open positions and applicants post their resumes for programs to review. The beginning of the year, December, and late March are usually when vacancies occur.

Pros

• Through AAMC, which is a trusted resource and the parent organization behind ERAS
• Used by many programs

Cons

• $75 feed for applicants or $30 fee for active ERAS users

Your home program/program director

Your program director is going to be your best friend and your most valuable resource during this transition. If your PD is really kind, they may even be able to make a post on a PD server letting other programs know they have a resident who would like to transfer and to reach out if they are interested in accepting you. That way, interested programs come to you.

Pros:

• The most reliable method of finding another program.
• PDs generally have a listserv where announcements are made about vacancies in a program.

Cons:

• Your mileage may vary depending on whether or not your PD is understanding. If you try to swap and fail, there is no guarantee that your PD won’t hold it against you for the remainder of your training. This may be risky, but you will have to discuss your transfer with your PD if you are truly serious about swapping anyway. 

Networking

It takes a village. Your friends, co-residents, colleagues, and mentors may have inside information regarding open residency spots. This is especially important for competitive specialties like dermatology and surgical subspecialties. If you can recruit those around you to advocate on your behalf, who knows! You might get lucky. 

Pros:

• If you have an army of people advocating for you, they may do the work for you. Personally, I’d trust one of my mentors more than a PD I didn’t know or a stranger on the internet if they advocated for someone. 

Cons:

• If you don’t have a solid network of mentors and friends in your field already, this might not help you land a spot
• Not as reliable. 

There are other specialty and non-specialty-specific resources (UnmatchedMD, APDS, ACOG, etc.), but those are not discussed in this guide. 

A Note on Swapping if Your Residency Is Closing:

Sometimes, residency programs close. This can be for a variety of reasons, the most notorious of which are ACGME violations. If this happens, you will have the opportunity to transfer to another program. If your program does close (even temporarily), transferring will be easy since your ACGME funding will go with you. Remember, residents are free labor for accepting programs and the ACGME will allow most other programs to go above their normal resident cap. 

Helpful links:

ACGME common requirements:

ACGME requirements by specialty:

How to report ACGME violations

How to contact an ombudsman

EMP Residency Advising

Happy hunting!