How Does Residency Matching Work? Get Your Dream Residency

A medical school graduate’s first job is determined by a computer algorithm called “The Match.” Just like for medical school, applicants submit an application to many programs. But unlike for medical school, an applicant is matched to only one program in one city. This process is known as residency matching and follows this trajectory: in the fourth year of medical school, applicants will submit a comprehensive application called ERAS to many programs in the specialty of their choice, get invited to and go on interviews, and then rank the programs where they interviewed. The programs will do the same and rank the applicants they interviewed. All of these rankings are entered into a computer algorithm that provides each applicant with one program where they match.

Fortunately, the algorithm attempts to place the applicant in their highest ranked program, given that the program also ranks an applicant highly. So how can an applicant get into their dream residency program? Though there are no guarantees, there are many factors that affect how programs rank applicants, and enhancing these factors will increase your chances of matching into your dream residency. Many of these factors are included in your ERAS application. Though this article is lengthy, by the end of reading this, you will know exactly what to do to maximize your chances of matching at your dream residency program.

First, just like any other application, ERAS requires you to enter your general information. One piece of this information is the name of your medical school. As you can imagine, programs consider the ranking of your medical school. You cannot control this factor, but there are many other ways to make your application stand out.

Programs can also consider your geographic information and where your family is located. If you have ties to a particular state, make it obvious on your interview day and make sure to explain why. Some programs prefer to match applicants that are likely to practice in their state after graduation.

Next, ERAS asks about your work and volunteering experiences, dates, and brief descriptions of these. It is similar to a medical school’s application activities section. Though this can be an opportunity to stand out, it is not among the most important factors for securing your match. However, if you have an interesting experience, it will likely come up in your interviews.

Research experiences, presentations, and publications are also included in the ERAS application for residency matching. Depending on which specialty you are applying to, research experience can be one of the most important factors in securing your dream match. For more competitive specialties, research experience and the number and quality of your publications are considered when programs create their ranking list. This is also important for programs that are academic rather than community-based. To build a strong research section, get involved in research early in medical school (meaning your first year). Identify potential mentors within your specialty of interest and reach out to them through e-mail, asking if you can get involved in a project they are currently conducting, or better yet propose a research topic of your own. Basic science research often takes longer to be published, so unless you are planning to take a research year in medical school, it is best to pursue clinical research. Once you are in a research position, work hard and be engaged with your team. Your research mentors end up working with you for a few years and make excellent letter of recommendation writers.

So as you know, your residency application will also include letters of recommendation. You are required to submit at least three and up to four letters of recommendation to each program. This does not mean that you need to submit all the same letters to every program. It is always in your best interest to have more letters. Some attendings may have ties to certain programs if they did their residency there, so submit the letters to each program accordingly. Letters should be requested from attendings you have worked with, usually on research or during your clinical rotation of your specialty. When asking for letters, a good rule of thumb is to ask if the attending can write you a “strong” letter of recommendation. If they say they cannot write you a letter, or that it will not be strong, ask someone else. Letters of recommendation are amongst the most important factors for your match, so you must ensure that they are high quality. Another tip for obtaining a strong letter is to let the attending you are working with know early on that you are applying in this specialty, and telling them that you may ask them for a letter at the end of the rotation. This will result in the attending paying more attention to you and watching you closely, so make sure you work hard and impress them! Finally, ask for your letters of recommendation as early as a few months in advance, and remind your writers about 1 month out from application submission. Some writers may require a few reminders.

As you already know, passing Step 1, your Step 2 score, and your grades are among the most important factors for residency matching. These are even more important for competitive specialties. Thus, it is important that you study hard for your Step exams and your clerkships. It is highly recommended that you receive honors on the rotation for the specialty you are applying to, though you should work hard on each clerkship and get the highest grades possible for you. Most schools are on a pass/fail system for the first two years, so these are equivalent amongst most applicants, and therefore do not hold high importance (unless you failed any classes.)

Included in your clerkship grades will be your away rotations. Doing away rotations is your chance to audition for your top programs. Make sure that you apply to these early. Once you are there, work harder than you ever have before, be kind and friendly with everyone (including and especially nurses), and impress everyone you work with. Make sure to do your top choice program rotations before your ERAS application is submitted for residency matching. Also, ask for a letter of recommendation from each away rotation and use it to apply to that program. A strong performance on an away rotation can secure matching at your dream residency program. Any weaknesses in your application can be overlooked if you show that you are a great fit for the program.

Just like for medical school applications, you will need to write a personal statement, answering why you chose your specialty. Your personal statement should be well written, but it is likely that it will sound very similar to other applicants. In your personal statement, you must convince the programs that your specialty is the perfect choice for you. If you have overcome challenges to get to where you are or grew up disadvantaged, these should also be included. Your personal statement is the only part of your application where you can make the reader feel, so make sure they feel that you are the perfect candidate for this specialty.

For the ERAS application, you will also need to submit a good quality professional headshot. Invest in getting a professional photographer and do not use an old photo. Make sure you are dressed professionally. For men, this means wearing a suit and tie, and for women, a nice blouse and blazer. Do not skim on this part! The last thing you want is having your application placed aside for a poor quality or unprofessional photo. Though it does not matter how you look, you must use this headshot to convey that you are the professional doctor that you are about to become.

So your ERAS application is submitted. Now what? Sit back, relax, and await interview invitations. This is the part where you must regularly check your e-mail because interview scheduling is first come, first serve. It is best to have a lighter rotation during this time. As soon as you receive the e-mail, you must log on and sign up for your preferred interview slot. If you are unable to check your e-mail regularly, give your login information to a family member or friend who can do it on your behalf. Make sure you also give them a calendar where you write out all interview date preferences and rank them in the order of importance to you. Sometimes, programs will interview on the same days and you may even have to choose between them, having to give up one of the interviews. Programs will often have their interview dates posted on their website prior to sending out invitations. Make sure to check these for every program you are applying to and plan accordingly. Interview slots fill up quickly and sometimes programs send more invites than they can accommodate, so it is very important to be on top of the interview invitation e-mails! In terms of scheduling, do not schedule your top program choices first or last. Preferably, you should schedule about 3-4 interviews with residency programs you are not as interested in so that your interview skills will be polished by the time you get to interview with your dream residency program. 

You should prepare for your residency matching interviews as you prepared for medical school interviews. Look up the most commonly asked questions, write out your answers, and practice saying them. Thoroughly read the website or each program where you interview and be ready to discuss why you want to be there. If your school offers interview workshops or mock interviews, take advantage of these. Ask your mentors to do mock interviews with you and give you feedback. On your interviews, maintain professionalism not only on interview day, but at pre-interview dinners. Keep in mind that you are always watched. Be personable, but professional.

There are two times that you can ask your mentors to call your top programs on your behalf – during the interview invitation period and before rank lists are submitted. If it has been a few weeks and you have not gotten interviews from your top programs, you should strongly consider asking your mentors to make calls. Before programs submit their rank lists, make sure you have your mentors call your top three programs.

After your interviews, consider sending a letter of intent to the program you will rank first. You must specify that you are ranking this program first and discuss how you are a perfect fit. Though it likely will not make a huge difference, this cannot hurt you. If the program is deciding between you and another applicant who has the same qualifications as you, the letter can serve to sway them in your direction.

As you are making your rank list, it is incredibly important that you rank the programs in the order that YOU want, and never in the order you think they will rank you. As previously discussed, the match works in the applicants’ favor, so you have nothing to lose and everything to gain by ranking the programs based on your preference. Even if you think your interview went horribly at a program you want to rank highly, RANK IT HIGHLY anyway. Plus, though you may feel like your interview went poorly, it is possible that the program thought otherwise. Some programs may e-mail you indicating that they are ranking you highly. Do not let these e-mails change your rank order. “Ranked highly” can mean that you are in their top 50, not necessarily their top 5. Rank your programs in the order you want! Again, you have nothing to lose, and everything to gain here.

So what do programs consider when ranking applicants? For most programs, the important factors for rank lists include USMLE Step 2 score and grades, letters of recommendation, away rotation performance, interview, and research experience. Of course, this can vary by specialty, so make sure to look into the most important factors to match into your specialty after you finish reading this article.

After rank lists are submitted by both applicants and programs, you will await Match Day, which is usually the third week of March. Results will be released at the same time to all applicants on a Friday at 12PM EST. The Monday prior, you will receive an e-mail indicating whether you matched or not, but it will not specify the program. Whether you matched at your top choice or not, celebrate your accomplishment. You are going to be a doctor in the specialty that you love and that is a huge success!

For additional residency advising including everything from navigating ERAS to mock interviews to program selection, Elite Medical Prep is here to help! Schedule a free consultation here to learn more!