How to Match into Anesthesiology for Residency

This blog (How to Match into Anesthesiology for Residency) was originally posted on September 13th, 2019, and updated on August 9th, 2023 by Dr. Seth Klapman

From A Program Director Viewpoint: What You Need to Match into an Anesthesiology Residency

The NRMP directors survey “at a glance” tool is designed to “assist Main Residency Match applicants in determining their goodness of fit for specialties.” The tool is very useful in gauging where your application packet stands compared to the applicant pool. It can also help determine whether adding additional components (like a letter of recommendation (LOR)) could give you a leg up as programs review your application. In this blog, we will cover how the information presented in this tool can help you learn how to match into anesthesiology for residency!

2023 Update

Please note, the most recent release of the NRMP directors survey is from 2020. There have been a few key changes since that time, most notably the transition of Step 1 to pass/fail. We will continue to update our blog series as we gain additional insights into these changes and how program directors are responding to them. We will also be sure to add in relevant information from the 2022 match cycle. In addition, we recommend taking a look through our 2024 residency application timeline to make sure you are prepared.

Applicants pursuing anesthesiology as their chosen specialty should possess a strong academic record, relevant clinical experience, and competitive board examination scores. These are important to stand out among the numerous applicants vying for limited positions. Additionally, research experience and a well-rounded portfolio can significantly boost an applicant’s chances of matching into a reputable anesthesiology program. As the field continues to evolve and advance, the demand for anesthesiologists is expected to remain high. This will contribute to the competitiveness of the specialty in the years to come.

We highly recommend going through this overview and seeing how you stack up before submitting your ERAS packet, as the following will be very helpful in evaluating the importance of certain application materials, as well as your realistic chances of matching.

How Competitive is Anesthesiology

Anesthesiology is considered a medium to highly competitive specialty to match into for medical residents in the United States. It attracts a considerable number of applicants due to its diverse and challenging nature, offering a combination of critical care medicine, pain management, and perioperative care. 

Among other sources, the competitiveness of anesthesiology residency programs is reflected in the National Resident Matching Program (NRMP) match data. The match rate for anesthesiology has been consistently high, with more applicants than available positions in recent years. The following comes from the 2022 NRMP Match Data:

In 2022, there were a total of 2,560 applicants to fill approximately 2000 positions in Anesthesiology. While the match rate for US MD Seniors was high (89.5% | 1267 matched / 1415 applied), the match rate for DO students (66%) and IMGs (42%) were significantly lower. 

What are Program Directors Looking for?

As discussed, the last published survey (NRMP directors survey “at a glance” tool) comes from 2020. While the data can still be quite valuable, there have been two major changes to residency applications in the interim:

1. Step 1 transitioning to pass/fail.
2. The addition of preference signals.

We’ll address both of these later in the post. 

How to Match into Anesthesiology for Residency: Getting an Interview Invitation

Program directors are receiving more applications than ever before. The following are the most critical components to getting your foot in the door and getting that interview. Based on the 2020 survey, the following are the most important factors.

To break things down a bit further regarding score importance for Anesthesia:

• Step 1 Score – For applicants applying in 2020, a 230+ looked like a solid score on Step 1. As Step 1 has moved to pass/fail, Step 2 will likely become the primary metric for deciding who to interview. 
• Step 2 Score – While passing Step 1 is important, program directors are likely to substitute Step 2 scores in their place when they consider candidates to interview. According to the 2022 NRMP Charting Outcomes in the Match, the average Step 2 score for a candidate matching into Anesthesia is 248 (note: this is ~10 points higher than the Step 1 score for those that took a scored Step 1).
  • While we don’t yet have complete data for Step 2, we know that range programs did NOT typically offer interviews to students below 215-220 on Step 1, and getting a 215-220 on USMLE Step 1 seemed to be the minimum threshold we would recommend for having a good chance at enough interviews. Given the higher average scores on Step 2, if you’re below the 225-230 range on Step 2, we suggest having a backup specialty you could consider. We will continue to evaluate new data in the Pass/Fail Step 1 era and update with additional information as it becomes available. 
  • Range programs DO typically offer interviews to students coming in at or above a Step 2 score of 240. 240+ seems to be the range at which you can feel comfortable being offered interviews by enough programs. If you’re in the 250+ range, you can likely be selective about where you apply.

What if I Failed USMLE Step 1 on My First Try or Am a Non-Traditional Applicant?

• Failing Step 1 is NOT a show-stopper!
  •  While it’s true that failing USMLE Step 1 is a BIG deal in ANY specialty, 2/3 of Anesthesia residency programs MAY still consider you if you’ve failed Step 1/Step 2. So, if you’ve failed an exam, you can still apply. But we HIGHLY recommend you apply to a big number (100+) of programs.

• Also, International Grads are a GO!
  • >1/3 of programs routinely consider IMGs, and only 10% never do. We still recommend doing your homework to determine which programs are more likely to consider IMGs. We also advise you to apply to a lot of programs.

Interviews and Ranking When Applying to Anesthesiology:

• Interviewees Get Ranked!
  •  If you get an interview invitation, you’re 90% likely to end up on the rank list if you choose to interview. We recommend making a rankings list of at least 10-20 programs. Once you have 15 interview invitations you can feel okay with prioritizing and canceling lower-priority interviews. The probability of matching for an average US MD Senior improves to >90% at about 10-11 contiguous ranks.

• Expect interview invitations from late-Sept to mid-Nov. If you’re falling short of 10-15 interviews by Thanksgiving, start reaching out to programs you are REALLY interested in to express interest in interviewing to beef up your rank list. However, if you didn’t send them a signal, you’ll have to justify your “new found” interest. Read more about signals below. 
• Expect to interview in Nov/Dec! 
  • For further discussion on how to prep for your interview see our blog post on How to Crush your Residency Interview.

New Features: Program Signals and Geographic Preferences

Watch our recorded residency roundtable on this topic here, or read on for more information.

Program Signals

One of the newer features of ERAS is program signals. These allow applicants the opportunity to express interest in individual residency programs. Signals are designed to help programs prioritize students for interviews. 

Anesthesia is leveraging a tiered program system:

• Gold signals are designed to identify an applicant’s “most preferred” programs.
• Silver signals are designed to identify an applicant’s “preferred” programs.

For the 2023-2024 cycle, students are given 5 gold signals and 10 silver signals. Given the number of signals available to applicants, it’s important to use your signals wisely. Based on a 2022-2023 Program Director Survey to the Supplemental ERAS, 90% of Anesthesia programs used program signals during the application review process. I’ve copied Table 20 and Table 21 from the survey below for additional insights. You can see that 92% of program directors used program signals to help screen applicants.

How Will This Differ from Past Years?

In the past, if a student didn’t receive an interview from a program, they could follow up to express interest. However, if you’re going to reach out to a program that you did not send a signal to requesting an interview, you should probably have a pretty good reason as to why you now have a strong interest in their program whereas before they were not in your “top 15.” See below from Table 23 in the survey.

If you’re a very competitive applicant, using signals is quite simple: send them to the programs you are most interested in. However, if you’re a less competitive applicant, the use of signals can become a bit more nuanced. If you use all of your signals at reach programs and are not offered any interviews, it may be more challenging to get interviews at programs in which you are more competitive. For these situations, I highly recommend discussing with one of our Anesthesia Residency Advisors. 

Geographic Preference

Anesthesia applicants also have the opportunity to identify their geographic preferences. For the vast majority of applicants, there is no need to try to game the system. Just choose regions where you would like to end up for residency. For those that have no geographic preferences and are happy to train anywhere, you can select “No geographic preference.” Be aware, if you truly have no preference, it is important to select “No Geographic Preference.” Program directors can see what you’ve chosen IF you’ve listed the region in which they are located OR “no geographic preference.” However, if you select another region or don’t put down any preference, they will see the field left blank. As you can see from the ERAS 2022-2023 PD Survey, the difference between a blank field and “no geographic preference” response comes across very differently to PDs.

Supplemental ERAS® 2022-2023 Application Cycle: Results of the Program Director Reaction Survey

HIGHLY RECOMMEND: ACCRAC PODCAST

To hear an amazing discussion from actual program directors on this subject, I highly recommend listening to the following podcast episode from Dr. Jed Wolpaw, program director at Johns Hopkins along with Drs. Dutoit and Teeter to discuss the changes to the ERAS application system including program signals, geographic preferences, experiences, and general advice. If you’re interested in Anesthesia, the ACCRAC podcast is one of the best. However, no need to try to listen to all episodes before you start residency. 

ACCRAC Podcast: Program Signals and Geographic Preferences

Summary of Anesthesiology Residency Applications:

• A solid anesthesia application would include a 230+ on Step 2, a LOR from an Anesthesiologist, and a decently strong MSPE. 
• Be sure you leverage Program Signals and Geographic Preferences to your advantage
• Anesthesia seems relatively IMG-friendly, but we still recommend doing your homework, especially identifying programs with active IMG residents. 
• If you’ve failed an exam, you can still apply in Anesthesia, but you should apply very broadly.
• Expect Interviews Late Sept-Mid Nov. Reach out to programs you have high interest in if you haven’t heard from them by Thanksgiving. Once you have about 15 interview invitations, you can start being picky about which ones you actually take.

Good Luck!

Wondering about your chances of matching into other specialties for residency? Check out our analysis of the NRMP directors survey “at a glance” tool for areas including neurology, dermatology, family medicine, transitional year, psychiatry, emergency medicine, and more under the Residency Applications category of our blog! If you need further or specialized assistance understanding which residency specialties you are best suited to apply to, you can contact us or visit our residency advising page to learn more about how Elite Medical Prep residency advising services.

For reference, the full interactive table tool can be found here: https://www.nrmp.org/match-data-analytics/interactive-tools/at-a-glance-program-director-survey/

For more residency matching assistance, consider enlisting the help of an Elite Medical Prep residency advisor! Schedule your complimentary consultation to learn more.