How Many Residency Programs Should I Apply to?

As an IMG, the short answer is at least 100. The long answer is that it all depends on the attractiveness of your application, the competitiveness of your desired field, how much choice you would like to have, and how much you are willing to spend on applications.

One mistake that some applicants make when applying to residencies is overestimating their chances and applying to too competitive of programs for their scores or too little residency programs. While some of us have applications that are exceptional, many of us are pretty average and have very similar “attractiveness” as the other myriad of candidates who apply to the same program. Because of this, more and more applicants are casting a wider net, applying to more and more programs over the years. This certainly doesn’t help relieve the headache of the selection committee who have to screen through all these applications, but it’s reality, and to increase your chances nowadays, you’ll have to apply to more programs. How little is too little, and how much is too much though? To answer this question, you must be realistic about what you have to offer to programs, and how attractive your application is. There are four factors to consider:

1. Which specialty are you applying to?
Some specialties are more competitive than others and require higher scores. If your scores aren’t as high as the average applicant applying for that specialty, then you’ll have to apply to more programs, in the hopes that one of them would be interested in inviting you to an interview. Check out my post here to see what scores you should aim for.

2. Are you an IMG?
As an IMG, you will need to apply to significantly more programs than the average US med student with equivalent scores to get the same (or less) number of interview invitations. As an IMG you should also apply to programs that have a history of accepting IMGs, particularly those from your school. Some school websites have a list of programs that their alumni have matched in. This is a great resource to start with when thinking about where to apply. Another useful resource in finding IMG-friendly programs that consider candidates with similar scores as you is Match A Resident. The service costs, but it is well worth it, and saves you a headache.

3. How are your scores, application, grades, evaluations, etc.?
If your scores are below average or if you have any red flags on your application (failures, leave of absence, multiple exam attempts, misconduct, etc.), I would not recommend spending your money on applying to prestigious programs like Mass General or Wash U. Invest your application budget on programs that would more realistically consider you, in states that are more IMG-friendly, and definitely apply to more programs. I’d recommend at least 100 programs. Although you may spend over $2000 applying to this many programs, the cost is miniscule compared to what it would cost you if you didn’t match and had to wait another year. It’s better to be safe than sorry. Like I mentioned above, Match A Resident is a great resource that suggests IMG-friendly programs based on your scores and stats. I highly recommend it.

4. Do you need a Visa?
Many programs may not sponsor Visas for foreign IMGs. If you need one, you should only apply to programs that do sponsor them, otherwise you will be spending money on applying to programs that won’t likely rank you. Sponsoring a Visa can be a lot of work and money for a program, so even if a program sponsors them, they may not prefer it. Therefore, if you are a foreign IMG (including Canadians), then you should apply to even more programs than your average US IMG. I recommend at least 100. Again you can search for programs that sponsor visas via Match A Resident, or simply go to the program’s website and look for that information.

Here, I’ve created a chart of the median number of programs applied to and median number of interview invitations received by matched US medical graduates and matched independent applicants, which include US IMGs, foreign IMGs, and DO graduates.  Notice that competitive specialties require more applications than less competitive specialties to get the same number of interview invites. Also note that independent applicants need to apply to significantly more programs than US grads and often get less interview invitations on average. This data is taken from the 2013 NRMP Applicant Survey.

	MATCHED US MD		MATCHED IMG/DO
Specialty	Applications	Interviews	Applications	Interviews
Anesthesiology	30	15	50	8
Child Neurology	18	15	45	10
Dermatology	72	10	85	6
Emergency Medicine	33	17	40	8
Family Medicine	17	14	50	8
Internal Medicine	25	15	94	9
IM/Peds	22	15	40	11
Neurology	20	15	50	9
Neurosurgery	46	22	91	12
Ob/Gyn	30	16	47	12
Orthopedic Surgery	62	16	60	7
Otolaryngology	56	15	89	4
Pathology	20	14	50	8
Pediatrics	22	15	50	10
PM&R	25	16	30	12
Plastic Surgery	53	18	55	3
Psychiatry	20	14	45	8
Radiation Oncology	56	16	63	6
Radiology	45	20	50	8
Surgery	38	16	77	4
Transitional Year	25	15	30	2

So the average US medical school applicant who matched in Family Medicine applied to 17 family medicine residency programs and received 14 invitations for interviews.  In contrast, the average IMG/DO applicant who matched in Family Medicine applied to 50 programs and received 8 invitations. Therefore to increase your chances to get the same number of invitations as your US MD counterparts, you’ll have to apply to around 100 programs. Remember, this chart just shows the median number applications submitted and median number of interview invitations received for those who matched. Those who did not match received even less interview invitations. There is a much wider range of numbers than those found on the chart, depending on the four factors I’ve elucidated above.

After interviews are all over, I would recommend ranking all the programs that you interviewed at, unless there is a program that you disliked so much that you’d rather wait a year to reapply than match there. Ranking less spots does not make you more likely to match in those spots. Only one rank is needed to match, and there are certainly candidates who have matched with only ranking one program. However, that doesn’t mean you’re guaranteed a match with 1 rank. You’re also not guaranteed a match with 20 (the max number you can rank). Ultimately, what is important is the quality of the interview, rather than the quantity. If a candidate is lucky and gets 20 interviews, but acts awkward, unprepared, and uninterested in all them, his/her chance of matching probably won’t be as high as the person who had 1 interview but blew the interviewers out of the water. However, NRMP statistics do positively correlate number of interviews or ranks to likelihood of a match. Therefore, generally speaking, the more the better.

Best of luck everyone!

Benji

Links for Residency Interview and Match