As members of the 2024-2025 Match cycle, you’ve dealt with so many trials and tribulations to get to this point—Step exams, rotations, and let’s not forget, a global pandemic. After all of the “unknowns” you’ve prepared for and conquered over the past three years, residency applications don’t have to be another one standing in your way.
To take some of the mystery out of residency admissions, we’ll delve into the key components of the process, break down what program directors are looking for on your application, and how to know if your application is competitive enough for a certain program.
What is the residency acceptance rate?
Every year, the National Resident Matching Program (NRMP), an institution that places medical school students into residency training programs across US teaching hospitals, tracks residency application data.
At the end of each Match cycle, the NRMP reports the applicant match rate, which is the percentage of active applicants who matched to PGY1 positions, not including those who go through the Supplemental Offer and Acceptance Program (SOAP).
NRMP has historically reported these rates annually, providing insight into how competitive various specialties are. For example, this past cycle, the overall residency acceptance rate for US MD seniors was 93.5%, but this rate varies significantly among different specialties, with some being more competitive than others.
The residency acceptance rate in 2024 for US DO seniors was 92.3%, 67.0% for US citizen international medical graduates (IMGs), and 58.5% for IMGs that aren’t US citizens.
This report summarizes data from the NRMP’s 2024 Main Residency Match. 2024 was the largest class in NRMP history when measured by the number of positions offered (41,503) and filled (38,941). The total PGY1 positions matched constituted an all-time high and an increase of 1,069 over the previous year. There was also a record number of active applicants at 44,853, with 1,901 more active applicants compared to 2023 and more spots filled across various medical specialties.
Trends in This Year’s Match Cycle
Overall, this year’s Match cycle saw an increase in both applicants and available positions, reflecting on both the desire and need for more physicians in the US.
More specifically, the NRMP found:
- An increase in the number of US DOs who match. This year saw 8,033 US DO seniors submit a rank order list, 597 more than in 2023. Of those 8,033 applicants, 7,412 matched to a PGY1 position at a rate of 92.3%, an increase of 0.7 percentage points from last year.
- 19,050 US citizen and non-US citizen students and graduates of international medical schools registered for the Match—1,668 more than in 2023.
- Of the 4,751 US citizen IMGs who submitted rank order lists of programs, 3,181 matched to a PGY1 position for a match rate of 67.0%. Of the 10,021 non-US citizen IMGs who submitted rank order lists of programs, 5,864 matched to a PGY1 position for a match rate of 58.5%.
The Reality of Residency Acceptance Rates
While the overall increase in the residency acceptance rate is a good sign, it doesn’t tell the full story. Each specialty and even each program has its own acceptance rate, with most specialties having more applicants than available positions.
For example, highly competitive specialties like dermatology, orthopedic surgery, and interventional radiology often have lower acceptance rates compared to primary care specialties such as family medicine and internal medicine.
(These numbers are further detailed in the report linked above and can be useful for those who want to delve deeper into the weeds of Match data.)
What is the residency admissions process?
Let’s talk now about the admissions process as a whole, something many applicants have questions about. From a program standpoint, the residency admissions process involves a number of key steps, from the initial application review, to the interview offer, and then the final selection of the incoming PGY1 class.
Here are the steps programs go through when deciding which applicants move forward:
1. ERAS Submission
Residency programs receive applications through the Electronic Residency Application Service (ERAS). Each application includes a candidate’s USMLE scores, medical school transcripts, personal statement, letters of recommendation, a Medical Student Performance Evaluation (MSPE), Dean’s Letter, etc.
Applying for the 2024-2025 residency cycle? Here’s everything to know about the 2025 updates to the ERAS application.
2. Initial Screening
Program directors and their teams, usually consisting of the associate program director (APD) chief residents, and other core faculty, perform an initial screening to filter out applicants who don’t meet the program’s minimum criteria, such as USMLE scores and attempts.
3. Detailed Application Evaluation
This involves a deeper dive, looking for an applicant’s compelling residency personal statement, strong letters of recommendation, and performance on clinical rotations via their MSPE/Dean’s Letter.
Further considerations are made evaluating an applicant’s meaningful experiences, research involvement, extracurricular activities, and hardships section.
Each section of the application is carefully reviewed during this stage. For instance, the personal statement is read multiple times to understand the applicant’s motivations, career goals, and if they fit with the program’s culture and values.
4. Program Signals
Programs that have opted into signaling will strongly consider program signals, where applicants can indicate heightened interest in specific programs, helping to identify genuinely interested candidates.
Pro tip: Use signals wisely! Check out this detailed post about program signaling.
5. Diversity and Inclusion
Many programs also aim to build a diverse and inclusive cohort, considering factors such as background, life experiences, leadership, and contributions to community service.
Residency programs from family medicine to ophthalmology value DEI (diversity, equity and inclusion). There have been various task forces launched in residency programs throughout the nation to promote DEI and advance equity in the medical field.
Part of this included posing questions to PDs such as “What percentage of current residents in your program are underrepresented in medicine?” Programs had milestones to address inequity from ACGME.
6. Ranking for Interviews
Based on the detailed evaluation, programs rank applicants and select a subset for interviews. Above factors such as clinical performance, leadership roles, and meeting program USMLE/COMLEX score requirements will influence this decision, as well as program signals and geographic preferences.
7. Interviews
Selected applicants are invited to interview, either in person or virtually. The interview process allows programs to assess interpersonal skills, professionalism, and cultural fit.
Residency program interviews typically include traditional question and answer sessions, behavioral questions, and sometimes situational judgment calls. Some programs may also conduct group interviews and ask difficult questions meant to assess medical knowledge of ethics, though this is rare.
8. Post-Interview Evaluation
After interviews, the program’s selection committee, which often consists of the program director (PD), the assistant program director (APD), chief residents, and core faculty and staff, meets to discuss each candidate’s strengths and weaknesses, incorporating feedback from interviewers.
Applicants are then ranked in order of preference based on strength of their application, overall fit, performance, and potential contributions to the program/field.
After interviews, just as programs rank applicants in order of preference, applicants rank programs based on their preferences. These rank lists are submitted to the NRMP, which uses a computerized algorithm to match applicants to programs based on mutual preferences.
Looking for some interview prep from our expert residency counselors? Check out this FREE Residency Mock Interview with the most common residency interview questions!
What do residency program directors consider during admissions?
Every year, like clockwork, I have medical students ask me what to focus on for residency admissions, and what PDs consider important. Up until a few years ago, the most important factors were your class rank and USMLE Step 1 score.
Now, with the transition away from traditional numerical scores, other factors such as service, research, and leadership have increased in importance. Your USMLE Step 2 score remains the heavy contender, though, with program signaling and geographic preferences also playing an important part in a PD’s decision-making process.
That said, don’t brush off your interviews. They really matter. In fact, a recent study involving over 4000 residency PDs across 23 specialties demonstrates the factor they considered most important was the interview.
Generally speaking, here’s breakdown of things PDs take a hard look at when it comes to admissions:
1. USMLE Scores
Step 1: With the transition to a pass/fail system, Step 1 scores are no longer a primary differentiator, but it’s still essential to pass Step 1 on your first try.
Step 2 CK: This score has gained increased importance as it remains a numerical value that program directors can use to assess your medical knowledge and clinical skills.
2. Performance in Clinical Rotations
Your performance during clinical rotations, especially on your core rotations and electives in the specialty you’re applying to, is crucial. Getting honors (if your school still grades clinical rotations) or exemplary remarks from letter writers from these rotations are a boon.
3. Letters of Recommendation
Strong letters of recommendation from faculty, particularly those who are well-known in their field, can make a substantial difference. Aim to build relationships with mentors who can speak to your clinical abilities, work ethic, and professionalism.
4. Research Experience
Participation in research projects, especially those resulting in publications or presentations, will enhance your application. Research experience in your desired specialty is particularly valuable, although research in other areas of medicine won’t hinder you.
5. Extracurricular Activities
Leadership roles, volunteer work, and involvement in professional organizations demonstrate your commitment to the field and your ability to balance multiple responsibilities and work with various groups of people. These extracurriculars can add volume to your application and help paint a better picture of who you are as an applicant.
6. Personal Statement
Craft a compelling ERAS personal statement that highlights your passion for the specialty, your career goals, and any unique experiences that have shaped your journey.
A good personal statement will help you secure an interview slot, which you can then use to impress the program leadership.
7. Interviews
The interview is the most weighted part of your application and your opportunity to make a lasting impression on the program. Practice common interview questions, be prepared to discuss your application in detail, and show genuine interest in the programs you’re applying to.
Remember, not all PDs emphasize the same thing!
When stratified by specialty, PDs in different fields emphasize different elements of an application. For example, surgical PDs are more likely to characterize the Step 2 score, class rank, letters of recommendation, and research/scholarly work as being very important, while primary care PDs favored the proximity of the candidate’s hometown and service.
The point is, there’s variability as to what PDs in different specialties emphasize in their admissions process, so view the list above as a set of overall guidelines. Be sure to know what PDs in your specialty want to see in an applicant early on, so you have time to put together a good application and increase your chances of being accepted!
How do you know if your application is competitive enough to apply for certain programs?
Determining the competitiveness of your application is tough and it can vary by application cycle. I advise my students to compare aspects of your application—the scores, research, etc,—to those of successfully matched applicants in your desired specialty.
You can use the Residency Explorer Tool to accurately evaluate the competitiveness of your application for any given specialty!
When it comes to evaluating the competitiveness of your application, doing the following can help:
1. Compare USMLE scores.
The simplest thing to compare is a numerical score. Put your USMLE or COMLEX scores side by side with those of matched applicants in your desired specialty. Ensure your scores are within a competitive range, I’d say within 10 points of the average.
For instance, if the average Step 2 score for those going into dermatology was 257 this year, and you score a 250, then you have a shot. However, if you scored a 235, you can still apply to derm, but I’d have a backup plan in mind and be prepared to use it.
2. Seek guidance from those with experience.
Consult with advisors and faculty members, particularly those who have experience helping applicants match, who can provide insights into the competitiveness of your application.
3. Evaluate specialty and program requirements.
Research individual programs to understand their specific requirements and preferences. Some programs may place a higher emphasis on certain criteria, such as research experience or community service.
4. Review the data.
For a holistic review of your application versus those that matched, look no further than the NRMP. The NRMP publishes an annual report, “Charting Outcomes in the Match,” which provides detailed statistics on applicant characteristics and match outcomes by specialty.
This report can help you understand the typical profile of matched applicants in your field. It’s an accurate report generated literally from the NRMP, so you can’t get access to better data than this. Best of all, it’s free!
A Closer Look at Competitive Specialties
Here are the match rates for some of the most competitive specialties:
- Thoracic surgery—95.8%
- Otolaryngology—95.8%
- Orthopedic surgery—92.1%
- Interventional radiology-integrated—91.4%
Thoracic surgery and most surgical specialties, especially orthopedic, are generally highly competitive, so how does it have a match rate over 90%?
Well, all of those applicants are highly competitive. For example, orthopedic surgery is generally considered a highly competitive specialty due to the rigorous demands of the field and the limited number of available positions.
Despite this, the specialty can show a relatively high match rate, similar to less competitive specialties like internal medicine. This is because the only ones who apply are highly competitive applicants, all of whom have exceptionally high USMLE scores, strong letters of recommendation, extensive research experience, and significant clinical exposure.
Many applicants who pursue orthopedic surgery are well-aware of the competitiveness of the field and only apply if they have strong credentials. Orthopedic surgery applicants often engage in targeted preparation activities, such as sub-internships in orthopedic departments, presenting at national conferences, and gaining early exposure to the specialty. This preparation strengthens their applications and increases their chances of matching.
**A Special Section for IMGs
An International Medical Graduate (IMG) is a physician who has completed their medical education outside of the United States. Matching into a US residency program as an IMG is typically more challenging, so scoring well on the USMLEs is particularly important.
In 2024, the medical specialties with the highest percentage of first-year positions filled by IMGs are:
- Internal Medicine – 43%
- Pathology – 37%
- Family Medicine – 32%
If you’re looking for more information about applying to a U.S. residency as an IMG, check out this post about how to find IMG-friendly residency programs!
How do I become a more competitive applicant?
How do you become a more competitive residency applicant? I recommend the following:
1. Start early.
Begin preparing your application materials well in advance. This includes requesting letters of recommendation, writing your personal statement, gathering your transcripts, and starting USMLE Step 2 preparation early.
2. Seek guidance.
Utilize resources available through your medical school, such as advisors, career services, and alumni networks. Attend residency fairs and informational sessions to learn more about programs and get your foot in the door.
3. Stay organized.
Keep track of application deadlines, requirements for each program, and the status of your applications. Use a checklist or spreadsheet to stay organized throughout the process.
4. Be resilient.
The residency application process can be stressful and challenging. Stay focused on your goals, seek support from peers and mentors, and maintain a positive attitude.
Should you apply to a residency program even if your application doesn’t match the average criteria?
This is situation dependent but the answer is likely, yes. If you’re concerned about a lower-than-average USMLE Step 2 score but have a strong application overall, go ahead and apply.
Now, you need to be close. If the average score is 240 and you’re scoring in the low 200s, your application will very likely get passed up. While it’s common to feel apprehensive about not meeting the average metrics for a program, it’s important to remember that residency programs review applications holistically.
Applying to a broad range of programs can increase your chances of matching, especially if you strategically include a mix of reach, target, and safety programs.
Similar to your college and medical school applications, have a few dream programs, a majority of programs that you fit well in, and a few backup programs.
Pro tip: it isn’t always about test scores!
Programs value applicants who have demonstrated commitment and passion through their work outside the classroom. Experiences such as volunteering, research, leadership roles, and working with diverse and underserved populations can significantly enhance your application. These activities not only show your dedication to the field, but also highlight your ability to empathize, communicate, and work effectively in a healthcare setting.
Remember, residency programs can teach you the medical knowledge and technical skills needed to succeed, but soft skills like compassion, resilience, and teamwork are harder to instill. By showcasing these attributes in your application, you can make a compelling case for why you would be an excellent fit for their program, even if some of your metrics fall short of the average.
Final Thoughts
By understanding the residency acceptance rate, what PDs look for in an applicant, and actively working to strengthen your application, you can increase your chances of matching into a program that aligns with your aspirations. Doing so will put you on track to having the medical career of your dreams.
Good luck on your journey to becoming a resident physician, and be sure to reach out if you need further assistance!
