For most senior medical students there is nothing more exciting than Match Day, when the future of your medical career is finally revealed after months of preparation and perpetual worry. And believe it or not, Match Day is an exciting time for residency program directors as well.

While the med school admissions process is something of a buyer’s market in which the schools seem to hold all the power, the NRMP Match represents a more level playing field. Applicants are desperate to impress the residency programs with their potential and academic prowess; but at the same time, the residency programs are actively courting and recruiting the students.

So where should you begin? Once you’ve settled on a specialty, how do you make sure that you’re applying to enough programs? Let’s walk step-by-step through my personal approach to the residency application process when I was a 4^th-year medical student circa 1999.

But first, a word of warning: There is no such thing as a foolproof, one-size-fits-all system for matching into a dream residency program. Just as choosing a specialty requires you to honestly evaluate your personality, strengths and weaknesses, and academic record, selecting the right residency program requires equally careful consideration of your long-term career goals and personal needs.

WHERE TO APPLY

My own personal needs were primarily geographic. I had chosen Internal Medicine, and I wanted to do residency in Dallas or somewhere in Texas, at the very least. (During medical school, my wife and I had sacrificed being near our families, who live in Dallas, and we wanted to be closer to them during residency.)
With those two primary criteria (IM programs near Dallas) in place, the next step in the process was all about the numbers.

• At the time, there were 5 Internal Medicine programs in Dallas and another 6 elsewhere in Texas.
• I decided that in order to give myself the best chance of matching in one of those 11 programs, I needed to rank at least 8-10 programs.
• Based on this decision, I estimated that I would need to get 20 interview offers.
• Therefore I decided to apply to 40 programs.

So now I had a target: I needed to find 40 IM programs. Going back to the map, I found a handful of programs within reasonable driving distance of Dallas, such as Oklahoma City and Little Rock, Arkansas. I also applied to several programs located farther away, but in places that my wife and I considered desirable, such as Tennessee and North Carolina. And I threw in a few 'big name' programs (such as Harvard, Johns Hopkins, Washington University) just to see if I got any bites.

WHERE TO INTERVIEW

Once the interview offers started coming in, it confirmed my expectations of being a reasonably competitive candidate. That meant I wouldn’t need to rank a huge number of programs just to increase my chances of matching, which in turn meant that I shouldn’t feel any pressure to interview at programs that I wouldn’t be thrilled to match into. So when it came time to interview, I chose to interview at only 10 programs (all in Texas, including four in Dallas). I liked all but about two of them, which I didn't bother to rank at all.

THE RANK ORDER LIST

Then it came time to submit the all-important Rank Order List. A lot of students will attempt to game the system by ranking a less-desirable program highly just because they think they are a lock at that program. And frankly, every year there are tales of Program Directors that play the same games, calling up students and asking where they plan to rank the program.

But the Match is not the NBA draft. There is no particular glory in being able to say you matched at your #1-ranked program—especially if you really had hopes of matching somewhere else (based on location, or the program’s reputation, or whatever). And the truth is that on Match Day, you’ll most likely be thrilled just to have a spot and to be able to move forward in your career.

So my advice for ranking programs is rather straightforward: simply rank them according to where you would most like to do your residency. Period. That gives you the best chance of being pleased on Match Day. Do not get caught up in worrying about where you think you are most likely to get in.

ONE FINAL PIECE OF ADVICE

When deciding which programs to apply to, don’t “double dip.” That is, don’t apply to both Family Medicine and Med-Peds or to both General Surgery and ENT. Double-dipping sends the message that you are indecisive and unable to commit to any one discipline. It may also suggest that you have some hidden shortcomings and that you lack confidence in your likelihood of matching into the specialty of your choice. If you apply to programs in more than one specialty, expect to be asked to explain yourself once you hit the interview trail.

Future blogs by Mike McInnis MD will feature further advice on residency application documentation, including Dr McInnis’ actual Personal Statement.