Determining the Optimal Number of Program Applications

The optimal number of residency programs to which you should apply must necessarily be highly individualized as each person has unique circumstances that may influence their application strategy.  Because of this, it is critical that you work closely with your departmental and deans’ office advisors in planning your application strategy to determine both the number and types of programs that would be right for you.  However, there are some data regarding internal medicine residency applications that may be helpful to consider in this process (you can access the most recent match data from the National Resident Matching Program (NRMP)). 

In recent years the number of residency programs to which students apply across all specialties has been rising steadily.  In internal medicine, the average number of applications by US allopathic students applying in internal medicine has risen from 21 to 27 over the past 5 years.  Yet, match data historically show that between 92% to 95% of US allopathic seniors consistently match to their preferred specialty.  This increase in program applications has been termed “application inflation.”

The reason for application inflation is thought to be related to several factors that compel students to apply to an increasing number of programs with the hope that doing so will minimize the possibility of not matching. 

One factor is that the number of overall applicants usually exceeds the total number of residency slots offered in the Match.  While this has been historically true for many years, the total number of applicants includes both US allopathic and osteopathic students as well as US graduates of international medical schools, non-US graduates of international medical schools, and all other applicants.  However, US allopathic graduates typically constitute slightly over half of total applicants, meaning that with the exception of a very small number of specialty choices, the number of available slots exceeds the number of applicants for this group of students.  Additionally, while the match rate of US allopathic graduates is consistently greater than 90%, the match rates of both US and non-US graduates of international medical schools is typically between 50% and 55%.

Another is the perception that the increasing number of US medical graduates associated with recent increases in medical school class size and the establishment of new medical schools, coupled with no expansion of government funding residency training slots, is adding pressure to the application process by effectively increasing competition for available residency positions.  However, the number of residency slots available has risen over time without additional government support, and there has therefore not been a major change in the balance of available residency training slots relative to the pool of graduating medical students.

Other factors may also make students feel as though they should apply to a large number of programs, including comparison of application numbers with those seeking a residency in very competitive specialties (such as dermatology or cardiothoracic surgery), where the number of applicants may exceed the available slots and in which case more applications may be reasonable.  Many students also feel great anxiety exacerbated by social media by tracking their friends’ applications and resulting interview offers, which may encourage them to apply to even more programs if they have not secured a similar number of interview.

Excessive residency applications may result in significant financial costs and may be a great source of anxiety that may be a distraction from your important educational activities.  Also, because most students end up applying to more programs than they either can or want to pursue, the logistics of scheduling and canceling interviews becomes increasingly challenging with a greater number of program applications. 

The significant increase in applications also has a significant negative impact on residency programs who may struggle to process the large volume of applications, provide enough interview slots for convenient scheduling, and offering high quality interview experiences simply due to the volume of people they may need to interview.

So what is an appropriate number of programs?  Data from a 2013 survey of clerkship directors in internal medicine who advise senior medical students regarding the application process revealed that they recommended applying to a median of ten programs for students in the highest academic quartile and fifteen programs for students in the lowest quartile.  And results from the 2017 Match showed that ranking twelve programs by allopathic US students yielded a probability of matching of nearly 95%.

The Alliance for Academic Internal Medicine (AAIM) is the umbrella group for medical educators and includes the Clerkship Directors in Internal Medicine (CDIM) and the Association of Program Directors in Internal Medicine (APDIM).  They have produced a resource center regarding application inflation for students, clerkship directors, residency program directors, faculty advisors, and medical school deans. 

Although the optimal number of residency applications is unique to each individual, you should consider this information and work with your advisors to determine a reasonable and manageable number of applications based on your own circumstances that will ultimately result in your matching at your desired program.