How Many Programs to Apply to?

How Many Programs to Apply to?
Deciding on the number of applications to submit is a
difficult decision with a number of factors involved including
geographic location. Students have to consider not only the
strength of their application, the types of programs (large
versus small, academic versus community, research versus
clinically focused, etc.), but also the significant costs involved
in the Electronic Residency Application Service (ERAS) and
the interviews themselves. The number of students applying
to psychiatry overall and the applications per student have
dramatically increased over the last five years. This has
made the application process more complicated both for
students and residency training directors.
To better understand the National Residency Matching
Program (NRMP) match for psychiatry, let’s take a look at
the numbers. Since 2014, the number of US and Canadian
students applying to psychiatry through ERAS has
increased from 1161 to 2082, an almost 80% increase, even
though the total number of US and Canadian students in
the match increased by only 15%.1
Similarly, the number
of applications per US and Canadian student applying to
psychiatry since 2014 has doubled from 26 to 52. Since
ERAS application fees increase as you submit more than 20,
and then 30 applications, 52 applications will cost almost
$1000! But is 52 applications the right number anyway?
For most students, it’s probably significantly more than
they need.
While the number of applications for an individual student
is still a complicated calculation based on the student’s
unique circumstances and aspirations, data-driven reports
can be useful to consider. One of the most commonly used
is the NRMP’s biennial report “Charting Outcomes in the
Match,” which documents how applicant qualifications
affect match success. These reports are available for US
allopathic and osteopathic seniors as well as international
medical graduates and include data comparing matched
and unmatched applicants on a number of variables. The
variables include, among others, USMLE Step scores and
AOA status, the number of “contiguous ranks” (the number
of programs ranked in psychiatry before a program in
another specialty is ranked), research projects, abstracts/
presentations/publications, and volunteer experiences.
Applicants may be comforted to know that even
applicants with relatively low Step scores are more likely
to match than not. A probability of matching graph allows
students to better understand how their Step 1 score and
rank list length affects their chance of matching. For the
2018 report,2 the probability of matching reaches about
80% with five contiguous ranks and over 90% with nine
contiguous ranks. While not directly correlated with the
number of applications, this report can help provide a goal
for the number of programs to interview and rank. Another potentially useful biennial report from the NRMP is
the “Applicant Survey.” The most recent one available is from
20173 and includes surveys of “US seniors” (U.S. allopathic
medical school seniors) and “independent applicants”
(everyone else). In that survey, US seniors who matched
into psychiatry and those who didn’t applied to a median
of 29 and 40 programs, respectively. After applying to a
median of 29 programs, those who matched were offered
a median of 14 interviews, attended 11 and ranked 10.
A recent addition to the above reports that can be helpful
for students applying to psychiatry in the match is the
AAMC’s “Apply Smart” report.4 This analysis includes
students who applied to ERAS in 2011-16 (concluding with
the 2017 NRMP match) and used a regression analysis to
find a “point of diminishing returns” where the benefits
of additional applications is less than adding applications
up to that point. For students applying to psychiatry with
a Step 1 score >224, the point of diminishing returns was
at 13 applications. Even for students with a Step I score
<205, the point of diminishing returns occurred at only 19
applications. Since each applicant is unique, these numbers
should not be used as a strict limit. However, this data does
give some information about where the relative benefits of
additional applications start declining for most applicants.
Although these reports can be quite helpful, the association
between the number of applications or interviews and
eventual match success rate is influenced by a number of
factors that are not included. Did the students apply to
only top-notch programs? Did they include lesser-known
or newer programs? Did they only apply to programs in
big cities on the coasts? Did they do visiting electives at
programs they were interested in? Did they include in their
application why they might be applying to programs that
are far away from their medical school? As the number of
applications per ACGME (Accreditation Council of Graduate
Medical Education)-accredited residency program has
increased from 161 to almost 450 in just the last five years,
residency Program Directors are increasingly looking in
applications for factors that might predict which students
would truly want to rank their program and thus factors
like location are becoming more important in selecting
students for interviews. In order to best consider an
individual situation, applicants are encouraged to discuss
their unique circumstances with their local advisors, Dean’s
office, and if available, home residency Program Director.
Lastly, what about the all-important interview skills
component? Even top scoring students from excellent
medical schools who interview poorly are at risk for not
matching no matter how many applications they submit.
In the end, the number of applications a student submits is
only one of the many factors that will determine whether
their match is successful.