How Many Residency Programs Should I apply to?

The numbers of applications to submit to the residency programs during the initial ERAS season per specialty will differ if you are an American medical graduate AMG or and International medical graduate IMG. Typically, the IMG will apply to far higher number of programs to get an acceptable number of interviews to help him or her get a successful residency match outcome.

The number of programs to apply to will vary from an applicant to another based on many factors which include in addition to the site of graduation and the type of specialty: financial ability, USMLE scores and attempts, number of USCE, year of graduation, need for visa and the amount of competition per that specialty. Except for the financial reasons which limit a lot and affect the number drastically in many cases, the remainder factors are played less often in the selection decision by the applicants. The reason for that is a lot of applicants started since 2009 with a new trend by applying to whatever they can afford to get the highest number of interviews possible. This creates a low pool of applicants getting interviews initially but eventually many will cancel and another bout of interviews are send again around November to fill the open interview spots.

In this post we are attaching here the median/range number of programs AMGs and IMGs usually apply to earn decent amount of interviews. Keep in mind that some financially able people has no limits on to how many residency programs or even specialties they are applying to, as long as they meet these Selection Criteria.

Specialty	Average Range of number of applications per AMG	Average Range of number of applications per IMG
Anesthesiology	20-40	50-80
Dermatology	50-90	70-100
Radiology	40-80	60-110
Emergency Medicine	20-40	50-90
Family Medicine	10-25	100-220
General Surgery	30-60	120-250
Internal Medicine	15-30	150-270
Med/Peds	10-20	30-50
Neurology	15-40	60-90
OB/Gyn	20-50	100-180
Orthopedics	40-70	100-130
Otolaryngology	45-80	60-100
Pathology	15-25	70-100
Pediatrics	20-30	100-140
PMR	15-40	40-60
Plastic Surgery	30-50	40-55
Psychiatry	10-30	70-140
Radiation Oncology	35-60	50-70
Transitional Year	15-30	40-70

Is internship a requirement before applying to residency in the US?

It is not a requirement to have completed a foreign internship to join a residency in the US if this what you mean by your question.

Medical residencies in the US are of 2 types in general depending on the specialty:

1- Either it includes internship integrated with the program so you match into PGY1 and continue residency in the same program

2- Or the program start with PGY2 but has a requirement of doing a US PGY1 hence you have to apply to both positions through the match in the same season where you will match to 2 different programs PGY1 and PGY2 simultaneously one staring same year and the PGY2 starting the next year.

If you match to a PGY1 only you can complete that year as hands on 1 year paid USCE and apply the next year to PGY2 positions. If you match to PGY2 only then you have either to find a PGY1 outside the match or forfeit your position and apply again from scratch the next season.

Surgery Residency for IMGs: Hard or just Competitive?

It is not hard an some extra steps are needed as any other competitive specialty. Let me first clarify the difference between competitive and hard. If you tell me 10% or less only of the positions in a certain specialty go to IMGs like Dermatology, Radiation oncology or plastic surgery YES this is hard. But if you tell me that in General surgery about 25% of spots go to IMGs, considering this is a competitive specialty even among AMGs themselves, then this is not hard or impossible but rather a competitive specialty that IMGs still get a good stake in it. With good credentials and preparation for the match, that many IMG surgery applicants unfortunately lack, you can hit your goal in the match. Let us go over the modifiable factors or steps you need to do for a successful match in surgery residency:

1. Bulk CV: Load your profile with Observerships or research or both if possible. But don’t waste your life in research as program directors usually prefer new graduates unless you were in a surgical residency back home then they would like and benefit from your experience.
2. If you are not done with your USMLEs, take it easy here and aim for a high score. You can monitor the progress of your studying using this awesome Table.
3. Try to get the advantage of having contacts in certain programs like your peers or seniors who matched before you. They can definitely throw a good word for you and get you some interviews here and there.
4. Match strategy is important and differ from other specialties in one thing: Prelim Surgery is a big player here. Most IMGs will apply to both Categorical and prelim positions. If you were not lucky in the first match and you get into prelim position which is relatively easy to get, this is considered one year hands-on surgery experience!  Many of those who start as prelim will end their year as Categorical residents because many AMGs will resign after they discover that surgery is not their favorite and hence you will be upgraded or you can move to another program that just had an open categorical spot. Anyway, if you continue as prelim, you will be able to apply the next year with one-year hands-on USCE. Make sure you apply widely to whatever programs you meet their Selection Criteria. You can find the average number of programs typically AMGs and IMGs apply to here in this Table.
5. When you get interviews, two things to remember, the Interviews questions are common and simple, try to read them before you go to any surgery interview. The other thing is don’t forget to send the Thank you cards. It is very important to make the directors and other people in the program involved in ranking the residents remember you.

A word of advice at the end, always consider back up programs like IM or FM when applying to competitive specialties. This way you at least get something out of your hard work on the USMLE track!

Good luck!

Types of residency programs

What are the types of residency programs you can apply to through ERAS?

There are 5 types of programs available via the ERAS NRMP match:

• Categorical Residency Programs
• Advanced Residency Programs 
• Preliminary Residency Programs
• Transitional year Residency
• Integrated Residency Programs

1- Categorical Residency Program means you do the whole training in one tract or block which will include the PGY-1 or internship as the first year. You will have to apply only to one spot via the match to get into this program. e.g. Categorical Internal Medicine and Categorical Neurology.

2- Advanced Residency Program means a program which starts as PGY-2. In this case you will need to match to a PGY-1 residency year at the same time. PGY-1 residency include Preliminary internal medicine, preliminary surgery and transitional year residency. Examples of advanced residency programs include advanced neurology and advanced radiology.

3- Preliminary Residency program means a program which is only 1 year, it means like an internship. It is done usually as a prerequisite for advanced programs. Also some people who have low scores and need hands on experience may apply to preliminary years positions extensively during the match so they can do this 1 year internship then apply again in the next match with stronger profile. There are two types of preliminary year residency: internal medicine and surgery.

4- Transitional year residency is also a PGY-1 only residency but the rotations are not concentrated to one specialty as in IM or surgery but include more electives and specialties. This type of residency is more competitive than the other prelims.

5- Integrated  Residency Programs (and Combined residency programs) as in case of plastic surgery where instead of doing first general surgery the applicant will go ahead directly into plastic surgery, you start from the beginning in an integrated plastic/general surgery. Our understanding is that ACGME will be eliminating the combined programs from existence by 2018. Combined program means the applicant finish general surgery residency first then move into plastic surgery residency. Other examples of integrated residencies include cardiothoracic surgery residency.

How many personal statements can I write?

The question is not really how many personal statements you can write but how many personal statements you can upload to ERAS!

Let us consider first the scenario of an applicant applying only to one specialty. You can either do it the easy way and assign the same personal statement for all the programs you are applying to or you can modify the same personal statement to be more personalized for each program you are applying to and hence you can upload as much PSs you want.

Now let us take the scenario of an applicant applying to many specialties. Although you can upload for each specialty its own personal statement and, as stated above, you can modify it to personalize it to different programs, but here you need to be aware of an important thing; if you are applying to an advanced program which require application to PGY-1 spots then you need to use the same PS for both. This means if you also decided to apply to Categorical of that PGY-1 spot in the same program as well then they will be receiving the PS of the advanced program which is not good because it will show that you are interested in another specialty. Hence don't apply to Categorical and Preliminary spots in the same program if you are also applying to advanced programs in the same institution.

Can I apply to Categorical and Preliminary in the same program?

Applying to Categorical and Preliminary spots in the same program is possible and common at no additional fee. However there are certain tips and tricks you should be aware of to avoid a frowning program director.

People apply to both categories in the same program usually because of one of these two scenarios:

A- You are applying to advanced specialties and you need the prelim year as a PGY-1 but you also want to apply to Categorical as backup.

B- You are applying to both of them because you feel your chances to get into residency is slim as a start without much USCE, so you will try to match to either one and if you matched to preliminary year then you will do it as a 1 year hands-on experience for the next year application.

Either way, and this is extremely important, the PD will receive the application to both spots as one ERAS application but he can see you selected both options. This means you can submit only one personal statement for that specific specialty program. So here what you do in this situation:

A- If you decide to apply to Preliminary and Categorical spots in the same program, you have to submit the personal statement of the Categorical specialty not the advanced specialty (for which you are applying for the preliminary spot). And in the interview you don't mention anything about your plans for the prelim spot, but if they ask you then you tell them that you are very interested in their program and you are ready to do a prelim year first to increase your chances with them for the next year. Meantime you will be applying to advanced "other specialties" in other institutions. Don't apply to Categorical and advanced specialties in the same institution if you are applying to preliminary year in their program as well.

B-Otherwise Don't apply to categorical spots in the same program you applying to prelim and advanced, and in this case you have to submit the advanced specialty PS to both prelim and advanced spots. Even if you decide to apply to prelim only in a program then you also still have to upload the advanced specialty PS.