The residency-application process is all about your "why." Why medicine, why a specialty, and why a particular program. But when it’s time to submit your Match rank-order list, another question takes center stage: Where is it located?
A survey conducted last year by the National Resident Matching Program (NRMP) revealed that during the 2023–2024 residency application cycle, applicants from U.S. allopathic and osteopathic medical schools rated desired location as the second most important factor when ranking residency programs. For both groups, location was surpassed only by overall goodness of fit as the top consideration in their rankings.
But deciding where to go—and how far to move—is deeply personal. Two AMA members who made significant moves for residency shared their strategies for navigating this decision. In advance of the March 5 deadline for applicants in the 2024–2025 residency selection to submit their rank-order list, here are some key factors to consider about making a major move for graduate medical education.
Take a targeted approach
Having grown up in California and attended college and medical school in the state, Laura Gephart, MD, wanted to gain a broader perspective on health care by moving away from Golden State. She was particularly interested in experiencing how medicine was practiced in larger cities with more diverse populations and varied health systems.
When crafting her Match rank-order list, Dr. Gephart prioritized obstetrics and gynecology programs in Chicago, New York, Boston, Philadelphia and Washington, DC.
“Location was the No. 1 priority, period,” said Dr. Gephart, an AMA member. “I said: What are the five cities that I would want to live in? And then I decided to apply to all the programs that have at least four residents a year and are academic medical centers in those locations.”
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Support systems matter
Residency training is physically and mentally exhausting. Having a support system is key to thriving. For that reason, Sean Figy, MD, had aims on returning home to the Northeast after earning his medical degree in the Midwest.
“Residency is really hard,” said Dr. Figy, an AMA member. “You cannot overestimate the value of having a team in your corner.”
“You need something that helps keep you a real person,” said Dr. Figy, now an associate professor of plastic and reconstructive surgery at the University of Nebraska Medical Center. “It’s really easy to lose your personhood if you don’t have anything outside of medicine.”
For Dr. Figy, matching at the University of Massachusetts Medical School in Worcester, about an hour from his family in the Springfield area allowed him to have that support.
Conversely, Dr. Gephart understood that leaving her home state would be a challenge.
“I knew it would be lonely,” said Dr. Gephart, a female pelvic medicine and reconstructive surgery specialist in Erie, Pennsylvania. “But that’s why I wanted a program with at least four residents a year—to create a family away from home.”
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Be practical
While Dr. Figy saw major pros to returning to the Northeast, the realities of plastic surgery meant that he couldn’t be too specific with his rank-order list. There simply weren’t that many opportunities available.
“I applied nationally, and I applied to every program that existed,” he said. “In plastic surgery, you don't have the luxury of being selective with where you apply. When I was applying there was something like 50 programs in the country. So I applied everywhere and ranked the programs where I did interviews. While going home was a goal of sorts, my rank list was all over the country.”
“For me, geography definitely was a key component, and I was lucky that all the programs I interviewed with in the Northeast were programs I liked,” he said. “But you also have to consider the programs you feel comfortable with, no matter where they are.”
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Consider the “regionality” of care
Dr. Gephart’s Match led her to Washington, D.C., but she found that program wasn’t the fit she had hoped and eventually transferred to a program in Florida to complete her residency. For fellowship, she trained in Texas. Having done her medical training in several different regions, she said, gave her valuable perspective.
“The best thing I've done in my medical career is be a medical student in California, a resident in D.C. and Florida, and then a fellow in Texas,” she said. “The practice of medicine is incredibly regional. And so you don't have the depth of understanding of the breadth of the way that … medicine is practiced without practicing somewhere else.”
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Think long-term
Where you train can limit certain opportunities in your post-residency career, Dr. Gephart said.
“It's become really clear to me that in certain states, where you train matters,” she said. “If you want to stay in California, you need to go to residency in California. Even if you left for medical school, if you want to be in California as an attending it really seems to help that you did residency or fellowship in the state.”
Dr. Gephart also advised students to be open-minded about opportunities that arise in residency and beyond.
“Location-wise, if you would you have ever asked me, ‘Do you think you're going to end up in Erie, Pennsylvania?’ My first response would've been like, ‘Where is that?’” Dr. Gephart said. “I would have never imagined it. I got this job through my relationships at the AMA, and it couldn’t have worked out better. I am extremely happy with my professional life.”
As applicants begin to finalize their Match rank-order lists, FREIDA™, the AMA’s comprehensive residency and fellowship database, is a vital resource. It includes more than 13,000 Accreditation Council for Graduate Medical Education-accredited residency programs and offers a streamlined user experience.
