Medicine is a calling, many people feel. You don’t choose it. It chooses you. As far as which programs physicians train in, that comes down to a rank-order list.
What factors do medical students consider most—and least—when choosing residency programs? Data recently released by the National Resident Matching Program (NRMP) shed some light on that question.
Among the data, reports and research produced by the NRMP is a survey that aims to weigh the factors to which applicants give strongest consideration when applying to and ranking programs. The 2024 version of the survey featured responses from about 12,000 applicants, representing roughly 25% of the applicant pool in the most recent residency-selection cycle.
NRMP asked survey respondents to list the factors that influenced both application and ranking choices and the relative importance of each of those factors on a scale of one to five. These factors may be worth keeping on a medical student’s radar in advance of the March 5 deadline for fourth-year medical students to submit their Match rank-order list.
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Most important factors
Among active U.S. allopathic senior medical students ranking residency programs across all specialties, these were the top five considerations.
- Overall goodness of fit—cited by 91%.
- Desired geographic location—90%.
- Interview day experience—88%.
- Reputation of program—83%.
- Quality of residents in program—83%.
The top five factors listed by applicants who were active U.S. osteopathic senior medical students ranking programs—on their final Match rank-order list—were as follows:
- Overall goodness of fit—88%.
- Desired geographic location—85%.
- Interview day experience—84%.
- Quality of residents in program—80%.
- Work-life balance—77%.
For MD applicants, work-life balance was a factor that dropped out of the top five while program reputation took on increased importance. DO applicants had the same top five factors as the previous application cycle.
Dive deeper:
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- Match ranking advice: Trust your gut
- An intern’s rank-order list do’s and don’ts
- Tips to help medical students fight rank-list uncertainty
- Meet Your Match: Composing a rank-order list
Ranking strategy and application statistics
Here are some other interesting nuggets from the survey.
U.S. MD seniors most commonly ranked the programs in order of their preference, with 95% citing that as a strategy for ranking programs, compared with 93% for U.S. DO seniors (also the most common strategy among that applicant type). Of U.S. MD seniors ranked, 79% ranked all the programs they were willing to attend (75% for DOs), and 74% ranked all programs with which they interviewed, regardless of preference. A smaller share of DO applicants, 63%, ranked all the programs with which they interviewed.
The median number of applications submitted by U.S. seniors who matched was 37, down from 40 in 2024 and 45 in 2023. The median number of interviews offered to matched U.S. seniors was 15, with those applicants attending a median of 14 interviews. Matched U.S. seniors typically ranked 14 programs.
Matched DO applicants applied to more programs, with a median of 49—down from 54 in 2023 and 60 in 2022. Their median number of interview invitations was 17, with those applicants attending 14 interviews and ranking 14 programs.
The median number of applications submitted by U.S. MD seniors who did not match was 50, down from 57 last year. The median number of interviews offered to applicants who did not match was 14, with those applicants typically attending 13 interviews and ranking a median of 13 programs.
The median number of applications submitted by unmatched DO applicants was 62 programs, down nine from 2023. Those applicants received a median of 13 interview invitations and typically attended 13 interviews and ranked 12.
Dive deeper:
- An intern’s rank-order list do’s and don’ts
- Tips to help medical students fight rank-list uncertainty
- Meet Your Match: Composing a rank-order list
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Declining application totals
Many physician specialties saw significant drops in application totals in 2024. That can, at least in part, be attributed to the expansion of program signaling—a system that allows applicants to indicate interest in a limited number of residency programs when they submit their applications. At least 20 specialties used signaling in the current residency selection cycle.
In an interview on “AMA Update” at the beginning of the 2024–2025 residency application cycle, NRMP Board Chair Deborah Clements, MD, highlighted the aim of signaling, and how it addresses application saturation that had become a burden on program directors. Dr. Clements speaks from experience—in addition to her role at the NRMP, Dr. Clements is program director for the McGaw Northwestern Family Medicine Residency at Lake Forest.
“Regardless of specialty, the number of applications that we receive exceeds our capacity to interview—even many qualified candidates,” said Dr. Clements, an AMA member. “So we make assumptions based on applications as to who might come to our programs.
In speaking of the utility of signals for applicants and programs, Dr. Clements said it might not always be obvious on paper that an applicant has ties to or deep interest in a program. Signals remedy that.
“The ability to signal programs prior to an interview has really given us the opportunity to potentially invite candidates we may not have previously considered,” she said. “If you're from California and you tell me you're interested in Chicago, in February, you worry. But maybe not. Unless I have a reason to believe that you are. And so, signals can help with that.”
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