Full Guide to Applying to Residency Programs in the US

No matter where you go to med school or what specialty you plan to practice in, there’s one thing that every physician-to-be has to do:

Complete a residency program.

But first, you’ll need to:

    1. Go through the lengthy residency application process
    2. Endure the interview process with a variety of different residency programs
    3. Make a match on Match Day

Only then can you become a medical resident and start your actual career as a physician in training.

Applying for residency can be a challenge for many medical students. Yet it’s a necessary process requiring thoughtful and careful planning. And you need to start the process long before you graduate medical school.

From when to apply to where, here’s our full guide to applying to residency programs in the U.S.

When Should You Apply for Residency?

Applying for residency starts with registering online for the Electronic Residency Application Service (ERAS).

The ERAS application process is a service through the Association of American Medical Colleges (AAMC). It streamlines finding and applying to residency programs around the country.

ERAS will submit your:

  • applications
  • USMLE transcripts
  • letters of recommendation
  • medical student performance evaluations
  • and other crucial documents to all the various programs you want to apply to.

The ERAS Timeline

The ERAS system opens in June to medical students between their third and fourth years of medical school.

In June, students need to register in the MyERAS application system. From June to August, you can work on your application.

On the first of September, you’ll be able to start submitting applications to your selected residency programs. At this time, you’ll also want to register with the National Residency Matching Program (NRMP) for your main residency match.

Interviews for residency programs typically begin in October.

Once you’ve completed your interviews, it’s a waiting game until Match Week in March. At that point, you’ll learn which program you’ve matched to (or if you haven’t matched with any).

There are two exceptions where you can match earlier than March:

  1. Medical students applying to military residency programs will receive notification of acceptance in January
  2. Urology and Ophthalmology programs make their matches in February


As with everything else, the Coronavirus pandemic affected the timeline slightly for 2020-2021.
Students planning to graduate in 2022 and beyond should prepare to begin the ERAS application process in June of 2021. (Remember to consult the AAMC.org website for a complete, up-to-date timeline.)

What International Medical Graduates Need to Know

The timeline for foreign medical graduates applying to U.S. residency programs includes an additional step.

For IMGs, including Caribbean graduates and those on J-1 visas, the first step in the process is to register for ERAS Support Services through the Educational Commission for Foreign Medical Graduates (ECFMG).

This is typically done at the beginning of June. Through the ECFMG, you’ll gain access to the ERAS system, at which point you can begin the ERAS application process.

International students should regularly consult the ECFMG, AAMC, and NRMP websites for up-to-date timelines and more details about the application process.

Further Reading: How to Master the Process of Applying to Residency.

What Do You Need in Order to Apply for Residency?

Woman using laptop to apply for a medical residency

There are various application materials you’ll need to gather to apply to residency programs in the U.S.

Besides the application required by each program, you’ll also need to submit:

  • Curriculum vitae
  • Letters of recommendation
  • Medical school transcripts
  • Personal statement
  • Copy of your medical school performance evaluation (MSPE) from your dean’s office
  • Licensing exam transcripts


What to Include on Your CV

To create an impressive CV, you’ll want to break your experience down into three main categories:

  1. Volunteer experience
  2. Work experience
  3. Research and publications

You do not need to include exam scores on your CV. Residency program directors will be able to view them on your transcripts.

Letters of Recommendation and Personal Statement

Letters of recommendation from esteemed faculty members can weigh heavily in the residency application process. Most programs require three — no more and no less.

Your personal statement is another critical factor. It’s the best way to distinguish yourself from other candidates, showing how you’ll make an excellent fit for a particular residency program.

When drafting your statement, take special care and be sure to have multiple sets of eyes proofread it for grammatical errors and typos.


Transcripts from your medical school, as well as from the USMLE, are required for the residency application process.

To be eligible for residency, you’ll need to pass Step 1 of the USMLE as well as pass Step 2 to demonstrate that you have Clinical Knowledge in your field.

You do not have to pass the Step 2 Clinical Skills portion of the examination, as this is no longer required for residency acceptance.

Related: Understanding Your Resident Doctor Employment Agreement.

How Many Residency Programs Should You Apply To?

There is no magic number as to how many residency programs you should apply to. The answer varies depending upon your test scores, medical school transcripts, and the specialty you choose.

The first step in deciding how many residency programs to apply to is to speak with your advisors for guidance.

Some specialties have limited residency programs and may require you to apply to every available program in the country.

These  include:

  • Orthopedics
  • Dermatology
  • Ophthalmology

Less competitive specialties provide for more flexibility when deciding how many programs to apply to.

These include:

  • Family medicine
  • Pediatrics
  • Psychiatry

Ideally, you’ll want to apply to as many residency programs as it will take to get 10-15 interview invitations. The more residency interviews you go on, the better your chances are of making a match.

According to data from the National Resident Matching Program, the likelihood of matching to your first-choice program varies slightly among MD seniors and DO seniors.

How MD Seniors Matched Based on Their Rank Order List:

  • First rank: 49.2%
  • Second rank: 16.4%
  • Third rank: 10%
  • Fourth rank: 6.8%
  • Fifth or greater rank: 17.6%


How DO Seniors Matched Based on Their Rank Order List:

  • First rank: 47.8%
  • Second rank: 17.6%
  • Third rank: 11.3%
  • Fourth rank: 7.4%
  • Fifth or greater rank: 15.9%

Specialty also makes a difference in how likely you are to match. For MD and DO seniors in 2020, the top four specialties that made matches were internal medicine, pediatrics, emergency medicine, and family medicine.

Overall, for 2020, 93.7% of MD seniors made a match, as did 90.7% of all DO seniors.

Related: Surgical Resident Salary: How much do they make?

What to Consider When Applying for Residency

Some graduating med school students look at residency positions as their “first job.” And while that may be partly true, it’s important not to lose sight of the fact that, first and foremost, residency programs are training programs.

And that’s why it’s essential to make a good match.

So what exactly makes for a good match?

That answer varies based upon several factors:

  1. How competitive the program is
  2. How highly regarded the program is for your specialty
  3. Where the program is located


Should You Consider Salary?

One thing that is not a factor in selecting a residency program is the salary. Resident salaries are relatively standard across the country, with the average resident earning an average of $63,400 per year.

This varies only slightly among specialties and years in residency. First-year residents earn an average of $57,100 annually and fifth-year residents make an average of $66,800.

Can You Get In?

When applying to residency programs, one thing to consider is how competitive the program is.

  1. Do you have the grades to get in?
  2. Are you confident that you can sell yourself in an interview?
  3. Do you have outstanding evaluations and letters of recommendation?
  4. Are you graduating from an esteemed and well-respected medical school?

According to the AMA, thoracic surgery, otolaryngology, neurological surgery, and radiation oncology are among the most competitive specialties. If you’re looking to train in these specialties, keep your options open-ended and embrace the application process. You may need to apply to far more residency programs than your fellow med students in order to make a match.

It’s also important to consider if the program (and its faculty) are highly regarded in your specialty. The AAMC Residency Explorer Tool is a great place to search different programs, assess their compatibility with your needs, and learn how competitive they are.

Consider the Work-Life Balance

Every residency program operates differently. Some may require you to work 60-80 hours per week, while others may top out at 100 hours per week.

If you’re trying to maintain a healthy work-life balance, you’ll want to investigate how a program operates and how it schedules its residents.

Where is the Program Located?

For some medical school students, the location of a residency is crucial. Still, this alone should not deter you from applying to (or accepting) a residency position, particularly if you’re applying in a highly competitive specialty.

It’s best to be flexible and be open-minded about where you’re willing to live.

If you accept an interview and then decide that you could never see yourself living in that particular city or town, do not rank them in your rank list. As long as you don’t rank them, you won’t match.

When it comes time to create your rank list, be sure only to include programs located in places where you are willing to live.

Not sure where you want to live yet? Take a look at the Top 10 Places to Live and Work For Physicians.

What Happens After You Apply?

Men shaking hands
Once you submit your applications, prepare for a series of residency interviews.

Related: Top 12 questions to ask during your residency interview

When interviews are over and they’ve reviewed all applications, each program will rank the candidates they want to accept. The candidates, in turn, will create their own rank list of their preferred programs.

It’s important not to make your rank list too short. A shortlist of three or four programs will NOT guarantee your acceptance into any one of those programs. It can actually increase your chances of not making a match.

What Happens if You Don’t Match?

Everyone talks about Match Day … but the fact is that it’s actually Match Week.

You find out if you match the Monday before Match Day. If you do match, you’ll have to wait until actual Match Day to see where.

Just knowing that you’ve made a match is incredibly reassuring. It’s a guarantee that you’ll conduct your residency in one of the programs on your rank list.

However, for some medical students, Match Day is not always a cause for celebration.

Soon-to-be residents are often disappointed in where they’ve matched. No matter how unhappy you may be, you’ll need to start preparing yourself for the fact that you’ve entered into a contract and will need to take part in that residency program, even if it is your fifth, eighth, or tenth choice.

Supplemental Offer and Acceptance Program

So what happens if you don’t match?

Students that do not match will spend their Match Week in SOAP.

A medical student’s worst nightmare, SOAP is a process in which unmatched students get an opportunity to accept unfilled positions. SOAP releases lists of unfilled jobs in rounds, allowing unmatched students the chance to accept the offer of one of those programs.

SOAP is a stressful and somewhat time-consuming process. Yet, it’s your last chance to match a residency program for the upcoming summer/fall season. SOAP conducts as part of the NRMP, and all offers accepted become legally binding contracts, just as with any other match.

Don’t wait until you don’t match to start learning about SOAP. These FAQs posted by the NRMP provide an overview of how the system works. It’s best to prepare ahead of time in case you find yourself scrambling for a residency program at the last minute.

Continue Reading…What happens if you’re an Unmatched MD?

Where you spend your medical residency matters. It pays to be thorough and focused throughout the residency application process.

Be diligent when applying, and be sure to include all the relevant transcripts and documents, so there’s no delay in the process. Follow the timeline to a tee so that you don’t miss important deadlines. Make sure you apply to enough programs to get enough interviews to make a match.

Without a plan of action, applying to residency programs will be more stressful than necessary. But with preparation and dedication, you can ease some of that stress and continue to focus on your studies in your fourth year of medical school.

For more information and guidance on applying to residency programs, contact Physicians Thrive now.

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