Understanding the Residency Application and Selection Process

August 16, 2016

Congratulations! After four years as an undergraduate, followed by four years in medical school, you are finally ready for residency. With your degree of M.D. or D.O., you are so close to practicing medicine independently. The time has come for you to complete a medical residency at a teaching hospital.

From navigating the residency application process to the thrill of Match Day, Northwest Permanente physicians provide guidance and advice to help you make the most out of your entire residency experience:

Choosing a Medical Specialty

In order to decide what residency programs and hospitals to apply to, you should first determine your specialty. For starters, do you want a medical or surgical residency? Physicians recommend relying on past experiences to choose the specialty that is right for you. During medical school, you explore specialties through rotations. Which rotation was most interesting to you? You can get additional experience by volunteering in medical settings outside of school, or by doing an extra medical school rotation. Some students spend time working in the specific hospitals they think they will apply to in order to gain a deeper understanding of the work being done there. When choosing a specialty, physicians say the best advice is to “go with your gut.”

Applying for Medical Residency

Prior to applying for residency, you’ll need to meet standard medical residency requirements. You must have completed medical school and earned an M.D. or D.O. accredited degree. You’ll also need to have taken the United States Medical Licensing Examination (USMLE) and/or Comprehensive Osteopathic Medical Licensing Examination (COMLEX).

In the United States, students apply for medical residency through the Electronic Residency Application Services (ERAS), a program run by the Association of American Medical Colleges (AAMC). The AAMC is a non-profit organization that represents most medical schools and teaching hospitals in North America.

The ERAS system simplifies the application process. Through the MyERAS application page, students submit required documents and scores to ERAS. Then, ERAS sends the information onto the hospitals to which the student desires to apply. You’ll submit your medical school transcript, your USMLE and/or COMLEX score, a personal statement, a CV, letters of recommendation, performance evaluations, and other materials, as requested by the hospitals you apply to.


After applying, interested programs will invite you to interview. Interview success requires planning and practice. Physicians recommend setting up your interviews early-on in order to schedule strategically. For instance, it can be advantageous to arrange your most desired program as your fourth or fifth appointment. This way, you are prepared and rehearsed for your highest-stake interview.

There are many logistics behind an interview: flight in and out, housing, local transportation, and itinerary. It’s imperative that you stay organized. Make sure that your itinerary includes who you’ll be meeting with, their titles and what part they play in the program. Be on time, dress appropriately, don’t lead off with questions about salary, and make sure to smile at everyone you meet.

Unfortunately, interviewing can be expensive. Many programs will require you to cover the costs of travel and accommodations. As such, budgeting is an important aspect of the planning process.

When practicing for the interview itself, know that residency programs look for dedication and passion for medicine. By being knowledgeable about your specialty, you can demonstrate these crucial characteristics.

As interviewers gauge your fit with their program, the interview is also an opportunity for you to consider if the program is right for you. What is the ethos of the program? Is it work-oriented or life-style oriented? Is the location suitable to you? You’ll spend multiple years and countless hours at the hospital during residency; it’s important to find a workplace that motivates and satisfies you.

The Match

After interviewing and applying to programs, you will rank the hospitals according to your preferences through the National Residency Matching Program (NRMP). The hospitals will likewise rank applicants. You may be matched with any program you rank. If you are not sure about a program, don’t put it on your list. Once you’re matched to a program, you will be required to participate in it.

The Match itself is done through a computer algorithm that compares all lists, and then pairs applicants with residency programs. The NRMP website offers a detailed explanation of the matching process, including examples of how the structure of the rank list may affect Match outcomes. Match Day occurs in mid-March, and on this day all applicants are notified if they were matched and where.

It is possible that you will not get a match at all. Applicants that are not matched will then participate in “the scramble.” These applicants may have the opportunity to join residency programs that still have openings after Match Day.


So, you’ve determined your program! While your unique experience will depend on your medical specialty, you should anticipate 60-80 hour strenuous workweeks. During residency, physicians recommend keeping a normal sleep schedule and making time for self-care. It will not be easy. It will, however, be worth it.

Good luck!

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