Today’s inane image of the day:
A glimpse into competitiveness through Match data
It has been almost a decade since I applied to anesthesia residency. It’s crazy how time flies. When I applied to the specialty back in 2014, anesthesiology was a somewhat competitive specialty – for the 2015 match, there was a total of 1,859 applicants for the 1,094 PGY-1 positions offered in through 120 anesthesiology programs [of note, back in my time, there were many more advanced spots available, so of note, there were also 1,581 applicants for the 506 PGY-2 anesthesiology positions; for the sake of consistency to compare between 2014 and currently, I’m going to only focus on the PGY-1 positions]. In the 2023 match, there were a total of 2,959 applicants for the 1,609 PGY-1 positions offered through 172 anesthesiology programs [and there were 2,006 applicants for 301 PGY-2 positions].
If we only look at PGY-1 positions and assume that everyone who applied could occupy a spot, back in 2015, the match rate would be 1,094/1,859 = 58.8% while in 2023 the match rate would be 1,609/2959 = 54%.
Of note, back in 2015, there were 28 unfilled anesthesiology spots while in 2023 there were 3. So even though the match rates are somewhat comparable, when there are unfilled or open programs, this is another measure of competitiveness [or alternatively, how picky programs were about how many candidates they interviewed/ranked]. In 2023, emergency medicine had 554 unfilled spots and only 8 unfilled spots back in 2015. Many have said that emergency medicine’s loss was anesthesiology’s gain as both specialties tend to attract a similar type of candidate.
Another marker of competitiveness for a specialty lies in the percent of US MD Seniors filled – anesthesiology had a 73% fill rate in 2015 and 74.5% fill rate in 2023. Compare this to emergency medicine – 79% in 2015 and only 42.3% in 2023; that specialty has truly seen a significant change.
This all being said, the specialty of anesthesiology is competitive to match into, and I want to share advice for those of you applying to the field. Disclaimer: I am not a program director, but I want to see you all succeed in your endeavors so this advice is my opinion on how you can give yourself the best possible chance for matching.
#1: Assess your competitiveness
I was a somewhat competitive candidate when I applied to the field. I do note in prior blog entries that my Step 1 score was average, but I scored one standard deviation above the mean for Step 2 CK [which demonstrates improvement]. I was second quartile in my class with honors in a handful of clerkships [notably, internal medicine but not surgery]. I was not AOA. I did not have any publications at the time of my application, but had presented posters. Ultimately, my “secret sauce” was my leadership positions and [I suspect] strong letters of recommendation.
Without a numeric Step 1 to give programs a standardized measure of your test taking performance, there will certainly be a reliance on your numeric Step 2 score. Ensure that it is the highest possible score and recognize that programs will use this as an indicator of your ability to take high-stakes examinations [after all, you’ll have to take TWO anesthesiology written board exams and ONE oral board/OSCE exam in order to become board certified].
Of note, your medical school also plays a role in your competitiveness for residency programs. I did not have a “name brand” medical school to help bolster my application. This being said, I was still graduating from a U.S. allopathic medical school, which is looked upon favorably. If you are a D.O. candidate, make sure that you apply to programs that have a track record of matching osteopathic graduates. The same goes for international and foreign medical graduates.
I highly suggest finding a mentor at your institution that will not sugar-coat your application competitiveness. If you are not a competitive candidate, there are ways to still match into a competitive specialty, but it takes serious investment and a dose of reality to make it happen.
#2: Do some soul-searching
Now that anesthesiology is using program signals [5 gold, 10 silver], many of us advise students to really only apply to 15 programs. The programs that you apply to without sending a program signal to will assume that they are your 16th choice. From a program’s perspective, not exactly an attractive position to be in, eh?
When you pick your 15 programs, make sure that you’d actually be willing to match into that program and live in that geographic region. If you’re allergic to the winter, please recognize that it gets cold in the Northeast. If the most important thing to you is to match into anesthesiology and you’ll adapt to whatever climate is necessary for that, then that’s ok, too. But just recognize that residency is challenging for everyone. I believe that every resident experiences burnout at some point during medical training. If you have some sort of support or tie to a specific region that’s important for your success in a program. Programs are looking for you to have all the ingredients for success, too.
Of note, many people will end up finding their first attending job near where they do residency. By doing residency in a specific area, you will inevitably make connections and build your network in that region. This makes it easier to find a job there. So, if you know you want to be in a specific city/state after training, seriously consider programs around there.
Ultimately, all of the programs you’ll be applying to are ACGME-accredited and when you graduate, you’ll be an anesthesiologist. Going to a “name-brand” residency might be helpful for some career paths [mostly research/academic paths], but may not be that useful if your goal is to be an excellent clinician providing anesthetic care. Or if you’d like to go into private practice.
#3: What about program signals?
As I said above, with the 15 signals available it’s prudent to use them wisely. I’ve been recommending that average candidates send 2 Gold signals to “reach” or “top-tier” programs, 1 Gold to a good fit, and 2 Gold signals to programs that you’d be willing to go to and are likely to get an interview at. Now, if you’re an excellent candidate [top scores, top clinical marks, tons of research, from a top-tier medical school and stellar letters of recommendation] then you can likely use all 5 Gold signals at top programs. I’d split up the silver signals in a similar manner to ensure that you can optimize your chances of interviews.
If your application isn’t the strongest, I’d seriously consider using those Gold signals for programs that will take you seriously. This is where a trusted mentor can help you strategize what will work best for you.
If you look into the 2022-2023 AAMC data on program signals, you’ll find that the programs that receive the most applicants tend to receive the most signals. Another datapoint that helps drive this concept home is:
“In each specialty, 10% of programs received about 20%-30% of available signals”
2022-2023 Eras data analysis: https://www.aamc.org/media/64591/download
This translates into the “top-tier” programs having the luxury of only interviewing candidates that actually signal them. I’d posit that “top-tier” programs will likely only need to interview applicants that send a gold signal.
There’s a lot of great data in that document linked above to help you strategize how to use your signals. It’ll be interesting to see how the expansion of the signals to gold/silver and 15 total will impact this year’s applications.
#4: Will my personal statement make all the difference?
Probably not. The most important things I can say about a personal statement is that you must ensure the following are true:
- You explain why you want to become an anesthesiologist. Seriously. I want to know that you know what you’re getting into.
- You have had many people review it and there are ZERO typos.
- You’ve written it [not ChatGPT].
What doesn’t work in personal statements or will ruin your candidacy in most programs?
- A haiku.
- Jokes.
- Referencing another program [be extra careful with assigning the right document to the right program!]
Consider using zeroGPT to determine if the computer thinks your personal statement was AI plagiarized.
#5: Do my letters all have to be from anesthesiologists?
Nope. Mine certainly weren’t. I had one anesthesiologist [my home program’s program director; of note, I also had a rotation review that noted that I was one of the best students they have had in decades of having students]. One letter from a gastroenterologist. And one really positive letter from my family medicine clerkship director [he specifically said to me that I was one of the top few students he has ever worked with in his decades of experience].
I’d suspect that my letters were very helpful in my success in getting interviews.
When I advise students, I stress the importance of a letter of recommendation from someone who can speak to your clinical skills AND who has given you extremely positive feedback. Those are going to be the best letters. It’s obvious when letter-writers are the Chair for a Department but have never worked with you. They’re really short and really don’t say much. So ultimately, it’s a waste of a letter.
#6: Away rotations often help but can also hurt
I attribute my match to MGH to an away rotation I did where a faculty member made a recommendation call on my behalf. Had I not done that rotation, I wouldn’t have gotten an interview at MGH. I believe this whole-heartedly.
So what does that mean for you? I advise that if you shine with in-person interactions or your clinical acumen, then do away rotations. They are a month-long interview. They push you in a new environment and to demonstrate your ability to have situational awareness. They also give you a glimpse into the program from the inside. But if you look “good” on paper but do not always shine in-person… consider sticking to home rotations or other opportunities to gain anesthesiology exposure [like my Virtual Anesthesiology Pre-Op Education Program! Information about the current season is usually on my Twitter account].
#7: Interviews
I give advice both on Zoom interviews and in general in other blog entries. Make sure to check those out. My biggest piece of advice for virtual interviews is to ensure that we can hear you clearly. I bought a Yeti microphone [you can find a lot of cheaper options, too] when I started doing more Zoom work [interviews, presentations]. Ultimately, I care more about hearing you than seeing you, so if you’re going to buy any piece of equipment, I’d do a microphone. Also, a wired internet connection. And if you strategically place things in your background [e.g. guitars, artwork], we’ll probably ask about it during your interview.
Of note, with the number of experiences limited to 10 this year, consider adding some sort of non-medical hobby or activity as one of them. We love asking about that stuff on interviews.
Also, we’re very casual on anesthesiology interviews. It’s nothing like medical school. If you’ve gotten an interview to a program, it generally means you have a good chance of matching there since the match algorithm favors the student. Do not forget: we are interviewing you but you’re also interviewing us for fit.
#8: Enjoy 4th year!
Make sure you do fun rotations that you may never get an opportunity to do again. I was seriously considering pediatrics so I did 2 pediatric away rotations for my electives. I’d recommend ENT, radiology, cardiology, or point-of-care ultrasound electives. These end up being helpful for your career in anesthesiology.
Between rank list submission and Match day, really live your life. Throw yourself into hobbies and things that nourish your soul. Travel. Do all the life things. Life doesn’t stop in residency, but it certainly borrows your identity for a few years.
Good luck!