Today’s inane image of the day:
If you’ve landed on this page, I assume you are an anesthesiology residency applicant or soon-to-be one. Please make sure to review my 2024 Match blog entry as my goal with this entry is to build upon my thoughts from last year and offer additional insights/tools to be prepared for Match 2025.
The elephant in the room – anesthesiology is becoming more competitive
I don’t think I would have matched at MGH if I had to apply again today with my application from 4th year. I do think that I would have matched somewhere in anesthesiology based on my overall application, but maybe not. There’s some component of randomness to this process with how competitive the specialty has become.
The NRMP 2024 Main Residency Match data shows that there were zero unfilled spots for 2000 offered positions. When I matched into the specialty in 2015, there were 28 unfilled PGY-1 (intern) year spots and 37 unfilled PGY-2 (advanced) spots out of 1600 total offered positions (4% of total spots went unfilled). Also, notably, when I applied there were 1859 applicants for the 1600 offered positions, so at least 259 applicants went unmatched; in 2024, 3034 applicants applied for the 2000 total offered positions. That left 1034 applicants that did not match into anesthesiology. That’s a 5x higher unmatched rate than almost a decade ago when I matched. Things have certainly changed in the last decade.
If you want to see the slides from my August 2024 ASA presentation, they are available here: https://bit.ly/3zb9IdH
What are my chances?
Let’s take an evidence-based approach rather than an anecdote-based approach using the NRMP Charting Outcomes™: Characteristics of Applicants who Match to Their Preferred Specialty data from 2024 (see below for the summary charts for US MD seniors, DO seniors and IMG/FMG). When looking at this data, remember that it only includes applicants that ranked an anesthesiology program as their 1st choice, which implies that the applicant had at least one interview. This data does not give the complete story of applicants that applied to the specialty and did not get an interview.
What is clear from the data is that there are certain applicant characteristics that make it harder and harder to match into anesthesiology with how competitive the specialty has become – those things include coming from an osteopathic institution, IMG, FMG, and re-applicants. While there are certainly individuals that match into the specialty in these groups, I highly recommend having a serious contingency plan for what to do if you do not match this cycle. Would you rather do a preliminary medicine/surgery year? Would you rather just match into another specialty? You need to ask yourself these questions before you apply because it’s better to match into something than have to go unmatched and through the SOAP process.
What about signaling?
Data from the AAMC (see below screenshot of slides on anesthesiology) on signaling as well as program director statements has made it very clear that signals matter in order to get an interview. Gold signals are more likely to convert to an interview and a match (assuming you’re a good fit/candidate for that institution), but silver signals also increase your likelihood of an interview and a match. Your ability to get an interview at a program that you did not signal is probably around 2% (see caption below box plot graph). This means that applying to beyond 15 programs will require that you probably have to add 50 programs to maybe get 1 interview. This is expensive ($1,000s+)… but depending on your mentality, might be worth the investment (personally, because you only get one chance at applying to residency for the first time, I’d rather spend all the money rather than ask “what if,” had I not).
Remember to use your signals wisely. Do not send all of your signals to reach programs… this will not convert to interviews. One faculty member I heard from said that in their unpublished data from last year’s match, the average number of interviews of unmatched applicants was 6 and it was 9 for matched applicants. This doesn’t tell the whole story, but indicates that you should to aim for a high signal to interview conversion to set yourself up to match.
Should I dual apply?
One of the faculty members I had on my Virtual Preop Call program this cycle actually wrote an editorial advising all anesthesiology applicants to dual apply to another specialty. His interpretation of “dual apply” includes preliminary medicine/surgery years. I agree on having a backup plan in the form of preliminary year programs. Plus handful of anesthesiology programs still have advanced spots so you need a separate internship, anyway. If you want to increase the likelihood you’ll match somewhere, it’s best to eligible for both a categorical and advanced spot.
Central application
More and more programs are utilizing Central App to make the review process easier. To see the most up-to-date list of programs utilizing Central App, go to this page: https://centralapp.accessgme.com/participating-programs/
I have heard from our program leadership that for our initial review, we will be filtering candidates through Central App. This does not mean that your ERAS is completely neglected; it’s likely it’ll still be utilized during the review and rank list process. With two different application platforms, there are more opportunities for error and typos. Make sure that you’ve reviewed all of your application materials with a fine-tooth comb. Consider having someone else [they don’t even have to be in medicine] review your materials to catch mistakes or statements that may be unclear.
In the future, it is possible that the specialty will move completely toward Central App… but that’s not this year.
Interviewing
I have written two entries about residency interviewing – “How to interview like a boss” and “Practical tips for your Zoom interview.” Although my original 2019 entry is somewhat dated in that it reflects in-person interviews, there is still very good general interview advice there. Additionally, there are a small minor of anesthesiology programs that are opting for in-person interviews. The practical tips entry is definitely still relevant, though many of you are much more facile with Zoom than was the case when I wrote it.
Additional advice for virtual interviews:
Try to avoid using Bluetooth devices as they have a pretty high failure rate and often have poor audio quality.
When I started doing more professional Zoom presentations, I purchased a real microphone [I got the Blue Yeti microphone]. Audio quality is one of the most important components of your virtual interview. Video quality is the second most important. Ultimately, we can still conduct an interview without video but if we cannot hear what you have to say then there’s really nothing to work with.
Find a place with wired or a very stable internet connection. The worse feeling will be to get the message “Internet connection unstable” in the middle of your interview. Many medical schools have rooms you can reserve for this. You can also consider finding a room to reserve at your local library. When I was running a virtual conference a few years back, I purchased an ethernet cable and adaptor for my laptop to be able to plug directly into my internet router. This is one way to ensure some stability to your internet.
Love letters and rank order list
Please read this entry, “Love letters [vs. letters of intent], rank order lists and the match” and/or watch the YouTube video on the topic.
Now is the time to hustle
The single most important piece of advice I have for you is that now is the time to hustle. The goal is to only apply to residency once. Taking the time to invest in getting it right the first [and hopefully, only] time is important. This means reading every applicant website closely. This means doing your research on programs. This means talking to recent applicants that matched into the specialty. This means doing well on your clinical rotations. This means expanding your network. This means asking questions. This means… you need to work hard. Ultimately, it is worth the investment; anesthesiology is a very fulfilling specialty. I still love my job. Good luck!