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Update: 4/15/2024
It's been quite the journey. I started this thread as an applicant about a decade ago with the purpose of understanding the civilian match process coming from military medicine. I found that there was not much transparency and all of the resources to help applicants make informed decisions were incredibly lacking or disorganized. So I compiled every bit of data and information that I could find to help myself be more informed about getting into the specialty, and then I compiled those details within this thread.
Fortunately, I was able to match into a civilian PM&R program, and subsequently learned even more about the match process while in residency and now in leadership within PM&R academics. These are, of course, my own opinions based on the statistics available and my own experience in mentoring over the last decade. But no two applicants are identical, neither are two programs, and there is a bit of randomness to this process. The data that I am sharing is 100% publicly available through NRMP and AAMC.
PRE-MEDS (MD vs DO vs FMG)
If you read enough SDN, the general consensus is MD>DO>FMG. But if you know for certain that you want to do PM&R, does it matter? To get this answer you have to look at the NRMP Match Data Sheets. There is a lot of data that can be interpreted in a number of way. The specialty specific stats get split into three categories: 1) only choice, 2) first choice, and 3) not first choice. I'm going to focus my attention on the first category, because that has the best statistics (especially for USMD/DO). USMD had 183 applicants matched and 21 applicants unmatched (89.7% match rate), and DO had 90 applicants matched and 28 applicants unmatched (76.2% match rate). There were far fewer FMG that ranked PM&R as their only choice, with only 10 applicants matched and 21 applicants unmatched (32.2% match rate). Looking at the data a little different, when considering ALL applicants (including those with multiple specialties ranked), there were 213 USMD matched applicants with 35 unmatched applicants (85.9% match rate). There were 134 DO matched applicants and 77 unmatched applicants (63.5% match rate). There were 15 FMG matched applicants and 19 unmatched applicants (44.1% match rate). Also note that FMGs have the lowest graduation rate of all school types. So my recommendation would be to avoid FMG. I would work hard to get into MD school, and use DO as a fall back plan. PM&R is considered a "DO-friendly" specialty, maybe the most friendly of all ACGME specialties, so consider how much lower the acceptance rate would be for other ACGME specialties. Graduates (of all types) are also statistically at a disadvantage (with the one exception being military applicants).
TYPES OF PM&R PROGRAMS
I will break this up into three categories: Advanced, Categorical, and Physician (R). Advanced programs are three year programs which start PGY-2. Categorical programs are four year programs that start PGY-1. Physician (R) programs are three year programs that start PGY-2. The difference between Advanced and Physician (R) is that you apply two years in advance for Advanced programs, and same year for Physician (R). Physician (R) is valuable for those who have already started post-graduate training. In regards to competitiveness of types of programs, categorical are typically the most competitive because most applicants don’t want to move between internship and residency, and it is also easier to match to one program vs two (PGY1 and PGY2). Physician (R) spots are competitive because there are typically less than 10 spots total available per year. Military brethren…timing is important. If you are getting out in two years…you need to apply to advanced programs now! Use applying to categorical/physician-only as a fall back plan next year. But it isn’t ideal because you need to get your separation request in before even the military match same year.
AM I COMPETITIVE FOR PM&R
Let me start by saying that PM&R, despite being one of the most competitive specialties by sheer numbers, is one of the more forgiving specialties in terms of board scores. I am not going to say that your numbers don’t matter, because they do. But you are more likely to get an interview at a reputable PM&R residency without elite scores than many of the other competitive specialties. PM&R prides itself on “fit” and “personality”. If you are a gunner…stay away, because you will stick out like a sore thumb. Many programs conduct a holistic review of applications, but I'd acknowledge that some applicants are helped more than others. Individuals from underrepresented backgrounds, such as ethnic minorities, military, and those with disabilities are more likely to benefit from holistic review than individuals not within those groups. On the most recent program director survey, the most significant factor in the decision to conduct a holistic review is "increase resident diversity". Both the average USMLE rate for matched individuals and the overall match percentage is very similar for PM&R and all specialties. It's a semi competitive specialty regarding board scores, but the competition comes in the form of large number of applicants with limited seats.
ERAS
ERAS is the system used to submit your application to programs you are interested in. I'm going to include this here so help preserve your wellness. I recommend opening a new email account specific for receiving interview invitations. Then you can set push notifications for receiving emails from that specific account. Most programs are good about giving applicants plenty of time to respond to interview invites so that you do not have to rush out of a patient encounter in the middle of the day to coordinate interviews. However, with that said, there are still some reports of not every program being civil/humane on this matter. By setting push notifications on your phone connected to your email you get immediate notifications about interviews so that you can be prompt on replying. The importance of not linking your school or primary personal email is because it would be distracting to get frequent push notifications for emails not specific to interviews, and has a high likelihood of adding to OCD tendencies and anxiety.
HOW MANY PROGRAMS TO APPLY/HOW MANY PROGRAM TO RANK
This is an excellent topic and you'll get a variety of opinions. Not to mention, this is very much a moving target because I anticipate changes with signals and the interviewing format (virtual versus live) over the next two years that is going to have a dramatic impact on strategy. So stay tuned, because I anticipate an additional edit to this section within the next two years.
I've decide to combine these two different topics into one section because even though, chronologically, you interview before you rank programs, the ultimate goal is to match. I'm going to discuss the match/ranking statistics first, which will help you better understand the context of applications.
If you look at charting outcomes you will see a graph that is commonly referenced to determine how many programs to rank. That graph shows that an applicant that ranks 12-13 programs contiguously has a 90% chance to match, and after that point there are diminishing returns and the probability never gets to 100%. Understand that there is quite a bit of bias that goes into that graph. First, most applicants are aware of the information derived from the graph (either from seeing the graph or being told by someone that you need "x" number of interviews to match). So the significant majority of applicants are intentionally meeting that threshold. But does an applicant need 12-13 ranked programs to match? The answer is not necessarily. For example, there are many applicants that match at their #1 ranked program. They clearly didn't need 12-13 ranked programs to match, they only need one. There are also individuals with over 15 ranked programs that fail to match. Applicants don't match by having a ton of interviews (though getting a ton of interviews is often a reflection of the strength of the applicant), they match by being ranked highly by at least one program.
In most cases, the individuals that match, do so by matching HIGHLY on their own rank list. There are not available statistics specific for PM&R, but there are stats on this topic that incorporate all specialties, and considering that PM&R is a middle of the pack specialty regarding competitiveness, I think that it is fair to extrapolate these trends to apply to PM&R. Here is how USMD's match based on their rank list: 1st rank 45%, 2nd rank 14%, 3rd rank 10%, 4th rank 7%, >4th rank 20%, unmatched 6%. That means that 74% of the applicants only needed four programs on their rank list to match. The DO stats aren't considerably different: 1st rank 43%, 2nd rank 16%, 3rd rank 10%, 4th rank 7%, >4th rank 17%, unmatched 8%. Again, 75% of applicants only need to rank 4 programs to match. So it is clear that most individuals that match do so by matching highly on their rank list. How many applicants are actually matching at programs ranked below 8 on their rank list? The number has be very low (sub-10%). If an applicant is not matching within their top 8, I'd actually wager that they are pretty unlikely to match at all. But as it stands, there is very little downside to ranking every program that you interview, and the average USMD applicant is ranking over 16 programs (likely slightly inflated because programs with both categorical and advanced programs are counted twice). The average applicant should attempt to rank at least 8 program.
Are all interview invites created equal? This is a topic very difficult to study. More work needs to be done to determine the characteristics of those that match versus those that do not match. I do know that interview linked to a home/away PM&R rotation has more opportunity than the interviews without a rotation. I believe that this would be especially true during the age of virtual interviews. The key to matching isn't getting 12-13+ interviews, it's getting ranked to match by at least one program. An applicant doing well on a rotation tied with doing well on an interview is going to have an advantage. I say all of this to tell you that if you have multiple home/away rotations and 8 interviews I'd feel more confident in your ability to match than 8 interviews with one home/away rotation. The number of home/away PM&R rotations, as well as the overall strength of the applicant, are all considerations in determining the length of a rank list (as well as the number of applications to submit). Speaking of the later...
If you thought that the decision on how many programs to rank (and how many interviews to attend) was nebulous and confusing, you haven't seen nothing yet! Get ready for some math. NRMP tracks match data, but it does not track data about applications. But fortunately, AAMC has started to track a limited amount of data regarding application trends. Applications to signaled programs resulted in slightly higher than 50% return on an interview. Applications to non-signaled programs resulted in about a 12% return on an interview.
This is year the AAP has decided to increase the number of signals from 5 to 8. So considering the 51% return on signals, the average applicant will get 4 interviews through signals. If an applicant is aiming for at least 8 programs to rank, an applicant would have to find a way to get 4 interviews from non-signaled programs. So considering the 12% return on non-signaled applications, that would take 33 applications for the average applicant to get 4 interviews. So if you at those 33 applications to the 8 signals, that would give you 41 applications.
The challenge is how to make adjustments if you are not 50th percentile. If you are an above average applicant, or below average applicant, what do you do? The AAMC did put out some stats on return on applications for applicants that were either 10th or 90th percentile. Starting with 10th percentile students, the return on a signaled program is 26% and it's 7% for non-signaled programs. For 90th percentile students, there is a 71% return on signaled programs versus 22% for non-signaled programs. We don't have good stats for 25th and 75th percentile so I had to project based on averages of between the 90th, median, and 10th percentiles. So using those stats, I have calculated the following:
USMDs/DOs:
10th percentile (Step 1-2 failure, remediation, no research, application red flags)- Apply to minimum 85 (not including signals)
25th percentile (215-230 step 2, minimal research/extracurricular activities)- Apply to minimum 52 (not including signals)
50th percentile (230-245 step 2)- Apply to minimum 34 (not including signals)
75th percentile (245-260 step 2, above average research/extracurricular activities)- Apply to minimum 19 (not including signals)
90th percentile (260+ step 2, exceptional research/work experience)- Apply to minimum 11 (not including signals)
FMGs/IMGS: Apply to 85 programs minimum (not including signals)
One train of thought is to apply to every program under the sun. Of course, this may be cost prohibitive for many. But with virtual interviews, it does cut the overall costs of the interview process significantly. It'd cost roughly $2500 to apply to every PM&R program. In most cases, it is not necessary to apply to every program and many ways you could be hurting both yourself and everyone else in the progress of doing it.
If, by chance, the number of signals doubles, then I'd feel comfortable reducing the average number of applications submitted by 30%.
ARE OSTEOPATHIC STUDENTS COMPETITIVE
PM&R is a very DO friendly field. It has the highest percentage of DOs per specialty. As of now I do not believe that it is necessary to perform a USMLE in order to match. I base this on research I performed on match rates for those who performed a USMLE and those who did not. The match rates were only negligibly lower for those without the USMLE. You can see my methods and calculations here: COMLEX vs. USMLE and COMLEX - PM&R. Note that I can't speak specifically about every programs opinion on this topic. So if you have a very specific program targeted, it would be wise to look into the application requirements for that program. But on the whole, most programs do not discriminate against DOs, and it doesn't seem to matter if the applicant has a USMLE score or not. It is interesting that the match rate is so much lower for DO applicants than MD applicants considering that the specialty is very DO-friendly. When I review applications, it is actually quite rare to see a USMD applicant that does not have a competitive application. Does that mean that there aren't below average MD students out there? Of course not. But they generally do not apply to PM&R. I cannot say the same for DO applicants. I frequently see DO applications with sub-500 COMLEX or failures, no research, etc. There is a bit of a discrepancy in the extracurricular opportunities for DOs versus USMDs, and I do not think that DOs have the same research opportunities as MD students that largely are attached to academic centers with attendings that are conducting research. But that is not even the biggest factor. I truly believe that DOs are a disadvantage when it comes to mentorship. DO schools are not consistently giving their students good advice and showing them "tough love" on the competitiveness of the specialties they hope to apply. I'm convinced that about 30% of DOs that apply to PM&R probably shouldn't be, or at least should be applying with a strong consideration of a backup. Meanwhile, USMD students are getting better advice from their schools and are self-selecting for less competitive specialties.
ARE FMG STUDENTS COMPETITIVE
The field is becoming more competitive for FMGs as the competitiveness increases on the whole. But it is becoming a challenge specifically for FMGs. The percentage of FMG matching to PM&R has been on a steady decline over the past 20 years. FMGs typically self-select for less competitive specialties and we are seeing a trend of fewer FMGs applying to PM&R over the past few years. So take that into consideration when looking at the match rate. The FMGs that are applying are either very strong FMGs (relative to their FMG peers), or they do not have great insight on the competitiveness of the specialty. When reviewing applications I tend to see that dichotomy. I do think that strong FMG applicants should attempt to match into PM&R but it's no guarantee, and I'd have a backup. Average FMGs are facing an uphill battle matching to PM&R. If "all in" on PM&R, I'd recommend getting auditions and signal your auditions, and perhaps only apply to your audition programs/signals (and perhaps new or historically less competitive programs), and use all of your other financial resources to apply/interview at a less competitive specialty. If you look at the statistics on FMGs that apply to PM&R as their ONLY option on their rank-order list (ROL), the match rate is about 32% (for both US and non-US FMG). Poor strategy.
ARE MILITARY APPLICANTS COMPETITIVE
Military applicants have a rare opportunity to close the gap with an excellent personal statement. The truth is that most med students’ personal statements look very similar. If you can tie together your fleet experience and training with your desire to do PM&R, the personal statement will help you stand apart. With the emphasis on holistic application review, this further helps military applicants. I would also say that military applicants have a good chance to stand apart in the interview process. Even if you were a mediocre med student, I would still strongly suggest that you apply to even the top PM&R programs because a PD may read your personal statement and want to meet you. That is an open door. There are not any statistics specific to military applicants in the civilian match, unfortunately.
WHAT ARE THE FACTORS PROGRAMS FIND IMPORTANT FOR ISSUING INVITES
The majority of programs are using holistic review to screen out applicants (roughly 60%). Increasing residency diversity is a significant factor in the significant majority of programs (95%) adopting holistic review, so that is certainly a factor. You have to look back at the 2021 Program Directors survey to see the factors that they found most important in granting interviews. The most notable academic factors at that time were: 1) MSPE (aka Dean's letter), 2) Failed attempt at USMLE/COMLEX, 3) USMLE score, 4) COMLEX score. The most impactful personal characteristics included: 1) Prior match violation, 2) Specialty LOR, 3) Commitment to specialty, 4) Diversity characteristics, 5) Professionalism/ethics. All other factors were far less impactful. I would recommend reading this article for more information: https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf.
I HAVE BEEN GIVEN AN INTERVIEW…WHICH DATE SHOULD I CHOOSE
Most programs are going to conduct invitations from October through January (with early November being the peak). Most invites will occur in September-October and trickle in afterward. Many programs will also not conduct interviews for the weeks of Thanksgiving, Christmas, New Years, and AAPMR Annual Meeting. With virtual interviews, strategy on when to schedule interviews has become less important. The key is just staying organized. Have a list of dates on your calendar that you cannot attend going into the process, and then keep track of all of the invitations that you receive so that you don't schedule two on the same day. The yearly Google Sheet is a solid resource in determining when each program usually conducts interviews.
DO LETTERS OF INTEREST MATTER?
I honestly don’t think that status update requests are incredibly helpful. PC’s get tons of these each week. What is helpful is expressing your interest to program coordinators while requesting an invitation if one becomes available. When should you consider emailing PCs? Considering that peak season is November, I would take advance of that time period. Only email PCs at programs you are genuinely interested in, and only do so if you know that the program has sent out a batch of rejections and you weren't on the list. Will programs hold it against you that you were a “waitlist guy/gal”? See below.
WHAT ARE THE FACTORS PROGRAMS FIND IMPORTANT FOR RANKING APPLICANTS
The process in which program directors rank candidates is very different than the process in which they issue interviews. Think about this for a second. If you rank every PM&R program before and after you interview, you will notice a big difference between your pre-and-post interview rankings. Which ranking list would you trust more? Of course you would trust your post-interview ranking more, because some programs will exceed your expectations and some will let you down. The same applies to applicants. There are some people who look good on paper…high board scores, lots of research, cured cancer, etc. But that does not tend to translate to where an applicant gets ranked. If you don’t believe me, look at this study: https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf. The most important factors in determine where an applicant gets ranked includes: 1) Interpersonal skills, 2) Interactions with faculty, 3) Interactions with housestaff during interview/visit, and 4) Feedback from current residents. The PD's were NOT asked about the significance of signals or home/away rotations, but one would suspect that an applicant that does a home/away rotation has a better opportunity of demonstrating interpersonal skills and better interactions with staff/residents.
Will you be considered as a “waitlist guy/gal”…the answer is absolutely. First of all, you may not have lower scores than the ones who received invites. The primary reason is that once you get your invite you are essentially put on a level playing field. So if you are offered an interview by your dream program late in the season and have to cancel a program lower on your list…do it without hesitation. The numbers get you the invitation; the personality gets you the ranking.
HOW SHOULD I RANK MY PROGRAMS
I don’t think that any one person will be able to help you with this topic. It was my most difficult topic to tackle…by a good margin. After speaking with a variety of residents, staff, and PDs…I have come up with these two questions that are helpful in determining where to rank programs.
Ask yourself the following about each program in which you interview:
1) Will I be able to gain the level of training needed to set myself up for success in fellowship/employment?
2) Is the program a place where I feel I can thrive?
They are broad questions…but they are incredibly important. Will you gain the tools and will you be able to stand out? If you live in a location where you don’t feel comfortable…then you will not be able to thrive in that environment. If you have a family, you want to consider cost of living, safety, schools, and livability. If you are worried about your family member’s living conditions, you will struggle to thrive. If you didn’t feel like you have a good rapport with staff and residents…then that will make it difficult to stand apart. Being able to thrive is essential because it will determine if you are able to gain incredibly important recommendations by staff members. And that in large part will determine if you will get a fellowship or employment. Part of thriving is feeling supported by staff members. Are these folks going to go to bat for you and place calls to people to get you a job one day? Prestige is a factor, but it is something that it difficult to quantify. It's a consideration, but you definitely need to verify that a program lives up to the hype.
DO LETTERS OF INTENT MATTER?
The answer to this question may vary by program. Is it a new program and the program is placing a high emphasis on recruiting chief residents that are ambassadors for their program? I'd argue that program has reason to value letters of intent. But if it is a well established program, should it matter if someone has you #1 or #2 on their rank list? Likely not. But it doesn't hurt to notify your top program that they are #1 on your rank list. Just be aware of ACGME match rules. You cannot ask the program where they intent to rank you. That's a match violation. Many programs do not conduct post-interview communication with applicants out of concerns of match violations. So if you get a "ranked to match" letter from a program, that is great, but don't panic if you do not receive one.
I wish you the best of luck.
It's been quite the journey. I started this thread as an applicant about a decade ago with the purpose of understanding the civilian match process coming from military medicine. I found that there was not much transparency and all of the resources to help applicants make informed decisions were incredibly lacking or disorganized. So I compiled every bit of data and information that I could find to help myself be more informed about getting into the specialty, and then I compiled those details within this thread.
Fortunately, I was able to match into a civilian PM&R program, and subsequently learned even more about the match process while in residency and now in leadership within PM&R academics. These are, of course, my own opinions based on the statistics available and my own experience in mentoring over the last decade. But no two applicants are identical, neither are two programs, and there is a bit of randomness to this process. The data that I am sharing is 100% publicly available through NRMP and AAMC.
PRE-MEDS (MD vs DO vs FMG)
If you read enough SDN, the general consensus is MD>DO>FMG. But if you know for certain that you want to do PM&R, does it matter? To get this answer you have to look at the NRMP Match Data Sheets. There is a lot of data that can be interpreted in a number of way. The specialty specific stats get split into three categories: 1) only choice, 2) first choice, and 3) not first choice. I'm going to focus my attention on the first category, because that has the best statistics (especially for USMD/DO). USMD had 183 applicants matched and 21 applicants unmatched (89.7% match rate), and DO had 90 applicants matched and 28 applicants unmatched (76.2% match rate). There were far fewer FMG that ranked PM&R as their only choice, with only 10 applicants matched and 21 applicants unmatched (32.2% match rate). Looking at the data a little different, when considering ALL applicants (including those with multiple specialties ranked), there were 213 USMD matched applicants with 35 unmatched applicants (85.9% match rate). There were 134 DO matched applicants and 77 unmatched applicants (63.5% match rate). There were 15 FMG matched applicants and 19 unmatched applicants (44.1% match rate). Also note that FMGs have the lowest graduation rate of all school types. So my recommendation would be to avoid FMG. I would work hard to get into MD school, and use DO as a fall back plan. PM&R is considered a "DO-friendly" specialty, maybe the most friendly of all ACGME specialties, so consider how much lower the acceptance rate would be for other ACGME specialties. Graduates (of all types) are also statistically at a disadvantage (with the one exception being military applicants).
TYPES OF PM&R PROGRAMS
I will break this up into three categories: Advanced, Categorical, and Physician (R). Advanced programs are three year programs which start PGY-2. Categorical programs are four year programs that start PGY-1. Physician (R) programs are three year programs that start PGY-2. The difference between Advanced and Physician (R) is that you apply two years in advance for Advanced programs, and same year for Physician (R). Physician (R) is valuable for those who have already started post-graduate training. In regards to competitiveness of types of programs, categorical are typically the most competitive because most applicants don’t want to move between internship and residency, and it is also easier to match to one program vs two (PGY1 and PGY2). Physician (R) spots are competitive because there are typically less than 10 spots total available per year. Military brethren…timing is important. If you are getting out in two years…you need to apply to advanced programs now! Use applying to categorical/physician-only as a fall back plan next year. But it isn’t ideal because you need to get your separation request in before even the military match same year.
AM I COMPETITIVE FOR PM&R
Let me start by saying that PM&R, despite being one of the most competitive specialties by sheer numbers, is one of the more forgiving specialties in terms of board scores. I am not going to say that your numbers don’t matter, because they do. But you are more likely to get an interview at a reputable PM&R residency without elite scores than many of the other competitive specialties. PM&R prides itself on “fit” and “personality”. If you are a gunner…stay away, because you will stick out like a sore thumb. Many programs conduct a holistic review of applications, but I'd acknowledge that some applicants are helped more than others. Individuals from underrepresented backgrounds, such as ethnic minorities, military, and those with disabilities are more likely to benefit from holistic review than individuals not within those groups. On the most recent program director survey, the most significant factor in the decision to conduct a holistic review is "increase resident diversity". Both the average USMLE rate for matched individuals and the overall match percentage is very similar for PM&R and all specialties. It's a semi competitive specialty regarding board scores, but the competition comes in the form of large number of applicants with limited seats.
ERAS
ERAS is the system used to submit your application to programs you are interested in. I'm going to include this here so help preserve your wellness. I recommend opening a new email account specific for receiving interview invitations. Then you can set push notifications for receiving emails from that specific account. Most programs are good about giving applicants plenty of time to respond to interview invites so that you do not have to rush out of a patient encounter in the middle of the day to coordinate interviews. However, with that said, there are still some reports of not every program being civil/humane on this matter. By setting push notifications on your phone connected to your email you get immediate notifications about interviews so that you can be prompt on replying. The importance of not linking your school or primary personal email is because it would be distracting to get frequent push notifications for emails not specific to interviews, and has a high likelihood of adding to OCD tendencies and anxiety.
HOW MANY PROGRAMS TO APPLY/HOW MANY PROGRAM TO RANK
This is an excellent topic and you'll get a variety of opinions. Not to mention, this is very much a moving target because I anticipate changes with signals and the interviewing format (virtual versus live) over the next two years that is going to have a dramatic impact on strategy. So stay tuned, because I anticipate an additional edit to this section within the next two years.
I've decide to combine these two different topics into one section because even though, chronologically, you interview before you rank programs, the ultimate goal is to match. I'm going to discuss the match/ranking statistics first, which will help you better understand the context of applications.
If you look at charting outcomes you will see a graph that is commonly referenced to determine how many programs to rank. That graph shows that an applicant that ranks 12-13 programs contiguously has a 90% chance to match, and after that point there are diminishing returns and the probability never gets to 100%. Understand that there is quite a bit of bias that goes into that graph. First, most applicants are aware of the information derived from the graph (either from seeing the graph or being told by someone that you need "x" number of interviews to match). So the significant majority of applicants are intentionally meeting that threshold. But does an applicant need 12-13 ranked programs to match? The answer is not necessarily. For example, there are many applicants that match at their #1 ranked program. They clearly didn't need 12-13 ranked programs to match, they only need one. There are also individuals with over 15 ranked programs that fail to match. Applicants don't match by having a ton of interviews (though getting a ton of interviews is often a reflection of the strength of the applicant), they match by being ranked highly by at least one program.
In most cases, the individuals that match, do so by matching HIGHLY on their own rank list. There are not available statistics specific for PM&R, but there are stats on this topic that incorporate all specialties, and considering that PM&R is a middle of the pack specialty regarding competitiveness, I think that it is fair to extrapolate these trends to apply to PM&R. Here is how USMD's match based on their rank list: 1st rank 45%, 2nd rank 14%, 3rd rank 10%, 4th rank 7%, >4th rank 20%, unmatched 6%. That means that 74% of the applicants only needed four programs on their rank list to match. The DO stats aren't considerably different: 1st rank 43%, 2nd rank 16%, 3rd rank 10%, 4th rank 7%, >4th rank 17%, unmatched 8%. Again, 75% of applicants only need to rank 4 programs to match. So it is clear that most individuals that match do so by matching highly on their rank list. How many applicants are actually matching at programs ranked below 8 on their rank list? The number has be very low (sub-10%). If an applicant is not matching within their top 8, I'd actually wager that they are pretty unlikely to match at all. But as it stands, there is very little downside to ranking every program that you interview, and the average USMD applicant is ranking over 16 programs (likely slightly inflated because programs with both categorical and advanced programs are counted twice). The average applicant should attempt to rank at least 8 program.
Are all interview invites created equal? This is a topic very difficult to study. More work needs to be done to determine the characteristics of those that match versus those that do not match. I do know that interview linked to a home/away PM&R rotation has more opportunity than the interviews without a rotation. I believe that this would be especially true during the age of virtual interviews. The key to matching isn't getting 12-13+ interviews, it's getting ranked to match by at least one program. An applicant doing well on a rotation tied with doing well on an interview is going to have an advantage. I say all of this to tell you that if you have multiple home/away rotations and 8 interviews I'd feel more confident in your ability to match than 8 interviews with one home/away rotation. The number of home/away PM&R rotations, as well as the overall strength of the applicant, are all considerations in determining the length of a rank list (as well as the number of applications to submit). Speaking of the later...
If you thought that the decision on how many programs to rank (and how many interviews to attend) was nebulous and confusing, you haven't seen nothing yet! Get ready for some math. NRMP tracks match data, but it does not track data about applications. But fortunately, AAMC has started to track a limited amount of data regarding application trends. Applications to signaled programs resulted in slightly higher than 50% return on an interview. Applications to non-signaled programs resulted in about a 12% return on an interview.
This is year the AAP has decided to increase the number of signals from 5 to 8. So considering the 51% return on signals, the average applicant will get 4 interviews through signals. If an applicant is aiming for at least 8 programs to rank, an applicant would have to find a way to get 4 interviews from non-signaled programs. So considering the 12% return on non-signaled applications, that would take 33 applications for the average applicant to get 4 interviews. So if you at those 33 applications to the 8 signals, that would give you 41 applications.
The challenge is how to make adjustments if you are not 50th percentile. If you are an above average applicant, or below average applicant, what do you do? The AAMC did put out some stats on return on applications for applicants that were either 10th or 90th percentile. Starting with 10th percentile students, the return on a signaled program is 26% and it's 7% for non-signaled programs. For 90th percentile students, there is a 71% return on signaled programs versus 22% for non-signaled programs. We don't have good stats for 25th and 75th percentile so I had to project based on averages of between the 90th, median, and 10th percentiles. So using those stats, I have calculated the following:
USMDs/DOs:
10th percentile (Step 1-2 failure, remediation, no research, application red flags)- Apply to minimum 85 (not including signals)
25th percentile (215-230 step 2, minimal research/extracurricular activities)- Apply to minimum 52 (not including signals)
50th percentile (230-245 step 2)- Apply to minimum 34 (not including signals)
75th percentile (245-260 step 2, above average research/extracurricular activities)- Apply to minimum 19 (not including signals)
90th percentile (260+ step 2, exceptional research/work experience)- Apply to minimum 11 (not including signals)
FMGs/IMGS: Apply to 85 programs minimum (not including signals)
One train of thought is to apply to every program under the sun. Of course, this may be cost prohibitive for many. But with virtual interviews, it does cut the overall costs of the interview process significantly. It'd cost roughly $2500 to apply to every PM&R program. In most cases, it is not necessary to apply to every program and many ways you could be hurting both yourself and everyone else in the progress of doing it.
If, by chance, the number of signals doubles, then I'd feel comfortable reducing the average number of applications submitted by 30%.
ARE OSTEOPATHIC STUDENTS COMPETITIVE
PM&R is a very DO friendly field. It has the highest percentage of DOs per specialty. As of now I do not believe that it is necessary to perform a USMLE in order to match. I base this on research I performed on match rates for those who performed a USMLE and those who did not. The match rates were only negligibly lower for those without the USMLE. You can see my methods and calculations here: COMLEX vs. USMLE and COMLEX - PM&R. Note that I can't speak specifically about every programs opinion on this topic. So if you have a very specific program targeted, it would be wise to look into the application requirements for that program. But on the whole, most programs do not discriminate against DOs, and it doesn't seem to matter if the applicant has a USMLE score or not. It is interesting that the match rate is so much lower for DO applicants than MD applicants considering that the specialty is very DO-friendly. When I review applications, it is actually quite rare to see a USMD applicant that does not have a competitive application. Does that mean that there aren't below average MD students out there? Of course not. But they generally do not apply to PM&R. I cannot say the same for DO applicants. I frequently see DO applications with sub-500 COMLEX or failures, no research, etc. There is a bit of a discrepancy in the extracurricular opportunities for DOs versus USMDs, and I do not think that DOs have the same research opportunities as MD students that largely are attached to academic centers with attendings that are conducting research. But that is not even the biggest factor. I truly believe that DOs are a disadvantage when it comes to mentorship. DO schools are not consistently giving their students good advice and showing them "tough love" on the competitiveness of the specialties they hope to apply. I'm convinced that about 30% of DOs that apply to PM&R probably shouldn't be, or at least should be applying with a strong consideration of a backup. Meanwhile, USMD students are getting better advice from their schools and are self-selecting for less competitive specialties.
ARE FMG STUDENTS COMPETITIVE
The field is becoming more competitive for FMGs as the competitiveness increases on the whole. But it is becoming a challenge specifically for FMGs. The percentage of FMG matching to PM&R has been on a steady decline over the past 20 years. FMGs typically self-select for less competitive specialties and we are seeing a trend of fewer FMGs applying to PM&R over the past few years. So take that into consideration when looking at the match rate. The FMGs that are applying are either very strong FMGs (relative to their FMG peers), or they do not have great insight on the competitiveness of the specialty. When reviewing applications I tend to see that dichotomy. I do think that strong FMG applicants should attempt to match into PM&R but it's no guarantee, and I'd have a backup. Average FMGs are facing an uphill battle matching to PM&R. If "all in" on PM&R, I'd recommend getting auditions and signal your auditions, and perhaps only apply to your audition programs/signals (and perhaps new or historically less competitive programs), and use all of your other financial resources to apply/interview at a less competitive specialty. If you look at the statistics on FMGs that apply to PM&R as their ONLY option on their rank-order list (ROL), the match rate is about 32% (for both US and non-US FMG). Poor strategy.
ARE MILITARY APPLICANTS COMPETITIVE
Military applicants have a rare opportunity to close the gap with an excellent personal statement. The truth is that most med students’ personal statements look very similar. If you can tie together your fleet experience and training with your desire to do PM&R, the personal statement will help you stand apart. With the emphasis on holistic application review, this further helps military applicants. I would also say that military applicants have a good chance to stand apart in the interview process. Even if you were a mediocre med student, I would still strongly suggest that you apply to even the top PM&R programs because a PD may read your personal statement and want to meet you. That is an open door. There are not any statistics specific to military applicants in the civilian match, unfortunately.
WHAT ARE THE FACTORS PROGRAMS FIND IMPORTANT FOR ISSUING INVITES
The majority of programs are using holistic review to screen out applicants (roughly 60%). Increasing residency diversity is a significant factor in the significant majority of programs (95%) adopting holistic review, so that is certainly a factor. You have to look back at the 2021 Program Directors survey to see the factors that they found most important in granting interviews. The most notable academic factors at that time were: 1) MSPE (aka Dean's letter), 2) Failed attempt at USMLE/COMLEX, 3) USMLE score, 4) COMLEX score. The most impactful personal characteristics included: 1) Prior match violation, 2) Specialty LOR, 3) Commitment to specialty, 4) Diversity characteristics, 5) Professionalism/ethics. All other factors were far less impactful. I would recommend reading this article for more information: https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf.
I HAVE BEEN GIVEN AN INTERVIEW…WHICH DATE SHOULD I CHOOSE
Most programs are going to conduct invitations from October through January (with early November being the peak). Most invites will occur in September-October and trickle in afterward. Many programs will also not conduct interviews for the weeks of Thanksgiving, Christmas, New Years, and AAPMR Annual Meeting. With virtual interviews, strategy on when to schedule interviews has become less important. The key is just staying organized. Have a list of dates on your calendar that you cannot attend going into the process, and then keep track of all of the invitations that you receive so that you don't schedule two on the same day. The yearly Google Sheet is a solid resource in determining when each program usually conducts interviews.
DO LETTERS OF INTEREST MATTER?
I honestly don’t think that status update requests are incredibly helpful. PC’s get tons of these each week. What is helpful is expressing your interest to program coordinators while requesting an invitation if one becomes available. When should you consider emailing PCs? Considering that peak season is November, I would take advance of that time period. Only email PCs at programs you are genuinely interested in, and only do so if you know that the program has sent out a batch of rejections and you weren't on the list. Will programs hold it against you that you were a “waitlist guy/gal”? See below.
WHAT ARE THE FACTORS PROGRAMS FIND IMPORTANT FOR RANKING APPLICANTS
The process in which program directors rank candidates is very different than the process in which they issue interviews. Think about this for a second. If you rank every PM&R program before and after you interview, you will notice a big difference between your pre-and-post interview rankings. Which ranking list would you trust more? Of course you would trust your post-interview ranking more, because some programs will exceed your expectations and some will let you down. The same applies to applicants. There are some people who look good on paper…high board scores, lots of research, cured cancer, etc. But that does not tend to translate to where an applicant gets ranked. If you don’t believe me, look at this study: https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf. The most important factors in determine where an applicant gets ranked includes: 1) Interpersonal skills, 2) Interactions with faculty, 3) Interactions with housestaff during interview/visit, and 4) Feedback from current residents. The PD's were NOT asked about the significance of signals or home/away rotations, but one would suspect that an applicant that does a home/away rotation has a better opportunity of demonstrating interpersonal skills and better interactions with staff/residents.
Will you be considered as a “waitlist guy/gal”…the answer is absolutely. First of all, you may not have lower scores than the ones who received invites. The primary reason is that once you get your invite you are essentially put on a level playing field. So if you are offered an interview by your dream program late in the season and have to cancel a program lower on your list…do it without hesitation. The numbers get you the invitation; the personality gets you the ranking.
HOW SHOULD I RANK MY PROGRAMS
I don’t think that any one person will be able to help you with this topic. It was my most difficult topic to tackle…by a good margin. After speaking with a variety of residents, staff, and PDs…I have come up with these two questions that are helpful in determining where to rank programs.
Ask yourself the following about each program in which you interview:
1) Will I be able to gain the level of training needed to set myself up for success in fellowship/employment?
2) Is the program a place where I feel I can thrive?
They are broad questions…but they are incredibly important. Will you gain the tools and will you be able to stand out? If you live in a location where you don’t feel comfortable…then you will not be able to thrive in that environment. If you have a family, you want to consider cost of living, safety, schools, and livability. If you are worried about your family member’s living conditions, you will struggle to thrive. If you didn’t feel like you have a good rapport with staff and residents…then that will make it difficult to stand apart. Being able to thrive is essential because it will determine if you are able to gain incredibly important recommendations by staff members. And that in large part will determine if you will get a fellowship or employment. Part of thriving is feeling supported by staff members. Are these folks going to go to bat for you and place calls to people to get you a job one day? Prestige is a factor, but it is something that it difficult to quantify. It's a consideration, but you definitely need to verify that a program lives up to the hype.
DO LETTERS OF INTENT MATTER?
The answer to this question may vary by program. Is it a new program and the program is placing a high emphasis on recruiting chief residents that are ambassadors for their program? I'd argue that program has reason to value letters of intent. But if it is a well established program, should it matter if someone has you #1 or #2 on their rank list? Likely not. But it doesn't hurt to notify your top program that they are #1 on your rank list. Just be aware of ACGME match rules. You cannot ask the program where they intent to rank you. That's a match violation. Many programs do not conduct post-interview communication with applicants out of concerns of match violations. So if you get a "ranked to match" letter from a program, that is great, but don't panic if you do not receive one.
I wish you the best of luck.
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I'll try to make an addendum at some point in the future after I get that figured out. 
