Can someone please explain to me about regional preferences of residency programs?

[Kirby Smart]

Hello! That title pretty much sums it up. I’ve forever heard, mostly on SDN, about how some residency programs apparently favor applicants from medical schools in the same general region (ie. you have a better shot at matching at Columbia if you went to medical school in NY, etc.)

Is this association true? As a student in the northeast, will I have a hard time matching somewhere in the southeast (where I am originally from)? I’m super ignorant on the topic and for the life of me couldn’t find a way to search this question so I would love if someone could enlighten me. Thanks! 🙂

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[Dral]

Lots of factors go into this.

One factor is that people in the same region may tend to know one another better. So a letter of recommendation may hold more weight as an example.

 

[aldol16]

The general idea is that programs do factor in whether an applicant would actually come to that program. For instance, if you've never been to California and apply to a California program with that background, it's likely that you won't be ranked highly since there's no reason for them to think you would actually go there. The more competitive the specialty, the more these small things tend to matter. It's notoriously hard to match in California, for instance, unless you have some sort of personal connection to the state.

This is why in some specialties, away rotations can help "open up" some regions of the country. It shows your commitment and interest to that area of the country. The onus is on you to demonstrate to the program that you're serious about them.

 

[Kirby Smart]

The general idea is that programs do factor in whether an applicant would actually come to that program. For instance, if you've never been to California and apply to a California program with that background, it's likely that you won't be ranked highly since there's no reason for them to think you would actually go there. The more competitive the specialty, the more these small things tend to matter. It's notoriously hard to match in California, for instance, unless you have some sort of personal connection to the state.

This is why in some specialties, away rotations can help "open up" some regions of the country. It shows your commitment and interest to that area of the country. The onus is on you to demonstrate to the program that you're serious about them.

Ahhh that definitely makes sense, thanks for explaining! So would the effect be for the most part negated if you were hoping to match back in your home state after being away at an out of state school for 4 years, since they then would likely be less doubtful that you would actually come to that program?

EDIT: and one other follow up question that you somewhat touched on: is this effect much less intense in less competitive specialties? I’m interested in a specialty that is near the bottom as far as competitiveness goes.

 

[Lem0nz]

State schools and state residency programs in particular have a more pressing need to retain physicians for their state. The state where I'm from and went to medical school tended to match nearly half of its residents from that med school for in state residencies. My state also happens to have a persistent and pronounced physician shortage. So that played a massive part.

 

[aldol16]

Ahhh that definitely makes sense, thanks for explaining! So would the effect be for the most part negated if you were hoping to match back in your home state after being away at an out of state school for 4 years, since they then would likely be less doubtful that you would actually come to that program?

Keep in mind that a lot of what goes in on selection is still a black box and dependent on the program - especially for the small competitive ones. With that said, if you were trying to match back into your home state where you have connections (family/friends), then there's a lower likelihood that they'll make that assumption about you. The idea is to show them love when you're applying/interviewing. They need to understand the reasons you have for going there.

EDIT: and one other follow up question that you somewhat touched on: is this effect much less intense in less competitive specialties? I’m interested in a specialty that is near the bottom as far as competitiveness goes.

I'm not sure about this.

 

[Redpancreas]

It was definitely a trend I observed. Reviewing my interviews, I was invited to more competitive programs in my region than elsewhere. We don't know the exact reason but I think it has to do with yield protection and trust in known quantities.

1.) Lets say Residency A has time for 500 interviews to fill 25 positions. They simply can't throw those slots at the top 500 applicants. It's always funny when PDs say making it here means you've made the cut and show a statistic of how they get 8000 applicants and have to cut that down to 500 interviews. They have years of data on the typical demographics/qualifications of candidates they end up with. They target those candidates with reaches/safeties which I estimate is maybe 800 candidates (complete guess) of the 8000 applicants and go from 800 realistic apps->500 interviews. I imagine they make small adjustments based on what they're seeing from their current residents yearly, but if they deviate too much from the overall formula they're likely looking at SOAPing.

2.) Additionally, a majority of students attending Residency A are distributed at schools close via simple statistics. Therefore residencies have more understanding of schools/letter writers/mentors in that radius and what codified language they use to assess students in the Deans Letter. PDs are risk averse. They're not trying to play money ball because there's no motivation to uncover the best residents since no one's competing. They're just looking to fill a class with reliable residents.

What can you do about it if you find yourself going against the trend? Be proactive and make it clear to a program that you're interested in them specifically by sending them an LOI. This year, many programs have discouraged pre-interview invite communication in anticipation of mass applications due to COVID which is unfortunate. Anyhow, if the leadership reads your email (which they will) and wants to meet you they may offer you an invite. I would imagine more competitive places don't have to yield protect as much and can get away with more national/competitive recruitment efforts given the whole cohort's likely applying to them.

 

[operaman]

Easy. Interviews are the limiting factor and a precious resource. Small programs typically interview 40-60 people out of the entire applicant pool. You want the people you actually interview to be those who are more likely to rank you highly. If you’re a program in flyover country and you mostly interview people from big cities on the coasts, you run the risk of not filling and having to soap. It also means you missed out on meeting other good applicants who may have really wanted to train there.

 

[VA Hopeful Dr]

State schools and state residency programs in particular have a more pressing need to retain physicians for their state. The state where I'm from and went to medical school tended to match nearly half of its residents from that med school for in state residencies. My state also happens to have a persistent and pronounced physician shortage. So that played a massive part.

This was my exact experience as well

 

[Kirby Smart]

Thanks everyone for the great explanations! Like I said, I’m currently at school in the northeast but my “dream” is to match at a semi-well known program back at my home state in the southeast (in a non-competitive specialty). Do you think if I do an away rotation and try to make it clear to them that they’re my top choice that they wont consider being at a northeast school as a risk for them?

 

[Banco]

Thanks everyone for the great explanations! Like I said, I’m currently at school in the northeast but my “dream” is to match at a semi-well known program back at my home state in the southeast (in a non-competitive specialty). Do you think if I do an away rotation and try to make it clear to them that they’re my top choice that they wont consider being at a northeast school as a risk for them?

While there is a regional bias to some extent, it is one factor among many, and you'll get interviews all over the country. You can make sure to showcase your interest to this specific program in some way via an individualized personal statement. Or you can put your permanent address as where you grew up, etc. Depending on your specialty, an away rotation may be helpful if it's a specific program you really want.

People going to school in the Northeast have no problem matching in other areas of the country. Also realize that the bias is partly confounded by self selection.

Long story short, you'll be fine as long as your application is good.

 

[WheezyBaby]

People have touched on most of it
1) individual preference to stay where you are
2) program preference to select people likely to want to be there
3) program familiarity with letter writers

The more competitive a given position is, the more factors are going to be weighed in applicant selection. Generally speaking, the northeast and west coast are the desirable / competitive geographic areas. The southeast not so much. Regardless, if you have a strong desire to be at a particular institution and you can eloquently put into words reasons for thay desire, it would be reasonable to reach out to a program with that information.

 

[Redpancreas]

Thanks everyone for the great explanations! Like I said, I’m currently at school in the northeast but my “dream” is to match at a semi-well known program back at my home state in the southeast (in a non-competitive specialty). Do you think if I do an away rotation and try to make it clear to them that they’re my top choice that they wont consider being at a northeast school as a risk for them?

The fact that the program is in your home state will already lend credibility to your intention. Doing an away would definitely help solidify that intention, but a well-worded email to the PD during the application season may have nearly the same effect without the risk. I'm saying that because who knows whether you'll actually be allowed to do the away this year. Additionally, and this is my opinion, the away hurts more than it can help (IF we're talking about a non-competitive field like IM or Neurology that's rounding-centric with large teams). There are just simply more ways to make a negative impression than a positive one. I would only do it if you think you are really far from the caliber of applicant said program recruits so you have nothing to lose and then even if you don't match there you can get a letter from someone there that you can use elsewhere. In real life, I have seen it go both ways so it's not unreasonable to consider the away. Just make sure you're on a level playing field with the home students (ex. Know the system, Ensure your EMR access isn't delayed, etc.).

 

[Kirby Smart]

The fact that the program is in your home state will already lend credibility to your intention. Doing an away would definitely help solidify that intention, but a well-worded email to the PD during the application season may have nearly the same effect without the risk. I'm saying that because who knows whether you'll actually be allowed to do the away this year. Additionally, and this is my opinion, the away hurts more than it can help (IF we're talking about a non-competitive field like IM or Neurology that's rounding-centric with large teams). There are just simply more ways to make a negative impression than a positive one. I would only do it if you think you are really far from the caliber of applicant said program recruits so you have nothing to lose and then even if you don't match there you can get a letter from someone there that you can use elsewhere. In real life, I have seen it go both ways so it's not unreasonable to consider the away. Just make sure you're on a level playing field with the home students (ex. Know the system, Ensure your EMR access isn't delayed, etc.).

Ahhh, that all makes sense, thank you so much! In all honesty, I’m actually an M1 so I‘m somewhat jumping the gun with these questions, but they’re just something I’ve always been curious about ever since I decided to attend med school in the NE while still having intentions to complete residency back in my home state. This info will be valuable to know as around this time next year and into the future as I prepare for rotations and residency applications. Thanks again!

 

[mcatstudent1]

This was also a factor of in person interviews. They wanted to see who would attend the interview. Virtual interviews this past cycle changed the game since so few applicants canceled any interview. Time zones were the only factor to contend with not trans country flights

 

[Ho0v-man]

Despite doing clinical rotations in the northeast, having my hometown in the northeast, and having all of my LORs from the northeast, I got the most interviews from the Midwest because that’s where my school is located.

 

[Dave1980]

Programs want happy residents. If you have a support system in place and know the area you are more likely to be happy.

 

[Jack Donaghy]

A lot of the regional preference or "bias" that you see is also self-selection. Anecdotally, I am from X state on the east coast, went to undergrad in X state, medical school in X state, and only applied to residency programs in X state and 2 neighboring states. I suspect many of my classmates with similar roots also only applied to this area.

 

[Steve_Zissou]

It was definitely a trend I observed. Reviewing my interviews, I was invited to more competitive programs in my region than elsewhere. We don't know the exact reason but I think it has to do with yield protection and trust in known quantities.

1.) Lets say Residency A has time for 500 interviews to fill 25 positions. They simply can't throw those slots at the top 500 applicants. It's always funny when PDs say making it here means you've made the cut and show a statistic of how they get 8000 applicants and have to cut that down to 500 interviews. They have years of data on the typical demographics/qualifications of candidates they end up with. They target those candidates with reaches/safeties which I estimate is maybe 800 candidates (complete guess) of the 8000 applicants and go from 800 realistic apps->500 interviews. I imagine they make small adjustments based on what they're seeing from their current residents yearly, but if they deviate too much from the overall formula they're likely looking at SOAPing.

2.) Additionally, a majority of students attending Residency A are distributed at schools close via simple statistics. Therefore residencies have more understanding of schools/letter writers/mentors in that radius and what codified language they use to assess students in the Deans Letter. PDs are risk averse. They're not trying to play money ball because there's no motivation to uncover the best residents since no one's competing. They're just looking to fill a class with reliable residents.

What can you do about it if you find yourself going against the trend? Be proactive and make it clear to a program that you're interested in them specifically by sending them an LOI. This year, many programs have discouraged pre-interview invite communication in anticipation of mass applications due to COVID which is unfortunate. Anyhow, if the leadership reads your email (which they will) and wants to meet you they may offer you an invite. I would imagine more competitive places don't have to yield protect as much and can get away with more national/competitive recruitment efforts given the whole cohort's likely applying to them.

Man, I hope they let us send letters pre-interview for next application season. My top choices are almost all in the Northeast, to which I have no ties.

I know people say that you need to express to the school why you want to go to the area, but my reasons are definitely not as good as “my family and support system all live within 3 hours of your program.” My reasoning is mostly lifestyle. I love the outdoors, getting out to ski, mountaineer, rock climb, etc and I don’t necessarily want to be in a massive city for residency so Maine, Vermont and those other programs up there seem perfect for me. Obviously, I care about getting a decent education, but other than that it’s lifestyle.

 

[Redpancreas]

Man, I hope they let us send letters pre-interview for next application season. My top choices are almost all in the Northeast, to which I have no ties.

I know people say that you need to express to the school why you want to go to the area, but my reasons are definitely not as good as “my family and support system all live within 3 hours of your program.” My reasoning is mostly lifestyle. I love the outdoors, getting out to ski, mountaineer, rock climb, etc and I don’t necessarily want to be in a massive city for residency so Maine, Vermont and those other programs up there seem perfect for me. Obviously, I care about getting a decent education, but other than that it’s lifestyle.

Most those places aren't super competitive and your mindset is in the minority so you should be fine. Most places are fine with letters of interests, some places this year I heard had policies where they did not except pre-interview communication but not close to the majority.

You can also craft a separate personal statement for those programs in the Northeast you're targeting alluding to some reasons you'd be a good fit.

 

[husky_doc16]

Thanks everyone for the great explanations! Like I said, I’m currently at school in the northeast but my “dream” is to match at a semi-well known program back at my home state in the southeast (in a non-competitive specialty). Do you think if I do an away rotation and try to make it clear to them that they’re my top choice that they wont consider being at a northeast school as a risk for them?

An away rotation will definitely help you build connections, and hopefully, match as well. I am currently applying this cycle to a non-competitive specialty and had no difficulty getting interviews from my home region, even though I go to med school across the country.