this isn't really correct
the most accurate thing to say is that with residency applications there is a "regional bias" to interview invites - meaning if you went to school in the South, and apply broadly, you're most likely to get invites from the South region, and you're most likely to match to programs in your region, because all else being the same residencies rank people higher that they think will actually want to go to their program, and will actually be happy there (a happy-ish resident is a more productive-ish resident) and they think geography plays into this hugely
programs you apply to that are outside your region that you don't have obvious ties to, will be met with a little more skepticism as far as your commitment to moving there (unless it's somewhere uber sexy)
people in medicine are conservative, they figure if you're not used to shoveling snow that you're not going to be happy moving from SoCal to Milwaukee
they think that people who already know what they're getting into geography -wise, or have a support system close by, are likelier to rank them higher and be prepared to live in that region
the last thing a program wants is for you to get SAD and drop out because you couldn't make the climate adjustment
90% of my residency interview day was about geography, no joke
if you have specific ties to a state out of your med school's region, like actually being from that program's state originally or having family there, then that would be something you would want to highlight in your app somehow to that program, they can see where you where to high school, undergrad, and med school, and what state you claim legal residence, and also in your PS to that program you can mention it (you can customize your PS program by program if you like for ERAS), and that can give you a big boost in trying to "return home
the general saying is that "residency is a regional game"
basically, bank on a residency in your region, or in a state that you have ties to
that doesn't mean people don't end up out of region - but if you're not from the region you'll have to be prepared to talk at length about that and who knows what that does for how the individual program makes their rank list
however, that doesn't mean that it's easier to match into your school's program or its affiliates, if anything if can be harder for a variety of reasons that it's hard to justify the generalization
many schools make a specific point of not taking hardly anyone from the school into the program to avoid being "in bred" appearing
this can be true for the community affiliate programs
I feel like programs straddle this line where they are conservative and take people from the region for the most part for culture reasons, but they also like to have a few "exotics" to show diversity and that their program is nationally desirable on some level
some community programs also might not want to take grads from a nearby school if they find that school has problematic graduates (I've *seen* this) however that bias can be overcome with if you rotate there and excel and make contacts
of course some places the med school is the feeder for the community residency programs
people are most likely to practice where they did residency, period
there's a lot of reasons for this, most of which is just ease
it's not that there's really any barriers to leaving your residency state and being an attending elsewhere, just activation energy
many people even if their residency is far from where they imagined themselves practicing, have set down enough roots to stay put
now, the regional thing I describe applies more for numerous residencies, like IM
if you were going for neurosurg which only has like 60 programs (I think) the regional part plays less of a factor as they are aware you will apply *everywhere* and will move *anywhere* and having strong regional preferences just doesn't make as much sense for either party (applicant or program)
the exception is that for something really competitive you are more likely to have networking ties or for your mentors/LOR writers to be known regionally
so the regional factor plays less a role in more constrictive specialties but is still there
now, say you were really competitive for psych, in that case, you can basically write your ticket almost anywhere in the country
also keep in mind part of what determines if you can leave your region or not will be how competitive you are, and how competitive the program is
if you were like me, a totally average applicant from a school of a good pedigree, applying to a medium competitive field, but applying to low competitive programs in the not most exciting places, you could get a lot of attention and take your pick
