In your words

Why residency applications need to change

The lack of transparency throughout the residency application process leads to wasted time for applicants and programs and causes untold amounts of stress, writes Sean Kiesel, DO, MBA.

Editor’s note: This story was originally published on KevinMD and is republished here with permission. It has been edited for The DO. This is an opinion piece; the views expressed are the author’s own and do not necessarily represent the views of The DO or the AOA.

So, what’s the problem?

Alright, anybody that has been through the process knows that applying to residency programs is a long and expensive process.

The issue is not how long it is, or honestly how expensive it is, even though those are problems.

A lack of transparency

The issue is the secrecy of it all from an applicant’s perspective.

Many applicants don’t know what is on their deans’ letter and their letters of recommendation. Also, while applicants and residency programs are allowed to express interest in each other after the interview, programs cannot commit to offering you a spot.

If you as the applicant could be privy to the information in those three areas above, you would spend less time and less money on the process, and you would ultimately leave open more interview spots at other programs for other students.

Knowing what is in your deans’ letter and letters of recommendation would be so helpful because then you would know if there are any issues brought up that you need to discuss. Sometimes, what someone thinks is a compliment actually isn’t to you, so knowing the content of those letters would let you be better informed.

If programs could let you know that they want you, imagine how much money you could save, time you could save, and how many interview spots at other programs could go to other students that may want it more!

I spent over $5,000 traveling to interviews after I interviewed at my number one program, and had they been able to communicate to me that they wanted me there, I could have saved all that money and time!

More importantly, those interview spots could have been extended to someone who wasn’t just padding the rank list for safety’s sake. (Yes, I went on more than I needed to just to make sure I would match somewhere.)

A small silver lining of the COVID pandemic is that it caused many residency programs to switch to an all-virtual format for residency interviews, which means current applicants will spend significantly less on the process. However, they may feel pressured to spend even more time on interviews without the constraints of coordinating travel.

How it could be better

This is a complicated process for sure, and the way it is done right now tries to make it fair for everyone.

As an applicant, it would be very helpful to see the letters of recommendation and see the dean’s letter.

There is a section of the MSPE (dean’s letter) that goes over your noteworthy characteristics. Some schools allow students to write their own noteworthy characteristics, but others do not. If you haven’t been able to write your own, it would be very helpful to see what they include before you apply.

Then last, it would be nice if you could openly communicate with the residency program about the mutual interest.

The residency should be able to say when they want you and vice versa. If a residency could honestly tell an applicant that they want them there, then the applicant could save tons of time, money, and stress.

It is such a simple thing, but would make a huge difference!

Why it matters

This process is long, costs a ton of money for both parties involved, and is incredibly stress-inducing. Simplifying it and allowing the things mentioned above would make it so much easier for the applicant and honestly could make it easier for the residency too.

It should be more of a job application, where the interest can be openly communicated, instead of the application process it is now.

Related reading:

How to prepare for virtual residency interviews for the 2021-2022 season

How DO students/graduates matched to their top-choice residencies in 2021


  1. Proud DO

    I don’t agree with this recent residency applicant’s ideas.

    Imagine how programs would feel about applicant data integrity if the applicant has knowledge of letter content and how that knowledge of data could be manipulated by the applicant. (Applicant could not send letters the applicant feels aren’t as strong).

    Applications to residencies should not involve data where the applicant can pick and choose letters of recommendation. Deans letters are already transparent data (or at least should be) where the letter includes data from rotation evaluations, grades, etc. if a student has concerns about this data – I would encourage the student to talk with their clinical education office – not try to game the residency application system.

  2. Doug Tacket, DO

    The residency application process IS a job interview. I GME however, it is treated as firm if speed dating.
    Getting to know the applicant and the program takes time and direct interaction and observation. Much of this is lost in the virtual interview process.
    Honestly, as a former program director, letters of recommendation were the last thing I looked at in an application because they typically were a rehash of the applicant’s CV, over the top remarks, and didn’t often give insight into who the applicant really is as a person. Dean’s letters were typically looked like a cut and paste of the applicant’s academic record, rarely were insightful comments included from clinical preceptors.
    My personal belief is that matching should take place every 28 days during interview season. Programs could be allowed to use or hold on to a fraction of their available positions and fill them at their discretion. This process could also contribute to either decreasing the volume of need for, or even eliminating the SOAP process. This would require a overhaul of The Match. But in the era where we are moving away from single high stakes exams, residency matching should be another ingrained process to undergo reconfiguration.
    Progress is never painless.

  3. Matthew White

    I still think it is better if programs can’t tell applicants if they’re interested. That saves a lot of applicants from being burned by false hopes and promises.

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