How to Match into your No. 1 program: Insights from 38 applicants who did it

Students and DOs who recently matched share details about competitiveness, letters of intent, audition rotations and more.

Match day is a terrifying day for medical students. All medical students want to match into the residency of their choice, but actually doing so can be difficult.

Although 99% of DO graduates seeking GME were placed into residency programs in 2021, fewer than half (42%) of DO fourth-years participating in the NRMP Match matched into the program they ranked No. 1 in 2021, according to the NRMP’s report (PDF).

This article will (hopefully) demystify The Match process for applicants who will soon be starting down the battle path of pursuing their No. 1 residency program.

I wanted to find as much information as possible for readers. So I interviewed 38 residents who matched into their No. 1 program. I wanted to pick apart their experience so that future applicants can try to replicate it.

The 38 residents I talked with come from 24 different medical schools and matched into programs in 23 different states. There were 36 DOs and 2 MDs. This group of 38 matched into 11 different specialties. Of these interviewees, 21 matched in the 2022 Match, 12 in the 2021 Match, and 5 in 2020 or before.

Considering the above demographics, this article should be an excellent place for applicants to start when setting out to apply for residency. There is certainly more fine-tuning when it comes to specific specialties. However, this should provide a solid foundation of information to build on.


The first question I asked these applicants was: How competitive of a candidate did you feel like you were for your No. 1 ranked residency program? The intent with this question was to provide a barometer for applicants to estimate their probability of matching into a program based on their competitiveness. Interviewees objectively estimated how competitive they were by using tools such as FREIDA and Residency Explorer.

When considering their competitiveness, interviewees weighed their board scores, CV, letters of recommendation, audition rotation experience (if applicable) and other factors. The results are below.

Most candidates felt they were either above average or average competitors for their No. 1 program. It is worth noting that very few candidates felt like they were below average competitors. This is insightful information for applicants to consider so that they can be realistic about their application expectations.


I also asked interviews this question: How did you feel your interview went at your No. 1 program? The results are below.

Most individuals who matched at their No. 1 program had extremely positive interview experiences. Readers can use this information as a yardstick for monitoring their experience as they progress through the application and interview season.

Letters of intent

Next, I asked if interviewees sent a letter of intent to the residency program that they ranked No. 1. A letter of intent was defined as an email or document sent to their No. 1 ranked program explicitly stating that the applicant intended to rank the notified residency program as their No. 1 choice in The Match. The results are shown below.

Most applicants I talked to did indeed send a letter of intent. However, a precautionary word is in order regarding this specific issue. Applicants should make informed decisions when considering a letter of intent.

Some interviewees said that some programs state that letters of intent are not entertained, and some even might penalize applicants for post-interview communication. Wording of the letter should be extremely intentional. Applicants should be sure to be informed before deciding what to do regarding a letter of intent.

Audition rotations

I also asked interviewees if they did a visiting/audition rotation at the residency program that they ranked No. 1.

This question shows that about half of the interviewees did visiting rotations and half did not. Bear in mind that 33 of the 38 individuals interviewed matched in either the 2021 or the 2022 match.

During these years, the COVID-19 pandemic drastically impacted visiting rotation experiences. It is hard to say if this data point will be representative in the future. Of the five interviewees who matched in 2020 or before, three did visiting rotations at their No. 1 program while two did not.

Visiting rotations

The 17 interviewees who did visiting rotations were then asked how their visiting rotation went. The results are below: 

Overall, individuals who matched into their No. 1 residency program who also did a visiting rotation at their No. 1 program commonly felt that their visiting rotation went very well.

What applicants prioritized

Lastly, I asked interviewees what they prioritized when ranking programs in the NRMP match. The following information will explain how to interpret the graph below:

  • I asked interviewees to pick one item that was their first priority, one item that was their second priority, one item that was their third priority, and some even indicated an item that was their fourth priority.
  • When an interviewee indicated that an item was their first priority, that item was awarded 4 points.
  • Second-priority items were awarded 3 points.
  • Third-priority items were awarded 2 points.
  • Fourth-priority items were awarded 1 point.

The results are shown below:

Geography was the most commonly cited priority among individuals who matched into their No. 1 ranked program, whether they wanted to live close to family or loved ones, stay in a specific region, avoid certain climates or live in a specific city size. 

The culture of the program came in as a strong second place. Culture includes factors such as the perceived happiness or satisfaction of residents at the program, the comradery felt among co-residents, the personalities of the individuals in the program or the personality of the program as a whole, or if interviewee felt like they would “fit in” with the residents in the program.

There are many moving parts to consider for an applicant aiming to match into their No. 1 ranked program. Hopefully this information will serve as a foundation to start from for readers who will soon be applying for residency. Good luck!

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

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

Cracking the Match: Everything a current (or future) residency applicant needs to know about the Match algorithm

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