Thursday, August 2, 2012

How To Get Into An Anesthesiology Residency

To all the medical student readers out there, here is the news you've been waiting for. A common question that I've been asked is what does it take to get into an anesthesiology residency. Well, there were no easy answers as it was purely speculative. However we now have concrete peer reviewed results to help with that inquiry. The current issue of Anesthesiology has published an article on the characteristics of applicants who successfully matched into an anesthesiology residency. The authors used the Electronic Residency Application Service to obtain their data. Since applications are made electronically and each applicant can apply to any or all anesthesiology residencies in this country, they were able to look only at applicants to Northwestern University's program in 2010 and 2011 to get a broad sampling. This gave them data on 1,976 applicants which corresponded to 58% of all anesthesiology applications at that time. That year, only about 66% of applicants were rewarded with a spot in a program in this country.

So who are the successful applicants? First of all, and not surprisingly, graduates of American medical schools are more likely to find a position than international graduates. The authors speculate that since it has been shown that international students have more problems with lower USMLE scores, language barriers, and higher failure rates on the ABA board certification, they are less likely to be chosen to enter a training program.

Another major, and one of the strongest, determinant of a successful match is a high USMLE 2 score, at least 210. The ratio of successfully matched applicants with a score of greater than 210 vs those with less than 210 was 1,076 vs. 86. So you can see that 210 seems to be a threshold for program directors. Score less than 210 on your USMLE and your chances of getting into a program shrinks significantly. While a higher test score does not equate to stronger clinical performance, the high achievers usually do better on in-service exams which leads to a higher likelihood of program accreditation. The authors think this makes directors more likely to choose better test takers regardless of their clinical abilities.

There's also a bias toward choosing female candidates for a slot. Perhaps since there are fewer female applicants, 36% of the applicants, they have a higher probability of getting chosen as programs try to show they don't discriminate against women. Also if you're older than 28, you'll have a harder time getting into anesthesiology. They theorize that since older students usually score lower on the USMLE, this makes them less desirable to programs looking for high achievers.

One surprising finding in this paper was that being well published bears no relationship whatsoever with successfully matching into an anesthesiology residency. Applicants who've done postgraduate work like getting a Ph.D. and working in a research lab are not anymore likely to get a spot than one who hasn't. As a matter of fact, the study found that the average number of publications made by those who made the cut was exactly ZERO. That's right. Despite what you may have been told about getting into a competitive residency, the quantity of papers published has absolutely nothing to do with the likelihood of getting in.

What do the residency program directors themselves consider the most important factors in residency applicants? They rated the residency interview as the most significant criteria when evaluating applicants. Excellent interpersonal skills and professionalism are highly prized by the gatekeepers. Next come grades and class ranking followed by USMLE scores. What is the least important element when looking for new residents? At the bottom of the list is interest in research and academic career. Surprising isn't it?

So there you go. If you are young, female, with excellent USMLE scores and graduated from an American medical school, you're golden. If you're older, male, finished at an international school and are interested in academic research, you may be out of luck. But you may still get in if you remember to bring your most vivacious personality and brightest smile to the interview.


  1. Thank you for posting this useful information! My dad is an anesthesiologist, but it seems that a lot has changed about the field since he was in school, so your blog is a great source for me to learn about it. I love your other articles, especially your insights on government regulation and the future of the profession. Keep up the good work!

  2. As an older, male, USIMG who is an MD/PhD candidate, I find this article incredibly depressing.

    1. Anon, I wouldn't worry too much about this article. I took a look at the source article and the cohort being sampled in the study by De Oliviera et al was included applicants to their program. It might not accurately represent the majority of anesthesia applicants.

      On the other hand, as someone interested in Anesthesia with no background/experience in research, I find these results to be more optimistic.

  3. love this post. helps me decide:)

  4. I disagree with this, I had a avg step 1 and 2, the only thing got me into anesth residency was my 5+ publications during medical school.....