Impact of parallel planning on residency match rate success

Abstract

Background

Medical students targeting competitive specialties or those with lower competitiveness for their preferred specialty are encouraged to parallel apply to a less competitive field. The AAMC provides data on the number of applicants who parallel apply but little information exists on their match success.

Objective

Our objective is to describe the success rates for students who parallel apply to more than one specialty.

Methods

Following IRB exemption, a retrospective cohort study of Indiana University School of Medicine graduates from the 2021–2024 residency match cycles was conducted. ERAS data and match reports were reviewed to identify students who parallel applied to more than one specialty, determining their match outcomes. Subgroup analyses were performed based on specialty type, and descriptive statistics were reported.

Results

Between 2021 and 2024, 1,411 IUSM students applied for the match, with 225 (16%) having a parallel plan; 39% of these students matched into their preferred specialty, 56% into their parallel specialty, and 5% did not match. The most common parallel plan specialties were Anesthesiology, Orthopaedic Surgery, and OBGYN. There were no statistically significant differences in parallel application rates among surgical, hospital-based, and primary care specialties.

Conclusions

Our study shows that 1 in 6 students will apply to a parallel specialty, with more than half matching into their parallel plan, making it a viable strategy for those targeting competitive specialties or with lower competitiveness. We found no difference in application rates between surgical, hospital-based, and primary care specialties, emphasizing the need for individualized competitiveness guidance.

Background

The residency match is a high stakes process for medical students pursuing a residency training program [1]. Many students will decide to apply to more than one specialty to help mitigate the risk of going unmatched [2]. While applicants do have some insight into the factors most highly considered by program directors in the selection process, much of the application evaluation remains opaque, often leading to uncertainty in individual student competitiveness [2].

The Association of American Medical Colleges (AAMC) has recommended that applicants who are applying to a highly competitive specialty or those who are less competitive for their most preferred specialty consider applying to a second, less competitive specialty of interest as a parallel or dual application [3]. The AAMC provides data on the number of applicants who parallel apply but little information exists on the match success rates of these applicants and if they matched into their preferred or parallel specialty [4].

To provide comprehensive information to medical students pursuing residency programs requires knowledge of a student’s preferred specialty, the specialties applied to, and ultimately what specialty the student successfully matched into. This would help mitigate the risk associated with the residency selection process and help secure a successful match. Our study’s objective is to describe the success rates for students who parallel apply to more than one specialty.

Methods

Following IRB exemption, a retrospective cohort study of Indiana University School of Medicine (IUSM) graduates was performed for the medical residency match cycles 2021–2024 (#22762). IUSM is the largest allopathic medical school in the United States and graduates over 350 students per year. Each medical student has a Lead Advisor who works with Medical Student Affairs to provide academic advising and career mentoring throughout medical school. Our school utilizes a formal tracking system to ensure that students are connected to mentors within their desired specialty. Once students decide on a specialty, they submit their name and desired specialty to our internal portal. This is tracked centrally with input from a student’s assigned lead advisor.

Electronic Residency Application Service (ERAS) data reports available through the Program Directors Workstation (PDWS) were reviewed to identify students who parallel applied to more than one specialty. A student’s “preferred specialty” was indicated as the specialty entered into our school’s student record system prior to the match or through personal knowledge of the student’s preferences. A “parallel plan” was defined as a categorical or advanced residency program different from a student’s preferred specialty or a preliminary position without an advanced program obtained on the Monday of Match Week. A strategy of ranking a preliminary year only training program on a rank list requires a student to re-enter the match for the following cycle. This was also considered a parallel plan.

Full National Resident Matching Program (NRMP), American Urological Association (AUA), Military Match, San Francisco (Ophthalmology) match reports were reviewed to determine whether a student matched into their primary specialty or their parallel plan. Subgroup analysis was performed based on whether the preferred specialty was a surgical specialty, a hospital-based/specialty care specialty, or primary care as defined by the AAMC. Descriptive statistics and ANOVA when appropriate was performed with SPSS 29.0.

Results

Between 2021 and 2024, 1,411 IUSM students applied for the match and 225 (16%) had a parallel plan. The most common specialties for those with a parallel plan were Anesthesiology, Orthopaedic Surgery, and Obstetrics and Gynecology (Fig. 1).

Fig. 1

Most preferred specialties for students with a parallel plan

For students with a parallel plan, eighty-eight students (39%) matched into their preferred specialty while 125 (56%) matched into their parallel specialty. Twelve (5%) did not match during the study period. The unmatched applicants make up less than 1% of the total cohort of students that applied during the time frame studied.

There was no statistically significant difference between surgical specialties, hospital-based specialties and primary care specialties (Table 1) in the number of students that parallel applied to residencies within those categories (p 0.24). The mean number of students that parallel applied to surgical specialties was 8.3 (95% CI 3.0-13.7), hospital-based specialties 5.5 (95% CI 2.2–8.8) and primary care specialties was 2.8 (95% 0.04–5.5).

There was also no difference between surgical, hospital-based and primary care specialties in the overall number of students that applied to them (p 0.15). The mean number of students that applied to surgical specialties was 41.9 (95% CI 4.76–79.01), hospital-based/specialty care specialties was 29.5 (95% CI 9.3–49.6) and primary care specialties was 81.5 (95% 9.5-172.5).

Discussion

Our study demonstrates that 1 in 6 students will apply to a parallel specialty and more than half will match into that parallel plan. This can be considered a viable strategy for students applying to a highly competitive specialty or if they are a less competitive applicant for their primary specialty choice. Career advisors should work closely with students to form appropriate parallel plans if there are concerns of their students going unmatched.

We investigated whether there was a difference in the number of students that applied – either as a preferred specialty or a parallel plan – to surgical, hospital-based/specialty care and primary care specialties. We found that there was no difference between groups in the number of students that applied to these categories. This reinforces the notion that students need guidance on individual competitiveness for a specific specialty as opposed to applying to a different category of residency program.

Historically, the National Resident Matching Program (NRMP) considers the most competitive specialties to be those that match with the highest percentage of U.S. medical school graduates. Anesthesia and OBGYN are now in that group with over 70% filled by US MD seniors [4]. Dermatology (80%), Otolaryngology (88.7%), Orthopaedic Surgery (79.3%) still rank higher. Knowledge of these results will help advisors counsel students effectively.

Strengths of our study include our large sample size which makes our results generalizable to other allopathic medical schools. We also have a dedicated career mentoring team with Lead Advisors assigned to each student to ensure standardized guidance throughout the residency application process. Lastly, our school database included preferred specialties, parallel specialties, and matched specialties to ensure complete information for our students.

Our study is not without limitations. Though we had information to applied specialties, we did not have access to rank lists. Students may have in fact ranked a parallel specialty higher than their preferred specialty based on other factors such as geography or family ties. Additionally, students may have changed their preferred specialty without updating their preference in our school database. We also did not investigate school performance or USMLE Step 2 CK scores which may have influenced decisions to parallel plan.

Advising students in career planning includes determining the potential need for a parallel plan. Students should be empowered to select their specialty of choice based on personal interests and skill level [5]. However, in the current climate of residency applications, having a parallel plan should be considered a viable strategy to ensure a successful match. With the rise in the number of students parallel applying to competitive specialties, understanding the data behind the success of such applicants is paramount [6].

Table 1 Breakdown of specialties included in each category