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Welcome to "Ask the Program Director," a column from MedPage Today where your most pressing questions about residency -- from the application process to life as a resident -- are asked and answered. Want to submit a question? Comment below or email perspectives@medpagetoday.com.

Dear residency program director,

Is it possible I'm "too competitive" for some residency programs? I recently got a "waitlisted" email from a program I'd applied to as a safety. It's not a super prestigious or highly academic program and I figured I'd get an interview at the very least, but now I'm getting worried as I wait to hear back from other programs -- especially the ones I view as more competitive. I'm wondering if programs will sometimes deprioritize strong candidates who they think are unlikely to rank the program high or if I'm just less competitive than I'd originally thought...

Dear applicant:

I'd like to answer your thoughtful question by asking you to reflect on your experience as an applicant who is receiving interview offers for residencies. As a "competitive" applicant, you may get many more interview invitations than you are able to accept because of limited time, preference, and other factors. Deciding which interviews to accept will likely be a result of multiple factors, including but not limited to geographic preference, reputation of the program, unique program curricula, culture, and personal and family considerations. Making the decision on which interviews to accept and which to reject will undoubtedly be difficult.

The same decision-making process also holds true for program directors when deciding which applicants to interview. We receive many more qualified and deserving applicants than we can actually interview. As an example, in the University of Maryland diagnostic radiology residency program, we received over 1,200 applicants this year alone, but we can only interview about 130. That's just over 10% of applicants. This means there will likely be hundreds of highly qualified, excellent candidates who will not receive an interview invite from us. This scenario is true across the board for all specialties.

Who a program director decides to interview is a result of an interplay of numerous factors. Most programs prioritize candidates who align with the mission of their program, which could include serving underserved populations or contributing to medical education, for example. Residency programs also look for candidates who will integrate well into their training environment. If an applicant is passionate about research and pursuing grant funding, but the program does not have a strong research infrastructure, then a program director may be reluctant to extend an interview despite the strength of the applicant.

Geography is another important consideration. Many program directors want to invite candidates who they believe will actually want to match into their program. A program director from North Carolina may be hesitant to offer an excellent candidate from California an interview if the applicant has no specific ties to North Carolina. A program director may think that the applicant does not have compelling reasons to leave California.

There are so many considerations when deciding who to interview, but it mainly comes down to which applicants will or could be a good fit. An excellent candidate on paper with outstanding grades and superb board scores may not be a great fit for a specific program based on personality or interests. In your case, it could be that you were "too competitive" and the program thought you'd be unlikely to actually want to match. Or it could be the overqualified aspect in addition to a whole host of other factors that made them think you weren't the right fit. It likely has no bearing on your other applications.

At the end of the day, us program directors only have a finite number of interview slots, so we are trying to maximize our chances of filling them with excellent applicants who will mesh well with our specific program.

That said, there are some things an applicant can do to put their application on a program director's radar. can draw a program director to your application for careful consideration. In addition, writing a thoughtful to the program can pay dividends in potentially securing an interview, particularly if you are waitlisted as you said you were.

I hope that answer gives you some clarity on the process from the perspective of a program director.

Are you a medical student or resident? Please comment below or email us at perspectives@medpagetoday.com with other questions you'd like to have answered by a residency program director.

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