"Applying Broadly" for Psychiatry Residency

[throwaway20425]

Hi all,

As psych is becoming more competitive, I have been advised to "apply broadly." I am not a competitive applicant and have been told that any program I have a chance at should be on my list.

Is this advice legit? It seems to me that sending my application to a random program in a region where I have no ties would be wasting money. Beyond stats, what does "have a chance at" really mean?

Of course, the other advice a low-stats applicant receives is to dual apply. I am concerned that, due to my application's clear bias toward psych, I will be an unconvincing FM/IM applicant and, in the process of dual-applying, will ultimately hurt my psych application.

I would especially appreciate thoughts from folks here involved in advising med students in psychiatry or have experience with residency recruitment. Thanks.

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[TexasPhysician]

The problem is that you have posted nothing about yourself. Your odds are thus between 0-100%. Psych has gotten more competitive, but I wouldn’t say it is more competitive than the average field out there. There are 1,000+ spots. The average US MD should match just fine.

 

[throwaway20425]

The problem is that you have posted nothing about yourself. Your odds are thus between 0-100%. Psych has gotten more competitive, but I wouldn’t say it is more competitive than the average field out there. There are 1,000+ spots. The average US MD should match just fine.

Thanks for your reply. To clarify though, I'm not asking for a "what are my chances" evaluation. (I apologize-- I recognize that that wasn't clear from my OP.)

I was hoping for more general feedback on how programs might evaluate an applicant/application that does not seem aligned with their program. For example,

• How often are programs seriously evaluating someone with no ties whatsoever to the area where the program is located?
• If you're reading an application and every part of it is related to one specialty (all extracurriculars, undergrad degree, research, electives, etc.) and not your specialty, will that application be considered further?

I guess the most specific way to ask my question is: How often are lack of ties to an area or lack of demonstrated interest in a specialty dealbreakers?

 

[Cath Up]

That has increasingly mattered in recent years as far as I have ascertained, as programs dealt with a significant increase in applicants and needed strategies to narrow things down. But obviously interest in the speciality and interest in an area are generally important.

For content, I applied a couple years ago to most programs in California as an above average applicant with no ties, but DO, and received zero Interviews. An MD applicant I know this season was more competitive than me, had no ties, was more selective, and received a few California interviews. It varies.

My impression is that some programs, possibly more often established community programs, may factor in ties to any area more strongly because they want to serve that area. Lots of nice academic places seem to just want to most qualified applicants. More recently, signaling has impacted things and I’m sure it increases chances of an interview despite no ties because programs like to be liked.

Psychiatry is still not particularly competitive as another poster pointed out- so if you have an average application you’ll do fine. It has always been a no brainer to me to “apply broadly” no matter what specialty. After four years of work you need to secure a job. At max several thousand dollars of debt to secure a desired job that will pay you millions is common sense. Yeah the cost is absurd and it’s a racket but entirely outside of our control and a waste of effort to fixate on independently. Take out credit card debt. Penny pinch. Do whatever it takes because it is very likely to be the money with the best ROI you will spend in your life.

Applying broadly in my opinion is applying to community and academic programs in and out of a desired region. It is applying to more programs than average. Applying intelligently involved many things including signaling mostly safely, personalizing applications, attempting to network and meet people, doing away rotations, expressing genuine interest, interviewing well, following up promptly, and scheduling interviews thoughtfully.

 

[psych_0]

Going to just say it. The fact that you're not asking "what are my chances" and instead timidly asking "What does apply broadly mean" suggests that you need to apply to more places than you think you should apply to unless there's something else you're not telling us. At our program this year we only interviewed applicants with either direct ties to our state (grew up here, family lives here, or they went to medical school in the area). We are NOT a desirable program at all. We're a bottom tier program....We matched all spots from our top 10 this year.

During the (virtual) interview meet n' greet with the residents the nights before interviews, several applicants mentioned that they had applied to >80-100 programs. Psych is not derm. It will never be derm. But with virtual interviews, people are applying to MANY more programs than most of us here on this forum applied to during match season way back when. As a program director it makes narrowing down applications that much more difficult. We don't have like a big or even small committee sorting through applications. It's literally just a generic filter: Step 2 score, no previous Step failures, no previous felonies/misdemeanors, and no failed classes. After that our PD (committee of 1) just hand picks applicants who have signaled our area and skims personal statements to see if they have any real ties to our state.

I hate virtual interviews with a passion. But with virtual interviews, people can just apply to as many as they want with no skin in the game. I've had medical students rotate with me and openly tell me they took interviews for the extra day off from a 4th-year rotation. Places they had no interest in at all. If you're a rockstar applicant, this is great. If you're a weak applicant, good luck. You have to kill the interview. Read some of my previous posts for how to stand out in interviews.

 

[TexasPhysician]

Thanks for your reply. To clarify though, I'm not asking for a "what are my chances" evaluation. (I apologize-- I recognize that that wasn't clear from my OP.)

I was hoping for more general feedback on how programs might evaluate an applicant/application that does not seem aligned with their program. For example,

• How often are programs seriously evaluating someone with no ties whatsoever to the area where the program is located?
• If you're reading an application and every part of it is related to one specialty (all extracurriculars, undergrad degree, research, electives, etc.) and not your specialty, will that application be considered further?

I guess the most specific way to ask my question is: How often are lack of ties to an area or lack of demonstrated interest in a specialty dealbreakers?

Top programs care 0 about ties to an area. They know people will come from wherever. Middle of the pack programs typically care the most. They know from history that they are chosen because of location most commonly which leads them to focus there. Bottom tier programs usually care little, because they are just happy to fill and maybe get a couple US MD’s.

Demonstrated interest in psych does matter, but that is because interest and people skills certainly matter in the quality of psychiatrist you become. We don’t enjoy training someone disinterested.

The average FM applicant should have diverse interests. Enjoy psych? Wonderful. Enjoy ob? Great! Your job is literally to do it all. You need no clear interest in FM in my opinion.

 

[Osminog]

If you apply to what turns out to be too few programs, the worst feasible outcome is having to SOAP—almost certainly into a specialty other than psychiatry given the extreme scarcity of psychiatry SOAP spots nowadays. If you apply to what turns out to be too many programs, the worst feasible outcome is having to decline excess interview invitations.

For someone who is seriously committed to a career in psychiatry, the difference between these two outcomes is enormous and easily worth a few thousand dollars in additional application fees.

 

[Merovinge]

If you apply to what turns out to be too few programs, the worst feasible outcome is having to SOAP—almost certainly into a specialty other than psychiatry given the extreme scarcity of psychiatry SOAP spots nowadays. If you apply to what turns out to be too many programs, the worst feasible outcome is having to decline excess interview invitations.

For someone who is seriously committed to a career in psychiatry, the difference between these two outcomes is enormous and easily worth a few thousand dollars in additional application fees.

Winning the award for most practical top level thinking about this topic.

 

[Merovinge]

I will say that I was also not a competitive applicant but got very lucky as psychiatry was considerably less competitive >10 years ago when I matched and still received interviews at very strong programs in places I had absolutely no geographic ties to. I agree with the above that good programs are used to people coming from all over. I don't think Brown asked even once, "why Rhode Island" during any of the interviews.

 

[FlowRate]

Thanks for your reply. To clarify though, I'm not asking for a "what are my chances" evaluation. (I apologize-- I recognize that that wasn't clear from my OP.)

I was hoping for more general feedback on how programs might evaluate an applicant/application that does not seem aligned with their program. For example,

• How often are programs seriously evaluating someone with no ties whatsoever to the area where the program is located?
• If you're reading an application and every part of it is related to one specialty (all extracurriculars, undergrad degree, research, electives, etc.) and not your specialty, will that application be considered further?

I guess the most specific way to ask my question is: How often are lack of ties to an area or lack of demonstrated interest in a specialty dealbreakers?

The second half of your last question should really be geared toward FM docs, not psychiatrists, since the lack of interest is in that specialty, not psychiatry. That said, I would assume that low- and mid- tier FM programs are used to being the fallback plan for many applicants. Top programs in any specialty, including FM/IM, attract applicants who look more similar to top applicants in any specialty than to the average applicant in their own, save for specific specialty interest.

 

[Stagg737]

For content, I applied a couple years ago to most programs in California as an above average applicant with no ties, but DO, and received zero Interviews. An MD applicant I know this season was more competitive than me, had no ties, was more selective, and received a few California interviews. It varies.

California is different. The state is so desirable to many that CA programs are more interested in either the top applicants or those with actual ties to the state. This is not unique to psych and that info can be found throughout SDN, common enough knowledge that it's literally the only state that completely ruled out (I was a weaker applicant with no ties).

Psychiatry is still not particularly competitive as another poster pointed out- so if you have an average application you’ll do fine.

Depends on how you look at it. Comparing the NRMP data from 2020 to 2024 it's more competitive even in the last 3-4 years. In 2020 there were 2,486 applicants for 1,858 positions (1.34 applicants/position) and in 2024 there were 3,176 applicants for 2,261 gen psych positions (1.4 applicants/position). Thought the applicants/position didn't change much, the number of unmatched US MDs almost doubled from 129 out of 1,246 applicants in 2020 to 237 out of 1,560 in 2024. Only 12 positions didn't fill this year compared to what's usually ~20 unfilled spots each year (other than 2021 when only 3 spots went unfilled). So even with adding over 400 positions, more people are left unmatched. I'll also say I was surprised with where people that matched where I work came from this year. Normally we have more DOs and one or two carib grads. This year we matched mostly US MDs and our FMG is someone who did an audition who I expected to match at a top-tier program (did other auditions at Top 10 programs, think Stanford/Yale).

Top programs care 0 about ties to an area. They know people will come from wherever. Middle of the pack programs typically care the most. They know from history that they are chosen because of location most commonly which leads them to focus there. Bottom tier programs usually care little, because they are just happy to fill and maybe get a couple US MD’s.

Generally agree with this, but I think even bottom-tier programs are able to be more picky now. There were 3,176 applicants for 2,261 positions this year. Total positions/programs has increased by ~400 but number of applicants has increased by almost 700, meaning more options and an ability for weaker programs to be a bit pickier. Where I'm at (mid-tier academic), not having geographic ties isn't a deal breaker, but having ties certainly helps.

I guess the most specific way to ask my question is: How often are lack of ties to an area or lack of demonstrated interest in a specialty dealbreakers?

The ties part has been answered. Geographic ties will never hurt. Top programs won't care unless you're also a top-tier applicant, but it may matter at other programs. Interest in psych should be a must. Where I'm at dual applying to other "safety specialties" (FM, IM, peds) won't hurt someone, and interest in IM would actually help as we have a combined IM/psych program here. However, if we know psych is a back-up (aka applying to anesthesia or derm + psych) that would not go over well and would at least move someone down the rank list.

If you competitive applicant, you should be applying broadly. I applied 7 years ago and applied to 75 programs. Pretty much everywhere that I was willing to work that I thought wasn't totally out of reach other than a small handful of programs I felt I would have been miserable at. I got 9 interviews and went to 8 (one was in AOA match). All but 1 were relatively within my geo area, but the non-geo one was very surprising and one other one surprised me. Matched my top choice, but had I not idk how far down my rank list I would have dropped and those reaches that were outside what I would have ranked if I only applied to 30-40 might have been really important. In retrospect, I'm glad I spent an extra several thousand dollars to get where I am than have not matched at all or SOAPed into another field like a lot of people I've met.

 

[comp1]

I wonder what year the OP is in med school. I hope earlier on than MS3 because the post is super frustrating in lack of detail. Every question could be answered with "it depends" and people could give very concrete advice to the OP's specific situation. I would definitely second the comment above about the amount of timidity being shown from a literal anonymous post really indicating that, for the OP in particular, the issues raised are more likely to be dealbreakers than for the average applicant.

 

[throwaway20425]

I really appreciate the perspectives and advice y'all.

I think part of my ambivalence on the issue is what I've read about the increase in the number of applications, how it's caused programs that are typically less selective to become more selective, and some suggestions that it's actually better to apply very strategically and do the most to help your app cut through the noise. But I appreciate that this is still possible while applying to lots of programs (and also what signals are for). I also understand now that even getting one additional interview at some random program might be the difference between matching psych or SOAPing and would make the extra cost of applying broadly worth it. I plan to embrace applying broadly and will send apps to all the programs I can manage to afford.

 

[throwaway20425]

I will say that I was also not a competitive applicant but got very lucky as psychiatry was considerably less competitive >10 years ago when I matched and still received interviews at very strong programs in places I had absolutely no geographic ties to. I agree with the above that good programs are used to people coming from all over. I don't think Brown asked even once, "why Rhode Island" during any of the interviews.

Depends on how you look at it. Comparing the NRMP data from 2020 to 2024 it's more competitive even in the last 3-4 years. In 2020 there were 2,486 applicants for 1,858 positions (1.34 applicants/position) and in 2024 there were 3,176 applicants for 2,261 gen psych positions (1.4 applicants/position). Thought the applicants/position didn't change much, the number of unmatched US MDs almost doubled from 129 out of 1,246 applicants in 2020 to 237 out of 1,560 in 2024. Only 12 positions didn't fill this year compared to what's usually ~20 unfilled spots each year (other than 2021 when only 3 spots went unfilled). So even with adding over 400 positions, more people are left unmatched. I'll also say I was surprised with where people that matched where I work came from this year. Normally we have more DOs and one or two carib grads. This year we matched mostly US MDs and our FMG is someone who did an audition who I expected to match at a top-tier program (did other auditions at Top 10 programs, think Stanford/Yale).

I know it's generally desirable for people already working in this field, but as a hopeful applicant, watching psychiatry become gradually more competitive has been frustrating. When I started on this path (I worked in this field before med school and matriculated with the intention of pursuing psych), in the absence of any major red flags, it really wasn't a question of *if* an applicant could match psych but where. Not the case now.

I personally know 3 solid (not amazing) applicants who weren't able to match psych this cycle. Additionally, similar to what others have described in this thread, a small community program I have strong personal ties to, which usually takes DOs and IMGs, filled with exclusively mid-tier MDs this cycle. I've fixated on all of this a bit-- the idea of not matching after all of this effort fills me with anxiety.

The other dynamic I have observed is that multiple classmates who started school gunning for ROAD specialties are now planning on applying psych. They have the stats to match ROAD but had a sweet psych rotation, saw that the lifestyle is good, and feel they can "tolerate" or "don't mind" treating mental illness, so now they're going to apply psych ¯\_(ツ)_/¯ And now they're applying to auditions at the same local community programs I am lol. I'm sure this trend is not unique to my school, and I'm curious how the stats of matched psych applicants will continue to change.

 

[throwaway20425]

The fact that you're not asking "what are my chances" and instead timidly asking "What does apply broadly mean" suggests that you need to apply to more places than you think you should apply to unless there's something else you're not telling us.

I wonder what year the OP is in med school. I hope earlier on than MS3 because the post is super frustrating in lack of detail. Every question could be answered with "it depends" and people could give very concrete advice to the OP's specific situation. I would definitely second the comment above about the amount of timidity being shown from a literal anonymous post really indicating that, for the OP in particular, the issues raised are more likely to be dealbreakers than for the average applicant.

You're both absolutely right. As I disclosed in my OP, I am not a competitive applicant. I'm a DO student with a preclinical course failure and poor GPA so I'd say I am, in fact, a below-average applicant. Hence, the advice I have received to dual apply and apply broadly.

I'm a rising 4th year DO student, finishing rotations, applying for auditions, and getting ready for COMLEX Level 2 and USMLE Step 2. I partially do not want to dox myself, but I am also aware that I'll get some tough love if I share my app here. However, I agree that concrete advice about my specific situation could be helpful. So, here it is:

Red flags: Preclinical course failure, bottom quartile
Undergrad: California mid-tier UC
School: DO school on the West Coast
Preclinicals: Graded, did poorly as mentioned previously, especially in 1st year, fair upward trend through 2nd year and into clinicals
Clinicals: My school has graded clinicals. I've gotten all As except a B+ in OBGYN and an A- in IM. My evaluations are excellent.
Level 1: Pass on first attempt, didn't take Step 1 (kicking myself for letting my school convince me to not to and am still considering doing this)
Level 2: Haven't taken Level/Step 2 yet. I do plan on both USMLE and COMLEX. I've done well on shelf exams and expect I'll get an average score on Level/Step 2.
LOR: I've gotten LORs from 2 FM, 1 IM, and 2 Psych. No auditions yet, no letters from proper academic faculty.
Research:
med school: 2 psych/addiction-related posters at national psych conferences, 2 addiction/psych-related talks/presentations (1 at a national DO conference and 1 just at a research symposium)
pre-med: 1 small pub and 1 talk related to basic sciences in psych, 2 posters and 1 talk basic sciences unrelated to psych
EC:
-Extensive, longitudinal leadership in national DO student org, especially related to advocacy and overdose prevention organizing
-involvement in national psych subspecialty org
-President of psych interest group
-volunteering with harm reduction and homeless outreach orgs
-involvement in organized medicine, advocacy, and resolution writing
-TA for a medical humanities course
-3 years working in community psych program dual-diagnosis treatment facility
Other: immediate family member with SMI, contributed to my initial desire to pursue this field (not a driving factor for several years though, in case you were worried)

Priorities (ranked high to low):
1. Match psych
2. Match at a program with good addictions and community psych exposure
3. Urban setting

I have ties to the West Coast, southwest, IL, NY, SC and NC.

I think there are parts of my application that are compelling and I know that I interview well, but I suspect that my primary problem will be getting screened out by a lot of programs for my poor GPA/class rank and having a course failure. And also not having step 1 if I end up not taking it.

**While we're at it, the reason I did so poorly in preclinicals is that I had horrible depression. I know this explanation is seen as a red flag, so I'm not sure how to frame this if/when it comes up.

 

[splik]

You're both absolutely right. As I disclosed in my OP, I am not a competitive applicant. I'm a DO student with a preclinical course failure and poor GPA so I'd say I am, in fact, a below-average applicant. Hence, the advice I have received to dual apply and apply broadly.

I'm a rising 4th year DO student, finishing rotations, applying for auditions, and getting ready for COMLEX Level 2 and USMLE Step 2. I partially do not want to dox myself, but I am also aware that I'll get some tough love if I share my app here. However, I agree that concrete advice about my specific situation could be helpful. So, here it is:

Red flags: Preclinical course failure, bottom quartile
Undergrad: California mid-tier UC
School: DO school on the West Coast
Preclinicals: Graded, did poorly as mentioned previously, especially in 1st year, fair upward trend through 2nd year and into clinicals
Clinicals: My school has graded clinicals. I've gotten all As except a B+ in OBGYN and an A- in IM. My evaluations are excellent.
Level 1: Pass on first attempt, didn't take Step 1 (kicking myself for letting my school convince me to not to and am still considering doing this)
Level 2: Haven't taken Level/Step 2 yet. I do plan on both USMLE and COMLEX. I've done well on shelf exams and expect I'll get an average score on Level/Step 2.
LOR: I've gotten LORs from 2 FM, 1 IM, and 2 Psych. No auditions yet, no letters from proper academic faculty.
Research:
med school: 2 psych/addiction-related posters at national psych conferences, 2 addiction/psych-related talks/presentations (1 at a national DO conference and 1 just at a research symposium)
pre-med: 1 small pub and 1 talk related to basic sciences in psych, 2 posters and 1 talk basic sciences unrelated to psych
EC:
-Extensive, longitudinal leadership in national DO student org, especially related to advocacy and overdose prevention organizing
-involvement in national psych subspecialty org
-President of psych interest group
-volunteering with harm reduction and homeless outreach orgs
-involvement in organized medicine, advocacy, and resolution writing
-TA for a medical humanities course
-3 years working in community psych program dual-diagnosis treatment facility
Other: immediate family member with SMI, contributed to my initial desire to pursue this field (not a driving factor for several years though, in case you were worried)

Priorities (ranked high to low):
1. Match psych
2. Match at a program with good addictions and community psych exposure
3. Urban setting

I have ties to the West Coast, southwest, IL, NY, SC and NC.

I think there are parts of my application that are compelling and I know that I interview well, but I suspect that my primary problem will be getting screened out by a lot of programs for my poor GPA/class rank and having a course failure. And also not having step 1 if I end up not taking it.

**While we're at it, the reason I did so poorly in preclinicals is that I had horrible depression. I know this explanation is seen as a red flag, so I'm not sure how to frame this if/when it comes up.

There is no benefit to doing Step 1. Just take Step 2 since it has a score. That will help if it is good.
Nobody care about your preclinical grades. honestly, i used to skip that section of the apps. you might be dinged for the course failure.
You want to get some good LoRS from some away rotations. Letters from people who are not part of a residency program are much less helpful. Try to do the aways at places that you have a potential to match at (i.e. they have DO students, ideally from your school).

 

[throwaway20425]

There is no benefit to doing Step 1. Just take Step 2 since it has a score. That will help if it is good.
Nobody care about your preclinical grades. honestly, i used to skip that section of the apps. you might be dinged for the course failure.
You want to get some good LoRS from some away rotations. Letters from people who are not part of a residency program are much less helpful. Try to do the aways at places that you have a potential to match at (i.e. they have DO students, ideally from your school).

The great Splik has spoken! Thanks for your reply. When I initially talked about not taking step 1, people advised against it, saying that not having step 1 was just another screen that a program could use to toss aside my application. So the advice, like applying broadly, was to give myself an additional chance not to be screened out, which might result in a couple more programs reviewing my app.

Or do you think there's not much overlap in the Venn diagram of programs that screen for step 1 and programs that would take a low-stats DO applicant lol