Wtf?!

[scrambled]

I didn't match, and I'm still reeling. Just trying to sort myself out before the scramble tomorrow. Can anyone tell me wtf happened here?

Step 1: 230+
Step 2: 240+

First two years: all passes
Third year: Honors in Surgery, Medicine, Psych, HP in everything else
Fourth year: Honors in 4 surgery electives/sub-i's
Class rank: 20-40%ile (edit: should be top 20-40%)

32 applied, 16 interviews, 13 ranked.

Interviews seemed to go pretty well. I got very positive letters back from several programs. And yet...this?!

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[Pollicis]

Wow that's terrible. Sorry to hear that. Are you an IMG? Did you rank some middle of the road programs as a backup?

 

[scrambled]

US grad, mostly academic programs, but a mix of upper, middle, and lower tier ones.

 

[dr.evil]

I can only assume they were worried about your grades and being in the bottom half of the class. That being said, I know several residents who were at the bottom half with much lower Step 1 & 2 scores who matched.

The other questions is how your interviews went. Do you think you came off arrogant or not passionate about surgery? Also, were the 13 programs you ranked top tier academics?

Sometimes, it's just a crapshoot.

Wishing you the best tomorrow with the scramble.

 

[scrambled]

hah, messed up my class rank, that's how frazzled I am. I'm in the top 20-40% of my class, not %ile.

 

[Winged Scapula]

Its hard to know...

the fact that you had a 50% offer rate (ie, 32 applications, 16 interview offers) suggests that there is something in your file that turned people off. Perhaps one or more of your letters is less than glowing, your PS, etc. or perhaps you "overreached" and assumed that because of your USMLE scores you were more competitive than you really were.

Still, its hard news to swallow especially if you don't have something to hang your hat on; I wish you the best of luck tomorrow.

 

[scrambled]

Actually, my interview rate was a little bit higher. I had to turn down several due to scheduling issues.

 

[TaiShan]

did you certify your list?

hard to believe it could happen.

 

[scrambled]

Hahahaha, yes, I did certify my list. Double-checked it, triple-checked it (I'm in med school, I have to be OCD ). Checked my email a million times today to make sure I didn't misread the email or get a follow-up one saying "oops, we sent you the wrong message". I'm still unmatched.

 

[TXSurgResident]

I am also scratching my head...

Talk to PD@ home program pronto- if there is something in your file that's off or incorrect, it may help 'splain what happened and they may be able to help somehow.

Best of luck

 

[tussy]

sorry to hear it - sometimes the computer algorithm and some bad luck combine to make a good candidate go unmatched.

Definitely talk to your home program; there could be a bad letter or mistake in your file (a few years ago i heard about 2 students with a similar name, one a superstar and one very very average and their letters got mixed up somehow). Ask the PD for some advice when you scramble and hopefully you'll get some useful feedback.

It;s probbaly just some bad luck but sucks none the less. Good luck with the scramble.

 

[Blade28]

Agree with Winged Scapula - everything about your app looks great, at least on paper.

But I agree that your interview offer rate was much lower than expected. Were you able to see any of your LORs, or your Dean's Letter?

Either way, best of luck in the Scramble.

 

[TaiShan]

I think one of LORs killed your app. You may have an opptunity to find out today though. Sometimes the secretaries are so busy during scrambling and they would give you all your files, which include LORs, to DIY. One of my medical school classmates painfully discovered, on the scrambling day, that some certain attending really did not like her that much.

 

[Blade28]

I think it's terrible when you ask attendings to write you letters - especially if you ask "Will you be able to write me a strong letter?" - and despite their assurances, they churn out something lukewarm, at best.

 

[SocialistMD]

Your grades (not sure why you did 4 surgical rotations as a fourth year) and USMLE make you competitive nearly everywhere in the country. If you didn't get interview offers at the top of the top programs where they only interview AOAs, that is understandable. However, if you got interviews at all other places, then it isn't likely there was anything in your application that hurt you any more than your personality/behavior at the interviews. Sometimes it just takes one statement, even meant as a joke, to do you in. Sometimes it is just being awkward socially that will hurt you at a program. General surgery is becoming increasingly more competitive and programs can become more and more selective as to who they rank. If you do anything to show them you aren't exactly what they want, you are out.

Sorry to hear about your current situation. Best of luck in the scramble. Don't get too down, though; there are plenty of people who have done it (including some on this forum) and have come out ahead in the end.

 

[scrambled]

By 12:18pm, I had scrambled into a pre-lim spot at the program I ranked second.

 

[Samoa]

That's great! You never know when a spot will open up at a program. One of the categorical residents at my program decided to switch fields about two or three months into intern year. I'm not exactly sure what happened to his spot, as there's been a lot of resident position shuffling here this year, and I'm not looking to get a spot in general surgery so I'm not keeping close tabs on it. But if that had been my goal, the opportunity was there to put in the hard work and have it pay off.

 

[balaguru]

Agree with Winged Scapula - everything about your app looks great, at least on paper.

But I agree that your interview offer rate was much lower than expected. Were you able to see any of your LORs, or your Dean's Letter?
...

Is it really that low? I know of someone with a 243 step, 2nd quartile and great LOR's who received 11 invites from 40 applications.

 

[Winged Scapula]

Is it really that low? I know of someone with a 243 step, 2nd quartile and great LOR's who received 11 invites from 40 applications.

Depends on where you apply to. If you overapply and apply to lots of programs where you aren't competitive, a 50% interview rate isn't low; OTOH if you underapply, its probably low.

On paper this applicant looks good, so its hard to say why he didn't get more interviews (althouhg it sounds like he had more interviews but just couldn't make them) or why he/she didn't match. I'm glad to hear he has something to start with on July 1. Hopefully something will open up for him next year.

 

[scrambled]

I actually don't think it was the LORs. Our deans look over our letters and tell us which ones to use.

Out of the four I used:

1. I've seen it, there was nothing even potentially negative,

2 & 3. I received compliments on the quality of both at multiple interviews,

4. From an attending I worked closely with, who gave me honors in his elective, and who is well known at my school for writing very positive letters.


Looking back at where I applied, perhaps the mix of programs wasn't good enough? I may not have had as many mid-/lower-tier programs as I remember. I was also doing a bicoastal app, I wonder if that played into it at all.

 

[SocialistMD]

I was also doing a bicoastal app, I wonder if that played into it at all.

I'm sure it did. Many of the very strong applicants (260+ Step 1, AOA) we had this year gave me the feeling that they were just using our midwestern program as a stopover between coasts. Unless they were from the midwest, they were all looking to either end up in California or on the east coast. If you were looking to go to a coast, they were your competition.

Glad you got a good prelim spot. You may find it ends up being a permanent spot next year, as there are always people who find surgery isn't what they thought it would be.

 

[jubb]

This isn't accusatory, just the thoughts on a why a person with a good application wouldn't match.

1)Technical error on match entry. Did you check on your application that you would be participating in the match? Did you make sure you entered categorical positions instead of prelims?

2) Did you apply to a lot of programs that had a low number of positions?

3) Did all the programs get the impression you would be seriously considering them for the top of your rank list and that they weren't a safety residency? IE... Did you send in thank you letters? Were you genuinely interested in the programs? When you talked about what you want in a residency did you tailor it to focus on the strengths of their program and to match up with what they had to offer? Did your personal statement box you in to a certain kind of residency (purely academic/purely community, only high powered places)

4) How did the interviews consistently go? Did you botch interviews or interactions with residents/faculty? Did you overly kiss up at every interview? Were you unrealistically enthusiastic or cheezy about your love of surgery? Were you overly confident/cocky?

I'm really sorry to hear that you didn't match and wish you the best of luck with getting back on track.

Justin

Justin

 

[goooooober]

You have to be very careful on interviews. It is often the small things that will cause your downfall, not the big ones. We had a guy who was a superstar on paper with board scores nearing 260 . However, the guy did not smile enough during pre-interview dinner and came accross as too serious . He was ruled out as a candidate . I was shocked to say the least because everyone told me during my interviews, the pre-interview dinner is chill and fun . You can be yourself. For future candidates, be very careful, you are being watched . Good luck to all.

 

[Winged Scapula]

It may very well be the wide geographic distribution as well as well as the overall competitivenes of the programs you applied to that did you in, OP.

As our own Rank Order List thread shows here, most applicants tend to stay in one region of the country for their residency apps. Programs like to know you are interested in them AND the area of the country they are located in. If it looks like you don't care where you go (at least geographically), it *might* make programs less likely to think you are really interested in them. Some programs that would be considered competitive because of their location wouldn't necessarily be as popular in Peoria.

Programs on both coasts tend to be more competitive as well because they are geographically desirable for lots of applicants. You could also be a victim of "regression toward the mean". That is, lower tier programs thought you were too competitive for them and wouldn't rank them, so didn't rank you and upper tier programs had lots of other stellar applicants, so you fell in the rankings...meaning that more mid level programs might have made the difference.

 

[Blade28]

I was shocked to say the least because everyone told me during my interviews, the pre-interview dinner is chill and fun . You can be yourself.

Yes, be yourself. But be on your best behavior.

It's a big mistake if you think you aren't being judged, albeit surreptitiously, during these pre-interview dinners/receptions.

 

[Pollicis]

It may very well be the wide geographic distribution

Not quite sure what is meant by this. How would the program know you applied widely unless you told them? And if you told them...WHY would you do that to yourself?? Just curious.

Anyways, back to the OP, congrats on getting that prelim. I know its not the way you expected things would work out, but its a good start and hopefully it will set things in motion for next year. Best of luck.

 

[Blade28]

Is it really that low? I know of someone with a 243 step, 2nd quartile and great LOR's who received 11 invites from 40 applications.

Depends on which programs you applied to, but if you applied to a fairly wide variety? Yeah, I'd say that's a low invite rate.

 

[Winged Scapula]

Not quite sure what is meant by this. How would the program know you applied widely unless you told them?

Faculty talk.

And if you told them...WHY would you do that to yourself?? Just curious.

Because they ask during interviews and it would seem awkward not to answer and possibly troublesome if you lied and they found out. This is usually how programs find out, but you're right - they wouldn't generally know unless they asked.

 

[MacGyver]

Faculty talk.

1) If they are discussing specific applicants, that should be a match violation and their program should be punished harshly for such anti-competitive behavior.

2) I dont think that happens very frequently at all. I can imagine it coming up in conversation if 2 PDs worked with the same applicant, but thats about the only context I can imagine this happening. For example, 2 PDs could be at a conference and one of them says "I had this absolutely fabulous med student scrub in with me whose surgical skills were better than my 3rd year residents!" and then the other guy says "yeah I worked with a guy like that once, whats his name?"

I seriously doubt PD #1 calls PD #2 and says "hey here's my list of applicants, what does yours look like?" Aside from being patently unethical douchebaggery, these guys are too busy to be playing those games.

Because they ask during interviews and it would seem awkward not to answer and possibly troublesome if you lied and they found out. This is usually how programs find out, but you're right - they wouldn't generally know unless they asked.

1) I was never asked this question, but if I was I would give a partial response. For example if I was applying to UCLA, I'd tell them about the other California programs I applied to, but wouldnt mention midwest or east coast programs at all. Like I said, there's almost zero probability they are going to find out otherwise. Even after match, they wont know which programs I applied to, they will just know that I didnt rank their program #1.

 

[Putrescine]

Hmmm. I have heard about programs looking upon you less favorably if you try to interview far from your home territory. Even more so for me since I had to convince my interviewers that I was absolutely going to leave Los Angeles, CA for the east coast / midwest. I am also a Southern California native.

I was up front about my wide application in the interview, and I also was upfront about the fact that my fiancee would have extreme difficulty being able to work in the state of CA. She lives in AZ right now. I applied to programs where I had large concentrations of her family or my family (Virginia / North Carolina and Michigan / Minnesota areas) and I also mentioned that in the interview.

I found out I matched, but in the end I did stupidly end up attending one California interview - ranking it dead last, and ranking it because I was afraid of not matching - so there's always that chance.

 

[SocialistMD]

I seriously doubt PD #1 calls PD #2 and says "hey here's my list of applicants, what does yours look like?" Aside from being patently unethical douchebaggery, these guys are too busy to be playing those games.

No, but they will call your home program director/chairman/anyone at your program they know and ask if you really are as good as your letters say you are. It isn't a match violation, and they are never too busy to ensure that they match residents who (a) will stay and (b) they won't have to fire. That is a chief interest of every program director.

I was never asked this question, but if I was I would give a partial response. For example if I was applying to UCLA, I'd tell them about the other California programs I applied to, but wouldnt mention midwest or east coast programs at all. Like I said, there's almost zero probability they are going to find out otherwise.

Again, you are giving your co-applicants too much credit. Residents and faculty see your interactions with the other applicants and eavesdrop on your conversations. If so and so says (to you) "haven't seen you since UVa," I now know you interviewed at UVa. I don't make it a habit of asking where other people have interviewed, but many offer that information and others mention it as an aside (i.e. "when I was in NY last week for an interview...") to the point that I can usually tell if people are geographical interviewers or scattershot interviewers. I am especially sensitive to those who are mostly interviewing on the coasts, with a pitstop in the midwest, because I know they most likely don't really want to come here because their priority is location.

 

[Winged Scapula]

1) If they are discussing specific applicants, that should be a match violation and their program should be punished harshly for such anti-competitive behavior.

2) I dont think that happens very frequently at all. I can imagine it coming up in conversation if 2 PDs worked with the same applicant, but thats about the only context I can imagine this happening. For example, 2 PDs could be at a conference and one of them says "I had this absolutely fabulous med student scrub in with me whose surgical skills were better than my 3rd year residents!" and then the other guy says "yeah I worked with a guy like that once, whats his name?"

I seriously doubt PD #1 calls PD #2 and says "hey here's my list of applicants, what does yours look like?" Aside from being patently unethical douchebaggery, these guys are too busy to be playing those games.

Once again, you've taken a molehill comment and made a mountain out of it. I never said PDs are calling each other up and comparing lists. Of course, they don't do that. But do they talk in abstract about candidates? Sure. Do specific candidates names come up sometimes? Do they call about specific candidates? Sure.

I am very familiar with faculty members calling friends who are faculty at program X where a candidate hails from and getting more information about then that cannot be gleaned from the application. Such as, "do they really want to come to this part of the country?" or "are they applying to their home program and if so, are you guys recruiting them?"

It is not a match violation but if it upsets you, please contact NRMP and every other employer in the country. This is no different than your boss at McDonalds being contacted by the Manager of Taco Bell when you apply for a job there.

 

[Winged Scapula]

Again, you are giving your co-applicants too much credit. Residents and faculty see your interactions with the other applicants and eavesdrop on your conversations. If so and so says (to you) "haven't seen you since UVa," I now know you interviewed at UVa. I don't make it a habit of asking where other people have interviewed, but many offer that information and others mention it as an aside (i.e. "when I was in NY last week for an interview...") to the point that I can usually tell if people are geographical interviewers or scattershot interviewers. I am especially sensitive to those who are mostly interviewing on the coasts, with a pitstop in the midwest, because I know they most likely don't really want to come here because their priority is location.

Absolutely agree.

Applicants divulge a lot of information without even knowing it and I pay attention to those details. Not because I'm looking for some nefarious details but because I am detail oriented and remember those comments.

So if you tell me about the snow at the airport last week and you are interviewing in the SW or West, I know you are interviewing some where else out of region. If you and candidate X from NYC know each other, I'll assume you are interviewing at some of the same programs, etc. Its all a matter of paying attention to what people say and if one is concerned about whether a candidate is using my program as a "safety" or it appears to be out of the geographically desirable area for that candidate, I'll ask about it. As Socialist says, programs in the "fly over" states have to be especially concerned about this because it is common that the coasters want to stay on the coast.

 

[Samoa]

No doubt this is exactly what goes on, but is it really fair to knock an applicant off your list based on a generalization that may or may not be true of that particular applicant, when they did spend the time and money to come and see your program? Frankly, I think it's condescending and disrespectful of both the applicant and the match process.

When I was applying, I looked at programs closely before I even put them on my application list. And yes, judging by geography my list looked very scattershot. Superficially, it looked heavily weighted towards coastal programs. But the real common thread was actually the research opportunities, with volume, variety, faculty and location as secondary factors. There were specific reasons for each program on my list. They weren't always the same, because sometimes an advantage in one area would outweigh a deficiency in another. But I was looking for a program, not a location. I would be really pissed off if any program assumed that I wouldn't want to go there simply because I was interviewing on both coasts, and it wasn't on one.

The whole point of the match is for both parties to get what they want, or at least would accept. So if either party starts playing head games to try and guess what the other party really wants, in order to artificially match higher on their own list, it defeats the whole purpose of the match. If the applicant has ranked your program, that means they'd be willing to match there. Flyover country or not. You do your program a disservice by eliminating good candidates based on "facts" not in evidence.

 

[balaguru]

Yes, but a program might get 800 apps and have resources to only offer 100 interviews. They must have some way of judging beforehand how likely a particular applicant is of ranking them. Location is fair since it tends to be pretty important to most applicants. Perhaps the few applicants to whom this is not important should devote a part of their personal statement/CV/interview to getting this across.

No doubt this is exactly what goes on, but is it really fair to knock an applicant off your list based on a generalization that may or may not be true of that particular applicant, when they did spend the time and money to come and see your program? Frankly, I think it's condescending and disrespectful of both the applicant and the match process.

When I was applying, I looked at programs closely before I even put them on my application list. And yes, judging by geography my list looked very scattershot. Superficially, it looked heavily weighted towards coastal programs. But the real common thread was actually the research opportunities, with volume, variety, faculty and location as secondary factors. There were specific reasons for each program on my list. They weren't always the same, because sometimes an advantage in one area would outweigh a deficiency in another. But I was looking for a program, not a location. I would be really pissed off if any program assumed that I wouldn't want to go there simply because I was interviewing on both coasts, and it wasn't on one.

The whole point of the match is for both parties to get what they want, or at least would accept. So if either party starts playing head games to try and guess what the other party really wants, in order to artificially match higher on their own list, it defeats the whole purpose of the match. If the applicant has ranked your program, that means they'd be willing to match there. Flyover country or not. You do your program a disservice by eliminating good candidates based on "facts" not in evidence.

 

[Samoa]

You're missing the point. At the interview selection stage, information on where else the applicant is applying is not available to the program.

My post refers to the situation where someone has been interviewed, and is not being ranked because they're interviewing without a regional preference.

 

[SocialistMD]

No doubt this is exactly what goes on, but is it really fair to knock an applicant off your list based on a generalization that may or may not be true of that particular applicant, when they did spend the time and money to come and see your program? Frankly, I think it's condescending and disrespectful of both the applicant and the match process.

Our intern classes for the last three years have gone to the following schools:
Washington University
St. Louis University
University of Chicago
University of Cincinnatti
University of Louisville
Ohio State University
University of Pittsburgh
University of Texas
University of Virginia
University of Miami
Cornell
Columbia
University of California-San Fransisco
University of Washington

I guess my point is that we don't eliminate people simply because they appear to want to go to the coasts, but those people who did come here from the coasts made sure to express interest and illustrated why they wanted to come to our program. There is a lot of pride that goes into match lists (think about how many times you heard on the interview trail "we only went down to 13 on our rank list..."), and programs don't like to rank people highly when they feel that won't be reciprocated. Programs in the midwest are often burned by people from the coasts who are very good applicants and seem very interested, but end up ranking them very low because of location. Personally, I think it is nice, because we end up with residents who are coming here for our program and not our city, which generally translates into hard-working and happy residents.

As an aside, it is interesting to compare the above list with the intern classes before that (and before the 80-hour work week). This is the list of chiefs from my intern year to now:
Wash U
MCW
U Chicago
Harvard
USC
Colorado
Johns Hopkins
UNC
Duke
Florida
Virginia
Brown
UC-SD

We still interview people each year from those programs, but they don't end up coming here anymore, even though we haven't stopped ranking them. I find that very telling.

 

[Winged Scapula]

You're missing the point. At the interview selection stage, information on where else the applicant is applying is not available to the program.

My post refers to the situation where someone has been interviewed, and is not being ranked because they're interviewing without a regional preference.

Fair enough. But if I'm interviewing 120 people for 4 positions, I need as much information about the candidate as possible to make my rank list. And sometimes the differences between ranks come from such information as to the likelihood that the person will actually want to be at my program. So I am trying to base it on facts, not hearsay and if I realize the candidate is from out of the region, I'll ask what drew them to my program.

This is not to say that I wouldn't rank someone from out of region, far from it, but I do need to hear the applicants reason for applying to a wide range of programs or far from home. I think that's fair. You can get upset all you want but the truth is that programs do this and do it frequently.

 

[balaguru]

You're missing the point. At the interview selection stage, information on where else the applicant is applying is not available to the program.

But your address is. Presumably inferences are made from that when deciding who to interview.

My post refers to the situation where someone has been interviewed, and is not being ranked because they're interviewing without a regional preference.

That's why I was suggesting that if it's truly not important being direct and bringing it up during the interview even if it's not asked about. This is maybe a bit weak but perhaps programs want to avoid matching someone who in the end might be unhappy.

 

[Samoa]

What we're discussing on this thread is programs who've already interviewed a candidate and then make some assumption about them having a geographic preference, based on where else they're interviewing. I.e. why someone who got a decent number of interviews, looks good on paper and isn't a tool in person, wouldn't match.

Regarding making the point that you're interested in the program despite its not being on a coast, it shouldn't be necessary to bring that up in the interview. The fact that you spent time and money to be there should speak for itself.

 

[scrambled]

About the bicoastal part. My school is on the east coast, I grew up on the east coast, but my family moved to the west coast during med school. I did emphasize (or thought I did) my connection at each interview, whether it was the fact that I grew up near that city, my family was nearby now, or I went to school at some point in that city.

And as far as interviews, again, I thought they went really well. I heard positive comments as I was leaving the room in some cases, and in others, I caught a glimpse of positive notes that the interviewers made.

The only explanations that seem to apply are that perhaps programs made assumptions about my desire to move (I was asked at almost every interview where else I was applying, often specifically about the opposite coast).

I've been doubting that being a minority woman hurt me (especially since it was mentioned as a strength at a couple of places). But comments from people at my school are now making me wonder.

Sigh. The worst part is not knowing why. I just want to know if it's something I did, and if so what that was. I don't want to be in the same position next year.

 

[pagemmapants]

All this talk about programs being sensitive to geographical ties is pretty disconcerting for someone like me.

What do you say to someone who was raised in the Northwest, went to college in California, then med school in NC?

Am I f'ed everywhere? If so, that's hardly fair at all.

 

[DJ KT]

Scrambled,

I'm sorry you had to deal with this when this is the time to celebrate 4 years of hard work. But that's great that you got a prelim spot at your number 2 choice. I know many people who did a great job as a prelim intern and ended up getting an offer for a categorical spot there. So work hard and show them what a mistake they've made not ranking you higher.

Also, just wondering, when you heard positive feedback from the schools, did you reciprocate your interest in them? It may be possible that some schools didn't think you were that interested?

Anyway, good luck! Congratulations on becoming a doctor!

 

[balaguru]

What we're discussing on this thread is programs who've already interviewed a candidate and then make some assumption about them having a geographic preference, based on where else they're interviewing. I.e. why someone who got a decent number of interviews, looks good on paper and isn't a tool in person, wouldn't match...

The thread has drifted across several topics, but if you want to keep hammering it then knock yourself out.

Congrats, to the OP.

 

[SocialistMD]

...it shouldn't be necessary to bring that up in the interview. The fact that you spent time and money to be there should speak for itself.

You're telling me you didn't have any safety net programs where you went to the interview to ensure you would have a match?

You're telling me you loved every program after your interviews and were interested in all of them?

I think it is very necessary to express interest in programs if you are interested, be it during the interview or after. There are people who have an interview on the east coast one week and the west coast on the next who stop over in the midwest because the cheapest flight on Travelocity demands it and because the hotels are cheaper there than they are on either coast.

I've been doubting that being a minority woman hurt me (especially since it was mentioned as a strength at a couple of places).

There was one girl who made a comment in an interview here who completely shut herself out of our program. Personally, I don't even think she was being serious, but thought she was smart and would test how honest the interviewer was about the program and it backfired. A word to the wise; don't ask an interviewer if coming to his/her residency program will interfere with your competitive dancing schedule...

 

[Pilot Doc]

Is it really fair to knock an applicant off your list based on a generalization that may or may not be true of that particular applicant, when they did spend the time and money to come and see your program? Frankly, I think it's condescending and disrespectful of both the applicant and the match process.

That's pretty naive.

Programs don't prioritize fairness beyond what's necessary to maintain their reputation. As mentioned above, they're looking to fill with applicants who won't quit and won't be fired. If throwing some babies out with the bathwater improve the chances of success, programs are wise to do just that.

 

[Winged Scapula]

The fact that you spent time and money to be there should speak for itself.

As others have noted, that just isn't the case.

There are very few programs, perhaps Harvard, Hopkins, Duke, etc. that can rely on the fact that almost everyone who applies is really interested in them (whether they still are after the interview is another issue for discussion). The fact is that there are simply too many residency programs around the country for applicants to have anything more than a passing knowledge of them...perhaps you applied because you like the city in which its located, or because they have a fellowship in something you're interested in. Most applicants have no idea why they apply to very many programs and for the vast majority of middle tier programs this is the case. For the lower tier programs, applicants may simply apply out of fear of not matching, a "safety" if you will.

It would be naive to think that everyone that applied to my program was so interested that they would rank it highly and be a good stable resident. People leave residencies for all sorts of reasons; I can control some of the internal ones, but I can't do much about someone coming to a program that isn't really where they want to be. So if knowing that most of your applications are a distance away from my location, it might behoove me to investigate that further as an unhappy resident is a resident who is likely to quit and people are often unhappy in new surroundings without family or friends.