Mastering Geographic Flexibility: A Guide for MD Graduates in Boston

Understanding Geographic Flexibility as a Boston MD Graduate

For an MD graduate in Boston, geographic flexibility is one of the most powerful—but often underused—levers in the residency match. You are training in one of the most competitive medical markets in the world, surrounded by major academic powerhouses and highly desirable Boston residency programs. That environment offers great advantages but also creates a “location bubble” that can quietly narrow your perspective.

Geographic flexibility is your willingness and ability to train in a wide range of locations—not just Boston, not just New England, and not just major coastal cities. For an MD graduate residency candidate, it means strategically aligning:

• Where you realistically can train
• Where you would genuinely be happy training
• Where you are most likely to match, given your profile

When used thoughtfully, geographic flexibility can:

• Significantly increase your odds of matching
• Open doors to stronger training than you’d find if you limit yourself to one city
• Position you better for fellowships—including a return to Boston or Massachusetts residency later
• Reduce the stress of the allopathic medical school match process

This article will walk you through how to think about geographic preference, how to balance your love for Boston with a realistic location flexibility match strategy, and how to communicate your choices effectively in your application and rank list.

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Why Geographic Flexibility Matters So Much in Boston

Boston is one of the most saturated and competitive markets in U.S. medical education. As an MD graduate in Boston, you are competing against:

• Local students (multiple MD and DO schools)
• National and international applicants drawn to major academic centers
• Residents and fellows who often stay in the region for additional training

At the same time, the number of Boston residency programs and Massachusetts residency positions—especially in prestigious specialties—is limited relative to the applicant pool.

The Boston Training “Gravity”

Being in Boston, it’s easy to focus almost exclusively on:

• Harvard-affiliated programs
• Other major academic hospitals in the city (and immediate suburbs)
• A narrow definition of what counts as “good training”

But the allopathic medical school match is fundamentally a numbers game: each program has a fixed number of positions; each applicant submits a finite number of applications and ranks. If you constrain yourself too tightly to Boston or even just Massachusetts, you:

• Compete for seats that thousands of high-achieving candidates are targeting
• Accept much greater match risk than your profile might justify
• Potentially overlook excellent programs in other regions that fit your goals and personality better

How Geographic Flexibility Directly Affects Match Probability

Several NRMP and specialty data trends reinforce the value of location flexibility:

• Applicants who apply only to one city or state are consistently at higher risk of going unmatched, especially in competitive specialties.
• MD graduate residency candidates who embrace a broader geographic footprint—multiple regions and settings—tend to have more interviews and safer match outcomes.
• Programs in less saturated regions often welcome strong candidates from Boston because they know you’ve trained in a demanding academic environment.

In practical terms: a Boston MD graduate who is open to, say, the Midwest, Southeast, and Mid-Atlantic, in addition to New England, almost always has a more robust interview season than someone limiting their applications to Massachusetts and perhaps one adjacent state.

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Clarifying Your Geographic Priorities Before ERAS

Geographic flexibility doesn’t mean, “I’ll go literally anywhere and I don’t care where I live.” Instead, it means knowing your real constraints and then expanding thoughtfully beyond your first-choice city.

Before you create your program list, sit down and answer these questions honestly.

1. What Are Your Non-Negotiables?

These are factors that, if absent, would severely undermine your wellbeing or your ability to function in residency. Examples:

• A partner whose job is limited to certain cities
• A legal or immigration constraint (e.g., visa sponsorship, state licensing nuances)
• Essential medical care needs (for you or a close family member) that require a regional center
• Obligations to dependents or caregivers

Document these clearly. If “Must stay in Massachusetts” is truly a non-negotiable—for example, because of a spouse’s job or a child’s medical needs—then your strategy will focus on:

• Applying broadly within Massachusetts and neighboring states
• Considering a wide range of program types (community, academic, hybrid)
• Being more flexible on specialty tier or program prestige

However, many Boston trainees label “Boston or nothing” as “non-negotiable” when it’s actually a strong preference, not a true constraint. That distinction matters.

2. Where Would You Like to Be?

Next, outline your preferences—places or regions that would enhance your life but are not life-or-death constraints:

• Proximity to Boston or New England (e.g., New York, Philadelphia, Providence)
• Desire for coastal cities vs. midwestern or southern metros
• Access to certain hobbies (outdoor activities, arts, cultural communities)
• Climate preferences

These are important but should not override your entire match strategy. Think of them as weights, not walls.

3. What Are Your Professional Goals?

Geographic preference residency choices are tied tightly to your career plans:

• If you aim for a highly competitive fellowship (e.g., cardiology, GI, heme/onc), strong academic training anywhere might matter more than staying in Boston specifically.
• If you plan to practice long-term in Massachusetts or the Northeast, a broader New England or East Coast residency could still align with that plan.
• Some specialties and fellowships heavily value strong letters and research from major centers—many of which exist outside Boston.

Ask:
“Is training at a top-tier academic center in another region more beneficial long-term than training at a mid-tier program in Boston?”
For many, the answer is yes.

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Building a Smart Geographic Strategy: Beyond “Boston or Bust”

Once your constraints and preferences are clear, you can design a regional preference strategy that preserves your goals while protecting you from an unnecessary unmatched outcome.

Step 1: Define Your Geographic “Tiers”

Create 3–4 tiers of locations based on your preferences:

• Tier 1: Ideal

  • Example: Greater Boston, broader Massachusetts residency programs, and nearby New England (Providence, Hartford, parts of New Hampshire or Maine)

• Tier 2: Highly Acceptable

  • Example: Major East Coast cities (NYC, Philadelphia, Baltimore, DC), larger Mid-Atlantic and Northeast metros

• Tier 3: Open but Less Preferred

  • Example: Midwest academic centers, select programs in the Southeast or South with strong reputations

• Tier 4: Would Go Only for Extreme Safety

  • Example: Small, very remote locations or regions you don’t plan to stay in long-term but would still be able to tolerate for 3–5 years

Avoid having only Tier 1. A realistic list for a Boston MD graduate residency candidate usually includes at least Tiers 1–3.

Step 2: Align Program Types with Regions

Different regions often have different program ecosystems. To maximize your match chances:

• In Boston and Massachusetts residency markets:

  • Apply broadly to both academic and community programs.
  • Recognize that even community programs here can be highly competitive due to location.

• In other Northeast and Mid-Atlantic cities:

  • Include a mix of big-name academic centers and solid community or hybrid programs.

• In the Midwest, South, and West:

  • You may have relatively easier access to strong academic programs that welcome Boston-trained MD graduates.

The key is to avoid building a list where every program is highly competitive and in a highly desirable city. Geographic flexibility allows you to balance prestige, competitiveness, and location.

Step 3: Use Data to Calibrate Risk

Look at specialty-specific NRMP data to refine your geographic flexibility match plan:

• Number of programs vs. positions in each region
• Historical fill rates—some regions fill overwhelmingly with U.S. MDs; others are more balanced
• Competitiveness of your specialty (e.g., derm vs. IM vs. FM vs. psych)

If your metrics (Step scores where applicable, clerkship grades, AOA, research, etc.) are below or near-average for your specialty:

• Lean more heavily on Tier 2 and Tier 3 regions.
• Consider applying to more programs in less saturated markets.

If your metrics are above-average:

• You still shouldn’t go “Boston only,” but you may not need as many programs from your least-preferred tiers.

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How to Communicate Geographic Preferences in Your Application

Your ERAS application, personal statement, and interviews are opportunities to signal both authentic interest in certain regions and reasonable geographic flexibility.

1. ERAS Geographic Preferences Section

ERAS now allows you to indicate geographic preferences (regions and urban/suburban/rural settings). Use this thoughtfully:

• If you strongly value staying near Boston, you can indicate a preference for the Northeast.
• But if you truly are open to a broader set of regions, say so—list multiple regions.

Avoid the trap of signaling “Northeast only” unless that is absolutely aligned with your actual application spread. Programs can see if your stated preference doesn’t match your behavior (e.g., you apply broadly to the Midwest despite claiming only Northeast interest).

2. Personal Statement and Supplemental Essays

Use your written materials to:

• Explain any genuine ties to a region (family, prior schooling, research year, significant relationships).
• Describe your openness to exploring new regions, especially if you don’t have many formal ties.

For example, a Boston MD graduate might write:

“While I have greatly valued my training in Boston, I am excited by the opportunity to train in a new region where I can both contribute to and learn from a different patient population and health system. My primary goal is to join a program that values mentorship, strong clinical training, and a collaborative culture, whether in New England or beyond.”

This signals that you’re not unnecessarily limiting yourself to Boston residency programs while still acknowledging your current context.

3. Program-Specific Communications (PS Statements, Emails)

When programs allow program-specific statements or supplemental questions, tailor your responses:

• Emphasize specific reasons for your interest in that city or region.
• If you’re applying far from Boston, briefly address why geographic distance is acceptable:
  • Interest in the patient population
  • Desire to experience a different health system
  • Long-term ties or interest in eventually practicing in that region

Avoid generic lines like “I am willing to go anywhere” unless you back it up with evidence (e.g., your program list and interviews truly span the country).

4. Interview Day Conversations

During interviews, you may be asked about your location flexibility:

• Be honest but balanced:
  • “I have enjoyed living in Boston, but I am very open to training in other regions if the program is a good fit. Ultimately, training quality and mentorship matter most to me.”
• If a program is in your Tier 2 or Tier 3, speak positively and specifically about the city or region (research beforehand).

Programs want to know:
“If we rank you highly, will you rank us seriously, or are we just a backup to Boston?”
Your answers should reassure them that you see their location as a genuine option.

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Strategic Examples for Boston MD Graduates in Different Scenarios

To make these concepts concrete, consider a few common profiles of Boston MD graduates and how each might approach geographic flexibility.

Scenario 1: Strong Applicant in a Moderately Competitive Specialty (e.g., Internal Medicine)

• Boston MD graduate, above-average scores and grades, some research, good letters.
• Wants academic internal medicine, long-term goal of cardiology or heme/onc fellowship, ideally back in Boston.

Smart geographic strategy:

• Apply to a range of Boston residency programs, including both top-tier and mid-tier institutions.
• Expand to Northeast and Mid-Atlantic academic centers (NYC, Philly, Baltimore, DC).
• Include a handful of strong Midwest university programs with excellent fellowship outcomes.

Why this works:

• Maintains a solid chance to remain in or near Boston.
• Protects against the risk of clustering only in ultra-competitive East Coast markets.
• Keeps future options open to return to Boston for fellowship, potentially with stronger research and leadership experiences from another region.

Scenario 2: Average Applicant in a Highly Competitive Specialty (e.g., Dermatology, ENT, Ortho)

• Boston MD graduate, solid but not exceptional board scores and research relative to specialty norms.
• Deep personal desire to remain near Boston but no immovable constraints.

Smart geographic strategy:

• Target a selective but realistic subset of Boston and Massachusetts residency programs in the specialty.
• Heavily diversify across multiple regions—Northeast, Midwest, South, and West—focusing on programs historically more open to outside applicants.
• Consider also applying in a backup specialty with broader geographic targeting.

Why this works:

• Reduces the risk of going unmatched in a narrow, high-demand location.
• Signals to programs outside Boston that the applicant is genuinely interested in their region.
• Keeps longer-term options open, including eventually returning to Massachusetts after residency.

Scenario 3: Applicant with Real Geographic Constraints (e.g., Family or Medical Needs in Boston Area)

• Boston MD graduate whose spouse’s employment, child’s schooling, or medical care truly requires staying near Boston.

Smart geographic strategy:

• Apply very broadly within Massachusetts residency programs and nearby New England states (Rhode Island, New Hampshire, Maine, Connecticut), including:
  • Academic centers
  • Community and hybrid programs
  • Less well-known but stable institutions
• Be explicit in your personal statement or interviews (where appropriate) about the constraint without oversharing personal details.

Why this works:

• Recognizes the genuine limitation and focuses energy on maximizing options within the constraint.
• Ensures you’re not only applying to the most prestigious or well-known Boston residency programs but also to those more likely to have capacity and interest.

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Balancing Career Ambition with Quality of Life

Geographic flexibility isn’t just a tactical move; it’s also about anticipating where you will thrive for 3–7 years of intense training.

Factors to Weigh Beyond Reputation

When you’re considering programs outside Boston, look at:

• Program culture: collegial vs. hierarchical, resident support, wellness resources
• Cost of living: your resident salary goes much further in some regions with lower housing costs than in central Boston
• Patient population: clinical diversity, exposure to underserved communities, urban vs. rural medicine
• Support systems: availability of local friends, family, or affinity communities
• Weather and lifestyle: your coping strategies for winters, summers, and city size

Many Boston trainees discover they can enjoy life—and thrive professionally—outside major coastal hubs. Others confirm that big-city life energizes them and choose accordingly. Both paths are valid; geographic flexibility simply broadens your choice set.

Returning to Boston Later

One common concern:
“If I leave Boston for residency, can I ever come back?”

The answer is yes—if you plan thoughtfully:

• Fellowships: Many Massachusetts residency and Boston fellowship programs welcome strong residents from across the country; your training pedigree and letters matter more than your residency ZIP code.
• Networking: Maintain ties with mentors in Boston, collaborate on projects, and attend national conferences where Boston faculty are present.
• Job search: Boston’s hospitals regularly hire attending physicians who trained elsewhere, particularly when they bring strong fellowship credentials or niche expertise.

So, training elsewhere does not “close the door” to Boston; in many cases, it diversifies your experience and makes you a more attractive candidate for future roles back in the region.

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Frequently Asked Questions (FAQ)

1. As an MD graduate in Boston, is it realistic to match only in Boston or Massachusetts?

It’s possible but often risky to focus only on Boston or even only on Massachusetts residency programs, especially in competitive specialties. These markets attract disproportionate interest, and many programs fill early with top-tier applicants from across the country. Unless you have a very strong application and specialty-appropriate metrics, relying solely on Boston residency programs can significantly increase your unmatched risk. Consider at least a regional preference strategy that includes broader New England and neighboring states.

2. How many regions should I list for my geographic preference in ERAS?

There’s no fixed number, but for most Boston MD graduate residency applicants, indicating multiple regions is beneficial if it aligns with your true application pattern. At minimum, consider including the Northeast plus at least one additional region where you are genuinely willing to train (e.g., Mid-Atlantic, Midwest, or South). Your stated geographic preference should match your program list; otherwise, programs may question your sincerity.

3. Will training outside Boston hurt my chances of returning for fellowship or a job?

Not typically. Many Boston fellowships and faculty positions are filled by residents trained at other strong programs across the country. What matters most is your clinical performance, letters of recommendation, research (if relevant), and fit with the fellowship or job, not your residency city. With good mentorship and networking, training outside Boston can actually broaden your experience and make you a more competitive candidate when you apply back to Massachusetts or Boston institutions.

4. How do I explain geographic flexibility in interviews without sounding noncommittal?

Frame your answer around priorities rather than places. For example:
“I’ve really enjoyed living and training in Boston, but my top priorities for residency are strong clinical training, collegial culture, and solid mentorship. I’m open to different regions that offer those elements, including here. I could see myself being very happy in this city and contributing meaningfully to your program.”
This conveys that you value fit and training quality, while still demonstrating honest openness to different locations.

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By treating geographic flexibility as a deliberate, data-informed strategy—not just a last-minute compromise—you, as a Boston MD graduate, can protect your chances in the allopathic medical school match, expand your options beyond a single city, and still keep the door open to returning to Massachusetts or Boston later in your career.