Residency Advisor
The official advice about “how many programs to apply to” is sanitized. Program directors will never tell you the real numbers they expect. I will.
They smile on panels and say things like “apply broadly, but be targeted” while quietly agreeing in their PD group chats what the real safe ranges are for different fields and profiles. I’ve sat in those rooms. I’ve seen the spreadsheets. Let me walk you through what they actually assume you’re doing—by specialty, by competitiveness, and by how “risky” you look on paper.
This isn’t about how many programs you could apply to. It’s about how many programs PDs secretly assume you already did.
The Unwritten Rule PDs Use
Here’s the dirty little secret: PDs back-calculate your “risk tolerance” from the number of applications and interviews you have, whether they admit it or not.
They know roughly:
- How many programs exist in their field
- How many interviews a typical applicant needs to match
- How many applications it usually takes to get those interviews
So when they see your ERAS application and later hear you only ranked 6 programs in a competitive field, they don’t think, “Wow, confident.”
They think, “You didn’t understand the game.”
Behind closed doors, PDs assume three tiers of application strategy:
- Aggressive / Risk-tolerant – applying to the minimum viable range.
- Standard / Safe – the range PDs expect a rational applicant to hit.
- Paranoid / Overkill – applicants blasting 80+ apps in low-competition fields.
You want to sit squarely in that middle band for your risk profile and specialty. If you’re below it, you look naïve. If you’re wildly above it, you look like you do not understand who you are on paper.
Let’s talk numbers. Real numbers.
How Many Programs PDs Expect by Competitiveness Tier
First, zoom out. PDs think in tiers before they think in specific fields.
| Tier | Examples | Typical App Range (Average Applicant) |
|---|---|---|
| Ultra-Competitive | Derm, Ortho, Plastics, ENT, Urology | 60–90+ |
| Competitive | EM, Anesthesia, Radiology, GI fellowships | 40–60 |
| Mid | IM categorical, Gen Surg, OB/GYN, Neuro | 25–40 |
| Lower | Psych, FM, Peds, Path | 15–30 |
These are not what students say on Reddit. These are what PDs quietly expect when they see your file and mentally ask: “Did this person take the Match seriously?”
Now let’s get into specific fields, with what PDs actually assume.
Internal Medicine (Categorical)
This is where PDs see the widest range of behavior—from 5 apps (insane) to 80+ (also insane for most).
Here’s the unspoken IM framework PDs use when they hear how many programs you applied to:
Rockstar US MD (Strong)
Step 2: 245+
Honors in medicine, strong letters, maybe some research
PD expectation: 20–30 programs
If you tell a PD you applied to 60 IM programs with that profile, they’ll nod politely and internally label you as anxious or poorly advised.Typical US MD / DO (Average)
Step 2: 225–245 (DO a bit lower but strong clinicals)
Some honors, solid letters, no red flags
PD expectation: 30–40 programsRed Flags / Risky
Step 2 under ~220, a fail attempt, no IM home program, visa need, or late specialty switch
PD expectation: 50–70 programs
| Category | Value |
|---|---|
| Strong | 25 |
| Average | 35 |
| Risky | 60 |
What PDs really think when they see your rank list with 8 IM programs:
I heard this exact line from an IM PD at a mid-tier university program:
“Anyone ranking under 10 IM programs without a god-tier application just didn’t get good advising. Or they ignored it.”
So if you’re asking, “How many IM programs should I apply to?” understand that PDs assume:
- Under 15: you better be an absolute monster candidate.
- 25–35: this is the silently accepted ‘normal’ for an average US graduate.
- Over 60: that’s the panic zone unless you have clear red flags.
General Surgery
Surgery PDs are more paranoid than IM. They’ve watched catastrophically overconfident people go unmatched.
They expect you to respect the field.
For categorical general surgery, the quiet expectations:
Strong US MD (Step 2 245+, honors, at least one decent surgery letter, real interest)
PD expectation: 25–35 programsAverage US MD / Strong DO
Step 2: 230–245, mixed honors/high pass, adequate letters
PD expectation: 35–50 programsRisky (low Step 2, no research, limited surgery exposure, red flags)
PD expectation: 50–70 programs
A university PD once said during an applicant review meeting:
“If they applied to 18 programs in surgery and didn’t dual-apply, I’m assuming poor judgment right off the bat.”
They don’t say that on panels. But they say it at 6:45 a.m. before M&M.
Also, categorical general surgery PDs assume that if your app is marginal, you’re either:
- also applying prelim in bulk, or
- also applying to another field (anesthesia, IM).
If you’re borderline and you only sent out 20 categorical applications and no prelims? That reads as: “didn’t understand the math of the Match.”
Emergency Medicine (including the chaos years)
EM’s been weird the last few cycles, but PD psychology hasn’t changed much. They expect breadth because they know there’s noise: shifting job markets, region preferences, and too many “all-or-nothing” applicants.
For the average applicant:
Strong EM applicant (240+ Step 2, strong SLOEs, no professionalism issues)
PD expectation: 25–35 programsAverage EM applicant
One home SLOE, one away, decent clinical performance
PD expectation: 35–45 programsRisky (no home program, weak SLOEs, mediocre clinical comments, lower scores)
PD expectation: 45–60 programs
The behind-the-scenes talk in EM PD circles for years has been:
“If they apply to less than about 30 EM programs without a clear geographic constraint, they either didn’t listen to us or they have no idea how variable interview offers are.”
They know a ton of programs soft-screen by geography, connections, and SLOEs. That randomness is exactly why they assume you applied broadly.
Psychiatry
Psych is deceptively competitive in some regions, but overall PDs still see a ton of overapplying here.
Real expectations:
Strong US MD (good scores, no major red flags, normal clinicals)
PD expectation: 15–25 programsAverage
Step 2 in the low 220s, some passes, couple of minor issues
PD expectation: 20–30 programsRisky / Significant red flags (fail attempts, extended time in med school, major professionalism issues, visa needs)
PD expectation: 30–40 programs
When a psych PD sees an applicant who sent 60 psych applications with clean scores and no red flags, they absolutely talk about it. Usually something like:
“Why did they go nuclear? Do we not see something here? Or is this just poor advising?”
That doesn’t necessarily hurt your chances, but understand: they are not expecting that volume from a straightforward candidate.
Family Medicine & Pediatrics
I’ll group these because PD conversations about them are eerily similar.
PDs in FM and Peds quietly resent how many applications they get from candidates who were clearly never going to rank them highly. They know they’re often treated as “backup fields.”
For an average US MD/FM or Peds applicant without red flags, the true expectation:
Strong
PD expectation: 10–20 programsAverage
PD expectation: 15–25 programsRisky (low scores, remediation, international grad, visa)
PD expectation: 25–35 programs
If you’re a US MD with okay numbers and you apply to 50+ FM or Peds programs, PDs don’t think, “Ambitious.” They think, “You either didn’t listen to anyone, or your school was covering itself by telling everyone to apply everywhere.”
They see your Dean’s Letter. They know.
Dermatology, Ortho, ENT, Plastics, Neurosurgery — the Blood Sport Fields
This is where the public advice is the most dishonest.
Every PD on a webinar will say some version of: “Quality over quantity. Make sure your application is strong and targeted.”
Then they go to the Association of Program Directors meeting and say numbers like this out loud.
For the ultra-competitive specialties, here’s the quiet truth:
Dermatology
Strong applicant (research, 250+ Step 2, derm letters): PD expectation: 50–70 programs
Average-ish with gaps: 70–90+Orthopedic Surgery
Strong: 50–70
Average / some weaker aspects: 70–90ENT, Plastics, Neurosurgery
Same general band: 50–80 depending on your profile
| Category | Value |
|---|---|
| Derm | 70 |
| Ortho | 65 |
| ENT | 60 |
| Plastics | 60 |
| Neurosurg | 55 |
Here’s what a derm PD said to me privately reviewing a borderline candidate:
“If they applied to under 40 derm programs with this CV, then they didn’t really want derm. Or they had no idea what was coming.”
Do some unicorns match derm with 25 applications? Sure. They’re not designing the unspoken rules. They’re the exception PDs secretly expect you not to assume you are.
These PDs know their match rates. They know how brutal it is. And they assume you do the obvious math: more apps, more shots.
Anesthesia, Radiology, Neurology, OB/GYN
These sit in the middle. Not derm-level brutal, but not FM either.
Anesthesiology
- Strong US MD: 25–35
- Average: 35–45
- Risky: 45–60
Diagnostic Radiology
- Strong: 30–40
- Average: 40–50
- Risky: 50–65
Neurology
- Strong: 15–25
- Average: 20–30
- Risky: 30–40
OB/GYN
- Strong: 25–35
- Average: 30–45
- Risky: 45–55
What they won’t say out loud: for these fields, PDs expect you to be more calculated. If you show up with 70 applications in a mid-competitive specialty without big red flags, they assume either:
- you’re very anxious,
- or your advising office is using a one-size-fits-none “apply everywhere” policy.
That doesn’t kill you. But it doesn’t make you look savvy either.
What PDs Really Care About: Interview Count, Not Just Application Count
Here’s the nuance students miss: PDs don’t only care how many programs you applied to. They infer your judgment from your interview numbers.
Behind closed doors, this is the mental model:
For most core residencies (IM, Peds, FM, Psych, Neuro, Anesthesia, OB/GYN):
PDs assume you’re aiming for ~10–14 interviews minimum.For competitive surgical and ultra-competitive fields:
They assume you know you need ~12–15+ to feel safe, and that many people will match a bit lower than their “dream” list.
| Category | Value |
|---|---|
| Low | 8 |
| Mid | 10 |
| Competitive | 12 |
| Ultra | 14 |
They know all of this is probabilistic, but here’s the bottom line in PD-speak:
IM PD, discussing a borderline candidate:
“Ten interviews in IM? They’ll probably be fine.”Gen Surg PD, about a similar candidate:
“Six or seven interviews? That’s rough. I’d be nervous for them.”Derm/Ortho PD, reviewing a strong but not elite candidate:
“Under 8 interviews? They’re in trouble.”
So they mentally reverse-engineer: how many programs did you probably apply to in order to land that many interviews? And if that number feels too low, they blame your judgment, not the market.
Dual Applying: What PDs Assume You Did (Even When You Didn’t)
Another quiet expectation: in several fields, PDs assume a certain subset of applicants are dual applying.
Fields where PDs commonly assume dual-application is normal:
- ENT, Ortho, Derm, Plastics, Neurosurg → often with IM, prelim surgery, anesthesia, or TY
- EM (in the post-EM-market-problem era) → with IM, FM, or anesthesia
- Some borderline general surgery applicants → with IM or prelim tracks
| Step | Description |
|---|---|
| Step 1 | Competitive Field Interest |
| Step 2 | Apply Single Field |
| Step 3 | Consider Dual Apply |
| Step 4 | Primary Field + Safety Field |
| Step 5 | Board scores strong? |
| Step 6 | Research and letters strong? |
If you’re aiming at a very competitive field with an average CV and you don’t dual apply, some PDs will quietly think: “No plan B. Dangerous.”
They won’t say it. But they absolutely discuss it when interviewing borderline folks.
Regional Reality: Why Your Zip Code Changes Expectations
One thing you don’t hear on advising panels: PDs absolutely account for geography when guessing how many programs you should have hit.
If you’re dead set on one city or one state, PDs assume you should be overshooting the general recommendations by:
- ~1.5x if you’re limiting yourself to a region
- ~2x if you’re limiting to a single metro area with lots of competition
So the PD thought process goes like this:
- “California-only psych applicant with average scores and 15 total apps? Naïve.”
- “Midwest-only FM applicant with 25 apps? That makes sense, they’re boxed in but doing the right thing.”
They know not everyone wants to move across the country. But they also know the Match algorithm does not care about your partner’s job, your lease, or your parents.
Quick Reality Grid: What PDs Secretly Expect by Field
| Specialty | PD Expected Range (Typical US Grad) |
|---|---|
| Internal Medicine | 30–40 |
| General Surgery | 35–50 |
| Emergency Medicine | 35–45 |
| Psychiatry | 20–30 |
| Family Medicine | 15–25 |
| Pediatrics | 15–25 |
| Anesthesiology | 35–45 |
| Radiology | 40–50 |
| Neurology | 20–30 |
| OB/GYN | 30–45 |
If you’re “average” for your field and you’re way below these numbers, you are counting on luck and overestimating your appeal.
If you’re obviously strong and want to be more selective, fine. But then you should know you’re strong, not just hope.
How to Use This Without Losing Your Mind (or Wallet)
Let me show you how real residents I’ve worked with adjusted their numbers using this behind-the-scenes framework.
Case 1: Average IM applicant, wants big city
- US MD, Step 2: 232, solid clinicals, no red flags
- Wants East Coast or major metros
- PD expectation: ~30–40 apps
- But because they’re targeting mostly competitive cities, a smart play is ~40–45, mixing city and some less sexy mid-size areas.
Case 2: Slightly weak gen surg applicant
- DO, Step 2: 225, one marginal eval, strong narrative interest in surgery
- PD expectation band: 50–70 programs
- Realistic strategy: 55–60 categorical, plus prelims and maybe a small IM backup list. This matches what surgery PDs assume you should be doing.
Case 3: Strong psych applicant, fine with most regions
- US MD, Step 2: 240, very solid clinical record, some psych-related activities
- PD expectation: 15–20 psych programs
- They applied to 18. Matched at #3. Zero drama, nothing heroic, just matching PD’s internal script.
The One Question You Should Be Able to Answer
If you sit across from a PD and they ask:
“Walk me through how you decided how many programs to apply to.”
You should be able to say something more intelligent than: “My friend told me 30 is enough.”
A strong answer sounds like this:
“I looked at NRMP data for my specialty, talked to my dean’s office, and adjusted based on my scores, my red flags, and where I was willing to live. I ended up applying to about [X], which felt like a responsible middle ground—not overkill, but not naïve.”
That’s the mentality PDs secretly expect behind your numbers. Not perfection. Just informed risk management.
FAQ
1. Is there such a thing as applying to too many programs?
Yes. Not in the sense that PDs will blacklist you for it, but in the sense that it tells anyone experienced you did not understand your own competitiveness. If you’re a clean US MD applying to 80 family medicine programs, anyone who’s been on a rank list committee will quietly laugh. Also, more isn’t always better: you dilute your ability to write decent preference signaling, track programs, and interview sanely.
2. If I’m a strong applicant, can I safely cut these numbers in half?
Not half. That’s what overconfident people do just before they post on Reddit in March asking what went wrong. If you’re truly strong: cut maybe 20–30% off the typical range, not 50–60%. PDs have all seen “great on paper” applicants get bizarrely few interviews because of geography, bad timing, or just noise.
3. I’m an IMG/visa-needing applicant. How does this change things?
For you, take the “risky” band for your specialty and that’s your starting minimum, not your max. Internal medicine? Think 60–100, not 30–40. Psych? 40–60, not 20–30. In PD meetings, people literally say, “If they need a visa, they better have applied very widely.” That’s the expectation.
4. What if I genuinely only want one region—like the West Coast or Northeast?
Then you don’t get to use the lower end of any of these ranges. PDs expect you to compensate with more applications, not fewer. If the typical IM applicant might apply to 30–40 nationwide, a West-Coast-only applicant with average stats should be thinking more like 40–50 in that region alone, mixing academic, community, and less glamorous locations. Region restriction is a self-inflicted competitive hit. You make up for it with numbers.
You now know the ranges PDs actually assume you’re playing in—even when they won’t say them into a microphone. With this, you’re not just guessing or copying your friend’s spreadsheet; you’re thinking the way the people on the other side of ERAS think.
You’ve handled how many programs to apply to. The next landmine is which ones to actually rank and how to build that list strategically. That’s the next chapter in this game—but we’ll get to that another day.
