```text ## What to Do After Residency Interviews
Finishing residency interviews feels like a huge accomplishment.
But once interview season ends, a completely new set of questions starts:
Should I send thank-you emails? Should I send a Letter of Intent? Can I contact residents? How do I rank programs? What if a program tells me they are ranking me highly? How do I actually submit my rank list? And what happens during Match Week?
This guide walks through what I learned during my own residency application process and what I now discuss with applicants as a resident and advisor.
Watch My Video on What to Do After Residency Interviews:
Immediately After Every Interview: Write Down Your Gut Reaction
At the end of EVERY interview, take five minutes and write down your immediate thoughts.
Do not tell yourself:
"I'll remember."
You probably won't.
After interviewing at multiple programs, they start blending together.
Write down how the Program Director made you feel, how the residents made you feel, how faculty interacted with residents, whether residents seemed genuinely happy, what stood out positively, what concerned you, any possible red flags, how you felt about the location, whether you could imagine yourself living there, whether you could imagine yourself becoming friends with the residents, and, most importantly, whether you could actually see yourself being happy there.
These notes become incredibly valuable when you are creating your rank list months later.
I also documented my own impressions from my Family Medicine and Psychiatry interviews and included them in my residency application resources.
Should You Send a Post-Interview Thank-You Email?
You may choose to send a short thank-you email after an interview if the program allows post-interview communication.
Keep it SHORT.
You do not need to write another personal statement.
Consider including a thank-you for their time, one specific thing you discussed during the interview, one brief sentence about why the program remains meaningful to you, and a personal connection to the program or geographic area, if relevant.
The goal is to help the interviewer remember the individual conversation you had.
Do not send the exact same generic email to every interviewer.
Understanding Post-Interview Communication
There is a lot of confusion surrounding Letters of Interest, Letters of Intent, program communication, and what programs can or cannot tell applicants.
These are NOT all the same thing.
What Is a Letter of Interest?
A Letter of Interest is generally sent BEFORE you have received an interview.
Its purpose is essentially:
"Please take another look at my application. I am particularly interested in your program."
These may be most useful earlier in interview season after programs have begun reviewing applications.
Once interview season is over, this type of communication is no longer particularly relevant.
What Is a Letter of Intent?
A Letter of Intent is typically sent later in the season, before rank lists are finalized.
This is where you communicate that a program is one of your highest choices.
For your TRUE #1 program, you may choose to clearly say:
"You are my number one program."
For another highly ranked program, you might instead say:
"You are one of my top programs."
Those statements are different.
Do NOT Tell Multiple Programs They Are Your #1
DO NOT tell three programs:
"You are my number one."
You only have ONE number-one program.
Be honest.
Programs within the same geographic area or specialty may know one another professionally.
You should never assume that misleading communication will remain completely isolated.
Bottom line:
Do not lie. Do not tell several programs that each is your #1.
When Should You Send a Letter of Intent?
If you choose to send one, it generally makes sense to send it before programs finalize their rank lists.
Historically, many applicants have considered late January or early February, although exact timing varies by specialty, program, and Match calendar.
Always follow the current communication guidance for your application year.
How Many Programs Should Receive a Letter of Intent?
There is no rule that you must send one at all.
Some applicants send only to their true #1 program.
Others may send brief expressions of continued interest to a small number of top programs while reserving the explicit phrase:
"You are my number one"
for ONE program only.
Do not send a dramatic "Letter of Intent" to every program on your rank list.
That defeats the purpose.
What Does "No Post-Interview Communication" Mean?
Some programs specifically request no post-interview communication.
Respect the program's instructions.
Programs may also have policies limiting what faculty and leadership communicate with applicants after interviews.
Do not interpret silence as a hidden message.
And do not repeatedly email because you are hoping they will reassure you.
If a program says not to contact them after the interview:
Follow their instructions.
Q: What If a Program Says They Are Ranking Me Highly?
Be happy that they liked you.
But DO NOT build your rank strategy around it.
Do not assume, "They told me I'm ranked to match, so I don't need to rank them highly."
And do not assume, "They told me I'm their #1, so I am definitely matching there."
Programs may communicate enthusiasm.
That does not guarantee the final outcome.
Programs Can Be Very Enthusiastic Without Making a Promise
During my own application process, I received communication from a program saying they were "very excited" about me and hoped I would rank them highly.
I was thrilled.
Later, I learned that similar messages had been sent to multiple applicants.
I also once had a Program Director tell me in person that they would be excited to interview me.
I applied.
And then I received a rejection.
Those experiences taught me something important:
Do not make major rank decisions based on flattering communication.
Rank programs based on where YOU genuinely want to train.
How Should I Rank Residency Programs?
This is one of the most common questions I receive through DMs and advising appointments.
There is no perfect formula.
And as medical students, that can be frustrating.
We like numbers, data, percentages, predictions, and objective measures.
But ranking programs ultimately requires some subjective judgment.
You have to decide where YOU want to train.
Trust Your Gut Feelings
If something felt wrong during an interview, do not automatically dismiss that feeling.
Ask yourself WHY.
Potential red flags might include residents appearing severely burned out, residents openly expressing dissatisfaction, a program being on probation or under significant accreditation concerns, residents reporting that they rarely receive full days off, a hostile relationship between residents and leadership, extremely high resident turnover, poor support for illness, pregnancy, disability, or family needs, or a general feeling that residents seemed afraid to speak honestly.
One unusual interaction does not automatically mean a program is terrible.
But patterns matter.
Think About Long-Term Happiness
Do not only ask:
"Would I be excited to Match here?"
Ask:
"Would I still want to live and work here after three years?"
Or four. Or five. Or seven.
Depending on your specialty and fellowship plans, this may become your home for a significant portion of your life.
Evaluate the Actual Workload
Ask yourself:
What does call look like? How frequent is call? Are residents alone? Are shifts 24 or 28 hours? How are weekends structured? How does sick leave work? What happens if a resident becomes ill? Do residents have adequate time to eat? Do they have time to use the bathroom? What is the actual average workweek? How dependent is the hospital on residents to provide essential patient care?
There is a significant difference between a program that educates residents while they provide patient care and a program that depends on residents primarily as inexpensive labor.
Consider Whether You Felt Accepted
Think beyond curriculum.
Where did you feel like you could actually be yourself?
Consider whether the program appeared supportive of residents who are IMGs, DOs, LGBTQ+, Black or Brown, first-generation, low-income, parents, married, single, disabled, religious minorities, or from other backgrounds that may matter to you.
You should not need to hide important parts of yourself for several years simply to survive residency.
Consider Family, Partners, and Disability Support
Residency does not exist separately from the rest of your life.
Think about whether your partner can find work there, whether your spouse can commute, whether you are near family, whether you have childcare options, whether you can afford housing, whether you will need disability accommodations, whether the hospital seems supportive of those needs, and whether pregnancy or parental leave would create major problems.
Your personal life matters.
If You Dual Applied, Decide Which Specialty You Actually Want
If you applied to multiple specialties, rank based on what career you actually want.
Do not automatically rank a program higher simply because it is more prestigious.
Ask:
What specialty do I want to practice for the rest of my career?
If you would rather become a psychiatrist at Program #4 than a Family Medicine physician at Program #1:
Rank the Psychiatry program higher.
Your rank list should reflect YOUR preferences.
Location & Lifestyle Matter
Think about city, state, cost of living, political climate, family support, transportation, commute, housing, weather, recreation, airport access, and whether the community fits the lifestyle you want.
You are not simply choosing a hospital.
You are choosing where you will LIVE.
Ask Yourself These Questions Before Ranking
Where would I be happiest? What specialty do I actually want to practice? Where did I feel most accepted as myself? What does my gut tell me? What do I value most in a residency program? Did anything feel strange during the interview? Would I still be happy there after several years? Where can I realistically live for the next three to eight years? What patient population do I want to serve? Does the program provide experience with those patients? Which program had residents I could imagine becoming friends with? Which program had faculty I would want as mentors? Which place best aligns with the physician I want to become?
There Is No Perfect Rank List
This may be the most difficult part.
There is no mathematical formula that can guarantee the perfect order.
You can create spreadsheets.
You can assign points.
You can compare salary, call, location, research, benefits, fellowship Match, and vacation.
But eventually, you still have to decide:
Where do I want to go?
That requires looking inward.
Trust the notes you wrote after interviews.
Trust the feelings you had during the interview.
And then compare them again several weeks later after the initial excitement has worn off.
Rank Programs in the Order YOU Prefer Them
Your rank list should reflect YOUR true preference.
Do not move a program higher because you think they ranked you highly.
Do not move a program lower because you think they may not rank you.
Do not try to "game" your list.
Rank programs in the order you genuinely want to attend them.
Only Rank Programs Where You Are Willing to Train
Do NOT rank somewhere you absolutely refuse to go.
If you match there, the Match carries significant obligations.
Only place a program on your list if you would genuinely be willing to train there.
Think carefully before saying:
"I'll just put it at the bottom because there's no way I'll match there."
If it is on your rank list, it is possible.
How I Personally Ranked Psychiatry vs. Family Medicine
During my own application cycle, I applied to both Psychiatry and Family Medicine.
One of my most important personal considerations was remaining in the Chicago area so my husband and I could continue living together while completing our individual residency programs.
I therefore focused heavily on programs within a reasonable commuting distance.
Ultimately, I ranked my Psychiatry programs first because Psychiatry was the specialty I most wanted to practice.
Then I ranked my Family Medicine programs.
My rank list reflected specialty preference, location, my relationship, program fit, and where I believed I would be happiest.
You can see my full Family Medicine and Psychiatry Rank List in my residency resources.
Connecting With Residents After Interviews
This is VERY underrated.
Residents can sometimes provide information you simply cannot get from program leadership.
You may have questions that you forgot to ask during interview day.
You may also want to understand something more specific about call, culture, housing, fellowship, parenthood, disability accommodations, IMG experiences, DO experiences, research, or living in the area.
Can You Email or DM Residents?
You can reach out respectfully to residents when appropriate.
Always remain professional.
Do not spam them, demand information, ask them to reveal confidential rank information, pressure them to influence leadership, or behave differently because you assume communication is "off the record."
Residents and program leadership work together.
If someone behaves extremely inappropriately toward residents, that information CAN make its way back to leadership.
Residents Can Give You Valuable Perspective
As a resident, I regularly talk to applicants about my own program, Psychiatry, Family Medicine, Neurology programs I know, and living and training in Chicago.
Those conversations generally do not determine someone's rank position.
But they can help applicants decide whether a program fits them.
Depending on the residency program, residents may also participate in applicant evaluation or ranking discussions.
So always interact with residents with the same professionalism you would show faculty.
What Should You Ask Residents?
Consider asking:
What surprised you about the program after starting? What do you wish you knew before ranking it? How responsive is leadership to feedback? Do residents actually spend time together? How difficult is call? What happens when someone is sick? What is the relationship between residents and faculty? Do people have time for family? Do residents feel prepared for fellowship or independent practice? Would you choose this program again?
Those questions often reveal more than:
"Do you like the program?"
Need Help With Your Rank List?
If you want individualized help reviewing your residency rank list, discussing program fit, or preparing for SOAP, you can sign up for an advising session with me.
How to Enter Your Rank List
When it is finally time to enter your rank list:
PAY ATTENTION.
Do not wait until the final few minutes before the deadline.
Only Rank Programs Where You Interviewed
Make sure you are entering the correct program.
Residency programs may have similar names, different tracks, different NRMP codes, preliminary programs, categorical programs, advanced programs, rural tracks, community tracks, or research tracks.
Double-check every program before finalizing your list.
Verify Every Program Code
Because rank lists use program codes, it is possible to accidentally select the wrong track or program.
I recommend keeping a separate spreadsheet containing the program name, location, specialty, track, program code, and your rank position.
This gives you something to compare against when entering your list.
SAVE, CERTIFY, CONFIRM
Remember these three words:
SAVE, CERTIFY, CONFIRM.
When you adjust your list, make sure you follow the current NRMP submission process completely.
Do not assume that because your programs appear on the screen, your final list is certified.
Verify that you receive the appropriate confirmation.
Keep a Backup Copy of Your Rank List
I recommend keeping your finalized ranking in a spreadsheet or another secure document.
Why?
Because mistakes happen.
I once forgot to properly certify after making changes and had to recreate part of my list.
Thankfully, I had everything written down separately.
Do not rely entirely on your memory.
Don't Keep Changing It After You Finalize It
Once you have reviewed your list, verified the program codes, saved it, certified it, and confirmed submission, consider leaving it alone unless you have a genuine reason to change something.
Constantly rearranging programs because of anxiety can make you question decisions you already made thoughtfully.
How Does Match Week Work?
Match Week is the culmination of months—and really YEARS—of preparation.
The exact schedule and communication process can change, so always review the current NRMP Match Week calendar for your year.
Traditionally, applicants first learn whether they matched.
Applicants who do not initially match may then participate in SOAP if eligible.
Later in the week, applicants who matched learn the program where they will train.
It can be an incredibly emotional week.
What If I Don't Match?
Not matching is devastating.
But it does NOT automatically mean your medical career is over.
There may be opportunities through SOAP or future application cycles.
If you are approaching Match Week with concerns about your number of interviews or Match probability, prepare ahead of time.
Know how SOAP works, what documents you may need, which specialties you would consider, who your advisors are, how to reach your medical school, and what support you have available.
Preparing for SOAP does not mean you are assuming you will fail to match.
It means you are preparing for multiple possibilities.
My Own Psychiatry vs. Family Medicine Decision
During my own ranking process, I spent significant time questioning whether Psychiatry or Family Medicine was the better fit.
I had received many more Family Medicine interviews than Psychiatry interviews.
At times, I wondered whether that meant:
Maybe I wasn't "good enough" for Psychiatry.
But the number of interviews did not answer the bigger question:
What type of physician did I actually want to become?
Why Psychiatry Ultimately Fit Me Better
I loved many things about Family Medicine.
I loved caring for people across the lifespan, connecting physical and mental health, working with marginalized communities, caring for patients with chronic medical conditions, serving Latino and LGBTQ+ communities, and practicing holistic medicine.
But I eventually realized that many of the things I loved about Family Medicine could still become part of my career as a psychiatrist.
Psychiatry would allow me to spend significantly more time focusing on mental health, behavioral health, trauma, psychotherapy, the relationship between physical and mental health, and the individual stories behind my patients' symptoms.
I realized that Psychiatry was where I wanted to spend the majority of my professional life.
So I ranked it accordingly.
Rank the Career You Actually Want
Prestige should not outweigh your long-term happiness.
Number of interviews should not determine your specialty.
What other people think you SHOULD do should not determine your specialty.
Ask:
What work do I actually want to wake up and do every day?
Residency lasts several years.
Your specialty may last decades.
Rank accordingly.
Final Thoughts on Ranking Residency Programs
Creating a residency rank list is difficult because there is no perfect answer.
You are balancing career, location, relationships, family, specialty, mentorship, finances, program reputation, clinical training, culture, and happiness.
No spreadsheet can perfectly quantify all of those things.
Use data.
Ask questions.
Talk to residents.
Review your notes.
Discuss your options with people you trust.
But eventually:
Trust yourself.
Your Rank List Should Reflect Your Life
The "best" residency program is not automatically the highest-ranked hospital.
It is the program where YOU can become the physician you want to become while still remaining a human being.
Think about where you will learn, where you will grow, where you will feel supported, where you can build relationships, where you can live, and where you can imagine yourself being happy.
That is what should guide your list.
Residency Rank List & Match Resources
Dr. Moss' Mock Interview Course, 1:1 Mock Interview With Dr. Moss, Residency Rank List Advising, SOAP Preparation Advising, Whether to Disclose Disability in Residency Applications, Residency Application YouTube Playlist, Blog Posts on Residency Applications, Residency Application Workbook, My Rank List With Family Medicine & Psychiatry Programs Across the Midwest, Dr. Jonah Moss' Neurology Rank List
For more resources, tips, and personalized advice, check out Dr. Moss' blog posts, "Life as a Patient-Doctor" Podcast, and Store
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