Choosing a residency program can be confusing. But once a medical student has chosen a specialty, it’s important to be aware of the different training pathways there may be. Many specialties offer only one training pathway, while others offer different pathways into the field through various residency and fellowship programs. We break down the different training pathways 4th year medical students can enter upon graduation below.
For those that have not yet decided on a medical specialty, read here.
The Ultimate Guide to Choosing a Residency Program
Types of Positions
There are 3 primary residency training “pathways” for 4th year medical students to consider.
“Categorical” and “primary” residency positions begin immediately after graduation from medical school and provide full training required for board certification in their respective specialty.
“Preliminary” residency positions are 1-year training positions that provide necessary pre-requisite clinical experience for an “advanced” residency position (though the “advanced” program will not begin until the “preliminary” program is completed, applicants generally apply to and rank these programs together in the same application cycle).
Some specialties will offer both “categorical” and “preliminary” → “advanced” pathways, but likely with differing program numbers and match rates.
There is technically a 4th category of residency positions, “reserved.” But these are not available to 4th year medical students.
(C) Categorical Positions
Categorical positions are the most common residency positions 4th year medical students will match. Most specialties require residency training in a categorical position.
But in addition to regular categorical programs (ex. anesthesiology), there are also combined programs (ex. pediatrics-anesthesiology). Combined programs generally provide the required training for residents to qualify for board examination in both specialties upon completion of the program (ex. board certification in pediatrics through ABP and board certification in anesthesiology through ABA).
| Specialties | Number of Programs | Match Rate |
| Anesthesiology | 165 | 71% |
| Child Neurology | 75 | 86% |
| Dermatology | 14 | 10% |
| Emergency Medicine | 277 | 94% |
| Family Medicine | 745 | 86% |
| Internal Medicine | 641 | 85% |
| Interventional Radiology | 24 | 21% |
| Neurodevelopmental Disabilities | 4 | 17% |
| Neurosurgery | 115 | 73% |
| Neurology | 139 | 66% |
| Obstetrics-Gynecology | 288 | 81% |
| Orthopedic Surgery | 210 | 65% |
| Osteo-neuromusculoskeletal Medicine | 5 | 00% |
| Otolaryngology | 134 | 68% |
| Pathology | 168 | 93% |
| Pediatrics | 235 | 89% |
| Physical Medicine and Rehabilitation | 43 | 33% |
| Plastic Surgery | 86 | 62% |
| Psychiatry | 352 | 87% |
| Radiation Oncology | 5 | 09% |
| Radiology (Diagnostic) | 34 | 10% |
| Surgery | 342 | 72% |
| Thoracic Surgery | 35 | 54% |
| Vascular Surgery | 68 | 72% |
| Combined Specialties | Number of programs | match rate |
| Emergency Medicine-Anesthesiology | 1 | 33% |
| Emergency Medicine-Family Medicine | 3 | 24% |
| Family Medicine-Preventative Medicine | 2 | 00% |
| Internal Medicine-Anesthesiology | 2 | 13% |
| Internal Medicine-Dermatology | 5 | 21% |
| Internal Medicine-Emergency Medicine | 12 | 31% |
| Internal Medicine-Medical Genetics | 5 | 33% |
| Internal Medicine-Pediatrics | 78 | 82% |
| Internal Medicine-Preventative Medicine | 4 | 16% |
| Internal Medicine-Psychiatry | 12 | 32% |
| Pediatrics-Anesthesiology | 5 | 38% |
| Pediatrics-Emergency Medicine | 4 | 24% |
| Pediatrics-Medical Genetics | 23 | 78% |
| Pediatrics-Physical Medicine and Rehabilitation | 3 | 25% |
| Pediatrics-Psychiatry (Child Psychiatry) | 8 | 39% |
| Psychiatry-Family Medicine | 6 | 23% |
| Psychiatry-Neurology | 4 | 13% |
| Specialties with their Own Match Program (Do not participate in NRMP) |
| Urology |
(M) Primary Positions
Primary positions are residency positions in training programs which emphasize general, primary care. These positions are available in either internal medicine or pediatrics.
| Specialties | Number of programs | Match rate |
| Internal Medicine | 86 | 29% |
| Pediatrics | 14 | 11% |
(P) Preliminary and (A) Advanced Positions
Advanced positions are residency programs in highly-specialized areas of medicine that require residents to have first completed a separate preliminary training year.
The preliminary training year can either be in a transitional position or a preliminary position. A transitional position rotates through a variety of departments while a preliminary position can be in either internal medicine, surgery, or ob/gyn.
| preliminary year | Number of Programs | Match Rate |
| Preliminary Year (Internal Medicine) | 353 | 35% |
| Preliminary Year (Ob/Gyn) | 15 | 04% |
| Preliminary Year (Surgery) | 251 | 30% |
| Transitional Year | 195 | 34% |
| Specialties | Number of Programs | Match Rate |
| Anesthesiology | 58 | 21% |
| Child Neurology | 4 | 06% |
| Dermatology | 138 | 67% |
| Interventional Radiology | 66 | 50% |
| Neurodevelopmental Disabilities | 2 | 27% |
| Neurology | 42 | 35% |
| Nuclear Medicine | 1 | 00% |
| Osteo-neuromuscular Medicine | 1 | 00% |
| Physical Medicine and Rehabilitation | 69 | 53% |
| Radiation Oncology | 83 | 87% |
| Radiology (Diagnostic) | 172 | 65% |
| Radiology (Nuclear Medicine) | 3 | 11% |
| Specialties with their Own Match Program (Do not participate in NRMP) |
| Ophthalmology |
Final Thoughts
Choosing a residency program is one of the most important decisions for young doctors (after choosing a specialty). While there may be different pathways to the same specialty, they will vary in length and program competitiveness. Fourth year medical students should begin to research specific training programs at specific universities once decided on a specialty and training pathway that is right for them.
