Do Residency Signals Actually Signal Intent? Insights From the 2024 Family Medicine National Resident Survey

Introduction: Family medicine (FM) residencies’ growing reliance on the Supplemental Offer and Acceptance Program (SOAP) has raised concerns about inefficiencies and costs associated with residency selection. In 2023-2024, the Association of American Medical Colleges Electronic Residency Application Service (ERAS) introduced program signaling and geographic preferences as tools to improve the residency selection process. However, the association between FM residents’ use of these tools and their residency choice has not been investigated. Methods: We used data from the 2024 American Board of Family Medicine National Resident Survey (NRS) which is administered to all residents taking the In-Training Examination. Postgraduate year-1 (PGY-1) residents were asked about their match experience and entry into FM. We conducted descriptive and bivariate analyses by resident characteristics. Results: The majority of 5,237 respondents report that they “signaled” the residency program (59%) and geographic area (72%) where they ultimately matched. International medical graduates were less likely to use geographic preferences and were less likely to be currently in a program that they signaled or that aligned with their geographic preference. DOs were more likely to use both tools and more likely to be in a program that had an aligned preference. Residents who entered through SOAP were less likely to have used either tool, but 10% of residents who entered through SOAP signaled their current program. Conclusions: In a study of nearly all PGY-1 FM residents, we found that applicants are using ERAS signals to indicate real program and geographic preferences, suggesting these tools may support better alignment between applicants and programs.