More Than One Path: Recent Cross-Application Trends Among Radiology Residency Applicants, 2020-2023

Cross-application is increasingly common in radiology yet remains understudied. We aimed to quantify the prevalence, characterize patterns, and identify predictors of cross-application among diagnostic radiology (DR) and interventional radiology (IR) applicants.

We analyzed all Electronic Residency Application Service applications submitted to DR and IR programs between 2020 and 2023. Cross-applications were defined as those applying to DR or IR and at least one nonradiology specialty. Applicant demographics, educational background, and academic characteristics were compared using χ² and t tests. Independent predictors of cross-application were assessed using multivariable logistic regression.

Among 9,012 radiology applications, 41.8% (n = 3,770) were cross-applications. Cross-application was most frequent among IR-only applications (94.0%) and more common in international medical graduates (63.9%), DOs (46.6%), and applicants ≥30 years old (56.0%). Compared with radiology-only applications, cross-applications had more publications but fewer research and volunteer experiences. Independent predictors of cross-application included IR-only status (odds ratio [OR] = 31.75; 95% confidence interval [CI]: 22.42-46.54), international medical graduate (OR = 2.86; 95% CI: 2.47-3.31), DO (OR = 1.90; 95% CI: 1.65-2.18), age ≥ 30 (OR = 1.71; 95% CI: 1.54-1.90), and re-application (OR = 2.10; 95% CI: 1.80-2.44), and Alpha Omega Alpha society membership reduced odds (OR = 0.48; 95% CI: 0.39-0.59).

Cross-application is a frequent strategy among radiology applicants. These results highlight the challenges of navigating a competitive match and the importance of advising that accounts for diverse applicant backgrounds and career goals. Understanding cross-application as a common and often pragmatic strategy may help inform advising practices and reduce misinterpretation of applicant intent.