Position types are one of those things that medical school largely leaves you to figure out on your own. Your home institution’s advising office may have mentioned them in passing during a career advising session in MS2. If you were lucky, a resident explained it to you during an MS3 rotation. If you were unlucky, you found out the hard way — either during ERAS or after the match algorithm ran.
We’re going to fix that here.
The four position types, explained clearly
Categorical is the standard. You apply, you match, you complete your full residency training in that one program from PGY-1 through the end. Internal Medicine, Family Medicine, Pediatrics, Psychiatry, OB/GYN, General Surgery, Emergency Medicine, Neurology — the vast majority of positions in these fields are categorical. You have one rank list, one application, and one program that takes you all the way through. Simple in structure, even if the competition isn’t.
Preliminary positions are one-year training spots — almost exclusively in Internal Medicine or General Surgery — that exist to satisfy the first year of clinical training required before entering certain advanced specialties. Radiology, Anesthesiology, Ophthalmology, Dermatology, PM&R, and Neurology (at many programs) all require a preliminary year before you begin specialty-specific training at PGY-2. The critical thing to understand here is that you are applying for your prelim year and your advanced specialty simultaneously, in the same ERAS cycle, and they are treated as two entirely separate applications with two separate rank lists.
Transitional Year (TY) positions are similar to prelim in function — they are one-year positions that serve as a bridge into an advanced specialty — but differ in structure. Where a prelim Surgery year is heavy on the OR and a prelim IM year is heavy on the wards, a TY year is intentionally broad: a mix of internal medicine, surgery, emergency medicine, and elective months. Many applicants going into Radiology, Ophthalmology, and Anesthesia prefer TY positions because they offer more variety and sometimes less call. The tradeoff is that TY spots are limited and competitive, which surprises people who assume a one-year position must be easier to match.
Advanced positions are the PGY-2 through final year spots that require a preliminary or TY year before you can start. When a program lists an “advanced” position in Anesthesiology, they are offering you a guaranteed spot starting at PGY-2 — but you are responsible for securing your own PGY-1 year somewhere else. The Match algorithm will try to align these, but it does not guarantee anything.
The big picture: two applications is not the same as two rank lists on one application
The most fundamental thing to understand about advanced specialties is that “two applications” means exactly that — two completely separate strategic plans, two separate budgets for program fees, two sets of interviews to manage, and two rank lists to submit.
This is why the workload for applicants in specialties like Radiology, Anesthesiology, Ophthalmology, Dermatology, and PM&R is genuinely higher than for categorical applicants. You are not just applying to residency. You are applying to two residencies at once and hoping the algorithm connects them cleanly.
The students who navigate this well are the ones who build both lists with intention from the start — who apply broadly for their PGY-1 year, who research the specific requirements of every advanced program on their list, and who never make assumptions about what “the algorithm will figure out.”
How many programs should you apply to for your PGY-1 year?
This is the question we get most often, and the honest answer is: probably more than feels comfortable.
The general framework we use:
Apply to at least 10-15 prelim/TY programs. Applicants who apply to fewer than that are taking on meaningful risk, especially if their list is geographically concentrated in a competitive region.
TY programs specifically: There are far fewer TY spots nationally than prelim IM spots. In any given year, roughly 1,100–1,200 TY positions are offered across all programs. If you are relying heavily on TY as your PGY-1 path, your list needs to reflect that scarcity. Apply to every TY program within reasonable geographic range before narrowing. Remember – some of the most competitive applicants in the entire match process are all going after these limit spots!
If you land >5 prelim interviews, you are generally safe for the PGY-1 part of Match Day.
If you are applying to any specialty that involves an advanced position, we strongly recommend having someone who has recently been through that exact pathway review your application plan before ERAS opens — not after. The structural decisions you make in the spring and early summer of MS4 set the conditions for everything that happens in the fall.
The information is out there. The problem is that it is scattered, inconsistently explained, and often filtered through people who went through a different version of the process than the one you’re navigating now.
That is exactly what our team is here for!
If you have questions about your position type strategy or want someone to review your full application – including your PS, signals, interview prep, and overall program list, schedule a free strategy call with our team using the link below!
