Compared to medical school admissions, how hard is it to get into a residency program?

Some residencies are indeed highly competitive, but the matching system takes away a lot of the pain. And about 95% of graduates do match. Compared to the roughly fifty-fifty proposition of acceptance into medical school, that should be a pretty soothing number. I didn't do loans, opting instead for indentured servitude (a military "scholarship").

The problem with looking at statistics regarding med school and residency applications is that you cannot assume that any two applicants are roughly the same, and the "likelihood" of whether or not they get in can be compared.

In fact, one "star" applicant to medical school may get many acceptances, while many applicants get one or no acceptances.

Nevertheless, here are some REAL numbers.

Based on the 2007 data, there were 42,315 US citizens who applied to  allopathic American medical schools (the ones that are members of the AAMC, the Association of American Medical Colleges).  Of those,  11,030 were accepted into and started in medical schools within their home state, while 6729 entered schools out-of-state.  That's a total of 17,759 or 42% that got in.  24,556 (58%) of US born/educated applicants did not get in.

The data for residency matching is a bit more complex, because it includes people who are just finishing med school, people who finished in the past, and people who trained both inside and out of the US.  US citizens and non-citizens are subcategorized as well as MD's and DO's.  

For the 2008 residency match, 28,737 applicants competed for the 22,240 first year positions and 2,826 second year match positions. Of these, 15,242 were US allopathic medical school seniors.

There are large differences in the total number of residency positions between the different medical specialties.  There are also large differences in the number of applicants seeking these different positions.  Some specialties are not particularly difficult to compete for and others are exceptionally competitive.

Some examples from my reading of the 2008 NRMP "match" data follow below.

Family Medicine:

Family Medicine is a specialty requiring a 3 year residency.  There are 455 training programs in the US with a total of 2636 positions for interns each year.  Of those, 105 of the programs did NOT fill all of their slots.  2387 of these slots were filled in the 2008 match, and of those, only 1156 (43.9%) were occupied by US medical school seniors, out of the 1303 who applied.  The rest were apparently foreign medical school graduates.

Family Medicine is apparently not excessively competitive.  An acceptable graduate from a US medical school stands an excellent chance of being able to get into the Family Medicine training program of their choice.

On the other hand, General Surgery:

There are 241 General Surgery residency training programs across the country with 1069 slots available for new interns who intend to progress through the 5 years (or more) of training.  In 2008, 1 (one) of those programs did not fill completely on the first pass leaving 2 jobs open which were snapped up the day after the match.  2115 total applicants to surgery are noted, and of the 1067 applicants that matched to surgery residency, 888 (83.1%) were US medical school seniors out of the 1161 who applied.


The bottom line is that about 42% of US college students applying to medical school were able to get in.  Meanwhile, 89% of US medical school seniors who wanted to get into Family Medicine were able to do so, while about 76% of those who wanted to go into surgery were able to do so.

People generally pick out an area for residency applications that they have a decent shot at.  The poorly competitive med student will not likely try to apply for a highly competitive residency training program.  For this reason, the residency applications process is less impacted by the sheer numbers of applications that medical schools deal with.

I hope that helps answer your question.

Depends which residencies, internal medicine and family practice, for instance, are very easy (though individual programs may be tough, finding a residency in those areas is pretty much a guarantee) - but others such as dermatology and radiology are extremely competitive and difficult.
Pay for a residency is generally around 40-60k a year, so pretty much nobody pays off their debt during that time, it takes most doctors many years of working as an attending (and earning 6 figures) to pay off their medical school debt, especially if they acquire new debt, like a mortgage, in the meantime.