The U.S. residency transfer process is increasingly formalized but remains fragmented. Residents may transfer due to program dissatisfaction, personal circumstances, or administrative errors. Transfers require mutual agreement between involved programs and approval from the National Residency Matching Program (NRMP). Recent data shows transfer approval rates averaging 20-30%, with 5-7% of residents attempting transfers annually. Transfers often involve rigorous evaluations, including candidate interviews and program reviews, to ensure continuity of care and educational quality. The process is influenced by supply-demand imbalances in specific specialties, such as primary care, where attrition rates exceed 15% post-match.

The complexity stems from regulatory frameworks and institutional priorities. The American Medical Association (AMA) and AAMC emphasize maintaining educational integrity, leading to strict transfer protocols. For example, the 2022 NRMP report noted 4,200 transfer requests, a 15% increase from 2021, driven by rising burnout and mismatched candidate-program expectations. A 2023 AAMC survey revealed 62% of transferring residents cited inadequate training or faculty conflicts as primary reasons. Conversely, programs face liability risks if transfers disrupt patient care, prompting conservative approval stances. The 2023 Medicare Access and CHIP Reauthorization Act (MACRA) amendments aim to improve transparency by mandating standardized transfer documentation, though implementation remains nascent. These factors collectively sustain high attrition costs, estimated at $200 million annually in lost training resources. Addressing systemic inefficiencies remains a priority for stakeholders to align residency education with evolving healthcare demands.