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The Million Dollar Question

Last Updated on June 26, 2022 by Laura Turner

Interview season. The time of year that roads and skies swarm with the best and brightest medical students to all corners of the country taking aim at the next step in their training – residency. Believe it or not, behind the shiny brochures, extravagant dinners and polished powerpoint slides, residency programs are just as nervous about attracting top talent as you are about getting your top choice.
The interview trail is usually a blur of dry cleaning bills, rental cars, and the smell of breath mints masking cheap coffee mixed with nervous sweat. The broken record of the obligatory “strengths and weaknesses” question loops in your head. One of the more terrifying moments in the day comes when an interviewer asks: “What questions do you have for me?” Regardless of who asks it–the intern only four months above you in training or the gatekeeping program director–you know you have to ask something. So why not make it count?
Things like call schedule, orientation timelines, research requirements, away rotations, moonlighting, and meal plans may look important to you on paper, but should not be foundations of choosing one program over another. In fact, the best questions regarding most of these details can not truly be asked until you are in fact already a resident. The proverbial hindsight being of course 20/20. Is a meal plan a perk if the food is terrible? Moonlighting opportunities? Moot point if your paperwork and 45-minute commute are already pushing duty hour restrictions. It is simply not possible to ask an informed question on the specifics of most logistical things before setting foot in the hospital.
The best bang for your buck in this golden opportunity to ask them anything boils down to one “Million-Dollar” question:
Where do the graduates go?
Most programs are proud to tell you, and will have specific data on hand for at least the last 3 to 5 years. Fellowship, small group practice, academic center, private practice, rural areas, urban centers, with program alumni, unemployed, mom’s basement–the nuance in these specifics will speak volumes.
From this data you can easily glean:
• board passing rate
• research requirements
• the reputation of the program over geographic regions
• the reputation of the program in competitive fellowships
• a network of alumni to help with future job placement
• faculty strengths
• procedure exposure
• much, much more
If all graduates of the plastic surgery program you are looking at go into a maxillofacial fellowship at an Ivy League university hospital, and that aligns with your goals, great! You can assume the program has a good reputation, skilled specialty faculty, sound research, strong professional conference participation, and that residents see a heavy maxillofacial caseload. If this is not in tune with your dream of becoming a burn specialist however, you may want to look at programs with a different focus.
You may feel like a specific family medicine program trains the most well-rounded doctors by exposing them to a rural patient population and teaching procedures like colonoscopies and cesarean sections. If on the other hand, you were planning on practicing in an urban area after graduation, those procedures will be lost to specialist. A residency program at a larger training institution might be better suited to your future goals of working as a primary care physician in an urban, specialist-heavy environment.
Variety is paramount here. Private practice, fellowship, rural, urban, hospital setting, outpatient setting, in-state, out of state, etc. A diverse mix of jobs tells us that the graduates leave the program prepared for anything and are competitive in any marketplace.
Free white coats each year? That will run the department a few dollars annually. Free food? Maybe a few thousand dollars over the course of a residency. Daycare? I’ll admit that might be hard to pass up in certain instances. Upon graduation, however, the stakes go up exponentially. Consider the above scenarios: a plastic surgery program can graduate three to four residents annually with average starting salaries in the $300,000 range. A family medicine program can churn out six to eight graduates with starting salaries of about $150,000. Crunch those numbers, and you guessed it: $1,000,000 worth of contracts signed by each graduating class.
Follow all of the usual advice: put your best foot forward, have fun, be yourself, and get ready to talk about the summer research poster you submitted at least 30 times. When the time comes–and it will–remember the “Million Dollar” question, and pay attention to how it either expands or limits the scope of your future practice. Most importantly, envision yourself and your level of future happiness in the scenarios that unfold.