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choosing a residency

Choosing a Residency That’s Right for You

Created June 6, 2016 by Brian Wu
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If you are in medical school, you have been making choices for a long time now, from what to major in as an undergraduate to what volunteer work during your gap year will give you the best chances at getting a coveted med school slot. But now that you are in medical school, one of the most important decisions still lies ahead: what kind of residency should you choose? This is an incredibly important choice that will shape the rest of your career. A good decision now will make it more likely that you will be satisfied with your professional life down the road.

The choice can be a difficult one. What things should you consider before you decide? Read on to find out more about the steps you should take in order to match to a residency that will leave you both personally and professionally satisfied.

Location, Location, Location
The location of your residency should be compatible with your lifestyle (and your family’s lifestyle if you are married or have children). If you are an urbanite, for instance, and used to life in the big city, then choosing a residency in a smaller, more rural location might not be the right for you. If you have family members in the particular state or region that you are close to, then finding a residency that will allow you to stay close is probably important. If you have school-aged children, moving to an area with a good school system will also likely be factored into your choice. Other aspects to consider include the climate, cost of living, and availability of parks, museums, restaurants and other amenities that are important to you and your family.

Know What the Specialities are Really Like
Chances are, you won’t fully understand what a specialty is like on a day to day basis until you are actually a practicing physician. But that doesn’t mean you can’t do your homework. Dig into databases like the one maintained by the American Association of Medical Colleges (AAMC), which lists over 120 speciality areas to consider, from anesthesiology and dermatology to pediatric orthopedics and vascular surgery. Each section details important information on things like salary, whether or not the speciality is heavily procedure-based, what the general age and gender of your patients will be, and what kind of setting you will work in (e.g. inpatient or outpatient; urban or rural).

Regarding salary, however, it is important to understand that recent changes in healthcare–such as the passage of the Affordable Care Act–can have a large impact on how much physicians are reimbursed for different procedures. Information that is up-to-date now might not remain so by the time you complete your residency.

Make it a Good Fit
Understanding as much as you can about a specialty area is important, because it will allow you to determine more accurately if a residency will fit with your personality, professional and personal life goals, as well as your values and interests. These may be harder to nail down than things like salary or the nature of the work, but they are just as important to your overall job satisfaction later in your career. This isn’t always something that students consider when they choose a speciality–and as Kaplan notes, that might explain why as many as 10% of first year residents wind up changing their speciality.

Also, it’s not just personality, values and goals that you should be considering, but also your previous work, clinical and research experience; the more you have of this to begin with, the easier the transition to your residency might be.

The AAMC website also has a Land Your Residency page which offers a database of possible programs to choose from and, even better, allows you to take a preference test which can help match your traits, experiences, likes and dislikes up with a residency that will work for you.

(Editor’s Note: The Student Doctor Network Specialty Selector can also be helpful here!)

Narrow Down Your Choices
Once you have all these factors, you can start looking at and applying for residencies that best fit the profile you have built up. Keep in mind, however, that no fit will ever be perfect. Again, the Land Your Residence page on the AAMC site gives you a great tool to rank your residencies by preference and keep track of the ones you are interested in.

As you narrow down these choices, several practical considerations will arise, such as expense of airfare to different locations across the country where you may travel to interview or tour a program. Another factor to consider is that fact that some residencies are more competitive than others, and this will affect the number of programs to which you apply. For instance, Kaplan estimates that you might have to do as many as 35 applications to get 5-6 interviews for competitive residencies, while for less competitive programs, you might do as few as 20 applications and get offers for 12-14 interviews. This will vary greatly.

Get to Know the Specific Residency to Which You are Applying
Once you have an idea of what specific residencies you would like to apply to, do your homework and don’t be afraid to dig deep. Don’t stop with the size, location and other basic parameters of the program. Find out about the academic backgrounds and research interests of the various faculty members. Be sure, if you can financially afford to do so, to visit the program, not only to interview, but also to talk to current residents in the program. What is their overall level of satisfaction with the program? What is the workload at the hospital, and how much academic work/research is expected in addition to clinical duties? Where do the residents go once they graduate? Is it expected that you will pursue a fellowship upon finishing residency, or do most graduates go directly into practice? Getting answers to questions like these can give you the information you need to decide if a specific residency is right for you.

Leave a Little Room for Instinct
Dr. Michael Richardson, writing on KevinMD.com, notes, “As each program presented itself in the best possible light, I had to rely heavily on my gut during the interviews….In residency, we will be pushed to our limits, given new responsibility and eventually find our place in the medical world. We all have our lists of what we want out of program, but our gut may not agree.”

It is also good to remember that, as important as this decision is, you shouldn’t overthink it. After all, if you get into a residency that is not a good fit for you, it is possible to change. However, these changes usually do not come without expending time and resources. It can be disruptive to switch from one program to another, and in order to practice some forms of medicine, such as family medicine, your second and third year of training must take place in the same program.

In order to avoid these issues to begin with, make sure you put plenty of thought and effort into your decision making process: while it may seem tedious and time-consuming now, a good deal of research and plain old-fashioned soul-searching today can save a lot of difficulties in the future.

References
Choose Your Speciality. American Association of Medical Colleges. 2016.
https://www.aamc.org/cim/specialty/

Choosing the Right Medical Residency Specialty. Kaplan. 2012.
www.kaptest.com/blog/residency-secrets/2012/08/14/choosing-the-right-medical-residency-specialty.

Gottlieb, A. How Should I Choose a Residency Program? Medscape. 2006.
www.medscape.com/viewarticle/548628

How to Choose (and Get Into) the Residency that is Right for You. Waco, TX Family Medicine
Residency Program. 2015.
www.residency.wacofhc.org/choosing-a-residency

Richardson, M. Choosing a Perfect Residency: What Goes into a Rank List. KevinMD.com
2014.
http://www.kevinmd.com/blog/2014/03/choosing-perfect-residency-rank-list.html

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