What to Look for When Choosing a Residency

Residency interviews are more like monster job interviews than they are school applications. You’ll spend the better part of a day touring the hospital. You might have a Q&A session, interview with the program director, faculty members, and residents. They’ll ask questions about your CV and your hobbies. They might ask you to present a case, attend rounds, eat lunch with faculty, or participate in a group event. They might even ask you about your personal growth. You’ll be “on” all day, and it may feel like there’s no better way to prep than to be yourself.
What’s more, selecting the right residency program has also become a high-tech experience with video interviews and virtual meet and greets. What hasn’t changed? The matching process is more competitive than ever due to a shortage of residency spots.
This year, 44,853 active applicants vied for 38,494 first-year and 3009 second-year positions, according to the National Resident Matching Program’s Main Residency Match. This left 3,350 medical school grads without a match.
Standing Out in a Shortage
Residency shortages have been an ongoing problem nationwide, said Michelle Poliak-Tunis, MD, program director for the University of Wisconsin-Madison, Madison’s Department of Physical Medicine and Rehabilitation Residency Program.
“There are usually more medical students graduating than there are residency slots,” said Poliak-Tunis, who was chief resident at Johns Hopkins University School of Medicine, Baltimore, in 2009. “The funding for these residency slots comes from Medicare, and the funding flow hasn’t caught up to what we need.”
For instance, Poliak-Tunis says that her program budgeted for three residency slots yearly for several years. This year, she got approval to increase her enrollment to four medical school grads.
“I had to jump through many hurdles to get that person added to our 3-year program,” she said. “At the end of the day, the biggest hurdle was funding, and we had to wait and see if our hospital would fund another slot.”
With these challenges in place, matching with a preferred residency program has become even more high stakes. So, how should students prepare to find a residency program that will fit their career aspirations, and how can they stand out in a sea of slot shortages?
You can prepare by role-playing questions with fellow students. Be ready to answer anything from what drew you to your specialty to personal questions and small talk. Learn everything about the program you’re interviewing for and show how you’d be a good fit.
It turns out that selecting a program involves a mix of solid research, speaking with others about the program you’re interested in, and diving into social media for clues about the place you’ll spend the next several years training.
Fit Matters
As a prospective resident, consider this: Whatever program you match with will be the institution you’ll be working in for the next 6 or so years.
“It’s very difficult to make a life decision like this based on a Zoom call,” Poliak-Tunis said. “You want to be prepared with questions for faculty members who will be your bosses and even other residents who are already working at this hospital.”
The residency phase is a significant portion of your training, too, so you want to match wisely, said Sallie Permar, MD, PhD, chair of pediatrics at Weill Cornell Medicine and NewYork-Presbyterian Hospital in New York City.
“As someone who is just initiating their career and building that network of people you will continue to rely on both as mentors and peers, you want to lean into the gut check of ‘do I feel like these are my people’,” said Permar.
“This is just as important as learning the career opportunities that may come from your residency.”
In addition to your gut, think about how you learn and make sure you’ll learn well at this institution, added Charles Mouton, MD, MS, MBA, provost, and dean of the John Sealy School of Medicine at the University of Texas Medical Branch, Galveston, Texas. “I always encourage students to look at their learning style and consider if this place will facilitate that learning.”
Consider Geography
While it’s essential to research the hospital system you may be joining, geography may trump every decision you make, especially if you have a partner, kids, or family to factor in.
“Applicants will look at a program for the sake of the program, but you need to do some deeper thinking,” said Samuel Sandowski, MD, vice president for medical education at Mount Sinai South Nassau, Oceanside, New York, and professor of family medicine and a professor of medical education at the Icahn School of Medicine at Mount Sinai in New York City.
“For most residents, it makes sense to do your training and stick around as opposed to, say, training in Georgia and then looking for a place to work in Idaho.”
That’s why doing intensive research about the town, its surrounding cities, or the rural areas you’ll be in while training matters as much as the program’s assets. “You want to think about whether this is a place you would want to settle into and start your career,” Sandowski said.
Search Residency Programs and Their Social Media
There are plenty of online sources of information to help prospective residents decide on a residency program. Doximity allows you to search for programs by specialty, state, size, reputation, and research output, and Freida, which is an American Medical Association platform, enables you to search for a residency or fellowship from more than 13,000 programs, all of which are accredited by the Accreditation Council for Graduate Medical Education.
Social media plays a vital role in a residency program’s marketing, too.
“If you had asked me 6 years ago if we were going to have Instagram and Twitter accounts, I would have wondered why,” said Poliak-Tunis. “Now we have all of them so that prospective medical students can get to know our program outside of the rectangles on Zoom or Webex.”
And, if you notice a preponderance of bad reviews about a particular program, pay attention.
“When stuff gets on social media, some of that misinformation is hard to overcome, and those posts can hurt the institution for one or two residency cycles,” Mouton said. “Ultimately, programs can enhance their reputation by the success of their graduates. That’s why it should be every program’s goal to make sure they offer excellent training and that every graduate is successful.”
Investigate a Residency’s Career Prep
In the end, choosing a residency comes down to finding a program that will offer the best preparation for the profession possible, Permar told Medscape Medical News.
“The most important advice I would give is that you should make sure you will be getting patient care experience, seeing many different disease processes, and learning how they can be prevented or modified through therapy,” she said.
And, while you’ll get that at many different programs, the icing on the cake will hopefully be robust internship opportunities and support for you to build on a passion that you can focus on throughout your career.
“There are programs that focus on community and advocacy, quality improvement, research, or all of the above,” Permar said. “Yes, you want to focus on patient care and interactions, but you also want to focus on a breadth and depth of experience. If you can find a residency program that offers all of this, the entire future of your career will benefit, and your patients will benefit from your experience, too.”
Lambeth Hochwald is a New York City–based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.
 
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