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7 Key Aspects of Selecting a Residency

posted Mar 31, 2016, 1:10 PM by Explore More   [ updated Apr 1, 2016, 6:50 AM ]
Author:  Jackie Weaver - Agostoni, DO, MPH, FACOFP

Selecting a residency program can be daunting. However, you should be able to narrow your search by considering a few key points. That being said, these are generalizations and you shouldn’t assume that all of a certain program type are created equal.

There are excellent small and large residencies, rural and urban, opposed
and unopposed. . .well you get the idea. 
These are things to take into consideration though as you look:

  1. Location - Urban vs. Rural: Both have advantages and disadvantages. Some of this may depend on where you see yourself practicing when you’re all done. It is possible to train somewhere more urban, and then work somewhere rural when you’re done. But sometimes it takes a little extra effort on your and the program’s part to be sure that you’re prepared for the potential lack of specialists and imaging modalities.

    If this might be you, find out what the program’s graduates are doing when they finish. If no one has ever graduated from the program and gone to work somewhere more rural then that may not be the program for you.

    Sometimes an urban setting allows you to see more acuity of care since tertiary care centers can manage their own heart attack and stroke patients, but you won’t necessarily get training in some procedures, like vasectomies, that are taught in more rural training settings.

    The diversity of the patient panel is also something that can vary between rural and urban settings.

  2. Size of Program: Are you looking for a 4-4-4 or a 12-12-12 program? Smaller can be more intimate, but it can also be more stressful if you are expected to do more of the coverage of services and/or call. Larger can mean more colleagues, but you don’t necessarily know them as well.

  3. Opposed or Unopposed: It’s a very common question during interview season. There are often a lot of misconceptions about this, and I would like to clarify a few things.

    Opposed means that there are other trainees at your training site, the theory being that if you’re competing with others for education, you won’t get as good of one. This may, or may not, be true. Programs that are unopposed in their own institution may still be opposed in other settings if they have to do certain rotations in other hospitals.

    As an example, if the residency has you do your pediatrics and OB rotations at outside hospitals, which is becoming increasingly the case, you may still be working alongside Pediatric and OB Residents.

    It just depends on how they have the experience set up if you are going to get a good, or sub-par, experience.

    In my personal experience, I wanted an opposed program. I thought that more of the staff/physicians were interested in teaching me because they were so used to having students around. I never competed for experience because I was in a large hospital that had tons of patients. Again, this isn’t always true, but it was my experience.

    Take it for what it’s worth. I am currently in an opposed program (with Internal Medicine being the other program), however, we are functionally unopposed.

    They admit their patients, and we admit ours. We share the patients who don’t have doctors, and the only time we work with them is in the ICU when they are the Senior, and FM is the intern. We all get along, and with a 520 bed hospital, there are plenty of patients to go around!

  4. Personality: Take into account the personalities of not only of the faculty and residents who work there, but also of the program itself.

    Is it friendly or intimidating? Is it informal with everybody running around calling each other by their first names, or is it more formal with everyone referring to each other as “Doctor” and wearing their white coats?

    Don’t assume that “relaxed” programs are less academically rigorous, or vice versa. Look at the curriculum and draw your own conclusions. If you thrive in a pimping-type of situation, go for it!

  5. Specialty Tracks: Some programs offer specialty tracks. These can be anything from Global Health and HIV training to Wilderness Health or Urban Underserved Care. If you have a special passion, see if any programs offer any special training in that area.

    In the same respect, just because a program has a track doesn’t mean that it has to be robust.

    Check multiple programs and compare what their “track” really means to your education. Getting to go global once during residency training may be what they offer, as opposed to getting to go each year of your training. Either one may be what you’re looking for, but it’s nice to know that you have options.

  6. Benefits: So, of course, this matters. You don’t want to be a starving family medicine resident for the next three years of your life. Most programs offer decent benefits, so this isn’t typically a deal-breaker, and you should take your cost of living into account when comparing benefits.

  7. Stability: You’re going to want to be able to finish your residency where you start it. Be sure that they are in good standing with all of their accrediting bodies.

    It is a good idea to find out how they adapt to change for any new rules that get put into place.

    Ask do residents get input, or is the decision made solely by the Program Director(s)?
    Do they re-evaluate new processes, or are you stuck with the new plan?
    How long does it take for them to adapt?
    The other stability factor to consider is how often the faculty change jobs. When faculty members are happy, they tend to stay for a while.  Happy faculty generally makes for happy residents.

Good luck on your hunt for the perfect family medicine residency for you, and BE HAPPY!