choosing a residency--house staff, faculty, or patients? or...

Of course bearing no relationship to any specific questions raised by my current search for internal medicine residency programs, but only as a completely abstract concern, I want to pose a question to the MD group:

if you had to choose one factor to determine your choice of programs, would it be:

the house staff you like the best?

the faculty you thought were the best educators?

the patient population that most matched your future goals?

or something else (say, location)?

and why?

and if you’re really game, beyond your first choice of factors, how would you rank the other factors?


Joe, I’m not sure I can rank those various features - they all weigh into the equation in some way. What you’re looking for is an overall sense of where you think you’d most like to be, because you’re going to be there for three years and you want to be happy wherever you are.

So the patient base certainly is a factor – are you going to be able to spend time helping the sorts of people that you envision treating once you’re out of residency? The house staff is a big factor – do the senior residents strike you as the sort of people you want to spend a LOT of time with? Attendings involved with the program – are they interested in you and in helping you to further your goals? Finally, the place – is the job environment one that you can imagine living with for up to eighty hours a week? (I liked that my hospital had great ancillary staff and that I wasn’t going to be called on to start IVs or draw labs.) And OUTSIDE the job, is it a place that appeals to you and that gives you opportunities to broaden your horizons and enjoy life outside of medicine – without having to expend precious time or $$ to do so? (For example, if you’ve got Saturday off, and you’re dying to get away, is there anywhere worthwhile to go for the day?)

I think Iserson’s book has a scorecard of sorts where you can rank all sorts of features of a residency program; these things you’ve listed, and more, are on that scorecard.

But I gotta say that I think the bottom line is to explore how you’ll feel in that environment for three or more years. Beware of thoughts like, “Well the program is great, the residents were fantastic and it sounds like the attendings are top-notch, plus the patient opportunities sound perfect for me. I just wish it wasn’t in BumF— Idaho.” (No offense to the good citizens of BumF— Idaho intended, of course.)

Just as in med school, you can make what you want out of your residency experience to some extent (and that’s something I’d spend time finding out about - elective time, research time, how much structure, how much freedom). So I would rank location, location, location above all the various specific program features.


excited for you that you’re at this point!

For me the top choice would be the education factor…where would I get the best training. The other factors you listed are also important but none more than the quality of the education.

The difficulty is in truly determining the quality of the training. In my experience on the interview trail most of the residents in a program say the training is good but in reality they have no way to compare it to another program since most have only trained at that one program.

Mary–thanks for your reply. I think location is really important too–and now that I think about it, I must agree with your prioritization of this because that decision has already been made–we simply didn’t apply to programs in places we didn’t want to live. (There are none on the list more than 30 miles from an ocean, for example–a prerequisite for my happiness, at least.) And I am couples-matching, so it’s a decision we are making together. Whether we want to live in each of these places equally is hard to say, especially as a pair with slightly different individual preferences about cities. And the program issues are complicated by the challenges of the couples-match–it has to be a city which we both like, with a combination of programs good for both of us. But anyway, all of that made the list a lot smaller right off, even before we got to the interview stage.

  • mpp Said:
The difficulty is in truly determining the quality of the training. In my experience on the interview trail most of the residents in a program say the training is good but in reality they have no way to compare it to another program since most have only trained at that one program.

Exactly! The residents all say "We like to have fun" and "We have some great faculty" and "We get a lot of good clinical exposure"--there are things that everyone says because how could they go on if they didn't believe that they'd ended up somewhere basically OK? (It would be a very depressed and bitter resident who was so frustrated as to drop applicant-clearing neutron bombs like "Our faculty are cruel and stupid" or "I'm surprised we haven't had any suicides yet.") It seems like understanding what people are saying comes from listening to the nuances of positive statements: "Our faculty are amazing, across the board" versus "We have some great teachers and when they get the time to work with you it makes it all worth it" or "Every resident here is incredibly smart" versus, "Of course there's a range, but our strongest residents would compete with anyone" etc.

Maybe I'm asking something more like, which of these factors makes you happiest and most excited about learning on a day-to-day basis? And I understand that these questions are mostly unanswerable and that at the end of the day the rank list will probably all boil down to some combination of spidey sense and practical concerns of couples-match logistics.

By the way, my own doctor responded to this question in a more future-oriented way, by saying: "Faculty. They're the ones who will find you your next job."

  • Quote:
Maybe I'm asking something more like, which of these factors makes you happiest and most excited about learning on a day-to-day basis?

I agree, impossible to answer. There will always be good and bad days where ever you are. I try not to let other people or things out of my control dictate my state of well-being; a lesson learned after many years of unhappiness. It takes a lot to make me unhappy; disappointed & frustrated at times maybe, but rarely unhappy.

The gut feeling/spidey sense is worth a lot. It tends to incorporate a lot of intangibles that you can't necessarily write out on a Pro/Con list.

Howdy y’all!

Joe, good luck with your rank list and the match. I remember what a gut wrenching experience putting that list together was.

You can do what I did and create a huge and overly complicated spreadsheet that tried to factor as many elements as possible into a decision matrix and come up with a rank list. This way it is ‘objective’.

If you do this, you’ll likely find, as I did, that it is unsatisfying. In the end, I admired my spreadsheet and then made my rank list based on nothing more that my gut instinct. It turns out my gut was pretty accurate. I suspect your’s will be, too.

Again, good luck. This is an exciting time. Enjoy it.

Take care,


Thanks Jeff. Yes, as I come closer to making a list, doing revisits, etc etc, it’s coming down to one or two practical concerns weighted against my gut. No spreadsheet necessary, I hope. The problem is that different parts of my gut (my duodenum vs my ascending colon? not sure) seem to say different things–responding to program directors, hospitals, outpatient clinics, housestaff, logos on the ID lanyards, nursing ratios and who knows what else. Then there’s my honey’s choices to be factored in… In sum, much worrying and hair-pulling and teeth-gnashing to be done, about a set of options which actually all seem to be variations on probably just fine. I still have nightmares about not matching, but towards the end of the primary care interview season it’s starting to genuinely feel like a buyer’s market instead of a seller’s market, which makes the end of the season a lot more pleasant than the beginning. I have never been so pleased that dermatology and the like never caught my interest.




I would add the quality of the ancillary staff. You can be with the best faculty in the world and it does not matter if you spend your days trying to get (even beg sometimes) others to do their job. In this environment you never get to reap the benefits of being with great faculty members.

For me, the list of places I applied to was determined by location. My question about the ancillary staff was one I asked at every interview. Then it came down to the residents and how I felt about them. The odd thing is in neuro, you only will ever be around the PGY-2s that you meet because they will be your PGY-4s. But I felt that the programs recruited people with similar personalities.

I felt that when ranking programs I could easily place them into tiers, then within each tier it was how I felt about the residents and how my hubby felt about the city. I remember agonizing over my rank lists (pre-lim and neuro).

Good luck,