How to go about picking a residency?

This is my 4th year and I have been busily doing all the things one does to apply for residency. Thought I’d share some of what I’ve picked up along the journey.

First, during late 3rd year (spring) I started working to set up subinternships at the residency programs I was interested in. I’m planning to do family medicine. So first I had to research residencies.

One way I did that was attending “Hospital Day” at my medical school in the 1st, 2nd, and 3rd year. By 3rd year, I already had a short list of programs I was interested in. This is an event organized by my med school (and many schools do this) with representatives from various regional residency programs (and some not-so-regional). I visited the table of every family medicine residency and asked questions.

  1. Is it unopposed? - if there are no other residency programs at that site, the family medicine residents may get to do more in terms of procedures in ER, Surgery, OB, etc. On the other hand, a program at a big academic medical center with fellows in lots of specialties might offer a rich learning environment. For me personally, as I’m planning to do rural family med and have many years of experience in the healthcare field, I was looking for an unopposed program.

  2. How is it accredited? I’m a DO student, and residency programs are either AOA accredited (DO residencies), ACGME accredited (MD residencies) , or dually accredited. As a DO student I can apply to ACGME programs, but they are more likely to want me to have taken USMLE’s in addition to COMLEX (which are the step exams I’m required to take in DO school). Dually accredited programs are more familiar with evaluating candidates using the COMLEX scores so it is less of an issue. I did NOT choose to take USMLE’s, but if I had wanted to go into a specialty with few AOA or dually accredited programs, I would have started my planning earlier and done USMLE’s also.

    I choose to apply primarily to dually accredited programs for 2 reasons.

    a) a faculty mentor suggested it because he felt that having to meet both sets of accreditation criteria result in a more rigorous program (you do end up with a few less electives)

    b) I want to continue to develop my OMT (osteopathic manipulative medicine) skills, so I was looking for a program that met continuing ed requirements in OMT as part of their residency training.

  3. What sort of pediatric experience/ ob experience is offered?

    The same faculty mentor suggested scrutinizing the peds component heavily because he stated that this is a weakness in many programs. Look at number of weeks of peds in the 3 years and the settings, and whether there is any inpatient experience. Also, I’m wanting to do at least vaginal deliveries/prenatal when I get out, so was looking for an “ob heavy” program, which is rarer on the East Coast.

    Whatever specialty you are looking into, there may be training opportunities you hope are included - interventional cardiology, laser or robotic surgery - whatever.

  4. What do the current residents think of it? - this is the huge advantage of “hospital day” --usually the residency brings along some of their residents. They will tell you probably a “sanitized” version of their experience, but one can get a feel for the program. Are they happy? Do they feel there is an appropriate progression of responsibility in the program? Do they have adequate “back-up” in the intern year? How is the community to live in? which brings us to …

  5. Location - what is the setting. Is it a big or small community hospital? Is it an urban, suburban, or rural community? Where is it?

    These were the major things I used in my initial research.

    Then there are the on-line tools to search programs:

    for AOA accredited programs. This site will also tell you if they are dually accredited. THere is a wealth of information about each program, including salary, call schedule, vacation days/year, CME days, etc. Also one can then go to the website for the program and find out their schedule and lots more.

    The search engine for ACGME accredited residencies is “Freida”: You do need to create an account.

    Staying in the eastern US was important to me, so I used location to search programs in neighboring states. There are so many family practice residencies that this helped decrease the total number I looked at markedly. I also had met representatives from or heard about residencies in some more remote locales, so I looked them up specifically by their websites.

    Pluses were:

    block scheduled night call - I’ve worked as a nurse for many years, and repeated nights are much easier than switching back and forth from day to night shift.

    more weeks of peds or inpatient peds

    At least 99 beds in the hospitals they were affiliated with

    More rural location

    Generous CME time/money.

    A few places had a housing allowance or actual free housing for residents. Most had moving allowances.

    Step three was informal information-gathering. Talked with my preceptors about where they did residency, what they liked about it, what they didn’t like. Tried to talk with someone who had gone thru residencies I was starting to put on my “A” list.

    One of the local residency programs I was looking at had produced 4 of the preceptors I worked with, all of whom spoke highly about the training they received. But two of them (half) suggested it was not as good as it had been, because many doctors with decades of experience were no longer there, and the current faculty were almost all recent graduates from residency themselves. This added a new criteria to my list - asking “how long have you taught here” to my questions of residency faculty. If I’m supposed to learn from the experience of my attendings, it would be helpful if they had a RICH experience.

    From these activities, I found 4 or 5 programs I was most interested in and scheduled 4th year rotations there. I ended up applying to 12 programs. 1 solely ACGME accredited, 2 solely AOA accredited, and 9 dually accredited. They span 5 states. Most are rural, a few are more urban. All but 2 are unopposed. I got 9 interviews. Still working my way thru those. I have one more “audition” rotation to attend, for which I am leaving tomorrow. However, one of the programs I visited only for the interview has unexpectedly risen to the top of my list. Have decided unequivocably that this is where I want to do my internship.

    One of the factors is that it is well-organized. This may not seem of supreme importance, but one program I rotated at was NOT well organized. The residents had to cover multiple sites and often were scheduled for 28 hours straight in their 2nd and 3rd year, and then had responsibilites when they should have 8 hours sleep, because training had been scheduled for their post-call day. They then had to reschedule this and it had a cascade effect on the subsequent schedule. Yeah, could live without the hassle.

    Something else to ask oneself when visiting a program is, what are the other residents like? The residency program will tend to select people like they DO select --do you feel you fit in well with the residents already there? Can you see yourself being part of their team? That’s a positive sign.

    That’s it for now. Stuff to think about, 3rd years!!! Just remember the Hitchhiker’s Guide to the Galaxy…with “Don’t Panic” in large, friendly letters on the cover…


Thanks Kate