Thanksgiving? Sure. Christmas? That too. But for thousands of fourth-year medical students and foreign medical graduates all over the United States, fall through early winter is a time of job hunting — interviewing for residencies. This is a critical step in our training, where we specialize in the individual fields of medicine that will carry us through our careers.
The residency hunt is no small task.
Where we match can have a profound impact on our lives, and on the communities where we learn. It’s a steady address for the next three to seven years, if not for an entire career. It’s building relationships with other doctors that can last a lifetime. It’s the day-to-day experience that molds us into doctors we want to be.
I interviewed at 14 places, asking some questions, but wishing I’d asked others. From quality of the training, to family practicalities, to gut feelings, many factors influenced my decision. But, well into my second year of residency at Cambridge Health Alliance, I can say with certainty that I made the right choice for me.
So, while you crisscross the country in search of your match, let me offer these tips to help you make the right choice for yourself.
You’re going to be living in this new city or town for at least three or four years, so ask current residents what they do for fun, or where their favorite places to go are. I interviewed at few programs where when I asked what made the community great, a common answer was the distance to the airport or the nearest city. If the best thing about a place is how easy it is to leave, regardless of how good the program is, you might want to rethink it.
Some of the best medical programs in the U.S. place a lower emphasis on some specialties than others (remember when Columbia University/New York Presbyterian tried to do away with their family medicine program?) Ask the people you are interviewing with how the hospital system regards the specialty. Pay attention to what you see while you are in the hospital. I’d heard of hospitals that viewed psychiatry services as a dumping ground for difficult patients. Wanting to specialize in psychiatry, I wasn’t interested in being undervalued from the get-go.
Ask the faculty who are interviewing you how long they’ve been at the hospital. Try to find out what the turnover situation is like, or read up on any recent shakeups in administration or higher-level faculty. I interviewed for one residency at a place where nearly everyone was new and could barely answer my most basic questions about the program. It raised a lot of red flags for me that mentors I might come to rely on might, poof, be gone one day. I also wanted to be somewhere where the program and staff were established. I went to a medical school that was trying to revamp its curriculum, and I was not interested in going through that process ever again.
Grey’s Anatomy is a great show. But, in real life, you need to run, and fast, from any program that shows any resemblance to the chaos, the drama, the competition, and the backbiting of Grey Sloan Memorial Hospital. Residency is too hard to forego camaraderie: One day last year, my senior resident and I were in tears, hugging. A patient had died suddenly, and we were supporting each other through that trauma, and that support was and is so important to me. Observe and ask about teamwork and team-building. You’ll need your team more than you know.
While interviewing, ask how often trainees fail to progress from one year to the next. If it happens too frequently, the program may not be recruiting top-notch applicants. On the flip side, it can also mean that the teaching and feedback may not be up to par. Also, ask how often trainees leave the program. And why? If it’s for anything other than family issues, you might be seeing what happens when environment doesn’t matter.
On those days when you feel alone, or when you need help, how will your program support you? Does it facilitate access to mental health providers? While interviewing, ask current residents: What happens when people get sick? How does it manage absences, like for maternity leave? Some programs are proactive in helping residents plan around these events. Others just divide up the work and dump it on the other residents. Done routinely, that could lead to resentment.
Does the program fill up every year? Match is a numbers game, so sometimes when a program goes unfilled, it’s often a fluke. But if this has happened a handful of times in the past few years, the program may be selling something applicants don’t want to buy, and you may want to ask why other applicants are not ranking it very high. It could be an undesirable location, a killer call schedule, or a comparatively lower salary than geographically similar programs. Or there could be rumors of financial trouble in the hospital or a shuffling in administration. When a program doesn’t fill the positions available, each person may need to carry a heavier workload. It’s worth finding out.
Does your program play by the Accreditation Council for Graduate Medical Education rules? Or does it do things like totally disregard duty-hour limits? Probation carries the risk that your program may lose its accreditation and your program may get shut down. If a program is on probation, be sure to ask why. Is the program open about the violations and enthusiastic about remediating them? If not, you may want to say no, or at least rank it lower on your list.
You might have a specific institution in mind — the highest, most prestigious place you can get to. And during your interview, you may be working your tail off to make the best impression on the director, the faculty, and the current residents. But take a step back, and look around: What makes these people happy? What are their values, not just as doctors, but people? I’m not saying that your love of poetry will clash with a program that prides itself on its after-hours basketball team, but if it’s going to be hard work to find your niche or your sources of happiness at that dream institution, that may be one thing too many to manage during this pivotal part of your career.
Interviewing for residency, ranking your favorites, and then waiting for the match is exciting and agonizing, all at the same time. We all have different reasons why we reach out to the programs we do, and I think it’s easy to go in, hoping you’ll sell yourself well, and forget that the program has to also sell itself to you. You might feel like you can’t, or shouldn’t ask questions, that you might be taken negatively. But you have to.
Residency doesn’t last forever, but the next three to seven years of your life can feel like forever if you end up in the wrong program. After each interview, take a few notes to remember how you felt and the things you would most look forward to if you were to match at the program.
One thing to consider is whether any program you are interested in will allow you to become the best version of yourself. For the many years you’ll be there, will the program support your individual strengths or is it just looking for worker bees? I interviewed with one chief resident at a program who was impressed with my writing, which is an important part of who I am. But when he wondered if I’d be able to keep that interest alive as a resident in that program, I knew that place wouldn’t be right for me.
I matched at CHA, and for me, it was the best fit. I entered a system that values psychiatry, treats residents well, and allows us to collectively bargain through our resident union. After years of a long-distance relationship, the Boston area was one of the places where my husband and I could both call home.
And I’ve realized, with experience after experience, that I trust my co-residents, my attendings, and the nurses and support staff who I learn from every day. We look out for each other. We care for each other. Whatever our beliefs, we strive every day to be empathetic, understanding, and with our patients in pursuing their treatment goals.
You’re going to be spending at least 80 hours per week with these people for the next several years, if not longer. My mother is a doctor, and her co-residents, decades later, are still part of our lives. A friend of mine finished his obstetrics-gynecology residency, and he and his cohort all got matching tattoos. It’s really that serious. Be empowered and bold to build the physician family who is best for you.
Jennifer Adaeze Okwerekwu is a psychiatry resident and can be reached on Twitter @JenniferAdaeze. She writes the Off the Charts column in STAT News, where this article originally appeared.
Image credit: Shutterstock.com