Choosing a perfect residency: What goes into a rank list

What do you do when your ideal residency program does not exist?  This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception.  I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what my top program was going to be. These criteria were supposed to outline a clear rank list, but by the end of my interview trail, all the programs were dead even.  After consulting with many mentors, friends, and family, my rank list relied on three fundamental rules: happiness, beer, and my gut.

Happiness and residency training are anything but synonyms, but their compatibility should absolutely play a role in deciding one’s residency program.  While on the interview trail, I met residents who were brimming with pride about their program, excited to share their passion and show how their program was helping them achieve their goals.  Their enthusiasm was contagious, and I could tell their program put residents’ needs first.

However, I also encountered residents who looked like they were just defrosted from the morgue and could benefit from a blood transfusion.  Instead of passion, I was greeted with fatigue and disinterest.  Sure medical residency is a time-intensive, demanding, and life-altering experience, but it is not unreasonable to believe that you deserve to be happy throughout the process.  Even if a program met my preconceived notion of “ideal,” if the residents looked like extras from the Walking Dead, that program quickly fell to the bottom of my rank list.

Beer has been scientifically linked to improved cardiac health, blood pressure, and stroke prevention, and, believe it or not, can serve as a great aid in deciding on a residency program.  One of my mentors shared with me a great pearl known as the beer rule. The beer rule asks one simple question: Can you see yourself having a beer with your fellow residents?  All of the residents I met on the interview trail were incredibly nice and respectful, but at certain programs I struggled to generate a conversation with some of them.  Then there were programs where I felt an immediate connection with the residents, as if we had been friends for years. Residency training is akin to being on a battlefield, and your fellow residents are your comrades in arms. They help you with tough medical decisions, have your back when you are swamped with work, and when you are down, they remind you that you do deserve to be a doctor.  If you feel that you cannot bond with your fellow residents after work over the beverage of your choice, then what will it be like to work with them?

Happiness and the beer rule are great for sorting out one’s rank list, but applicants can easily fool themselves into thinking they would be happy at a program that they know deep down is not a good fit.  Malcolm Gladwell in his book Blink wrote about how our gut feeling can channel the power of our unconscious and instinctively analyze a situation before our conscious mind has a chance to grasp the situation. As each program presented itself in the best possible light, I had to rely heavily on my gut during my interviews. Most importantly, my gut gave me an edge over the one who tried to fool me the most: myself.

When I made my initial rank list, something felt off. My top program met all my requirements, fulfilled the beer rule, and looked like a place I could be happy. I even vetted my list with many mentors and colleagues who all approved, but deep down, I had a different number one.  After a long internal debate, I realized what my gut was feeling.

The program that was truly my number one made me excited to be a doctor.  When I first applied to medical school, it was in the midst of the health care debate and no one knew what the future of medicine was going to be. This was an incredibly exciting time as I was ready to enter this new world of medicine and be a part of this great change in health care. I wanted to be that doctor who revolutionized how we serve our patients and redefine what it means to be a doctor.

Unfortunately, my original passion dissipated as I struggled to keep pace with an overwhelming medical curriculum and began to see the countless cracks in our health care system.  I was disheartened with the current state of affairs and thought real change was not possible, until I met with one program who’s inception was to challenge how we approach health care and residency training. The attendings were leaders in their field, determined to make a change, and their dedication to medical training invigorated me to enter intern year with new fervor. This program reminded me why I chose to be a doctor and made me feel that anything was possible. This new criterion that was taking shape — that the program must make me excited and confident about being a resident — was one I never considered before, but my gut was telling me that it was the defining feature of my rank list.

Choosing a residency program is so daunting because it signifies the next important step in our medical career.  In residency, we will be pushed to our limits, given new responsibility, and eventually find our place in the medical world.  We all have our lists of what we want out of our program, but our gut may not agree.  Just remember to keep an open mind, so that if your gut is telling you something, you’ll hear.  You may learn something you never knew was important to you.

Michael Richardson is a medical student who blogs at Primary Care Progress.

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