Which Residency Should You Choose?

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Dear recent graduates,

I would be remiss if I didn’t begin by congratulating you on everything you have accomplished so far. Surviving medical school and applying for residency should be celebrated. Often, we glide by without a second thought, and it’s a shame.

In the words below I will share a few insights into applying for and choosing a residency, but first, it’s important to know the experiences that have molded my opinions. By understanding a bit about where I’m coming from, you can better incorporate the information into your own world. I am from the University of New Mexico and was an average (at best) applicant for orthopedics. I matched into Parkland and UT Southwestern Orthopaedic residency, which was a “reach” residency for me. I then continued into a highly regarded fellowship, and I am now the program director for Orthopaedics at University of Texas Health Science Center at San Antonio.

I will attempt to make salient points to all applicants regardless of the field of medicine, but please realize what this is: an opinion piece. With that in mind, here are five considerations I see as important for picking a residency:

Listen to others and then ignore. It is important to listen to others and their experiences to build a framework for your decision. But disregard those who are anonymous on Reddit and Twitter, as well as those individuals whose experiences are outdated. Find those people you trust and truly know. That might be a current resident at a particular program or one who went through a residency you are interested in. Then crumple it up (metaphorically since everything is electronic), and make your own decision. You are an adult and know what is best for you. Whether the residency is educationally based, hands on, academic, community, or anything else, it doesn’t matter. What is right for you will be different than what’s right for your friend, mentor, or anyone else. You will be spending 3 to 7 years molding yourself for the rest of your life. Be confident enough to choose what is best for you. Only you can truly know that.

You have earned the right to be where you are. Often, “I just want to match” overrides self-worth. An interview is an offer that programs do not take lightly. They have chosen you and respect everything you have accomplished. Ask the questions that matter to you. If the questions matter to you and the program does not like them, then the program is not the one for you.

Culture, culture, and more culture. It is probably an error that this isn’t first on this list. I would argue that the culture of the residency is the most important attribute of the residency and your success. The difficulty is uncovering the truth in 10 to 15 minute “Zoom” interviews. Culture is extremely relative. For some, culture is about “blue collar” versus “white collar” programs, while for others, it’s about the “work hard/play hard” mentality. Some applicants already have a large professional family, and others are looking to form one with their new peers and mentors. For procedural/surgical-centric fields, culture may be about “high-volume and academic.” For example, I would define our residency as “blue collar, work hard/play hard, family-centric (external and internal family), and high-volume.” I believe this to be a great way to learn orthopedics, but I am biased. Decide what your culture is and find a program that aligns well. Reach out to residents and faculty offline, outside the interviews. If you have a strong interest in a program and it is geographically conducive, meet with the interviewers who you felt best supported you.

Call and vacation matter but in different ways to different individuals. To some this could be the most important aspect of culture and to others an afterthought. Don’t be afraid to ask staff, residents, other medical students, or anyone who will listen to these questions. If call schedules and vacation time policies are among your highest priorities, make these your most asked questions. If they are important to you then they should be important to your program. We, as a field, need to make this topic no longer taboo.

Make your happiness. Residency, medicine, and life are hard. Fatigue is real and you will feel it many times throughout your life and career. Regardless of the residency you choose, no matter how great, fatigue will happen. It is important to acknowledge and address this. The best way to combat this is to find the residency that supports you the most in the areas that are most important to you. If you value mentorship, find a residency where people look for methods to mentor students, residents, and staff. Cups of coffee or dinners go a long way. If inclusion and healthcare disparities are your passion, find a program that affords you the patients and opportunities to address this. If your passions are a focal point, it will make you happier and less fatigued.

You could ask every director of every program of every field, and all would offer different opinions. If you made it this far, I applaud you. Listen to my opinion and if you learned anything, promptly ignore it. I am an advocate of mentoring, so please feel free to reach out with any questions I did not address, or any that need to be clarified. And good luck!

Ryan Rose, MD, is an assistant professor and program director at UT Health San Antonio, and the medical director of UHS Hand Service.

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