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Choosing a Residency

Choosing a Residency

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Published by: danskip1025 on Mar 11, 2012
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Things To Consider When Selecting a Residency Program Stability.

First, look at the stability of the program and the institution. In the current times of cutbacks, decreased reimbursements and mergers, it is vital that you are familiar with the finances and outlook of the institution at which your are considering training. The last thing you want to happen when you arrive to start your training, is to find that the community hospital you were hoping to spend much of you time at has been sold. There are various ways to gather this type of information. I would start by just asking the residents. If you are not familiar with the city’s health care environment, they can tell you about recent events that have occurred in the area. During your interviews, ask about the stability of the health system and any changes that are foreseen in the future. Inquire as to the strength and weaknesses of the department and hospital. However, don’t just look at the financial stability; find out about the educational stability as well. Is there a permanent department chair? Are there any top departmental administrative changes that have occurred or are expected? How long have the program director and department chair occupied their positions? Support. “We are here to support you!” As an applicant, this is what you are looking for -- a program that cares about your education and future. Look for evidence that a program cares about its residents. You can judge this by looking at the quality of fellowships attained, turnover rate in the program (how many residents leave/transfer after the first year), availability of mentors, number of residents that stay at the institution to complete fellowships, and departmental response to resident complaints as examples. Flexibility. How much is there in the program? Although most programs have set schedules, some are more flexible than others. Many of you will have significant others who are also residents and who you would like to be see as much as possible during your residency. Does the program match call nights, vacation, and elective time? There are other things to look for. How amenable are they in allowing residents to change schedules to attend a conference? For residents who become pregnant during their residency, how hard was it for them to get time off? Institutional Climate. I am referring to the political/social/work climate at an institution. We all come from varied backgrounds and we should expect institutions to have a myriad of backgrounds as well. You will find institutions that are very conservative in their ways and therefore very unresponsive to change. This could be manifested by very poor relations with the surrounding community or a lack of community outreach programs. There are other institutions, which are much more liberal, for a lack of a better word, in their actions and relationships with neighbors. If you come from a medical school that is very progressive and proactive, you might not be happy at a program where you hit a wall every time you come up with a new initiative or idea. I have not spent much time in this discussion on finding out about call schedules, holiday breaks, vacation time, number of elective months, free meals, call rooms, parking, etc. After about interviews, they all start blending together. I’m not saying that these variables are not important, because they can be. But, most applicants do not decide to pick one program over another based on whether a television is available in every call room. Know Your Career Goals
 By the time you start looking at residencies, most of you will have started to form some kind of consensus/idea of where you would like your career to lead. The program you end up choosing will play a large role in helping you achieve these career goals.

It is easier to look for a job after fellowship if you know those working in your specialty in that area. but this is not always the case. but many applicants do not analyze all the advantages and disadvantages of a specific location.Therefore it is imperative that you plan and keep your options open. Many job offers are not posted nationwide but disseminated within a closed circle in a community. as they can sometimes be much more honest about these issues than those within a program. you might be out of the loop. very difficult. it does not matter much where you do your residency. you can complete it anywhere.D. Although the Mayo clinic in Rochester. But it is in your best interest to complete your fellowship in NYC. . It is not impossible but very. For various reasons a sense of mistrust can develop between a hospital and it’s surrounding community. If you are prohibited from doing this because of insufficient funds then you are doing yourself a disservice. Patient Population. then take time to consider them carefully. A well known and regarded program will give you a better opportunity to attain a higher ranked fellowship. If you have decided to serve under privileged communities then a very academically geared program might not suit you. If you are coming from Texas. If you want to settle down in New York city as a pediatric nephrologist. I therefore looked to train in a city where there was a large minority population and resources to work with them. This can make your attempts to develop community programs or even simple events difficult. It is always easier to transition from an academic institution to a rural community practice. The End Game. MN would have given me excellent training it would not have provided me with the patient make up I was looking for. Most of us entered medicine to give back to our communities and participate in their health care. etc.increased contacts and networking. What is there to do in the city? Do you have access to trails if you are into mountain biking? Do they have a music symphony / opera house if you like the arts? If these or other questions such as these are important to you. Community Outreach. How much are you going to spend? You have to enjoy your residency and the free time that you have during it. This boils down to two things: How much will you make? vs. I suggest speaking with the staff at an institution: secretaries. I found this to be a very important part of my decision in choosing a residency. then you likely will not be looking for a rural primary care program. The main reason -. In medical school I was involved in outreach to undeserved populations in my city and wished to continue to have this opportunity as a resident. nurses. Is Location Important?
 This can be a straightforward variable in your decision making process. In looking at your goals in medicine I suggest that you try to start figuring out where you want to end up practicing and in what environment. Prestige/Advancement. It is much more difficult to complete a residency at a community hospital and then try to get into a competitive fellowship at Johns Hopkins for example. Let us look at some now: Cost. Remember there is life outside of the hospital. Outside Activities. What do you do if you are not sure? I suggest keeping your options open by looking at a more academically oriented institution. cafeteria workers. Academics? If you have just spent eight years getting your Ph. You would think that all hospitals would feel the same. This goes hand in hand with the above advice.

we have to think about our families. Are you going to have one day off a month for the next five years? Your family also has to live in the city where you end up in. Camaraderie. Although we try to be “strong” trainees when it comes to how long we work and stay in the hospital. Do you want your children to grow up in this city? Are you going to be able to afford child care? Does your institution offer reduced/free child care services? What is the quality of the public school system? These questions can affect which neighborhood you will choose to settle down and live in and also affect your commute. I would encourage you to look further. Most of us will have loved ones back home who miss us and don’t like us spending thirty-six hours without seeing us. Will they have job opportunities in their chosen profession? Will they like the city? The main thing to remember is that you will not be happy in your residency if your significant other is not! Children. They are more frank with their answers. Significant Other. They can give compare the program with that which you have encountered in your medical school. It is hard to figure out the dynamics within a program from a short interview day. Remember that you will be spending a large portion of the next several years with a small group of people many of whom will become very close friends. I also recommend taking a look at the percent of minority residents and attendings in the program. Make an effort to speak with them regarding their experiences. Ask friends who are at the same institution. . Do they feel appreciated? Have they felt discrimination? Would they choose the same program given what they know now? Family Issues
 As residents in training we are making decisions on a program which will affect everyone in our family circle. to give you the “scoop” on the residents there. It is always wise to talk to any resident who went to your medical school. Therefore. whether or not they are in your same specialty.Along with population demographics. Their needs are also important to focus on when making your decision. Make an effort to contact them either on your interview day or afterward. when it comes to looking at programs it is necessary to look at time off.

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