For those in the middle of residency or done with it, what do you think are the most important factors in choosing the best family medicine residency? With so little to compare programs on paper and such a short amount of time spent in the clinical settings during interview day, I'm not sure which factors of each program are most important when deciding my rank list
What are the most important factors of a good residency program?
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deleted480308
Placing people in fellowships of the type you want
Are residents happy with their treatment
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You want to be worked hard, but not abused. Post-grad fellowship placement is important. Next to that, bar none, is seeing a lot of patients. You need to see ~1650 patients to graduate an ACGME residency. I saw ~2100. A lot of medicine is rote, but you need repetitive exposure. Seeing this many patients made me much more comfortable for outpatient only.
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(Sorry to be pedantic: 1650 outpatients, 750 inpatients. The rules as of last year: https://www.acgme.org/Portals/0/PDF...FAQs_2017-07-01.pdf?ver=2017-06-30-140058-287)
Here are some questions that can help narrow things down. You should be able to email or call with these questions if you already interviewed. Don't expect any one individual faculty member or resident to know what's going on with everything. I'm coming from mid-tier mixed MD/DO/IMG full spectrum west coast.
1. Ask faculty or PD: Are there parts of the curriculum where it's challenging to meet ACGME requirements?
Answer should be a yes, with an honest disclosure of trouble spots and what the program is doing to address them.
2. Ask a chief resident: Tell me something that has been challenging in working with the faculty and staff.
You should get something that isn't entirely positive, which indicates that the residency at least involves the chiefs in how it is run.
3. Ask residents: Tell me about the best clinical teacher here.
You should ask multiple residents and get multiple answers, indicating there are attendings who want to teach and should. If no FM faculty are mentioned (yellow flag), ask which FM attending is the best teacher. People should be honest if great teachers are leaving/retiring. If the residents talk about who used to be great more than who is great, that's not good.
4. For unopposed programs, ask residents: What kind of patients or illnesses do residents not automatically see in the hospital or in the community?
You should be told about the "private" patients that specialists don't allow residents to see, any services that aren't staffed with residents (for us it's trauma...until we do a dedicated elective), any patients that go elsewhere such as cards/onc/pedsED/prisoners/people with money, any missing specialties like endo/rheum/ID. It would be bad if the residents don't know what they're missing.
5. For opposed programs, ask residents: Which of the other residencies make it hard to get experience?
You should be told that the obgyn residents are bitchy (universal), the surgery residents won't give up cases (universal), and what accommodations have been made to get FM residents experience such as time at external facilities. It would be bad if the FM residents just accept that they're low priority or if they're cool with not getting experiences.
6. Ask a resident or two: how many of the people in your class would you invite to your wedding?
If more than one resident makes it seem like fewer than say 75% of their classmates would be welcome, that's uncomfortable.
7. Pay attention to whether the residents are happy to see each other. In my program we can go MONTHS with two individuals not being in the same room/building, and we generally get excited to see each other again. The free food at interviews attracts residents; this will sound crazy, but residents should have a hard time hiding from you that they're more excited to see other residents than they are to see today's batch of interviewees. This is you next year, this is what your support group will be, this is what it should look like to be on a team you like being on.
8. Ask a group of residents, like at lunch or the social: Where are the last graduating class members now?
It shouldn't be at all mysterious - the current R3's and R2's should have been friends with, and interested in, the graduating class just 6 months ago, and the graduating class should have been open with the juniors about recruitment and fellowship.
9. Ask R3's: what are you doing next year?
You should get everything from "I have no idea" to "hoping to hear from Big Fat Fellowship this week" to "I just signed with..."
From the above you should get a sense of:
- is there a culture of support and friendliness among the residents?
- are the hospital and the clinic supportive and inclusive of the FM residents?
- are the FM faculty competent and engaged?
- are soon-to-be-graduates totally burned out or are they excited about what they get to do next?
You should also directly see and hear residents involved impressively in patient care. While you're getting the tour you should see residents everywhere in the hospital. Get shown, not told, that the residents are deeply engaged, getting up and leaving fast for a delivery, letting a staff member interrupt your conversation for patient care, etc. It's a lot worse for a resident to seem bored or uninterested, than to seem tired or stressed. It's unacceptable for residents to be shadowing in their home facility.
Hope this helps.
Here are some questions that can help narrow things down. You should be able to email or call with these questions if you already interviewed. Don't expect any one individual faculty member or resident to know what's going on with everything. I'm coming from mid-tier mixed MD/DO/IMG full spectrum west coast.
1. Ask faculty or PD: Are there parts of the curriculum where it's challenging to meet ACGME requirements?
Answer should be a yes, with an honest disclosure of trouble spots and what the program is doing to address them.
2. Ask a chief resident: Tell me something that has been challenging in working with the faculty and staff.
You should get something that isn't entirely positive, which indicates that the residency at least involves the chiefs in how it is run.
3. Ask residents: Tell me about the best clinical teacher here.
You should ask multiple residents and get multiple answers, indicating there are attendings who want to teach and should. If no FM faculty are mentioned (yellow flag), ask which FM attending is the best teacher. People should be honest if great teachers are leaving/retiring. If the residents talk about who used to be great more than who is great, that's not good.
4. For unopposed programs, ask residents: What kind of patients or illnesses do residents not automatically see in the hospital or in the community?
You should be told about the "private" patients that specialists don't allow residents to see, any services that aren't staffed with residents (for us it's trauma...until we do a dedicated elective), any patients that go elsewhere such as cards/onc/pedsED/prisoners/people with money, any missing specialties like endo/rheum/ID. It would be bad if the residents don't know what they're missing.
5. For opposed programs, ask residents: Which of the other residencies make it hard to get experience?
You should be told that the obgyn residents are bitchy (universal), the surgery residents won't give up cases (universal), and what accommodations have been made to get FM residents experience such as time at external facilities. It would be bad if the FM residents just accept that they're low priority or if they're cool with not getting experiences.
6. Ask a resident or two: how many of the people in your class would you invite to your wedding?
If more than one resident makes it seem like fewer than say 75% of their classmates would be welcome, that's uncomfortable.
7. Pay attention to whether the residents are happy to see each other. In my program we can go MONTHS with two individuals not being in the same room/building, and we generally get excited to see each other again. The free food at interviews attracts residents; this will sound crazy, but residents should have a hard time hiding from you that they're more excited to see other residents than they are to see today's batch of interviewees. This is you next year, this is what your support group will be, this is what it should look like to be on a team you like being on.
8. Ask a group of residents, like at lunch or the social: Where are the last graduating class members now?
It shouldn't be at all mysterious - the current R3's and R2's should have been friends with, and interested in, the graduating class just 6 months ago, and the graduating class should have been open with the juniors about recruitment and fellowship.
9. Ask R3's: what are you doing next year?
You should get everything from "I have no idea" to "hoping to hear from Big Fat Fellowship this week" to "I just signed with..."
From the above you should get a sense of:
- is there a culture of support and friendliness among the residents?
- are the hospital and the clinic supportive and inclusive of the FM residents?
- are the FM faculty competent and engaged?
- are soon-to-be-graduates totally burned out or are they excited about what they get to do next?
You should also directly see and hear residents involved impressively in patient care. While you're getting the tour you should see residents everywhere in the hospital. Get shown, not told, that the residents are deeply engaged, getting up and leaving fast for a delivery, letting a staff member interrupt your conversation for patient care, etc. It's a lot worse for a resident to seem bored or uninterested, than to seem tired or stressed. It's unacceptable for residents to be shadowing in their home facility.
Hope this helps.
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Friendly environment and procedures
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Look at faculty turn over. Look how long the PD has been in place, and how many PDs they've been through in X# of years. 3 PDs in 5 years is a bad sign.
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It's better to scramble/soap than to rank a program (or specialty) you really, really don't want.
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This is one lesson I learned at someone else's expense. Too many people think of scrambling as the worse hell imaginable.
There are worse things.
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That seems fraught with problems.
Better a program you don't like than no program at all.
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While I'm sure there are some programs in other specialties (general surgery in parts of NYC) that are so toxic and malignant that being unmatched is better. I can't imagine the same with FM..
D
deleted87716
That, and the devil you know. The programs in the scramble aren't going to be among the best, and there are no interviews or second looks.
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deleted87716
Unmatched means potentially spending a year folding jeans at the Gap and having a giant red flag on your application the following year. I can't imagine why anyone would prefer that.
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There are some (general) surgical residencies (*cough* IMG heavy in NYC) where you're at high risk of being fired, threatened nonstop daily and worked to the ground. Rare exceptions where it's even worse than going unmatched.
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A bit more nuance on the "don't rank it if you can't stand it" discussion.
If you have app damage, such as a failed step, red flags on your MSPE, repeated year, etc, then you should rank every program where you interviewed. You need a residency more than you need happiness, for better or worse, and you should not assume you'll do any better in SOAP than in the match.
If you do NOT have app damage, and you are considering ranking a program where you are fairly certain you'd be miserable, consider the following:
- you will find out on Monday of match week if you matched or not
- if you didn't match, you are given access to the national list of programs that didn't fill ("SOAP")
- during that week you get to "scramble" for open positions ("SOAP" used to be called the scramble and it wasn't online in the olden days)
- you will probably discover programs that are comparable to those you ranked, with things you previously considered "problems" but no longer do because you're on the other side of interview season and you understand more things and your med school classmates are divulging more info than they did before the match
- if you are at a reputable medical school, your dean will rally on your behalf and make phone calls to help you
- you can predictably get an IM intern year or surg intern year, if you find you're no longer sold on FM or you otherwise want to "buy time"
- - note that if you take a "prelim" intern year, you have to spend time and money to get a PGY2 position during your intern year
- - ouch.
- - but people do it all the time.
- you have so much more information and perspective in mid-March of your 4th year than you did in mid-March of your 3rd year when you were forced to make up your mind about specialty and get faculty to write you letters and gamble in VSAS to get an AI and wring your hands off
- - so maybe you should have a bit of faith that 2 months from now you may be able to make a better decision than you were previously able to make
- after SOAP week, there are STILL programs that didn't fill, and you will STILL be able to get a residency, if you decide that something is better than nothing
FM residency is 3 years, which goes by incredibly fast, and then you start getting recruited, and then you start making doctor money, and the details that seemed life-threatening as a 4th year med student are kind of adorable in retrospect.
Residents are in their late 20's and early 30's, on average, which means what you think it means: weddings and babies. Babies mean what you think they mean: leaves of absence and delayed graduations. There are always FM PGY2 positions that need to be filled. You won't graduate "on time" if you change programs. This is not a tragedy.
In addition to YOUR happiness, your fellow residents are profoundly affected if you choose to rank a program you hate, and then match there. Your fellow residents will be forced to carry your work when you start being unable to keep up the pace because you are miserable for exactly the reasons you hesitated to rank the program.
You might be one of those fellow residents, carrying the work of a miserable intern who doesn't want to be there. That miserable intern will most likely fail to establish the professional relationships that help with career planning and future jobs.
tl;dr: don't be a miserable intern regretting your life choices
Good luck y'all.
If you have app damage, such as a failed step, red flags on your MSPE, repeated year, etc, then you should rank every program where you interviewed. You need a residency more than you need happiness, for better or worse, and you should not assume you'll do any better in SOAP than in the match.
If you do NOT have app damage, and you are considering ranking a program where you are fairly certain you'd be miserable, consider the following:
- you will find out on Monday of match week if you matched or not
- if you didn't match, you are given access to the national list of programs that didn't fill ("SOAP")
- during that week you get to "scramble" for open positions ("SOAP" used to be called the scramble and it wasn't online in the olden days)
- you will probably discover programs that are comparable to those you ranked, with things you previously considered "problems" but no longer do because you're on the other side of interview season and you understand more things and your med school classmates are divulging more info than they did before the match
- if you are at a reputable medical school, your dean will rally on your behalf and make phone calls to help you
- you can predictably get an IM intern year or surg intern year, if you find you're no longer sold on FM or you otherwise want to "buy time"
- - note that if you take a "prelim" intern year, you have to spend time and money to get a PGY2 position during your intern year
- - ouch.
- - but people do it all the time.
- you have so much more information and perspective in mid-March of your 4th year than you did in mid-March of your 3rd year when you were forced to make up your mind about specialty and get faculty to write you letters and gamble in VSAS to get an AI and wring your hands off
- - so maybe you should have a bit of faith that 2 months from now you may be able to make a better decision than you were previously able to make
- after SOAP week, there are STILL programs that didn't fill, and you will STILL be able to get a residency, if you decide that something is better than nothing
FM residency is 3 years, which goes by incredibly fast, and then you start getting recruited, and then you start making doctor money, and the details that seemed life-threatening as a 4th year med student are kind of adorable in retrospect.
Residents are in their late 20's and early 30's, on average, which means what you think it means: weddings and babies. Babies mean what you think they mean: leaves of absence and delayed graduations. There are always FM PGY2 positions that need to be filled. You won't graduate "on time" if you change programs. This is not a tragedy.
In addition to YOUR happiness, your fellow residents are profoundly affected if you choose to rank a program you hate, and then match there. Your fellow residents will be forced to carry your work when you start being unable to keep up the pace because you are miserable for exactly the reasons you hesitated to rank the program.
You might be one of those fellow residents, carrying the work of a miserable intern who doesn't want to be there. That miserable intern will most likely fail to establish the professional relationships that help with career planning and future jobs.
tl;dr: don't be a miserable intern regretting your life choices
Good luck y'all.
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I mean do you have personal knowledge of this? bc I hear this alot but nobody ever gives any actual anecdotes
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There have been threads online providing specific anecdotes.
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As a premed student trying to decide between multiple schools, and looking at schools match lists for FM I am having difficulty seeing if the programs students have matched into in the Chicago area are good programs or not so good. How does one tell? Would it be safe for me to attend a school out of state without the possibility of using elective rotations at these programs, but STILL matching into that or another program?
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Thanks for a detailed response. My decision b/w schools would be a 4 year MD program in the area I live in and want to practice in, or going out of state for a 4 year program if i dont get into the in-state MD, or going out of state to a 3 year MD program in a neighboring state... all of those versus the in state DO I currently hold a seat at. (To clarify, i am kinda counting chickens before they hatch because i have yet to hear from those 3 MD schools post interview)
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Go MD if you can. The DO school makes a fine back up, especially for FM.
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deleted480308
absolutely MD if you get in over any DO
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Yeah I definitely will, but ill be conflicted on 3 year curriculum out of state (MCW-CW) or 4 year curriculum in state (Rosy Franklin). I want to do FM residency and practice in the suburbs of Chicago, but one year less sounds intriguing in Wisconsin
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take the 1 year less. you will save money in tuition, interest, a year of physician salary.... the benefits go on and on. RFMS is the same tier as MCW so there isnt a huge advantage there. If you are USMD then you will be able to match back in the Chicago area if you want to.
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