Below is a revival of a post from last year. I still agree with everything I wrote then.
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About halfway through intern year, you will realize that your decision was based on all kinds of bogus stuff, because you didn't yet know what really mattered to you. That's just part of the learning.
You're going to work 80 hrs/week everywhere. Things that make life less painful are: not having to come in to round on weekends if you're not on call. Fewer months of q3 call. No post-call clinic as an intern. Having seniors who will help out at key times when you're struggling, instead of having rigid expectations that you must see every admission (esp when you're a new intern). We all work hard, so let's not argue about who works hardest.
Does the program give you a set schedule in June with every vacation and call day determined, so you can plan ahead for the year, or do you want the flexibility of being able to take vacation days when you please?
There are big differences btw living in different communities. That might be a factor. Do you want a smaller town, more conservative and agricultural, more entrenched cultural divides, a relatively poor community, a very high-needs patient population from whom you can learn a lot, vs. a college town, wealthier and more educated, with a different flavor of learning. Where do you want to live? Where do you want to work? Do you really want to commute?
Look at the extracurricular interests of the other residents and think, if I don't have much in common with them, what am I going to do for fun? Don't fall into the trap of thinking you'll be driving to the nearest big city for an exciting social life; in reality, not many people make those trips very often.
Look at the structure of the inpatient FM service and realize that rounding on 7+ patients each morning is a challenge for the average intern; this gets very difficult if you are simultaneously admitting medicine pts and covering L&D, for example. Is the service set up to help you stay focused and learn, or are you running all over the place? Remember that as an intern you have to do a lot more than a med student, and seeing and discharging even 5 people is a LOT of work if you have to write prescriptions, dictate, reconcile the med list, etc. Some services admit and then d/c 90% of their patients in 3 days - that's a lot of admission and d/c paperwork, and it all takes time.
Look at the faculty - how many of them are doing the things you want to be doing - e.g. OB, gyn procedures, inpt medicine, sports med, procedures, C/S - ideally, you need to have more than 1 person doing the things you like. There is a big diff btw wanting to do optional procedures and being expected to do them. If you are expected to do them, then there will be adequate teaching/supervision available. If it's optional, you will have to work harder b/c you'll be out of the norm, and you may find there's no one to supervise you.
Look at the clinic pt population and their problem lists - are you going to see a good range of pathology in your areas of interest? or are you going to end up with 90% prenatal? or 90% older pts with chronic disease and comorbid psych problems? you need a good variety. How much sports med/MSK stuff does your clinic do, if that's important? guys, there needs to be enough ob/gyn that you will get enough continuity deliveries + women's health even when 80% of female pts want to see a female provider. Girls, there need to be enough male pts that you will get to do well-man checks and get comfortable with gender-specific issues.
What kind of performance feedback do you get from the faculty? You should be getting structured, 1:1 verbal feedback from a faculty member 2x/year, and other informal feedback more often, esp when you're just starting. Are the seniors good about helping you improve, or do people criticize behind each other's backs? Are the faculty open to improving - do you hear them talk about skills they are working on as teachers and clinicians? Is there an open environment where everyone supports each other in learning (faculty and residents), or is everyone busy criticizing?
If you want to make any money as a doctor, go to a program where you have to do your own billing at least for clinic visits. This is a painful but necessary long-term learning process and needs to be integrated into your learning.
Finally, some parts of the US are very liberal or very conservative, so be realistic (not idealistic) about the religious/political views of your coworkers, and choose an environment that you will be comfortable working in.
good luck
