Creating a rank list for residency is much like choosing which medical schools to apply to. It’s a very personal decision, which means self-awareness and self-reflection is key to your decision making.
What specialty are you pursuing? What hopes do you have for your future career? Where do you want to live for the next 3+ years? Are you more interested in academic or community medicine? It’s important to have clear answers to these questions and more before you dive into the tough process of choosing where to spend residency.
It’s important to note, however, that unlike medical school, you don’t get to pick. You submit your Rank Order List (ROL), get assigned to a residency on that list, and that’s where you go. While choosing your ROL is within your control, narrowing that list down is no small feat.
In this guide, we break down the critical factors to consider when choosing where to spend your residency years. Note that we won’t cover how to choose a specialty. If you’re looking for guidance there, check out our other guide: How to Choose a Medical Specialty for Residency.
1. Program Fit
Choosing a residency program is like choosing a medical school all over again. You need to do your research to compare and contrast programs you believe will be an ideal fit for you and offer what you hope to get out of your time in residency.
Program fit encompasses a wide range of factors, including division or department culture, who you’ll work with, program prestige, research availability, and much more.
It’s unlikely you’’ll find a program that matches all of your exact criteria, so take the time to narrow down your priorities. Is research availability more important to you than the program’s prestige? Is the size of the program and how closely you will work with patients your top priority, or are you most concerned with the program’s location?
Be careful not to fall into the trap of looking for the best program when you should be looking for the best program for you. A program’s prestige might be exciting and advantageous, but you’ll be hindering your wellbeing and ability to succeed in residency if you choose a prestigious program that does not align with your needs and values.
Think about both sides of the equation. What can the residency program offer you, and what will you be able to offer that residency program in return? Remember, at the end of the day, you are the prize. Understanding what you can specifically offer a program and why they’re an ideal fit for you will also help you stand out during residency interviews.
2. Program Size
The size of the program is another important consideration, as this will affect how many colleagues you have as well as the call structure.
The more colleagues you have, the more call is spread out, which will relieve some of the pressure on you. If your program is small and you’re one of very few residents, you’ll be on call a great deal. This can mean filling in more than you’d like and added stress on top of an already very stressful process.
While being in the thick of it will provide excellent training, it’s important to evaluate your priorities. If a modicum of work-life balance, which is hard enough to find in residency, is a priority for you, being the one of the few residents on call will severely hinder that.
Completing residency at a small program also limits the number of people you can get to know, network with, and learn from.
On the other hand, there are benefits to a small program, especially if you want to build deeper connections with a smaller group of people. Having a small, tight knit group of people who all depend on each other creates an enhanced sense of community and belonging.
Additionally, smaller programs mean you’ll be given more one-on-one time with attendings, fellows, and patients, which can propel learning. You may also be given more responsibility and have the opportunity to participate in procedures sooner since there are fewer staff to rely on.
However, larger programs certainly have their advantages as well. More residents often equate to a wider and more diverse rotation structure, which can provide you with broader training and open more doors for you on a national level. If you’re interested in academic medicine, rotation variety, networking with well-known and respected physicians, and pursuing prestigious, high-level fellowships, a larger program is likely a better fit for you.
3. Where You Want to Live
Where do you want to spend the next three to seven years of your life? There’s quite a lot to unpack with this question, as it very easily snowballs into a dozen other questions.
What kind of climate do you enjoy? Is snow a dealbreaker for you? Do you prefer rural or urban areas? What’s more appealing, fresh air and the hiss of a slowly closing screen door or the consistent hum and roar of traffic and city life?
What’s the state of your finances, as in, what cost of living can you afford? If you have a significant other, where do they want to live? Are they comfortable moving?
Beyond considerations like climate and cost of living, you must also consider the patient population. Are you interested in community or academic medicine? Do you want to see more zebra cases or the bread and butter of your specialty? For example, with surgery, you won’t find many advanced surgical centers in the middle of nowhere.
As with medical school, and possibly even more so, residency is going to take up a notable portion of your life. Although your life outside of residency will be limited, it won’t be nonexistent. Think of all the aspects of your day-to-day that are important to you. If you’re an avid biker and that’s how you exercise and blow off steam, moving to a city that isn’t bike friendly and also lacks bike trails will be one more strain on you.
Your passions and interests outside of medicine will prevent you from burning out over this intense time. Choosing a city that helps you easily keep up with your interests, mindfulness activities, exercise, etc., will benefit your health and your performance in the long run.
It can help to consider what you liked and didn’t like about the city you attended medical school in. What was that city lacking for you? What did you enjoy most about it? What aspects of the city, such as transportation, gym access, community events, nature areas, costs, etc., made life easier or more difficult for you?
4. Family Considerations
The location of your residency program is also tied into a number of family considerations. As some medical students reach their mid-to-late twenties, family goals become a priority in addition to career goals.
Are you hoping to have children and build your own family while in residency? Do you have a significant other who will be joining you, or do you hope to find a partner during your residency years?
If you’re considering having kids in the next few years, your location will need a good education system, outdoor spaces, and be generally clean and safe. If you’re in surgery, your residency is likely to be in a more urban area. For some, downtown Chicago might not be the place they imagined starting a family.
Additionally, how far away are you comfortable living from your parents and loved ones? As you age, unfortunately, so will the people you care about, which may mean you want to live closer to them. After all, it will be three to seven years of your life, and you may have already spent four years away from them during medical school.
Plus, if you are considering having kids, your parents can be an invaluable source of free daycare and babysitting.
Likewise, if you are moving to a residency program with a significant other, how far are they comfortable living away from their own family?
5. Couples Matching
Couples matching ensures your residency program will be in the same geographic location as your spouse/partner.
Are you currently in a relationship with a fellow medical student? Where are they in their education? Are they pursuing the same specialty? How serious is the relationship? Do you see yourself committing to this person for life or one day having children with them? Are they as serious about you?
While these questions put a lot of pressure on the relationship, it’s necessary to consider this aspect of your future and begin having some serious conversations with your significant other. If they’re also looking at residencies, where are they looking? What priorities do they have for their residency? Where do you both want to live for the next several years of your lives? Are they close with their family? How far away from them are they comfortable living?
If you’re both in residency, dating long distance will be incredibly difficult. It’s extremely unlikely your schedules will match up, and years of asynchronous communication does not a strong relationship make.
If you’re both interested in couples matching, know that your chance of matching at the program you want is lower. While the process is simple, it will involve a great deal of communication, coordination, compromise, and sacrifice.
To couples match, you need to pair your rank lists. Your match will be successful when both lists find a match on the same line. Your pairs of program choices will be considered by the matching algorithm. You will match to your most preferred pair of programs on your rank order list where each of you have been offered a position.
When you log in to the NRMP website, you must both agree that you want your rank lists coupled. You will then make your lists together and ensure the lines match up.
An example of a paired rank list:
- UC-SF Surgery – UC-SF Pediatrics
- Ohio State Surgery – Ohio State Pediatrics
- Stanford Surgery – Stanford Pediatrics
Seek advice from your deans and advisors, but the best resource you have for couples matching is other couples who have recently gone through the process.
Learn more about couples matching from two physicians who successfully matched together: Residency Couples Match – Shedding Light and Debunking Myths, and check out Couples in the Match on the NRMP website.
How to Decide
Like with medical school, it’s integral to conduct ample research. Unfortunately, while MSAR was great for researching medical schools, there isn’t the same kind of all-encompassing tool for residencies. You can find some information on FREIDA, Doximity, and the Residency Explorer Tool, but it will be difficult to research smaller programs.
You can also learn about each program’s didactics on their respective websites. Compare and contrast. How does each program talk about their overall mission?
However, by far your best resource is word of mouth.
True to their name, your advisors are there to give you advice. Utilize them.
Ask mentors where you should apply. Word of mouth is much more informative and useful than the information you’ll find on the programs’ websites.
Ask any faculty members who know you well which programs you should be looking at. They possess the kind of golden information you can’t find anywhere else. How would you fit in? Which programs match your learning style and preferences? Which have similar values to your own?
And most importantly, talk to the residents who are already there. How do you vibe with the community? Do the residents have similar values and interests to your own? Ask them what the call structure is like. Do a lot of people have families? What are health Insurance and benefits like? After all, this is a job you are signing a contract for.
For any major life decision, research is the first and most important step for effective decision making. Even though your rank order list (ROL) isn’t due until February, you should be researching programs and reflecting on your preferences many months before this. Keep your residency goals and preferences top of mind throughout medical school so that you have plenty of information to work with once it comes time to make a decision.
If you’re having trouble deciding, this guide outlines how to effectively make tough decisions: 7 Strategies for Better Decision Making.
Success in Medical School, Residency, and Beyond
The Med School Insiders blog is filled with hundreds of articles that are continually updated with the most recent and accurate information for premeds, medical students, and residents.
If you haven’t chosen your specialty yet, read our guide: How to Choose a Medical Specialty for Residency.
And check out our So You What to Be… series, which provides insight into what it’s like to pursue different specialties and other healthcare careers. We have dozens of articles and corresponding YouTube videos. If you don’t see a specialty you’re interested in, leave a comment below.
