Five Residency Questions Doctors Wish They'd Asked

You've submitted applications to your chosen residency programs, and it's now time to begin interviewing with those that have offered you invitations. It's a nerve-wracking process requiring many months of careful preparation and plenty of time perfecting answers to the residency interview questions you're most likely to encounter before Match Day. But did you know that the questions you pose to your interviewers may be just as important to your future success?

Residency programs vary considerably and finding the one that most closely matches your educational, professional, and personal needs will require careful sleuthing during the interview process. While the Association of American Medical Colleges (AAMC) offers a comprehensive list of basic questions for download on their website, we decided to take a more intimate look at what actual physicians wish they'd asked during the residency interviews in their past. Below are the top five.

1. How successful is your program and its past residents?

Before you applied for the residency, you likely spent time learning as much as you could about the program. This may have involved reviewing the program's overall curriculum, attending physicians, and teaching faculty, as well as the websites of the hospitals affiliated with it. You may have also searched for publications by key faculty members and scrutinized the program's accreditation history.

However, while you can find a great deal of information about residency programs online if you spend the time and know where to look, there are many questions related to program and graduate success that will probably require a more direct approach.

"Looking back on when I interviewed, I wish I would have understood more about the risks of burnout," says Kelly Cawcutt, MD, MS, FACP, and assistant professor of medicine at University of Nebraska Medical Center in Omaha. "Had I known, I would have asked how many residents had left the program in the last five years. And as someone going into a sub-specialty, I also would have asked more targeted questions regarding the number of residents who apply for fellowships and then get accepted."

Nicole Washington, MD, board certified psychiatrist and chief medical officer at Elocin Psychiatric Services in Tulsa, Oklahoma, points out that a lot of turnover within a residency program—whether student or faculty—should be a red flag. "If a program has had multiple residents leave other than to pursue fellowships," she says, "you should ask more questions to try to determine exactly why people are leaving before completion."

Nicholas Jones, MD, FACS, and a plastic and reconstructive surgeon in Atlanta, notes that looking at the pathways taken by previous graduates is just as important as knowing how many finished the program. "I would have liked to know what the residency program's graduates did after graduation," he explains, "because that would tell me if the program was successful at putting people where they wanted to be."

Jones says he'd also dig into the program's pass/fail rate for board-certified exams. "The number of residents who go on to be board certified can really give you an idea of the education they received," he adds.

2. How would you describe the culture of your residency program?

A residency program's culture defines the way attending physicians, teaching faculty, and residents are expected to behave as well as the beliefs and values they share. This culture ultimately shapes the residency experience beyond the program's formal structure and affects everything from work-life integration and gender equity to mentoring, institutional support, and ethics.

"Program culture is important, and potential residents need to determine if it will be a good fit for them," says Washington. She suggests getting specific about what you want in your residency experience and examining whether the program you're considering lines up with those preferences.

"Are you looking for a program with more families than single people or vice versa?" Washington asks. "Do you want a program that has a large social component or does that not matter to you? Do you prefer a very formal program or one where faculty and residents are called by their first name?"

3. Are there programs in place to improve resident life?

The physicians we interviewed noted that it's especially important to ask about work-life balance and resident wellness—two areas that can be influenced by a program's culture—when evaluating potential residency opportunities.

"Long hours, call, and low pay really affect quality of life," says Jared Heathman, MD, a triple-board-certified psychiatrist in Houston. "Amenities like a gym at the hospital, access to healthy food and counseling, wellness retreats, and the like can go a long way to making your residency enjoyable."

Kyle Bradford Jones, MD, FAAFP, author, and associate professor in the department of family and preventive medicine at the University of Utah, says he wishes he had asked more about how residency programs dealt with resident stress, burnout, and mental health.

"It's a very common problem for residents to experience depression, severe anxiety, and signs of burnout during their residency, especially their first two years," Bradford Jones adds. "Each program handles this differently, and I wish that I had a better sense of how the programs to which I applied approached such situations."

4. Does the program include any education on the business side of practicing medicine?

According to the Journal of Graduate Medical Education, few residencies train physicians on topics like risk management, job hunting, negotiation skills, employment contracts, and other issues pertaining to the business practice of medicine after graduation. However, this knowledge is essential if you want to run or be part of a successful medical practice in the future.

"It's ridiculous how much medicine has become a business," says Shannon Sovndal, MD, a board-certified emergency medicine physician in Boulder, Colorado. "I would ask if the residency program will prepare me to evaluate my production, relative value units, and interface with the billing company. I would also ask if I will learn to calculate ROI—or return on investment—so I can competently evaluate the opportunity cost of one action versus another. As a resident, I had no idea how much of my time would now be spent on the business side of things."

5. Does the program provide any resources for spouses?

For an additional fee, the National Residency Match Program allows couples to link their rank order lists for the purposes of finding residency positions in the same geographic location. However, this is only useful if both people in the relationship are at the same stage in their medical career. In many cases, residents have spouses and significant others who are ahead or behind them or who are not doctors but deserve equal consideration.

"My husband, who was two years ahead of me in training and an ENT, would be looking for work as an attending in the city I where I would be doing my residency," says Edna Ma, MD, a board-certified anesthesiologist in Los Angeles. "I wish I had asked more about the types of resources they had for spouses of matching residents, such as if they had relationships with the surrounding hospitals or other departments that could support another physician. Since we were not technically 'couples matching,' it seemed that we were on our own regarding finding employment for my husband. If I had asked the right questions about this during the interview process, we could have streamlined his transition into private practice."

Article Originally Published on ACOG Career Connection