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Two Hundred New Residency Slots Open

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For a long time there has existed a bottleneck in the physician training system with more medical students graduating than residency spots available. This phenomenon has been one of the contributors to the physician shortage in the United States. 

In an effort to begin to relieve the problem, in 2021 Congress passed the Consolidated Appropriations Act Section 126 to expand the number of Medicare-supported residency slots. 

Last month the Centers for Medicare and Medicaid Services announced a list of hospitals that were awarded 200 new residency positions under the Act. About seven in 10 of the positions are going to primary care and psychiatry training programs. 

You can read an American Association of Medical Colleges (AAMC) news article about the new slots here. 

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Wondering How to Evaluate a Medical School or Residency Program? Consider Your Happiness and Trust Your Intuition.

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Medical school and residency applicants routinely ask me how to evaluate institutions, especially since most interviews are virtual. This is a huge topic, but here are some thoughts:

  • To me, geography is one of the most important factors – at least equal to the reputation of the institution. You want to make sure you are in a location that will make you happy – near community, family, friends and/ or the ability to enjoy your hobbies.
  • Cost is sometimes a deal breaker when it comes to medical school. There can be significant differences – especially state versus private institutions – and scholarships can make a huge impact in your debt profile going forward.
  • Of course, didactics and academic opportunities are critically important for both medical school and residency. However, many programs of similar caliber have equivalent curricula and offerings. You likely could be happy at many different institutions. With regard to residency specifically, it’s important both to ensure you’re getting a lot of hands-on experience and to look at what fellowships are available, with your interests in mind.
  • Faculty is hard to assess because – like anything – there are good and bad ones. Also, faculty come and go. Having said that, if you are applying to residency, the program director is critical (understanding that he or she could leave at any time 🙁 ).
  • With regard to residency, call schedule and overall work hours are important to consider. Certain programs within the same specialty require a lot more hours and scut work than others.

One of your best bets is to talk to current medical students or residents. Oftentimes they will be very honest about the pros and cons of their institution.

Once you’ve assessed all of the above – narrowing down your list by geography and quality – I would analyze the vibe you have. If this sounds too touchy-feely, remember that intuition is not a magical assessment; it’s based on major and minor facts that you consciously and subconsciously analyze.

Remember: If you’re a medical school applicant, consider yourself fortunate if you have more than one option to choose from. Earning admission to medical school is extremely challenging; it’s a great problem if you have to struggle to decide among multiple schools!

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What Do Program Directors Really Want?

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Imagine you’re a program director (PD) reading hundreds of ERASes and conducting scores of interviews. What questions would you ask yourself as you assess each residency candidate to avoid big headaches?

1) Can this person do the job? Is s/he competent?

2) Will this person “play well with others” and not create complaints from patients, faculty, and/or other services.

3) Will this person stick with the program and not leave prematurely? A PD does not want to scurry around to fill an open call schedule/ residency slot.

As you finish crafting your ERAS and approach your interviews, consider how to demonstrate your competence and collegiality, as well as your commitment to the field and the residency program. For the former, ensure you showcase academic successes, extracurricular activities that demonstrate teamwork, and – if asked – hobbies and reading materials that demonstrate your winning personality. For the latter, highlight sub-internships, research projects in the specialty, and knowledge about the program and city it’s in.

Making sure the PD knows you aren’t going to cause him/her trouble is at least half the battle.

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Beware: Smart People Can Offer Dumb Advice

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Thanksgiving is a time for gratitude and reflection. It’s also a time to consider what will make you happy in the future.

When I was a medical student applying for emergency medicine residency programs, a well-meaning, smart dean gave me foolish advice: I was determining the order of my rank list and was particularly concerned about one program that had an excellent reputation but was in a city I didn’t like. The dean told me, “You’ll be so busy during residency, it won’t matter where you live.” Luckily, the advice rubbed me the wrong way, and I wholeheartedly disregarded it. I would argue that where you live for medical school, residency, or fellowship is as important as the quality of the institution. The reasons are several-fold:

1. Medical education/training is time-consuming, and you want to be in a city you can enjoy fully when you have a few moments to blow off steam.
2. Medical education/training is extremely stressful, and you want to be in a city where you have social support.
3. Medical education/training is not completed in a vacuum. Your personal life continues. If you’re single you may meet someone and end up staying in the city where you’ve trained for the rest of your life. If you’re in a long-term relationship you may decide to have children or may already have them. Down the road you might not want to relocate your family.

Not everyone gets the opportunity to go to medical school or train in a residency and fellowship program in a city she likes. But you can make choices that will increase your chances. Consider these options – and your happiness – as you practice gratitude this week and make professional decisions this coming year.

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Check Yourself Before You Wreck Yourself: How to Create a Match Rank Order List

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As you look toward the NRMP Match rank order list deadline on March 1, you’ll want to avoid simple missteps. Improving written materials and interview skills is critical, but all of that work can go to waste if applicants do not understand basic strategies for the Match. Way back in November 2015, the NRMP published an article called, “Understanding the interview and ranking behaviors of unmatched international medical students and graduates in the 2013 Main Residency Match” in the Journal of Graduate Medical Education. The data is still relevant today.

Sadly, the authors found that some applicants made strategic errors including the below:

  • Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.
  • Not attending all interviews, thus failing to capitalize on every opportunity to market themselves. (I suspect this error is less common now with the advent of virtual interviews.)
  • Misunderstanding the Match and, thus, ranking programs at which applicants did not interview.
  • Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

It kills me to read about these mistakes :(. Here is a video explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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