How to Make A Residency Rank List That Puts Your Happiness First
- Feb 21, 2023
- Reviewed by: Amy Rontal
Interview season is officially winding down, and with that comes a big sigh of relief. You are hopefully recovering from Zoom fatigue and spending much-deserved time with loved ones. But you’re not at the finish line quite yet! Match Day looms large and before you can tackle that emotional roller coaster, you must finalize your residency rank list.
You have ideally met with your trusted advisors and read some informative Blueprint posts about which factors to prioritize on your rank list, such as a program’s reputation, fellowship opportunities, research clout, and hospital capabilities. These factors are important—but they aren’t everything. Let’s set aside Doximity Rankings for a moment and focus on the everyday things that will make you a happy intern.
How to Be A Happy Intern: Program Qualities to Prioritize on Your Rank Order List
Your Life as a Resident
When it comes to building a happy and healthy residency program experience for yourself, there are two worlds to consider: your work, and your life outside of work. Let’s start with the factors that ensure the life built around your education is a happy one.
Ask the residents at your top programs what a typical day is like for them—then put yourself in their shoes. On inpatient rotations, you are waking up at 5 a.m. and arrive home 12 hours later. This doesn’t leave very much time for inefficiency. This strain on your schedule and energy makes it important to consider if it’s affordable to live near the hospital to minimize commuting time, ensure there is good takeout food to grab on the way home after a long workday, and keep an eye out for activities and businesses close by.
To elaborate on that last point: you’ve got to keep in touch with the world outside of work. And as great as it is to have the beach three hours away, you are seldom going to travel that far on your one day off (when you’re also catching up on laundry, meal prep…and sleep). Find out if on your days off you can easily get to a nearby running trail, Trader Joe’s, cozy coffee shop, salsa studio, jiu-jitsu gym, sports bar…whatever will rejuvenate you for the week.
Another factor to consider is how easy it is to get home to your family. Are there direct flights from a local airport or a reliable driving route that can get you home in a pinch? These are small things that become big things when you are low on time and energy during your intern year.
Trivial as it may sound, the weather will have a big impact on your happiness in residency. I wanted to train in the southeast because having four seasons makes me happy. I also never wanted to scrape snow off my car at 5 a.m. before heading to the hospital. At the same time, I have many friends who would be miserable in the southern summer heat.
This is a place you will be living for at least the next three years. Where you train for residency often becomes where you train for fellowship and ultimately build your career. The weather is something that will impact you every day—most of all on your precious weekends away from the hospital!
3. Cost of Living (COL)
Where you live on your modest resident’s salary will have a big impact on your daily life and your financial well-being during residency. Most residents prioritize living close to the hospital to maximize sleep and minimize commuting stress. If you have kids or want to rent a house, consider if you will be able to afford the kind of living situation your family desires.
Where you live will have an outsized effect on your finances which can be stressful on a resident salary and with student loans. You will want extra money after paying your rent to enjoy your off days exploring new restaurants or traveling.
Think hard about the benefits and trade-offs of living in a higher COL area. Try to see this decision as potentially a longer-term commitment, as most residents stay in the area after training.
If you’re not moving with a partner and plan to be dating your intern year, think about the area you are moving to. Some cities are growing and attracting young people whereas others may be more difficult to date in. Ask current residents what the dating scene is like, or test run a dating app in the area.
Your Work as a Resident
Now let’s look at the “working” part of what makes for a happy work-life in your residency program experience.
1. Patient Population
One of the most rewarding parts of medicine is taking care of the people in your community. Ask the residents what patient populations they serve. If you are bilingual, ask what opportunities are available to you to engage with these patients. If you care about serving refugees, veterans, certain ethnic groups, or a wide socioeconomic spectrum, ensure your top programs align with these goals.
2. Training Setting
Types of Care Centers
You should also consider the training environment. If you work at a large tertiary or quaternary center, you will see many complicated cases since patients will be referred there for highly specialized care. You will be working alongside specialists who are pioneers in their field and true experts in a very specific slice of medicine.
This can be very intellectually stimulating as well as afford you quality research opportunities. Similarly, facilities will be well-equipped for complex care with a catheterization lab for cardiac procedures, a transplant center, level-one trauma capabilities, and multiple ICUs.
While not as equipped to handle complex cases, a community hospital provides an experience with its own perks. You tend to see more bread-and-butter cases which will prepare you well for general practice. You also will see how medicine works in a Veterans Affairs system or private practice hospital, which tends to be very different from academic settings. Since most physicians will work in a nonacademic setting after training, this is a very valuable experience!
Number of Hospitals
A final aspect of your training to consider is the number of hospitals you will work in. The more hospitals you train in, the greater exposure you will have to various patient populations, EMRs, paging/communication systems, levels of care, and even different hospital cultures. This can help inform the kind of work environment you seek as an Attending.
However, too many hospitals can make you feel isolated if your friends and coworkers are all spread around many work sites. It can be harder to engage in educational events like morning reports or noon conferences that take place at the main hospital. You may also spend too much time and focus navigating different EMRs, lose time hopping between different physical spaces that could be spent learning medicine, or miss out on intangibles like bumping into your friends in the elevator.
While one hospital probably doesn’t provide enough variety, four or five can become burdensome. My recommendation is to choose a program with two to three training environments that have different patient populations so that you can diversify your clinical experience without stretching yourself too thin.
3. Program Size
The size of your future residency program is one of the most underappreciated factors when crafting a rank list. For many programs, particularly surgical specialties, classes tend to be smaller by nature and you won’t have much choice. However, if you’re in a medicine or pediatrics program, the size of the program should be a major consideration.
A program that is very small will enable you to get to know your coworkers very well. This can be a huge asset or a drawback depending on how well you jive with your class. One downside is that with a small program, if you are off work it’s very likely your friends are all at the hospital so it might be difficult to plan outings.
Medium and Large Programs
This is less likely the case with a larger program. Another oft-forgotten advantage of a medium or large program is that it will be easier for you to find shift coverage for a weekend wedding, for example. While a larger intern class will present more options to be social or swap shifts, it may make it harder to find a close-knit friend group.
Questions about the rotation and call schedule are ubiquitous during residency interview dinners and with good reason. Your day-to-day work schedule has the biggest impact on your happiness of any of the variables discussed. It’s important to be happy at work, but your ability to leave the hospital and go home to your family and hobbies is what will truly make your residency a happy one.
Length of Rotations
Consider the length of the rotations. My program has short, two-week blocks. The thought of such a quick turnover initially intimidated me. Halfway through my intern year, I feel completely different. Spending just two weeks on rotations I dislike makes them much more palatable.
A short rotation model also creates more flexibility in my schedule since there are many more rotations per year. Finally, returning to the same rotation a few times a year makes my progress feel very tangible.
Most programs have longer month-long rotations which have their own perks. While four consecutive weeks of inpatient work can be draining, it is generally followed by four weeks of outpatient, meaning several weekends off in a row. Such a schedule allows you to engage in hobbies with more consistency, like joining a sports league in your outpatient months. It may be easier to engage in a research project or other extracurricular.
The downside is that you will work a month with only four days off which is a difficult stretch. Many residents also feel their learning curve declines toward the end of the rotation as fatigue and perhaps some boredom sets in. Ultimately, you will have to decide which kind of lifestyle you desire.
One final schedule consideration is the call or admitting schedule. It is hard to know as an MS4 what type of admissions workflow you prefer, so don’t get too caught up in all the details.
One detail that is worth noting is when your shift ends. Some programs require all residents on the team to stay until the shift change at 7 p.m. My program allows you to leave when your work for the day is done. This means on your non-call days you sign your pager over to the call resident, who cares for your patients and their patients until shift change. It leads to marginally more work on call days as you are responsible for more patients, but it is glorious to leave the hospital at 3 p.m. on non-call days (especially in the dark winter months!).
5. Job Benefits
While you should not make your rank list based on program perks, there are many little things that make a difference. For example, having a dedicated parking garage close to the hospital is priceless when compared to fighting city parking or walking several blocks in wintry weather.
Some other high-value perks to look out for include being able to access the campus gym on your way home (which makes it more likely you’ll actually use it), a good medical and dental plan, especially if you have a family (a perk worth several thousand dollars a year), and retirement matching or a moving stipend (which is like striking gold in your search for program perks!).
There are other ways a residency can offer perks that show they’re committed to investing in you as a doctor and a person. A program that has “protected time” for conferences (meaning you are excused from clinical duties) and pays for your board study resources is showing you that they care about your education.
A program that provides free mental health counseling and arranges it with your schedule is showing you they value more than just your work. Most importantly, a program that caters a lunch every day and provides a stipend for the hospital cafeteria is showing you they care about you not being “hangry”! No program will have all these perks, so decide what’s most important to you.
The Bottom Line
With so many variables to consider it is no wonder many fourth-year students find making a rank list to be the most stressful part of the ERAS process. You can make spreadsheets for days, but ultimately it should come down to your life priorities. Think about the environment where you would like to work and live in based on the advice above and you can’t go wrong!
And if you’re still anxious about soldiering through the remaining ERAS process, don’t hesitate to reach out to peers, mentors, or even residency counselors for more guidance.
About the Author
I'm originally from the Northeast but attended college and medical school in Virginia. I just started residency in Internal Medicine this past year and am enjoying tutoring with Blueprint in my free time! I have always felt drawn to mentoring, especially when it comes to helping students like me who have no family in medicine to guide them. Now as a tutor at Blueprint, I’ve spent hundreds of hours teaching students at all levels. I think a lot about medical education and am excited to share my reflections on all things medical school and residency. In practice, I enjoy general medicine and as a bilingual physician find it especially rewarding to care for Spanish-speaking patients. When I’m not in the hospital, I enjoy salsa & bachata dancing, traveling to South America, dogs, and spicy food.