Choosing Where to Apply for Residency: Crafting Your Residency Program List

Creating the list of residency programs you are applying to is the first critical step in your journey to ending up at the perfect program for your lifestyle and career goals in medicine. Beyond specialty choice, this post will dive into other factors of each program itself and how they can shape your day-to-day experience, clinical exposure, and future opportunities. Here's a breakdown of the key factors to consider when deciding where to apply to.

Location

If your partner has a job that requires you to stay in a particular area or can only move to regions with specific job markets, your options may be limited. While some couples choose to live apart, this is a big decision that you may want to avoid by focusing on a smaller geographic region.

If you have kids, think about the impact of moving on their education. You may prefer to stay within your current district or seek out areas with top-rated schools.

Training Opportunities

Every residency must meet certain ACGME requirements, but real-world training varies widely.

Psychiatry Example: ECT and Psychotherapy

Some psychiatry programs offer significant ECT exposure or robust psychotherapy training (sometimes both!), while others meet the bare minimum requirements. These differences can dramatically shape your experience and comfort with different treatments if, for example, you want to perform ECT as part of your practice.

Family Medicine Example: Obstetrics

Here's another example: in family medicine, certain programs meet only the baseline number of deliveries, while others provide full-spectrum training and extensive hands-on experience. Deciding if this is important to you is something your should consider now when crafting your list.

Think about your chosen specialty and look at how programs differ in their curriculum and clinical opportunities. Decide which aspects are must-haves, which ones are "nice to haves", and which ones you don't care much about.

Thinking Ahead About Fellowship

Even if you’re unsure about pursuing a fellowship, it’s wise to evaluate programs that offer in-house options or are located in cities with a wide range of fellowship opportunities. This reduces the need for relocation and increases your chances of matching with programs in the area.

Exposure During Residency

Programs with fellowships may expose you to a particular subspecialty during residency. However, at some programs, fellows may take priority for the learning opportunities, limiting resident exposure to that subspecialty.

Alumni Match Rates

Even if a program doesn’t offer a fellowship, check their alumni success. If former residents frequently match into competitive fellowships, that’s a positive sign.

Work-Life Balance

When you see programs with up to 80 hours a week of work, do some math before applying. A week has 168 hours. Subtract your work hours, sleep, commuting, and personal obligations to calculate your free time.

You can still learn effectively without 80-hour weeks. A brutal schedule doesn’t guarantee better training—it often just means less time to process what you’ve learned (and lead to burnout).

Call Schedules

Find out if "call" means being onsite and if you're able to sleep overnight while on standby. Some programs offer post-call days off; others don’t.

Types of Call

• Night float: Preferable for those who dislike frequent schedule flips.

• Short vs. long calls: Ask about duration and frequency.

  
  

Prestige and Your Residency Program List

Prestige rarely impacts job opportunities unless you’re pursuing an academic career. Instead, look at the institution’s local connections—do they open doors in the city you want to work in?

Academic Affiliation

Some programs use the name of a prestigious institution without meaningful ties. Always ask how faculty are involved with the parent institution and whether the program is the “home” program or affiliated in name only.

Rotation Locations

Variety vs. Convenience

Some residents enjoy the variety of multiple hospitals and clinics; others prefer the stability of a single site. Programs with locations hours apart may cause major logistical challenges.

Resident Wellness

Social Media vs. Reality

Instagram may show smiling faces, but pay attention to resident interactions at open houses. Do they look exhausted? Do they hesitate when asked what they like about the program?

Culture Clues

• Resident-run vs. Attending-run: Resident-run can mean high workload and less support.

• Residents who don’t mention hobbies or leisure activities could be a red flag for the program.

Salary

Cost-of-Living Adjustments

Once adjusted for regional cost of living, most residency salaries are comparable. I recommend focusing on other factors instead of paying too much time on doing calculations to adjust for costs of living.

Rural vs. Urban

Contrary to popular belief, rural hospitals can offer broader clinical exposure. Many rural programs handle a wide range of conditions due to limited specialist availability.

If you're aiming for full-spectrum family medicine or procedural-heavy internal/emergency medicine, rural settings may offer richer training opportunities than urban programs where subspecialists dominate.

What Really Matters

This is going to depend on you and your preferences, nothing that your advisor is going to tell you or even the same as your peers applying to the same specialty. Overall, prestige and an urban environment tends to be overvalued for most programs, but you have to make sure other factors align with your lifestyle and long-term goals. After making your initial list of residency programs to apply to, attend as many open houses and interviews as you're able to, and show up prepared to ask questions so that you can inform your rank list post-interviews.

For more tips, listen to the episode What to Consider When Choosing Where to Apply for Residency

Frequently Asked Questions

1. How can I find out about the real culture of a residency program?

The best way to get an authentic feel for a program's culture is to speak directly with current residents by attending open houses, reaching out via email, and asking thoughtful questions during the interview process. Pay close attention to their tone, body language, and enthusiasm (or lack thereof).

2. What’s the best way to evaluate call schedules across different residency programs?

Start by reviewing the program’s website, but always ask current residents for what call looks like in practice. Clarify what “call” means—programs differ widely on frequency (e.g., every 4th night vs. night float), duration (short vs. 24-hour), post-call policy (day off, half-day, or nothing), and weekend call burden.

3. How important is it for a residency program to be affiliated with a medical school?

An affiliation with a medical school can be valuable, especially if faculty members are involved in academic teaching, research, or mentoring. However, not all affiliations are meaningful, so you want to ask how integrated the program is with the school and if residents are actively involved in teaching students.

4. Should I apply to community or academic residency programs?

You'll probably want to apply broadly to a mix of both and then narrow down based on your interview experience, but this depends on your future career goals. Community programs often provide more hands-on experience and better call schedules, while academic programs may offer more research opportunities and subspecialty exposure.

5. How do I assess the quality of a residency program's training if I can’t visit in person?

If in-person visits aren’t possible, leverage virtual open houses and your virtual interview experience. Show up prepared to ask for specifics about the program such as the number and diversity of rotation sites and specialty-specific training highlights (e.g., procedures).