Residency application season has begun!

When I was applying last year, I spent a lot of time thinking not just about what programs I wanted to go to, where I wanted to live and how best to answer “Where do you see yourself in five years?” — but also trying to develop a method for making this decision. This is the mental model I came up with that helped me through interviews and making my rank list.

It starts with two questions:

1. What do I want to do after residency?
2. What do I want to get out of residency?

For some, these questions are straightforward. For others, not so much.

I think it is important to be honest with yourself about what you want to do after residency — being specific helps. You will not have a perfect answer, so don’t try to find one. The answer will change a lot, before, during, and even after residency, but thinking about this question will assist with answering the next one.

If you’re clear about what you want to do after residency, it can make the answer to question two easier.

If I want to be an orthopedic radiologist who works at an academic medical center in Milwaukee, for example, I want to go to a residency program that will set me up for that end. Sometimes, the answers to questions one and two are discordant. That’s OK.

One resident I spoke with had a background and wanted to have a career in advocacy, but didn’t want to go to an advocacy focused residency to get a different experience. We all have our reasons. Trust yours.

Of course, neither of these answers is set in stone. In fact, it is essential to continue to revisit these questions before you interview, while you are at different places and after all your interviews. Be open to changes in these answers, as it can be your gut telling you something your mind hasn’t caught up to.

Now, the factors for how to differentiate programs: the Six Ps. Everyone will weigh each of these factors differently, thought the first and last are likely the most important.

1. Place. We all have things pulling us towards different places: family, significant others, weather, affordability, the desire to be somewhere new. You will be living in this location for years. Think about what is important in your life and how geography may affect those things. Place, more than any of these other factors, is very personal, so try to make the best decision for you.

2. Program. Every program is different — but not that different. After all, ACGME requirements exist. What is different is that imperceptible thing we call culture. There is no right or wrong culture; you just need to find the place that vibes the best with you. While it’s natural to perseverate on the only data you’re given, schedules and specific research experiences ultimately don’t matter as much as how you fit into the program and whether its values align with yours. If you feel at home, you can find opportunities and thrive in any program.

3. Pedigree. There are two things to say about this. First, take a look at where graduates with your interests have gone, both immediately after residency and in their careers, to see if the program prepares residents to do what you want to do. Second, for better or for worse, the name and reputation of a place matter.

4. Patient population. Hospitals serve different patient populations, clinically and demographically. Think about whether there are certain patients you want to care for, in service of the two questions above. If you want to be an oncologist, see what kinds of cancer patients the hospital treats. If you care about vulnerable populations, make sure your hospital or clinic actually takes care of them.

5. Program director. I didn’t realize how important program directors were until I went on my interviews. They will be your built-in mentor, your support, your sounding board, and one of your most influential relationships during and after residency. Talk with them and see how you feel about them as people.

I’ll note here that individuals will say nice things to you during this process. Friends of mine have been told by program directors and chairs of their top choice that they’d love to have them at their residency … and then not match there. So take these comments with a grain of salt; they are trying to recruit you, just as you are trying to impress them.

6. People. I saved the most important factor for last. Your co-residents are everything. You spend the majority of your days, every single day, for years, with them. They will be your friends, your colleagues, your support through good times and bad. The friendships from residency are lifelong. So make sure that you like the folks you meet on interview day. You won’t love everyone. But if you aren’t comfortable with the majority of the people you interact with, pay attention. Most doctors are nice, but much like culture above, you may or may not vibe with them, and if you don’t it will make residency much harder than it needs to be.

Ultimately, picking a residency program comes down to feel. And it is very personal. This mental model is just a way to help you tease out what is important to you and why. So ask yourself: What programs do I feel good about? How you feel about the things you value will be the biggest factor in your decision. Trust that feeling. And even if you don’t end up where you wanted to go, trust the universe. Most folks find, even if they didn’t match to their first choice, they end up in the best place for them.

Sudhakar Nuti is an internal medicine resident.

Image credit: Shutterstock.com