Section A
Introduction
Key Factors in Making your Decision
Choosing your future career is a very complex process and many factors are taken into account before a final decision is made. This guide objectively examines many of these factors and hopefully it will provide you with a solid decision-making framework.
The key factors in this book can be broken into:
- Program Features
- Career Goals
- Location
- Additional Factors (e.g., family and friends)
These factors have been succinctly examined by Dr. J. Gonzalez at the American Medical Association. A summary of his paper “Selecting Your Residency Program” is outlined below:
As you read through each of the sections of this guide, keep the features of each of the above variables at the forefront of your mind and they will help you refine your decision. Also keep in mind some variables may hold more importance than others in your career decision. The relative importance of these variables may play a role in your future career path. For example, if a medical student valued family life and interests unrelated to medicine to a greater degree, the student may be more interested in specialties that allow a flexible schedule.
Stability
Look at the stability of the program, especially the finances and outlook of the institution at which you are considering training.
Support
As an applicant, you want to know that the program will be there to support you. You can judge this by looking at the quality of fellowships attained, turnover rate in the program (how many residents leave/transfer after the first year), availability of mentors, number of residents who stay at the institution to complete fellowships, and departmental responses to resident complaints, as examples.
Flexibility
Does this exist in the program? How amenable is the program in allowing residents to change schedules to attend a conference? For residents who become pregnant during their residency, how hard is it for them to get time off?
Institutional Climate
What is the political/social/work climate at an institution? Very conservative institutions are less responsive to change. This could be manifested by very poor relations with the surrounding community or a lack of community outreach programs.
Academics
Decide whether you want to pursue research, work in the community or do a little bit of both. You will begin to get an idea of this toward the end of medical school as you get more experience. In this regard, remember that when applying for a competitive fellowship at a tertiary care hospital, you will likely have an advantage if your residency was completed at a tertiary location. A well-known and well-regarded program will give you a better opportunity to attain a higher ranked fellowship.
The End Game
Always consider where you want to end up living. If you want to settle down in Ottawa as a pediatric nephrologist, it does not matter much where you do your residency; you can complete it anywhere. But it is in your best interest to complete your fellowship in Ottawa. The main reason? More contacts and networking. It is easier to look for a job after fellowship if you know those working in your specialty in that area. Many job offers are not posted nationwide but disseminated within a closed circle in a community.
Significant Other
Always look at the demands of the residency in terms of normal work hours, call hours, and time required for studying as it will affect the amount of time you see your loved ones.
Your family has to live in the city where you end up, too. Will they have job opportunities in their chosen professions? Will they like the city? Keep in mind that an unhappy family will equal an unhappy residency.
Children
If you have children, you may consider whether your chosen city is a reasonable place for children to grow up. You may also have to consider child care and the nature of the public school system.
Camaraderie
The residency journey is often long and you will likely spend a lot of time within the hospital. Talk with residents to determine the climate in the program and whether it is friendly or unwelcoming.