Residency Training - A Final Year Timeline

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As July 1^st rolls around yet again, another group of new interns will be starting in every residency program around the country. This time of year is important and symbolic for all residents because it represents their progression to the next year of training, and for the lucky seniors amongst us, it means that residency has finally come to an end.

As the famous saying goes, “The days were long, but the years were short,” and this applies to residency more than any other experience I can think of. Each day, week, month rotating through the requirements and taking call as a resident can feel like they drag on, and especially for junior residents, the hard work and hours put in feel never-ending. The good news is, however, it DOES end. And when you’re on the precipice of being a full-fledged attending (or, for some of us, a first-year fellow), looking back it all seems to have gone by so fast.

For the rising chief and senior residents, this period is an especially important time, not just because of the responsibility of leading your fellow residents and representing the department within your institution. This period of time, when transitioning into final year of residency, is essential for starting to map out your timeline for the final year and planning what the “next step” will be.

Presumably, by now, you have completed the “deep” thinking required in making the decision as to what general direction you would like to go when it comes to post-grad plans. Of note, this article is referring specifically to those residents who choose to stay in medicine following residency. However, it must also be said that a certain percentage of MD’s who finish residency do not go on to the clinical practice side of medicine. That will be covered in another article!

Fellowship Training

The main question all residents must ask themselves around their penultimate year in residency is: “Do I pursue fellowship and sub-specialize, or am I done training?” There is no right answer, and different paths are ideal for different physicians. If you decide to be finished and start out with your career (finally!) as an attending, congratulations! You chose a noble path. If you feel the need to further hone your focus and press the gas pedal on research and education, maybe fellowship is the right path, also noble.

In general, the process for starting fellowship applications begins in the second-to-last year of residency. Due to the wide variety of specialties that offer multiple fellowships, it is best to refer to the main governing body for your specialty and click the “Education” link for more information about fellowships and the application process. Of note, in the US there are accredited and non-accredited fellowships. This is based the individual societies within a specialty that deem fellowships to be up-to-par with the standards for education and training. ACGME also accredits fellowships, and monitors/regulates said fellowships similarly to residency programs. The most important aspect of planning out fellowship application process is understanding what the exact deadlines are for your specific desired sub-specialty. Even within a specialty there can be (and often are) varying timelines for the application seasons, and one must be vigilant about this so as not to miss the opportunity. Similar to residency match, almost all fellowship programs operate via the ERAS application system, in conjunction with NRMP for the “match” process. Another important point for residents thinking about fellowship applications is to be communicative with your residency program director early-on, so that they can be aware of your likely upcoming need for PTO days for interviews.

First Job Search

For those residents who have decided to finish training and work as an attending physician following residency graduation, the transition into your final year of residency is also vital for embarking on the job-finding process. The market for new doctors is a hot one, but the job search can become frustratingly complex if one enters without knowing what you really want.

The main divisions to think about when contemplating your future as a doctor will be: Do you want to work mostly in a hospital, or do you want to practice ambulatory medicine within the community? If you stick to hospital medicine, do you want to be in a teaching environment with residents and students, or somewhere where you call all of the shots?

Do you want to be within the hustle-and-bustle of a city, or provide more suburban or even rural medicine? Family and personal factors aside, these questions will help you decide what type of practice or system you would like to focus on for employment.

Before answering any of the (likely) many recruiting emails you are receiving, make sure you settle with yourself how you will answer these questions. Decide what is important to you going forward and how you would like the first few years out of residency to look. It’s OK if your priority is making a lot of money, or having an easier schedule, or avoiding any call. You’ve worked hard, and now is the time to name what you want so that people who are paid to find you a job can actually help you!

By July of your final year in residency, you should also have your resume brushed up and dusted off. Utilize the guidance of professional mentors and your program director to help polish your resume until it shines. You’ve achieved a lot and need to make sure future employers know it!

Similar to fellowship-seekers, make sure you tell the administration at your program you are beginning to look for jobs. Not only will this help in terms of obtaining PTO for interviews, but it will also help put feelers out for potential jobs within your own institution or within their (likely large) professional networks.

The summer and early fall of this year will likely be the period when you will begin speaking to recruiters, practices, and hospital administrators about first interviews. If you’ve had your eye on a specific practice or hospital and haven’t heard much about job openings, it’s okay to call them directly and ask to speak with HR or even department chairs about potential job openings. Ask for “informational interviews” to learn more about an institution so that if a job does open up, they know you’re interested.

Now that you’re prepped with your priorities, resume, and with time on your side, you can begin preparing for interview season whether that is for fellowship or for attending positions. We will discuss how to look your best and nail the interview in another blog post.