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5 Key Findings from Over 62K Residency Reviews

Op-Med is a collection of original articles contributed by Doximity members.

Despite rising concerns over long work hours and low wages, residency reviews remain overall positive, according to an analysis of 62,570 verified residency reviews. 

The analysis covers reviews submitted from August 2015 through July 2022 to Doximity’s Residency Navigator, which each year serves as a guidepost for many fourth-year medical students in their residency search.

 Residency programs have an overall satisfaction score of 4.66 on a five-point scale, reflecting a willingness among current and recently graduated residents to recommend their program. The most positively reviewed residencies by specialty are child neurology, medicine/pediatrics, and orthopaedic surgery. And residencies located in Minnesota and North Carolina have the best reviews.

In addition to overall satisfaction, residents rated programs by work hours; schedule flexibility; career guidance and mentorship; culture, or cohesiveness of the community; clinical diversity; and surgical volume for select specialties.

To follow are key findings and insights from the residency reviews.

1) Top Residencies by Specialty

Overall satisfaction with residency programs is high across all specialties, with a range in score of 4.41 to 4.86. At least 90% of the reviews are positive (four-star and five-star ratings) for all specialties except for pathology (still largely positive at 85%). 

Child neurology and medicine/pediatrics report the highest ratings in overall satisfaction. The specialties boast notably high scores for residency culture, career guidance, and clinical diversity, though more moderate scores for work hours.

“​I've never met an unhappy child neurologist,” said Dr. Sujay Kansagra, associate program director of the pediatric neurology residency program at Duke University Medical Center. “I think it's the long-term relationship we build with children and their caregivers that really creates the high job satisfaction in our field. It's also such a deep field with various subspecialties, allowing residents to really pick their areas of interest.”

Beyond child neurology and medicine/pediatrics, proceduralists tend to be the most satisfied. Despite lower scores for schedule flexibility, the majority of procedural specialties are among the most satisfied overall, driven largely by strong reviews in culture and career guidance.

In the case of orthopaedic surgery, Dr. George Dyer, program director of the Harvard combined orthopaedic residency, has found that orthopaedic residents are satisfied above all because they have the opportunity to “perform one of the best jobs there is: being an orthopaedic surgeon.” 

“They are finally fulfilling a wonderful dream,” Dr. Dyer said. “That does not mean orthopaedic training is all roses. It is hard, long, and frustrating at times. … [But] at the end, an orthopaedic resident will be happy if they feel they have been adequately prepared to do their job to the best of their ability.”

E-ROAD” lifestyle specialties (emergency medicine, radiology, ophthalmology, anesthesiology and dermatology) sit in the middle of the pack for overall satisfaction, with relatively higher ratings for work hours and schedule flexibility, but lower ratings for career guidance and culture. Anesthesiology residency is an exception and has a smaller percentage of positive reviews than most specialties.

2) Top Residencies by Location

As is the case for specialties, residency satisfaction remains predominantly positive across locations. Residencies in all U.S. states received an average rating of at least 4.1, with most above 4.5. 

Minnesota tops all U.S. states for best-reviewed residencies, securing the greatest satisfaction score in most categories. 

“We are fortunate to have strong, well-established health care systems and educational institutions in Minnesota … where our residents learn from experts who revel in the mentorship relationships that they form with learners,” said Dr. Matthew Meunier, family medicine residency program director at the Mayo Clinic in Rochester. “Exceptional medical training and mentorship opportunities, combined with wonderful recreational and natural resources and an affordable cost of living, make Minnesota an ideal place for residents to spend their time in training.”

A common thread among the highest-rated states for residency is the presence of major academic medical centers: in Minnesota (No. 1), the Mayo Clinic and the University of Minnesota; in North Carolina (No. 2), the research triangle including Duke and the University of North Carolina Hospitals; and in Massachusetts (No. 5), a vast pool of academic medical centers including Massachusetts General Hospital and Boston Medical Center.

A look at residency programs by metropolitan area follows a similar pattern. Most of the top five metropolitan areas feature several major medical institutions. The San Francisco Bay Area, for example, is home to the University of California, San Francisco and Stanford University

The high ratings for these metropolitan areas — including the San Francisco Bay Area (No. 1), Boston-Cambridge-Newton (tied No. 2), and Los Angeles-Long Beach-Anaheim (No. 5) — primarily stem from strong reviews in culture and career guidance.

When categorized by major U.S. regions, the satisfaction reviews are nearly equal, with the West slightly ahead in residency culture, the South offering the greatest clinical diversity, and the Midwest in front in work hours, schedule flexibility, and career guidance.

3) Staying in State vs. Out of State

Residents who work in the largest specialties are most likely to stay in state after graduation.

The top 10 specialties with the greatest in-state retention are mostly specialties with the largest total number of active physicians, including family medicine (61%), psychiatry (61%), emergency medicine (55%), internal medicine (50%), and anesthesiology (49%). More available positions overall may give graduating residents in these fields more in-state opportunities. This correlation between retention and specialty size also resembles the pattern from the 2020 AAMC physician report

Surgical residents, in contrast, are more likely to work out of state than in state after graduation. Fewer than half of residents in every surgical specialty end up staying in state.

Among the five specialties with the lowest in-state retention, most are surgical: ophthalmology (38%), orthopaedic surgery (42%), otolaryngology (42%), urology (44%), and PM&R (45%). Fewer available slots for surgeons likely makes it more challenging to stay in state than for primary care physicians or other specialists. Prior reports have also shown that surgeons are more likely than primary care physicians to choose a job location because of a unique work opportunity, rather than working where they trained. 

“It may be more difficult for surgeons to find a good job specific to their specialty, and many uber-specialized surgeons (like pediatric heart surgeons) can only get jobs at major university centers,” said Dr. Jan Kamiński, clinical assistant professor of surgery at University of Illinois at Chicago. “On the other hand, primary care physicians are in short supply everywhere and can essentially function as a solo practitioner.”

“Where a surgery resident ends up probably has more to do with where they do fellowship compared to the location of their residency program … since most job prospects and opportunities come from fellowship training,” added Dr. Brian Sullivan, a fifth-year orthopaedic surgery resident at John Hopkins

By location, the states most likely to keep their residents are California (69%), Florida (57%), and Texas (55%) — the three states with the largest total population in the U.S. Conversely, the majority of residents who practice in most of the other states leave after graduating.

What’s more, residents who train at the same institution as their medical school are more likely to say they are satisfied than those who train farther away. Overall satisfaction ratings are 4.72 for physicians who trained at the same institution as their medical school, 4.7 for those who trained at an institution within 50 miles of their medical school, and 4.66 for those who trained 50 or more miles away. 

4) Diminishing Returns

As a whole, positive reviews predominate regardless of residency year, with first-year residents leading the way. The highest percentage of positive reviews occurs during PGY1 (99% positive), followed by PGY2 (97%), PGY3 (95%), and so on. 

Residency scores slightly dip year over year, though they remain relatively high across all categories. Overall satisfaction scores, for example, range from 4.96 to 4.69, falling marginally after each year of training. The drop-off in ratings is widest between PGY1 and PGY2, falling most in terms of clinical diversity (from 4.88 to 4.64) and career guidance (from 4.87 to 4.68). 

Residents also tend to give more positive reviews during residency than alumni do. The average score is 4.73 for reviews posted during residency, compared with 4.64 for those posted after residency. 

An overall downward trend points to slightly diminishing satisfaction with residency over time. It may also reflect the ever-growing list of responsibilities and expectations for residents year over year, with only minimal adjustments in wages and schedule flexibility. 

5) Ready to Practice

Whether due to physicians’ passion for their specialty or pride in their program, residency review scores are high across the board. There is an acknowledgement among physicians of the challenging nature of residency  — including limited budgets, bureaucracy restraints, and more recently, calls for unionization — yet the reviews continue to be largely positive. 

Still, certain aspects of residency may have more room for growth than others. On average, the rating is lowest in the category of career guidance at 4.41, which includes mentorship and support around job and fellowship placement. In a small survey of residents in their final year, 57% indicated they had received no formal training on matters of employment, such as contracts, interviewing, and reimbursement. 

The highest residency satisfaction scores are in surgical volume at 4.83 (for relevant surgical specialties) and clinical diversity at 4.71 (for non-surgical specialties). Scores are slightly lower for culture (4.58), work hours (4.5), and schedule flexibility (4.48).

Ultimately, there are several qualities that are almost universally shared by leading residency programs across the country — rigorous training, individualized and flexible education, and a supportive learning environment, according to Dr. Meunier. 

“Many programs are able to provide rigor, flexibility, or support; but strong programs are able to balance all these qualities at the same time,” he said. “Programs should be able to support their residents so they thrive during residency and not just survive their training.” 

“Residency programs are not ‘one-size-fits-all.’ There is a great residency program for everyone, and a great trainee for every program,” Dr. Dyer added. “But in the end, the common denominator is that the trainee feels ready to practice at the conclusion of their training.” 

Explore the full residency program directory online, including thousands of peer reviews.

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