Important Questions to Ask

A Non-Exhaustive List

Of note, these questions are designed from my experience in a non-surgical residency. Surgical residencies may have different unique circumstances.

Consider asking these questions on interview:
How long since the program been in existence?
How long has the program been ACGME accredited?
Has it ever lost ACGME accreditation? If so, why? If not, do you expect that in the future?
Has this program ever been on ACGME probation? If so, why? If not, do you expect that in the future?
Has any other program at the hospital ever lost ACGME accreditation or been placed on probation? Things like that can sometimes that can affect this program (e.g, My pediatrics residency program in which our neurosurgery program closes and then pediatrics starts admitting and rounding on peds neurosurgery patients).
How many residency positions are in this upcoming class?
How many were in each class for the last 3 years?
How have they prepared for the increased number of resident trainees?
If the number of positions decreased, why?
Who is the program director?
Who is the chairperson of the department?
Is the program director also the chairperson of the department? Or are they related to each other in any way?
How long has the program director been in that office?
How long has the chairperson been in that office?
For both the chairperson and the program director, who was there before and why did they leave? Are they still at the institution?

For current interns and residents:
Who is supervising you as an intern on night float?
Who makes the decisions about who is accepted for residency? (the program director? A committee of attendings/residents?
What will your schedule be as an intern?
Are you ever pressured not to document hours worked?
Who will be your chief residents when you are an intern? How many of them are there? What are they like to work with? (Ask several people in the class below them—they have worked together generally for several years).
Have you ever been pressured to accept an inappropriate patient (for example, what do you do when an ER doctor pressures you to admit a surgical patient to a non-surgical service)? What recourse do you have in that case? What was the outcome?
Does your hospital depend on residents for its operations? Or could the attending run it successfully without residents? (Neither is bad; it depends on the number of residents, specialists, nurses, hospital beds, and other resources available. But you will be busier as a resident if the hospital depends on you for its operations! Flip side: they might miss your help more if you were gone.)
What is the normal number of admissions you have per night? How about per 24 hours?
Do you normally chief all admissions with a senior resident? How about with an attending that day?
Does every attending physician round every day on every patient with the team? If not, why not?
What is the longest shift you have ever been required to work as an intern?
What is the longest shift you have ever been required to work as a senior resident?
What is the longest shift I would be required to work in this program? Are any shifts longer or more frequent than that planned for the future?
Who sets the call schedule? How frequent is call on each rotation?
How frequent is call in the ICU/MICU/NICU/PICU/SICU? What changes do you expect for this schedule in the future?
How often do you have to work more than 80 hrs in a week?
Do you know of any resident in your program who has quit during your time here?
How about in other programs in the hospital?
Do you know of any resident who has died during during your time, whether it was expected or not? Why?
Do you know of any attending physician who died? Why?
Do you know of any nurses, secretaries, or other staff who have died? Why?
(If you are changing specialties): Has your program accepted people from another residency program before? How about from one outside your institution? What was your experience? What concerns, if any, came up?
Are you required to attend morbidity and mortality conferences? In those conferences, are interns or residents required to admit to mistakes that were not their own, but other peoples’ mistakes? Are these conferences valuable educational opportunities? Do they lead to improved quality of health care delivered?
Are you required to attend tumor board? In those conferences, are interns or residents required to admit to mistakes that were not their own, but other peoples’ mistakes? Are these conferences valuable educational opportunities? Do they lead to improved quality of health care delivered?
Do you know of any attending who have had their medical or procedural privileges decreased or limited (no more endoscopies, bronchoscopies, etc.)? Do you know why?
Do you know of any graduates who were unable to obtain initial post-residency employment for a significant period of time? Why?

Look up on FRIEDA and confirm at interview:
Is the hospital(s) nonprofit or for-profit?
How many hospitals would I be rotating through during the program? Are you planning to add or take away any?
How many clinics would I be rotating through during the program? Are you planning to add or take away any?
Would I be the PCP of record in my residency clinic? If so, would I have a required panel size and what would it be? What would my clinic obligations be when I am on an inpatient rotation?
What electronic medical record is in use at each hospital? Are we expecting that to change at any of the hospitals?
Are all these teaching hospitals with senior residents on each rotation, or when if at all will I be working directly with an attending?

Read the contract they offer you for these things:
Will they let you have a leave of absence for personal/family reasons if you need it? I would look for this in the contract rather than asking it in person, to avoid leaving the wrong impression.

Observe when you are there:
Are the residents too tight with co workers- for example, do they like go out to bars every night after work and ostracize you if you don’t go?
Are there likely to be the advantages of a larger program—it’s easier to blend in, easier to get coverage if you need time off.

Investigate the following for each program you apply to:
Check AMA and other sources (consider residentswap.com) for resident vacancies. You can also call the residency office and ask if there are any vacancies. Some vacancies are not advertised.
If there are vacancies in September (especially multiple!), it may be a sign of weakness in the program. People left that quickly.
Talk to people you know at programs and ask their opinion of the program.
Your med school may have a list of previous students who went there.
Consider calling the ACGME ombudsperson if they have received resident complaints about it recently??

What is your schedule for didactics on each rotation?
Does your program offer any resources to prepare for the ITE’s? What ITE score is required at every level of training?
What happens to residents who do not achieve that score? What if they keep not achieving it over multiple years?
What percentage of your residents get the required ITE score?
What percentage of your residents pass specialty boards on the first attempt? How has that changed over time? What are you doing about it?
What do you do for surgical and OB gyn education? What is your approach to teaching procedures? What procedures if any could I learn and would I be required to learn during my training?
Are there any other residencies in any of these hospitals or clinics I would be working at?
Are there any fellowships at any of these hospitals or clinics? How many?

What change do you anticipate during the next 5 years in this program?
What changes do you anticipate during the next 5 years in these hospitals?
What changes do you anticipate during the next 5 years in these clinics?

How many of the residency positions are federally funded and how many (if any) are funded by the institution?
What is the financial situation of the hospital and this residency program? Profitable? What is the payer mix (how dependent on Medicaid)?
What is the financial situation of our clinics? What if anything do you do to promote continuity in clinic? How well is that working?

Has the hospital ever been on probation or similar status from JCAHO or any similar state organizations?
Look up program director and hospital on CMS’s OIG list of excluded persons and organizations or see if they or their parent company has had a corporate integrity agreement with CMS
https://exclusions.oig.hhs.gov/SearchResults.aspx
https://oig.hhs.gov/compliance/corporate-integrity-agreements/cia-documents.asp#m
Look up the hospital on Becker’s Hospital Review
Look up the hospital’s rating by the Center for Medicare and Medicaid services. A hospital with more stars tends to provide better patient care.
Just look them up on Google reviews and Google news, but remember that reviews can be faked either positively or negatively

Do they have call rooms for me as a resident on night float? How about 30 hour call? How about on ICU rotations?
How about surgery and OB? Are they shared rooms? Enough for everyone? Clean? Quiet? Is there a phone and a computer with EMR access?
Will I ever have to cover multiple hospitals? on call at once? If so, which hospitals? Where would I sleep while on duty? How busy is a typical call night and how often are you up all night?

 

 

 

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Whether it’s a residency or not, your medical job is an important part of your future. I am a board-certified US medical school graduate and US residency graduate and enjoy sharing what I have learned about applying to medical jobs, from residency onward.