Applying for and being accepted to a residency after medical school is a complex, important decision. There are several factors to consider including the reputation of the place, the likelihood you will be accepted, the culture, whether it is a "good fit", your performance in medical school,where you went to medical school and undergrad, bias,whether you are applying as a couple, the local cost of living, and, the location and lifestyle amenities it offers and how much it pays.
The roots a physician creates during that time frame can extend decades. In fact, roughly half of residents who completed residency training from 2007–2016 are practicing in the state where they did their residency training, according to the Association of American Medical Colleges. The average debt of a graduating medical student is $190,000, so you will need to do the math, particularly in a city with unaffordable housing and otherwise high cost of living. Things get complicated in a hurry if you marry another doctor in debt. In some instances, your debt will greatly influence your decision. Even the 1% are getting squeezed.
The average yearly salary for a first-year medical resident is about $52,000 in the United States, according to the recruiting website Glassdoor. How far that number goes will depend on what sort of lifestyle a physician desires, their family obligations and where they plan to live. Consider consulting a cost-of-living calculator.
In addition, if you are interested in physician innovation and entrepreneurship, here are some questions to ask during your due diligence and interviews:
- How robust is the local innovation ecosystem, particularly if it is outside of Boston, New York and the SF Bay area.?
- Who are the local connectors, physician champions and entrepreneurs, salespeople and mavens?
- Is it easy to find entrepreneur mentors?
- How much, if any, time will you be given to hone your entrepreneurial interests?
- If you invent or discover something, who owns the intellectual property?
- Is there any money available to pilot a project or create a prototype?
- Does the location offer bioentrepreneurship education, training, internships or fellowships?
- Can you take a leave of absence if you want to?
- Are there non-clinical jobs available in the local startup community?
- What organizations are included in the local ecosystem and what benefits do they offer to medical professional trainees?
Since you might not match or, if for some reason, you find yourself in a city where you are unwilling or unable to practice medicine, you should ask yourself these questions early and often. In that case, here is how to find a job in your biocluster, or a non-clinical job.
While you need the answers to these questions, it is extremely unlikely that you will get them from the people interviewing you so you will need to go to third party sites and resources and talk to locals in the know. In addition, be careful what you ask for. Given the competitive nature of residency slots and how the game is played, the last thing program directors want to hear from you is that 1) you have no intention of practicing medicine more than 5 years, 2) you are interested in creating a digital health company instead of practicing medicine, and 3) they run the risk of having a "disruptive physician" in their midst for 3-5 years. Be a crypto-entrepreneur even if your Wharton undergrad, Stanford computer engineering grad school degree and McKenzie experience prior to applying to medical school is a dead giveaway.
Unless you are the best of the rest, all this might be moot and you will probably go to where you are accepted or create Plan B if you are not.
Good luck in your search. Winding your way through the GME match bottleneck can be hazardous not just to your career, but to your bank account as well. Until things substantially change, innovate your heart out. Just don't tell anyone you are doing it until the time is right.
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs.
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