1. Geographic Location
I can honestly say this is probably one of the most important factors to consider when deciding where to apply for residency. Is a particular program close to a spouse, family member, or a region of the country you wish to live? If you absolutely hate living in big cities, and could never fathom having to take public transportation to work, then matching into a residency program in a major city might not be the best fit. If your dream program happens to be located in an area of the country you know you don’t want to live, then it is likely you ultimately wouldn’t be happy matching there. Residency programs last several years, and while the fit of the program is important, remember that you are LIVING here and need to be just as happy outside of work as you are in it in order to succeed physically and emotionally during residency.
2. Cost of Living
While programs in big cities, such as Boston or NYC, may provide slightly higher salaries, it is important to keep the cost of living in mind (especially if you’re looking to upgrade from your med school studio or one bedroom apartment). Even with roommates, housing in big cities can cost over $1,200/month for rent alone. Additionally, many large cities require tenants to pay for street/lot parking and utilities. Regardless of the area, some programs also charge residents to park at the hospital. Unfortunately, these things are important to pay attention to when deciding where to apply.
3. Size of Residency Program
The size of a residency program tends to vary from specialty to specialty. However, the size of a specialty cohort may also vary substantially from program to program. The size of a program will impact your workload and academic relationships. For example, a surgical specialty with only one or two residents may require one to take call quite frequently. However, this might be a favorable option for someone who wants to know their faculty well and have the opportunity to receive frequent one-on-one attention.
4. Reputation of Program for a Particular Specialty
Programs also vary in terms of their reputation, and will therefore offer more opportunity for residents in different specialties. One program might be known for matching residents into a particular fellowship that interests you. Another might be known for helping graduates get jobs at top academic centers. These are all important factors to consider when deciding where to apply.
5. Benefits of Program
The salary most programs offer tends to be fairly similar, so it shouldn't be a deciding factor when applying. However, the benefits programs offer can vary substantially. For instance, some programs provide residents with meal cards for free food when working on shift, whereas others do not. Some may provide free access to a fitness center right in the hospital. The amount of CME funds may also differ from program to program, so if you have a particular interest in research or attending conferences, this may be something to pay attention to. Some programs provide free parking, personalized scrubs, affordable medical/dental insurance, travel reimbursement to offsite locations, funds for international study, etc. Know what benefits are important to you when considering a program.
6. Apply (and Rank!) Where YOU Want to Apply
I remember when I was trying to decide where to apply for residency, I got a surprising amount of input from family and nonmedical friends. They often suggested applying to places based simply on the name of the program, because it was located near them, or because they thought it would be a great place to live. Ultimately, the decision about where to apply, and eventually where to rank, is entirely up to you and you alone. You must decide where you think you will be the happiest.
Overall, deciding where to apply for residency is based on a number of factors. If time and finances permit, it is certainly acceptable (and necessary, in some cases) to initially apply broadly to a variety of different programs in several locations. If you travel to one location and decide you don’t like the area, you can always cancel other interviews in that city. Likewise, if a program seems great on paper but after the interview you realize it’s not the right fit, then you certainly don’t have to rank it.
The bottom line: Let your heart guide you to apply and rank programs where you think you will be the happiest during these intense—and rewarding—years of your life.