How to pick a residency if you are interested in entrepreneurship

Here are the results of the 2023 NRMP match.

Applying for and being accepted to residency after medical school is a complex, major decision. There are several factors to consider including the reputation of the place, the?length of residency training for a given specialty, 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.

Medical students using FREIDA can find information about training programs, key application deadlines, and specialty training statistics, which provide a helpful overview of residency programs based on trends across all programs in a specialty. Explore more than 180 specialties and subspecialties on FREIDA’s Specialty Guide , which has expanded to include important training information such as graduates’ career plans and specialty statistics.

Among active U.S. allopathic senior medical students applying to residency programs across all specialties, these were the top five considerations.

• Desired geographic location—cited by 88%.
• Perceived goodness of fit—84%.
• Reputation of program—83%.
• Academic medical center program—68%.
• Quality of residents in program—67%.

Here are the 10 best and worst states for physicians.

Here are states interested in technology

Where you do your residency, in part, will, in part, depend on where you went to medical school i.e pubic or private paying in-state costs or out of state. ?A 2017 study ?based on tuition data gathered between 2006-16 found that the median cost of attendance for students paying in-state tuition—across all states—over four years was $232,800. That figure compares favorably to the $306,200 four-year median cost of attendance for medical students attending private institutions over that time frame. Students attending public schools paying in-state tuition saved $73,400, according to the data.

According to the Association of American Medical Colleges’?2019 Report on Residents , more than half (54.6%) of the individuals who completed residency training from 2009 to 2018 are practicing in the state where they did their residency training.

Two primary care specialties were among the top five specialties that most commonly saw residents practice in the same state in which they trained. The top five were:

• Family medicine—64.6% of residents staying in state to practice.
• Psychiatry—64.5%.
• Pediatrics—60%.
• Pathology: anatomic and clinical—59.9%.
• Vascular surgery: integrated—59%.

However, the best practice location might not be the best place to practice your ambitions in entrepreneurship if you are one of a small number of graduating medical students with an entrepreneurial mindset.

The ten best cities for entrepreneurs in 2022.

The ten best cities for entrepreneurship in 2024

But, given the exodus from California, are you sure you want to do a residency there?

Suppose you will be doing remote work??Here are some suggestions.

Since most medical students do not have an entrepreneurial mindset and few will have learned biomedical innovation and entrepreneurship, most have little or no interest in picking a residency that will help them get their ideas to patients

However, if you are one of the small but gradually increasing percentage of medical students interested in physician innovation and entrepreneurship, here are some questions to ask during your due diligence and interviews:

1. How robust is the local innovation ecosystem, particularly if it is outside of Boston, New York, and the SF Bay area.??Here's a list of the top 50 surge cities.
2. Who are the local connectors, physician champions and entrepreneurs, salespeople and mavens?
3. Is it easy to find entrepreneur mentors?
4. How much, if any, time will you be given to hone your entrepreneurial interests?
5. If you invent or discover something, who owns the intellectual property?
6. Is there any money available to pilot a project or create a prototype?
7. Does the location offer bioentrepreneurship education, training, internships or fellowships during your residency?
8. Can you take a leave of absence if you want to?
9. Are there non-clinical jobs available in the local startup community?
10. What organizations are included in the local ecosystem and what benefits do they offer to medical professional trainees?
11. Here are the usual tips on how to be a successful resident. ?Medical training is a culture of conformity.?How you will you do if you want a culture of creativity?
12. Since it is likely that you will be practicing where you did your residency, looking for your first job after residency is going to be an equation that includes your personal and professional wants and the opportunities available.

The decision, in part, depends on whether you stay local for medical school, assuming you have that choice.?Here are the pros and cons.

Great entrepreneurs can come from anywhere, but some universities have a truly exceptional track record of producing future entrepreneurs . Here is a comparable list for academic medical centers

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 McKensey 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.

Here is how to write your own letter of recommendation.

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 ?on Substack and Editor of Digital Health Entrepreneurship