Friday, 7 September 2012

Residency Interview Question: Academics or Private Practice in the Future?

Introduction:
 
There are several curve ball questions which the interviewer can ask during a residency interview that often leaves the candidate perplexed as to what will be the implication of answering it one way or the other. There are unfortunately no straight answers to such questions and one such commonly asked but important question is: what do you plan to do in your future as a physician? Do you plan to stay in an academic setting or do you plan to have a private practice? The problem that an applicant faces when posed with this or a variation of the question is that – one is never sure what to say! If you say you want to do private practice, then there is a chance that the faculty interviewer or program director may look at it unfavorably (they themselves may be academicians) or if you say you want to do academics but have no skills or experience to back it up, you may look unprepared. 

Method

Using data from program directors survey (2012), one can glean some important information as to how to answer this question. The programs (specialties) were placed on the x-axis based upon the emphasis a program places on academic career of the applicant (in the order of increasing importance, from left to right), This is displayed by the green line with yellow circles in figure 1. Also included is the effect of having some prior research experience on the likelihood that a program will invite an applicant for interview (blue circles, trend line).

Figure 1: Perception of programs for career in academics (source NRMP)

Results and discussion:

Based on the ‘program interest in applicant academic career’ (which is an almost linear graph), the area is divided into 3 zones:

1.    Programs with < 30% importance (low): Med-peds, family medicine (FM), PM&RS, Pediatrics, Anesthesia, Obstetrics and gynecology.
2.    30-39% (medium): Internal medicine (IM), Orthopedics, ENT, Emergency medicine (EM) and Neurology.
3.    >40% importance (high): Psychiatry, dermatology, General surgery, Pathology, Child neurology and neurosurgery.

Thus, for those applicants who have applied to med-peds, family medicine or pediatrics, it may be better received if you indicate a non academic job in future. You can use this answer during the interview or imply in your personal statement, that your future plan is going to be practicing medicine in the community in a non-academic setting. For applicants to Internal medicine, they can chose either answer depending on your perception of the interviewer and the program. For neurology applicants, even though it would be a zone II program, it may be better to indicate that you would like to pursue an academic career post residency. Finally, for pathology and neurosurgery, which are the at the end of zone III, choice of academic career may be better received.

I have to point one important thing, regardless of what the interviewer leans towards, it should not affect what you really feel like when the answer the question, because ultimately you will do what is best for you. There are many things that affect the outcome of the interviews and this result only indicates, how your answer may be received by the programs possibly affect your chance of interview and being ranked into a program.
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Reference:
National Resident Matching Program, Data Release and Research Committee: Results of the 2012 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2012.

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