When evaluating urban vs rural residency programs, it can be tough to choose which type is the correct one for you. When first learning how to prepare for your residency applications, you will come across certain residency programs that are dedicated to caring for communities outside of major metropolitan areas. Where you complete your residency is a big decision for your future as a resident doctor, so there is a bit of pressure in selecting the right path. There are positives and negatives to each type of program beyond their location that may not be immediately obvious to the average applicant.
This article will delve into the features of both urban and rural residency programs for applicants to compare and determine which is best for them. We also touch on how professional residency help services can further aid any medical student or graduate wishing to apply for their residency.
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Features of Urban Residency Programs
Many medical graduates are attracted to starting their training in an urban area, as cities are where most health care professionals are currently working. There can be many benefits as well as drawbacks to urban residency programs, depending on multiple factors, such as your specialty, educational background, and personal interests. Here are some key features of urban residency programs you should keep in mind when applying:
The main advantage of applying to urban residency programs is that there is more of everything. In metropolitan areas, you will simply find more hospitals, medical centers, clinics, and residency programs to choose from. There is a higher population, meaning more patients to serve and more possibilities overall. There are opportunities for both primary care specialties, such as an internal medicine residency, and more specialized departments such as orthopedic surgery. In a larger city, you will find basically every type of medical department you can think of. If you completed medical school abroad and you would prefer an urban location for your residency, you may find a variety of IMG friendly residency programs in bigger cities as well.
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On the flip side, this could mean that there are more of the negative aspects of a career in medicine as well. Depending on the specialty you choose, there is a higher possibility you will be exposed to more crime cases, road accidents, and other unfortunate circumstances in a city when compared to a more rural setting. That is an aspect of an urban residency you will need to keep in mind.
Urban residency programs can lead to exposure to innovative medical research and the most up-to-date technology. There is learning you will gain in a city hospital or medical center that you will not be able to experience elsewhere. Some of the most competitive residencies are found in urban areas due to the high volume of applicants with interest in those regions. They are often the epicentre of advancement in the medical field and attract many future doctors. If that culture of innovation is something that interests you, it may be best to apply to a residency program in an urban area. Cities tend to be home to the majority of teaching hospitals, which can be a perfect choice for the residency training period of your career. These institutions are fully accustomed to having residents working alongside attending physicians, which can be extremely useful in your growth as a medical professional.
Cities also have more diverse populations. If you select an urban residency, you may get the chance to work with patients from various cultural and ethnic backgrounds, rather than a specific rural community. Many future doctors want to affect the lives of as many people as possible and want to practice medicine without any limitations. An urban residency program will allow for that. The city you train in may include many foreign languages, which may appeal to you if you speak various languages. There are also larger disparities in socioeconomic status, age, and health issues in urban patients, so you will be working with a plethora of different people every day who have differing life experiences. This will contribute to a more complex residency experience overall where no day is the same as the last.
The setting you will be completing your residency in can alter your overall experience, so it is important to make the right choice for you. It may not be fathomable at the moment, but you will have time off of work to spend in whatever city you choose. The city is full of hustle and bustle, and it is unlikely you will ever be bored. There are restaurants, concerts, art museums, and other events available to you regularly, and you will never have to travel far to reach them. There are too many things that can be done while living in a big city that it is impossible to name them all. Transportation is also more easily accessible for the most part, so you may not need your own car while completing your residency. However, cities will be more expensive to live in without the guarantee of a higher salary. If you are wondering “how much do residents make?”, you should be paid enough to live comfortably. That being said, if you want to save as much money as possible, an urban program may not be for you.
Examples of Urban Residency Programs
1. Dermatology Residency Program at the University of California, Los Angeles David Geffen School of Medicine
This program in one of the USA’s most populated cities is meant to train physicians to be exceptional dermatology clinicians and teachers. It also includes various sub-specialties such as medical dermatology, pediatric dermatology, dermatologic surgery, and dermatopathology to provide residents with a multidisciplinary education.
2. Family & Community Medicine Residency Program at the University of Texas Health Science Center Long School of Medicine
One of the most IMG friendly family medicine residency programs, this program in San Antonio, Texas, is designed to familiarize residents with community settings, including school health centers, group homes, nursing homes, and more. In addition to their full scope clinical training, residents stemming from the Long School of Medicine participate in health fairs and promotion activities throughout the city.
3. General Surgery Residency Program at McGill Medical School
Located in the heart of Montreal, Québec, the general surgery residency at McGill is an urban program in Canada’s second largest city. This world-famous university has a long history in surgical training and research with distinguished alumni working all over the world. The surgery department’s faculty are accomplished surgeons who are especially recognized for their resident education.
Features of Rural Residency Programs
While a significant proportion of residency programs are in more urban areas, a rural setting can also be a great option for residents beginning their professional careers. As with city programs, rural programs have both pros and cons that can make the decision about where to continue your medical education difficult. Here are some key features of rural residency programs that applicants should be aware of:
It goes without saying that there tend to be fewer physicians in rural areas. Therefore, the broader primary care specialties will be more available than specialized residencies such as surgery or dermatology. Family medicine residency programs, in particular, seem to be quite common for rural areas. With rural residency programs, you are less likely to feel overwhelmed by the number of options and may be attracted to their accessibility. If you are figuring out how to get into residency programs as an IMG, a rural stream could be an option worth looking to. While there is a higher number of IMG friendly programs in the cities, rural programs tend to correlate with the most common specialties that IMGs get matched with in both the US and Canada. Due to the demand for doctors in these regions, more residents are taking the opportunity to train in rural areas. As such, these programs could be some of the least competitive residency programs to get into. Depending on the applicant’s individual situation and interests, the simplicity of a rural residency program could be appealing to you.
Rural doctors tend to wear many different hats for patients and have vast medical knowledge. As you can be working in a sparsely populated area, you may be one of the closest doctors for miles. Luckily, as a resident, you may be supervised by other physicians who are more accustomed to a rural landscape. This can be a viable opportunity to learn by example and really test the skills you have learned in medical school. The primary care specialists who thrive in rural programs are often considered generalists who can treat a wide variety of conditions or symptoms. Rural regions can deepen your training and practice by assessing the needs of underserved individuals who do not have the same proximity to medical care as city dwellers do. You may be required to work in smaller clinics or medical centers, as well as conduct house calls or travel directly to the source of the issue. You will mainly need to rely on yourself and those immediately around you to make accurate diagnoses or a proper referral to a specialist. As you are away from the convenience of the city, calling for additional aid from other hospitals or medical centers can be a significant component of your residency.
What differentiates rural residencies from urban programs is the kinds of people you will be serving. Some of what can be considered the best family medicine residency programs have a rural component to them, as they accept both IMGs and domestic residents to serve a particular community in their region that needs the additional help. These populations may have different common health problems or needs that you will be responsible for assisting with as a family doctor or otherwise. A rural residency could end up being more personable in comparison to an urban program. Getting to know the people and environment they reside in will just be another part of your residency. That is a unique quality about rural communities that metropolitan hospital departments lack. While you will still be caring for patients on a daily basis, rural medical procedures can be seen as less fast-paced at times.
One of the main features of a rural residency is its location. While different rural regions may have different environmental qualities, the proximity to nature heavily influences the lifestyle of a resident doctor. In your off-time, rural areas are particularly known for outdoor activities and wonderful sights. Those who prefer isolation and spending time in nature may prefer a rural residency program. Take advantage of the hiking trails, national parks, biking paths, and sightseeing to further enrich your experience as a resident. If you are an international medical graduate, you can receive exposure to new locations outside of your country of origin that you might not be familiar with. Staying in a rural area may also be more practical for a resident doctor, as you will likely have more space for yourself with a cheaper living cost. However, you may need a car or some other mode of transportation that can get you where you need to go. Long commutes are not for everyone. If this is not a problem for you, then a rural residency may be a great choice.
Examples of Rural Residency Programs
1. Family Medicine Residency – Rural Program at the East Carolina University Brody School of Medicine
This nationally known program is located on the coastal plains of North Carolina, and residents can match with one of two sites that serve communities of up to a maximum of 4,500 people. Experienced rural physicians will provide the proper guidance and mentorship to residents as they acquire an understanding of the region.
2. Internal Medicine Residency Program at the Adena Health System
Chillicothe, a rural community in Southern Ohio, is the main hub of the Adena internal medicine residency program. Rather than having a rural track, this program’s location is within a 261-bed facility. This program provides all the training necessary to become an internist through a comprehensive and integrated approach.
3. Family Medicine Residency Program – Rural Stream at the University of Manitoba Max Rady College of Medicine
This Canadian program offers six rural streams that work with Indigenous communities. Working with the university’s Elder in Residence, residents will gain a better understanding of issues surrounding access to treatment and be a part of research that influences how health care is provided in Manitoba.
Location should be a crucial part of your criteria when it comes to the residency programs you choose to apply to. When you ask “how long is residency?” and know you will be stationed at your location for several years, where exactly you are staying can make a big difference in your experience throughout residency. This is where you will officially start your career as a licensed physician, so make sure you carefully consider all the available options.
What we can draw from putting urban and rural residencies beside each other is that while they have their distinct differences, each type of residency program can be a great opportunity to practice medicine. It is fully up to the applicant to discern which option is better suited for them, based on their needs, interests, and values. The most important aspect to consider is perfecting your application so that you get matched on your first try. Applying smartly and strategically based on how well program requirements match with your experience or background will maximize your chances at getting matched. There are useful strategies for how to improve your application after going unmatched, but these are a last resort and should not be the goal for any medical graduate.
1. What are the most significant differences between an urban and a rural residency program?
Besides the obvious location differences, some of the most significant differences between urban and rural residences are in terms of specialty. When figuring out how to choose a medical specialty, those wanting to work in rural locations may not be focused on surgery, for example. Primary care specialties tend to have the highest match rates in both urban and rural settings, but rural programs usually need more generalist doctors than specialists, who can be found in bigger cities.
2. What are the current match rates for graduates coming out of medical school?
Reviewing medical schools with the best match rates can provide more information about this, but allopathic medical schools in the US are currently at 92.8% while DO schools are at 89.1%.
3. What are the specialties with the highest match rates?
Primary care specialties, such as family medicine, internal medicine, and pediatrics, are some of the least competitive residency specialties regardless of where the program is located. These specialties also usually have the highest match rates for both domestic applicants and IMGs.
4. Are urban or rural residencies more friendly to IMGs?
There is no concrete answer to this. While there are likely more urban opportunities for IMGs simply due to the higher number of IMG friendly hospitals and medical centers in these areas, some rural programs are exceptionally friendly toward IMGs and can be great opportunities as well. It is up to the individual school or residency program, which is why researching what requirements are necessary is essential.
5. What services can I use to help me find a match?
Residency match services will be great tools for you as you maneuver through the application process. In the US, ERAS is the main service you will use. Meanwhile, many Canadian programs use CaRMS. The websites of these services provide admissions information and requirements about programs across the country, including both urban and rural opportunities.
6. What is a residency rank order list?
A residency rank order list is what you will compile when applying to residency programs. You will order each program you’ve applied to from your most desired to your least desired. When both parties rate each other highly, a match occurs, and you are basically accepted into that program. If you have applied to both urban and rural residencies but would prefer to live in a big city, you would rank urban programs near the top of your list.
7. What are some concrete measures I can take to improve my residency application?
At the end of the day, the location of your residency program will not necessarily determine whether you are accepted. Preparing stellar application documents, such as a residency letter of intent, or having an impressive residency CV, will be key to making a great first impression. Scoring well on any licensing exams, such as USMLE Step 1, will surely get you to the next stage of the process.
8. How can academic consulting help me with my residency application?
Partnering with a residency prep company can be a solution if you are struggling to organize your applications. An expert consultant can provide advice on how many residency programs to apply to and whether a rural or urban residency would be better suited to your needs. They can also deliver residency interview coaching to help you craft the perfect responses and secure a match with your desired program.
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