Post-residency satisfaction: How prepared are residents for the real world?

You know first-hand how all-consuming residency can be. It’s a marathon guaranteed to make even the most dedicated future MDs feel the squeeze. The COVID-19 pandemic also added complex layers to the mix for many. Unsurprisingly, these unprecedented challenges meant residents frequently experienced mental health issues like depression and anxiety.[1] 

So, given how complex we know the experience to be, how do recent residents feel about their program—and what do they think could have better prepared them for direct patient care?

While the learnings may not be globally representative, they offer insights into the reality around residents' preparedness.

An overview of the respondents 

More than three-quarters (77%) of survey respondents graduated from their residency in the last three years, with the majority completing residency between 2017 and 2022. In fact, over half (54%) of survey respondents graduated residency in 2022.

A little over half (56%) of all respondents practice in urban settings, with 33% practicing in suburban environments and just 10% practicing in a rural geographical area. It’s worth noting that a 2021 review in the Journal of Public Health: Oxford Academic shows that rural areas experience greater patient healthcare inequities and healthcare staff retention challenges. [2] This underscores a need to analyze and support rural physicians’ needs and perspectives.  

Many residents feel satisfied with their program experience

Matching with and landing a residency is a life-changing experience for a medical student. It is especially tough considering that residency programs have not expanded enrollment, creating a training bottleneck. Many students go in wondering if the program will be right for them in the long term; here’s what our surveyed residents had to say about their experience. 

Forty-two percent of respondents said they were completely satisfied with their residency program, followed by 38% who said they were somewhat satisfied. However, 17% said they were somewhat unsatisfied with their residency program, while 2% felt completely unsatisfied. There was no significant difference between the rate of satisfaction in one’s residency experience and their geographical location. 

There’s a reason why residents have to have these tools in place: Med school is associated with high rates of depression, anxiety, and burnout, according to a 2023 study in Medical Teacher. Some of this may even sound all too familiar to you. Or, you may be one of the residents who decided to take a break from residency.[3]

Our survey respondents indicated times when they felt compelled to quit residency. While half of the respondents did not feel the desire to quit, the remaining respondents cited the following reasons: Long hours and stress (43%), the COVID-19 pandemic (12.5%), feeling unprepared to take care of patients without oversight (9%) and other (3%). 

This may provide a clue into why so many healthcare workers are leaving the industry, with some reports saying some 20% of the workforce has walked away.[4]

While we know that the COVID-19 pandemic saw an increase in healthcare staff working long hours—and reporting subsequent burnout—it’s worth noting that graduates from years prior to 2020 also cited long hours and stress as reasons why they considered quitting residency. 

When unsure of something or when overwhelmed, residents can sometimes feel like they can’t ask certain questions. MDs encourage residents to ask questions, believing that learning an answer is better than guessing it. Furthermore, asking questions trains future MDs to converse better with patients. Thus, we asked our respondents if they felt as if they could ask for help during their time in residency. Most (82%) said they could, but nearly 20% said they could not. 

Drilling down even further, we asked if residents knew where to turn for help if needed.  A vast majority (93%) said yes, while 6% said no. Of those who responded yes, they generally turned to a variety of sources: attending physicians (92%), other residents (72%), educational materials (38%), or  “other” (3%).

Supporting patients 

Going into medicine is a big decision—and many residents feel compelled to practice after experiencing certain “a-ha!” moments with patients. In a recent MDLinx article, residents said that experiences educating, validating, and comforting patients underscored the importance of their work. 

So, are recent residents feeling prepared to care for patients—and what might be some barriers to doing so?

We asked our surveyed respondents if they felt their residency’s educational component prepared themfor post-residency. Most (93%) responded yes, while 6% said no. Of those that said no, there were multiple reasons: First, they felt that the lectures didn’t cover the information they needed to know for board testing (60%), their lecture material didn’t fill in gaps in their knowledge (80%), and their lectures were disorganized or irregular (40%). 

There were also specific areas in which most residents felt unprepared. Forty-two percent felt they were unprepared to handle patient billing. 21% said they felt unprepared regarding documentation. 13% said they felt unsure about medical knowledge, and another 4% said they were unprepared for direct patient care. 

One respondent even noted needing help “identifying diagnoses, ordering labs/imaging, collaborating for differentials,” while another said they struggled with “coming up with a plan for patient care.” Another respondent noted that they struggled the most with “medical management of complex diseases.”

Other reasons residents felt unprepared included finding a job post-graduation (8%), taking care of their mental health (7%), and handling student debt (3%).  

The residents shared specific areas where they felt challenged during their residency and needed help. A majority of recent residents cited needing help with procedures and medical knowledge (echoing a 2017 article in BMC Medical Education that states many new graduates felt unprepared to work).[5]

Another area of concern? For many respondents, managing workload and scheduling was an issue (with a few noting that finding childcare was a concern—something that many healthcare workers are struggling with). Resolving scheduling conflicts was one respondent's toughest challenges.[6]

Additionally, many respondents noted needing help with billing, placing orders, and navigating the healthcare system in general.

Some of the residents surveyed also said that they felt there were ways their residency program could have done more to better prepare them for patient care: 37% said they would have liked if the program made attendings more accessible, 36% said they would have preferred better lecture components, and 20% said they would have liked to have access to mental health services. 5% cited other reasons. 

COVID-19's impact on residents

COVID-19’s impact on medicine is undeniable. With Pfizer's COVID-19 vaccine, mRNA vaccine technology was on the world stage, proving its ability to save lives and change the medical landscape. Further, its rapid rollout was simply unprecedented, being the fastest vaccine rollout in history.[7] As a result, additional research on mRNA technology is being done to fight against the flu and HIV.[8] 

The pandemic also changed the way medicine is practiced—for better or worse—with mobile testing vehicles and video calls becoming a norm. Survey respondents noted this shift, explaining that more and more of their patient visits were done via video call at this time. However, one of them noted, “Telemedicine isn’t the same as seeing patients face to face.” 

Throughout all of this change, residents felt the pressure: “Managing patients with COVID-19 added more stress due to unknown factors of the disease,” one of the respondents said. “There was panic, anxiety, and fear, which added to the stress of residency.” 

Residents themselves were at risk during the pandemic. Research shows that emergency medicine residents experienced higher rates of SARS-CoV-2 infection in 2020 than previously known at the time—specifically those in urban healthcare settings.[9] 

Residents did all of this when medical supplies and resources were limited, when already-existing weaknesses in the medical industry were coming to a head, and when the mental health of healthcare workers was frayed. 

A key way the pandemic altered residency for many of our respondents? Many of them were only able to practice medicine on one type of patient—a patient diagnosed with COVID-19: One respondent noted, “[I saw] way too many COVID-19 patients. No other etiologies were coming to the hospital.” Another said, “Managing COVID-19 with comorbidities such as COPD, asthma, and diabetes was also more complicated.”

Patient loss also forged an impact on residents: “I saw one thing—and that was constant death,” one respondent said. Others noted experiencing burnout, which a study in BMJ Supportive & Palliative Care has shown was common in residents due to COVID-19. [11]

But sometimes the residents weren’t even caring for patients. “[The pandemic] decreased our caseload. There were months where we were put on non-patient care rotations, which I think was detrimental to our overall education,” one respondent shared. Another mentioned that they lost experience doing procedures they otherwise would normally have had practice doing: “[Because] a whole year of my residency was basically dedicated to COVID-19, I wasn't able to do a lot of procedures. I feel this affected my education.” This was a concern many of the respondents shared.

“Our training was different from our non-pandemic peers,” one respondent wrote. “Elective and mandatory rotations were changed,” a respondent noted.  

In the end, the COVID-19 pandemic impacted resident preparedness, mainly when it came to patient care. The majority (66%) of respondents said the pandemic impacted their patient care experience, while 33% said it did not. For residents in urban settings, as compared to residents in suburban or rural areas, this impact was especially true. 

That said, some residents said that the pandemic’s trial-by-fire quality actually helped them prepare for patient care. “It helped with triaging, handling an increased load of patients, handling increased levels of deaths, handling overtime work, and more note writing,” wrote one resident. “It helped me more but was more difficult,” said another.

One resident also found a potential silver lining in the pandemic’s chaos: It taught them how to take care of themselves, as well.