The Race of Residencies in the Residency Race

6 years ago
I have this habit: I count people.  Every time I arrive at a function or meeting, I’m like a covert operative and immediately analyze the situation.  But I’m not looking for possible emergency exits, I’m counting the number of white people.

Sometimes I count the people of color instead. Basically I count whichever one is in the minority. These days, this usually means counting people of color and it’s usually in the single digits.  Thus, the habit is not as all-consuming as it might initially seem; usually it only takes about one second.

And while this sort of behavior might give me something in common with bigots, I’m not a bigot. I’m just not colorblind.


In times of stress we revert to old habits so it's not surprising that a few days ago I found myself tallying the race if each resident in every program that I was considering. As a medical student on the verge of graduation, the deadline for submitting our rank lists is just around the corner.

Unlike applying for college, medical school, or even most jobs, the residency application process is a mutual one. Nobody is accepted and nobody is rejected.  Each residency program makes a rank list of the applicants they want with their favorite at the top.  Each applicant does the same with residency programs. The lists are submitted and computer magic spits out the optimized combination.  On “match day” the results are released and each applicant is given a slip of paper with the name of the program that they’ve been assigned.

The process is similar to dating. It’s a complicated social dance of desperately trying to get a program to like you while at the same time trying to figure out which program will make you the happiest. The process is only intensified by everyone around telling you that it's the most defining decision of your career. 

As I reduced each smiling face into a hashmark on my paper, I thought about the email that had prompted this undertaking.  It was from my friend and fellow Family Medicine applicant. In it she ruminated about the ranking process. She noted that most of the programs that we were applying to were dominated by white faces. Was that an appropriate thing to be concerned about? How much weight should diversity carry in the ranking process?

I realized that I had only been taking vague notice of resident diversity so I decided to be more objective.  I decided to count. Any person I was unsure about, I counted as "person of color - not otherwise specified."  Of the programs that I was applying to, the percentage of white residents ranged from 31% to 79%.

Sitting in front of all the numbers, I pondered their actual significance.

Most of the time becoming a resident simply feels like plodding along to the next predetermined step in the path to becoming a doctor.  The vast majority of my life has been this way: preparatory. When I applied to medical school, there weren't any life considerations. It didn't matter if I didn't have any family nearby, and it didn't matter where I wanted to live after I graduated. It wasn’t real life yet, just school.

But there are also moments when I think, “This will be my first job as a doctor.  This is, like, LIFE!” Professional networks in medicine are regional. The network you form is important because that’s where your mentors come from. It’s no wonder that two thirds of residents end up practicing where they train.  This time it’s not just about getting into a good residency; the specific program matters.

Medical school in the midwest has been moderately traumatic.  I'm sick to death of only white people.  I'm also tired of feeling like I'm one of the few people who understands the difference between charity and empowerment.  And even more importantly, I want to be in an environment where everyone around me challenges me and pushes me to be my best. It has to be a diverse.

Racial diversity is an indicator of not only diversity of thought, but also a dedication to justice.  I routinely calculate racial diversity in a room because it means something. At the same time, it doesn’t mean everything. Like most things in life, it’s complicated.

It would be stupid to miss out on a fantastic opportunity simply because it’s mostly white people. In fact, generations of folks have died fighting for exactly that right.  Besides, most of my life has been spent with white folks who have taught me so many important things, including about race.

Furthermore, given my educational and financial privilege, I have a lot in common with liberal white folks.  Maybe that’s where I belong - mucking about with other folks of privilege, together trying to find the best way to improve the world. Responsibly leveraging the privilege that one has is difficult. I can always use some more good ideas.

Ultimately my ideal residency program would have a focus on care for the underserved, a culture of social justice activism, academic rigor, and a diverse community. It’d like it to be somewhere I could see myself living for awhile. In the end weighing all these things turns out to be more gut instinct than anything else, just like dating.  Sometimes one thing is worth compromising on for another, sometimes it’s not.  And funnily enough, every once in awhile, upon meeting each other, requirements that were once “deal breakers” suddenly are not as crucial as you once thought they were.

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