Medical graduates once wore out their fingers typing their applications to residency programs. Today, the Electronic Residency Application Service (ERAS) makes it much easier to broadly apply to multiple programs. As a result, residency programs now contend with an overwhelming volume of applications.
"You don't really get to pick your job, and we don't really get to pick the residents—the National Resident Match Program matches students with programs," said Douglas L. McGee, DO, vice dean of graduate medical education at Sidney Kimmel Medical College in Philadelphia.
Because both sides are making decisions with limited information, programs work hard to identify candidates who will thrive within their culture.
Applicants in turn, are looking for quality training along with the personal and professional factors that will make a residency program the right fit for them, said Dr. McGee. Academic reputation, board pass rates, and faculty strength all play an important role.
Sidney Kimmel Medical College is affiliated with Jefferson Health, a Philadelphia-based system that spans 32 hospitals and physician practices. Jefferson Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Many adjustments have taken place since the COVID-19 public health emergency, forcing institutions to pivot and re-evaluate their strategies. In an interview, Dr. McGee discussed what Jefferson Health has done to stand out and attract top residency candidates, offering a place that residents can call “home.”
A focus on high standards
The health system places a premium on measurable outcomes and the overall training experience to attract top candidates. At the foundation is program quality.
"Making sure that your programs are accredited and are accreditation problem-free" is essential, said Dr. McGee. Equally important are board certification exam pass rates, which residents view as a critical indicator of a program's effectiveness.
"Board pass rate is very, very important," he said. While residency graduates receive a certificate upon completing their training, the ultimate goal is eligibility for board certification.
"What they get out of the program, in addition to excellent clinical training, is literally permission to sit for the board certification examination," Dr. McGee explained. Because board certification may be necessary when applying for hospital privileges and independent practice, applicants pay close attention to a program's success in preparing trainees for those exams. The certificate received at the end of training is not board certification, but the ongoing work in a residency program aims to prepare residents for licensing or a board exam.
Jefferson Health also works to attract residents by building a nationally recognized faculty.
"We don't just read the books, we write the books," he said, referencing a tagline that captures the value of having faculty who author textbooks, publish research, and hold leadership roles in national professional organizations. Those accomplishments create what he described as a "halo benefit" for the program and help demonstrate the strength of the educational environment.
Optimizing the virtual interview
Beyond academic credentials, applicants are looking for a place to call home.
"One of the things that's really important for the residents is that they feel like they fit in with the house staff and with the training program," Dr. McGee said. For that reason, the interview process plays a critical role in recruitment.
That process has changed dramatically since the COVID-19 public emergency. Before 2020, residency interviews took place almost entirely in person. Applicants traveled to hospitals, met faculty and residents face-to-face, toured clinical spaces, and experienced the culture firsthand.
"There was a lot of value in that," Dr. McGee said. Through conversation and nonverbal cues, meeting in person allowed applicants and programs to evaluate compatibility.
Today, virtual interviews have largely become the norm. While applicants appreciate avoiding the expense and logistics of traveling across the country, he acknowledged that some aspects of the experience are harder to replicate online.
"We've all gotten very accustomed to a different way of doing business," Dr. McGee said. Programs have become much more effective at virtual recruitment, but "it's not easy to fully address that fit piece when people aren't really coming to your physical space.”
In some cases, residents match with a program and sign a contract before ever setting foot in the hospital.
"I know that there are residents that the first time they physically show up at your hospital is the first day that they work," he said. Despite that shift, the virtual model has not appeared to create significant acculturation challenges. Still, “it’s a challenge that we do it differently than we used to.”
Choosing the environment you work in
Prospective residents aren’t just interested in formal benefits and resources—they want to fit in with the program and the surrounding community.
"There's a difference between support systems that we may have in place for them and the support that they feel," said Dr. McGee.
Jefferson Health’s residency programs span a wide geographic footprint across eastern Pennsylvania. This allows residents to choose environments that align with their lifestyles and personal needs. Some are drawn to the energy and convenience of urban life in Center City Philadelphia, while others prefer suburban or rural settings.
"There are residents who match in some of our programs that won't match in one of our Center City programs because they don't want to be in an urban environment," Dr. McGee said.
Beyond the community itself, Jefferson places significant emphasis on helping residents acclimate to their new environment and training program.
"A lot of what residency training programs have, are really around acculturation—how it is that you get the residents acculturated to your program so that they can thrive in your program," he said.
Offering mental health support
One of Jefferson's signature initiatives focuses on mental health and well-being. Every incoming resident has the opportunity to meet with a mental health professional. The program is structured as an opt-out service, helping residents establish a connection before they may need support.
"They have an opportunity to meet with one of our mental health professionals as soon as they start, so that they have connected to a resource and a name to a face," Dr. McGee said.
Residents who appear to be struggling academically or clinically are often facing challenges outside of medicine. Addressing those underlying issues can have a profound impact on performance and well-being.
"Finding out that what the resident needs in support totally outside of their training program helps them perform better in their training program," he said.
Jefferson also recognizes the unique challenges faced by non-U.S. citizen international medical graduates, who make up an important part of the residency workforce. For these physicians, acclimating to a new country often involves much more than learning a new workplace.
"Imagine coming from another country where you've gone to medical school and you are not familiar with not only the environment and how to find a bank and where to go get groceries, but how the healthcare system works, and now you're expected to train in that," Dr. McGee said.
To support those transitions, Jefferson works closely with international residents and organizations that assist physicians on visas, helping them navigate both daily life and the U.S. healthcare system.
"Acculturation for our international graduates is important," he said, as they’re a crucial part of the physician workforce.
When program directors become mentors
One trend Dr. McGee has noticed among today's trainees is a strong desire for engagement, feedback, and a voice in their training experience.
"They value that they have a voice in the process," he said. "They want a lot of feedback."
Residency programs are naturally structured around continuous evaluation and coaching, but he noted that younger generations often expect feedback to be more explicit and frequent. Creating opportunities for residents to contribute ideas and have some control over aspects of their work environment can also strengthen engagement.
"Letting residents have control and feel as if they've got some stake in this is really important," Dr. McGee said.
At the same time, residents want to know that program leaders genuinely care about their development.
"When the residents graduate, program directors have to assert on paper that the resident is ready to enter autonomous independent practice," he said. "Which is a pretty high bar."
Because of that responsibility, residency programs continually raise expectations as trainees progress. Feedback, coaching and increasing responsibility are all part of the process of transforming medical students into practicing physicians.
Ultimately, Dr. McGee said, mentorship culture is built on trust. Residents need to believe that the challenges they face during training serve a larger purpose, and that program leaders are committed to helping them succeed.
"There's a coach in Philadelphia that used to say, 'You have to trust the process,'" he said. "And really, in many ways, that's exactly what has to happen for our residents. They have to trust that the program directors want to get them where they want to be."
Happy practices retain physicians
Jefferson Health has also become more intentional in how it retains physicians after training.
"Where residents train is often where they will continue to work," said Dr. McGee. "GME as a pipeline function has gotten to be a really important topic."
Residents need to see that people are happy with the practice environment. When they observe faculty who are fulfilled despite the everyday challenges of healthcare, they can more easily envision building a career within the organization. They say to themselves, “I could work here.”
Mentorship also plays a major role in retention. The professional relationships residents develop with faculty and program leaders often become an important part of what keeps them connected to an institution after graduation.
"The mentorship relationships that you build with your faculty and with your program director are an important part of the stickiness that happens with residents that want to stay after they've trained," he said.
Moreover, Jefferson has begun exploring more proactive recruitment strategies for residents nearing graduation. In some physician specialties, residents may receive job offers and signing bonuses well before completing training.
"Some of our programs have actually started to engage with the residents based on the premise that they would stay," Dr. McGee said, including discussions about contracts and signing bonuses before residency is complete.
Not only is this more cost effective, but physicians who transition directly from residency into attending roles already know the organization's systems, culture, and clinical operations.
"How much simpler it is to hire a resident that on June 30 was a resident, and on July 1 is a member of your attending staff?" he said. "They know how to use your medical record. They know what floor stuff is on. They know who they're working with."
Looking ahead, Dr. McGee expects health systems to become even more intentional about connecting medical education, residency training and physician recruitment.
"How do you find people who you can engage while they're students, that are great, that you can train, and they can become what they want to be and what you want them to be so that they can stay with you and never have to leave unless they want to?" he said. "Everybody's sort of wrestling with that idea."
