More than half of physicians who completed residency training over a 10-year period are practicing in the state in which they trained. But the likelihood of staying local varies by the state and specialty in which you completed your graduate medical education (GME) training.
Data highlighted in a 2024 report by the Association of American Medical Colleges (AAMC) sheds light on the states residents stay in—or leave—upon the completion of their training. Here are some key insights into the numbers.
Resident retention by state
The AAMC data shows that 58.6% of physicians who completed training in Accreditation Council for Graduate Medical Education-accredited programs between 2014 and 2023 are now practicing in the same state where they completed residency. The data set is part of the most recent version of the AAMC’s Report on Residents, which highlights unique trends among states, specialties and phases of the GME continuum.
The states and territories with the highest retention rates among individuals who completed residency training going on to practice were:
- California—where 78.5% of residents practiced in-state after residency.
- Puerto Rico—75.6%.
- Alaska—71.3%.
- Texas—67.0%.
- Idaho—67.0%.
On the flip side of the coin, the states and territories in which residents most commonly left their training location after completing residency were:
- District of Columbia—where only 39.4% of residents practiced in-state after residency.
- Delaware—42.5%.
- Rhode Island—44.9%.
- New Hampshire—45.1%.
- Wyoming—46.0%.
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training.
Dive deeper:
- Why child care costs have resident physician parents seeing red
- Master these 5 domains to succeed as a senior resident physician
- 4 tips to help resident physicians become telehealth superusers
- Thinking about fellowship? Ask these questions
- 3 tips to effectively manage debt during physician residency
Subscribe and thrive in residency
Get tips and insider advice from the AMA on navigating and making the most of medical residency—delivered to your inbox.
How specialty affects where you practice
As far as retention by specialty, the AAMC shows that among specialties with at least 500 practicing physicians in the data set, those with the highest in-state retention rates were:
- Family medicine—in which 68.7% of physicians stayed in state after residency.
- Psychiatry—68.2%.
- Pathology: anatomic and clinical—65.1%.
- Child neurology—64.1%.
- Internal medicine—62.5%.
Specialties with the lowest in-state retention rates tended to be those that were more procedure-oriented. Among those with 500 or more physicians in the data set, those with the lowest in-state retention were:
Colon and rectal surgery—in which 33.2% of physicians stayed in state after the completion of their residency training.
- Plastic surgery—38.5%.
- Thoracic surgery—44.2%.
- Ophthalmology—46.3%.
- Pain medicine (multidisciplinary)—47.8%.
One other demographic finding in the data set was related to in-state retention by gender. The report noted that men who completed residency training between 2014 and 2023 were less likely to practice in the state where they completed their residency training (56.2%) than women who completed training during the same period (61.5%).
The AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice.
Should you stay or should you go?
AMA member James Docherty, DO, is a family physician who did his residency training in Upstate New York and opted to stay for practice. His specialty retains more in-state residents than any other, while New York is slightly below average, with 56.4% of resident physicians remaining in state to practice.
Dr. Docherty’s reasons for staying in New York were both professional and personal. Originally from Long Island, he had already limited his residency applications to the Northeast to remain close to family. When offered a faculty role at his residency institution—where he could lead osteopathic recognition programs in internal and family medicine, a key interest—he chose to stay.
"I already knew all the folks who I would work with really closely, and I enjoyed working with them as a resident,” he said. “So I assumed I would work well with them as an attending—and that has been the case."
While he’s pleased with his choice, he does see why matriculating residents may look elsewhere. Opportunities are abundant, and physicians who have completed their training are in the driver’s seat with their decision.
“Up until you graduate residency, you're in this mindset of, 'Who will take me?', whether it's medical school or the Match,” Dr. Docherty said. “But after graduation, the dynamic flips.”
Dr. Docherty’s advice to residents about whether to stay or move after training is to be deliberate in your decision. Whether it’s maximizing your earnings or living in a certain place, focus on what you want—in your career in medicine and your life outside of work—and view your job prospects through that lens.
"Make sure that you're not picking a job purely because you're comfortable,” he said. “It’s really easy to pick a job with your program or in the same place [you trained] because it’s comfortable. But I wouldn’t pick something simply because the transition is easy.
"You probably won’t ever be as free to choose where you want to be geographically than after graduating residency or in that transition period."
