If you are a resident or fellow preparing to enter practice, your career path may take you down the street or across the country, and the specialty in which you practice influences that reality.

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According to the Association of American Medical Colleges’ 2019 Report on Residents, more than half (54.6%) of the individuals who completed residency training from 2009 to 2018 are practicing in the state where they did their residency training.

Those figures, however, can vary significantly based on specialty. Looking at the data, here are some interesting trends related to specialty choice and physicians practicing in their training location.

For medical students beginning to consider specialty choice, FREIDA™ allows you to search for a residency or fellowship from more than 12,000 programs—all accredited by the Accreditation Council for Graduate Medical Education.

FREIDA's Specialty Guide is designed to simplify medical students’ specialty selection process, highlight major specialties, detail training information, and provide access to related medical specialty society information.

Residents who stay

Two primary care specialties were among the top five specialties that most commonly saw residents practice in the same state in which they trained. The top five were:

  • Family medicine—64.6% of residents staying in state to practice.
  • Psychiatry—64.5%.
  • Pediatrics—60%.
  • Pathology: anatomic and clinical—59.9%.
  • Vascular surgery: integrated—59%.

Related Coverage

Final-year residents: How to pick a practice setting that fits you

As far as breaking down residents who stay in their state of training by gender, a higher proportion of women who completed residency from 2009–2018 are practicing in the state of their residency training, 58.3%, compared with 51.4% of men.

Learn which medical specialties have the biggest gender imbalances.

Residents who leave

The specialties that saw the smallest percentage of trainees stay in their state of residency training were largely surgery-based. It is worth noting, in certain instances, smaller surgical specialties, such as colon and rectal surgery—which had just under 800 residents complete training between 2009-2018—may see residents leave their state of training due to heavy competition for limited practice opportunities.

The five specialties that most commonly saw residents practice in a different state than the one in which they trained were:

  • Colon and rectal surgery—31.7% of residents staying in state to practice.
  • Thoracic surgery—35.5%.
  • Plastic surgery—38%.
  • Ophthalmology—40.4%.
  • Neurological surgery—41.1.

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Pandemic significantly alters job market for residents, fellows

The data also found that retention rates vary heavily by state—with California, on the high end, retaining 77.5% of residents. On the low end, the District of Columbia kept just 36.1% of its residents in the region as full-time practitioners.

The AMA provides many resources to help physicians understand employment contracts, such as the Career Planning Resource and a variety of model contracts e-books (free to AMA members).

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