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Grit is Not Enough

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University of Pennsylvania professor Angela Duckworth wrote the best-selling book Grit about the power of passion and persistence in predicting success (her TED talk on grit has over 18 million views), but to her credit, she admits to being nearsighted in her new book Situated,which I’m reading now. 

MacArthur “Genius Grant” recipient Duckworth asserts in Situated that your environment – workspace, geographic location, mentors, friends, and even the culture you immerse yourself in— counts as much as (or more than) grit in determining success, and she offers many compelling studies to support her point.

According to Duckworth, instead of focusing on sheer willpower, you should situate yourself among people and in places that make your goals easier and temptations harder.

The book is a good read, and its thesis is worth serious contemplation when deciding where to go to medical school, train, and start your career.

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AAMC Report on Residents 2025

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Yearly, the Association of American Medical Colleges publishes a report with residency statistics. The 2025 edition has some interesting data:

  1. In 2024, women accounted for 50.2% of residents and fellows, representing a persistent increase that has been noted over the past years.
  2. Only approximately 29.4% of medical students list the same specialty preference on their graduation questionnaire as they did on their matriculating student questionnaire.
  3. US osteopathic (DO) seniors saw a 92.6% PGY-1 Match rate, the highest ever.

You can find more information here.

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Two Hundred New Residency Slots Open

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For a long time there has existed a bottleneck in the physician training system with more medical students graduating than residency spots available. This phenomenon has been one of the contributors to the physician shortage in the United States. 

In an effort to begin to relieve the problem, in 2021 Congress passed the Consolidated Appropriations Act Section 126 to expand the number of Medicare-supported residency slots. 

Last month the Centers for Medicare and Medicaid Services announced a list of hospitals that were awarded 200 new residency positions under the Act. About seven in 10 of the positions are going to primary care and psychiatry training programs. 

You can read an American Association of Medical Colleges (AAMC) news article about the new slots here. 

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Wondering How to Evaluate a Medical School or Residency Program? Consider Your Happiness and Trust Your Intuition.

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Medical school and residency applicants routinely ask me how to evaluate institutions, especially since most interviews are virtual. This is a huge topic, but here are some thoughts:

  • To me, geography is one of the most important factors – at least equal to the reputation of the institution. You want to make sure you are in a location that will make you happy – near community, family, friends and/ or the ability to enjoy your hobbies.
  • Cost is sometimes a deal breaker when it comes to medical school. There can be significant differences – especially state versus private institutions – and scholarships can make a huge impact in your debt profile going forward.
  • Of course, didactics and academic opportunities are critically important for both medical school and residency. However, many programs of similar caliber have equivalent curricula and offerings. You likely could be happy at many different institutions. With regard to residency specifically, it’s important both to ensure you’re getting a lot of hands-on experience and to look at what fellowships are available, with your interests in mind.
  • Faculty is hard to assess because – like anything – there are good and bad ones. Also, faculty come and go. Having said that, if you are applying to residency, the program director is critical (understanding that he or she could leave at any time :-( ).
  • With regard to residency, call schedule and overall work hours are important to consider. Certain programs within the same specialty require a lot more hours and scut work than others.

One of your best bets is to talk to current medical students or residents. Oftentimes they will be very honest about the pros and cons of their institution.

Once you’ve assessed all of the above – narrowing down your list by geography and quality – I would analyze the vibe you have. If this sounds too touchy-feely, remember that intuition is not a magical assessment; it’s based on major and minor facts that you consciously and subconsciously analyze.

Remember: If you’re a medical school applicant, consider yourself fortunate if you have more than one option to choose from. Earning admission to medical school is extremely challenging; it’s a great problem if you have to struggle to decide among multiple schools!

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What Do Program Directors Really Want?

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Imagine you’re a program director (PD) reading hundreds of ERASes and conducting scores of interviews. What questions would you ask yourself as you assess each residency candidate to avoid big headaches?

1) Can this person do the job? Is s/he competent?

2) Will this person “play well with others” and not create complaints from patients, faculty, and/or other services.

3) Will this person stick with the program and not leave prematurely? A PD does not want to scurry around to fill an open call schedule/ residency slot.

As you finish crafting your ERAS and approach your interviews, consider how to demonstrate your competence and collegiality, as well as your commitment to the field and the residency program. For the former, ensure you showcase academic successes, extracurricular activities that demonstrate teamwork, and – if asked – hobbies and reading materials that demonstrate your winning personality. For the latter, highlight sub-internships, research projects in the specialty, and knowledge about the program and city it’s in.

Making sure the PD knows you aren’t going to cause him/her trouble is at least half the battle.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital. She was appointed to the Assistant Residency Director position for the Harvard Affiliated Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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