Essential Questions for MD Graduates in Addiction Medicine Residency

Understanding Your Goal as an MD Graduate in Addiction Medicine

As an MD graduate preparing for the allopathic medical school match in Addiction Medicine—or for an addiction medicine fellowship after primary residency—your interviews are not just about programs assessing you. They are also your chance to assess them.

You’re entering a specialty that sits at the crossroads of psychiatry, internal medicine, primary care, emergency medicine, and public health. You’ll be treating patients with complex co‑occurring medical, psychiatric, and social issues, often in high‑stakes situations. That means the questions you ask programs must go beyond generic “What’s the call schedule?” and into details about:

• The breadth and depth of substance abuse training
• The clinical environments you’ll practice in
• How programs support wellness and safety, especially around emotionally heavy cases
• The quality of teaching, supervision, and mentorship
• How they prepare you for board certification and future career options

This guide will help you structure what to ask program directors, faculty, and current residents/fellows—not just to impress them, but to make sure the program truly matches what you need clinically, academically, and personally.

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Core Principles: How to Approach Questions in Addiction Medicine Interviews

Before diving into specific scripts and examples, anchor your approach to questions with three principles:

1. Be specific to Addiction Medicine
   Show you understand the field. Instead of “What’s your patient mix like?” ask:

   • “How much exposure will I have to patients with co‑occurring opioid use disorder and severe mental illness?” This signals that you’re already thinking like an addiction physician.

2. Aim for concrete, not vague answers
   Replace, “Is teaching good here?” with:

   • “Can you walk me through what a typical teaching week looks like—lectures, case conferences, on‑service teaching?”

3. Ask different tiers of people different types of questions

   • Program Director (PD): Big-picture vision, curriculum, program culture, career outcomes
   • Faculty: Supervision, teaching, clinical philosophy
   • Current Residents/Fellows: Real daily life, workload, how the culture actually feels
   • Support Staff/Coordinators: Logistics, benefits, scheduling

Use the sections below as a practical menu of interview questions for them, with context and examples of how to adapt them to your own style.

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High‑Yield Questions to Ask the Program Director

When you think about what to ask the program director, focus on vision, structure, and alignment with your long‑term plans. The PD has the clearest view of the program’s philosophy, change trajectory, and how they support trainees.

1. Questions About Program Philosophy and Patient Population

These questions help you understand the clinical identity of the program.

Examples:

• “How would you describe the mission and clinical identity of this Addiction Medicine program? What distinguishes it from other programs in our region?”
• “What are the predominant substances and patient populations your trainees work with (e.g., opioids, alcohol, stimulants, polysubstance, pregnant patients, adolescents, justice‑involved individuals)?”
• “How integrated is Addiction Medicine with other departments—psychiatry, internal medicine, emergency medicine, OB/GYN, and primary care?”

What you’re listening for:

• Whether the program gives a wide range of substance use disorders or very narrow exposures
• How much co‑management is done with other services
• Whether the PD has a thoughtful, patient‑centered philosophy vs. a purely operational answer

2. Questions About Curriculum and Substance Abuse Training

You need to know how deeply you’ll be trained, not just how busy you’ll be.

Examples:

• “Can you walk me through the core rotations and how they build comprehensive substance abuse training across inpatient, outpatient, and community settings?”
• “How is didactic time protected, and what are the key topics or longitudinal curricula that all trainees receive (e.g., pain management, withdrawal management, harm reduction, behavioral therapies)?”
• “How do you incorporate training on co‑occurring psychiatric disorders, chronic medical conditions, and social determinants of health?”

To link this to your experience as an MD graduate residency applicant, you might preface with:

“Coming from an allopathic medical school match background with strong internal medicine exposure, I’m especially interested in how your curriculum blends medical and psychiatric aspects of addiction.”

Red flags:

• Vague description of teaching (“We do some lectures when we can”)
• No clear structure for didactics
• Minimal mention of co‑occurring conditions

3. Questions About Supervision, Autonomy, and Safety

Addiction Medicine can involve complex, high‑risk patients. You need balanced supervision and support.

Examples:

• “How is clinical supervision structured on each rotation? For example, on inpatient consults or outpatient MAT (medication-assisted treatment) clinics, what level of autonomy do trainees have with prescribing and management decisions?”
• “How are safety concerns handled—for example, if a patient makes threats, or if there is diversion risk or boundary issues? How are trainees supported in these situations?”
• “Are there formal debriefing structures or Schwartz Rounds–type forums for emotionally difficult cases, such as overdoses or patient deaths?”

Why this matters:
You’re signaling that you understand the emotional and safety dimensions of this work—and you’re checking if the program takes these seriously.

4. Questions About Outcomes: Boards, Jobs, and Fellowships

Whether you’re entering Addiction Medicine as your first specialty or as an addiction medicine fellowship after prior residency, you need clarity on training outcomes.

Examples:

• “What has been your board pass rate over the last few years, and how do you support trainees who may need additional help preparing?”
• “Where have recent graduates gone in terms of careers—academic medicine, community practice, integrated primary care, public health roles, research?”
• “If someone is interested in a hybrid career—for example, partial clinical time and partial leadership in hospital substance use initiatives—how does your program help them get there?”

Follow‑up to clarify fit:

• “I’m particularly interested in [e.g., academic work in opioid use disorder, leadership in hospital-based addiction consult services, or policy/advocacy]. How have you supported trainees with similar interests?”

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Questions to Ask Faculty and Attendings: Daily Training and Clinical Philosophy

Faculty will shape your clinical identity. Use your time with them to probe how you’ll be trained on the ground.

1. Questions About Teaching and Feedback

Examples:

• “On a typical day when we’re working together on consults or in clinic, how do you like to teach? Case-based discussions, bedside teaching, brief teaching points throughout the day?”
• “How often do you give formal or informal feedback, and in what format? Are there midpoint evaluations or regular check‑ins?”

You might add:

• “In my MD graduate residency rotations, I grew most with attendings who were very explicit and timely with feedback. How does that work here?”

Look for:

• Faculty who can clearly describe their teaching style
• Evidence of structured feedback processes, not just “we tell you if something is wrong”

2. Questions About Clinical Style and Evidence Use

You want to see whether they practice in an evidence‑based, humane, and realistic way.

Examples:

• “How would you describe the program’s approach to harm reduction, especially around patients who are not ready for abstinence?”
• “Can you share an example of how the team handled a case where patient goals differed from the treatment team’s priorities?”
• “How standardized are your protocols for initiating buprenorphine, methadone, or extended-release naltrexone? Is there room for individualized care based on patient preference and clinical circumstances?”

Pro tip:
Notice if attendings mention shared decision‑making, trauma‑informed care, or motivational interviewing—these are good signals in Addiction Medicine.

3. Questions About Interdisciplinary Collaboration

Addiction care is inherently team‑based.

Examples:

• “What does your interdisciplinary team typically look like—social work, counselors, peer recovery specialists, pharmacists? How closely do fellows or residents work with them?”
• “How are decisions made about level of care—outpatient vs. intensive outpatient, residential, inpatient detox—and what role do trainees play in those decisions?”

You’re evaluating:

• Whether you’ll learn from and with other disciplines
• Whether the program reflects real‑world addiction treatment settings

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Questions to Ask Current Residents or Fellows: Reality Check

Trainees can tell you what the brochure doesn’t. This is where your interview questions for them should probe daily life, culture, and hidden strengths/weaknesses.

1. Questions About Culture, Workload, and Support

Examples:

• “Can you walk me through a typical week—clinical time, didactics, notes, after-hours work?”
• “When things get really busy or emotionally heavy, how does the team respond? Do you feel supported by attendings and leadership?”
• “If you had to describe the culture in 3 words, what would they be—and why?”
• “How approachable is the program director when issues arise? Do you feel they advocate for trainees?”

Watch for:

• Hesitation before answering questions about culture or support
• Statements like “It depends who you’re working with” said with discomfort
• Overly generic answers that sound rehearsed

2. Questions About Training Quality and Confidence

Examples:

• “At this point in your training, how comfortable do you feel managing common substance use presentations independently in various settings (ED, inpatient, outpatient, consults)?”
• “Is there any area where you wish you’d had more exposure—e.g., adolescents, pregnant patients, co‑occurring severe mental illness, pain management, justice‑involved populations?”
• “If you were redesigning the curriculum, what’s the one change you’d make?”

3. Questions About Career Planning and Mentorship

Examples:

• “How early did people start getting guidance about jobs or post‑fellowship paths?”
• “Has it been easy to find mentors aligned with your interests (research, clinical, policy, medical education, quality improvement)? Do mentors stay involved after graduation?”
• “Do you feel the program prepared you well for your next step—whether that’s independent practice, academia, or leadership roles?”

4. Questions About Red Flags…Without Asking “What Are the Red Flags?”

Sometimes direct questions won’t yield honest answers in a group setting. Instead, ask questions that reveal problems.

Examples:

• “Have there been any significant changes in leadership, call structure, or curriculum in the last couple of years? How were those changes communicated and received?”
• “How does the program respond when trainees bring up concerns? Can you recall a specific example and how it was handled?”
• “Is there anyone who left the program early or didn’t complete training? What were the circumstances, if you’re comfortable sharing generally?”

You’re listening for:

• Patterns of poor communication
• Abrupt leadership changes with unclear reasoning
• Trainees feeling they cannot safely voice concerns

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Targeted Questions About Research, Teaching, and Special Interests

Many MD graduates entering Addiction Medicine come with particular goals: research, teaching, advocacy, public health, or leadership. Clarify how well the program supports those paths.

1. Research and Scholarly Activity

Questions for PD or research‑oriented faculty:

• “What kinds of ongoing addiction-related research projects are available for trainees—clinical trials, implementation science, health services research, medical education, community-based research?”
• “Is there protected time for scholarly work, or is it more informal and self-directed?”
• “How many trainees in the last few years have presented at regional or national conferences, or published manuscripts? How are they supported in doing so?”

If you’re specifically interested in research careers:

• “I’m interested in integrating research with clinical practice long-term. How have you supported prior trainees who wanted to pursue NIH funding, additional research training, or research-focused faculty positions?”

2. Teaching and Medical Education

If you enjoy teaching and see yourself in academic medicine:

• “Do trainees have opportunities to teach medical students, residents from other specialties, or community clinicians about Addiction Medicine?”
• “Are there any formal medical education tracks, certificates, or faculty development workshops available to trainees?”
• “How is trainee teaching evaluated and supported?”

3. Policy, Advocacy, and Public Health

Addiction Medicine often intersects with policy, legislation, and community health.

Questions to consider:

• “Are there opportunities to participate in policy or advocacy work—such as working with local health departments, harm reduction organizations, or legislative initiatives?”
• “Do you have collaborations with community-based treatment programs, syringe service programs, or recovery organizations where trainees can rotate or partner?”
• “Have prior graduates gone into public health leadership, governmental roles, or health systems leadership focused on substance use?”

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Logistics, Lifestyle, and Fit: The Practical Questions You Still Need to Ask

While content and culture are critical, you’re still a human with limits and needs. These questions to ask residency or fellowship programs will help you understand what day‑to‑day life looks like.

1. Schedule, Call, and Workload

Examples:

• “How is call structured for this program? Is it home call, in-house, primarily phone-based, or mostly backup for complex cases?”
• “Approximately how many hours per week do trainees typically work on different rotations? How much of that is direct patient care versus documentation and administrative tasks?”
• “Are there any rotations shared with other services where workload tends to be heavy or unpredictable?”

2. Wellness, Benefits, and Support

Examples:

• “What formal wellness resources are in place—protected wellness time, mental health services, access to confidential counseling, debriefing groups?”
• “Given the emotional weight of addiction work, do you have any specialized support (e.g., support groups for vicarious trauma, debriefing after overdose deaths)?”
• “How does the program handle leave—for illness, parental leave, or personal emergencies? Are schedule adjustments feasible and handled transparently?”

3. Evaluations, Remediation, and Program Transparency

It’s important to know how the program responds when someone struggles.

Examples:

• “How are trainees evaluated, and how often? Who reviews the evaluations with them?”
• “If a trainee is struggling—clinically, academically, or personally—how is that typically handled? Can you describe the remediation process and the kinds of support that are offered?”
• “Is there a mechanism for anonymous feedback from trainees about the program, and how is that feedback acted upon?”

As an MD graduate, you’re also implicitly asking: “Will I be safe to grow here, make mistakes, and learn?” Programs that answer this clearly and non‑defensively are often healthier environments.

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Strategy: How to Organize and Use Your Questions Effectively

Having excellent questions is only half the battle; you also need a strategy for using them in the constrained time of interviews.

1. Prioritize by Person and Setting

Prepare a list divided into:

• Program Director: 6–8 top‑priority program‑level questions
• Faculty: 4–6 clinically focused and teaching‑focused questions
• Current Residents/Fellows: 8–10 culture, workload, and reality‑focused questions

You won’t ask them all, but you can pick the most relevant based on how the conversation flows.

2. Anchor Questions to Your Story

Whenever possible, connect questions to your background or goals. For example:

• “In my MD graduate residency training in internal medicine, I saw a lot of patients with co‑existing alcohol use disorder and cirrhosis. I’d like to deepen that skill set. How does your program prepare trainees to manage complex medical comorbidities in addiction?”

This turns generic interview questions for them into a dialogue about your fit and potential contribution.

3. Take Notes and Compare Across Programs

After each interview day, jot down:

• Key features of substance abuse training and clinical exposures
• Vibes about culture and support
• How clearly they answered hard questions
• Anything that felt concerning or particularly impressive

When it’s time to build your rank list after the allopathic medical school match interviews, these notes will help you move beyond superficial impressions.

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Frequently Asked Questions (FAQ)

1. How many questions should I ask during a residency or addiction medicine fellowship interview?

Aim for quality over quantity. In each major conversation (with PD, faculty, or residents/fellows), 2–4 thoughtful questions is usually appropriate. You want space for follow‑ups and natural conversation, not a rapid-fire checklist. Prioritize questions you cannot answer from the website or brochure, and save detailed “nuts and bolts” for residents/fellows or the coordinator when time allows.

2. What are the most important questions to ask program directors specifically?

For program directors, focus on:

• Program mission and clinical identity
• Structure and depth of substance abuse training
• Board pass rates and graduate outcomes
• Support systems (feedback, remediation, wellness)
• How they respond to change and trainee feedback

A strong core set might include: “How do you define success for your trainees?” and “What changes have you made in the last few years in response to trainee feedback or evolving addiction science?”

3. Is it okay to ask hard questions about burnout, safety, or people leaving the program?

Yes—and in Addiction Medicine, it’s especially appropriate. The key is tone: be respectful and curious, not accusatory. For example: “Given the emotional weight of this field, how does the program address burnout or compassion fatigue among trainees?” Programs that respond transparently and concretely are often healthier than those that deflect or minimize these issues.

4. How can I stand out as an MD graduate in Addiction Medicine interviews through my questions?

Stand out by:

• Asking specialty‑specific, nuanced questions (e.g., co‑occurring disorders, harm reduction, interdisciplinary care, justice‑involved populations)
• Linking questions to your prior training and future goals (“In my MD graduate residency, I saw… so I’m particularly interested in…”)
• Demonstrating awareness of both clinical complexity and systems‑level issues (policy, stigma, public health)
• Listening actively and asking thoughtful follow‑ups rather than racing through a list

When your questions show that you understand Addiction Medicine’s depth and are reflecting seriously on fit, programs will remember you as a mature, intentional candidate.

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Use this framework as a starting point, then personalize your questions to reflect who you are as an MD graduate and who you hope to become as an Addiction Medicine physician. Your questions are not just about gathering information—they’re one of the strongest tools you have to show programs that you’re ready for this work.