Recognizing Resident Turnover Red Flags in PM&R Residency: A Guide

Understanding Resident Turnover in PM&R: Why It Matters

In Physical Medicine & Rehabilitation (PM&R), program culture and stability are just as important as case volume, fellowships, and board pass rates. One of the clearest indicators of underlying program problems is how often residents leave, transfer, or extend training unexpectedly. High or unexplained resident turnover is a major resident turnover red flag for any training environment—and PM&R is no exception.

For residency applicants focused on the physiatry match, spotting these warning signs early can save you from years in a program where you feel unsupported, misaligned with your goals, or chronically stressed. Because PM&R is a relatively small specialty, every resident departure is noticeable and often has ripple effects on workload, morale, and reputation.

This guide will help you:

• Understand what “normal” turnover looks like in PM&R
• Recognize when residents leaving the program signals deeper issues
• Ask targeted questions during interviews and second looks
• Interpret what you see and hear on interview day and beyond
• Protect your wellbeing and long-term career satisfaction

---

What “Normal” Turnover Looks Like in PM&R

Not all resident turnover is a sign of a dysfunctional program. Before labeling something as a resident turnover red flag, it’s important to understand what can be normal in the context of PM&R residency.

Common Benign Reasons for Turnover

Some resident movements are understandable and not necessarily due to program problems:

1. Life Circumstances

   • Spouse or partner relocation
   • Family illness or caregiving needs
   • Personal health issues requiring a leave or schedule modification
   • Change in long-term life plans (e.g., moving internationally)

2. Career Reassessment

   • Resident realizes PM&R is not the right specialty and transfers early to another field
   • Resident reassesses priorities (e.g., decides they strongly prefer outpatient primary care or psychiatry)

3. Unique Opportunities

   • Resident is accepted into a highly competitive combined program or specialized training not available locally
   • Funded research or military obligations leading to a different pathway

When one resident over several years leaves for a clearly explained, personal reason—and both faculty and current residents seem supportive—that is usually not a sign of a toxic environment.

What Should Raise Your Eyebrows

Patterns and numbers matter. Concerning scenarios include:

• Multiple residents leaving in consecutive years
• Several residents extending training (beyond leaves of absence) for vague reasons
• PGY-2s or PGY-3s in PM&R who “suddenly” disappear from the roster with no clear explanation
• Residents openly describing transfers or withdrawals as “program-related”

In a small specialty like PM&R, having one or two residents leave every year from a typical-sized program often suggests real program problems, especially if explanations feel scripted or guarded.

---

Direct Turnover Red Flags: When Residents Are Leaving the Program

Some red flags relate directly to residents leaving the program or being cycled through too frequently. These are often the clearest indicators you should investigate further.

1. High Number of Recent Transfers or Withdrawals

What you might see or hear:

• “We had a few people transfer out recently, but they just wanted to be closer to family.”
• “We’ve had some changes in the class structure, but everything’s fine now.”
• Roster shows missing PGY levels (e.g., 3 PGY-4s, 2 PGY-3s, 4 PGY-2s) with no explanation.
• Alumni list has several residents marked as “did not complete” or “transferred.”

Why this matters in PM&R:

PM&R programs are typically smaller than IM or surgery. Losing even one resident has a noticeable impact on coverage for inpatient rehab units, consult services, and outpatient clinics. Multiple departures often mean:

• Increased call burden for remaining residents
• Compressed educational opportunities (less time for procedures, EMGs, MSK ultrasound)
• Strained relationships with off-service departments if coverage becomes unreliable

How to explore this diplomatically:

• “I noticed some differences in class sizes on your website. Have there been any recent transfers or changes in the number of residents per year?”
• “Are there any recent examples of residents who decided to leave PM&R, and what factors contributed to their decision?”

You’re not looking for names or gossip; you’re looking for whether explanations are consistent, transparent, and plausible.

---

2. Vague, Rehearsed Explanations About Departures

Warning pattern:

• Different faculty give slightly different, evasive stories about why residents left.
• Residents say things like, “Yeah… they just had some personal stuff,” and quickly change the subject.
• You’re told, “It’s not really something we talk about,” for ordinary-seeming transitions.

Why this matters:

In a healthy PM&R program, leadership can usually explain high-level reasons for resident transitions without violating privacy:

• “Two residents transferred closer to family in the last 5 years.”
• “One resident realized they wanted to do neurology instead, and we helped them transfer early.”

If you consistently get guarded, nervous, or inconsistent answers, it may mean:

• There were serious conflicts about workload, culture, or mistreatment.
• Residents felt they couldn’t safely voice concerns while in the program.
• Administration handled issues poorly or with punitive approaches.

Follow-up questions:

• “How does the program handle situations when a resident is struggling or unhappy?”
• “Can you describe how feedback from residents about workload or curriculum changes is typically received and acted upon?”

Programs that handle attrition professionally will be able to describe processes and lessons learned, not just deflect.

---

3. Sudden Expansion Followed by Turnover

Some PM&R programs expand rapidly—adding additional resident slots without fully securing support in the form of faculty FTEs, clinic space, or inpatient beds. This can become a hidden resident turnover red flag a few years later.

Signs of this pattern:

• Program doubled in size within a short timeframe (e.g., from 4 to 8 residents per year in 2–3 years).
• Recent graduates or current residents mention “growing pains” or “overextension.”
• Rounds, clinics, and call schedules appear crowded or chaotic despite high turnover.

Why it matters:

Unexpected consequences of rapid growth:

• Excessive workload as coverage needs outstrip resource growth.
• Inconsistent supervision and feedback, especially on off-site rotations.
• Diluted procedural experience (e.g., too many residents, not enough EMG slots or injections).
• Frustration leading to transfers, leaves of absence, or burnout.

Questions to ask:

• “I noticed the program has grown in recent years. What changes were made to support the larger resident cohort?”
• “How has the increase in residents affected procedure volume, one-on-one teaching, and call schedules?”

Look for concrete answers: added faculty, expanded clinic space, new VA or rehab hospital partners—not just “we’re still sorting that out.”

---

Indirect Warning Signs: When Turnover Indicates Deeper Program Problems

Sometimes, programs don’t openly advertise residents leaving the program, but you can infer problems from other signals. These indirect signs often correlate with both past and future turnover.

4. Overstretched Residents and Chronic Coverage Issues

In PM&R, coverage strain might show up as:

• Residents frequently being pulled from didactics to cover the inpatient rehab unit or consults.
• Residents missing core educational experiences to keep services afloat.
• Chronic reliance on “extra call shifts” or “voluntary” coverage when someone is out.

Red flags during interview day:

• Multiple residents mention “we’re really short-staffed right now” without clear temporary cause.
• Call schedule looks heavy or unpredictable compared to other PM&R programs.
• Experiences like EMG, MSK ultrasound, or injections are described as “you have to really advocate for yourself” to get adequate numbers.

Why this predicts turnover:

Over time, excessive workload and missed educational opportunities push residents to:

• Seek transfer to a more balanced PM&R program.
• Develop burnout, leading to leave of absence or departure from training.
• Regret their match decision and warn prospective applicants informally.

Ask:

• “How often are didactics protected from clinical duties? Are residents ever pulled from conference for coverage?”
• “When someone is on vacation or leave, how is coverage distributed?”

Healthy programs will acknowledge strain when it occurs—but also show a systematic approach to protecting education and wellness.

---

5. Culture Clues: What Residents Say (and Don’t Say)

In many ways, culture is the root cause behind resident turnover red flags. Subtle cues about interpersonal dynamics and psychological safety often tell you more than formal presentations.

Look for Consistency in Resident Stories

Healthy pattern:

• Multiple residents, across PGY levels, describe similar strengths and weaknesses.
• They are honest about challenges but balance them with clear positives.
• Comments about leadership, workload, and education are specific and grounded.

Worrisome pattern:

• Seniors and juniors give wildly different versions of reality.
• One or two “handler” residents do most of the talking, while others stay quiet or look nervous.
• Residents emphasize “enduring” or “surviving” more than “learning” or “growing.”

In PM&R specifically, a supportive, rehabilitative mindset usually extends inward—physiatrists should model the same patient-centered, team-based compassion with their trainees. When that’s missing, turnover is more common.

Ask:

• “If you had to rank the program’s three biggest strengths and three areas to improve, what would they be?”
• “Have there been any major changes in leadership or culture since you started, and how has that impacted day-to-day life?”

You’re listening for whether residents feel:

• Heard by leadership
• Safe to bring up concerns
• Optimistic that change is possible

---

6. Leadership Instability and Poor Communication

Frequent turnover among program directors, assistant program directors, and key faculty can be a major upstream cause of resident turnover.

Signs of instability:

• Program director has changed multiple times in the last few years.
• Residents constantly reference “before the last PD” or “since the last big change.”
• Faculty seem divided about the program’s direction or curriculum.

Why this matters in PM&R:

PM&R training relies heavily on:

• Consistent long-term faculty mentors (for inpatient rehab, EMG, spasticity, pain, MSK, etc.).
• Stable relationships with affiliated rehab hospitals and VAs.
• Thoughtful integration of ACGME milestones into rotations and procedures.

Instability can lead to:

• Confusing or shifting expectations for residents.
• Poor follow-through on feedback and wellness initiatives.
• Fragmented educational experiences across sites.

Ask:

• “How long has the current program director been in place?”
• “Have there been any major leadership changes, and how has that impacted the residency experience?”
• “How are big changes communicated to residents, and how are residents involved in those decisions?”

Programs with a stable foundation and transparent communication are less likely to drive residents away.

---

7. How to Investigate Turnover During the Physiatry Match Process

You won’t get a slide titled “Our Resident Turnover Problems,” so you must gather data systematically. Here’s how to assess resident turnover red flags in a structured way as you navigate the physiatry match.

Step 1: Do Your Homework Before Interview Day

• Review the program’s website, especially:
  • Current residents by year
  • Recent graduates and their career paths
  • Notices of program size changes or new sites
• Compare class sizes across years:
  • Are there missing PGY levels or obviously smaller cohorts?
  • Do some classes appear to have residents who are “off cycle” without explanation?

If something seems off, jot it down as a specific question to explore.

---

Step 2: Ask Targeted Questions on Interview Day

Use neutral, non-confrontational language. Some examples tailored to PM&R:

• “How have resident class sizes changed over the past 5–10 years?”
• “Have there been any residents who transferred to other specialties or programs? What prompted those transitions?”
• “What does the program do when residents are struggling with workload, personal issues, or burnout?”
• “Can you share a specific example of resident feedback that led to a concrete change?”

Ask both leadership and residents similar questions and see if the answers align.

---

Step 3: Read Nonverbal and Environmental Cues

Pay attention to:

• Body language when you ask about culture, support, or attrition.
• Whether residents feel comfortable speaking honestly around faculty.
• How faculty talk about residents—as partners in training or simply “coverage.”

In PM&R, a specialty grounded in team-based care, a respectful and collaborative tone should be the norm. If the tone feels defensive, adversarial, or dismissive, that environment is more likely to push residents to leave.

---

Step 4: Use Post-Interview Channels Wisely

After interview season:

• Reach out to alumni you might know through your home PM&R department or away rotations.
• Attend virtual Q&As or informal meetups where residents may share more detailed insights.
• Join PM&R interest groups or forums and listen for patterns, not isolated complaints.

Questions you might ask residents privately:

• “If you had to decide again, would you choose this PM&R residency?”
• “Have there been any residents who left early, and what do you think contributed to that?”
• “How well does the program support residents who are struggling academically or personally?”

You’re not collecting gossip; you’re gathering risk information about a 3–4 year life decision.

---

8. Balancing Red Flags with Overall Fit

No program is perfect. A single resident departure or a challenging transition in leadership doesn’t automatically mean you should strike a PM&R program off your rank list. The key is to interpret turnover in context.

When Turnover Is a Manageable Yellow Flag

Turnover may be acceptable when:

• It’s rare (e.g., one departure in 5–7 years).
• Reasons are clearly personal or unique (military obligations, serious family illness).
• The program can articulate what they learned or how they adapted.
• Current residents seem satisfied overall and feel supported.

In this case, the program might still be a strong fit if other aspects—clinical volume, mentorship, desired fellowships—are excellent.

---

When Turnover Is a Serious Red Flag

Consider heavily discounting or removing a program from your rank list when:

• There is a pattern of residents leaving the program in multiple consecutive years.
• Explanations are consistently vague, inconsistent, or defensive.
• Current residents seem exhausted, unsupported, or fearful of speaking openly.
• Leadership instability or rapid expansion is clearly not matched with resources.
• Your gut sense after multiple data points is: “Something is not right here.”

Remember: It is far better to rank fewer programs you genuinely trust than to add a program where resident turnover and program problems are obvious and unaddressed.

---

9. Protecting Your Wellbeing and Career in PM&R

Your residency should be a place where you:

• Grow into a confident physiatrist
• Feel physically and psychologically safe
• Have time and support for board prep, scholarly work, and personal life
• Develop mentorship relationships that launch your career

Ignoring resident turnover red flags risks placing yourself in an environment that undermines all of the above. You deserve a program that practices the very principles of rehabilitation on its own trainees: recognizing challenges early, providing support, and focusing on long-term functional outcomes—both for patients and residents.

As you navigate the physiatry match, use resident turnover as one of several key lenses—alongside case mix, fellowships, location, and personal priorities—to identify where you will truly thrive.

---

FAQ: Resident Turnover Warning Signs in PM&R

1. Is it always bad if a PM&R program has had a resident leave or transfer?
No. A single resident departure over many years—especially for clear personal, geographic, or career-fit reasons—is not automatically a resident turnover red flag. The concern arises when there are multiple departures, vague explanations, or a pattern suggesting deeper program problems like poor culture, overwhelming workload, or leadership instability.

---

2. How can I ask about residents leaving the program without sounding confrontational?
Use neutral, data-focused questions:

• “Have there been any residents who transferred or left the program in recent years?”
• “What types of issues typically lead residents to consider changes, and how does the program support them?”

You are not asking for names or sensitive details—just overall patterns and how the program responds.

---

3. Where can I verify information about resident turnover if the program seems evasive?
You can:

• Compare current resident rosters and alumni pages over multiple years.
• Talk to PM&R residents or faculty at your home institution who may know the local or regional reputation of that program.
• Reach out to current residents or recent graduates privately through networking, interest groups, or mutual contacts.

Look for consistency in what multiple independent sources tell you.

---

4. If a program has clear turnover issues but is strong academically, should I still rank it?
That depends on your risk tolerance and priorities. Significant resident turnover red flags—especially repeated residents leaving the program for unclear reasons—strongly suggest problems with culture, support, or workload that can negatively impact your training and wellbeing, even if case volume is high. In PM&R, where professional satisfaction and quality of life are core values, it is often wiser to favor a slightly less “prestigious” program with a stable, supportive environment over one with chronic turnover and unresolved program problems.