Identifying Resident Turnover Warning Signs in PM&R for DO Graduates

Understanding Resident Turnover as a DO in PM&R

Resident turnover is one of the most important—yet often under-discussed—signals about a residency program’s health. As a DO graduate planning to enter the PM&R residency (physiatry) match, recognizing resident turnover red flags can help you avoid programs with deeper structural, cultural, or educational problems.

In Physical Medicine & Rehabilitation, where team dynamics, mentorship, and longitudinal learning are central, residents leaving a program is rarely “just a coincidence.” While there are occasionally benign reasons (family moves, dual-career issues, true career change), persistent or poorly explained turnover often points to program problems that may affect your training, well-being, and board preparedness.

This article will walk you through:

• Why turnover matters specifically in PM&R
• Concrete warning signs to look for during interviews and away rotations
• How to ask about turnover without sounding confrontational
• How to weigh turnover concerns as a DO graduate in the osteopathic residency match era
• Practical steps if you suspect a program has serious issues

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Why Resident Turnover Matters in PM&R (Especially for DO Graduates)

PM&R residency training is relatively small compared with other specialties. Many programs have 6–18 residents total, sometimes fewer. This magnifies the impact of any resident departures. In a small program:

• Losing even one resident can significantly change call schedules, coverage, and workload.
• Educational gaps (fewer senior residents to teach procedures, EMG, injections) are felt more acutely.
• A toxic culture is harder to “hide” because everyone interacts frequently.

Unique implications in PM&R

In PM&R, stable, cohesive teams are crucial for:

• Longitudinal patient care (e.g., SCI, TBI, stroke, amputee, chronic pain clinics)
• Multidisciplinary coordination (PT/OT/SLP, nursing, psychologists, prosthetists)
• Building procedural and electrodiagnostic skills over time
• Developing niche interests (sports medicine, interventional spine, neurorehab, pediatrics)

High or recurring resident turnover can:

• Undermine team trust and communication
• Reduce faculty bandwidth for teaching (more time spent filling service gaps)
• Limit resident exposure to subspecialty experiences
• Signal unresolved conflict between residents and leadership

Why turnover should matter to DO graduates

As a DO graduate entering the osteopathic residency match landscape under the single accreditation system:

• You may be more attuned to culture, mentorship, and osteopathic identity support.
• Programs that fail to support DO residents (e.g., dismissive attitudes toward OMT, bias in evaluation) may show this indirectly through selective turnover—with DO residents leaving more often than MD colleagues.
• Some DO graduates historically gravitated to smaller, community-based PM&R programs, where a single problematic attending or unstable leadership can have outsized influence and drive turnover.

Turnover is not always a deal-breaker, but it is almost always a data point that deserves careful exploration.

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Common Types of Resident Turnover: What’s Normal vs Concerning?

Not all resident departures are created equal. How you interpret turnover depends on the frequency, timing, and transparency around it.

Benign or understandable reasons for leaving

A residency program may occasionally lose a resident for reasons that are relatively low-risk from a program-quality perspective:

• Spouse/partner relocation or military deployment
• Major family illness requiring geographic move
• Genuine, well-documented career change (e.g., switching from PM&R to anesthesia or radiology for long-standing, clearly articulated reasons)
• Resident struggling with nonclinical personal issues who is supported in transitioning out

Key features of these situations:

• Leadership and residents can explain the reasons clearly (while preserving privacy).
• The explanations are consistent between residents and program leadership.
• There isn’t a pattern of many residents leaving over several years.
• When someone leaves, the program has a plan to redistribute workload fairly.

Concerning patterns of turnover

1. Multiple residents leaving in a short timeframe

• Two or more residents in the same class or back-to-back classes depart.
• Departures are vaguely explained (“personal reasons,” “wasn’t a good fit”) without any additional credible context.
• Remaining residents appear anxious, guarded, or overly rehearsed when asked.

2. Recurrent upper-year attrition

• Senior residents (PGY-3/4) leaving PM&R or switching to a very different field unexpectedly.
• Graduating residents not recommending the program or describing it as “it gets better when you’re a fellow” (a subtle red flag).

3. Disproportionate turnover in a particular subgroup

For DO graduates, watch for:

• Multiple DO residents leaving or transferring out in recent years.
• DO graduates underrepresented in leadership roles (chiefs, committees) despite equal numbers in the program.
• Whispered comments about bias in evaluations, assignments, or fellowship letters.

4. Non-transparent or conflicting explanations

• Program director tells you one story about a resident departure, but residents tell you another—or will not discuss it at all.
• Faculty blame residents (“they just couldn’t handle it”) without acknowledging any program contributory factors.
• The program refuses to share basic, non-identifying information about turnover trends.

If you hear “we’ve had some residents leave over the past few years” combined with obvious discomfort, you should mark that program as high risk and probe further.

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Specific Resident Turnover Red Flags to Look For

Below are concrete resident turnover red flags to watch for during your PM&R interviews, away rotations, and pre-interview research—especially important in the osteopathic residency match context.

1. Evasive answers when you ask directly about turnover

You should always ask:

“Have any residents left the program or transferred out in the last 5 years? If so, can you tell me generally why and how the program responded?”

Red flags in the response:

• “We don’t really keep track of that.”
• “Some have left, but I don’t know the details.”
• “It’s complicated; I probably can’t talk about it.”
• Residents give quick, rehearsed-sounding answers: “Everything is fine now,” without elaboration.

What you want to hear instead:

• A specific, non-identifying description:
  “We had one resident move for family reasons and another switched to neurology; here’s what we changed or learned from that experience.”
• Evidence of self-reflection:
  “We realized our call system was contributing to burnout, so we redesigned it and increased attending support.”

2. Residents warn you subtly—or explicitly

Pay close attention to informal comments during resident-only sessions and social events:

• “This place isn’t for everyone.”
• “You’ll be fine if you’re thick-skinned.”
• “The attendings care about patients, but not necessarily about residents.”
• “We’ve had some people leave, but that’s just residency in general” (especially if said in a defensive tone).

If multiple residents independently hint at serious issues—especially around respect, safety, or retaliation—you should treat this as a major warning.

3. High PGY-1 or PGY-2 exit rate

In categorical PM&R or in the advanced PM&R years:

• More than one intern or junior resident leaving in the last few years is concerning.
• Residents describing the early years as “just a weeding-out phase” suggests a culture that normalizes attrition instead of improving training.

For DO graduates, who may sometimes feel they “have more to prove,” this environment can be particularly psychologically and professionally damaging.

4. Unstable or frequently changing leadership

Turnover among residents is often linked to turnover in leadership:

• Multiple program directors or associate program directors cycling through in a short period.
• Recent removal or resignation of a PD under unclear circumstances.
• Residents reporting that the leadership “is new and still figuring things out” but cannot point to concrete positive changes.

While a new PD can be a good thing, if high resident turnover coincides with leadership chaos, proceed with caution.

5. Heavy service load without education, leading to burnout

Residents often leave programs where they feel like cheap labor rather than trainees:

• Very high call burden without commensurate learning or supervision.
• Frequent cross-coverage of multiple services, leaving little time for procedures or EMG.
• Residents describing their role as “just keeping the rehab unit running” with minimal didactics.

When these conditions persist, some residents will transfer or exit the field, adding to resident turnover and further increasing the load for those who remain.

6. Reputational concerns among faculty or fellows

When rotating at other institutions or talking to attendings in the PM&R community, listen for:

• “That program has had some residents leave recently.”
• “They’re still working through some issues with culture/leadership.”
• “Their graduates are solid clinically, but there have been concerns about burnout and satisfaction.”

One stray comment isn’t decisive, but if several independent sources hint at program problems, it may explain why residents are leaving the program.

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How to Ask About Turnover During PM&R Interviews and Rotations

You can discuss resident turnover professionally and tactfully. The goal is to gather real information without appearing adversarial.

Questions for the program director and leadership

1. Direct but neutral:

   • “Have any residents transferred out or left the program in the last 5 years? If so, were there any patterns or lessons learned that led to changes in the program?”

2. Focused on improvement:

   • “If a resident is struggling—either clinically or personally—how does the program support them? Have there been times when that process resulted in someone leaving or transferring?”

3. About culture and psychological safety:

   • “How do residents usually raise concerns? Can you share an example of feedback that led to a concrete change?”

Pay attention not just to the words, but to:

• Body language and tone
• Whether they acknowledge any imperfection
• Whether they can give specific examples

Questions for residents (especially in resident-only sessions)

1. Open-ended culture question:

   • “How has the program changed in the last few years? Have any residents left, and did that impact your experience?”

2. Safety and support:

   • “Do you feel comfortable going to leadership with concerns? What happens if a resident is unhappy here?”

3. DO-specific question:

   • “As a DO, have you ever felt treated differently in terms of rotations, evaluation, or letters? Have any DO residents left the program, and if so, do you feel they were supported?”

During away rotations (auditions)

As a DO graduate in PM&R, an away rotation can give candid insight into resident turnover red flags:

• Ask senior residents individually, in an unhurried moment, about recent graduates and any residents who left.
• Observe whether faculty speak respectfully about past residents, even those who struggled.
• Notice if staff or nurses make offhand comments like, “We’ve seen a lot of residents come and go here.”

You are not interrogating; you are gathering safety data about where you might spend 3–4 critical years of your life.

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Interpreting Turnover in the Context of Your Own Priorities

Not every program with resident turnover is unsafe or unfixable. As a DO graduate in the physiatry match, you’ll need to interpret each resident turnover red flag within your own goals and risk tolerance.

When turnover may be acceptable

You may reasonably consider ranking a program that has:

• One or two clearly explained, understandable departures over several years.
• New leadership that acknowledges past problems and shows specific, implemented improvements (e.g., revised call schedules, new mentorship structures, increased wellness resources).
• Residents who, despite acknowledging history, now appear supported, engaged, and generally satisfied.

Ask yourself:

• Does the program appear to be on a positive trajectory?
• Do the remaining residents appear burned out or cautiously optimistic?
• Are the changes described specific and verifiable (new rotations, protected time, new faculty hires)?

When turnover should strongly lower a program on your rank list

Strong caution is warranted if you see:

• Multiple residents leaving in a short period, with vague explanations.
• Mixed or fearful messaging from current residents.
• History of DO residents leaving or transferring out, especially if DOs report feeling less supported.
• Unresolved cultural issues, such as dismissive attitudes, retaliation against feedback, or chronic disrespect from key attendings.
• Minimal recognition of problems by leadership—“There’s no issue; they just couldn’t cut it.”

In these cases, even an excellent clinical experience may not justify the personal cost of training in an unstable or abusive environment.

Balancing turnover concerns versus match realities

As a DO graduate aiming for a PM&R residency in a competitive geographic area, you might feel pressure to overlook red flags. Try to think long-term:

• Your residency experience will shape your well-being, professional identity, and fellowship opportunities for years.
• A slightly less “prestigious” program with stable, supported residents is often better than a big-name institution with high resident turnover and program instability.
• Boards, fellowships, and future employers care more about your training quality and references than about the name alone.

Turnover isn’t the only variable—but it is an important one. Place programs with serious, unexplained, or recurrent residents leaving the program lower on your rank list, regardless of reputation.

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Action Steps if You Suspect a Program Has Turnover Problems

If you identify one or more resident turnover red flags in a PM&R program:

1. Document what you hear and observe

   • Immediately after your interview day or rotation, write down:
     • What was said (as close to verbatim as possible)
     • Who said it (resident vs PD vs faculty)
     • How many independent sources raised similar concerns
   • This will be crucial during rank list time when programs blur together.

2. Seek additional perspectives

   • Talk with:
     • Your DO school’s PM&R advisors
     • Alumni who have rotated or interviewed there
     • Mentors who know the national PM&R community
   • Ask open-endedly: “What have you heard about culture, leadership, and resident stability at this program?”

3. Reframe your evaluation criteria Consider rating each program on:

   • Educational quality (procedures, EMG, clinics, didactics)
   • Culture and support (respect, mentorship, wellness)
   • Stability (leadership continuity, resident satisfaction, turnover history)

   A program with high clinical volume but low culture/stability scores should drop on your rank list.

4. Decide your personal red lines Examples of potential deal-breakers:

   • Leadership retaliation or fear of speaking up
   • History of DO residents being marginalized
   • Recent removal of multiple residents for “fit” without transparent remediation processes
   • Repeated mental health crises or leave among residents without systemic response

5. Use the rank list—not the application—to protect yourself Once you’ve interviewed, your remaining leverage is your rank list. It is reasonable—and wise—to rank a safer, supportive PM&R program above one with serious, unresolved turnover issues, even if the latter seems more “impressive” on paper.

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FAQs: Resident Turnover Warning Signs in PM&R for DO Graduates

1. Is some resident turnover normal in PM&R programs?

Yes. Life happens—family moves, unexpected health issues, or a genuine change in career goals. A single resident leaving over several years, especially with a clear, benign explanation, is generally not a major concern. The red flags emerge when there is recurring, poorly explained, or clustered turnover, particularly if multiple residents leave in quick succession or from the same class.

2. As a DO graduate, should I be extra cautious about programs where DO residents have left?

You should pay particular attention when DO residents seem to leave more frequently than MD colleagues or when DOs report feeling less supported. This may point to unspoken bias or a culture that doesn’t fully value osteopathic training. Ask explicitly how previous DO residents have done, what leadership roles they’ve held, and where they matched for fellowship. In the current osteopathic residency match era, many top-tier programs fully embrace DO graduates; prioritize those environments.

3. How can I ask about residents leaving the program without sounding negative?

Frame your questions around learning and improvement, not blame. For example:

“I know every program occasionally has residents who leave or transfer. Can you share how your program has handled that in the past and what you learned from those situations?”

This wording acknowledges that turnover can happen anywhere while signaling that you value reflection, transparency, and systems-level thinking—all traits of a mature program.

4. If a program seems perfect otherwise, should turnover alone keep it off my rank list?

Not necessarily, but persistent, unexplained, or recent resident turnover should significantly affect where you rank the program. Consider:

• Is the turnover isolated and clearly explained or recurrent and vague?
• Are there tangible signs of positive change (improved schedules, new leadership, better support)?
• Do residents seem genuinely better off now, or are they just “getting by”?

If turnover is part of a pattern of resident dissatisfaction, leadership instability, or safety concerns, it may be safest to rank that program low or not at all—even if its name or facilities are impressive.

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By approaching the physiatry match with a clear understanding of resident turnover warning signs, you, as a DO graduate, can better protect your training experience, well-being, and long-term career in Physical Medicine & Rehabilitation. Use turnover data as one of several key factors—alongside educational strength, culture, and fit—to build a rank list that supports both who you are now and the physiatrist you aim to become.