Recognizing Resident Turnover Warning Signs for DO Graduates in Preliminary Medicine

Understanding Resident Turnover as a DO Graduate in a Preliminary Medicine Year

For a DO graduate pursuing a Preliminary Medicine year, recognizing resident turnover warning signs is critical. Prelim IM positions are often a bridge—either to advanced specialties (neurology, radiology, anesthesiology, PM&R, etc.) or as a stepping stone for those reapplying to categorical internal medicine or other specialties. Because you only have one year in the program, you cannot afford to end up in a toxic environment or a program with serious resident turnover red flags.

High resident turnover doesn’t just mean people are “moving on”; it can signal program problems, poor support, unsafe workloads, or a culture that undermines education and wellness. As a DO graduate, you may already be attuned to issues of respect, inclusion, and training quality. Learning how to interpret turnover patterns—especially in osteopathic residency match–friendly or blended (MD/DO) environments—is essential.

This article focuses on:

• How to distinguish normal vs. concerning turnover in a prelim IM program
• Specific warning signs before and during interview day
• Practical questions you can ask to uncover hidden program issues
• Red flags specific to DO graduates and to the prelim medicine structure
• How to weigh risk vs. reward when ranking programs

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1. Normal vs. Concerning Turnover in Preliminary Medicine

What “normal” turnover looks like in a prelim IM program

Not all resident movement is bad. In fact, some apparent “turnover” is built into the design of preliminary medicine:

• Planned transitions to advanced programs

  • Many prelim medicine residents are already matched into PGY-2 spots in neurology, radiology, anesthesiology, ophthalmology, etc.
  • They complete only one year in prelim IM and then move on. This is not a red flag; it’s the structure of their training trajectory.

• Expected family or life events

  • One or two residents over several years needing to relocate for a spouse, illness, or family crisis is normal.
  • Programs usually can explain this clearly and without hesitation.

• Occasional non-renewal or remediation

  • A rare resident who is not renewed or transferred for significant professionalism or performance reasons can occur in any program.
  • The key: this should be a rare exception, not a recurring pattern.

What problematic resident turnover looks like

When you see patterns of residents leaving the program prematurely—especially in multiple consecutive years—this can indicate serious issues:

• Multiple prelim or categorical residents leaving during or after PGY-1
• Frequent transfers “to other institutions” with vague explanations
• Alumni or current residents hinting about “a lot of turnover lately”
• Significant changes in staffing levels year-to-year

For DO graduates, this matters even more. If a program already has strained resources and residents are leaving, DO residents—sometimes still perceived as “outside” in historically MD-focused programs—may feel greater vulnerability, less advocacy, and more scrutiny.

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2. Concrete Resident Turnover Red Flags to Watch For

A. Numbers that don’t add up

On interview day or during research, pay attention to numbers:

• Headcount mismatch

  • Example: The website says the prelim IM class size is 12, but you only meet 7 current prelims and 1 is “off service” for vague reasons.
  • If more than 1–2 residents per class are “missing,” ask why and listen carefully.

• Chronically short classes

  • If multiple PGY classes have fewer residents than their intended complement (e.g., should have 12 but only 9 in multiple consecutive years), this can indicate program problems:
    • Residents leaving program mid-year
    • Non-renewals
    • Inability to fill positions due to bad reputation

• High number of “recent transfers” in or out

  • A couple of transfers over several years is normal.
  • A pattern of multiple transfers every year is a stronger warning sign.

Actionable tip:
When you meet residents, casually ask:

“Has your class always had this many prelims, or did people leave or transfer?”
Look for discomfort, vague answers, or quick subject changes.

B. Inconsistent or evasive explanations

How people answer your questions is often more revealing than the specific words.

Concerning answer patterns:

• Overly vague responses

  • “People just move on; it’s not a big deal.”
  • “Some residents didn’t find it the right fit.”
  • “We’ve had some turnover, but that’s normal everywhere.”

• Multiple different explanations for the same event

  • One resident says someone left for “family reasons,”
  • Another says, “I think they were struggling with performance,”
  • Faculty says, “They went to another opportunity.”

• Defensiveness from leadership

  • If the PD or APD becomes visibly tense or evasive when you ask about residents leaving program, that’s a strong resident turnover red flag.

Healthy program responses typically sound like:

• “We had a resident leave last year to be closer to family; this was a unique situation.”
• “We’ve had one non-renewal in the last five years, and we can’t share details, but we made sure support and due process were in place.”
• “We had some challenges a few years ago, but here’s what we changed since then…”

C. Missing senior residents or lack of continuity

In internal medicine, senior residents (PGY-2/3 categorical residents) are crucial. In a prelim-heavy program, you should still see a stable core of senior IM residents.

Warning signs:

• Very few senior residents available to meet you, with no clear explanation
• Seniors appear new to the hospital systems or unfamiliar with workflows
• Frequent comments like “We’re still understaffed since people left”
• Rotations where interns function without consistent senior supervision

For a preliminary medicine year, having reliable seniors is essential to your learning and safety; they buffer you from the worst of service burdens and help you grow clinically in a short time.

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

A. How residents talk about each other and leadership

Conversation tone often reveals the reality behind formal presentations.

Positive signs:

• Residents speak about the PD and chiefs with respect and specific praise
• They describe approachable leadership who respond to concerns
• They can give examples: “When we were overwhelmed on nights, the PD added a float.”

Red flags:

• Repeated vague comments:

  • “We just keep our heads down.”
  • “It is what it is.”
  • “You just have to survive intern year.”

• Residents hinting at fear or retaliation:

  • “I’d rather not say with faculty around.”
  • “We don’t really complain much—it doesn’t go well.”

• A clear divide between prelims and categoricals:

  • Prelims feel like second-class citizens.
  • Coresidents say, “You’re just here for a year, so they don’t invest much in you.”

As a DO graduate, be especially attentive to whether DOs feel fully part of the team. If DO residents express that they are less supported, or you don’t see any DO graduates in leadership or chief roles, that’s additional context for your decision.

B. How they describe workload, schedules, and backup

High workload alone isn’t always a red flag—prelim IM is often intense. But patterns of overwork with no backup frequently drive residents leaving programs.

Concerning phrases to listen for:

• “We’re always covering for people who left.”
• “We’ve had to pull extra shifts because of vacancies.”
• “There’s no real backup system; we just push through.”

Ask specifically:

• “When someone is out sick, who covers?”
• “Have you had to routinely stretch coverage due to vacancies or turnover?”
• “How quickly does leadership adjust schedules when people leave?”

If coverage issues are chronic, they can turn your prelim year from challenging to unsafe—particularly problematic if you’re trying to excel for a competitive PGY-2 specialty.

C. How they respond to DO-related questions

As a DO graduate in the osteopathic residency match era, you should pay attention to program culture around DO training:

• Are DOs present in the prelim or categorical IM classes?
• When you ask, “How do DOs do here?” do residents:
  • Give concrete reassurance?
  • Struggle to think of examples?
  • Show discomfort or dismissiveness?

Red flag phrases:

• “We haven’t had many DOs, but I’m sure it’s fine.”
• “We treat everyone the same” (with no specific examples, and no DOs around to confirm).
• “You might have to prove yourself a bit more, but that’s just medicine.”

A strong program can articulate exactly how DOs are supported, whether with additional resources for COMLEX/USMLE alignment, mentorship, or advocacy in fellowship applications.

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4. Structural and Historical Indicators of Program Problems

A. A recent history of residents leaving program

Some turnover in a single year can be an outlier. Multiple consecutive years is a trend.

Ask:

• “In the last 3–5 years, how many residents have left early or transferred?”
• “Has the program ever been placed on warning or probation?”
• “Have there been any major changes in leadership recently?”

Warning signs:

• Leadership dodges these questions.
• Answers are very non-specific: “A few here and there, but that happens everywhere.”
• Residents privately admit that “a lot of people have tried to leave.”

Even without exact numbers, you can gauge whether there is patterned attrition. Programs that are transparent—“We had three early departures in 2019 due to X and we’ve done Y to fix it”—are usually safer than programs that say “we don’t talk about that.”

B. ACGME citations, probation, or loss of positions

Review ACGME or state board information when available, and ask directly on interview day.

Key questions:

• “Has the program had any significant ACGME citations related to duty hours, supervision, or education in the last few years?”
• “Have there been any changes in the number of residency slots?”

Red flags:

• Loss of positions without clear, benign reasons (e.g., funding shift due to hospital closure vs. performance concerns).
• Vague language about “restructuring” with no educational rationale.
• Residents telling you that the program was on “warning” recently, while leadership downplays or denies it.

C. Rapid leadership turnover

Frequent changes in:

• Program Director (PD)
• Associate Program Directors (APDs)
• Chief residents who resign early or step down mid-year

can signal underlying chaos or conflict.

Ask:

• “How long has the PD been in their role?”
• “How stable has leadership been over the past 5 years?”
• “Have chief residents typically completed their full year?”

A PD who just started can be a positive if they’re highly invested; but if they are the third PD in four years, that’s more concerning, especially if resident turnover also seems high.

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5. Special Considerations for DO Graduates in a Prelim IM Year

A. Evaluating support for your long-term goals

As a DO graduate, you may be:

• Using a preliminary medicine year before a PGY-2 in another specialty
• Reapplying to categorical IM or another field
• Strengthening your clinical record after a challenging match cycle

In all cases, you need letters of recommendation, clinical growth, and a safe environment. High resident turnover can jeopardize:

• Continuity with mentors (faculty who stay long enough to observe and write strong letters)
• Stability of rotations you need for your advanced specialty
• Your ability to perform at your best in a stressful environment

Ask programs directly:

• “How do you support prelim residents in obtaining strong letters, especially those reapplying?”
• “Do prelims meet regularly with advisors, and are DOs represented among advising faculty?”
• “Can you give examples of where DO prelim graduates have matched or progressed in the last few years?”

B. Disparities between prelim and categorical experiences

Some programs treat prelims as full members of the residency; others use them as “extra hands.” The latter is a common driver of residents leaving program mid-year or discouraging future applicants.

Watch for:

• Prelims consistently assigned heavier service rotations with minimal elective time
• Categorical residents given more educational opportunities (conferences, leadership roles, committees)
• Prelims reporting that they feel disposable: “They know we’re gone in a year, so…”

Ask specific, detailed questions to prelims:

• “What proportion of your year is ward heavy vs. elective?”
• “Do you attend the same didactics and conferences as categoricals?”
• “Do you feel leadership is invested in your growth even though you’re only here for a year?”

For DO graduates, ask if DO prelims have historically matched successfully into competitive specialties from this program. If not, consider whether you want to be the one proving it can be done.

C. How DO match dynamics intersect with program red flags

With the single accreditation system and combined osteopathic residency match pipeline, DOs match broadly, but some programs:

• Have little history with DOs and are still evolving their culture
• May be more willing to fill unfilled or high-turnover spots with DO applicants
• Might see prelim DO residents as “backup” rather than deliberate recruits

This doesn’t mean such programs are automatically bad, but it increases the need for careful vetting. You want a program that actively wants you, not one that passively fills a vacancy.

Signs of genuine commitment:

• DO representation among core faculty or chiefs
• Program leadership mentioning prior DO grads by name and outcomes
• Thoughtful responses to questions about integrating COMLEX/USMLE perspectives, OMM, or DO training backgrounds

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6. How to Assess and Act on Turnover Warning Signs

A. Pre-interview research strategies

Before you interview:

1. Check program websites carefully

   • Look for resident lists by PGY level over a few years if archived.
   • Note any year-to-year changes in class size.

2. Use word-of-mouth and forums cautiously

   • Online reviews (Reddit, SDN, specialty forums) can flag concerns but can also amplify outliers.
   • Treat recurring negative themes (e.g., “toxic culture,” “people are trying to transfer out”) as signals to investigate, not verdicts.

3. LinkedIn and alumni tracking

   • Search recent grads from the program and see whether there are gaps (people listed as “residency, 2019–2020” only) or frequent transfers.

B. Targeted questions to ask on interview day

For PDs or APDs:

• “How has resident retention been over the last 3–5 years in both prelim and categorical tracks?”
• “What kinds of changes have you made in response to resident feedback?”
• “Can you describe how you support residents who are struggling or considering transferring?”

For current residents (prelim and categorical):

• “Have any of your classmates left early, and how was that handled?”
• “Do you feel leadership is transparent with you about program challenges?”
• “How sustainable is the workload now compared to prior years?”

For DO-specific concerns:

• “How have DO residents historically done in this program?”
• “Do DOs hold leadership roles or serve as chiefs?”
• “Have DO prelims successfully transitioned to advanced specialties or categorical spots?”

C. Balancing risk vs. opportunity in your rank list

Not every program with some turnover is a disaster. You may still rank a program with mild concerns—especially if they offer strong training, good location, or rare opportunities—but:

• Multiple major red flags (evasive leadership, many missing residents, fearful culture) should push a program lower on your list.
• For a single-year prelim, avoid programs where:
  • Residents routinely leave mid-year.
  • The environment seems unsafe or unsupervised.
  • DO residents appear marginalized or absent.

Remember, the goal of a prelim medicine year is to launch your career, not to simply survive. You need a place where you can both work hard and be supported.

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FAQs: Resident Turnover Warning Signs for DO Graduates in Prelim Medicine

1. Is high resident turnover always a reason to avoid a prelim IM program?

Not always. Some turnover is normal, and occasional clusters can be tied to external events (leadership changes, hospital mergers, pandemic-related stress). The concern arises when there is a pattern of residents leaving program, especially without clear explanations, combined with other red flags like overwork, poor supervision, or fearful culture. Look for transparency and evidence that problems were recognized and addressed.

2. As a DO graduate, should I avoid programs that haven’t trained many DOs?

Not necessarily. A program new to DOs can be an excellent opportunity if leadership is genuinely enthusiastic and intentional about recruiting and supporting DO graduates. Focus on:

• Their openness and concrete plans to integrate DOs
• Visible respect for your training background
• Willingness to discuss prior DO matches (if any) and rational absence if they are new to DOs
  Combine this with your assessment of turnover patterns and culture.

3. How can I tell if a “resident turnover red flag” is just online rumor?

Use a triangulation approach:

• Compare what you read online with what you see and hear on interview day
• Ask residents privately and note if multiple people independently share similar concerns
• Look for objective indicators (changes in class sizes, ACGME citations, leadership turnover)
  If online criticism is strong but the program is transparent, self-aware, and shows concrete improvements, you might still consider it—especially for a single-year prelim.

4. What’s worse for a prelim year: heavy workload or high turnover?

Heavy workload is expected in many prelim IM programs and can be manageable if:

• Supervision is strong
• Schedules are compliant with duty hours
• Leadership responds when things become unsafe

High turnover, especially when combined with poor support, often indicates underlying program problems that are harder to fix quickly and can jeopardize your safety, learning, and letters. When forced to choose, a busy but stable program is usually safer than a less busy but unstable one where residents frequently leave.

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By carefully evaluating resident turnover warning signs, asking targeted questions, and considering your unique perspective as a DO graduate in a preliminary medicine year, you can build a safer and more strategic rank list. Your intern year will be demanding no matter where you go; make sure it’s also supportive, educational, and sustainable, not a place where turnover is telling you to run in the opposite direction.