Recognizing Resident Turnover Warning Signs in PM&R Residency Programs

Understanding Resident Turnover as a Red Flag in PM&R

For an MD graduate seeking a PM&R residency, resident turnover is one of the most important—yet often underappreciated—warning signs when evaluating programs. In a stable, healthy training environment, residents rarely leave once they start. When you see multiple residents leaving a program, or hear about frequent changes in the resident roster, it may signal deeper program problems that can affect education, wellness, and your long‑term career.

In Physical Medicine & Rehabilitation, where teamwork, mentorship, and interdisciplinary collaboration are central, losing residents disrupts the culture and continuity of care. As you navigate the allopathic medical school match and narrow down where to apply and rank, learning how to interpret resident turnover red flags can protect you from landing in a toxic or unstable environment.

This article breaks down:

• What resident turnover actually means (and what it doesn’t)
• Specific patterns that should raise concern
• Nuanced, specialty‑specific issues in PM&R
• How to ask about turnover tactfully on interview day
• How to weigh these warning signs in your rank list

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What “Resident Turnover” Really Means

Resident turnover typically refers to residents leaving a program before graduation, transferring to another residency, switching specialties, or being dismissed. For PM&R programs, which are generally smaller (often 6–12 residents per year), even a few departures can significantly impact the culture and workload.

Normal vs Concerning Turnover

Not all turnover is a red flag. Some movement is expected. The key is pattern, frequency, and context.

Examples of normal or neutral turnover:

• One resident per several years transfers for family reasons (spouse relocation, illness of a family member).
• A resident with a clear, long‑standing passion for another field (e.g., neurology or orthopedics) changes specialties early in PGY‑2.
• A resident with persistent academic struggles receives support but ultimately doesn’t continue; this is unfortunate but can be handled professionally and transparently.

Examples of concerning turnover:

• Multiple residents leaving in the same class year.
• Residents from several consecutive classes leaving or transferring.
• Residents leaving midyear with vague or inconsistent explanations.
• Residents citing “culture,” “lack of support,” “burnout,” or “no longer a good fit” without elaboration.
• Very high rate of residents not completing the program over the last 3–5 years.

Because PM&R residencies are relatively small, a pattern like “1 resident leaving per year for the last 4 years” is not minor—that might mean 15–25% of the entire resident body churning regularly. That is a substantial red flag.

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Structural Red Flags Behind High Turnover

When residents leave a PM&R program, it’s often because deeper structural issues aren’t being addressed. Here are the most common underlying program problems you should be thinking about.

1. Toxic or Unsupportive Culture

Culture can make or break a PM&R residency. This field thrives on collaboration—with PTs, OTs, SLPs, psychologists, and other physicians. A poor culture magnifies stress and drives people out.

Warning signs:

• Residents describe the environment as “sink or swim,” “not very supportive,” or “you just have to survive.”
• Faculty are perceived as unapproachable, punitive, or dismissive of feedback.
• Public shaming, aggressive questioning, or belittling is normalized.
• Little camaraderie between senior and junior residents; minimal social cohesion.

How this leads to turnover:

In an unsupportive culture, early mistakes or struggles quickly snowball into persistent anxiety, fear of failure, and dissatisfaction. Over time, residents may seek transfer to similar PM&R programs with better mentorship and collegiality.

What you can ask:

• “How would you describe how residents handle mistakes or bad days here?”
• “Can you give an example of a time a resident was struggling and how the program supported them?”

2. Unsustainable Workload and Coverage Gaps

PM&R is often (incorrectly) perceived as a “lifestyle” specialty. While it can offer good work‑life balance, that is by no means automatic. When residents leave, remaining residents usually absorb extra call and clinical duties—which can quickly become a vicious cycle.

Red flags related to workload:

• Call schedule that has intensified after residents left (e.g., q3 to q2, or frequent 24‑hour in‑house calls without recovery changes).
• Residents openly mention being “burned out,” “constantly covering holes,” or “doing double coverage” for missing positions.
• Frequent cross‑coverage of multiple inpatient rehab units at once.
• Ongoing use of “temporary” schedule patches that have become permanent.

Example scenario (PM&R‑specific):

A program loses two PGY‑3 residents in consecutive years. Instead of finding long‑term coverage solutions, the program expects remaining residents to cover three inpatient services plus consults and admissions, with minimal attending support. Over two years, call frequency doubles, and residents report chronic fatigue and stress. A third resident leaves midyear.

This pattern is more than individual dissatisfaction; it’s structural.

Questions to probe:

• “Have there been major changes in the call schedule in the last few years? What prompted them?”
• “How did the program manage clinical coverage when residents left? How did that affect day‑to‑day life for the remaining residents?”

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3. Poor Communication and Transparency

High resident turnover paired with vague explanations is often a major resident turnover red flag. Transparency (or lack thereof) reveals how a program handles difficulty and conflict.

Concerning signals:

• Faculty or leadership give generic, non‑specific reasons for residents leaving (“personal reasons,” “seeking other opportunities”) with no additional context.
• Residents give clearly rehearsed, identical answers about departed colleagues.
• No open discussion about what changes (if any) were made after previous residents left.
• Policies around remediation, leave, grievances, and wellness are unclear or inconsistently applied.

Because MD graduates are trained in evidence and candor, you should be wary of responses that feel scripted or evasive, especially when multiple residents have left in recent years.

Healthier alternative:

A strong program might say something like:
“We had a PGY‑2 transfer to be closer to family out of state, and another who realized their passion was neurology. We did a debrief as a program afterward—no one likes to see colleagues leave—but residents told us they still felt supported and not overburdened. We adjusted coverage and added an NP to help with consults.”

That level of specificity and reflection is reassuring.

Questions that reveal transparency:

• “Have any residents transferred or left the program in the last 5 years? If so, what were the main reasons?”
• “What changes, if any, did the program make in response to those departures?”

4. Weak Educational Structure and Mentorship

Some residents exit PM&R programs not because of culture or call, but because they don’t see a path to becoming the physiatrist they want to be. This is especially relevant for MD graduates who are aiming for competitive fellowships (sports, interventional spine, TBI, SCI, pediatric rehab, pain, etc.).

Educational and mentorship red flags:

• Residents report limited exposure to subspecialty rehab (e.g., little SCI or TBI time, very minimal EMG or interventional spine experience).
• Didactics frequently canceled for service needs and not rescheduled.
• Minimal faculty mentorship in areas key to modern PM&R (MSK ultrasound, EMG, interventional procedures).
• Weak board pass rates, with no systematic remediation support.
• Little to no scholarly activity support; residents discouraged or indifferent about research.

In this environment, driven residents may transfer to stronger educational programs or feel “stuck” with fewer opportunities at graduation, leading to dissatisfaction and further turnover.

Questions to ask:

• “How often are didactics protected? Are residents routinely pulled away for service needs?”
• “Can you describe how the program supports residents who want to pursue fellowship X (e.g., interventional spine, sports, TBI, SCI)?”

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PM&R-Specific Context: What Makes Turnover Especially Important

While resident turnover is important in every specialty, several PM&R‑specific factors make it particularly important to scrutinize for an MD graduate residency applicant.

Small Program Size with outsized impact

Many PM&R programs are relatively small compared with large internal medicine or surgery departments. Losing 1–2 residents can:

• Double call frequency for an entire class.
• Reduce peer support on complex inpatient rehab rotations.
• Limit peer learning for EMG, ultrasound, and procedures.
• Force cancellations or reductions in continuity clinics if there’s no backup.

If a program has a history of multiple residents leaving the program, you need to assess how they handled coverage—and whether systems changed.

Heavy Dependence on Interdisciplinary Teams

Physiatry thrives in team‑based care. A dysfunctional environment—short‑staffed nursing, PT/OT, speech, case management, or social work—can push stress downward onto residents. If resident turnover coincides with high turnover in therapy, nursing, or other rehab staff, it may reflect broader institutional instability.

Ask residents directly:

• “How stable has the therapy staff and nursing staff been over the last few years?”
• “Do you feel like the rehab unit is adequately staffed so that residents can focus on physician‑level work?”

The “Lifestyle” Misperception

Some MD graduates choose PM&R expecting consistently low stress and predictable hours. When they encounter high census, challenging patients, and demanding call, some may feel mis‑matched and leave.

This is an important nuance: one or two residents leaving a PM&R program for “expectation mismatch” is not necessarily a fatal red flag. However, if multiple residents have left citing burnout, long hours, or misaligned expectations—and those issues aren’t addressed—it likely reflects poor advising, recruitment, or program self‑awareness.

Alignment with Your Career Goals

If you’re aiming for interventional pain, sports, or a high‑volume EMG practice, a PM&R residency without strong procedural training may push motivated residents to transfer out. You must assess whether:

• The program’s clinical strengths match your long‑term goals.
• Past residents secured fellowships or positions that you would be happy with.
• Leadership is responsive when residents request rotations or experiences (e.g., additional ultrasound or spine clinic time).

Resident turnover driven by lack of opportunity is sometimes subtle, but just as important.

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How to Investigate Turnover During Interviews and Away Rotations

As an MD graduate, you are expected to use critical thinking and tact. You need information about the physiatry match and the quality of programs—but you also want to ask in a way that is professional and not accusatory.

Step 1: Do Your Homework Before Interview Day

• Check program websites and social media:
  Look at class photos over several years. Do PGY‑2, PGY‑3, and PGY‑4 rosters look stable? Are there unexplained gaps?

• Search for alumni lists:
  Programs that proudly show where graduates match into fellowship or practice usually have reasonable stability. If lists are incomplete or stop abruptly, it may be a subtle sign of churn or disorganization.

• Talk to trusted mentors:
  Academic PM&R attendings, especially those on the physiatry match or selection committees, often know which programs have had persistent issues with residents leaving the program.

Step 2: Observe During Interviews and Rotations

During interview day or an away rotation, pay attention to:

• Resident demeanor: Do they seem genuinely content and collegial? Are there undercurrents of tension or guardedness?
• Consistency of responses: Do faculty and residents tell similar stories about the program’s strengths and challenges, or do you hear conflicting narratives?
• How they talk about leadership: Is the program director described as approachable and responsive—or distant and defensive?

Step 3: Ask Direct but Professional Questions

Here are scripts you can adapt:

To residents (in private, ideally):

• “Have any residents left or transferred recently? How did that affect the rest of the residency, practically and emotionally?”
• “If you had to rank programs again for the allopathic medical school match, would you choose this program again? Why or why not?”
• “Do you feel the program responds well when residents raise concerns?”

To program leadership:

• “How stable has your resident complement been over the last several years?”
• “When residents have struggled—academically or personally—what kind of support has been available?”
• “Have there been any significant changes to workload or curriculum in response to resident feedback?”

You’re not just gathering facts; you are also assessing how people respond. Defensive, vague, or dismissive answers are themselves concerning.

Step 4: Reach Out to Recent Alumni

If possible, try to contact residents who have recently graduated or left the program. They are often more candid once they are outside the system.

Questions to consider:

• “How did the program handle hard conversations or conflict?”
• “Did you feel prepared for your fellowship or first job?”
• “If residents left while you were there, what do you think really drove those decisions?”

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How to Weigh Turnover When Ranking PM&R Programs

You will rarely find a program with zero issues. Your goal is not to find perfection, but to identify which weaknesses you can tolerate and which are deal‑breakers.

When Turnover Should Heavily Lower a Program on Your Rank List

Consider moving a program lower (or off) your rank list when you see:

• Multiple residents leaving across several classes with minimal transparency.
• Resident stories of burnout, overwork, and lack of support, especially if they describe ongoing patterns.
• Significant educational gaps (e.g., no meaningful EMG or procedure exposure) plus residents leaving to seek better training.
• Leadership dismissive of concerns, or blaming residents who left instead of engaging in program self‑reflection.

In PM&R, where program size is small and culture is critical, such patterns significantly raise the risk that you will face avoidable stress and undertraining.

When Turnover Is a Concern but Not a Deal‑Breaker

Some programs have had past issues but are clearly working to improve:

• A few residents left during a specific leadership transition, but:

  • There’s now a new PD or chair
  • Residents describe meaningful positive changes
  • Didactics, wellness, or call schedule have been restructured

• A single resident left for clear personal or geographic reasons (e.g., spouse’s job, aging parents), and:

  • Residents openly talk about it with empathy
  • Coverage was handled fairly and transparently

In such cases, resident turnover is a yellow flag rather than a bright red one. If other aspects of the program strongly match your goals (location, fellowship outcomes, procedural training), it may still be a reasonable choice.

Putting It Into Context With Your Priorities

Ask yourself:

• Educational fit: Does this program prepare me for the physiatry career I want (inpatient vs outpatient, interventional vs general, academic vs community)?
• Personal fit: Do I feel I could thrive in this culture, based on what I’ve seen and heard?
• Risk tolerance: If there is some history of residents leaving the program, are the current solutions convincing enough that I’m comfortable ranking it highly?

Use resident turnover as one key variable in your overall ranking strategy—especially as an MD graduate residency applicant who may have more choice and leverage in the PM&R match.

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FAQs: Resident Turnover and PM&R Residency Red Flags

1. Is any resident turnover automatically a red flag?

No. A small amount of resident turnover over several years is normal, even in excellent programs. The concern arises when there is a pattern of residents leaving, vague explanations, and signs that workload or culture worsened for those who stayed. Focus on patterns, transparency, and how the program responds.

2. How can I ask about residents leaving without sounding confrontational?

Keep your tone neutral and frame questions around learning and understanding:

• “I’m trying to understand how programs handle challenges. Have there been residents who transferred or left in recent years, and how did the program support the rest of the team during that time?”
• “If residents have left, what kinds of changes did the program implement afterward?”

This shows professionalism and maturity rather than hostility.

3. What if a program I really like has had a few residents leave?

Dig deeper. Determine why residents left and what changed afterward. If the reasons are clearly personal/geographic, if residents and leadership are candid, and if workloads and morale seem stable now, it may still be an excellent choice. Weigh that information against the program’s strengths in training, mentorship, fellowship placement, and location.

4. Are PM&R programs generally safer from toxic cultures because of the “nicer” stereotype?

Not necessarily. While many physiatrists are collaborative and patient‑centered, PM&R programs vary widely. Some have outstanding cultures and wellness initiatives; others struggle with overwork, under‑staffing, or unsupportive leadership. Do not assume a program is healthy because PM&R is seen as a “lifestyle” specialty. Apply the same critical lens to resident turnover, call schedules, and culture that you would in any other specialty.

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For an MD graduate entering the physiatry match, recognizing and interpreting resident turnover red flags is one of the most powerful tools you have to avoid unstable, unsupportive training environments. Pay attention to patterns, ask thoughtful questions, and trust the collective picture that emerges from residents, faculty, and alumni. Your future as a physiatrist—and your well‑being during these crucial years of training—are worth that diligence.