If you have quietly stopped doing anything in residency beyond what’s required, you have two real options: treat the minimum as a deliberate plan for a specific kind of career, or treat it as a signal and change something before it decides for you. Most residents do neither and keep coasting with the guilt, which is the expensive version. Our residency survival guide covers the wider training picture; this post is about choosing on purpose.
A PGY-2 on Reddit described exactly this: the required research done and nothing more, no conferences, a fellowship plan dropped, and a program director who had started asking why. Others the same week wrote about days off spent in a fog, about wanting a fully remote job after one bad consult day, and about family who treat being a doctor as the whole of their worth. None were failing; all were stuck between paths.
What the minimum actually requires
Start with the facts, because guilt inflates them. The ACGME’s 2026 Common Program Requirements say residents “must participate in scholarship,” and leave the details to each specialty’s Review Committee and your program. That is a participation requirement, not a publication quota. Posters and conference travel matter for fellowship and academic jobs; for a community hospitalist or outpatient generalist, they matter far less.
Two costs that show up later
A thin CV is not the real cost. The first is how your program reads silence. The same requirements oblige your program director, with the Clinical Competency Committee, to review your performance with you twice a year, help you build an individualized learning plan, and “develop plans for residents failing to progress.” If your clinical work is solid, skipping optional projects won’t trigger that on its own. But a PD who can’t tell whether you’re content, burned out or halfway out the door will often assume the worst, and the next step is a meeting with paperwork attached.
The second cost is slower. Coasting without deciding keeps every option half-open, so none of them gets built. You aren’t lining up a fellowship, collecting the references a strong first job needs, or preparing an exit. Leaving tends to happen early: a JAMA Surgery meta-analysis of general surgery residents found pooled attrition of 18%, with roughly 80% of departures in the first two years and uncontrollable lifestyle the most commonly cited reason. That’s one specialty and older data, but people who leave usually decide early. Drifting past that window doesn’t preserve the choice. It makes the same choice later and costlier.
Path one: the minimum, on purpose
If what you want is a predictable job with defined hours, the low-ambition route is legitimate. Make it a plan. Name the setting you’re aiming at: outpatient internal medicine, a shift-based hospitalist or urgent care role, community practice, or remote reading if you’re in radiology. Then do the few things that setting rewards: strong clinical evaluations, a first-attempt board pass, and two or three attendings who would describe your judgment well on a reference call.
Path two: change the conditions, not the career
Sometimes disengagement is a reaction to a rotation, a schedule or a program rather than to medicine. One test: picture the attending job you’d have in your specialty, at a place you’d choose, with reasonable hours. If that picture still feels bad, the problem is probably the career. If it feels fine, it’s probably the conditions, and those end.
Use the time off you’re entitled to, and use the care your program is required to offer. The ACGME requires access to confidential, affordable mental health assessment, counseling and treatment, and requires that residents be able to attend appointments scheduled during work hours. If the fog on your days off has lasted weeks and isn’t lifting, that deserves a professional look, not more willpower. The Physician Support Line (1-888-409-0141) is free and confidential, staffed by volunteer psychiatrists from 8 a.m. to 1 a.m. Eastern seven days a week, and open to residents. If it ever turns darker than that, call or text 988.
Path three: an exit you plan like a project
If the attending-job picture is a clear no, plan the exit instead of fantasizing about it. Find out what finishing would buy you: completing training and passing boards keeps clinical work available as a part-time or locums fallback while you build something else. Leaving earlier closes more of that door, and how much depends on your state’s licensing rules, so check them before you decide. Teaching, the alternative the PGY-2 named, is a real job with its own credentials and pay scale; price it before you romanticize it. Family expectations are real, but they are an input, not a veto.
What to tell your program director
You don’t owe your PD your full internal debate, and oversharing can color evaluations and the references you’ll need later. You do owe them enough that your silence stops reading as a problem. A workable script: “I’ve decided my goal after training is a clinical job in [setting], not fellowship or academics. I’m going to put my effort into clinical skills and boards and complete the scholarship the program requires. Is there anything in my evaluations you’d want me to work on for that path?” Hold the exit conversation until you’ve actually decided; “I’m thinking about leaving medicine,” said in a semiannual review, can shape how every evaluation after it is read.
Doing the minimum is a fine plan and a poor default. Pick one of the three paths this month, write down the setting or the exit you’re aiming at, and let that decide what extra work, if any, is worth your hours.
Decisions like this are hard to make alone, and harder when you can’t say them out loud to your program or your family. DocCommons is being built to connect residents with practicing and retired physicians who stood at the same fork. It isn’t live yet, but you can put your name on the waitlist now.