Importance of location of residency?

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If you plan on going into private practice, is it important to do residency in the same town (or close to it) that you plan on working in? What if this doesn't work out?

It would greatly help, but not mandatory.

Good question. I've been wondering the same thing. Do you establish contacts and networking in the region where you do residency - I'm thinking yes. Given this, I'm going to rank according to where I wish to practice after training. Can anyone else elaborate on this question?

It doesn't matter if the region has a shortage of psychiatrists.

It's helpful. In my last job, I was familiar with state mental health law. I knew where all the drug rehabs were and the reputations of each. I knew the status of the local state hospital system. I knew where all the partial programs were and which ones focused on which population.

I never knew how much locally based knowledge I had until I didn't have it anymore. I knew I wouldn't be able to "302" people in IL (even though I can still involuntarily commit in a process practically identical to the one I called a 302), but when patients need rehab or partial, it's been a learning process figuring out where to send them. Also when patients tell me that they were hospitalized at "McFarland", I initially didn't appreciate the significance of that like I would have if someone told me they had been to Mayview. (State hospitals, all).

There are jobs everywhere so I don't think you need to do residency where you want to end up, necessarily. But if you do you will be familiar with local resources and have local contacts that will be very helpful.

Do you establish contacts and networking in the region where you do residency - I'm thinking yes.

Yes.

Several psychiatrists I know simply just work at a place, go home, that's it. End of story. If you're well connected, you'll know of several opportunities others don't. You'll know a place once you've been in it, scouted it out, asked what each place pays, and know the major players in the area. This can take about 1-3 years to figure out depending on factors.

By the time you finish residency, you'll have a lot of this figured out in the specific area.

This does make a difference. I could, for example, work at a place for $125 an hour or another place for $200, because I know the right people looking to hire. If you don't know these things, you'll be locked into the place you work and have little other opportunities.

Originally Posted by Sharpie1

If you plan on going into private practice, is it important to do residency in the same town (or close to it) that you plan on working in? What if this doesn't work out?

I was told by my child psychiatry clerkship director that doing residency where you plan to practice is very important (so that a good local name could be a better choice than a great national name somewhere across the country). He mentioned getting to know the specific rules and resources available in the area which can help your patients. I imagine networking and establishing a reputation and patient base are other big perks.

I think, though, that moving after residency will probably be fine (there is a good chance I will do this myself). You can learn the new rules and resources, and it may even be a plus in an academic setting that you can bring an outside perspective (since many programs take lots of their own grads).

Agree..though you'll be starting over in a sense. The rebuilding phase will take over a year. It's not just about business. In practice, you will have to know where to refer a patient, and you want to only refer to people that you trust. Going to a new area--you don't know who the good people are.

My wife shot the idea to me to move to Iowa, one of the most underserved areas in the country because that's where her family lives. I know I'd making a fortune doing private practice there. The idea, however, of starting over yet again, among leaving things like the house I love, new friends I made, the pathfinder gang I'm in (a RPG), and probably being the only one in the area without colleagues to discuss difficult cases, that really bugged me.

If you're in your late twenties to mid 30s, I'd recommend being open to a move. Me? I'm getting close to 40, got a new daughter, and noticing that I'm getting older, I don't know if I want to move again.

Originally Posted by sunlioness

It's helpful. In my last job, I was familiar with state mental health law. I knew where all the drug rehabs were and the reputations of each. I knew the status of the local state hospital system. I knew where all the partial programs were and which ones focused on which population.

I never knew how much locally based knowledge I had until I didn't have it anymore. I knew I wouldn't be able to "302" people in IL (even though I can still involuntarily commit in a process practically identical to the one I called a 302), but when patients need rehab or partial, it's been a learning process figuring out where to send them. Also when patients tell me that they were hospitalized at "McFarland", I initially didn't appreciate the significance of that like I would have if someone told me they had been to Mayview. (State hospitals, all).

There are jobs everywhere so I don't think you need to do residency where you want to end up, necessarily. But if you do you will be familiar with local resources and have local contacts that will be very helpful.

How much do you think this matters going INTO residency. At one of my top choices, it's in my hometown, which I've lived in for ~30 years and know backwards and forwards. I know that if a patient comes in and I ask if they've ever been hospitalize, and they say, "No, but I was in "Covenant" once," that is means they had a psychiatric hospitalization 15-20 years ago in a hospital which is no longer operational. Here, I can establish better and faster report with a patient. For example, one paranoid schizophrenic told me he worked part-time at a certain well-known ice-cream shop in town, and I said, "oh yeah! One of my good friends worked there too. "Boss' Name" is a great boss, isn't he? I remember this one time..." And the patient and I really clicked. I can do this with almost every patient from this area.

Does it matter? I dunno. I can certainly function in other areas. I did away rotations and did fine, and felt I established good, solid patient rapport at those places...but it WAS different.

On a similar note: Regarding the recent-ish influx of FMGs into psych. How much does one's own national or ethnic culture play into your clinical decisions and therapeutic alliance. Obviously, here in the states, a strong command of English (and sometimes Spanish) will serve you better than poor English, and vice versa for Americans in other countries...but what about little cultural twists and turns.

I had one inpatient kid, diagnosed during his stay with schizophrenia partly because he was running around saying, "My head is a lunchbox." We all thought that was kinda funny, but definitely delusional, because his head wasn't a lunchbox.

Well, it turns out that in the part of the Nearby Inner City that he is from, "Lunchbox" is used as an adjective, meaning "a loopy, almost lightheaded, medicine-head type feeling." He was saying that he felt too sedated. A few dose adjustments later, he was doing much better, and stopped saying his head was a lunchbox.

Now, I can't claim that my knowledge of certain regional Ebonics dialects is that awesome (I looked it up online, ha), but on a larger scale, I think knowing the regional and national culture very well can play an important role in the care of patients.

Thanks guys, this is all very helpful feedback. Appreciate it for sure.

Yes, thank you.

How much would this all matter if let's say the residencies that you are considering are an hour and a half apart, and both an hour from where you want to practice, but one obviously more connected to the area of where you want to practice?

I'm guessing an hour away is hardly considered far. My debate is going to one program in the south of my state vs my #2 which is in the north of my state. That's where location matters I would think (and we're not talking Rhode Island, my state is big).

Originally Posted by Sharpie1

Yes, thank you.

How much would this all matter if let's say the residencies that you are considering are an hour and a half apart, and both an hour from where you want to practice, but one obviously more connected to the area of where you want to practice?

Why would one be more connected than others? Is you ultimate goal to practice at a specific facility rather than a specific town/city?

If that's truly the case, I think the choice is clear.

Originally Posted by digitlnoize

Why would one be more connected than others? Is you ultimate goal to practice at a specific facility rather than a specific town/city?

If that's truly the case, I think the choice is clear.

It's more connected because it's within the same state that I plan on living in, whereas the other program is not (even though they are still fairly close to each other). There are many others pro's and cons to both programs, which is why the decision is not easy...I can't decide which cons I'd rather deal with.