2012-2013 C&A Program Reviews/Impressions

[trophyhusband]

Well the 2012-2013 Child and Adolescent Psychiatry match has come and gone. It will hopefully be our last go round in the match process. As I use this board quite often for information about the goings on in the world of Psychiatry, I thought I’d give back by posting these reviews/impressions of programs where my wife interviewed.

Now some things to know about my wife and her goals since that will be what these reviews are written toward. My wife’s main interests are inpatient, day treatment, developmental disabilities, and residential treatment. She has not had good experiences in outpatient medicine up to this point and is looking for less outpatient experience in her fellowship or at least a lot of specialty clinics so she doesn’t have to be in her own office every day. She also does not enjoy C/L so less of that would be preferable as well.

All of the programs she interviewed with were good programs. Some of which are unlikely to be reviewed on SDN. So since she thought highly of these programs, we wanted to give them some publicity here. Hopefully next year’s applicants will find this info useful.

Note: These reviews are not in order of ranking or anything.

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[trophyhusband]

Brown

About the Program:
Program has basically everything I want on paper. But after the interview I found it just wasn't for me.

The first six weeks is an intensive overview to integrate fellows into the program, which seems like a good idea. This was the only program that I interviewed at that had this type of set up.

Program is very therapy oriented, which is good and bad. The therapy training seems to be very strong and would be of some interest to me. However there is probably a little too much emphasis on therapy for my tastes. When I asked the PD whether there was any outpatient med management training, he struggled to come up with any and said to the effect "I think there is some in second year." I plan on doing therapy in the future but I don't plan on only doing therapy so I would like to get more exposure to med management then seems to be emphasized here.

Overall, I did like the different clinics/settings that were available. There are two separate DTP/Partial programs, separate child and adolescent inpatient units, and the center for autism and developmental disabilities (CADD). All of these were well within my areas of interest and seemed especially strong.

I wasn't a fan of how the outpatient psychotherapy clinic was set up. You share an office and the clinic is from 4-7PM. You're required to have 5 hours of clinic a week. So since you're sharing an office you likely won't be able to get your clinic time from 4-5PM Mon – Fri. So you'll need to work some evening hours and you need to work with your office mate to set up a schedule (not horrible but not ideal either).

Call didn't seem too bad. 4-5 weekends of home call. Only have to go in for consults @ Rhode Island Hospital and they pay you $200 each time you have to go in.

Faculty:
Faculty all seemed to be top notch and seemed to be long-termers so that's a plus.

I didn't connect at all with the PD, which seems odd since everyone raves about how great he is… probably just one of those things.

Loved Dr. Meservy who works in the CADD, so much so that I considered ranking Brown higher just on the basis of being able to work with him and be mentored by him.

Strengths:
Strong reputation.
2-3 hours for ER admit evals.
Verbal orders (incl seclusion & restraint)
Remote access and remote orders.
CADD
Diversity of clinics/rotations

Weaknesses:
Share an office
Evening clinic
More therapy and less med management than I would prefer
Cafeteria at the Bradley hospital was really sad (trite I know but it stood out, ha)

Location:
Really liked Providence as it was quite charming and walkable. Brown campus in town really added something.

 

[trophyhusband]

Maryland/Sheppard Pratt

About the Program:
Another program that had basically everything I wanted on paper. I really liked this program and it might have been #1 if it weren't in Baltimore. Just couldn't see ourselves living there… even for two years.

There was an excellent diversity in clinics/rotations as well as patient populations between the UM clinics/hospital and the Sheppard Pratt clinics/hospital. There are separate child and adolescent units, a DTP/Partial program, neurodevelopmental unit (Sheppard Pratt), and multiple other rotations/clinics. The problem with this is that you will be traveling between downtown Baltimore and Towson which is about a 30 minute trip (so you may be eating lunch in your car) going from one site to the next.

You get your own outpatient office and there is free parking at both UM and Sheppard (kind of a big deal in Baltimore).

Most days are 7:30-5ish. There is one late clinic day a week. Call is 4wks of backup a year (gen psych resident in ER is primary) and 2-3 weekends of rounding 8-11am. There is also short call from 3-5PM q3-4 while on inpatient or day treatment. The plus on short call is that I consider it to be part of a normal work day anyway. The negative is that if you have a clinic patient scheduled, then you have to do some juggling with both; the clinic is about a couple blocks walk from the hospital (no tunnels for winter either).

There are 1 or 2 afternoons of elective in 2nd year. Some of the options are eating disorders outpatient clinic, community PACT, international (didn't really ask how this would work), admin, and advocacy.

Really liked the program overall.

Faculty:
Small # of faculty at UM for this being such a large program. Liked the ones that I met however.

Strengths:
Diversity of clinics/rotations
Big program
Very minimal C/L (contract only calls for 50 consults a year at UM)
Neurodevelopmental unit at Sheppard said to be a very good experience
(forensics supposed to be an interesting experience)
They baby-step you through creating a meta-analysis that is publishable by the time you graduate as your research project; time is allocated for this.

Weaknesses:
Driving from site to site seems like it would be a pain
Interview day seemed a bit disorganized and the program itself made me wonder a bit about how organized it was in general
Diversity in therapy didn't seem to be a strong as I would like (but if you push for it you can get more)
Sheppard Pratt rotations seemed to be more service oriented from fellow descriptions

Location:
Baltimore is not the place for us. We liked visiting and doing stuff in the Inner Harbor, but we couldn't see ourselves living there no matter how short the time period. Really good crabcakes though.

 

[trophyhusband]

University of Michigan

About the Program:
Another program that I loved that I wish I could have ranked higher. Though, this seems to be more of a gut-feel-comfort-factor thing. They just didn't have the diversity of clinics/rotations that I was hoping for in my training.

Six months of inpatient the first year (two months of which is C/L). The inpatient unit will be moving to a new building soon, but not in time for my first year of the fellowship. The current unit is fine and unremarkable, but nothing bad that I could see. Was told that when a good fellow is on the C/L rotation, then it is a busy one but when a less efficient one is on then it's not as busy… that description left a bit of a bad taste in my mouth.

When you're not on inpatient it seems that the rest of the fellowship is outpatient based, which is not necessarily a good thing in my mind since I've disliked my outpatient experiences thus far. With that said, most people I've talked to from here and currently in the program seem to like the Michigan O/P experience. There seem to be quite a few different clinics available, but they don't really align with my current interests. There is an autism clinic, but it doesn't seem like there is much of an opportunity to see developmental disabilities in a specialty clinic setting (I'm interested in autism but more interested in DD). There is no DTP or RTC, which are both strong areas of interest for me. There is a DTP at an affiliated hospital (St. Joe's) which I could rotate through on elective time, but no one has pioneered that option yet.

The program is starting up an eating d/o partial program that sounds interesting. I don't have a strong interest in eating d/o's but it could be helpful in working with DD populations in the future.

Really like how they have their journal club set up. Focus on learning the "must know" studies first and then fill in from there and they also have a writing seminar that sounded interesting.

You get a half day for new outpatient evals (3 a week) and 60 minutes for followups in 1st year and all are staffed. In second year you get 30-60 minutes and only staff when you feel it's warranted.

Call is 2 times a month first year and 1 time a month second year. Call is from 6-10PM in psych ER. SW or NP sees the patient first (or you can tag team). Seems pretty light. You are responsible for your inpatient patients 24/7, however don't seem to get calls via beeper very often though.

Faculty:
Seemed very warm and inviting. Really liked the PD and felt a good connection. Only issue I noted was that a lot of the faculty was fairly young and fresh out of training (including the PD). So don't know if this indicates a lot of turnover or not.

Strengths:
Felt very comfortable and felt like my values aligned with the program's
Journal club & writing seminar
Connected with PD
Less C/L
You get your birthday off on top of 4 weeks of vacation

Weaknesses:
Lots of outpatient
Current fellows didn't seem overly ambitious (probably a year to year thing)
Worry about diversity of patient population (fellow basically said if not for Medicaid patients it would basically be a private hospital setting)
No developmental disabilities clinic or DTP/RTC
Unsure whether the therapy was just enough or a little less than I'd like

Location:
Liked Ann Arbor for the short time I was there. Might be a bit of a challenge for my husband to find a job however.

 

[trophyhusband]

OHSU

About the Program:
Really liked the PD. Didn't feel a real connection with the program or the city. The PD's vision of the program sounds very good to me. Unfortunately, it won't be up and running in time for my fellowship training.

This program has a good diversity of clinics/rotations which align with my interests. They have DTP, RTC, and developmental disabilities clinics. They also have a sleep medicine clinic.

The inpatient experience is only half a day and is being moved to a new Providence Hospital facility 30 miles (minutes?) away (Oregon City). So you'd probably be driving during lunch to get from one place to the other. I have a strong interest in inpatient so a half day is a bad thing from my perspective, but I know to others this is probably a good thing.

There is a lot of outpatient clinic, which again, isn't my favorite. But the fellows seemed to be very happy with the experience.

Therapy seems to tilt to psychodynamics currently, which is reflective of what the current fellows want. I'd prefer more of CBT given the population I want to work with. They are working toward more evidenced based therapy modalities but it's a work in progress.

Currently there is a ½ day of elective for 4 months of second year. This could be increased to a full day in the future.

This program was heavier for call. Call is home call Friday PM to Thursday PM 8-9 weeks per year.

Faculty:
The PD Dr. Usher was one of my favorites from the interview trail. He has a lot of ideas for the program. If he can implement them, this is going to be a very good program. I liked the other faculty that I met.

Strengths:
Diversity of clinics/rotations
PD
Family therapy seemed strong – Loved the family therapist couple I met. They truly seemed interesting in teaching.

Weaknesses:
Less inpatient
A lot of outpatient
Travel from inpatient unit to outpatient clinics

Location:
Wasn't a fan of Portland. My husband however loved it.

 

[trophyhusband]

UTSW

About the Program:
Enjoyed the program. I have worked with the PD in the past and really like him personally.

Program has a good diversity of clinics/rotations. They do have a DTP that I think is outstanding. They also have an eating disorders inpatient unit and partial hospitalization program, the only downside is this site is 30-45 minutes away from the main hospital in Plano. DD is covered in second year through a community clinic.


Rotations are in ten week blocks first year. Two separate inpatient rotations one at the children's hospital and one at the eating disorder unit. This is better than it had been in the past. It used to be one unit dominated by eating disorders. Fellows seemed to like these rotations well enough.

Two separate 10 week rotations through C/L, which cover ER, Children's hospital both inpatient and all outpatient clinics. Not a fan of C/L so this isn't a plus for me.

Didactics are all day Tuesdays both 1st and 2nd year and the lectures repeat. There is no set elective time so you would need to skip the beginning lectures in second year to do electives you might be interested in pursuing.

Psychotherapy training covers both years and your clinic is from 4-6PM. Though you can come in at 8AM instead since clinic doesn't officially start until 9AM if you'd prefer to not work evenings.

Thursday evenings in both years are spent at the Salesmanship Club for family therapy.

There is a required research project which doesn't bother me since I don't mind doing research projects.

Call is relatively heavy. You're responsible for your inpatient patients 24/7 via beeper. There are approx. 18 short calls from 5-11PM Monday – Thursday from home because there is a social worker on site. You will need to come in if SW is overwhelmed or the patients are complicated (said to only happen 3-4 times a year). There is also a nightfloat 1st year from 11PM to 8AM Sun – Thurs where you are backup to the attending. So essentially the attending gets the call, but you need to go in and do any evals for restraints/seclusions (Texas law requires face to face evals for this). Weekend call is 5PM Fri to 11PM Sun where you follow up on C/L consults old (~4 avg) and new (~2) and work on restrains/seclusions and ER which is for 5 weekends first year and one less weekend second year. Also, 1 holiday call per year.

Faculty:
Really like Dr. Norcross the PD. Liked the other faculty that I met.

Strengths:
Strong DTP
Like the PD
Diversity of clinics/rotations
Seems like the right amount of therapy for me
Full day of didactics

Weaknesses:
Heavy call
Driving to eating d/o unit
Does not withhold taxes as they consider your pay a stipend (annoys my husband)
Heavy C/L
Lectures repeat between 1st and 2nd year


Location:
Dallas is meh; some people love it and others hate it.

 

[trophyhusband]

University of Utah

About the Program:
This program has just about everything I want either as a part of the program or through electives.

There is a great diversity of clinics/rotations available. They have two RTC rotations, two different DD clinics, and a DTP that can be rotated through as an elective.

The inpatient unit is new and looks top notch. There is a DTP program that you don't normally rotate through but you can follow your inpatient patients through if you're interested.

There are two different RTC's that make up a 5 month rotation 1st year. Utah has some unique state laws that make RTC's more attractive even to out-of-state patient's families. Seems like an interesting opportunity.

4 months of C/L in first year that is split into two month blocks. Again, not my favorite but I'd make due. They try to incorporate some therapy into this, which may make it interesting.

Of particular interest to me is the HOME program, which is a capitated arrangement that take care of individuals with DD. It seems super interesting and would love a chance to see it in action.

There are quite a few other clinics/rotations available and they seem to have just about everything that anyone could want... only thing missing from my other interviews was an eating d/o clinic or unit (which isn't a huge interest point for me).

Call is light. One weekend a month 1st year from Fri 5PM to Sun 12PM. Call is from home except for morning rounding. The first day you cap at 4 admits and the next day you see the previous days 4 admits + up to 4 new admits. The 2nd year has less weekends (approx. 1 every 2 months I think). The faculty are willing to do CSE and give you feedback to make call worthwhile.

Faculty:
There seems to be more faculty here than any of the other programs. This may because there is a triple board program as well so you get to utilize some of those attendings. PD seems very dedicated to education.

Strengths:
Education first
Strong DD experience
PD
Plenty of supervision
Research & elective time
Not a fellow reliant program
Triple boarders bring different experiences to the program

Weaknesses:
Only 2 fellows per year so if you don't like your co-fellow you're S-O-L
DTP is not a set rotation
4 months of C/L and only 3 months of inpatient (wish it was flipped)
Lectures repeat between 1st and 2nd year
Journal club not as strong as some other programs
Didn't get a good handle on how much therapy was available/required

Location:
Liked it more than I would have thought SLC seems to have most of the things we would want. Lots of outdoor activities available.

 

[trophyhusband]

University of Washington

About the Program:
Fairly diverse program with a lot to offer. Seattle Children's will be roughly doubling in size as will the inpatient unit just before the fellowship year starts. 15 new staff positions (7 Psychiatrists, 8 others) will be added but have not been hired yet. Not sure how this will affect the fellows which is kind of scary.

Two rotations through the inpatient unit for a total of 5 months, which seemed pretty decent. I have a strong interest in inpatient so more time spent on the unit is a good thing.

Two and a half months of C/L; it was intimated to me that it could be a little scutty. However, was told that I'd be seeing a lot of different things and the hours weren't too bad.

The Child Study Treatment Center is a state long term hospital which is a fairly long drive south of Seattle. You can ride with the attending if you're interested and which probably helps since you can ride in the HOV lane. 5-8 patients at a time and seems like a good experience. There are no duties here on Wed due to outpatient clinic and also no duties on Friday due to didactics in the morning so you need to work one evening on the other three days.

One of the 1st year rotations is two and a half months of working at various outpatient specialty clinics.

There are quite a few clinics/rotations in second year as well. You also get 1-2 days of elective time in second year which I would be using to rotate through the Neurodevelopmental clinic where most DD patients are seen.

There is also the possibility in taking part in Seattle Children's Leadership Education in Neurodevelopmental Disabilities (LEND) training program, which is a sort of fellowship (non-accredited) within a fellowship and it seems like an incredible opportunity.

Unfortunately, there is no DTP available which is one of my main interests. But there may be something available electively at another site.

Therapy training seems pretty good to me. Training in CBT and PICT is available and the program encourages fellows to attend UW sessions for DBT and modalities.

Call is split between years (so q10ish) and you cover the inpatient unit, consults, and all outpatient issues. Do admits to the unit until 10PM though the crisis team usually does the admits. It's rare to be called after 10 or 11PM. For six months of the year you get a full post call day and for the other six months you get a half day. First years cover the holidays.

Faculty:
I liked the faculty that I met. I feel like I had a good connection with the PD and the assistant PD.

Strengths:
Strong training
Therapy training seems to strike a good balance
Less outpatient than other programs
More inpatient than C/L
Good diversity of clinics/rotations

Weaknesses:
Uncertainty over Children's Hospital and Unit expansion
No DTP
No regular DD clinic (but available through elective)
Got the vibe that C/L is a little on the scutty side.

Location:
Really enjoyed Seattle; it's seems like our type of city. There is a lot to do and kind of reminds me a bit of Chicago. Not sure I'll be able to handle the rain gloom long term but it should be fine for a couple of years.