UNSOM-Las Vegas
(Disclosure: This was one of my earliest interviews, and I have to admit I was not yet aware of all the relevant nuts and bolts of clinical training. For instance, I will have to email them back and ask more about didactics**, your role on medicine**, what supervision actually consists of**, as well as psychotherapy training** and more info on call**. But Vegas is an interesting place to live and to practice psychiatry in, and the last substantive thread I've seen on the program is from 2007, so it's high time we had an update. Of note, UNLV will be "owned" by UNR(eno) as of next year, but this is an administrative change that shouldn't affect your life as a resident.)
1. Ease Of Communication: Unfortunately, my interview scheduling experience was among the worst with this program. I got an email at around noon, and replied at 3 pm (I was 2 hrs ahead of vegas, too). Although it was relatively early in the interview season, they only offered 4 dates. Having heard nothing after an hour (either by phone or by email), I followed up with a phone call. I was told that three of the dates I listed in my email were already taken (that fast???!!!), and the fourth one was vastly inconvenient. I had a mind to tell them right then and there to forget it, but my avoidant personality got the better of me, and I settled for the inconvenient date.
As a matter of policy, they've also stated that they don't respond to interview thank you's and don't send out letters to the tune of "we were very impressed with you and would love to see you in our program." Allegedly, people in the past have interpreted these sorts of communications as promises of getting highly ranked and matching into the program.
2. Accommodation & Food: They don't offer accommodations or discounts for lodging, but they'll tell you which hotels are closest to campus. (IMHO, AirBNB is better any day, but when it comes to your own transportation, watch out for the super-aggressive cabbies around the strip.) I wasn't able to make the dinner the night before, but it was allegedly very good. They also fed us an excellent breakfast -- read: it featured more than just carbs -- as well as a solid lunch.
3. Interview Day (Schedule, Type Of Interview, Unusual Questions, Experiences): The organization of the interview day was also a little... different. There were about 20 interviewees, and we were split into three groups. There were also three parts of everyone's day: interviews, a tour of SNAHMS, and a tour of the university hospital. There was no tour of the VA, as it's located outside the city (maybe a 30 minute drive, as we were told). The groups varied in the order of the activities. The interviews were very chill, and unique in that you got to talk to the two chiefs at the same time, and then to two faculty at the same time. Each interview was 30 minutes. There were no particularly stressful questions. In fact, this was one of the few programs that made the question "why here" sound not at all threatening, and more like a means of starting the conversation.
3a. The people:
Among the residents, there is about a 50/50 MD/DO split. I didn't meet as many residents as I might've liked due to missing the dinner, but the ones whom I did meet throughout the day were very laid-back and chill. One of the chief seemed a little stiff in his address, but this was an exception. Notably, the interns we met during our tour seemed very happy, and had time to stop and chat during our tour, which was led by 3rd years.
Of note, the residents were predominantly male -- there is an average of one female per resident class. Of these, about half have families, and some residents cited that they wished the class would do more together outside of work (they probably can't due to having kids), but there are regular meet-ups at the department chair's house such as movie nights and trivia nights.
In regards to the gender imbalance, I was told that this is something the program is actively working to correct. They do in fact invite an equal number of women and men to interview, but even at the interview day, there were maybe 4 women out of a total of 20. The program also ranks as many women as men, and -- off record -- I was told that when there is a woman and a man who are about equally desired, the woman will be ranked higher. The program is also quite family-friendly, with no less time off and benefits than anywhere else. So the only possible explanation appears to be the reputation of Vegas -- namely, that it's "unsafe" and "sketchy," or (according to some comedians) that there are probably exotic dancers at the pre-interview dinner and that's how they attract applicants. But in all honesty, the women who were there told me they were quite happy and did not feel like the reputation of Las Vegas bore out at all.
4. Program Overview: Program got started in the 90's, so early on there were kinks to be worked out, but it seems that things are going much better. This is a very small program for the size of the population (4 residents per year until very recently; now 6), and the only one in town. This means you get quite a bit of attention from the attendings, and you see quite a bit of pathology. The good news is, most services have caps at ~7 patients per resident, and patients are picked according to educational value. Most notably, Vegas is the mecca for psychosis, bipolar, substance abuse, and other addictions such as gambling. You also get a lot of visitors and transplants from all over the U.S. and the world, so if you're interested in the interface of mental illness and culture, this may be the place for you.
Intern year, you have required medicine, ER, and FM rotations. Core work is done at the VA, university hospital, and SNAHMS, a county facility. There are psych ER's both at the VA and SNAHMS (190 psych beds + 30 beds at psych ER). Second year, the pediatric psych service features an addiction and substance abuse component. 3rd year, outpatient and therapy is mostly at SNAHMS with some VA.
SNAHMS is surprisingly well-funded and well-run, with lots of outpatient and community services available. Third year outpatient is also largely at SNAHMS. The county social workers are "amazing," and gather all the collateral -- including from sources out of state -- so you don't have to. The facility is one of those beautiful, green space filled ones that doesn't look like an institution at all. The only downside is that the staff areas are relatively open, despite (rare) incidents in the past such as a patient getting in there and throwing a laptop.
**Call is relatively easy -- on weekends, you can choose to take it from home, and there is no overnight call. I need to follow up on whether this is just 1st year or throughout.
VA -- service is frequently gummed up by vets with gambling and substance abuse problems who run out of money before the end of the month and need a place to stay.
UN hospital support staff have been described as "overworked but very knowledgeable."
There's an in-house Child and Adolescent fellowship, and a Forensics fellowship that miiiiiiiight be available by the time we graduate from residency.
**I am not sure what the dedicated forensics opportunities are -- although the PD is a forensic psychiatrist and there are lots of involuntary patients in the county systems.
4th year electives include the private sector, which many residents and faculty are fans of, because Vegas has a large void of psychiatrists, and private practice after several years of insitutional work is something many residents have on their radar.
Not much in the way of rural medicine or telemedicine; it seems they have their hands more than full with what's going on locally.
Didactics -- dedicated 1/2 day with no clinical duties, pager duty, or notes/orders to write.
Bottom line: The program is more clinically oriented, with less focus on research and high tech interventions. In the words of the PD: "If you want to do something like imaging research, this is not the place for you. I don't even think there's even on PET scan machine in the entire city." I think this is one of those university-affiliated programs that *has* research options if you are interested in them, but won't push them on you and you have to be proactive in finding opportunities.
5. Faculty Achievements & Involvement: PD is a forensic psychiatrist. Residents site faculty being dedicated to teaching and always available, often by text or phone, and friendly faculty-resident relationships.
The PD requires his own moment in the spotlight, I think. As both the founder of the program and the PD, he is very involved in supervision and teaching. He's also quite the colorful character -- very spontaneously funny (see comment below about "drug dealers, exotic dancers, and people who park their cars at the Bellagio), but also very direct and opinionated in his talk to the group ("some programs think having multiple hour-long interviews in better. I think what we do is better -- you get to meet more people in less time.") Was very, very nice during the interview, though.
6. Location & Lifestyle: Vegas can afford a great lifestyle -- the cost of living is quite low (one resident has 5 kids, and he did just fine on an intern's salary with his wife staying at home to home-school-them). There's also much more to the city than just the strip. Highbrow stuff such as museums and opera might not be as plentiful as elsewhere, but natural wonders abound outside the city limits, there's a vibrant night life, restaurant scene, shopping, and any shows that come through are bound to be fabulous. Of note, locals can get cheap seats to many shows at sites like fillaseat dot com, and the hotels and resorts provide ample opportunities for a staycation.
As in any large city, it's important to exercise common sense in staying safe, but the female residents deny ever having felt unsafe walking to their car or being out at night. Indeed, Vegas may even be a good place to be a young woman, as it's easy to get into clubs and bars with your girlfriends for free -- even if you have a prominent wedding ring on your finger.
Of note, it may not be immediately obvious what neighborhoods are "nice" and which ones are not. There have been stories of residents from out of town getting apartments in what seemed like reputable places, only to witness drug deals on the corner come nightfall. If you choose to come here, you are advised to contact the current residents and staff for housing recommendations. The good news is, it's relatively easy to buy a house, and there are many gated communities of renters and home-owners are almost invariably a good bet. Schools also vary depending on neighborhood.
Culturally speaking, Vegas is full of transplants (much like LA, many people come here because they "have a dream.") It's also likely to be different from most places in that the amount of education you have does not necessarily correlate with the amount of respect you get. According to the PD, "the locals at the top of the food chain in Vegas are the drug dealers, the exotic dancers, and the people who park cars at the Bellagio. Many MD find this insulting, which is part of the reason why there is a shortage of doctors here."
7. Salary & Benefits: salary in low 50's, personal and family benefits, including dental -- though dental is limited in scope of practitioners who will take it. Ample external and internal moonlighting opportunities, with many residents doubling their salary.
8. Program Strengths:
--depth and breadth of clinical pathology
--large population to draw from, with checks and balances in place to make sure you actually have time to learn and get attending face-time
--low cost of living, definitely not a boring place to live
--lighter call duty
--lots of moonlighting opportunities
--prep for private practice in 4th year
--county facilities and support staff are excellent, though other clinical sites are more average
--2 psych ER's
9. Potential Weaknesses:
--some people understandably can't get past the reputation of Vegas -- which is deserved in some ways but not in others (no, it's not unilaterally unsafe and sketchy, but yes, people there don't put as much stock in education)
--resident demographics skewed towards the male/family side of things, and in context of a small program, this may make bonding outside of clinical duties harder
--less emphasis on research/imaging/procedures
