Advice sought: OHSU vs. CPMC

[Messerschmitts]

The top of my ranklist has constantly been in flux for the past few weeks; I am debating between Oregon Health and Science vs. California Pacific Medical Center.

On the surface there is little difficulty; OHSU has by far the better, more well-known name. It is a major research university programme with more prestige, better perks (free food), less expensive living, and better and more diverse facilities (VA hospitals, state hospital, etc. etc.).

However, my lifelong dream has been to live in San Francisco, and CPMC is my only choice for residency in the Bay Area (no others have invited me). San Francisco has been almost an obsession, I love that city to death and want to make it my home. I've been told it is advantageous to train at a programme in the city where you want to eventually practise since it is during residency that you start laying down the foundations of your professional contacts and roots. Thus, even if CPMC is less "prestigious" or has less badass training than OHSU it may be better in the long run. Or it may not, perhaps it's better to get a better training, then move. But then I may not be able to leave Portland because of all my ties to the area by the itme I graduate.

CPMC is by no means a weak programme either, they consistently fill with American medical graduates from top 10 medical schools, and boasts a 1-to-1 facutly-to-resident ratio with particular strength in psychotherapy training. SF's patient base is more ethnically diverse than that of Portland. However, the residents I spoke to admit they spend about half their salary on rent; a 1 bdrm apartment in SF costs in the $2000/mo range. There is no extra stipend for housing, you just get paid a little more. No free food. Terrible EMR system with lots of paper charting. The resident offices are tiny and are shared. The hosptial has a spectacular view of the Bay from the 7th floor but it is generally and old facility.

By contrast OHSU has one of the most gorgeous facilities I've seen, on top of a pristine hill with sky bridges connecting brand-new hospitals evoking an ewok treetop village, complete with gondola/ski-lift to the top. I think they have a better call system. They have more variety of hospitals and facilities to train at. Their hosptials are total EMR, free food everyday, and Portland is a beautiful city in its own right. I could see myself loving Portland.

But yet it is not San Francisco, where I left my heart. Portland is kind of white bread compared to the unparalleled diversity of SF, and as beautiful as it is, in my own subjective view the Bay Area is still more beautiful by far. Plus it is much sunnier and warmer in the Bay Area than Portland. SF is not LA, but from what I've seen it is significantly nicer weather-wise than Portland. And if I trained at OHSU I would still likely try to get a job in SF after graduation. Would it have been better for me to have just trained in SF and saved myself the trouble? Even if the training is not as good at CPMC, the joy of being in the city I want to spend the rest of my life in would mean a lot to me too. But I would have so much more disposable income in Portland, plus there is no sales tax in Oregon!

Another factor: I have gone to great lengths to "engineer" my return to the Bay Area. I did an away rotation at CPMC, and would likely not have been invited to interview otherwise. I didn't do one at UCSF or Stanford because I felt I would be wasting an away rotation at a programme I had no chance at. I felt CPMC was a practical, approachable goal. To get that away rotation I had to obtain letters of recommendations and go to great lengths. I had to be on my best behaviour all month. I cultivated connexions. In short, I feel like I went through a lot of trouble to give myself the best shot of landing a spot in San Francisco. If I were to choose OHSU I would feel a little bad about "wasting" all that effort.

And thus I go back and forth, back and forth like this in my mind ad nausem. Appreciate any thoughts.

Bottom line: I think I would get a better training at OHSU, but I want to settle in SF, and CPMC lets me get my foot in the door career-wise. But then again, maybe I'll match at my 3rd or lower choice and all this hair-pulling will be moot! Who knows!

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[Doctor Bagel]

From reading this, my impression is that you like CPMC a little better and that it lines up more with your long term career goals than OHSU. It sounds like you could get good training at either spot. Research is maybe more available at OHSU, but does that matter to you? And the cost of living stuff, how much does it bug you spend half your salary on rent? I don't think it would work for me, but maybe you're really frugal and don't care?

 

[maranatha]

...evoking an ewok treetop village,

I've seen the hospital and never thought about that... That is awsome!!! I vote for OHSU just for the Star Wars reference.

Seriously, I recommend going back to both places for a second look. I would also try to contact some graduates and/or upper level residents and get their take on the training. Would also try to speak to some psychiatrists in SF and find out how difficult it would be to get set-up in SF without having done your training there. In some larger cities with an over abudance of psychiatrists, it could be tougher to come in as an outsider.

That was a major issue for myself when picking a residency and has come up again when applying to Child Fellowships. I ultimately went for the program that was a better fit in regards to training over doing a residency and fellowship where I eventually want to work. (The training programs where I want to work are great, but there were other personal issues that came up.) It is a gamble, but the city I want to move to may not be as difficult as somewhere like NYC or SF to get into. If so, I don't know....

 

[Indryd]

In one year, I anticipate being stuck in the same dilemma as you are, Portland or SF.

I am a NorCal native; growing up, SF was "the" city. But as an adult, I spent a lot of time Portland and loved it. And while SF has so many things no other city on the west coast has, Portland can provide some things SF can't.

I'll admit, imo NY and SF stand out head and shoulders above every other city in the country. They are damn near untouchable in their greatness. But you pay dearly to live there.

Among the Cities of Mere Mortals, Portland is truly an amazing city with a young, progressive population. If you like outdoorsy stuff, Portland, no question. But even if you prefer the music, art, and general "city" atmosphere, Portland can provide that, and in a very unique way.

Here's what will be the deciding factor for me: I already have a family (read no money no money no money), so the kind of money it costs to live in SF makes it damn near out of the question.

Yet, I am still torn and very strongly thinking about SF and will be applying to every program in NorCal.

But if you have or are planning any time in the next 5 years or so to start a family, think about Portland.

Good luck man!

 

[psychotrope]

Rank the san francisco program #1. Some people need to be in a place like san francisco/la/nyc. Some people need to be in a place 180 degrees from that. Some people can do fine and be happy in either.

From your posts it's pretty clear where you want to be and how much you value being there, and Im sure you'll get what you need from any of the programs you've interviewed at.

Even if you do go somewhere other than san francisco and come back after 4 years, 4 years is still a long time.

 

[atsai3]

Bottom line: I think I would get a better training at OHSU, but I want to settle in SF, and CPMC lets me get my foot in the door career-wise. But then again, maybe I'll match at my 3rd or lower choice and all this hair-pulling will be moot! Who knows!

Coming from OHSU would put you in a better position to compete for fellowships nationwide, given that CPMC is really a sort of regional program. But it would be a fairly difficult life to go to Portland and spend 4 years trying to 'engineer' your return to SF. That is also a gamble that you will be able to leave your social networks, potentially a spouse/partner, etc. behind. If you are pretty sure you are going to forgo fellowship and head straight for the SF job market, then that would argue for a strong consideration of CPMC. Even more so if you are thinking about private practice.

The other factors you listed are important factors, but perhaps not as important IMHO.

• Shared office -- the residents at UCSF have to share offices during their PGY2 year. So really it only comes down to a comparison of having to share an office for the last two years.
• Poor systems -- SFGH is using paper. LPPI is using paper. UCSF/Moffitt has a terrible EMR system. St. Francis is using paper. The community clinics are using paper. If you go into private practice after graduation, you will probably be using paper. The SF VAMC and Palo Alto VAMC have a great EMR, but this is the same story in most cities throughout the country.
• Old facility -- SFGH, LPPI, St. Francis, UCSF, SF VAMC, etc. are all old, dilapidated facilities as well.
• Money-- sales tax, cost of living, etc. You get paid about $5K/year more at CPMC, which probably doesn't really cover the differences in cost of living and sales tax. But falling $5-10K behind per year -- even if you have to take out additional debt -- is not much compared to an attending salary.

 

[peppy]

If I were to choose OHSU I would feel a little bad about "wasting" all that effort.

Don't underestimate the value of having a solid "safety school" option for your #2 rank. The west coast programs are all very highly sought after AND the match appears to be becoming more competitive with each passing year, so you can't count on getting your #1. With the trends of match competitiveness, having a #2 choice that you don't like quite as much as your #1 but would still be happy to wind up at for location reasons if your dream program doesnt work out is absolutely valuable.
And that's basically what I think it boils down to for you. It sounds like your honest preference is #1 OHSU and #2 CPMC but you are finding it hard to let go of the dream of living in San Francisco. It sounds like yoru emotional attachment to San Francisco is making you WANT to like the CA program, but you didnt mention anything outstanding about the program that really draws you to it except the location. The fact that there are enough people who want so badly to live in San Francisco that even a bad program there could probaby attract top 10 graduates (not to say that CPMC is a bad program, just saying that the location is very desirable to many) doesn't mean the program is great in and of itself.

 

[Messerschmitts]

I'll admit, imo NY and SF stand out head and shoulders above every other city in the country. They are damn near untouchable in their greatness. But you pay dearly to live there.

Among the Cities of Mere Mortals, Portland is truly an amazing city with a young, progressive population

HA HA HA HA Cities of Mere Mortals!!! Here lies my kindred spirit. I honest to gods laughed out loud in glee, because here is the one person on the board to truly understands my obsession with SF. I could not have said it better myself. A city like SF is not for everyone, and there are plenty of people who would never choose to live there. But for people like me it is paradise on Earth. And something else you say is true; everyone who calls SF home has paid a price to be there, has made some kind of sacrifice in one way or another. The real question is how much am I willing to sacrifice for San Francisco? When is the price too great? I would have been naive to think I was going to live in a place like San Francisco without make some big sacrifices.

I also agree though, that as cities of mere mortals go, Portland is fairly awesome. I could not wish for a better "runner up" city. I want to thank everyone on the board for your inputs. I hope I don't come off as arrogant, I am VERY grateful to have been invited to interview at these two very desirable and excellent programmes, and I am aware how fortunate I am to be in this "dilemma". In the end I would be spectacularly happy at either place. But I still have to come up with a ranklist, and someone's gotta be #1, and someone's gotta be #2, etc. I will continue to ponder my situation. In the meantime I thank everyone for any other viewpoints.

 

[Doctor Bagel]

Don't underestimate the value of having a solid "safety school" option for your #2 rank. The west coast programs are all very highly sought after AND the match appears to be becoming more competitive with each passing year, so you can't count on getting your #1. With the trends of match competitiveness, having a #2 choice that you don't like quite as much as your #1 but would still be happy to wind up at for location reasons if your dream program doesnt work out is absolutely valuable.
And that's basically what I think it boils down to for you. It sounds like your honest preference is #1 OHSU and #2 CPMC but you are finding it hard to let go of the dream of living in San Francisco. It sounds like yoru emotional attachment to San Francisco is making you WANT to like the CA program, but you didnt mention anything outstanding about the program that really draws you to it except the location. The fact that there are enough people who want so badly to live in San Francisco that even a bad program there could probaby attract top 10 graduates (not to say that CPMC is a bad program, just saying that the location is very desirable to many) doesn't mean the program is great in and of itself.

Or as your #3 or #4 or at least somewhere on your list. There's no risk as far as I understand in being as aspirational as you wish in how you order your list as long as your entire list isn't full of reaches. I haven't really paid a lot of attention to CPMC, but it sounds pretty competitive, and I know OHSU can be. Someone at my school in the class above me ranked OHSU above the program he ended up at -- I don't know a ton about his application, but he's a US grad who didn't have any major weaknesses afaik and wound up at a pretty strong psych program. So pick #1 and #2 based on preferences, but if those are your #1 and #2, I'd advise thinking seriously about the programs below it, too, and the order you rank them in because it honestly might come to that. I know, total buzz kill thought.

Also, it's funny how peppy and I read your post and walked away with different ideas about which program you prefer. I'm reading it like you can think of lots of logical reasons why OHSU might be a better choice, but it still sounds to me like SF is what you really want and that's more important to you than the other qualities of a program. But you did list more positives for OHSU, so I can see where peppy's coming from.

 

[Messerschmitts]

Also, it's funny how peppy and I read your post and walked away with different ideas about which program you prefer. I'm reading it like you can think of lots of logical reasons why OHSU might be a better choice, but it still sounds to me like SF is what you really want and that's more important to you than the other qualities of a program. But you did list more positives for OHSU, so I can see where peppy's coming from.

Oh it totally makes sense that 2 different people would read my post and come away with two different impressions, because the whole point is that I can't make up my mind and like many things about both programmes. I want SF, but I also want the training that OHSU has to offer.

And I totally agree that these two are very competitive programmes, and I'd be pretty happy down to maybe my 7th choice. But I still have to decide which one is #1

 

[Doctor Bagel]

Oh it totally makes sense that 2 different people would read my post and come away with two different impressions, because the whole point is that I can't make up my mind and like many things about both programmes. I want SF, but I also want the training that OHSU has to offer.

And I totally agree that these two are very competitive programmes, and I'd be pretty happy down to maybe my 7th choice. But I still have to decide which one is #1

So here's how I do it when I have a make a decision like this between 2 things. Think about which thing you would be saddest to lose -- for some reason that helps me clarify my thoughts over thinking about what I'd be happiest to gain. So losing SF at least for 4 years and maybe longer vs. losing the training at OHSU. One way to get at that feeling is to make the list and see which variation of it makes you more sad.

 

[Messerschmitts]

I want SF, but I also want the training that OHSU has to offer.

To be diplomatic (and truthful) I should probably also mention that, despite the above being true, CPMC still does ofter very solid and desirable training, and Portland is still a very awesome city.

 

[peppy]

Perhaps the lower cost of living in Portland would allow you to save up the money to visit San Francisco on your vacation time often enough to satisfy your love of the city. That might quite possibly be better than to be living in SF but having no spare money or time (depending on how much more call that program has) to enjoy it.

 

[VMSmith]

What are your career goals? (Or do you not know yet?)

My sense is that going to OHSU would probably be a better choice if you want to stay in the academic world, SF or not...but in which case you risk not being able to land a position in SF after you graduate. If you plan to do primarily private practice, and plan to do hospital/academic work only while building your practice, it may be better to go to CPMC - then you'll have 4 years worth of making connections and setting up your referral network.

Given that you KNOW that you want to be in SF and want your first job to be in SF, I think it makes the most sense to rank CPMC #1. From your post I get the impression that for you, location trumps program prestige (and even quality of training)...my feeling is that you want to rank CPMC #1 but are having trouble coming to terms with ranking a stronger program below it.

 

[VMSmith]

Another factor to consider, during residency you will learn a lot not just about psychiatry itself but also about a lot about the mental health system in your particular city. If you train in Portland and move to SF right after graduation, you'll likely have quite a bit of learning to do to figure out both the mental health system and laws related to mental health particular to California and to SF.

Again, if your goal is more academically oriented and you plan to spend a lot of time doing research and teaching, then this stuff doesn't matter so much. But there are quite a few practical matters to consider if you plan to do mostly clinical work.