Importance of Residency Prestige in future planning

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Asklepian

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As a preface, this may seem stupid to some of you. But here's my perceived dilemma.

As an MS4, I have had the pleasure at interviewing at several top-tier and mid-tier Psych residency programs, and found that so far I didn't click as well at the most prestigious ones. However, I want to leave the doors open to myself for a top-tier (read, SF or Boston) fellowship or faculty position, and am not sure if I should just toss my gut out the window and pick reputation to help clinch this. I definitely want to be a leader in the field down the road, but am not sure if I'm being overly neurotic about name/quality of training, or if I'm on the money.

I've gotten some private message help from a few of the forum legends, but wanted to open it up and ask if any of you (especially attendings) have a strong feeling on this. I'm sure I'm not the only one in this boat.

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It's easier to get top academic positions if you trained at a top academic program, but that doesn't mean that you can't get them otherwise. I know that it matters at my program (WashU) - almost all of our faculty members trained here, with the exception of a couple who trained at other similar-tier programs.

It means less for fellowships because there are generally more positions than applicants.

Also, be careful about putting too much emphasis on "click" factor on a single interview day. It's hard to get an accurate representation of a program in one day, and programs are generally more similar than they are different. You will notice that the better programs tend to also work you a bit harder, but that part isn't surprising - obviously, it's hard to be good at something if you don't work hard at it. Of course, that doesn't mean that hard work automatically translates to better training... there are some places (a small minority of places) that will make you put a lot of time into tasks that aren't necessarily educational, but you are unlikely to find that at the "top" programs to which you're referring.
 
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I definitely want to be a leader in the field

Wanting to be a leader automatically disqualifies one from being suitable for leadership. On the other hand if you just want to be at the top of a hierarchy then a desire to be top turd on sh-it mountain will serve you well.
 
As a preface, this may seem stupid to some of you. But here's my perceived dilemma.

As an MS4, I have had the pleasure at interviewing at several top-tier and mid-tier Psych residency programs, and found that so far I didn't click as well at the most prestigious ones. However, I want to leave the doors open to myself for a top-tier (read, SF or Boston) fellowship or faculty position, and am not sure if I should just toss my gut out the window and pick reputation to help clinch this. I definitely want to be a leader in the field down the road, but am not sure if I'm being overly neurotic about name/quality of training, or if I'm on the money.

I've gotten some private message help from a few of the forum legends, but wanted to open it up and ask if any of you (especially attendings) have a strong feeling on this. I'm sure I'm not the only one in this boat.

The big money in the future is going to all down to coming up with new disease entities that can be targeted with pharmaceuticals.... its not new but its a tried and tested method.

I'm giving you this for nothing....

Go for something like tri-polarism. Write a bunch of papers proposing tri-polarism and identify some likely candidates among the current NOS population, or anywhere really, just reassign, long run it doesn't really matter.

Once you have your idea of tri-polarism accepted in principle, flesh it out a bit..... you know different sorts of tri-polarism that just happen to all look the same.... this will handily explain away all the variable results with out damaging the core idea that tri-polarism is a real thing.... an actual disease.... sure you'll get some resistance but you just have to play up to this.... remember their is no such thing as bad publicity in this game. You'll be the go to guy for tri-polarism in no time if you play your cards right.

Later on in your careerer you can do the same thing all over again.... i'm thinking uni-polar. uni-polar one two and er...seven. Leave something for the other guy as they say.... let someone else flesh out uni-polar three four five and six.....

Good luck.
 
The big money in the future is going to all down to coming up with new disease entities that can be targeted with pharmaceuticals.... its not new but its a tried and tested method.

I'm giving you this for nothing....

Go for something like tri-polarism. Write a bunch of papers proposing tri-polarism and identify some likely candidates among the current NOS population, or anywhere really, just reassign, long run it doesn't really matter.

Once you have your idea of tri-polarism accepted in principle, flesh it out a bit..... you know different sorts of tri-polarism that just happen to all look the same.... this will handily explain away all the variable results with out damaging the core idea that tri-polarism is a real thing.... an actual disease.... sure you'll get some resistance but you just have to play up to this.... remember their is no such thing as bad publicity in this game. You'll be the go to guy for tri-polarism in no time if you play your cards right.

Later on in your careerer you can do the same thing all over again.... i'm thinking uni-polar. uni-polar one two and er...seven. Leave something for the other guy as they say.... let someone else flesh out uni-polar three four five and six.....

Good luck.

That's not a bad joke. Unfortunately the effect is dampened by the fact that you have one premise for all your material. Which changes a bit of wit into you being a "that guy" at the cocktail party. Congrats. Being a that guy takes an unusual singularity of mind. For instance, I don't inhabit the automotive mechanic forum on a saturday night. Just the psych forum. Which means I have no life but I'm not quite that guy status yet, because, at least, this is what I do for a living. Which you've never responded in kind with, not-so-incidentally.

It's just this theory I have of the Che Guevara T-shirt wearing that guy types: they usually such at practical life and thus favor the imaginary.
 
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Many of the fellowships at top places are not that competitive in psychiatry.

If you want an academic position at UCSF, the easiest way is probably becoming an excellent resident at UCSF. At least in the south, most academic centers hire from within.
 
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It's easier to get top academic positions if you trained at a top academic program, but that doesn't mean that you can't get them otherwise. I know that it matters at my program (WashU) - almost all of our faculty members trained here, with the exception of a couple who trained at other similar-tier programs.

It means less for fellowships because there are generally more positions than applicants.

Also, be careful about putting too much emphasis on "click" factor on a single interview day. It's hard to get an accurate representation of a program in one day, and programs are generally more similar than they are different. You will notice that the better programs tend to also work you a bit harder, but that part isn't surprising - obviously, it's hard to be good at something if you don't work hard at it. Of course, that doesn't mean that hard work automatically translates to better training... there are some places (a small minority of places) that will make you put a lot of time into tasks that aren't necessarily educational, but you are unlikely to find that at the "top" programs to which you're referring.

I really appreciate this, especially the last paragraph. I think there are conflicting opinions on how to choose a residency, and the "click" factor, although important, may be overstated. N = a very limited number, and the interactions are abbreviated, so putting everything on this could be detrimental, and I see your point.

Wanting to be a leader automatically disqualifies one from being suitable for leadership. On the other hand if you just want to be at the top of a hierarchy then a desire to be top turd on sh-it mountain will serve you well.

This is trolling. Ridiculous.

Many of the fellowships at top places are not that competitive in psychiatry.

If you want an academic position at UCSF, the easiest way is probably becoming an excellent resident at UCSF. At least in the south, most academic centers hire from within.

Point taken. However, isn't there something to be said for a variety of training locations, as well? I have been encouraged not to "inbreed" by several faculty members.

The bigger question is, why are you worried about your Pedigree?
It is not so much my pedigree I am concerned about, as the reason that pedigree seems to exist. I wish to get the highest-quality training possible so that I can spend my few years on this earth really making a difference in the field. If that's pretentious-sounding, I apologize. It is truly meant only out of passion.
 
It's not so much in sounding pretentious, rather questioning the belief system in what defines "best quality" - I'm reminded of an old saying, 'Beauty is in the eye of the beholder.'

With current match rates becoming more difficult since the flood gates opened in ~2006/7, any residency that you can get into and complete will be the best.

Apply broadly and rank as many places as you can. This is my best advice for you.
 
I really appreciate this, especially the last paragraph. I think there are conflicting opinions on how to choose a residency, and the "click" factor, although important, may be overstated. N = a very limited number, and the interactions are abbreviated, so putting everything on this could be detrimental, and I see your point.



This is trolling. Ridiculous.



Point taken. However, isn't there something to be said for a variety of training locations, as well? I have been encouraged not to "inbreed" by several faculty members.


It is not so much my pedigree I am concerned about, as the reason that pedigree seems to exist. I wish to get the highest-quality training possible so that I can spend my few years on this earth really making a difference in the field. If that's pretentious-sounding, I apologize. It is truly meant only out of passion.
If your goal is academia then you should go to a high powered program. Be advised, however, that -within the upper tiers- your pedigree doesn't matter a ton. People hire who they know. For example if you go to JHU or UNC and are an excellent resident there then you likely have a better chance landing a faculty position there compared to someone who trained at MGH, UCSF, etc.
 
Apply broadly and rank as many places as you can. This is my best advice for you.

In this case I don't know the applicants quality, but if they are one of those people making ivory tower rounds then it would be pretty silly to waste a bunch of lower tier programs time and money interviewing there. Not only that, it probably dilutes the applicants interview experiences and wouldn't allow them to take an extra day or whatever at a place they are actually interested in going. I remember at one of my in state "safety" type programs, one of the interviewers looked at my numbers and basically asked me why I was wasting their time (asked a little more diplomatically than that).
 
If your goal is academia then you should go to a high powered program. Be advised, however, that -within the upper tiers- your pedigree doesn't matter a ton. People hire who they know. For example if you go to JHU or UNC and are an excellent resident there then you likely have a better chance landing a faculty position there compared to someone who trained at MGH, UCSF, etc.

In the sense your highlight in your example, this may be true. On the other hand, based on talking to recent graduates, if you are hoping to move to a strong academic program far from where you trained geographically, it is very helpful having gone to a program with a strong name.
 
In the sense your highlight in your example, this may be true. On the other hand, based on talking to recent graduates, if you are hoping to move to a strong academic program far from where you trained geographically, it is very helpful having gone to a program with a strong name.
All else equal, sure. But you really shouldn't overestimate the effect. You think Jurgen Unutzer believes UW offers lesser clinical or research training than MGH? Heck no. So if, say, you really like Seattle or have family there or you went to med school there and are wondering whether to stay for reaidency and 'pass up' the opportunity to train at man's greatest hospital, then by all means stay. Be an excellent resident at UW, distinguish yourself academically (ie research), and I'll bet you have a better shot at landing a job compared to a stellar MGH grad that no one (at UW) knows. Same with UCSF vs Columbia etc.

Keep in mind I am talking about within tier comparisons. If we are talking about a resident at Maricopa vs MGH who wants to move to Hopkins after finishing residency, then sure it will help to have trained at MGH.
 
In this case I don't know the applicants quality, but if they are one of those people making ivory tower rounds then it would be pretty silly to waste a bunch of lower tier programs time and money interviewing there. Not only that, it probably dilutes the applicants interview experiences and wouldn't allow them to take an extra day or whatever at a place they are actually interested in going. I remember at one of my in state "safety" type programs, one of the interviewers looked at my numbers and basically asked me why I was wasting their time (asked a little more diplomatically than that).

Again, because the match has more applicants and positions in all disciplines, one doesn't have the luxury of being choosy. Applicants across the board may have a preference, but the reality of the situation is that any residency spot is a good residency spot to advance ones career. There could be the off chance in conducting a year's worth of research for a "better" spot, but in the end we're all equals in the eyes of state boards, the ABPN and insurance companies.
 
That's not a bad joke. Unfortunately the effect is dampened by the fact that you have one premise for all your material. Which changes a bit of wit into you being a "that guy" at the cocktail party. Congrats. Being a that guy takes an unusual singularity of mind. For instance, I don't inhabit the automotive mechanic forum on a saturday night. Just the psych forum. Which means I have no life but I'm not quite that guy status yet, because, at least, this is what I do for a living. Which you've never responded in kind with, not-so-incidentally.

It's just this theory I have of the Che Guevara T-shirt wearing that guy types: they usually such at practical life and thus favor the imaginary.

......here.... have my last rollo.... if you want to be doing something else on a Saturday night then thats no fun.

Right (flicks sympathy switch to disengage to resume normal service)..... not sure what "that guy" signifies..... I'm feeling it must be in part cultural because I don't get what you mean..... one thing though.... being me requires zero effort on my part... it just happens.

But hey... thanks for the t-shirt! The punk rock anarchist outfit was fun as well..... I have to say though that while I generally don't reveal myself here I can tell you I don't otherwise own a t-shirt. I tend to think they are basically childrens clothes and basically one step away from a facial tatoo....

And thanks for the info.... Ive worked out this is a psychiatry forum.... when I wandered in off the internet superhighway I thought it must be one of those internet dating sites that I've read about in magazines in the dentists waiting room.... it kind of made sense because reading the threads I could see why the authors might be.... you know.... struggling to attract the opposite sex..... then I realised.

So.... no life yet guy..... what got you so interested in lunatics..... its a thankless task you know.... working with mad people... a lot of them don't even appreciate the interest you're taking......
 
Graduating from a residency probably none of you has heard of, which I transferred into as a third year. After a 2 year break in training and leaving my first program under less than ideal circumstances. I have great test scores and good letters but am far from an ideal candidate with all that baggage.

Got interviews at every program I applied to for fellowship including a few top tier programs. This is just my experience but I went in saying 'why not?' and assumed I would NOT get interviews at these programs. I was wrong.
 
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......here.... have my last rollo.... if you want to be doing something else on a Saturday night then thats no fun.

Right (flicks sympathy switch to disengage to resume normal service)..... not sure what "that guy" signifies..... I'm feeling it must be in part cultural because I don't get what you mean..... one thing though.... being me requires zero effort on my part... it just happens.

But hey... thanks for the t-shirt! The punk rock anarchist outfit was fun as well..... I have to say though that while I generally don't reveal myself here I can tell you I don't otherwise own a t-shirt. I tend to think they are basically childrens clothes and basically one step away from a facial tatoo....

And thanks for the info.... Ive worked out this is a psychiatry forum.... when I wandered in off the internet superhighway I thought it must be one of those internet dating sites that I've read about in magazines in the dentists waiting room.... it kind of made sense because reading the threads I could see why the authors might be.... you know.... struggling to attract the opposite sex..... then I realised.

So.... no life yet guy..... what got you so interested in lunatics..... its a thankless task you know.... working with mad people... a lot of them don't even appreciate the interest you're taking......
The "that guy" refers to someone who is predictable and people groan when he comes over to talk to them at a party because they already know what he is going to say. Don't be "that guy"!
 
The "that guy" refers to someone who is predictable and people groan when he comes over to talk to them at a party because they already know what he is going to say. Don't be "that guy"!

Thanks! . i've not heard that expression before......i'm relieved as well.... I don't think their is a danger of me falling into that camp...... unless "oh thats interesting....what do you think about x w or z" counts...:) its the sort of guff I usually summon up on "those occassions"

I think I've just invented "those occasions" as the sort of occasions with a very high "that guy" types in attendance...
 
I think psychologists and psychiatrists are both all too familiar with "those occasions". For us, it's when "that guy" says, "I know someone who ______ what do you think about that?" Or even better "You're a shrink what do you think about ________". Usually that guy (or girl don't want to be sexist), has their own opinion that they just want validated so I tend to avoid giving any answer, make a brief quip or non-sequitir, and move away.
 
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