Some random study/career planning questions from a student

[shan564]

Hello everybody,

I just wanted to ask a couple of basic questions to help guide my long-term planning.

I'm currently a 4th (final) year medical student at the University of Sydney in Australia, but I grew up in the US and I'm a US citizen. I'm planning to come back to the US for psychiatry training, and I'd prefer to do a med/psych or FP/psych program if possible. I did a psych elective at Tulane and I'm expecting very good rec letters from two faculty members there.

Right now, I'm taking time off from school to study for USMLE Step 1. Yeah, I should have taken it at the end of 2nd year, but unfortunately, I'm an idiot.

If I took the test today, I think I'd get about 220-230. I have another two whole months to study and I think I can get up to the 240-250 range.

So, a few questions:

I realize that Step 1 scores aren't as important for psychiatry as they are for other specialties... but is that also true for IMGs? I already have good American rec letters, I usually do well at interviews, and I had great grades in my med school psych rotation, although my grades in other rotations were about average. Is there much benefit in taking more time off to study? Or is there no clear benefit to an extra 20 points on the exam? Would the extra 20 points help get me into a "better" program (or at least give me more choices)? Or would I be better off investing that extra time in research, or studying for step 2, or just relaxing?


Thanks for taking the time to help resolve my anxiety! I'm pretty sure there's some alprazolam in the house somewhere, but that's just a backup plan...

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[nitemagi]

Get the best score you can on step 1, don't skimp on it.

 

[psychphan]

I think the important thing, especially for non traditional applicants, is to have something that makes you stand out. Something different, to separate you from the other 1900 applicants who apply to psych every year. If you honestly believe you can score in the 250 range, that would be the 'look at me' star on your application, and IMO would very likely get you more quality interviews. I think you would be doing yourself an injustice not to go for it.

 

[splik]

med/psych programs are a bit more competitive (the good ones anyway) and tend to be few and far between. the most important thing for FMGs is your Step 1 score as it is the only thing that can be used to compare you directly with everyone else. Scoring highly will help (>220 and you won't be shutting any doors) however a very high score is not a golden ticket alone. You need to have an altogether solid application and ideally strength in one or more of the following areas: research, teaching, leadership, community participation, advocacy, innovation some sort of selling point that marks you out as a potential future leader in the field. it is also important to have a decent personal statement that explains why you want to do a combined program and not just psych. You should also be aware that what you will lose out on in these programs is psychotherapy training, so if that is very important to you, think twice.

I am an FMG and did not score highly on step 1 - my score was below the average even for psychiatry. I am certain this affected how many interviews i got, perhaps mostly at mid-tier places however it could well be the FMG thing as I know people who scored even less than me (i.e. <200 but were US seniors and got interviews as 'top' programs). I was still able to get interviews at a number of strong programs and in fact most of the programs i was actually interested in. but i have a more unusual CV and am very very funny which is almost as good as having a high step 1 score.

 

[Shufflin]

Wait, didn't I see you on the pathology discussion board and you were all gung-ho for pathology for a long time? What happened to your pathology plans? Why change, is it because psychiatry is not as competitive these days? I hate it when IMGs turn to psych for that reason...

 

[splik]

give the kid the benefit of the doubt people change their minds maybe hes just come to his senses. hopefully it isnt for that reason as it is probably easier to get into path than a med/psych program. there were more unfilled spots for path than there were for psych last year even though path has half as many spots in the first place. psychiatry is becoming more competitive, whilst path is porbably becoming less competitive due to all the problems they are facing. though i cant think of 2 specialties more dissimilar - one is about dead people and looknig under a microscope the other is about people who don't want to live and excavating the secrets of the soul.

 

[shan564]

Thanks for the advice everybody; that's very helpful. I appreciate all of the people who took their time to reply. Looking back, it was probably silly for me to even consider giving anything other than my full effort to Step 1.

Wait, didn't I see you on the pathology discussion board and you were all gung-ho for pathology for a long time? What happened to your pathology plans? Why change, is it because psychiatry is not as competitive these days? I hate it when IMGs turn to psych for that reason...

Yes you did... I'm surprised you remember. It has nothing to do with competitiveness... I just changed my mind after doing my psych rotation and after having some very relevant personal experiences that, as a coincidence, happened at about the same time. Also, I spent some time in the pathology department at my hospital and I wasn't too inspired by it... I always thought pathology was cool in intellectual terms, but the practice isn't as interesting as I'd hoped. Psychiatry was somewhat different - I always thought that it seemed boring based on a lot of misconceptions that I had, but once I cleared up those misconceptions, I was able to make a much better decision.

though i cant think of 2 specialties more dissimilar - one is about dead people and looknig under a microscope the other is about people who don't want to live and excavating the secrets of the soul.

Ha, I think most pathologists might disagree with that characterization of their specialty...

I was particularly intrigued by the intellectual pursuit of both pathology and psychiatry... although admittedly, both fields appealed to different aspects of my personality. I was interested in pathology because it seems to look deeply into every disease process to thoroughly understand what is going wrong. But after gaining some more experience, I decided that psychiatry gives its practitioners a much better opportunity to think critically on a daily basis rather than just following a flowchart or an algorithm.

Honestly, I think it's largely a rule-out sort of thing. For various reasons, I've ruled out internal medicine (unless it's a combined med/psych program), surgery, neurology, dermatology, and most other specialties. I haven't ruled out radiology, ophthalmology, pathology, or psychiatry, so during most of my third year, I was floating between those four options. In the end, doing a psych rotation helped me make a decision, and that's why I decided to do my elective in psych also.

Also - although this wasn't a huge deciding factor, whenever I told my friends/family that I was thinking about going into pathology, they always said something along the lines of "Really? You? That doesn't really seem like a good fit." When I tell people that I've decided on psychiatry, the response is always "Yeah, that sounds like the right field for you."

 

[whopper]

I'm sure there's some way to use a personality test to help someone decide the best field of medicine to enter, but as far as I know no one's researched it yet.

If you like dealing with people I'd say that's a factor for psychiatry vs. pathology. My own perception if pathology is you're pretty much a lab guy. If you find that fun I figure that's one for pathology though I've never worked much in this field other than what medschool required and an internship in college.

The biggest difference I can think of with these two fields is psychiatric diagnosis is based on behavior and observation (most of the time), while pathology is more about seeing things under a microscope.

 

[psychphan]

How competitive is Med/Psych really? Sure there are very few spots, but that's because no one wants them, Last year there were only 60 applicants for the 19 spots, which did not fill btw. I can't find the charting outcomes from past years but I believe in 2010 there were 26 spots and a similar number of applicants. Programs keep cutting out their med/psych residencies because not enough quality applicants want to pursue it. How competitive can it be?

 

[notdeadyet]

How competitive is Med/Psych really?

Competitive, but not as competitive as folks make it out to be.

At the end of the day, there aren't that many programs and they're usually not offered at top programs. I seriously considered going combined and when I asked about this, most folks felt that the combined psych residencies were a solution looking for a problem. With the exception of truly rural practice (as in only practitioner of any stripe for hours), it's hard to make a good case for it. That's why the more reputable programs offering the combined option tend to have a focus on rural medicine.

As for the competitiveness, it lies in the fact that you essentially need to be well ranked by both the medicine/family department AND psych department. Some programs don't fill because they can't find candidates both departments like.

And the biggest filter they look for? To screen out folks who intend to be psychiatrists but just don't want to hang up the stethoscope. Yes, you can do c/l or work inpatient, but lots of folks want to be psychiatrists and not loses the physical medicine focus too. Usually that's just a phase in the solidifying of your intent to be a psychiatrist. But for those who truly want to stay double boarded in both and practice both fields of medicine the rest of their life, there is the combined option.

Have a compelling, well thought out explanation for why you want to do combined, have scores above average for a med and psych applicant at a particular program, and apply widely (I.e.: most programs) and matching is definitely doable...

 

[splik]

that might not seem like much but thats a greater than 3:1 ratio compared to say psychiatry which has a less than 1.3:1 ratio of applicants per place. Sounds competitive to me. Also at some places e.g. Duke the caliber of the med/psych residents far exceeds the categorical psychiatry residents so you could infer that at lwast some of these applicants are more competitive. I expect a number of applicants however are IMGs looking for IM categorical and hedging their bets.

 

[splik]

i think the case for med/psych is it is useful for those wanting to do pain medicine, palliative medicine or geriatric psychiatry or work in a med/psych faculty position. i dont think it would be ideal for consultation-liaison psychiatry actually as psychotherapeutics is an important part and the fat that gets cut in the these programs. it is not much use otherwise of course.

 

[psychphan]

that might not seem like much but thats a greater than 3:1 ratio compared to say psychiatry which has a less than 1.3:1 ratio of applicants per place. Sounds competitive to me. Also at some places e.g. Duke the caliber of the med/psych residents far exceeds the categorical psychiatry residents so you could infer that at lwast some of these applicants are more competitive. I expect a number of applicants however are IMGs looking for IM categorical and hedging their bets.

Yes it's 3:1 but if you look at it the other way, you only have to beat out about 40 people to get a spot. And I believe just a couple years ago it was closer to 2:1, then programs started shutting down for the aforementioned reasons.

Also, categorical psych is much close to 2:1 than 1.3:1. Last year there were 1965 applicants for the 1097 spots.

 

[notdeadyet]

i think the case for med/psych is it is useful for those wanting to do pain medicine, palliative medicine or geriatric psychiatry or work in a med/psych faculty position.

I heard the "work in a med/psych faculty position" a lot talking to folks too. I find it instructive when a program lists as one of its top uses to further the program you're asking the utility of. Kind of like Amway.

Pain, palliative, and Geri are all decent uses (though you dont need a full IM for these). Of course it begs the question if it's worth losing all elective time in which you could get actual training in theses fields.

 

[atsai3]

How competitive is Med/Psych really? Sure there are very few spots, but that's because no one wants them, Last year there were only 60 applicants for the 19 spots, which did not fill btw. I can't find the charting outcomes from past years but I believe in 2010 there were 26 spots and a similar number of applicants. Programs keep cutting out their med/psych residencies because not enough quality applicants want to pursue it. How competitive can it be?

Med/psych is generally less competitive. At most programs, it is harder for them to recruit into the combined program because it is 5 years. They certainly lose a lot of the pre-C/L folks who would rather do 4-year psych residency, 1-2 years of which will be outpatient, followed by 1 year of getting paid as and treated like a fellow (rather than being a med/psych resident for 5 years and likely having to take intermittent ICU call even as a 4th/5th year). Many people think that they have a better shot at landing a med/psych or FP/psych position simply because they think they have a higher endurance for toughing out the extra year (or years, depending on what your ultimate practice goal is). But they generally try hard to weed those people out. Really the only program that has managed to sustain a high caliber of residents (i.e., neither the med/FP nor psych halves have to compromise on quality) is Duke, and they are really vigilant about blocking the folks who are simply trying to backdoor it into Duke med.

 

[billypilgrim37]

Really the only program that has managed to sustain a high caliber of residents (i.e., neither the med/FP nor psych halves have to compromise on quality) is Duke, and they are really vigilant about blocking the folks who are simply trying to backdoor it into Duke med.

I don't know about the IM/psych, but I couldn't disagree more about FM/psych or TB (and come on, Atsai, it's not like I've probably ever disagreed with you on really anything). I know folks at the programs at Cincy, Iowa, Pitt, Davis, Brown, and Kentucky, and those folks are/were dramatically better applicants/residents than their average categorical peers. These folks would have all been at very top psych programs had they gone categorical. Especially the triple boarders, though I would say there's the same trend in fm/psych, though admittedly maybe not AS strong. Most of the triple boarders I know are just plain all stars.

 

[nitemagi]

I don't know about the IM/psych, but I couldn't disagree more about FM/psych or TB (and come on, Atsai, it's not like I've probably ever disagreed with you on really anything). I know folks at the programs at Cincy, Iowa, Pitt, Davis, Brown, and Kentucky, and those folks are/were dramatically better applicants/residents than their average categorical peers. These folks would have all been at very top psych programs had they gone categorical. Especially the triple boarders, though I would say there's the same trend in fm/psych, though admittedly maybe not AS strong. Most of the triple boarders I know are just plain all stars.

Possible this could be institution dependent. There aren't that many FM/Psych or IM/Psych programs. It's a smaller applicant pool for many fewer slots. UCDavis is a big name in addition to Duke. My impression from interviewing back in the day is that the individuals in the programs are outstanding (also in reference to my friends/colleagues in FM/Psych at my former residency), but that on paper they didn't always come from big name schools. They were most definitely outstanding individuals, though. I could make an argument that these are stand out individuals from their respective schools (some lower tier) who self-select for the most ambitious simply by the fact of pursuing double boarding and trying to master two difficult specialties.

 

[atsai3]

I don't know about the IM/psych, but I couldn't disagree more about FM/psych or TB (and come on, Atsai, it's not like I've probably ever disagreed with you on really anything). I know folks at the programs at Cincy, Iowa, Pitt, Davis, Brown, and Kentucky, and those folks are/were dramatically better applicants/residents than their average categorical peers. These folks would have all been at very top psych programs had they gone categorical. Especially the triple boarders, though I would say there's the same trend in fm/psych, though admittedly maybe not AS strong. Most of the triple boarders I know are just plain all stars.

Whoops, forgot about the triple boarders. I agree that they are a special breed.