Surviving in a "program to avoid"?

[psych72]

Hi everyone,

As I am wrapping up my 4th year rotations and looking forward to what awaits me in residency, I am also a bit terrified about what to expect. I've had a wonderful experience with my school's preceptor hospital and the hands on approach I have had. I did have to go a bit further down my rank list at a program that I didn't know a whole lot about and left me a little "uneasy" come interview day, but I am still glad I matched there over some other places. However, I did some digging and my program was listed in a thread called "programs to avoid":

http://forums.studentdoctor.net/threads/programs-to-avoid.888012/

I can't reply to it since its closed, but seeing as though its 2 years old, and a lot of new laws through ACGME have come out regarding patient caps and work hour limitations, are these things still an issue?

Are there still "malignant"/programs to avoid in Psychiatry? Part of the culture of Psychiatrists that appeals to me so much is the wellness/work balance, I practice it regularly and I even try and convey that philosophy to the patients I see in other disciplines. I mean when i think of malignant I honestly think of general surgery where there is so much of a harsh demeanor amongst scrub techs, nurses, etc. I don't mind working hard 55+ hours a week if that means I will be well prepared. But I truly wonder if there are any programs to avoid anymore?

I'd like to think that I'm a pretty friendly person who would blend in well with staff, colleagues, etc. but I am not so good with politics, as I really haven't had to deal with that too much in my rotations, and audition rotations in general.

I know residency is suppose to be a tough experience, and a steep learning curve in terms of patient care/learning medicine, but I just want to be able to make sure I start off on the right foot in terms of navigating my way through a program that may be considered one to avoid/"rough".

I'm all ears for any advice from those who have some experience on this issue.

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[Shikima]

With the direction match is going and the competitive nature;

Any port in a storm.

 

[whopper]

Are there malignant programs out there? I'm sure there are just as I know I've seen some with my own eyes, have friends that have been in some and these people wouldn't lie to me about their experiences, and just knowing too well that human nature allows for this type of thing.

But don't be cynical too soon.
Programs get better or worse over time due to various reasons. E.g. the GME may have clamped down on something bad, the program may have fixed itself, they might've gotten a new PD.

So if you're already matched in a program you believe to be malignant, have some hope. For now all you can do is batten down the hatches since you're obligated to go to the new program.

Almost any program is going to be tough the first year, even the easier ones. So don't go into it already starting to think it's a terrible program. Try to be objective. E.g. The PD-he's tough but is he fair? A tough but fair PD may be a better one to have than one that is too lax.

But if it does turn out to be a nightmare, look into transferring out, or you're just going to have to embrace being an indentured servant as much as you can. Watching Twelve Years a Slave may help you cope cause you'll only be one for 4 years and you won't get literally whipped, but disrespected, controlled by people who don't know what they're doing, and part of a dysfunctional structure, those will be things this movie will give you something to relate.

 

[Dharma]

With the direction match is going and the competitive nature;

Any port in a storm.

Which direction is that?

 

[Shikima]

Getting harder and more competitive.

 

[mdwstresident]

Ha! I love the 12 years a slave analogy. After seeing this movie I told my husband I could relate and he laughed. Truthfully I can relate and I don't think I'm at a malignant program.

 

[Doctor Bagel]

One, that thread is super old and hearsay types of information is always older than that -- it takes a while for gossip, insider knowledge to get out, and by the time it's out, it's often no longer true. Who knows how applicable any of the information in that thread is now? Also, splik was trying to make it interesting, and interesting is often a little more embellished than the truth, right? I'm sure he didn't intend for us to take all the information in that thread literally.

Two, yeah, being in a program is better than not being in a program. Transferring once you're already in is easier than trying to get in if you fail to match or if you leave without another spot. It's that whole it's easier to get a job when you already have a job type of thing.

Regarding malignancy, it's not a black or white type of thing. There are programs that have things that can make some (maybe even most) residents miserable. Most programs suck in some way to most residents.

About being political, the best thing is probably just to keep your mouth shut. Some of us aren't so great at that. Being smooth probably helps, but it's not needed to survive.

 

[whopper]

IMHO is a program is malignant it'll likely stay that way for at least a few years. Program directors don't change hands often. If it's malignant a likely number of checks and balances are not in place that don't fix themselves quickly. That said the thread is not recent and things may have changed.

Something that characterizes a malignant program IMHO is a blatant disregard for residents in respect and education. Respect is a broad definition but I'll further specify it by stating a good program will be within the ACGME definitions of maximum work, (hopefully less than the max), will treat residents with proper decorum (no name calling, screaming, etc), if criticizing residents will do so in the spirit to make them better physicians, avoid being in the legal definition of a hostile work environment, and will grade fairly. It will also not give them impossible tasks.

A good friend of mine was in a program where to stay in the PD demanded he be on paroxetine. In fact the PD prescribed it. That is way over the line in so many ways. My friend didn't even meet the criteria of a disorder where paroxetine would benefit. The PD alleged my friend had ADHD and that the med would help him work faster.

Another person I knew was in a program where almost every single resident was from a third world country. She told me the PD would make the residents work well over the maximum limits stating that "In XXX (his country of origin and the same as most of the other residents), these hours are a joke!" He told the residents if they stayed at work over the maximum they were doing so voluntarily-and they could not report it and thus the program could not be penalized, but if they worked less he would take it as a personal insult to his culture. (I'm not joking).

These are clear examples of a malignant program.

 

[psych72]

Thanks for the feedback, I know its probably old in some respects. I am glad to have a job to pay back my ginormous loans from DO schools like Shokima says, anything is a port in this compettiive season.

Ignorance is bliss i guess, I am hoping to be the best that I can be and hopefully won't have any mean spirits to encounter

 

[Salpingo]

Hi everyone,

As I am wrapping up my 4th year rotations and looking forward to what awaits me in residency, I am also a bit terrified about what to expect. I've had a wonderful experience with my school's preceptor hospital and the hands on approach I have had. I did have to go a bit further down my rank list at a program that I didn't know a whole lot about and left me a little "uneasy" come interview day, but I am still glad I matched there over some other places. However, I did some digging and my program was listed in a thread called "programs to avoid":

http://forums.studentdoctor.net/threads/programs-to-avoid.888012/

I can't reply to it since its closed, but seeing as though its 2 years old, and a lot of new laws through ACGME have come out regarding patient caps and work hour limitations, are these things still an issue?

Are there still "malignant"/programs to avoid in Psychiatry? Part of the culture of Psychiatrists that appeals to me so much is the wellness/work balance, I practice it regularly and I even try and convey that philosophy to the patients I see in other disciplines. I mean when i think of malignant I honestly think of general surgery where there is so much of a harsh demeanor amongst scrub techs, nurses, etc. I don't mind working hard 55+ hours a week if that means I will be well prepared. But I truly wonder if there are any programs to avoid anymore?

I'd like to think that I'm a pretty friendly person who would blend in well with staff, colleagues, etc. but I am not so good with politics, as I really haven't had to deal with that too much in my rotations, and audition rotations in general.

I know residency is suppose to be a tough experience, and a steep learning curve in terms of patient care/learning medicine, but I just want to be able to make sure I start off on the right foot in terms of navigating my way through a program that may be considered one to avoid/"rough".

I'm all ears for any advice from those who have some experience on this issue.

I think residency is like parenthood. You can never really prepare for it, all the things you dread the most are actually pretty tolerable, and the things that end up being the most challenging are totally unanticipated. There are some people that are amazing parents, and others who are questionable, but the vast majority are "good enough" to keep the human race going. Also, you spend a lot of time cleaning up liquids from your clothes that you can barely identify.

Okay, maybe not the best metaphor. Regardless, unless your program is RENOWNED to be a malignant diploma-mill, there's usually a niche for everyone to thrive. Conversely, there's burnout even at the best, cushiest programs. But I would definitely not use that thread as a preparation for the road ahead (there were some stellar programs on it, and the criteria ran the gamut from truly 3rd world-level care to being located in a town with pollution to rejecting splik's application).

 

[psych72]

i closed that thread for a reason. i am not sure if i regret creating it but it clearly has caused some headaches. there was a disclaimer, i wouldn't take it too seriously. there is a difference between a program to avoid and a malignant program. all malignant programs should be avoided, but not all programs to avoid are malignant.

ya I hear ya. Really though, I did have some doubts about the program before ranking, because they didn't have pics or anything about the current residents, nor would they really let us talk to the current residents, but I will be board eligible and it's only 4 years. Just gotta remember to keep my head down and do the best I can. Not going to really go through the whole transferring thing though because, realistically, it's going to be a gamble and let's say your current PD doesn't write a you a glowing LOR because they don't want you to leave, its going to be make things really complicated down the line.

Very lucky to have matched at all, and luckily, I won't be in a place where I'll have to worry about snow!

 

[keifernny2]

All programs have ups and downs. Best thing is to keep your head down, make sure you know how to identify narcissists in power, and don't cross them.

 

[psych72]

All programs have ups and downs. Best thing is to keep your head down, make sure you know how to identify narcissists in power, and don't cross them.

I agree, it's better to just keep quiet and remember that there will be light at the end of this tunnel. That is what kept me going through the first 2 years of med school, gotta expand it to 4 for residency.

 

[psych72]

One, that thread is super old and hearsay types of information is always older than that -- it takes a while for gossip, insider knowledge to get out, and by the time it's out, it's often no longer true. Who knows how applicable any of the information in that thread is now? Also, splik was trying to make it interesting, and interesting is often a little more embellished than the truth, right? I'm sure he didn't intend for us to take all the information in that thread literally.

Two, yeah, being in a program is better than not being in a program. Transferring once you're already in is easier than trying to get in if you fail to match or if you leave without another spot. It's that whole it's easier to get a job when you already have a job type of thing.

Regarding malignancy, it's not a black or white type of thing. There are programs that have things that can make some (maybe even most) residents miserable. Most programs suck in some way to most residents.

About being political, the best thing is probably just to keep your mouth shut. Some of us aren't so great at that. Being smooth probably helps, but it's not needed to survive.

Lets say you are in a program that is very busy and the PD is not keen on letting you go, you would have to seek his/her permission to transfer. There is a lot of risk here. You need to put yourself out there on ERAS or mail out your apps then your current PD would find out. If you don't get in, it kind of puts a bad mark on you in front of your PD because it seems like you don't want to be there in the first place, who knows if they may try to retaliate against you by dimissing you or just making your life miserable.

Transferring is definitely not an approach without significant risks. Also, the whole interviewing process is going to be a whole lot more difficult when you have resident obligations and you actually have work to do. Being a med student, i got a lot of leeway when it came to interviewing.

 

[splik]

seriously, the chances of you having end up at a program where the PD would retaliate against you for transferring out are very, very low. there are probably a few, but none of the 10 on that list (if your program is one of the 10) are such programs. you probably want to have a good reason such as "to be closer to my family" rather than "this program blows" but I think you have let your imagination run away with you. also I do know of some programs where there was some funny business but the PDs were fired and replaced with more reasonable people. It is very, very unusual for program directors in psychiatry to be tyrants and sadists. not saying they don't exist because they do but chances are low. feel free to PM me.

 

[keifernny2]

It's all about your relationship with your PD, and unfortunately, as an intern, they usually don't know you that well yet (and you don't know them that well either).

It's important to find out what the history of the program has been regarding transfers (both in and out), and what your PD's history has been as well. The only people that can tell you this are senior residents (sometimes) and those that actually left the program.

To disagree with the above, a PD doesn't have to be a tyrant or a sadist to not want you to leave their program.

Generally they may just not want to start a trend, and by blocking you , they can hopefully keep everyone else in the program as well.

 

[psych72]

Thanks guys. I 'm going in with an open mind and focusing on the positives.

 

[psych72]

It's all about your relationship with your PD, and unfortunately, as an intern, they usually don't know you that well yet (and you don't know them that well either).

It's important to find out what the history of the program has been regarding transfers (both in and out), and what your PD's history has been as well. The only people that can tell you this are senior residents (sometimes) and those that actually left the program.

To disagree with the above, a PD doesn't have to be a tyrant or a sadist to not want you to leave their program.

Generally they may just not want to start a trend, and by blocking you , they can hopefully keep everyone else in the program as well.

I checked and I think they mentioned it is alright. But I don't know regarding transferring if criteria such as your PRITE performance is also taken into account.

 

[psych72]

To those MS3's or future applicants, make sure you look at the programs website to see if they put pictures or names of current residents a lot of programs to avoid seem to leave this info out. Idk why though

 

[OldPsychDoc]

To those MS3's or future applicants, make sure you look at the programs website to see if they put pictures or names of current applicants, a lot of programs to avoid seem to leave this info out

I presume that you mean "residents"--as no program is likely to be listing all of their applicants online.

 

[psych72]

I presume that you mean "residents"--as no program is likely to be listing all of their applicants online.

Yes thanks I corrected it

 

[peppy]

To those MS3's or future applicants, make sure you look at the programs website to see if they put pictures or names of current residents a lot of programs to avoid seem to leave this info out. Idk why though

The program I graduated from doesn't post their list of residents online, but it is an extremely benign place where nobody gets fired unless they do something completely egregious. I would consider it more of a worrying sign if the program doesn't let you meet a lot of residents when you interview.

 

[psych72]

The program I graduated from doesn't post their list of residents online, but it is an extremely benign place where nobody gets fired unless they do something completely egregious. I would consider it more of a worrying sign if the program doesn't let you meet a lot of residents when you interview.

This. I completely agree with u. A few programs made to a point to not let us meet residents when we interviewed

 

[whopper]

Best thing is to keep your head down, make sure you know how to identify narcissists in power, and don't cross them.

You have the right to survive but as a physician that should be committed to doing your part, at least when you graduate, or are safe in the knowledge you will graduate, bring up issues that should be fixed. At the least write the GME, head of the department, anyone that you believe will listen fairly and if not in the program above the program such as ACGME. If other residents agree with you and identify the same problems have the join your chorus. Being a physician just isn't about surviving till being an attending and then living an easy life. You are supposed to do your part for the community.

 

[MLT2MT2DO]

This. I completely agree with u. A few programs made to a point to not let us meet residents when we interviewed

Holy red flags, Batman!

 

[psych72]

Holy red flags, Batman!

I should clarify, they only had us meet with the chief, but we didn't get lunch or even dinner time to meet residents because they were "busy"...I knew the place had a reputation of being busy though

 

[keifernny2]

When the program asks for interview day feedback, it is a suggestion you may make.

A program that hides its residents from you is probably one you won't enjoy working/learning at.

 

[psych72]

You have the right to survive but as a physician that should be committed to doing your part, at least when you graduate, or are safe in the knowledge you will graduate, bring up issues that should be fixed. At the least write the GME, head of the department, anyone that you believe will listen fairly and if not in the program above the program such as ACGME. If other residents agree with you and identify the same problems have the join your chorus. Being a physician just isn't about surviving till being an attending and then living an easy life. You are supposed to do your part for the community.

The problem is people don't have the guts to bring up the issue or those that have graduated don't want the new residents to get cut any slack. This is a theme that is very prevalent in Medicine. People created such an uproar when 80 hour work weeks were instituted, some genuinely believed it was not right for residents, but others just were bitter because they had been asked to work much harder.

 

[psych72]

When the program asks for interview day feedback, it is a suggestion you may make.

A program that hides its residents from you is probably one you won't enjoy working/learning at.

True but your assuming a program of this nature would care about feedback. I was never asked for feedback on most of my interviews.

At the end of the day, malignant programs that make you work hard definitely exist, even in Psychiatry, but its important to note that you will have a job and be board eligible when the dust settles. It's enduring the 4 years that makes it challenging.

 

[Dharma]

To those MS3's or future applicants, make sure you look at the programs website to see if they put pictures or names of current residents a lot of programs to avoid seem to leave this info out. Idk why though

I was just joking around w a buddy the other day saying that I rule places out based on their crappy websites! I didn't really mean that but a half-@$$ed web page doesn't exactly bring the tingles when it's a first introduction.