What specifically is going on with the match for psychiatry?

[HarryMTieboutMD]

To the original poster: CALM DOWN. First, I don't know why you are trying to predict (read: limit) your step 1 score... study as hard as you can and do your best. Having been on both sides of this I can tell you that the top 3 items on your application that matter far and above ANYTHING else are: where you went to med school, your Step 1 score, and your academic performance (and I doubt this even matters that much unless you are AOA because every school does it differently now, and there is no comparison). Research only trumps the above 3 if it's substantial and significant (eg, you have a PhD, Doris Duke with substantial work, multiple first author pubs, etc). Otherwise it's nice, but several posters and a middle author paper won't get an otherwise middle of the pack US MD grad into MGH or Columbia (though I'm sure there are exceptions). Generally, the top places take the best applicants.

Psych is more competitive because in an absolute sense everything (besides radiology) is more competitive. More US MD schools=more US MD grads vying for a fixed number of residency spots... this is brought up on every SDN forum regarding psych competitiveness. Also, with everyone doing UWorld and memorizing first aid from MS1, step 1 score inflation was a foregone conclusion. Nevertheless, standardized test scores are sexy- if you haven't learned that after the SAT and MCAT, well, then I can't help you. IF you really want to build a research portfolio, no one is stopping you from taking a research ye

As multiple people have said, barring a bunch of red flags, it's a buyer's market.

---

Members don't see this ad.

 

[lockian]

This post brings up some general concerns (that I believe are now quite common amongst those "in the know" about GME), and some personal concerns, from the perspective of medical student. If you notice any misconceptions, incorrect statements or unfounded interpretations, I respectfully welcome you and ask you to shine your light into the matter. I'll give a tiny personal background and then jump into the main theme. Lastly, my goal is not to make anyone anxious. It is to create awareness.

I am an MS2 at a mid-tier U.S. M.D. school. I came to medical school to become a psychiatrist. One of the reasons why I was confident this was a good decision versus getting a PhD in Psych was how seemingly uncompetitive and guaranteed psych seemed. And I value a psychiatrist's job description more. I've tried, but I can't see myself being nearly as happy long-term in another specialty or a job outside of medicine. I have done well academically and will probably have ~225-239 for Step 1, and it will be obvious based on my CV that I was strongly committed to psych starting year 1. My kryptonite has been research. The field and process of research have crushed me and put me in my place thus far. The fruitlessness of my long-term (since summer before MS2) research efforts has been disheartening. I have grown from these challenges, but it doesn't change the fact that I am not yet published in any sense. In 2014, the average research # of abstracts/posters/pubs was 3.8. I have 0. Luckily the distribution shown was bimodal (i.e. many with 0, many with 5+). Other than research, I see myself being solid in most other facets.

It's just my luck (and many other's luck) that psychiatry as a specialty is going through such a rapid and unexpected change over such a short period of time. There are so many variables involved in this I sense, that nobody is clearly saying/or can clearly say what the reality is and what its consequences are for future applicants. The only people who talk about the increased #'s of U.S. M.D.'s applying and matching and apparent increased competitiveness (whether it is due to genuine passion or Psych as 2nd choice to ROADS) as if it's a good thing are those who are already comfortably in the field. From my perspective, it has me a bit scared, and it doesn't help that "something" about getting into psychiatry is changing so fast that there isn't enough time to accurately draw conclusions and make changes in my extracurriculars, research, study habits, etc. (if necessary) before it's time for me to apply for residency. I'm concerned that from starting medical school in 2014 to finishing in 2018, that psych will go from being competitively on par with family medicine to being equal with surgery by the time I apply. It feels surreal that it may be changing in ways that would have once been thought to be unlikely by most. In 2013, saying that this evolution could happen in the next 2 years, between 2014-2016, would have drawn chuckles.

I knew psych was growing more attractive, but in TWO years, 10% more of the total psych spots are being consumed by U.S. M.D.'s. From 2014 to 2016, we have gone from 51% of total matches being U.S. M.D. to 61% of the matches being U.S. M.D. It also happens to be that, on average, the #1 hallmark of a competitiveness is the exclusivity to U.S. M.D. students. With this trend, we'll be at 71% by 2018.

I have been following the NRMP's data and SDN's forums regarding the match this year, and it seems this year once again continued this increasingly competitive trend. For example, in 2016, roughly 61.4% of all medical students matching into psychiatry were U.S. M.D. students, compared to 2015 which was 57.2%, compared to 2014, which was 51.8%. The total absolute # of U.S. M.D. Students matching in 2016 went up by ~80 compared to 2015 and is up by ~170 since 2014. The total increase and psych residency spots across the country was ~30 from 2015-2016, which does not fully account for the ~80 total increased U.S. M.D. students that matched this match. Lastly, there were ~200 more TOTAL U.S. M.D seniors involved in the whole match compared to last year, which also doesn't fully account for the ~80 total increased U.S. M.D. students matching this year. Heck, from 2014 to 2015 unmatched U.S. M.D. rates went from ~3% to ~6%. NRMP hasn't said what it was for 2016, yet. And I don't know anything about how the average individual applicant's stats (e.g., step scores and research) has been changing since 2014's Charting Outcomes.

Can we have a frank discussion about what is specifically going on? If it's not just 1 thing, then what are the multiple powerful variables at work? What does it mean? Why? Is this trend likely to plateau anytime soon or regress (like it did from 2012-2014 w/ 55% to 51% U.S. M.D. match %)? What does a medical student need to do differently in today's medical education system if they are hellbent on matching somewhere decent in psychiatry? I would love to hear perspectives from people different than myself. The facetious old adage of "Got a pulse? No red flags? Then welcome to psychiatry!" seems like a sentiment that may no longer apply.

I believe that what you're seeing on this forum may be skewed. This is just my casual observation, but it seems that the distribution of people on this forum is bimodal: there's those struggling with red flags looking for advice, and superstars anxious whether they'll match into Longwood or Stanford. In the real world, there are a lot of people in between (hello! *waves*). Also keep in mind that "matching someplace decent" has a much more varied meaning in psychiatry. The patient population you'll get to see is vitally important, and may even eclipse the prestige factor. As someone else said on these forums, the mark of a true psychiatrist is to be able to fix things when all parts of the biopsychosocial axis are going to hell, so when you look for a program, a varied and high-acuity population is key. There are also a lot of very underrated programs that aren't often discussed on these forums.

Some things that may indeed be going on with the field:
1) Yes, more people are entering psychiatry because it is a "lifestyle" specialty, there's a well-known demand for it that will enable you to go almost anywhere you want once you graduate (not so for other lifestyle specialties)
2) There are still a lot more psychiatry spots than there are US seniors going into the field. That's huge. You may have to apply to more programs, and it'll be harder to "suicide match" -- yes, I've met psychiatry residents who's ranked <5 programs or even just one midtier academic place and were just fine... that may have to end. But unless you shoot too high and don't have a good balance of "reasonable," "safety," and "reach" programs, I would be extremely shocked if you don't match somewhere that'll set you up for success down the line.
3) The change that psychiatry is experiencing still has a ceiling. There's no way of knowing where that ceiling is until we get to it, but it exists and it's probably lower than you think. Due to decreasing stigma, we're getting more people who may have otherwise gone into FM, IM, or pediatrics, along with more neuroscience PhD's due to the increasing biologic focus of the field, but psychiatry is still too different from every other specialty and is protected in that regard. I also think the only way it can become general surgery is if gen-surg's popularity drops because, let's face it... gen surg is a brutal.

Finally, take a deep breath and put aside the frantic number crunching. If you are truly passionate about psychiatry and came to med school to be a psychiatrist, this will show in many aspects of you application, from your PS, to LORs, to interview performance. I'm a big believer in the intangibles and true passion for a field, as it's helped me distinguish myself despite imperfect stats.

Also... psssst: Have you done any research prior to medical school? It counts! *waves arms* Everything counts! It doesn't matter if you haven't published or if it hasn't gone anywhere! Put it down anyway. (Case in point, my official research experience list is 7 items long, but there's only one bonafide publication... you've got to realize that people pad like CRAZY for the purposes of NRPM and ERAS stats). You can talk about the frustrations of not getting publishable data as a learning experience on interviews. Or take a year off for research between M3 and M4 if you really want to.

 

[scudiera]

^+1 to the research prior to medical school. Did nothing the past 4 years, happened to do some stuff w/ the NIMH that was Psych related yeaaaaaaaars ago and it still came up during interviews.

Also, I think point 3 is very true.

I think the thing that irks me about this thread is the vibe some people give off... I don't want my co-residents to be people who see Psych as a refuge of last resort or who begrudge people like myself who came to the field late because they realized it's what they truly liked. I hear "Gone are the days when you could fall backward into a decent residency spot, boo hoo" and think: "Well, good." If you're average or below average, it's going to be hard for you. The Psych match is not competitive, but nothing is owed to you because you liked the field for longer or really really want it. Numbers and academic performance ought to and do matter.

 

[clausewitz2]

^+1 to the research prior to medical school. Did nothing the past 4 years, happened to do some stuff w/ the NIMH that was Psych related yeaaaaaaaars ago and it still came up during interviews.

Also, I think point 3 is very true.

I think the thing that irks me about this thread is the vibe some people give off... I don't want my co-residents to be people who see Psych as a refuge of last resort or who begrudge people like myself who came to the field late because they realized it's what they truly liked. I hear "Gone are the days when you could fall backward into a decent residency spot, boo hoo" and think: "Well, good." If you're average or below average, it's going to be hard for you. The Psych match is not competitive, but nothing is owed to you because you liked the field for longer or really really want it. Numbers and academic performance ought to and do matter.

Part of it may be a belief that it is a richer field if there is more room for people whose primary strengths are not test-taking or brute-force memorization. I accept the reality that numbers will probably always matter, but do you really think Step 1 scores are at all predictive of clinician quality in this field?

 

[MacDonaldTriad]

http://leeds-faculty.colorado.edu/Rosse/Research/resident performance.pdf

It seems that the entire application process is a waste of time.

 

[scudiera]

@clausewitz2 Unlikely to be predictive of task-oriented performance but may still be an indicator of overall awareness of the patient's health as a whole and problem recognition/initial management (unlikely). Fortunately Psych is self-selective for people who can handle the unique type of work we're so fortunate to be able to do. I personally do not hope (nor do I ever believe it will) reach "popular" levels of competitiveness because I like the way PDs seem to be handling the interview process. The field is definitely richer for the varied experiences people bring to it, I think there's a lot more direct influence of our personal life on our research interest/scope of practice (ie. LGBT, cultural, professional psych, etc.) than in probably any other specialty. I'd hate for this to lose out to less passionate/diverse but academically "better" people on the whole.

Honestly, ultimately I trust that the PDs know what they're doing. Most resident classes I met on the trail seemed cohesive and fit in the vision of their program (all big academic center programs), the residents were bright and motivated, and I thought generally gave a really positive impression of the field. There's always numbers creep, and you have got to keep up - just like you ought to keep up with CME - but the PDs fortunately seem to know better than me what makes a good resident/clinician and interview broadly to seek such people out.

 

[W19]

It won't be self-selective if there is an increased in salary and lifestyle and job market are still good... Look what is happening to EM! Competition is going thru the roof by the year. It seems like med students are becoming more practical. I truly hope psych PD will be able to sniffle the BS and select people who genuinely want to become psychiatrists.

 

[Dharma]

It won't be self-selective if there is an increased in salary and lifestyle and job market are still good... Look what is happening to EM! Competition is going thru the roof by the year. It seem like med student are becoming more practical. I truly hope psych PD will be able to sniffle the BS and select people who genuinely want to become psychiatrists.

I think that due to the nature of psychiatry, those driven primarily by motivations of lifestyle and job market will find themselves truly miserable, burning out early, and running for the hills. It's a nice fail-safe.

 

[scudiera]

LOL EM can make an easy 350k, it's very medical, very procedural, no follow-ups, and it's shift-work, and it's also a 3-year residency. It's pretty awesome if you aren't interested in continuity of care. Of course it's competitive. Psych is none of those. Please don't think Psych is ever going to get there. It's a great field and I'm excited to be starting residency but let's be real. If you're that worried, just strengthen your application or apply more broadly.

 

[W19]

What would you guys/gals recommend for someone who scores <21o in step1?

 

[scudiera]

Wreck step 2 and apply broadly.

 

[W19]

LOL EM can make an easy 350k, it's very medical, very procedural, no follow-ups, and it's shift-work, and it's also a 3-year residency. It's pretty awesome if you aren't interested in continuity of care. Of course it's competitive. Psych is none of those. Please don't think Psych is ever going to get there. It's a great field and I'm excited to be starting residency but let's be real. If you're that worried, just strengthen your application or apply more broadly.

My point exactly!

 

[darkhope]

What would you guys/gals recommend for someone who scores <21o in step1?

Are you DO/IMG? If not, and you passed, I wouldn't worry that much. Relax

 

[FlowRate]

What would you guys/gals recommend for someone who scores <21o in step1?

Study hard for your shelf exams. Do better on Step 2.

 

[lockian]

Part of it may be a belief that it is a richer field if there is more room for people whose primary strengths are not test-taking or brute-force memorization. I accept the reality that numbers will probably always matter, but do you really think Step 1 scores are at all predictive of clinician quality in this field?

Feel free to throw shoes at me, but I don't think Step 1 scores are predictive of clinician quality in ANY field. Honestly, internists probably have to know the most step-type material because they see the biggest variety and have to think most broadly, but ironically scores in that field are average. Step 2 scores are probably more of a predictor, along with clinical grades.

 

[clausewitz2]

Feel free to throw shoes at me, but I don't think Step 1 scores are predictive of clinician quality in ANY field. Honestly, internists probably have to know the most step-type material because they see the biggest variety and have to think most broadly, but ironically scores in that field are average. Step 2 scores are probably more of a predictor, along with clinical grades.

Average Step 1 scores now mostly track money if we are comparing specialties.

 

[lockian]

LOL EM can make an easy 350k, it's very medical, very procedural, no follow-ups, and it's shift-work, and it's also a 3-year residency. It's pretty awesome if you aren't interested in continuity of care. Of course it's competitive. Psych is none of those. Please don't think Psych is ever going to get there. It's a great field and I'm excited to be starting residency but let's be real. If you're that worried, just strengthen your application or apply more broadly.

This is off topic, but see, the lack of follow up is exactly what would make EM unsatisfying to me personally. Unless you consider caring for "frequent flyers" follow up.

 

[technopoly]

Average Step 1 scores now mostly track money if we are comparing specialties.

This.

 

[image187]

whoa, take an ativan man!


Sent from my iPhone using SDN mobile

 

[W19]

Are you DO/IMG? If not, and you passed, I wouldn't worry that much. Relax

US MD... It was a hypothetical step1 score. I have not taken it yet!

 

[sunshine1160]

Is the field becoming increasingly more difficult for DOs? I'm a DO very interested in psych, top quarter of my class, and thought continuing this trend and doing at least average on boards would mean a match. I hate to add to the tension in this thread, but should average DOs start worrying about matching psych?

From what I have been told, if you are a DO, even with just COMLEX, and your language/communication skills are ok, there are certain places you can match for sure (where they primarily get FMG's who don't have good language skills).

 

[Leo Aquarius]

LOL EM can make an easy 350k, it's very medical, very procedural, no follow-ups, and it's shift-work, and it's also a 3-year residency. It's pretty awesome if you aren't interested in continuity of care. Of course it's competitive. Psych is none of those. Please don't think Psych is ever going to get there. It's a great field and I'm excited to be starting residency but let's be real. If you're that worried, just strengthen your application or apply more broadly.

This is what makes EM absolutely terrible. I served my EM rotations in residency and med school and hated, yes hated, the shift work sleep disorder that turned my mind into mush and mood into awkward depression that took 2 days to resolve.

They can have their EM jobs. I'll take my psychiatry/pain medicine. That's true shift work. 8am to 5pm every day. Work stays at the office.

 

[Extralong]

LOL EM can make an easy 350k, it's very medical, very procedural, no follow-ups, and it's shift-work, and it's also a 3-year residency. It's pretty awesome if you aren't interested in continuity of care. Of course it's competitive. Psych is none of those. Please don't think Psych is ever going to get there. It's a great field and I'm excited to be starting residency but let's be real. If you're that worried, just strengthen your application or apply more broadly.

This is why psychiatry is off-putting to some, because they hear/see statements about how extravagant other specialties are, the amazing salaries that come out of those specialties, and so forth, followed by "Psych is none of those," "please don't think Psych is ever going to get there."
When I hear non-sense like that, I like to point out that I disagree. (EM psychiatry, sleep medicine, Forensics, pain medicine all have what you want).

Furthermore, I believe that it would be prudent to listen to the discussions earlier on this thread from senior members that have been out in practice, are in academic settings, are program directors that all have/had experience in seeing a trends in applicants, their residents, and fellows. All in all, I don't believe the above quote is accurate at all, but rather an inflexible pessimistic view.

 

[yanks26dmb]

This is why psychiatry is off-putting to some, because they hear/see statements about how extravagant other specialties are, the amazing salaries that come out of those specialties, and so forth, followed by "Psych is none of those," "please don't think Psych is ever going to get there."
When I hear non-sense like that, I like to point out that I disagree. (EM psychiatry, sleep medicine, Forensics, pain medicine all have what you want).

Furthermore, I believe that it would be prudent to listen to the discussions earlier on this thread from senior members that have been out in practice, are in academic settings, are program directors that all have/had experience in seeing a trends in applicants, their residents, and fellows. All in all, I don't believe the above quote is accurate at all, but rather an inflexible pessimistic view.

I actually enjoy the shift work that EM offers...as well as the, "work more, make more" aspect of the field.

I've been told psych CAN be a lot like this, given the extreme shortage of psychiatrists. I'm torn about which field to enter, but I really do enjoy what I've heard/read about psych to this point. Is it difficult finding shift style work (in the ER perhaps, as you mentioned) that would afford a similar life/work-style as EM?

 

[notdeadyet]

Is it difficult finding shift style work (in the ER perhaps, as you mentioned) that would afford a similar life/work-style as EM?

Look at consult, inpatient, or many hospital jobs in general. There's plenty.

 

[yanks26dmb]

Look at consult, inpatient, or many hospital jobs in general. There's plenty.

Gotcha - thanks for the info.

Though, I'm assuming the hourly rate is still far below EM..?

 

[notdeadyet]

Yes.

Folks may opine that psychiatrists can out earn EM docs through cash only private practice, forensics, etc.

But for shift work, hour for hour, EM docs will be below our own. "Far" is a matter of perspective and taste. Most HOSPITAL inpatient, consult, and PES work I've seen is about $170-200k starting. YMMV.


Sent from my iPhone using Tapatalk

 

[notdeadyet]

One thing to throw out there about EM is that I would be surprised if there wasn't a readjustment pretty soon. Hear me out.

There are a LOT of EM programs churning out a LOT of EM docs. It works now, because many Emergency rooms are staffed by family and internists out in the sticks.

But that is changing and as that conversion happens and EM docs occupy all the EM jobs, things will get more competitive and I wouldn't be surprised if there wasn't a readjustment in salary or at least a shortage of freedom of job/geography choice. EM docs have nowhere to go outside of emergency rooms that pay as well. They can do doc in a box, but the pay sucks. They can't really open up a practice (nor would they want to).

One of the beauties of psych is t just the nice hourly compensation we receive, but also the wide variety of types of jobs and the huge demand.

And the latter is t going anywhere. Look at the age breakdown of psychiatrists and you'll see we skew old. So there is huge growth just to KEEP the current number of psychiatrists and even that number is much less than need.

Will we saturate? Maybe. But we are looking at that happening in psych in another 30 years, if at all. EM is looking at that potentially starting to happen in 10 or so.


Sent from my iPhone using Tapatalk

 

[lockian]

This is what makes EM absolutely terrible. I served my EM rotations in residency and med school and hated, yes hated, the shift work sleep disorder that turned my mind into mush and mood into awkward depression that took 2 days to resolve.

They can have their EM jobs. I'll take my psychiatry/pain medicine. That's true shift work. 8am to 5pm every day. Work stays at the office.

Disturbingly, more people in my class have gone into EM than into IM this year... I'm also coming off a night float rotation and re: sleep cycle disorder... the struggle is real. My stepdad is a nocturnist, too, and I don't know how he lives.

 

[Blitz2006]

This is why psychiatry is off-putting to some, because they hear/see statements about how extravagant other specialties are, the amazing salaries that come out of those specialties, and so forth, followed by "Psych is none of those," "please don't think Psych is ever going to get there."
When I hear non-sense like that, I like to point out that I disagree. (EM psychiatry, sleep medicine, Forensics, pain medicine all have what you want).

Furthermore, I believe that it would be prudent to listen to the discussions earlier on this thread from senior members that have been out in practice, are in academic settings, are program directors that all have/had experience in seeing a trends in applicants, their residents, and fellows. All in all, I don't believe the above quote is accurate at all, but rather an inflexible pessimistic view.

Agree totally with above.

I mean MUSC started an Interventional Psych fellowship, training you in procedures like ECT/DBS/rTMS/VNS/tDCS. Sure, most will argue this is a waste of a year, but the point is there are procedures for psychiatrists as well. I agree that DBS is still many years away from becoming mainstream. And TMS is really not convincing with the present data, but there is scope. Plus stuff like IV Ketamine.

But yeah, you can always do Sleep or Pain if you really want to do "real" procedures. Mix it up with some suboxone and methadone clinic. Do an ER Psych shift, or work in a jail. So much variety in psych.

Burn out? Then switch into full time pp and create your own hours.

ER seems more restricted to me. Apart from working an urgent care, pretty much stuck in ER...

I know a guy who works at NYU. ER attending. 3 shifts a week, 230k. Moonlights in a Bronx hospital for $185/hr. Speaking to ER friends, avg. Salary for them in NYC area is 250k.

So ER guys maybe make 350k in the Midwest, but ive seen psych offers on Merritt Hawkins in the Midwest for 320-350k.

So I'm not convinced that ER guys make more than psych. People don't go into ER for $, they go into it for the 3 day weeks.

But personally, I like being an expert on a subject.

Just my 2 cents,

 

[Blitz2006]

One thing to throw out there about EM is that I would be surprised if there wasn't a readjustment pretty soon. Hear me out.

There are a LOT of EM programs churning out a LOT of EM docs. It works now, because many Emergency rooms are staffed by family and internists out in the sticks.

But that is changing and as that conversion happens and EM docs occupy all the EM jobs, things will get more competitive and I wouldn't be surprised if there wasn't a readjustment in salary or at least a shortage of freedom of job/geography choice. EM docs have nowhere to go outside of emergency rooms that pay as well. They can do doc in a box, but the pay sucks. They can't really open up a practice (nor would they want to).

One of the beauties of psych is t just the nice hourly compensation we receive, but also the wide variety of types of jobs and the huge demand.

And the latter is t going anywhere. Look at the age breakdown of psychiatrists and you'll see we skew old. So there is huge growth just to KEEP the current number of psychiatrists and even that number is much less than need.

Will we saturate? Maybe. But we are looking at that happening in psych in another 30 years, if at all. EM is looking at that potentially starting to happen in 10 or so.


Sent from my iPhone using Tapatalk

Well said. ER may become the next Radiology at this rate...

 

[lockian]

I just don't like EM from a moral standpoint because it's capitalizing on the fact that the healthcare system is broken. ERs get as much traffic as they do (creating the ER docs' salaries in this way) because people can't get in to see their PCPs or don't have other access to healthcare. My s/o once aptly described the ER is the dumpster of medicine. So many things they see aren't true emergencies, or wouldn't be if there was a proper amount of FM and IM docs... and, tbh, psychiatrists too.

 

[lockian]

Also, this may just be my stupid opinion, but psychiatrists have to deal with things you can't pay some people enough to do. It's the specialty where you're most likely to get physically attacked, get feces thrown at you, not to mention shovel psychosocial **** every day and climb the highest of communication barriers.

 

[notdeadyet]

psychiatrists have to deal with things you can't pay some people enough to do. It's the specialty where you're most likely to get physically attacked, get feces thrown at you, not to mention shovel psychosocial **** every day

No, that would be Emergency Medicine.

And the data supports at least some of this. Definitely the attacked part, there have been studies. Haven't seen a feces throwing study, but this rarely happens in psych outside of PES (or board meetings, from how they're described).

I have great affection/respect for our EM breathen. They put up with a lot more acutely dangerous craziness than the big majority of we psychiatrists.


Sent from my iPhone using Tapatalk

 

[Leo Aquarius]

Psychiatrists retire because they want to, not because they have to.

 

[lockian]

No, that would be Emergency Medicine.

And the data supports at least some of this. Definitely the attacked part, there have been studies. Haven't seen a feces throwing study, but this rarely happens in psych outside of PES (or board meetings, from how they're described).

I have great affection/respect for our EM breathen. They put up with a lot more acutely dangerous craziness than the big majority of we psychiatrists.


Sent from my iPhone using Tapatalk

Wow, interesting that there's actually research on this. Of course, the amount of dangerous craziness likely varies with the psychiatry practice you have. A stable outpatient population will have much less, but if you take a high-acuity or forensics unit...

 

[notdeadyet]

True. But most of the wild and woolly ones that come in to psych emergency are already in handcuffs. The folks who are truly acute rarely present themselves to emergency psychiatry. And the forensic ones are already incarcerated.

In the emergency department, you get the wild and woolly ones walking in off the street, and they are usually bleeding and not happy about it!

EDs are kind of special that way. And one of the reasons I think EM docs are prone to assault is that they still deal with mostly folks who aren't mentally ill, so they don't have a permanent protective guard up from dealing with a more "exclusive" population like we do in PES. I typically feel a lot safer in PES and forensic units than I do in a lot of office based practices because of it.

 

[zyxab]

As a PD and getting up in the years, I just want to emphasize

1) Don't get freaked. Good people easily get into psychiatry.
2) These things go in cycles. Yes, psych is going up but we have been here before. While it would be great that we stay up, more likely than not we will go down again. We have had more US graduating MD seniors in the past. According to my numbers in the last two decades about 50% of the time we have been above the 60% US senior level. The maximum was 66.4% in 2005. The absolute lowest was just in 2014 - 51.8%. In my mind not until we consistently get above the 2005 mark can we state that things are different now (and above the pattern of the past 20 years).

The anxious posters in this thread should probably be paying more attention to this post. Psychattending just told you everything you need to know.

 

[Gavanshir]

PS: Don't compare with GS. Academic Gensurg is very competitive. Don't compare with or consider an IM backup, academic IM is insane. Psych is not going to get the sort of rise EM got in the past 3 years where I won't be surprised if the 2016 average step score is closer to surgical subspecialties.

I don't believe EM was that competitive this year. SGU had a high number of EM matches, 41 this year and 37 last year.

 

[FlowRate]

I don't believe EM was that competitive this year. SGU had a high number of EM matches, 41 this year and 37 last year.

EM, like all mid-tier and lower specialties, has a wide spread--if you absolutely must do EM, it's very possible to match somewhere, but it won't be the place everyone wants to go. (Perhaps save any significant red flags.)

 

[VMSmith]

You don't need research or high Step 1 scores to match at a good or even great residency in psychiatry. The most competitive programs will be difficult to match or get interviews. Because they are competitive and considered "top" programs, they get to decide who the interview and rank out of pretty much the entire applicant pool. So, if you don't have something that makes you stand out you'll have a difficult time if your goal is to train at one of those programs.

But what is considered "top" and competitive does not necessarily mean the best. They're only the best if the things that you're looking to do in your career match up with the advantages that training at one of those programs can give you. If you know that you are not really a researcher, shooting for a research-heavy residency just because it's "a top program" doesn't really make sense. If you want to settle down, live and set up a private practice in the Midwest, then shooting for a "top" residency at a prestigious academic institution in Boston doesn't really make sense.

The anxiety you see among people in SDN in this forum tends to be either very competitive candidates who are shooting for a "top" residency for whatever reason, and people with red flags who want to match anywhere. None of the people posting in this thread so far (an MS2 who seems to be doing well academically at a mid-tier school, and an MS1 or 2 at a low-tier US allopathic school who is just passing preclinicals) necessarily matches either of those groups. As MS2s all you need to do is not fail your classes and not bomb Step 1. If you can do those two things then you'll match at a good program for psychiatry, as long as you do fairly well in your clinical years.