Low key Psychiatry residency Gems...

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carlosc1dbz

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Hello,

I was thinking of adding a few more programs to my application list. Everyone knows, more or less, where the "big name" programs are, but I'm looking for some great programs that are not as nationally recognized. Can anybody let me know about strong programs that are not listed on US News and report, that have really happy residents because of their great working environment, great attending and great preparation? I know there has to be programs like this out there.

Thanks!
 
I don't know how much this guy is being utilized. The former program director of my general residency program consistently won awards for being a top doctor in the state for psychiatry and was one of the best teachers I've ever had. Despite that I graduated from a small program, his participation in it as a PD thrust this program, IMHO, to one of the best programs in the tri-state area despite that it was not a program with a recognizable name.

After he left, well a lot of that quality went with him. I don't know how my alma mater's doing now, but I can say that the former PD would truly elevate whatever program he's at.

He's currently at U. of New Mexico. I'm going to keep mum on his name because I don't know how he'd feel about me broadcasting it. I don't know how much participation he has in training residents there.
 
Funny you should mention. UNM is consistently considered a diamond in the rough. Many big name academics move there to retire but keep teaching, such as Yager. Nice program. Have some friends that went there.
 
One person can make a huge difference to a program, especially if that person is effective and central enough so that she or he impacts on the rest of the faculty as well as on the trainees. Going to a place because of one person is, however, potentially problematic since that person can leave, get reassigned, or even turn out not be as great as you thought.
 
UC Davis is well known and in a great location, but it might be seen as a diamond in the rough compared to its better-known neighbors in SF and Palo Alto. It also fits some of your criteria for being a very well-run place with a strong and organized chair. I know less about U of Maryland, but it seems to me that it might be a program that offers excellence in the shadow of its more famous neighbor in Baltimore.
 
Look into Iowa and South Dakota. I remember seeing things I liked about the programs.
 
Yeah well in some of my old posts when was I still in residency, I touted my old program mostly because of that attending I mentioned. Trust me, after he left, a lot of things weren't as good.

I haven't kept up with him, but if this guy has any participation with residents, I'd definitely consider UNM a few notches higher. I checked out his profile on UNM's residency website and they did say one of his interests is teaching so I'm sure he is teaching at the residency. I'd place that guy higher in teaching than some doctors I knew that were nationally recognized. As I said in other threads, a doctor could be one of the best in the field at what he does but that doctor might not be able to teach for squat.

Teaching is a combination of knowledge x ability to teach x ability to listen. If one of those factors is zero, the teaching experience is still zero.

I know of a few doctors that are literally considered some of the best in the field and I would never want to work with them.
 
UNM and UC Davis are both programs that would be considered first tier on anyone's list if they weren't located in Albuquerque and Sacramento.

And if you like one, you'll like the other. Very similar personalities (extremely approachable faculty, devotion to the underserved, diversity of populations, and strong leadership).
 
UNM and UC Davis are both programs that would be considered first tier on anyone's list if they weren't located in Albuquerque and Sacramento.

And if you like one, you'll like the other. Very similar personalities (extremely approachable faculty, devotion to the underserved, diversity of populations, and strong leadership).

I agree. I really liked both programs when I interviewed at them two years ago. UC Davis also has, I believe, a somewhat lighter call schedule, which has some value, imo. Both appeared to have really involved chairs, which is a plus. The UC Davis guy even gives you free books!
 
I don't know much of the general psychiatry residency program at UC Davis, but Charles Scott, the PD of the forensic psychiatry fellowship is one of the best in the country, and he is a fantastic teacher. That, however, doesn't necessarily mean the general psychiatry program is good.
 
I don't know how much this guy is being utilized. The former program director of my general residency program consistently won awards for being a top doctor in the state for psychiatry and was one of the best teachers I've ever had. Despite that I graduated from a small program, his participation in it as a PD thrust this program, IMHO, to one of the best programs in the tri-state area despite that it was not a program with a recognizable name.

After he left, well a lot of that quality went with him. I don't know how my alma mater's doing now, but I can say that the former PD would truly elevate whatever program he's at.

He's currently at U. of New Mexico. I'm going to keep mum on his name because I don't know how he'd feel about me broadcasting it. I don't know how much participation he has in training residents there.

Thank you everyone for your input. This is wonderful information. My friend just interviewed at UNM for another residency and said the place was amazing and that everyone seemed so happy. This was for Peds.
 
I agree. I really liked both programs when I interviewed at them two years ago. UC Davis also has, I believe, a somewhat lighter call schedule, which has some value, imo. Both appeared to have really involved chairs, which is a plus.
One thing that was interesting (and coincidental, as call schedule was pretty low on my priority list) is U.C. Davis has a very light call schedule that they were committed to keeping as part of their work-balance philosophy and the PD at UNM stated bluntly to residents that in the reworking of call schedule to meet new requirements, residents would not have to take more call (they planned on paying moonlighting or hiring per diem). And he put that in writing.

I don't think lighter call is necessarily a great yardstick for the quality of a given program, but I do think that how a program views the importance of resident-wellness and response to resident needs is a vital (and sometimes tough to judge) component.
 
Agree. I do believe residents need to work hard, but not 120 hours a week-hard. I'm talking more along the lines of when they do work, they work extremely well, don't cut corners, and take it upon themselves to read up on things they need to learn more. They also must be given time to study for USMLE III if they haven't taken it yet. Doing that even on an 80/hour a week schedule is inhuman.

In all honesty, I do think residents should do all-nighter calls, but on the order of simply just learning about what it's like and to get into that mindset. How long will that take? Perhaps just a few weeks to a few months tops. After that the learning benefit peaks, and then it just becomes sadistic torture. Of course an institution may require it for appropriate reasons such as providing needed services, but to do so only to make residents suffer is way overkill.
 
I've read on the boards before that USC (that's South Carolina)-Columbia and San Mateo have very little/no call. But I don't know this for sure.
 
I don't think lighter call is necessarily a great yardstick for the quality of a given program, but I do think that how a program views the importance of resident-wellness and response to resident needs is a vital (and sometimes tough to judge) component.

Workload is an interesting tension from a faculty perspective. On the one hand, we like to encourage wellness, including the development of a healthy balance between work and non-work. At the same time, there are real-world people to care for, and residents are one way to get the work done. And at the same time, faculty are ambivalent about setting up the last formal training experience to be, well, too easy. I think we realize that psychiatry residency is emotionally difficult, but it's pretty easy to compare the hours of our residents to, say, surgeons, and perceive that psych residents tend not to work as hard. Further, there is a lot to learn, and paring back on work hours does diminish the amount of patient care the resident will ever get supervised on.

And patient hours are reduced not just to let residents get home early or take less call. Whenever a program allows for elective or research time, fewer patients will be seen. This means that department resources/money will get diverted from other areas (faculty, perhaps, or infrastructure) in order to pay the moonlighters who are covering responsibilities that had been covered by residents. And it means that residents may (MAY) get less solid training.

One important reason programs diminish schedules is out of generosity and a spirit of holistic wellness. Another, separate, reason is that the overt reduction in hours is a blatant recruiting tool. That is one reason that "hidden gems" are likely to mandate fewer training hours: they recognize that they are a bit hidden and want to ratchet up their place in the selectivity hierarchy. The alternative is to be seen as a sweatshop and gradually recruit badly. The only other way out of the dilemma is to be the PD at one of the 5 or 7 most selective residencies (we can argue which programs are the best and the best fit, etc, but the most highly selective programs know exactly who their competition is just by looking at the match results); these programs remain highly selective partly because of geography (NYC, SF, or Boston, anyone?) but also because those same geographical biases are shared by faculty so that these programs tend to have very deep faculty benches--and, at least in NYC, there are lots of affluent people who want to see MD therapists and pay top dollar, which allows the faculty to compensate for base salaries that are less than what they'd get in private practice and often less than what they'd get at the less prestigious places down the street or across the country. And the PD's at these most selective places are under much less pressure to reduce workload since, well, they keep getting great residents, and they do generally believe that people get better training when they get more training.

So, as chair, you have a bunch of competing (and diverse) subgroups--residents, faculty, infrastructure, deans, administrators--all of whom need to be made reasonably happy. And even if the PD decides she/he wants to reduce the workload, PD's tend not to have the actual power to make that decision. It has to be a department or institutional decision since it means less work will get done, fewer patients will be billed, and something else will get reduced. It's a zero-sum game, and resident happiness is but one variable in the puzzle.
 
Call, ugh. I'm at a relatively call heavy program, although our schedule is much better this year. There is some educational value, certainly, but I agree with whopper -- it dies off after you've done 20 or so overnight calls. Last year, I missed about a third of didactics in one psychiatry block because of call, and now I'm missing several weeks of didactics because of night float. I get that this stuff needs to be covered, but honestly, it's about service, not education. Once you've admitted 50 drunk folks in the ED at 3 am, I think you're good.

Also, I can get all judgmental about myself here, but the more I work doing these service types of things, the less I read, which impacts my education. For me, choosing a program with a lot of call was probably an educational negative. Fortunately, 3rd and 4th year are relatively call free, so maybe it'll balance out.
 
OHSU?

It may live in the shadows of it's more prestigious West Coast counterparts, but it sure seems to get a lot of love on SDN when you review the interview posts over the past few years.

...plus it's in Portland!
 
Call, ugh. I'm at a relatively call heavy program, although our schedule is much better this year. There is some educational value, certainly, but I agree with whopper -- it dies off after you've done 20 or so overnight calls. Last year, I missed about a third of didactics in one psychiatry block because of call, and now I'm missing several weeks of didactics because of night float. I get that this stuff needs to be covered, but honestly, it's about service, not education. Once you've admitted 50 drunk folks in the ED at 3 am, I think you're good.

Also, I can get all judgmental about myself here, but the more I work doing these service types of things, the less I read, which impacts my education. For me, choosing a program with a lot of call was probably an educational negative. Fortunately, 3rd and 4th year are relatively call free, so maybe it'll balance out.

I think that doctors, as a profession, really need to examine if this "more work = better education" belief is actually true. I agree with Doctor Bagel here, and think that while there is some value to admitting some drunk folks at night in the ED, there comes a point at which you've mastered that particular "technique" and your education would be better served by learning something else.

Honestly, why we are still using a 19th century model to teach medicine in the 21st century is entirely beyond me. You know, pretty much every other healthcare provider out there gets to get a real job immediately upon graduating from their school. PA students get 3 years of school, then are somehow, magically, more qualified and much higher paid than an intern with 4 years of medical school. The old "Osler Model" of "Residency" no longer works in today's world, IMO. Even the term "Residency" is an anachronism.

Obviously, further training in our chosen fields is necessary to become "experts." That being said, we shouldn't be considered any more restricted than a PA upon finishing our more complete training. That just doesn't make sense. (Also, I'm not trying to single out or pick on PA's here. I value PA's and have worked with many fine ones.)
 
Education from call plateaus unless there is solid ongoing supervision, which is really true for any clinical care. One can learn in a not-too-long period of time how to get by in any clinical setting without too many major disasters. Learning beyond that takes ongoing effort and either self-directed learning or supervision that maximizes the clinical experience.
 
Another advantage of all-nighter calls is that rarely, but it does happen, sometimes there's an emergency where there's an influx of people. For example, in one city I've known, whenever they do a specific annual music concert, the ER is flooded with people having psychotic breaks from the drug use. Being under that type of stress can prepare you for these types of emergencies.

But like I said, the learning advantages plateau quickly. Another problem is rearranging a schedule so that someone does an all-nighter call only a few weeks a year is difficult, and sometimes programs put hard call schedules because they have to for provision of services.
 
Education from call plateaus unless there is solid ongoing supervision, which is really true for any clinical care. One can learn in a not-too-long period of time how to get by in any clinical setting without too many major disasters. Learning beyond that takes ongoing effort and either self-directed learning or supervision that maximizes the clinical experience.

What type of supervision would be adequate? It seems like a hard issue unless you have dedicated overnight faculty to provide consistent supervision. We don't here; instead, we have phone supervision by various on-call attendings who switch off every week. I'm wondering how many programs have good supervision of this off hours work. I'm guessing not many.

Hmm, maybe having some emergency psych curriculum built around the call experience would be useful. As I mentioned above, call beats me up too much to do self-directed learning.

Also, about my comments regarding call at my program -- I was looking through my call schedule again, and it's really not that bad now. I think most of my negative comments are related to left over negative emotions from last year. I still think call is largely a service-oriented task for most residents everywhere, though.

Getting back to the other programs -- I remember the New Mexico PD mentioning certainty that hours changes were coming and was already thinking through how his program would deal with it. That was in 2009 before any official ACGME announcement had been made, but he knew that the ACGME could not completely ignore IOM recommendations. That's pretty impressive.
 
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Another advantage to all night call is that it mimics many moonlighting jobs. It helps to have the experience of being the only psychiatrist (and sometimes the only MD) in the entire hospital.

Written while moonlighting.
 
What type of supervision would be adequate? It seems like a hard issue unless you have dedicated overnight faculty to provide consistent supervision. We don't here; instead, we have phone supervision by various on-call attendings who switch off every week. I'm wondering how many programs have good supervision of this off hours work. I'm guessing not many.

Hmm, maybe having some emergency psych curriculum built around the call experience would be useful. As I mentioned above, call beats me up too much to do self-directed learning.

Also, about my comments regarding call at my program -- I was looking through my call schedule again, and it's really not that bad now. I think most of my negative comments are related to left over negative emotions from last year. I still think call is largely a service-oriented task for most residents everywhere, though.

Overnight faculty is rare, in person. Tandem call is useful for a time, to learn from senior residents. Other things we used to do included videotaping patients at time of admission, to go over the interview with an attending. Also presenting and discussing patients the next morning and ongoing dilemmas. Videotaped sessions are the next best thing to in-person supervision.
 
Call scheduke at LSU is very light IMO. q7 intern year, with short call during the week (5-10pm), and12 hr shifts on the weekend. I'm not entirely sure but i think the weekend call for interns is day shift. From what I gathered they did NO overnight call as interns, including no night float. Then as second years call is q9 overnight home call. No call 3rd or 4th yr.

I know that wasn't the original question, but the thread has kind of morphed into a call thread, and I was impressed by the schedule and thought Id share.
 
Call scheduke at LSU is very light IMO. q7 intern year, with short call during the week (5-10pm), and12 hr shifts on the weekend. I'm not entirely sure but i think the weekend call for interns is day shift. From what I gathered they did NO overnight call as interns, including no night float. Then as second years call is q9 overnight home call. No call 3rd or 4th yr.

I know that wasn't the original question, but the thread has kind of morphed into a call thread, and I was impressed by the schedule and thought Id share.

This is pretty much what I've been seeing everywhere. Isn't one of the new rules "no unsupervised overnights" or something like that?

Edit: It looks like it's direct supervision, or indirect with direct supervision immediately available. This combined with the recommended 10 hours off (mandatory 8) and the maximum of 16h/day shifts, I think has been translating into no overnights for interns...at most places, it looks like.
 
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Edit: It looks like it's direct supervision, or indirect with direct supervision immediately available. This combined with the recommended 10 hours off (mandatory 8) and the maximum of 16h/day shifts, I think has been translating into no overnights for interns...at most places, it looks like.
That would be surprising and a little disappointing.

At most places I interviewed at (and the one I'm working at), this rule translated into still doing night call and night float, but with faculty back-up by telephone and a doc in the hospital if something really weird goes down.

I'd find it odd to never do overnight call as an intern.
 
That would be surprising and a little disappointing.

At most places I interviewed at (and the one I'm working at), this rule translated into still doing night call and night float, but with faculty back-up by telephone and a doc in the hospital if something really weird goes down.

I'd find it odd to never do overnight call as an intern.

Yeah, I've done 3 interviews so far, and all of them have had short call q week and one 12 hour weekend shift (which can be overnight, if you get the 8pm-8am shift) which is appx. q month, sometimes 2/month...

Second year has been involving 1-2 night float months, plus the same call system as above (except during the night float month).

So, the weekday night shifts seem to be largely covered by the night float team. Now, this is only 3 places, so we'll have to see what happens at my other places...

I agree that it seems a bit odd, but at the same time, it also doesn't make much sense to me to make the person with the least experience work the most. I know that's the way things have been done in the past, and medicine is very resistant to change, but it may not be the smartest way to manage people, time, or training.
 
That would be surprising and a little disappointing.

At most places I interviewed at (and the one I'm working at), this rule translated into still doing night call and night float, but with faculty back-up by telephone and a doc in the hospital if something really weird goes down.

I'd find it odd to never do overnight call as an intern.

Our interns don't do overnight call either. Instead, they do one to two short calls a week and an 8 am to 8 pm Sunday call every other weekend. They don't even do overnight call on medicine anymore. It's very different. I'm not sure it's educationally worse, though. We don't have any attendings in the hospital overnight, though, which caused a lot of limitations. We do 6 to 7 weeks of nightfloat 2nd year, which isn't an increase from last year.

I'm wondering if the programs that have overnight call for interns are the larger ones with independent psych EDs and whatnot that require having a psychiatrist inhouse 24/7.
 
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I'm wondering if the programs that have overnight call for interns are the larger ones with independent psych EDs and whatnot that require having a psychiatrist inhouse 24/7.
That makes sense. Ours does, so we technically have a BC psychiatrist in-house 24/7.
 
Places I liked were the two south carolina programs, URochester and the other SUNY programs upstate, and also Einstein in Philly.
 
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