Stanford – Palo Alto, CA
1. Ease of Communication:
Message through MyERAS mid-October with 6 interview dates in Nov and Dec asking me to rank my preferences in an email back. There was also an Area of Interest form to fill out. Notified of Happy Hour following the interview day in the initial email communication. Email with schedule of interview day and interviewers was given the evening beforehand.
2. Accommodation & Food:
No accommodation provided, but link given with all hotels in the area with prices after the Stanford discount. I stayed with a friend in the area and used Uber to get in, which was super quick and easy. Parking pass is provided for the day if needed. Breakfast and lunch had lots of healthy options (fresh fruit!), coffee, and tons of variety in drinks and food.
3. Interview Day (Schedule, Type of Interview, Unusual Questions, Experiences):
The day started at 8:00am. Very organized schedule given the day before so we can look up our interviewers. The academic services administrator was waiting for us when we arrived and took us to this nice conference room with lots of healthy snacks and coffee. The packets we were given were extremely detailed, and included an Academic Psychiatry journal, in which the department chair Laura Roberts is the Editor-in-Chief, as well as a very impressive 140-page journal about all the psychiatry projects going on at Stanford and each faculty member there. We started off with an hour orientation from Dr. DeGolia who is the APD and then we meet with the PD/Chair. There was a chartered shuttle waiting for us to tour the Palo Alto VA hospital next. Some people had interviews here, others didn’t. The Palo Alto VA is probably the nicest hospital that I’ve ever step foot in. The psychiatric ward has 20 beds per unit with 4 units there, and each unit is beautiful. Residents get capped at 8 patients and faculty take care of the rest. The rooms were clean, the hallways nice, and the common area had foosball, a ping pong table, billiards, a beautiful courtyard, a nice flat-screen TV, and so much more. The recreation therapy for the patients in the afternoon was golfing at the Stanford Country Club, which apparently residents have free (I was told) access to. We had a shuttle to the Stanford University Hospital next where we went to the inpatient psych units, which were less beautiful than the VA but still very nice. The patients were wearing pajama looking scrubs with Stanford emblems on it. Apparently they get many Stanford undergrads and graduate students, who come from all over the world, which implies (as I was told) that the patient diversity is wide.
We went to Grand Rounds where they had a guest speaker come in to talk about a topic in psychiatry. There were so many people at that Grand Rounds that it was standing room only, which I interpreted as a strong psychiatry community. Some of my other interviews had Grand Rounds where it was barely one or two dozen people present. Afterwards, we had lunch with the residents and then sat in on the first part of their didactic session.
Then followed a battery of interviews. They really tried hard to match your interviewer to what you ranked on your Area of Interest form, which was an amazingly personal touch that made it much easier to have conversations with the interviewers about common interests. There were a total of 5-6 interviews depending on the schedule, where you meet with the PD, APD, a resident, and other faculty members. Overall, it was a very conversational feel where most the faculty knew my application inside and out. There were two interviewers however where it was clear that they did not read my application beforehand. At the end of the day, there was a wrap up session and feedback session about how the interview day went with the APD, which was great. The interview day ended at 5:15pm. We went to a restaurant in downtown Palo Alto for happy hour afterwards, which had amazingly delicious food. I was so tired by this point from 2 tours, 6 interviews, and PowerPoint presentations that it was hard for me to be as socialable, but the residents seemed to be very well-balanced and enjoyed their life despite working hard. They seemed incredibly impressive from their backgrounds, their scholarly project they were working on, and how much they loved Stanford. We were done with dinner around 8:00pm.
4. Program Overview:
The program seems to really cater to whatever the residents want to do with strong individual attention and a family feel while still having high standards. The Program Director and Chair have really made resident education an increasing priority among the faculty at Stanford and there seems to be a lot of buy in. They work all over nearby counties including San Mateo, Santa Clara, Santa Cruz, Monterey, and Alameda.
• PGY1: standard medicine, neuro, inpatient psych. Outpatient starts first year. Four weeks of night float. 4 weeks of psych ER. They recently got kicked out of the psych ER at Santa Clara County Hospital (faculty who wanted to teach left, remaining faculty didn’t want to teach residents) and they’re working to partner with Santa Cruz County Hospital (?) to work in their psych ER, but at this point it’s unclear whether this partnership will develop. In any case, the psych ER experience may not be the best here given the recent developments.
• PGY2: 3 months inpatient, 2 months geropsych, 2 months C/L, 2 months scholarly concentration (this was the unique aspect!), 1 month assessment methods for research (this is also unique), 1 month addiction, and 1 month night float.
• PGY3: All outpatient! 12 months continuity clinic (VA or Stanford), 12 months long-term psychodynamic psychotherapy (IPC) and CBT (in child, psychopharm/mood, community psych in underserved clinics, or in SMI/psychotic disorders), and 12 months of scholarly concentration. Other outpatient clinics include SMI, clozapine clinic, doing prolonged exposure with the PTSD clinical team, telemental health clinic, or addiction pharmacology clinic. Moonlighting starts this year, but not sure how much they get paid.
PGY-4: 6 months of 50% selective and 50% scholarly concentration, and then 6 months of 100% selectives (Kaiser Redwood City, Vaden Student Health, chief residency). Continued outpatient long-term psychodynamic psychotherapy (IPC). Outpatient clinics include advanced depression, advanced bipolar, OCD, women’s wellness, geriatric, neuropsych, psychosomatic, ECT, and general evaluation.
Graduates: About 1/3 find academic positions, >1/3 do community and <1/3 do private practice.
I would say that the program is very resident-centric in terms of developing a scholarly project as long as it promotes the development of critical thinking skills. This can be anything from getting more clinical exposure (child, DBT, HIV, etc), community outreach (one resident was partnering with local schools to teach coping skills), research of course, global health opportunities (Zimbabwe, Belize, Guatemala, India, and Jordan were some of the named places), extra psychotherapy training (Feeling Good Institute with David Burns or Existential Psychotherapy with Irvin Yalom), developing education curricula, and anything else you might think of (one resident worked with the design school to build an ICU space to decrease risk for delirium). It seems as though you can really develop projects and have strong faculty support for this. Some residents have done additional degrees such as PhDs, MBAs, and MPP/MPA with the support of the program. Other residents chose to pursue psychoanalysis training with the Palo Alto Psychoanalytic Psychotherapy Training Program or the SF Center for Psychoanalysis.
Changes from the past years: psych ER is currently in limbo, increased psychotherapy teaching by faculty, increased community psychiatry opportunities (thanks to Steven Adelsheim who was recruited within the past 3 years), expanding global mental health program.
5. Faculty Achievements & Involvement:
World-class faculty. The Chair, Laura Roberts, is a force to be reckoned with. She is the Editor-in-Chief of Academic Psychiatry and has published at least 3 psychiatric textbooks every year for the past several years (there was a postcard in front of her office with that list). We were given a 140-page booklet highlighting the psychiatric department, including the research labs and the community involvement from the psychiatric department, which shows how much they’ve been doing. There are 519 department faculty and an additional 381 department staff. They publish 400+ in their department every year from 159 funded research projects.
6. Location & Lifestyle:
Palo Alto is definitely more of a suburban feel and even the downtown area is just one street with boutique shops and fancy restaurants. That said, it’s a safe place to live, the school districts are great if you have kids, SF is about an hour away, you have access to all the Stanford University perks, such as the gym, sports events, cultural events, and lots of hiking/outdoor activities.
7. Salary & Benefits:
The highest salary of the California programs. PGY-1 salary starts at $62,587 for 2016-2017 and goes up to $74,755 by PGY-4. Add the housing allowance of $500 per month for all residents and fellows. There’s also a one-time moving allowance of $3,000. You get reimbursed for Step 3, CA medicine license, Med license renewal, and DEA. Education expenses up to $2000 per year. Work expenses of $1000 per year (cell phone, mileage, meals on duty). Vacation of 3 weeks/year plus 1 week of educational time. Health insurance is fantastic with NO co-pay for visits or prescriptions (WOW!), and you can choose between the Stanford one (Aetna?) or Kaiser. Access to two gyms on campus (rock climbing anyone?), Stanford Division 1 sports games (need to buy tickets), unlimited access to BART/Caltrain/local buses, Stanford Country Club for golfing, etc. There’s also subsidized university housing on campus if you get lucky in the lottery.
Salaries with housing+relocation allowance included:
PGY1 - $71,587
PGY2 - $71,748
PGY3 - $76,761
PGY4 - $80,755
8. Program Strengths:
• Very resident-centric and family feel with high standards
• Lots of flexibility in schedule so you can cater it to your individual interests
• Dedicated time for scholarly concentration with 2-3 months in 2nd year (unique to this program)
• Lots of internal fellowship opportunities, which means access to faculty who are experts in those fields (C&A, sleep, neuropsych, addiction, etc.)
• Access to world-class faculty (David Burns with CBT, Irvin Yalom in Existential Psychotherapy, Laura Roberts in Ethics, Jose Maldonado in Psychosomatics, Karl Deisseroth in Optogenetics, David Spiegel in Hypnotherapy, and much more!)
• Beautiful location and facilities where the weather is always perfect due to strange microclimate magic, and only <1 hour from San Francisco
• Highest salary with probably the most amount of fringe benefits in CA
• Psych research is extremely strong with many diverse opportunities for basic science, translational, clinical, and community research
• Psychotherapy seems strong, especially in psychodynamics and CBT - lots of elective time to pursue other modalities if desired
9. Potential Weaknesses:
• Lack of formal mentorship and advising program
• Community psychiatry is improving, but no firm county hospital experience
• Lack of Psych ED experience given recent ousting from Santa Clara
• Potential lack of patient diversity, but residents say that they see foreign students to Google executives which provides for a bigger range of diversity
• Probably still need a car to get around since no one seems to take the public transportation
• Palo Alto is still really expensive, even with the higher salary and housing allowance, and is a sleepy suburban town.
10. Overall impression: Definitely a strong program that offers lots of fleixibility to shape your own path! I would put it in the top 3 in California, especially if you want an academic career. Program seemed very well balanced between biological and psychotherapy with access to world-class faculty mentors. You can customize your training to maximize your own growth in whatever way you see fit. Stanford University has incredible resources and facilities, and there’s lots of cultural and sports events. The location and weather are fantastic.
They claim that it is available but you have to be licensed and when I asked who was currently moonlighting I was told that one of the fellows was. This is a huge turn off for such an expensive city
