University of Washington - Seattle (Seattle track +/- research track)
Ease of communication: Interview invitation and scheduling are by email; you fill out a form listing your 3 interview date preferences from all the available dates, your interests etc. My interview date was confirmed promptly. A few days before the interview I received an email with my interview day schedule, UW maps and directions, and information about the resident dinner. In addition to this, I also received a snail mail package containing a confirmation of my interview, UW maps and directions to the interview site, hotel info and a magazine on Seattle attractions/dining.
Post-interview communication is encouraged to clarify any questions, but we were told that it wouldn’t have any impact on ranking.
Accommodation & food: A list of nearby hotels was provided by email with interview confirmation, as well as by snail mail. I stayed at one of the recommended hotels, which was OK. Interestingly, the regular rates at the hotel I stayed were lower than UWMC negotiated ones, and you can get even lower rates online, so I would recommend checking out the hotels on the list online. Most of the hotels on the list have their own shuttles to UW and/or UW-Harborview free shuttle stops close to them, but I ended up taking a Lyft to my interview.
The resident dinner the night before the interview was at a cute place in the Capitol Hill neighborhood, which is a funky/artsy/LGBT-friendly area of the city (I don’t think I saw as many rainbow flags in Castro, SF J), which is also the most popular neighborhood for residents to live in because it’s convenient to commute to the main training sites by public transportation from there. The dinner was well attended by PGY2-4 residents (about 6-7 of them, almost as many as applicants). We were all seating at one long table, and in the middle of the dinner residents sitting on one site of the table switched with those sitting on the other side of the table, which was a little weird at first but provided an opportunity to speak with more residents/hear more points of view. Alcohol is not paid by the program, and nobody ordered, so neither did I, though it was the kind of place to enjoy your beer at. Some of the applicants went to a bar after dinner but I was too old for this sh (scratched out) too jet lagged to join.
Day of the interview food: a standard light breakfast of coffee/juice, pastry, fruit and yoghurt to be consumed during the chair’s and PD’s presentations. Pizza lunch with residents at their noon(ish) conference at Harborview; given that there was plenty of time from our arrival to the beginning of the presentation, we got to talk with several more PGY1-4 residents eager to answer our questions.
So bottom line is, I got to talk to *a lot* of residents across all years. I don’t know if the program administration reads SDN or what but they certainly took measures to address previous years’ complaints of the paucity of residents during the dinner and the interview day.
Residents were all friendly, down to earth people who were all happy with the program. In contrast to the previously reported issue of residents not being close within and between classes, I got a feeling that residents knew each other fairly well and spent quite a bit of time with each other. One of the things that help inter-class cohesion, in my opinion, is teaching call (see below). In addition, the PD, Dr. Susan Murray, seems to encourage organization of inter-class events, such as hiking trips etc.
Interview day (schedule, type of interviews): the interview started at UWMC at 8:00 am with introductory talks from the chair Dr. Jurgen Unutzer and the PD Dr. Susan Murray. Both of them were proud and enthusiastic about being part of UW Psychiatry, talked about the strong community and integrative/collaborative focus of the program, innovations in mental health care delivery pioneered by UW Psychiatry (collaborative care, telemedicine, mobile applications for psychiatry), the almost overwhelming range of opportunities available at the program, the beauty of the Pacific Northwest and the advantages of life in Seattle.
After that we took a shuttle to Harborview, the main training site, for a tour. Dr. Murray accompanied us on the shuttle, and we all had an informal and fairly easy-going conversation on topics ranging from life in Seattle to pets to TV series. Just like pretty much everyone I met during my UW visit, Dr. Murray is a very warm, approachable and down to earth person. She is dedicated to providing the best possible training and helping residents pave their future career paths; she also cares about her residents as people – I’m not going to divulge the details, but one of the residents told me about some issues (s)he had during his/her training, and how helpful, supportive and accommodating the program administration was. In addition to this, I was told that the program was family-friendly, though I didn’t get into any details on this.
Harborview Medical Center, a large public hospital, is one of the program’s main and most beloved training sites. (see below re: training sites) The tour was lead by a PGY-4 resident who showed us one of the 3 psychiatric units (which include “regular” inpatient psychiatry beds with mostly involuntary patients, some med-psych beds with patients followed by Medicine and receiving a higher level of medical care than typical psych inpatients, like IV infusions, and psych ICU for the most acute, most often psychotic involuntary patients who are serious threat to self and/or others), inpatient and C-L resident workrooms, an outpatient resident office (shared with another resident, so no personalizing), the ED and the cafeteria. Harborview as a whole looks better than pretty much any other public hospital I’ve ever seen and features beautiful views of Mt. Rainier etc.
After the tour, the interviewees (7 of us that day) had individual interview schedules with interviews taking place at Harborview, UWMC or VA (those who had interviews at the VA were taken there by car by a member of the administration). I had five 30-min interviews, but I think the typical number of interviews is four (one of mine was a research interview) and included an interview with the PD Dr. Murray, two faculty interviews and one resident interview throughout the day with a break for lunch/resident conference (see above). The day ends around 3:30ish pm unless you expressed an interest in seeing Seattle Children’s and meeting with the child psych fellowship PD, in which case it could go till 4:30ish or so.
All of my interviews were conversational and included the typical questions about why psychiatry and why this program, as well as specific questions about my application. Most of my interviewers thoroughly read my application (Dr. Murray made some notes on a hard copy of it, and my resident interviewer came prepared with a list of questions); one told me he didn’t get a chance to read my application because of clinical responsibilities, and I appreciated his honesty; we ended up having a good conversation anyway. For all of my interviews, we spent about half the time discussing my application including some benign questions about my background/childhood and the other half discussing the program. Definitely have some questions ready, as you will be asked if you have any. I actually prepared a whole list of possible questions for my interviews but ended up spontaneously asking questions about things that piqued my interest during the morning intro etc. We also discussed general topics related to psychiatry, like the funding of mental health services, involuntary commitment, differences in psychiatric training and practice in the West coast vs. the East coast etc. Quite thought provoking and relevant to my ranking decisions.
Program overview: A lot of the information is available on the program’s website, which is one of the best psych residency program websites I’ve seen:
University of Washington Psychiatry Residency Training Program Some information there is out of date though, so in my brief overview I’ll try highlighting the unique aspects of the programs and important things that are different from what the website says.
Training sites: Harborview Medical Center (public, 3 psych units comprising 66 beds that include med-psych beds and psych ICU, PES, C-L, psych and collaborative care clinics, including an HIV/AIDS clinic), UWMC (tertiary care academic, a small psych unit of 10 beds for mostly voluntary patients, inpatient and outpatient C-L strong in oncology, transplant and obstetrics, and outpatient psych and collaborative care clinics), VA (24 psych beds, 4 beds devoted to acute detox, strong in addictions, also C-L, emergency psych and outpatient clinics including PTSD, addictions clinics and consults to primary care clinics), Seattle Children’s Hospital (41 psych beds, C-L and clinics), a residential treatment program for children and adolescents at a nearby state psych hospital (where you can get experience with young offenders), and multiple community outpatient clinics including clinics focusing on Hispanic population, immigrants/refugees, LGBT, adolescents etc.
Off service requirements: 6 months in two 3 months blocks alternating with psychiatry. Starting 2018-2019, you will have an option of doing either all adult (2 months inpatient medicine, 2 months inpatient neurology, 1 month ED and 1 month medicine consults which is apparently a light rotation) or a combination of adult and child (2 months inpatient peds, 1 month adult medicine, 1 month adult neuro, 1 month peds neuro, 1 month ambulatory peds). Off service call is per the service requirements, including 28- to 30-hour q5d overnight call at Harborview and q8d overnight call at the VA while on medicine. But I was told that that, while psychiatry interns are generally treated as any other medicine intern, medicine faculty and senior residents are very supportive, so while medicine is a busy rotation psychiatry residents talked positively about it. More or less the same with peds (busy but supportive environment; I don’t know about peds call). Didn’t hear any comments about the neuro service aside from the fact that some psych residents became friends with their neuro seniors, so they got invited to their weddings etc.
On service requirements:
PGY-1: 6 months in two 3 months blocks of inpatient psychiatry including 3 weeks of night float (Harborview and whether VA or UWMC).
PGY-2: 4 months of inpatient psychiatry (either VA and UWMC, whichever you didn’t do in PGY-1), 4 months of C-L (a combination of Harborview, UWMC and the VA), 1 month of PES (Harborview), 6 weeks of night float at either of the main sites, 2 months of selective (choose from CAP, outpatient addiction, geri, outpatient community psychiatry at Harborview, or research or teaching), begin ½ day/wk of continuity clinic and start first (supportive) psychotherapy case.
PGY-3: all outpatient including 1 day/wk of CAP for 12 months, 1 day/wk of addictions for 6 months, 1 day/wk of geri for 6 months and at least 1 day/wk of continuity clinic, the rest is elective time.
PGY-4: all electives except for at least 1 day/wk of outpatient psychiatry (1/2 day/wk continuity clinic, ½ day/wk primary care consultation).
Psychiatry call: 12-hour weekend shifts (day or night) from every other week in PGY-1 to less than once a month in PGY-4. PGY-3s do a combination of solo and training call, in which you supervise a PGY-1; PGY-4s do mostly training calls.
Didactics: protected didactics time on Thursdays (1/2 day for PGY-1s and a full day for PGY-2s and -3s that also includes supervision and administrative meetings). Topics include the things that all psychiatry didactics have plus a motivational interviewing workshop in PGY-2, cross-cultural psychiatry and clinical interactions seminar (case-based discussion of doctor-patient relationship, including transference-countertransference issues) in PGY-3.
Psychotherapy: as residents have told me, despite the prevalent notion that the East coast is all “psychodynamic” and the West coast is all “biological”, UW provides a strong psychotherapy training that starts early (PGY-2), features a weekly continuity clinic, plenty of supervision (one of the residents told me (s)he’d had to “fire” one of his/her supervisors, even though (s)he liked them, because (s)he was getting *too much* supervision) and a variety of psychotherapies to learn on top of the typical/required supportive, psychodynamic and CBT (such as DBT, family, couple, group, interpersonal, cognitive processing, hypnosis, you name it). For psychoanalytically-minded people, there is a psychoanalytic institute in town, and a number of residents completed a 2-year training there in their PGY-3-4 and went on to psychotherapy-focused private practice. There is also a psychotherapy career enrichment pathway that provides mentorship and additional opportunities for psychotherapy training. Finally, there are opportunities for psychotherapy research.
PGY-2: at least one weekly psychotherapy case for the first 4 months and then two weekly psychotherapy cases during weekly continuity clinic. Didactics in supportive and psychodynamic therapy, CBT and motivational interviewing. At least 1 hour/wk of psychotherapy supervision. Starting PGY-2 residents are required to complete 6 months of free/sliding scale weekly individual psychotherapy or 6 months of weekly supervision focusing on how resident’s personality etc. affect their therapeutic work.
PGY-3: at least one day/wk of continuity clinic that is supposed to be focused on psychotherapy cases, more didactics and ½ day/wk of supervision.
PGY-4: ½ day/wk of continuity clinic. Psychotherapy electives and optional psychotherapy training courses. More advanced didactics and at least 2 hours/wk of psychotherapy supervision (but you can certainly get more, including dedicated supervisors for different kinds of psychotherapy).
Focus on teaching: By this I mean both teaching of residents by the faculty (see below) and residents learning to tech by means of formal teaching didactics, teaching medical students, presenting at resident conferences and teaching PGY-1s on training call and a weekly didactic session.
Pathways: an initiative designed to help residents with developing their specific interests and their career in psychiatry. Pathways provide mentorship, seminars, special opportunities for clinical rotation and electives etc. There are currently 8 pathways: addiction, advanced psychotherapy, community leadership, cultural psychiatry, integrated care, perinatal psychiatry, research, teaching scholar. Residents can participate by attending seminars etc. in as many pathways as they like, but earning a pathway certificate requires completion of a project, which means that you can realistically be fully involved with only one pathway.
Research: neuroscience, health services and addictions. The psychiatry residency research program is supported by an R25 NIMH grant. Research track with dedicated research time, mentorship and funding accepts up to 4 residents each year.
Fellowships: all ACGME-accredited psychiatry fellowships except forensic psychiatry, plus non-ACGME-accredited fellowships in neuroscience research, primary care psychiatry, integrative care and geriatric health services (with an option to earn an MPH). Pain, sleep and hospice and palliative care fellowships at UW are open to psychiatry residency graduates.
Moonlighting: internal and external moonlighting is allowed after passing Step 3. We were told resident can make $150/hour for internal moonlighting at PES, and quite a few residents make a substantial amount of money doing disability evals.
Faculty achievements and involvement: Some of the big names are Marsha Linehan (founder of DBT), Jurgen Unutzer and Anna Ratzliff (pioneers in collaborative and integrated care) and John Neumaier (research on serotonin receptors).
Residents are happy with faculty’s approachability and with the balance between independence and supervision. In fact, I was specifically told by one of the PGY-1 (!) residents that I could let my supervising attendings know how independent I wanted to be and that they would generally work with you accordingly.
On the attending side of things, I was told by one of my faculty interviewers that a particular strength of the program was that most of the faculty were clinical and teaching but not research faculty, which means that residents are taught by people who work in clinical practice all the time and who are dedicated to teaching, as opposed to researchers who spend maybe 1-2 months/year doing clinical work. Also, as pointed out by the same interviewer, unlike many programs on the East coast where attendings would show up for rounds for an hour or so to OK resident’s plans for the day and than disappear into their offices/private practice, attendings at UW spend *hours* on the wards every day discussing cases with residents and students.
Location & lifestyle: The beautiful Pacific Northwest inspires outdoor activities including hiking, climbing, bicycling, kayaking, skiing etc. While Seattle is known for its rain, it’s more of a drizzle than a downpour, though winter days can be gray indeed. Summers, on the other hand, are gorgeous.
The city of Seattle offers all kinds of things a major city does including good restaurants, music joints, theater, art. Seattle is a dream for a coffee-loving bookworm like myself with its many independent and used book stores and atmospheric coffee shops.
Capitol Hill, a funky LGBT-friendly neighborhood, is the most popular among residents (about ¼ of them live there; the rest are scattered all over Seattle and surrounding areas). It’s fairly expensive ($1900/month for a one-bedroom apartment is considered a bargain) but offers a convenient public transport commute to training sites and easy access to entertainment. Apparently residents spend quite a bit of time with each other going to restaurants, outdoor activities etc. Despite working hard and the aforementioned call, they say they have a good work-life balance on psychiatry, especially in PGY-3-4 and have plenty of time to pursue hobbies etc.
Salary & benefits:
University of Washington Psychiatry Residency Training Program
Updates:
2017-2018 salaries (presumably there will be a small increase next year): PGY-1 - $56,520, PGY-2 – $58,728, PGY-3 - $61,140 and PGY-4 – $63,768. Of note, there is no state tax in WA.
Benefits:
- 21 days of paid vacation;
- 17 days of paid sick and health maintenance leave;
- 5 days of professional leave;
- medical, dental, life and long-term disability insurance;
- UW retirement plan;
- Professional development fund of $350/year;
- WA medical licensing fees and Step 3 exam fee paid.
Program strengths:
1) Clinical areas of strength: collaborative/integrative care, community psychiatry, C-L, addiction, geri.
2) Research areas of strength: mental health care delivery, technology in psychiatry, addiction, dementias, TBI.
3) A great variety of training sites that will give you exposure to just about any population and psychopathology you can think of.
4) Supportive program administration and faculty who are really invested in teaching and helping residents find their career paths.
5) Plenty of quality psychotherapy supervision.
6) Psychotherapy training and continuity clinic starts in PGY-2.
7) A great variety of electives to choose from and plenty of elective time; a very flexible program. Great for self-directed people and/or people with broad interests in psychiatry.
8) The pathways initiative designed to help residents with their career development.
9) Friendly, down to earth residents.
10) A liberal LGBT-friendly program in a very livable, liberal and LGBT-friendly city.
Potential weaknesses:
1) No forensic psychiatry fellowship on site, though there are definitely opportunities for involvement/exposure to forensic psychiatry at Harborview and Western State.
2) Seattle weather may not be for everyone (though not an issue for me).
3) Possibly not the best balance between salary and cost of living, though the same is true for most programs in major cities.
4) Having to commute to multiple training sites. Surprisingly, quite a few residents don’t have cars or only use cars for trips outside of the city. Apparently Seattle has a decent bus system and the commute has improved significantly with the recent introduction of a new light rail line that goes from Sea/Tac airport to UWMC. Most residents drive to the VA because parking is free there but take public transportation to UWMC and Harborview because parking is expensive there (something like $9/day).
5) Residents say the program is relatively call-heavy (see above), though a lot of psychiatry calls are training or home calls, and while medicine calls are indeed intense, inpatient medicine is only 1-2 months.
Personal conclusion: a great program with a big heart that makes me seriously reconsider my geographic preferences.
