Am I overvaluing location?

[uhmocksuhsillen]

I've been very fortunate to have been offered a large number of interviews, as a DO no less too.

I have half at nice University programs, per doximity somewhere in the 20-40 rank. Then I have another handful which are small community programs, definitely not on par with some of the higher ranked places.

My issue is, one of the community programs is in socal, which is where I am from and would like to one day return. I find myself moving this program way up my list but I'm wondrring if I'm doing myself a disservice by ranking it above clearly better programs. Residents seem happy, and it appears to be sufficient in training.

Will my quality of education suffer at a small community program compared to a bigger/"better" program?

Is it more important to do residency where I want to live after, or should I go to the best program that feels like a good fit?

I really enjoyed an interventional pain rotation and there's a chance I try to work towards that fellowship during residency - I'm guessing my odds of matching are better coming from a bigger University program?

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[wolfvgang22]

There is no "right answer" to your question.

I go for best fit first, then quality of program.

Most people practice within 150 miles of where they did residency, and the networking you do in residency is valuable. I ranked several "top" programs lower than my #1 choice, and although my friends thought I was nuts at the time it worked out well. I avoided cold weather locations and was quite happy with my choice. I later did fellowship at a "top" program elsewhere, in part because of my ego, and although I learned a lot from top people in the field I sometimes wish I had remained in my residency city where I have dear friends. It depends on your personal wants and needs.

 

[yanks26dmb]

There is no "right answer" to your question.

I go for best fit first, then quality of program.

Most people practice within 150 miles of where they did residency, and the networking you do in residency is valuable. I ranked several "top" programs lower than my #1 choice, and although my friends thought I was nuts at the time it worked out well. I avoided cold weather locations and was quite happy with my choice. I later did fellowship at a "top" program elsewhere, in part because of my ego, and although I learned a lot from top people in the field I sometimes wish I had remained in my residency city where I have dear friends. It depends on your personal wants and needs.

Do you think this is due to logistics, putting down roots, etc. OR is it more due to the fact its harder to get a job in a region outside of the one you trained. Like OP, I too am from SoCal and would love to one day return. I have fallen in love with program on the east coast and the south east and am only so-so on the ones closer to home...but if my ultimate goal is to get back to SD/OC/LA, should I stay out west for residency? I guess I would be trading 4 years of being in a place that is a worse fit but provides a more guaranteed path home IF the latter is true.

 

[WisNeuro]

Do you think this is due to logistics, putting down roots, etc. OR is it more due to the fact its harder to get a job in a region outside of the one you trained. Like OP, I too am from SoCal and would love to one day return. I have fallen in love with program on the east coast and the south east and am only so-so on the ones closer to home...but if my ultimate goal is to get back to SD/OC/LA, should I stay out west for residency? I guess I would be trading 4 years of being in a place that is a worse fit but provides a more guaranteed path home IF the latter is true.

In psychiatry, if you have a pulse, you can pretty much get a job in most areas, regardless of where you did residency. In the past several states I've lived in (South, PNW, Midwest) there were numerous job openings for psychiatry all over the region. I can't speak to SoCal, but I'd be surprised if it's any different unless it's super saturated at the moment.

 

[whopper]

Populated areas such as NYC or Washington DC, the shortage of psychiatrist problems aren't anywhere near as bad. In fact (but it's from data that's a few years old but I don't think it's changed) those 2 cities there weren't a shortage. I wouldn't be surprised if big cities in California didn't have a shortage, in fact would not expect this but I haven't seen the specific data for those localities.

It seems psychiatrists are attracted to cosmopolitan, metropolitan areas and nice weather.

 

[yanks26dmb]

I guess the alternative is to do telepsych, live where you want, and job search until something pops up in your area...

 

[wolfvgang22]

Do you think this is due to logistics, putting down roots, etc. OR is it more due to the fact its harder to get a job in a region outside of the one you trained. Like OP, I too am from SoCal and would love to one day return. I have fallen in love with program on the east coast and the south east and am only so-so on the ones closer to home...but if my ultimate goal is to get back to SD/OC/LA, should I stay out west for residency? I guess I would be trading 4 years of being in a place that is a worse fit but provides a more guaranteed path home IF the latter is true.

It's mostly due to putting down some roots and getting comfortable and making friends and knowing how things work with the mental health system in the area. I did residency out west. I know it can be more competitive to Match there because the weather and quality of life is good and people want to stay near home. I wasn't raised in Cali but several of my friends in residency were from the Western U.S.

 

[Shufflin]

Couple things.

Psychiatry into pain fellowships is extremely difficult given how competitive it is. Hate to even suggest this, but being DO I would put this goal as a "great if it happens but don't plan on it". I know folks who've tried and not had any interviews. You have to be a stellar psych resident from a name program to be looked at IMHO.

Switch to PM&R or Gas if you truly want to do interventional pain. Why? 3 reasons. Those backgrounds will give you more hands on experience needed for that job. Getting into a fellowship will be easier, and - most med students don't know this - employers will hire you much more readily. Psychiatrist pain doctor? What? Never heard of this employers will say. Jobs look for Gas and PM&R trained pain fellows.

I'm familiar with all the programs in SoCal. There's one community program that's super strong, not sure if that's the one you're looking at. A couple further north that are not.

I'm from Cali. Can PM me.

 

[Bartelby]

Residency is rough, being happy with your location is important. As mentioned above, if interventional pain is your goal you are at a very large disadvantage as a psychiatrist and need any edge you can get. If you are committed to that I would recommend the more competitive programs. If you are not very stuck on that goal program name is less important.

It's a tough call, but if your gut tells you to take the less competitive program you should strongly consider doing so.

 

[ridethecliche]

Yeah, psych to pain sounds like a lost cause these days... The numbers are way better for PM&R and anesthesia as mentioned.

As others mentioned, life is gonna be kinda brutal for parts of residency. If being somewhere specific is a big source of your happiness, then I wouldn't call it a small consideration. Sounds big.

 

[whopper]

Can't answer this question. There's so many factors as to what makes a program good for you including your life balance.
I did residency within a reasonable driving distance to my parents' home (about 2.5 hrs). Heck yeah that added to my quality of life to be able to see them at least once in awhile.

 

[Neuro111]

I sorta disagree with the location part. you should train where you get the best experience, see different complex set of pathologies etc. community programs dont necessarily get these complicated cases. obviously if youre looking at lets say program 20 and program 30 and youre choosing between the cold of Midwest vs sunshine of Florida yeah i agree location matters. but otherwise, choose the place with the best training. you'll get over the initial discomfort of a new place within months and residency flies by...fast.