Benefits > negatives????

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Sep 1, 2008
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I've heard that it is beneficial in psychiatry to do your residency in the city you want to practice in for the rest of your life. Not necessary but obviously beneficial.

Well I think my ideal city would be a suburb of a major city (1-2 hours from a city's center). If I wanted to practice in a place similar to Conroe, TX or even College Station, TX, is there still enough of a benefit to consider Baylor in Houston that may be 1-2 hours away?

I guess I'm wondering - How close to your program do you need to be geographically to still be of any benefit to your practice?

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Not sure I really agree with the premise that it's distinctly beneficial to do residency near where you want to practice. Just off the top of my head (and that's all there is anymore)...

1st: Psychiatrists are in demand most everywhere
2nd: If there is a benefit, it would depend greatly on the type of practice you want (which you might not know before residency).
For inpt psychiatry, train where you want to train, then move to wherever you want to practice. For outpt public psychiatry, residency is almost not required. For jail/prison psychiatry, go to where the feds have mandated increases in psychiatrist numbers - because they'll pay very well to get you in the door. If you want to hang out your own shingle for a psychoanalytic practice - train at a residency where that's highly valued (and where there are plenty of people willing/able to pay for it) and make inroads into the professional community quickly during residency.
3rd: There are downsides of staying in the same area
- those attendings who knew you as a resident can be slow to acknowledge you as an attending and colleague - you may always be the "youngster"
- there can be an "intellectual incest" of staying around those who trained you.
4th: "near where you trained" is very relative to the area. Folks in Houston don't normally think of College Station as a suburb of Houston. The phrase "trained at Scott & White" carries more weight in Austin than it does in Temple, Tx (where many of the docs trained at Scott & White), and it carries more weight in Austin than it does in NY or SF (where few have heard of Scott & White).
5th: I think the oft-quoted statistic that "70% (or is it 80%) of residents never move more than 30 miles from their residency," has more to do with the graduates' "comfort zone" and the fact that they've started to put down roots during residency than it has to do with the benefits to their practice of staying in the area.
6th: Overall, probably more important to do well at a residency with a basically good reputation than it is to complete residency near where you will practice.

All of this is WAY more thought than I should be putting in at this hour on a Sunday night.
You might have gotten that idea from me since I've written that there's benefits to practicing where you did residency.

However I also agree with Kugel.

In short, I've written that because you develop connections where you did residency. The program where you trained, several other doctrors-psychaitry or not have worked with you for years. Its quicker to develop referrals, go up higher in the job since you're a known quantity (assuming you did good work) etc. Several doctors where I trained were given jobs based on their reputation as residents that they would not have earned otherwise. By the time I graduated I had 4 places asking me to work with them, and asked me based on my rep as a resident.

(Though if you didn't do a good job, staying in the area could set you back!-and I can think of a few residents that very few want to touch with a 10 foot pole.)

However Kugel also brings in some good points, and I very much agree with the "intellectual incest" argument. I've learned several things after moving from NJ to the Cincinnati area that were not typically taught where I trained. Most residents stay locally--> and it may cause a geographic culture of how psychiatry is practiced including which meds are given, the approach to the patient etc.

There's pros & cons to both. Since I did move, I'm mostly dealing with the con that I'm working on a reputation that took 1 year to establish vs 4. I started out at the new place basically being just another doctor to everyone else, where if I stayed at my last place, I know I would've been ahead vs some of the other attendings.
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Most residents stay locally--> and it may cause a geographic culture of how psychiatry is practiced including which meds are given, the approach to the patient etc.

Can this be overcome by doing rotations elsewhere (other than your home institution) during residency elective months? Can people usually arrange that kind of thing?
Of course it can.

I think though that residency in most places has certain "medals" you can earn that you don't earn elsewhere that add more distinguishment. However work well enough at any place, and your rep will eventually grow. Getting a publication out while working in a non-university hospital without a formal academic program and it could be a case of ho-hum in your department. Doing it in an academic setting, or earning awards--several of which are only offered in academic settings can accelerate the advancement.

Electives can be a primer to networking. Thing about psychiatry is there's never too many psychiatrists in a given area except for perhaps NYC, Boston, Washington DC and a few other urban areas. Go to a hospital, do some good work over enough time--it can literally spread your rep around an entire county in the psychiatric attending community.
Exception is probably C&A fellowship. There are so many different agencies, schools, group homes etc involved that it takes awhile to get up to speed if you start fresh.