Best Hospitals for Adminstering ECT

[MaddieMay]

I am interested in switching from psychology to psychiatry for the specific purposes of administering ECT.

I have reviewed US News and World Report and their ranking of top psychiatric units, but I have no idea what their criteria are.

Are any hospitals well known for their expertise regarding ECT?

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[Anasazi23]

SUNY Stony Brook comes to mind.

Any large academic center will be able to provide good formal training in ECT. Any residency at all requires at least exposure to it.

Can someone comment on if there are different credentialing processes in different states in order to conduct ECT? I've been doing some searches, but am not coming up with much.

 

[OldPsychDoc]

SUNY Stony Brook comes to mind.

Any large academic center will be able to provide good formal training in ECT. Any residency at all requires at least exposure to it.

Can someone comment on if there are different credentialing processes in different states in order to conduct ECT? I've been doing some searches, but am not coming up with much.

In my experience, ECT credentialling has been a part of the hospital credentialling (inasmuch as it's their liability on the line) as opposed to any state licensing issue. There maybe a state out there that would prove my experience lacking, however...

 

[billypilgrim37]

I have reviewed US News and World Report and their ranking of top psychiatric units, but I have no idea what their criteria are.

They assemble as many 60+ year old psychiatrists they can find into a middle school gymnasium, flash the name of the program up on a blank screen for about 50 microseconds, and then observe how many beard-strokes can be counted in the audience.

 

[Doc Samson]

I am interested in switching from psychology to psychiatry for the specific purposes of administering ECT.

I have reviewed US News and World Report and their ranking of top psychiatric units, but I have no idea what their criteria are.

Are any hospitals well known for their expertise regarding ECT?

I know Duke runs a CME course for ECT training and MGH has published a lot on ECT for medically related catatonia, so I'm guessing that they might be perceived as being well known for it, but as Sazi says, any major academic institution should be able to provide training.

 

[OldPsychDoc]

They assemble as many 60+ year old psychiatrists they can find into a middle school gymnasium, flash the name of the program up on a blank screen for about 50 microseconds, and then observe how many beard-strokes can be counted in the audience.

This just in...

Press Release--US NEWS AND WORLD REPORT

"NEW VOICES TOP 'MOST CYNICAL DOCTORS' LIST"

Despite a nearly four-year reign at the top by senior moderator, OldPsychDoc, billypilgrim, a promising newcomer, has set new marks for cynical social commentary. With his latest post questioning the very basis of the Sacred Ratings, he has set a new standard of snarkiness.

The newly dethroned OldPsychDoc issued a statement reading:
"We are entirely honored to yield our title to this outstanding young cynic. Who knew that someone could reach this level of sarcasm before he even dons the long white coat of an intern? It is especially impressive that he does so with a post that questions the very basis of our ability to make meaningless comparisons between programs, while simultaneously poking at the carcass of the sacred cow of psychoanalysis. Like Jack Nicklaus in the presence of a young Tiger Woods, I feel unworthy to even caddy for this new master. He surely is destined for a phenomenal career as a psychiatry attending, or even, perhaps one day, as an internet forum moderator."

 

[Doc Samson]

This just in...

Press Release--US NEWS AND WORLD REPORT

"NEW VOICES TOP 'MOST CYNICAL DOCTORS' LIST"

Despite a nearly four-year reign at the top by senior moderator, OldPsychDoc, billypilgrim, a promising newcomer, has set new marks for cynical social commentary. With his latest post questioning the very basis of the Sacred Ratings, he has set a new standard of snarkiness.

The newly dethroned OldPsychDoc issued a statement reading:
"We are entirely honored to yield our title to this outstanding young cynic. Who knew that someone could reach this level of sarcasm before he even dons the long white coat of an intern? It is especially impressive that he does so with a post that questions the very basis of our ability to make meaningless comparisons between programs, while simultaneously poking at the carcass of the sacred cow of psychoanalysis. Like Jack Nicklaus in the presence of a young Tiger Woods, I feel unworthy to even caddy for this new master. He surely is destined for a phenomenal career as a psychiatry attending, or even, perhaps one day, as an internet forum moderator."

As optimist-in-chief, I recognize the achievements of my cynical counterparts, but object to the use of "carcass" describing psychoanalysis - it lives!

 

[Anasazi23]

This just in...

Press Release--US NEWS AND WORLD REPORT

"NEW VOICES TOP 'MOST CYNICAL DOCTORS' LIST"

Despite a nearly four-year reign at the top by senior moderator, OldPsychDoc, billypilgrim, a promising newcomer, has set new marks for cynical social commentary. With his latest post questioning the very basis of the Sacred Ratings, he has set a new standard of snarkiness.

The newly dethroned OldPsychDoc issued a statement reading:
"We are entirely honored to yield our title to this outstanding young cynic. Who knew that someone could reach this level of sarcasm before he even dons the long white coat of an intern? It is especially impressive that he does so with a post that questions the very basis of our ability to make meaningless comparisons between programs, while simultaneously poking at the carcass of the sacred cow of psychoanalysis. Like Jack Nicklaus in the presence of a young Tiger Woods, I feel unworthy to even caddy for this new master. He surely is destined for a phenomenal career as a psychiatry attending, or even, perhaps one day, as an internet forum moderator."

Spoken like a true humble king.

Don't be so quick to dethrone youself, my liege.

You should write for the onion.

 

[billypilgrim37]

Despite a nearly four-year reign at the top by senior moderator, OldPsychDoc, billypilgrim, a promising newcomer, has set new marks for cynical social commentary. With his latest post questioning the very basis of the Sacred Ratings, he has set a new standard of snarkiness.

No, Master, I remain but your Padawan.

And I actually thought I was validating the subconscious...

 

[OldPsychDoc]

Spoken like a true humble king.

Don't be so quick to dethrone youself, my liege.

You should write for the onion.

That's the nicest, most wonderful thing anyone's ever said to me!
I'm verklempt...:cry:

 

[MaddieMay]

I'd heard all kinds of negative things about USN&WR, but wanted to go to the source to determine their criteria for ranking psychiatric units.

I called them and asked about the criteria used and they said they send out surveys to a random group of board-certified psychiatrists and ask them to rank psych units based on reputation alone. If the hospital is recommended by at least 3% of those who return the surveys, it goes into the ranking according to how many physicians perceived that the units had a good reputation.

I wouldn't really care how they rank hospitals as long as they put their methodology (or lack thereof) in the magazine or on the website.

What a crock!

I also found out by calling hospitals directly that Northwestern in Chicago (Evanston) doesn't do ECT at all.

According to a psychiatrist I talked to at The University of Chicago, the hospital decided their inpatient psych unit wasn't making enough money, so they had the unit transferred to Mercy Hospital. The ECT docs go to Mercy M-W-F to administer ECT to the patients there.

Strange.

I'm going to look into U of I Chicago Circle and Rush Memorial next.

Has anyone had psych experience at The Mayo Clinic in Rochester, MN?

 

[OldPsychDoc]

..I called them and asked about the criteria used and they said they send out surveys to a random group of board-certified psychiatrists and ask them to rank psych units based on reputation alone. If the hospital is recommended by at least 3% of those who return the surveys, it goes into the ranking according to how many physicians perceived that the units had a good reputation.
...

So basically, exactly what billyp. said.

 

[toby jones]

I had a chuckle at the post because that seems quite in line with the way that philosophy actually does rank philosophy programs (with a number in a box instead of beard strokes though lol). Reputational survey aka peer review.

 

[toby jones]

By the way, I do find it a little odd that a person would want to change into psychiatry for the stated reason that they want to administer ECT. Do (or did) people change into psychiatry because they wanted to give people Prozac or Lithium? People seem to change because they want to prescribe, but I'm not sure they change because they are attached to a particular kind of prescription.

It would be placing *Significant* empirical bets. That ECT would continue to be used etc. It isn't authorized as a 'first line' treatment as it is. Would you be happy in psychiatry if you weren't administering ECT?

 

[Doc Samson]

That ECT would continue to be used etc.

You're expecting ECT to go away?

 

[toby jones]

I don't know whether it will or not. I'm just saying that it would be making significant empirical bets to rely on it being around. Like if I moved to psychiatry in virtue of Prozac... Not that that is outlawed, or anything, it simply isn't 'flavor of the month' anymore.

How about you? You think we will still be inducing seizures in people 100 years down the track? Artefact of our current state of knowledge or surviving through to the 'final psychiatry' (once we know everything there is to know about treating mental disorders)?

 

[Faebinder]

I wouldn't bet that ECT will survive a 100 years.. but certainly 20 years. So far there is no better substitute. Maybe "Deep Brain Stimulation" will become better?

 

[Anasazi23]

I'm thinking and admittedly hoping that TMS makes the jump to replace ECT one day. Just now they're finding ways to penetrate deeper into the cortex, where we know that the field stimulation most likely needs to take place.

 

[Doc Samson]

I don't know whether it will or not. I'm just saying that it would be making significant empirical bets to rely on it being around. Like if I moved to psychiatry in virtue of Prozac... Not that that is outlawed, or anything, it simply isn't 'flavor of the month' anymore.

How about you? You think we will still be inducing seizures in people 100 years down the track? Artefact of our current state of knowledge or surviving through to the 'final psychiatry' (once we know everything there is to know about treating mental disorders)?

It's going nowhere in my career span (i.e. the next 30+ years). Once we know "everything there is to know" all treatment will be obsolete, since all mental illness will be preventable. Of course, knowing "everything there is to know" is impossible, so it's a completely artificial argument.

 

[toby jones]

I agree that talking of a 'final science' is an ideal that will never be reached - and certainly not in our lifetimes! I'm not sure that knowing what we need to do to prevent certain things will result in our doing those things, however. For example, we know we can prevent obesity by providing healthy food at lower prices and taxing the crap out of junk food - but that is never going to happen. We know we can prevent eating disorders by limiting exposure to western (hollywood in particular) ideals of beauty - but that is never going to happen either. We may well be able to screen for certain diseases in pre-embryos - but that doesn't mean that selecting which are 'viable' will follow...

I'm not sure about ECT in our lifetimes... There do seem to be considerable differences in the threshold for delivering ECT in different parts of the country (or in different hospitals or whatever). I don't expect that it will disappear anytime soon, but it could be that the conditions that it is reccomended for changes in our lifetime such that its use becomes more severely limited... Perhaps...

 

[whopper]

In general, I have found USN&WR's listing to also be a crock. I have not yet found any ranking list I have seen for psychiatry programs that seems to gauge what I would want in a program.

One list for example I saw only ranked programs in terms of how much money that program received in research. Yes that does say something, but not everything a potential candidate is looking for. Work hours, resident satisfaction, board passing rates, fellowships, ratings of teaching attendings--geez, why aren't these things also being factored?

Are any hospitals well known for their expertise regarding ECT?

From a clinical standpoint, there seems to be so few hospitals doing ECT that whatever is the closest hospital--that's where you're going to send the patient.

In terms of academics--my suggestion is if you really want to know as much as you can about it during residency, go to a program where ECT is given and is done by someone noteworthy in the field, & make sure that noteworthy doc does teaching & has a good teaching reputation. Even if you do not go to such a program, there are conventions & programs where ECT training are given that you can attend as a resident or attending.

I have heard that so few institutions do ECT, this task of finding noteworthy people may not be so tough.

 

[OldPsychDoc]

...From a clinical standpoint, there seems to be so few hospitals doing ECT that whatever is the closest hospital--that's where you're going to send the patient.

In terms of academics--my suggestion is if you really want to know as much as you can about it during residency, go to a program where ECT is given and is done by someone noteworthy in the field, & make sure that noteworthy doc does teaching & has a good teaching reputation. Even if you do not go to such a program, there are conventions & programs where ECT training are given that you can attend as a resident or attending.

I have heard that so few institutions do ECT, this task of finding noteworthy people may not be so tough.

whopper, is that really the case where you are? That few hospitals perform the procedure? Here in our area (upper midwest, major metro area) every hospital that has inpatient psychiatry has an ECT program.

It probably IS true that there are few places where ECT is being done "academically". Columbia, I think is probably leading on the TMS front.

 

[MBK2003]

I really love the idea of TMS and really, really want it to be shown to be effective and particularly in adolescents for whom meds don't always work well. However, after having treated 2 inpatients who were parts of the rTMS studies at a prestigious academic center, I'm concerned that the REAL effectiveness of rTMS will get lost in the noise based upon the patients in the initial studies. One subject was NPD with chronic depressive symptoms (& emptiness) after reaching the age of 45 and still not having a life partner, I felt like only Kohut could have made that gentleman feel less depressed. The other person had dependent personality disorder and depressed mood following the death of their primary (only) social support. I'm all for effectiveness studies, but was surprised there was such significant axis II comorbidity in the study population. I guess this is why there's intention to treat.

 

[whopper]

whopper, is that really the case where you are?

Yes.

In South Jersey--Cooper Hospital which is the headquarters for my program recently restarted it after losing it for about 1 year. The attending doing it left. They weren't able to get another attending for several months to do it. Also, before we lost it, we only had it for about 2 years, and never had it before that. We're still in a situation where hardly any psychiatrist in the state knows we have it because the dept hasn't exactly sent letters out to all the docs in the state.

Next closest hospital is Virtua which has no psychiatry residency program. That's it for South Jersey.

Now Jersey's a small state, but its also one of the most densely packed in terms of population. Out of all the hospitals in South Jersey--2 hospitals.

 

[Doctor J 216]

Duke and Columbia (for sure duke, I think Columbia). The best and most published ECT papers, the clinics are meticulously run. Duke has a combined medicine/ psychiatry service, and their inpatient service is run by med/ psych physicians, so you'll learn tons about treating psychiatrically ill patients who have comorbid medical complications. The prospect of tapping into the medical as well as the psychological is often the reason that psychologists switch anyway.

But if you are looking into residency, you really need to think about evidenced based medicine, which really is a way to learn to think for yourself by critiquing available literature, experiential stuff, etc. A good evidenced based residency will teach you critical thinking, and all of the latest evidence supported treatments including therapy (CBT, etc).

Having been at two premier academic institutions, all ECT is not the same. Learn it well. But more importantly, learn Evidenced Based Medicine. It will prepare you to adjust to changes in therapeutics as time goes on without skipping a beat. Many bright physicians ill trained in evidence based medicine leave residency well versed and up to date but soon lose that edge since they cannot filter new literature quickly and systematically. Many rely on continuing medical education programs provided by corrupt pharmaceutical companies, and are swayed by the funky math they do.

I digress. Good luck. Oh yeah, about US News Ranking, for psych they are done completely by reputation poll. Menninger (spelling) keeps showing up on the rankings, though they are all but defunct from their original place in KS, and are now in TX. Another perennial top 10, sheppard pratt/ enoch, has now become an HMO haven and does not provide the depth of training you need. I think Duke loses out b/c of geographic location. If you really wanted to crunch numbers, you would see that places like Pitt, Duke, and others actually get more research funding for mental health than many "more respected" places. Go where the grants go, there is no deception in that.

 

[Doc Samson]

Go where the grants go, there is no deception in that.

Research grants don't necessarily correlate with good clinical training. I've heard Dr. Kupfer from Pitt say that you only need 2 years of clinical work to become a good psychiatrist, you can spend the other 2 doing research. I remember what I was like at the end of PGY-2, and I work with PGY-2s every day - they're not (yet) good psychiatrists.

 

[billypilgrim37]

I've heard Dr. Kupfer from Pitt say that you only need 2 years of clinical work to become a good psychiatrist...

While I won't dispute what you may have heard, the version of this phrase I've heard a few times is that residents should spend their first two years of residency learning to be good psychiatrists before they get involved in any research. I never thought he was implying that two years was sufficient to be a good psychiatrist, or that clinical training after that was somehow unnecessary or unimportant, but that a good clinical foundation was necessary to be a good researcher.

 

[OldPsychDoc]

While I won't dispute what you may have heard, the version of this phrase I've heard a few times is that residents should spend their first two years of residency learning to be good psychiatrists before they get involved in any research. I never thought he was implying that two years was sufficient to be a good psychiatrist, or that clinical training after that was somehow unnecessary or unimportant, but that a good clinical foundation was necessary to be a good researcher.

And I think it is true that Kupfer (who still lives in my brain next to Voldemort, Palpatine, and Mr. Burns--and scarier than them all put together! ) would want the legacy of Pitt to be a place that produces researchers, not primarily clinicians.