Best residencies....

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johnhoedack

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What residency programs come to mind that are the strongest but also have very low cost of living? I would like to go to a good program but with a ridiculous amount of loan debt on my back I'd also like to be able to pay interest on it while still affording to live during residency.
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http://forums.studentdoctor.net/threads/top-25-psych-programs.548979/page-3

Pick the ones from my list that are in cheap areas. You know, I have a family and live in California and am paying interest payments each month on my loans. It can be done in expensive areas.

By the way, I think Shikima is right. You create your own best experience no matter where you're at. You won't have a choice on match day where you end up. Make it YOUR best residency.
 
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there are quite a few in the midwest that might fit the bill perfectly. the best of these lot would be:

Wash U in St Louis if you like more biological psychiatry.
MCW in Milwaukee if you like more emphasis on psychotherapy training.

both excellent programs with excellent training and good salary (especially MCW) and good moonlighting opportunities (as far as i know) in very affordable but still fun cities.
 
In addition to looking at cost of living, find out about moonlighting. Cambridge Health Alliance is a great program in a city with a high cost of living, but it has ample in-house moonlighting opportunities that would allow you to put a serious dent in your loans.
 
WashU, Mayo, Iowa, Indiana, UTSW, Baylor
 
johnhoedack said:
What residency programs come to mind that are the strongest but also have very low cost of living? I would like to go to a good program but with a ridiculous amount of loan debt on my back I'd also like to be able to pay interest on it while still affording to live during residency.
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except at very bad residencies which lack structure(maybe 20% of all residencies), it doesnt much matter.....the far more important factor in terms of what sort of training you get is what YOU put into it.
 
I'm placing a vote for UC Davis. For those interested in California, I don't think you could do better quality for the economic win. Cheaper rent + excellent moonlighting opportunities. UCSF Fresno is a great little program with similar benefits too.

There are lots of high quality programs with posh resident living potential all over the country. All you have to do is subtract the most expensive places and go from there.
 
Thanks guys this has given me some good places to look I to for sure.
 
Second Nasrudin on the UC Davis rec. Top notch education, well established, some of the best forensic opportunities in the country, good psychodynamic training, pretty good moonlighting, and one of the cheaper rents in California. Sacramento is a nice town too, despite the maligning any town >5 miles from the coast gets from most Californians.
 
johnhoedack said:
What residency programs come to mind that are the strongest but also have very low cost of living? I would like to go to a good program but with a ridiculous amount of loan debt on my back I'd also like to be able to pay interest on it while still affording to live during residency.
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Places I went that I liked and had fairly good costs of living:

UVA
VCU
USC-Palmetto
USF (FL)
Indiana
MCW (Wisconsin) - extra credit for paid call shift = moonlighting!
Iowa

Really though, the pay vs housing disparity between any place outside of a major, major city like NYC/LA/etc is going to be peanuts compared to your loans or future doctor salary. You could do much better by looking at where you'll be happy and making good financial decisions during residency. For example, we bought a house last year and are racking up the equity like a boss. Getting a killer deal on a good house in a good market with good resale value will get you a nice chunk of change.
 
vistaril said:
except at very bad residencies which lack structure(maybe 20% of all residencies), it doesnt much matter.....the far more important factor in terms of what sort of training you get is what YOU put into it.
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So does that mean reading DSM-V in it's entirety? Trying to understand what you mean.
 
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I love Charlottesville, but it doesn't have a low cost of living. But you get what you pay for (nice town).
 
But true, it is a good market there. Or at least that's what jim Duncan will tell you.
 
ahmedjq said:
Some of my attendings recommended that you get through it at least once during residency.
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It's too bad that real psychiatry is so much more than a checklist. I enjoyed reading about Psychiatry in the clerkship so much more than the actual practice of it. I've heard that so called armchair Psychiatry is no longer the case. Personally I don't understand why it's necessary to have much of Psychiatry be an inpatient experience. I think Psychiatry would get a huge influx of applicants if Psychiatry was kept to be a wonderful outpatient specialty.
 
DermViser said:
So does that mean reading DSM-V in it's entirety? Trying to understand what you mean.
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No, not the DSM. That obsession largely ends with clerkship. Once you get into residency and have learned the basic diagnostic criteria, you don't think about it much.

If you are at a decent program, residency IS largely what you put into it. And by decent, I mean just that: a residency that is not poor. A residency that has a decent amount of different inpatient and outpatient services, approachable faculty, and is used appropriately by the system/university.

What you put into it means that you don't just sit passively and wait for someone to anoint you a great psychiatrist. You seek out to answer questions by lit searches and reaching out to those in the know. You stay late as needed to help with a particularly challenging case. You select some cases that particularly speak to you and go above and beyond. You get involved in services and offerings you may have few chances to outside of residency.

Psychiatry, in my mind, is one of the easiest specialties to do poorly and one of the hardest to do well. Folks can take a suicidal patient, ask SIGECAPS, and throw an SSRI at him. Or you can do more and actually be a good psychiatrist. Do it with passion, creativity, and intensity and you can be a great psychiatrist. The top programs often attract top applicants because of the nature of things, but an ambitious and insightful resident at a solid community program will turn into a better psychiatrist if they give it their all than will a resident of the same talent who coasts through doing the bare minimum at MGH.

Make sense?
 
notdeadyet said:
No, not the DSM. That obsession largely ends with clerkship. Once you get into residency and have learned the basic diagnostic criteria, you don't think about it much.

If you are at a decent program, residency IS largely what you put into it. And by decent, I mean just that: a residency that is not poor. A residency that has a decent amount of different inpatient and outpatient services, approachable faculty, and is used appropriately by the system/university.

What you put into it means that you don't just sit passively and wait for someone to anoint you a great psychiatrist. You seek out to answer questions by lit searches and reaching out to those in the know. You stay late as needed to help with a particularly challenging case. You select some cases that particularly speak to you and go above and beyond. You get involved in services and offerings you may have few chances to outside of residency.

Psychiatry, in my mind, is one of the easiest specialties to do poorly and one of the hardest to do well. Folks can take a suicidal patient, ask SIGECAPS, and throw an SSRI at him. Or you can do more and actually be a good psychiatrist. Do it with passion, creativity, and intensity and you can be a great psychiatrist. The top programs often attract top applicants because of the nature of things, but an ambitious and insightful resident at a solid community program will turn into a better psychiatrist if they give it their all than will a resident of the same talent who coasts through doing the bare minimum at MGH.

Make sense?
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But what does that mean? Asking questions to delve into why the person feels the way they do? Doing psychotherapy?
 
DermViser said:
But what does that mean? Asking questions to delve into why the person feels the way they do? Doing psychotherapy?
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Read the paragraph above the one you bolded. It means doing more then the minimum and actively furthering your learning through research, readings, and more extensive or deep clinical experiences.
 
Honestly, all of that stuff stems from whether you care about providing your patients the best level of care. If you care about patients
notdeadyet said:
Psychiatry, in my mind, is one of the easiest specialties to do poorly and one of the hardest to do well. Folks can take a suicidal patient, ask SIGECAPS, and throw an SSRI at him. Or you can do more and actually be a good psychiatrist. Do it with passion, creativity, and intensity and you can be a great psychiatrist. The top programs often attract top applicants because of the nature of things, but an ambitious and insightful resident at a solid community program will turn into a better psychiatrist if they give it their all than will a resident of the same talent who coasts through doing the bare minimum at MGH.

Make sense?
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This cannot be emphasized enough. All the attending I have been blessed to work with really emphasize the fact that good psychiatrists don't try to checklist people. Once you get the patient talking, you can pick up the diagnosis just by the way they describe certain things going on in their life.
 
Personal initiative is really important but I think it's worth pointing out that the mentors and the kind of people that surround you will make a big difference. It will take a lot more effort to challenge and push yourself to the limit with uninspiring mentors and a "checklist culture". There will also be many things that you'd notice with great mentors that you possibly wouldn't notice on your own with uncaring ones. There's also a tendency for medical students and trainees to model their practice on their superiors, and sometimes this can happen unconsciously, regardless of the effort you put in. I really don't think you can underestimate the value of personal teaching and mentorship in medicine, and you're definitely more likely to get better mentorship at the top programs.
 
It's easy to pick up good or bad habits. Take a close look at how you see patients, how you interview them, how you write notes, and you'll likely see pieces of different attendings and residents you've worked with in the past. We definitely model some part of our practice on those we learn from, there is no escaping that. Residency is still going to be about what you are willing to put in every day, however. I agree that someone giving 110% at a community program will get more out of their 4 years and will likely be a better psychiatrist than someone just putting in their time at MGH. Of course this is sort of a silly comparison because nobody who makes it to a top program is going to waste the opportunity. Hopefully.
 
If you want a good cost of living, you're going to either have to get a residency that pays a lot and/or be in a place with a low cost of living. Just from there scratch off a lot of urban places such as NYC, Philadelphia or LA unless you're alright with living in a hard to find place (so hard to find that you'll likely not find it) or have friends or family that will take you in and subsidize you. It's still possible to get a good cost of living in some residencies in cities because there might be a suburb or even rural area around the residency that's very cheap. E.g. Northern KY is about a 15 minute drive outside of Cincinnati and the cost of living there is far cheaper than living in Cincinnati.

As for best programs, I agree that a lot is what you put into it, but better programs will have a non-malignant culture, attendings that will foster your growth, a good variety of clinical exposure (E.g. involuntary and voluntary units, ECT, forensic, geriatric, VA, TBI, eating disorder clinics, child units, research).

You can still be a very good psychiatrist even at a program with very little of these offerings but it will then become more upon you to make up for the gaps. E.g. you might have to intentionally only stay at a job for 6 months as an attending to fill up for what you lacked in residency, then move on to the next job to help fill in what you missed.

I had several terrible attendings in residency but by then program director filled in a lot of what I needed. So for that reason I still thought my program was good, but that PD left my fourth year, so I couldn't say it was still that when I left.

As an attending, working in multiple settings does broaden your ability to figure things out. E.g. if you worked in community health, then as an inpatient doctor, you know what you need to do to get your patient ready enough for a community agency to handle the patient.

But some docs (and this is not being sarcastic) stay in a small box that does suit their purposes. E.g. they might be hyper-specialized, and want to stay in that box and may even be good at what they do in it.
 
Leo Aquarius said:
You won't have a choice on match day where you end up. Make it YOUR best residency.
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That's not entirely true. You do have a choice which places you rank. It's not like it's totally random with no say-so from you. The best thing to do is attend all your interviews and make a decision at that time. Even the residencies in expensive cities could very well be close to less expensive suburbs, as @whopper said in reference to Cincy and northern Kentucky.
 
When the rank lists are submitted to the computer a couple days prior to match day it's all out of your hands at that point. On match day you can't modify your rank list, it's too late then. So, in fact, it is true. We both agree that you have a lot of influence on where you go because of rank choices.
 
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