Biological vs Therapy emphasized programs

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

kindasorta

Carrot
10+ Year Member
Joined
Dec 17, 2012
Messages
279
Reaction score
13
In wrestling the snake that is my rank list, I'm not sure how to approach this. I want to be a PP doc. No interest in academics. Not keen on having some goober med student stepping on my pant leg all day. I feel like strong therapy training, while maybe not utilized quite as much in the realities of modern psych reimbursement, will still just make me a better psychiatrist. In contrast, I feel like the pharm stuff is pretty straight-forward. Read the factoids in a book, now you know them. Whereas therapy requires practice and mentorship.

So would I be at a disadvantage training at a bio heavy program? Or is it really just a wash in the end - and are the real differences matters of navel-gazing and academic nonsense.

Members don't see this ad.
 
Last edited:
So would I be at a disadvantage training at a bio heavy program?

One thing I realized on the trail was that programs aren't one or the other: a bio heavy program can have very strong psychotherapy.
 
Members don't see this ad :)
Not on my list.

the psychotherapy component is sort of what you make it....I find it hard to believe that if one was super interested in therapy they couldn't manage to get placed with supervisors who are also of this mindset.
 
the psychotherapy component is sort of what you make it....I find it hard to believe that if one was super interested in therapy they couldn't manage to get placed with supervisors who are also of this mindset.

So what are the therapy-heavy programs lacking that the biological programs provide? Am I naive in saying that med management is a pretty easily self-learnable thing. Or better said, that any and all programs will teach you what you need to know with respect to med management.
 
the psychotherapy component is sort of what you make it....I find it hard to believe that if one was super interested in therapy they couldn't manage to get placed with supervisors who are also of this mindset.

Agreed. At WashU, which probably has a reputation for being one of the most biologically-focused programs around, I met plenty of people who were very therapy-focused. One of my interviewers was a PhD psychologist who doesn't agree with the institution's overall philosophy of trying to stick with evidence-based treatments all the time... he figured that psychodynamic therapy (and other types of therapy) can add a valuable component that often can't be measured effectively in clinical research. And he's a senior faculty member. The residents spoke highly of him as a potential therapy supervisor.

kindasorta said:
So what are the therapy-heavy programs lacking that the biological programs provide? Am I naive in saying that med management is a pretty easily self-learnable thing. Or better said, that any and all programs will teach you what you need to know with respect to med management.
I agree that most programs seem to provide the same level of training for psychopharmacology - a few inpatient psych rotations, a large number of outpatients to follow, etc.

But biological psychiatry is a lot more than just psychopharmacology. I experienced many many different features of different programs that will help to train you well in biological psychiatry. At WashU (which, again, is widely regarded as one of the best in bio psych), they give you required rotations in "interventional psych" (ECT, TMS, VNS, DBS), geriatric psych, addictions, C/L, day hospital, etc... as well as 4 months of required research, joint didactics with other neuroscience-related fields, and lots of elective options. At Cleveland Clinic, they have required rotations in sleep medicine and pain medicine, and also have a LOT of clinical faculty in psychosomatic medicine (which is basically the focus of the entire program)... and they're also closely tied with other neuroscience departments. At Indiana, they have a big TMS clinic and give you the opportunity to get certified in TMS, ECT, etc... and they also have a huge addictions rotation as well as close neuroscience ties. At Florida, they have a massive addictions recovery center and also a big DBS program. At Iowa and Mayo, they have a dedicated med/psych unit where everybody rotates. Mayo also has a huge psychosomatic program as well as psych-friendly fellowships in sleep, pain, and behavioral neurology. At Kansas, the program director is med/psych trained and everybody in the program is very focused on the med/psych interface. And all of those programs have strong research in bio psych... WashU is huge in everything and has the Human Connectome Project, Mayo and Iowa are huge in psychiatric genomics/pharmacogenomics, Cleveland Clinic and Indiana are in love with neuroimaging, Florida is small but influential in addictions and DBS, etc.
 
Last edited:
  • Like
Reactions: 1 user
Agreed. At WashU, which probably has a reputation for being one of the most biologically-focused programs around, I met plenty of people who were very therapy-focused. One of my interviewers was a PhD psychologist who doesn't agree with the institution's overall philosophy of trying to stick with evidence-based treatments all the time... he figured that psychodynamic therapy (and other types of therapy) can add a valuable component that often can't be measured effectively in clinical research. And he's a senior faculty member. The residents spoke highly of him as a potential therapy supervisor.


I agree that most programs seem to provide the same level of training for psychopharmacology - a few inpatient psych rotations, a large number of outpatients to follow, etc.

But biological psychiatry is a lot more than just psychopharmacology. I experienced many many different features of different programs that will help to train you well in biological psychiatry. At WashU (which, again, is widely regarded as one of the best in bio psych), they give you required rotations in "interventional psych" (ECT, TMS, VNS, DBS), geriatric psych, addictions, C/L, day hospital, etc... as well as 4 months of required research, joint didactics with other neuroscience-related fields, and lots of elective options. At Cleveland Clinic, they have required rotations in sleep medicine and pain medicine, and also have a LOT of clinical faculty in psychosomatic medicine (which is basically the focus of the entire program)... and they're also closely tied with other neuroscience departments. At Indiana, they have a big TMS clinic and give you the opportunity to get certified in TMS, ECT, etc... and they also have a huge addictions rotation as well as close neuroscience ties. At Florida, they have a massive addictions recovery center and also a big DBS program. At Iowa and Mayo, they have a dedicated med/psych unit where everybody rotates. Mayo also has a huge psychosomatic program as well as psych-friendly fellowships in sleep, pain, and behavioral neurology. At Kansas, the program director is med/psych trained and everybody in the program is very focused on the med/psych interface. And all of those programs have strong research in bio psych... WashU is huge in everything and has the Human Connectome Project, Mayo and Iowa are huge in psychiatric genomics/pharmacogenomics, Cleveland Clinic and Indiana are in love with neuroimaging, Florida is small but influential in addictions and DBS, etc.

Appreciate it. You always have the most thoughtful replies.
 
But biological psychiatry is a lot more than just psychopharmacology. I experienced many many different features of different programs that will help to train you well in biological psychiatry. At WashU (which, again, is widely regarded as one of the best in bio psych), .

Washington university has about 40 residents pgy1-4 currently, and of those 40 a grand total of 4 come from top 20ish med schools(and really only 1 that comes from a non-not their own top 20ish med school).....they also have a bunch(>10) DO's and fmgs.

Nothing wrong with that of course, and I dont have any doubts that washingtonU provides solid training and whatnot. But they certainly aren't getting the best candidates out there, or even close to it really. They appear to be getting mostly moderate to middle of the road people.
 
So what are the therapy-heavy programs lacking that the biological programs provide? Am I naive in saying that med management is a pretty easily self-learnable thing. Or better said, that any and all programs will teach you what you need to know with respect to med management.

i honestly wouldnt get too hung up on how therapy vs biologically-heavy(whatever that means) a program is. some people who have no interest at all in therapy should probaly avoid programs where would be hard to just sleepwalk through the requirements, but other than that just focus on the overall training of the program and not whether it is therapy-heavy or not.

i get amused when I see med students making bulleted pros/cons list for every program. The big questions one must tease out in their head when picking a program are:

-do I want to live in this area
-do I want to work with mostly all amgs, or are lots of fmgs tolerable
-do I want to go to a program with a light workload, or a program with a very light workload
-do they have a child fellowship that you would stay for(for those interested in child)
-does the community generally have moonlighting opportunities available the pgy-3/4 years

Those are bigpicture things that may actually matter. Moving a program up or down based on something like whether you do your addiction month at a VA vs somewhere else is stupid and silly
 
-do I want to work with mostly all amgs, or are lots of fmgs tolerable

Is this really worthy of being considered one of the five most important questions? An argument could be made for assuming that a program with many IMG's has difficulty recruiting AMG's, and is therefore perhaps less competitive. But as an independent variable, is the question of whether or not one can 'tolerate' working with motivated individuals that happen to be foreign really a more important issue than things like having a broad clinical exposure, research opportunities and interesting electives?
 
Last edited:
A little bit of psychotherapy training is useful regardless of how you practice psych, since psychotherapy techniques can help you have a better interview and build rapport with patients. I think you can get that at any program if you take the therapy opportunities seriously.
If you have no interest in psychotherapy and go to a program where they push therapy heavily, you might feel frustrated about spending a lot of time on therapy that you could be spending doing things you're interested in. Really, I'd say just try to be honest with yourself about how much you picture yourself doing therapy in the future.
 
One thing to consider is the patient population and places you'll be rotating. I don't agree that psychopharm can be learned right out of a book--not the more complicated or risky stuff. If you go to a program where 99% of the patients are non-compliant substance induced mood disorder patients who frequently malinger in your ER or come to your clinic to get disability paperwork filled out, it is not likely that you will get much experience in using TCAs to treat OCD. And if your program's didactics are about therapy all the time, you won't get as much teaching about biological topics, and the interest among people won't be as strong, and the attendings in your program may be reluctant to let you utilize all the treatments that are out there.
 
Members don't see this ad :)
psychopharm is easier to learn than psychotherapy, but it's not as easy as just reading a book, else there would be no reason for residency. reading is important (residents probably don't read enough) but actually trying out different agents with a diverse patient population is how you actually learn, with careful supervision and discussion. in particular, there isn't a great deal of evidence to guide you in terms of combination strategies or treatment of the uncommon psychiatric syndromes. You really want to get become au fait with lithium, clozapine, conventional antipsychotics including chlorpromazine, stimulants, TCAs, MAOIs, prazosin, less commonly used anticonvulsants (e.g. tiagabine) and dealing with challenging situations - e.g. how are you going to manage your patient with rapid-cycling bipolar disorder who has failed multiple combinations, or the patient who develops agranulocytosis on clozapine but it's the only drug that works and when you stop it she develops a severe supersensitivity psychosis, or how to manage profound depression and existential despair at the end of life, or which antidepressant should you pick in your patient with tetrabenazine-induced depression, or how do you manage your bipolar patient with severe manic episodes when off meds who is now pregnant? etc etc
 
Is this really worthy of being considered one of the five most important questions?

it sets the vibe of the program in many cases.

I think a lot of amgs prefer to work with amgs. I don't think that is anything earth shattering.
 
it sets the vibe of the program in many cases.

I think a lot of amgs prefer to work with amgs. I don't think that is anything earth shattering.

I would go to Yale just because of how awesome their IMGs were- they were so interesting and fun to talk to, and their global perspective is really quite refreshing in our US-centric world. I think a dozen AMGs clustered together in one class may in fact breed a more narrow perspective and lead to more limited discussions on psychiatry. Who know, maybe US psychiatry and health care isn't in fact #1 in the world, and we may be able to learn something from other systems of care.

I find it really sad that reportedly programs have to second think ranking to match a top applicant, simply because they were educated outside the US, and fearing how people like vistaril may then evaluate their program based on that.
 
I find it really sad that reportedly programs have to second think ranking to match a top applicant, simply because they were educated outside the US, and fearing how people like vistaril may then evaluate their program based on that.
Don't sweat it. This is one of the many reasons why I don't buy Vistaril's claim that he goes to "one of the top programs in the NE."

Paranoia about IMGs and DOs matching in your psych program is a sign that you're not at one of the better ones. Middle of the pack and lower programs may have this prejudice of how potential applicants will perceive their having IMGs and DOs, as it's a buyer's market at that level. But at the better programs (and definitely the top ones), you don't see this so much as they can afford to recruit people they think are best qualified and will be the biggest asset to their program rather than go by alma mater.

The top programs don't want to attract people who are going to compulsively check the medical school of all the applicants and fret, as frankly this doesn't suggest an open-minded outside-the-box thinker that top programs desire to push their program forward and keep that top program reputation.

For IMG/DO paranoia, look to the lower/middle of the pack programs. I met DOs and IMGs who matched at some of the top ones. They were chosen because they were top notch, as were their AMG counterparts. Prestige and pedigree doesn't hold as much water at the better programs, it's a salve for the insecure.
 
Don't sweat it. This is one of the many reasons why I don't buy Vistaril's claim that he goes to "one of the top programs in the NE."

Paranoia about IMGs and DOs matching in your psych program is a sign that you're not at one of the better ones. Middle of the pack and lower programs may have this prejudice of how potential applicants will perceive their having IMGs and DOs, as it's a buyer's market at that level. But at the better programs (and definitely the top ones), you don't see this so much as they can afford to recruit people they think are best qualified and will be the biggest asset to their program rather than go by alma mater.

The top programs don't want to attract people who are going to compulsively check the medical school of all the applicants and fret, as frankly this doesn't suggest an open-minded outside-the-box thinker that top programs desire to push their program forward and keep that top program reputation.

For IMG/DO paranoia, look to the lower/middle of the pack programs. I met DOs and IMGs who matched at some of the top ones. They were chosen because they were top notch, as were their AMG counterparts. Prestige and pedigree doesn't hold as much water at the better programs, it's a salve for the insecure.

well what we know is that the top programs on average have far fewer dos/imgs than other programs. That's just what the numbers say.....
 
well what we know is that the top programs on average have far fewer dos/imgs than other programs. That's just what the numbers say.....
Yes, top programs have fewer DOs and IMGs than bottom programs. It's competitive. That's what makes them competitive programs. But the theory that you keep throwing around about wanting to avoid programs that accepts DOs and IMGs demonstrates that you're not training at a top program.

You'll notice DOs and IMGs at top programs (where they can take who they want) and DOs and IMGs at bottom programs (where they can't be choosey). It seems to be a lot of the middle-of-the-pack programs where there is the actual policy against accepting DOs and IMGs. It's as if they want to protect their ho-hum program's fragile reputation. I never hear of this palpable concern for training alongside DOs and IMGs anywhere else.

That's not to say it's open doors at the top programs for these folks. They need to be top medical students. But top medical students aren't only found at a handful of top med schools or even allopathic med schools or even American med schools. It takes a pretty closed mind to assume that the best minds from around the world aren't good enough for a particular program.
 
Yes, top programs have fewer DOs and IMGs than bottom programs. It's competitive. That's what makes them competitive programs. But the theory that you keep throwing around about wanting to avoid programs that accepts DOs and IMGs demonstrates that you're not training at a top program.

You'll notice DOs and IMGs at top programs (where they can take who they want) and DOs and IMGs at bottom programs (where they can't be choosey). It seems to be a lot of the middle-of-the-pack programs where there is the actual policy against accepting DOs and IMGs. It's as if they want to protect their ho-hum program's fragile reputation. I never hear of this palpable concern for training alongside DOs and IMGs anywhere else.
.

this doesn't jive with the numbers.......the best programs tend to have the smallest numbers of dos/imgs, the middle programs tend to have moderate numbers of dos/imgs, and the lower programs tend to be majority imgs. Now of course with classes being both small and variable year to year, this doesn't always hold true for each program....but when looked at and plotted the results are pretty striking.
 
Don't sweat it. This is one of the many reasons why I don't buy Vistaril's claim that he goes to "one of the top programs in the NE."

Paranoia about IMGs and DOs matching in your psych program is a sign that you're not at one of the better ones. Middle of the pack and lower programs may have this prejudice of how potential applicants will perceive their having IMGs and DOs, as it's a buyer's market at that level. But at the better programs (and definitely the top ones), you don't see this so much as they can afford to recruit people they think are best qualified and will be the biggest asset to their program rather than go by alma mater.

The top programs don't want to attract people who are going to compulsively check the medical school of all the applicants and fret, as frankly this doesn't suggest an open-minded outside-the-box thinker that top programs desire to push their program forward and keep that top program reputation.

For IMG/DO paranoia, look to the lower/middle of the pack programs. I met DOs and IMGs who matched at some of the top ones. They were chosen because they were top notch, as were their AMG counterparts. Prestige and pedigree doesn't hold as much water at the better programs, it's a salve for the insecure.

Wait i thought he was in the MidWest. He even said he was northwest of Missouri. Something tells me Vistiral is lying.
 
Yes, top programs have fewer DOs and IMGs than bottom programs. It's competitive. That's what makes them competitive programs. But the theory that you keep throwing around about wanting to avoid programs that accepts DOs and IMGs demonstrates that you're not training at a top program.

You'll notice DOs and IMGs at top programs (where they can take who they want) and DOs and IMGs at bottom programs (where they can't be choosey). It seems to be a lot of the middle-of-the-pack programs where there is the actual policy against accepting DOs and IMGs. It's as if they want to protect their ho-hum program's fragile reputation. I never hear of this palpable concern for training alongside DOs and IMGs anywhere else.

That's not to say it's open doors at the top programs for these folks. They need to be top medical students. But top medical students aren't only found at a handful of top med schools or even allopathic med schools or even American med schools. It takes a pretty closed mind to assume that the best minds from around the world aren't good enough for a particular program.

As a +1 to this... I'm an IMG, and I was invited for interviews at a lot of mid-to-top-tier programs, but I had very few invitations for interviews at lower-mid-tier and lower-tier programs.
 
Don't sweat it. This is one of the many reasons why I don't buy Vistaril's claim that he goes to "one of the top programs in the NE."

Paranoia about IMGs and DOs matching in your psych program is a sign that you're not at one of the better ones. Middle of the pack and lower programs may have this prejudice of how potential applicants will perceive their having IMGs and DOs, as it's a buyer's market at that level. But at the better programs (and definitely the top ones), you don't see this so much as they can afford to recruit people they think are best qualified and will be the biggest asset to their program rather than go by alma mater.

The top programs don't want to attract people who are going to compulsively check the medical school of all the applicants and fret, as frankly this doesn't suggest an open-minded outside-the-box thinker that top programs desire to push their program forward and keep that top program reputation.

For IMG/DO paranoia, look to the lower/middle of the pack programs. I met DOs and IMGs who matched at some of the top ones. They were chosen because they were top notch, as were their AMG counterparts. Prestige and pedigree doesn't hold as much water at the better programs, it's a salve for the insecure.

This isn't entirely true. I am at a rather mediocre residency program, top quarter in the nation if we're lucky, but probably looking more at the middle third, and there is no IMG fear here. My program totally relies on IMGs; otherwise they wouldn't fill in the match, at least not with decent people.

Though I see your point--there are probably a lot of mid tier programs that do look down on IMGs.

The problem I have with IMGs is that they are easily exploited. They can be incredibly good applicants and people and they can end up matching at horrible programs that will take advantage of them. It is almost impossible for me to imagine what it must be like to come to this country only to be an overworked and often disrespected resident for 4 years.

Whereas my medical school, in all its snooty arrogant evil, did not accept almost any IMGs, and they are a "top" program for sure. I heard comments there about how foreign grads just aren't as smart and stuff. I'm really glad I'm not there, because they were so full of themselves!
 
Top