Bummed Carib Grad

[Lavenlian]

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Grad (on time, w/o LoA) in May 2012 from known Caribbean school.

Step I - 193/78 (1st attempt)
Step 2 CK - 201/82 (1st attempt)
Step 2 CS - passed (1st attempt)
Taking Step 3 - August 18th and 19th


Couldn't apply psych this year b/c of LoR issues. Has since been resolved (happened after the match) and have 1 psych LoR uploaded on ERAS.

Have 20 weeks PM&R rotations - school suggested I go for that (b/c it's the closest thing to psych, supposedly) d/t previous LoR issues. PM&R experience tolerable - but not as enjoyable as psych. Had 10 interviews but obviously, I didn't match.

Wanting to apply to Psych (and only Psych) this year.

Wondering what I can do to improve my application after I take my Step 3 (e.g. observership, research, work in a psych hospital). Getting paid would be great since I have no income - but willing to do something voluntary in NY/NJ or Houston metro area (have family there and can stay for no cost) as long as it will strengthen my application for psych.

Honestly, I don't see myself enjoying any other specialty and am working to match into Psych residency anywhere

Thanks and appreciation in advance.

P.S. I am a US citizen.

 

[markglt]

Maybe an MPH??

 

[vistaril]

Grad (on time, w/o LoA) in May 2012 from known Caribbean school.

Step I - 193/78 (1st attempt)
Step 2 CK - 201/82 (1st attempt)
Step 2 CS - passed (1st attempt)
Taking Step 3 - August 18th and 19th


Couldn't apply psych this year b/c of LoR issues. Has since been resolved (happened after the match) and have 1 psych LoR uploaded on ERAS.

Have 20 weeks PM&R rotations - school suggested I go for that (b/c it's the closest thing to psych, supposedly) d/t previous LoR issues. PM&R experience tolerable - but not as enjoyable as psych. Had 10 interviews but obviously, I didn't match.

Wanting to apply to Psych (and only Psych) this year.

Wondering what I can do to improve my application after I take my Step 3 (e.g. observership, research, work in a psych hospital). Getting paid would be great since I have no income - but willing to do something voluntary in NY/NJ or Houston metro area (have family there and can stay for no cost) as long as it will strengthen my application for psych.

Honestly, I don't see myself enjoying any other specialty and am working to match into Psych residency anywhere

Thanks and appreciation in advance.

P.S. I am a US citizen.

Im confused.....exactly what is the problem?

You are an american citizen.
You go to ross/sgu/AUC, which are respectable schools
You passed steps, although you didnt get a great score you still passed.
you havent told us of any red flags. Not having a ton of electives in psych is NOT a red flag.

What is your question again?

You just need to apply to psych(not sure why you didnt last year....generic LORS wouldnt have killed you). If you apply broadly enough, you WILL match. In fact, one could argue that you should target mid-tier university programs. I think if you apply broadly enough to them in all of one region, you'll get in one of those.

Who in the heck is giving you such crappy advice at your school.......

As for the prmr angle, that's ******ed. PMR is also noncompetitive, but in some ways it is harder to match into because there are fewer slots/programs......

 

[OldPsychDoc]

Grad (on time, w/o LoA) in May 2012 from known Caribbean school.

Step I - 193/78 (1st attempt)
Step 2 CK - 201/82 (1st attempt)
Step 2 CS - passed (1st attempt)
Taking Step 3 - August 18th and 19th


Couldn't apply psych this year b/c of LoR issues. Has since been resolved (happened after the match) and have 1 psych LoR uploaded on ERAS.

Have 20 weeks PM&R rotations - school suggested I go for that (b/c it's the closest thing to psych, supposedly) d/t previous LoR issues. PM&R experience tolerable - but not as enjoyable as psych. Had 10 interviews but obviously, I didn't match.

Wanting to apply to Psych (and only Psych) this year.

Wondering what I can do to improve my application after I take my Step 3 (e.g. observership, research, work in a psych hospital). Getting paid would be great since I have no income - but willing to do something voluntary in NY/NJ or Houston metro area (have family there and can stay for no cost) as long as it will strengthen my application for psych.

Honestly, I don't see myself enjoying any other specialty and am working to match into Psych residency anywhere

Thanks and appreciation in advance.

P.S. I am a US citizen.

Pass Step 3, apply broadly, and pray that your LORs are enthusiastic about you.

 

[Lavenlian]

Maybe an MPH??

Actually, I did one in Texas before going to med school. 😀

 

[vistaril]

Pass Step 3, apply broadly, and pray that your LORs are enthusiastic about you.

what are you seeing in his OP that leads you to believe he should even take step3?

He has far more to lose by taking step3 than not taking it.

Most people, including most americans who went to carrib schools for med school, dont have step3 passed even if there is some gap between their grad date and start of residency.

Even though his scores aren't good, he *did* pass step1 and step2(and passed step2 by like 13 pts or whatever).....so he's a good bet to pass step3 on the first attempt as well.

I think in the grand scheme of things for psych, he has a perfectly decent application. I didnt see any major red flags. He's an american citizen. He states he went to one of the main carrib schools(presumably ross or sgu). He doesnt mention failing any rotations or any ethical issues.

will he be able to match at a university california program? or a top program period? No. but there are well over 100 psych programs in the country, and of those 100+ A BUNCH would be thrilled to fill their classes with american citizens who went to ross/sgu and passed all their steps on the first attempt.........

 

[OldPsychDoc]

what are you seeing in his OP that leads you to believe he should even take step3?

He has far more to lose by taking step3 than not taking it.

Most people, including most americans who went to carrib schools for med school, dont have step3 passed even if there is some gap between their grad date and start of residency.

Even though his scores aren't good, he *did* pass step1 and step2(and passed step2 by like 13 pts or whatever).....so he's a good bet to pass step3 on the first attempt as well.

I think in the grand scheme of things for psych, he has a perfectly decent application. I didnt see any major red flags. He's an american citizen. He states he went to one of the main carrib schools(presumably ross or sgu). He doesnt mention failing any rotations or any ethical issues.

will he be able to match at a university california program? or a top program period? No. but there are well over 100 psych programs in the country, and of those 100+ A BUNCH would be thrilled to fill their classes with american citizens who went to ross/sgu and passed all their steps on the first attempt.........

We don't want to rank residents who we think may not pass Step 3 and become fully licensed. (We require it to be passed before the end of PGY2--and if not, you won't get your PGY3 contract!) Yes, a good result with Step 2 is a strong predictor of success, BUT an applicant who is fortunate enough to be both eligible to take it (some states won't allow you to sit for it without 6 months of internship) and to have passed it is going to move ahead of many otherwise theoretically equivalent applicants on our rank list. In our program, he will be competing against excellent local university grads, outstanding DO grads, and creme de la creme IMGs (with wonderful English communication skills, since I know you worry about that)--so frankly, he'll want that advantage.

 

[st2205]

How is PM&R like psychiatry? Is it the physiatry that's tripping them up?

 

[Lavenlian]

Im confused.....exactly what is the problem?

You are an american citizen.
You go to ross/sgu/AUC, which are respectable schools
You passed steps, although you didnt get a great score you still passed.
you havent told us of any red flags. Not having a ton of electives in psych is NOT a red flag.

What is your question again?

You just need to apply to psych(not sure why you didnt last year....generic LORS wouldnt have killed you). If you apply broadly enough, you WILL match. In fact, one could argue that you should target mid-tier university programs. I think if you apply broadly enough to them in all of one region, you'll get in one of those.

Who in the heck is giving you such crappy advice at your school.......

As for the prmr angle, that's ******ed. PMR is also noncompetitive, but in some ways it is harder to match into because there are fewer slots/programs......

Thanks for responding. I wanted to show something for myself in this year off - something with relevant psychiatry experience. I will definitely apply to over 100 programs nationwide. I do have an MPH and have clinical research experience - so I was thinking along the lines of psych research.

And yes my school sucks at giving at advice - PM&R apparently got ridiculously tough this past match cycle due to increased applications for limited spots. I did not apply to Psych this year due to the fact I didn't have a Psych LoR - but thank goodness, I was able to get it (although it cost me a year 🙁).

 

[vistaril]

We don't want to rank residents who we think may not pass Step 3 and become fully licensed. (We require it to be passed before the end of PGY2--and if not, you won't get your PGY3 contract!) Yes, a good result with Step 2 is a strong predictor of success, BUT an applicant who is fortunate enough to be both eligible to take it (some states won't allow you to sit for it without 6 months of internship) and to have passed it is going to move ahead of many otherwise theoretically equivalent applicants on our rank list. In our program, he will be competing against excellent local university grads, outstanding DO grads, and creme de la creme IMGs (with wonderful English communication skills, since I know you worry about that)--so frankly, he'll want that advantage.

1) there is no indication to think he "won't pass step 3 and become fully licensed". In fact, the first time step3 pass% of candidates who have passed step1 and step2 on their first attempts is astronomical. Even if the very unlikely should happen and he fail step 3 on his first attempt, he'd be almost guaranteed to pass it on a second attempt and licensure would never be an issue. Quite frankly if a program has ever had an issue with a resident not passing step3 after TWO WHOLE YEARS, I'd say that speaks volumes about that candidate and any program that let him/her in.

2) The best psych programs in the country have almost NO people applying with step 3 under their belt. Sorry, that's true and we all know it. The reason for this is obvious- the best programs in the country get almost all american grads on schedule, and no american grads on schedule have taken step3 yet when applying. A few havent even taken step2 cs. I was one of the two residents in our program last year who had to sort through applications and participate in the screening process with the assistant PD, and at no point did we ever say "oh gosh, this person hasnt taken step 3". Quite frankly, any candidate who is eligible to have taken step3 would have been less favorable.

3) the fact that your program takes IMGS and DOs would certainly indicate that the OP would be a perfectly reasonable candidate at your program. It doesn't mean he would neccessarily get into it, but given that there are OVER 100 such programs in the country, he's definately going to get in one.

is the OP going to match at stanford? No. Can the OP pick any one solid university program at random and feel he has a > 75% chance to get in there? No. But if he applies to a broad range of non-elite university programs, he has near a 100% chance to get in one. Taking step3 is thus not needed.

in fact, if I were the OP I would avoid programs that are flooded with non american IMGS and obviously sketchy candidates. He's a pretty blah candidate himself, but he can do better than going to a program where 5/6 of the new interns are nonamerican and all require some sort of visa......

if the OP wants to tell us what region he is from or wants to target, I'd be happy to send him a list of 10-12 programs he should target

 

[vistaril]

Thanks for responding. I wanted to show something for myself in this year off - something with relevant psychiatry experience. I will definitely apply to over 100 programs nationwide. I do have an MPH and have clinical research experience - so I was thinking along the lines of psych research.

And yes my school sucks at giving at advice - PM&R apparently got ridiculously tough this past match cycle due to increased applications for limited spots. I did not apply to Psych this year due to the fact I didn't have a Psych LoR - but thank goodness, I was able to get it (although it cost me a year 🙁).

see this is the part that MAKES NO SENSE and makes me wonder if there are other factors that are really hindering you.

How the heck could you not get a psych LOR????

Did you do a psych rotation your ms3 year????

Were there psychiatrists on it???

Did you do a half ass decent job, and at some point tell one of the attendings that you were interested in psychiatry??

If the answer to the above 3 questions is yes, then what the heck prevented you from contacting one of the attendings on your psych rotation, explaining that you are going into psych, and would appreciate a LOR? That's how I did it. that's how everyone does it.

there are real reasons why someone doesnt start residency on time and has a gap between or during med school......failing step 1 or 2 a couple times, medical illness, failing clinical rotations for various reasons. All these are BIG DEALS and thus cost people starting residency on time.

What happened to you(couldnt get a LOR....wtf???) is a ridiculous reason for someone to basically lose a year of their life and career.....

As for "more experience in psychiatry", this isn't needed......many people only do their ms3 core rotation before applying. In fact, I've heard some people say that since youre going to spend the rest of your life doing psych, it's a good time to get more exposure in other areas of medicine........that's one way to look at it at least. I dont think doing a couple electives as an ms4 in psych is a bad idea either, but it is certainly not neccessary....

Also, over 100 programs? that is ridiculous if you are shooting straight with us. Select 20-25 or so programs and apply to those. You dont need to apply to 100.

 

[splik]

2) The best psych programs in the country have almost NO people applying with step 3 under their belt. Sorry, that's true and we all know it. The reason for this is obvious- the best programs in the country get almost all american grads on schedule, and no american grads on schedule have taken step3 yet when applying.

err...the OP is not an 'american grad' and is not a candidate for 'the best psych programs in the country'. OTOH i am a foreigner, i am at one these programs, and I did have step 3...which undoubtedly helped me match...the OP may well match without it, but a step 3 pass can only help his/her app, and as you said yourself, almost certainly will pass.

in fact, if I were the OP I would avoid programs that are flooded with non american IMGS and obviously sketchy candidates. He's a pretty blah candidate himself, but he can do better than going to a program where 5/6 of the new interns are nonamerican and all require some sort of visa......

whilst the OP might do well to go to a program that is not full of foreigners in terms of making friends etc (foreigners tend to be older, have families, hang around with their own cultural group), what exactly is wrong with 'nonamerican' who 'all require some sort of visa?'

 

[vistaril]

Thanks for responding. I wanted to show something for myself in this year off - something with relevant psychiatry experience. I will definitely apply to over 100 programs nationwide. I do have an MPH and have clinical research experience - so I was thinking along the lines of psych research.

And yes my school sucks at giving at advice - PM&R apparently got ridiculously tough this past match cycle due to increased applications for limited spots. I did not apply to Psych this year due to the fact I didn't have a Psych LoR - but thank goodness, I was able to get it (although it cost me a year 🙁).

wtf??? There are very real reasons for losing timebetween or during med school......failing step 1 or 2 a couple times, medical illness, failing clinical rotations for various reasons. All these are BIG DEALS and thus cost people starting residency on time.

What happened to you(couldnt get a LOR....wtf???) is a ridiculous reason for someone to basically lose a year of their life and career.....did you not do an ms3 rotation in psych? if you did, why the hell couldnt you get a letter of rec? Are you so avoidant that you couldnt ask an attending on the rotation to do that for you?

As for "more experience in psychiatry", this isn't needed......many people only do their ms3 core rotation before applying. In fact, I've heard some people say that since youre going to spend the rest of your life doing psych, it's a good time to get more exposure in other areas of medicine........that's one way to look at it at least. I dont think doing a couple electives as an ms4 in psych is a bad idea either, but it is certainly not neccessary....

Also, over 100 programs? that is ridiculous if you are shooting straight with us. Select 20-25 or so programs and apply to those. You dont need to apply to 100.

 

[vistaril]

Thanks for responding. I wanted to show something for myself in this year off - something with relevant psychiatry experience. I will definitely apply to over 100 programs nationwide. I do have an MPH and have clinical research experience - so I was thinking along the lines of psych research.

And yes my school sucks at giving at advice - PM&R apparently got ridiculously tough this past match cycle due to increased applications for limited spots. I did not apply to Psych this year due to the fact I didn't have a Psych LoR - but thank goodness, I was able to get it (although it cost me a year 🙁).

wtf??? What do you mean you couldnt get a letter? Were you present during your ms3 psych clerkship? Were the attendings present as well? Why couldnt they write you a letter? There are real reasons for people to miss time after or
between or during med school......failing step 1 or 2 a couple times, medical illness, failing clinical rotations for various reasons. All these are BIG DEALS and thus cost people starting residency on time.

What happened to you(couldnt get a LOR....wtf???) is a ridiculous reason for someone to basically lose a year of their life and career.....

As for "more experience in psychiatry", this isn't needed......many people only do their ms3 core rotation before applying. In fact, I've heard some people say that since youre going to spend the rest of your life doing psych, it's a good time to get more exposure in other areas of medicine........that's one way to look at it at least. I dont think doing a couple electives as an ms4 in psych is a bad idea either, but it is certainly not neccessary....

Also, over 100 programs? that is ridiculous if you are shooting straight with us. Select 20-25 or so programs and apply to those. You dont need to apply to 100.

 

[diagonal]

What happened to you(couldnt get a LOR....wtf???) is a ridiculous reason for someone to basically lose a year of their life and career.....did you not do an ms3 rotation in psych? if you did, why the hell couldnt you get a letter of rec? Are you so avoidant that you couldnt ask an attending on the rotation to do that for you?

Some preceptors won't write letters because, to them, med students are a source of extra cash, not little saplings they want to nurture. Solid conclusion jumping homey.

 

[Lavenlian]

1) there is no indication to think he "won't pass step 3 and become fully licensed". In fact, the first time step3 pass% of candidates who have passed step1 and step2 on their first attempts is astronomical. Even if the very unlikely should happen and he fail step 3 on his first attempt, he'd be almost guaranteed to pass it on a second attempt and licensure would never be an issue. Quite frankly if a program has ever had an issue with a resident not passing step3 after TWO WHOLE YEARS, I'd say that speaks volumes about that candidate and any program that let him/her in.

2) The best psych programs in the country have almost NO people applying with step 3 under their belt. Sorry, that's true and we all know it. The reason for this is obvious- the best programs in the country get almost all american grads on schedule, and no american grads on schedule have taken step3 yet when applying. A few havent even taken step2 cs. I was one of the two residents in our program last year who had to sort through applications and participate in the screening process with the assistant PD, and at no point did we ever say "oh gosh, this person hasnt taken step 3". Quite frankly, any candidate who is eligible to have taken step3 would have been less favorable.

3) the fact that your program takes IMGS and DOs would certainly indicate that the OP would be a perfectly reasonable candidate at your program. It doesn't mean he would neccessarily get into it, but given that there are OVER 100 such programs in the country, he's definately going to get in one.

is the OP going to match at stanford? No. Can the OP pick any one solid university program at random and feel he has a > 75% chance to get in there? No. But if he applies to a broad range of non-elite university programs, he has near a 100% chance to get in one. Taking step3 is thus not needed.

in fact, if I were the OP I would avoid programs that are flooded with non american IMGS and obviously sketchy candidates. He's a pretty blah candidate himself, but he can do better than going to a program where 5/6 of the new interns are nonamerican and all require some sort of visa......

if the OP wants to tell us what region he is from or wants to target, I'd be happy to send him a list of 10-12 programs he should target

I'm a native Texan, I love the South - but I am residing in NY as I did my clinical rotations here and in NJ, so I would definitely target this region as well.

 

[vistaril]

err...the OP is not an 'american grad' and is not a candidate for 'the best psych programs in the country'. OTOH i am a foreigner, i am at one these programs, and I did have step 3...which undoubtedly helped me match...the OP may well match without it, but a step 3 pass can only help his/her app, and as you said yourself, almost certainly will pass.



whilst the OP might do well to go to a program that is not full of foreigners in terms of making friends etc (foreigners tend to be older, have families, hang around with their own cultural group), what exactly is wrong with 'nonamerican' who 'all require some sort of visa?'

1) the OP will match without it. His chance to match if he applies reasonably approaches 100%. His chance to match if he applies reasonably and passes step3 before he applies also approaches 100%. The only thing that would bring his chances to match at significantly below 100% is if he does something like not apply reasonably or has a horrible day and fails step3. Thus, taking step4 is stupid.

2) nothing is neccessarily wrong with foreigners....I dont have a lot of experience with them as my program is good enough that we dont have to take them. But given the choice between going to a program filled with americans or a program filled with non-americans, I would go to the program filled with americans.

3) It is well known that in most residencies the preference is american grads > american IMGS from the more established schools > fmgs

 

[Lavenlian]

wtf??? What do you mean you couldnt get a letter? Were you present during your ms3 psych clerkship? Were the attendings present as well? Why couldnt they write you a letter? There are real reasons for people to miss time after or
between or during med school......failing step 1 or 2 a couple times, medical illness, failing clinical rotations for various reasons. All these are BIG DEALS and thus cost people starting residency on time.

What happened to you(couldnt get a LOR....wtf???) is a ridiculous reason for someone to basically lose a year of their life and career.....

As for "more experience in psychiatry", this isn't needed......many people only do their ms3 core rotation before applying. In fact, I've heard some people say that since youre going to spend the rest of your life doing psych, it's a good time to get more exposure in other areas of medicine........that's one way to look at it at least. I dont think doing a couple electives as an ms4 in psych is a bad idea either, but it is certainly not neccessary....

Also, over 100 programs? that is ridiculous if you are shooting straight with us. Select 20-25 or so programs and apply to those. You dont need to apply to 100.

Look I was planning to save the specifics for the interview. But if you insist, my preceptor had no contact with me - I was assigned to another psychiatrist. She has severe MS and ambulates with a straight cane. She is relatively young, has only been an attending for a couple years, and she was writing rec letters for the first time. She made a mistake by not uploading the letter on an official letterhead. It was flagged by ERAS.

I tried to get in touch with her via phone and e-mail for the course of 6 weeks to no avail. It ended up that she was out with an MS exacerbation. When my school adviser got in touch with me, I was told not to apply to Psych b/c I did have a Psych LoR on ERAS and that it would be a total waste of time and money to do as such. Since I liked Psych and pretty much nothing else, I was told to try for PM&R (the school had picked up a new PM&R rotation) and I went down that avenue.

After not matching, I randomly showed up to the Psych hospital without an appointment to see my attending (whose condition has become worse since I last saw her). She works public psychiatry (so she's always inundated). She was able to send me off with a sealed LoR that I mailed to ERAS.

I have no red flags - took all my classes and exams - passed them all on first attempt and no disciplinary issues. I am only considering applying to so many programs because I don't want to take the risk of not matching, AGAIN.

Please understand my situation. I'm being honest and I'm not here to waste anyone's time.

 

[vistaril]

Some preceptors won't write letters because, to them, med students are a source of extra cash, not little saplings they want to nurture. Solid conclusion jumping homey.

nonsense.....any physician who agrees to participate in medical education and take on medical students enters into an implied agreement to do things like write letters for students who have spent significant time on their service when asked.

Now they dont have to be A+ letters, and they can even be short and generic and therefore fairly meaningless. But it's just part of being a teaching attending.

 

[splik]

2) nothing is neccessarily wrong with foreigners....I dont have a lot of experience with them as my program is good enough that we dont have to take them.

er...and MGH, Columbia, UCLA, and UCSF were not good enough and thus did 'have to take "them"'??! or could they perchance have decided that they wanted to best applicants regardless of whether they were from the US, Europe, South America or Asia?

 

[diagonal]

nonsense.....any physician who agrees to participate in medical education and take on medical students enters into an implied agreement to do things like write letters for students who have spent significant time on their service when asked.

Now they dont have to be A+ letters, and they can even be short and generic and therefore fairly meaningless. But it's just part of being a teaching attending.

You're just wrong.

 

[vistaril]

Look I was planning to save the specifics for the interview. But if you insist, my preceptor had no contact with me - I was assigned to another psychiatrist. She has severe MS and ambulates with a straight cane. She is relatively young, has only been an attending for a couple years, and she was writing rec letters for the first time. She made a mistake by not uploading the letter on an official letterhead. It was flagged by ERAS.

I tried to get in touch with her via phone and e-mail for the course of 6 weeks to no avail. It ended up that she was out with an MS exacerbation. When my school adviser got in touch with me, I was told not to apply to Psych b/c I did have a Psych LoR on ERAS and that it would be a total waste of time and money to do as such. Since I liked Psych and pretty much nothing else, I was told to try for PM&R (the school had picked up a new PM&R rotation) and I went down that avenue.

After not matching, I randomly showed up to the Psych hospital without an appointment to see my attending (whose condition has become worse since I last saw her). She works public psychiatry (so she's always inundated). She was able to send me off with a sealed LoR that I mailed to ERAS.

I have no red flags - took all my classes and exams - passed them all on first attempt and no disciplinary issues. I am only considering applying to so many programs because I don't want to take the risk of not matching, AGAIN.

Please understand my situation. I'm being honest and I'm not here to waste anyone's time.

the fact that you couldn't properly deal with such a relatively straightforward problem that affects YOUR WHOLE LIFE in such a major way is pretty concerning.

Honestly, when asked about this in interviews, I would think of some other story to tell....because this looks bad. If you can let a relatively small inconvenience snowball into something catastrophic(like this did....you lost a whole year for no good reason), what is the guarantee that it wont happen again?

the appropriate thing to do when your school advisor contacted you would be to explain the situation, tell them that you would like to submit your eras to all the psych programs, and then for the next month to two months do WHATEVER IT TOOK to make sure that MS psychiatrist sent in that letter. If you need to, you could even have personally emailed or called each program and explained the situation.......

or another alternative would have been to hurriedly schedule an early ms4 psych elective and get a LOR to send in from that through eras so that each school would have one shortly thereafter......

It's really amazing how incompetently you handled this. I hate to be so blunt, but you somehow managed to turn a minor inconvenience/stroke up a bad luck into a major catastrophe. and it was all your own doing.

when stuff like this happens, you have to be more proactive.

 

[vistaril]

er...and MGH, Columbia, UCLA, and UCSF were not good enough and thus did 'have to take "them"'??! or could they perchance have decided that they wanted to best applicants regardless of whether they were from the US, Europe, South America or Asia?

without going back and checking the % of nonamericans at each of those programs, I can confidently say that over the last decade those 4 programs have had much lower %'s of non-americans match there than the psychiatry averages........

there is a very clear trend that the better a program is, the less likely they will have non-americans. Obviously that doesnt mean there will never be one, but as I said before, the % of fmgs at those programs you mention is very low compared to psychiatry as a whole

 

[Lavenlian]

the fact that you couldn't properly deal with such a relatively straightforward problem that affects YOUR WHOLE LIFE in such a major way is pretty concerning.

Honestly, when asked about this in interviews, I would think of some other story to tell....because this looks bad. If you can let a relatively small inconvenience snowball into something catastrophic(like this did....you lost a whole year for no good reason), what is the guarantee that it wont happen again?

the appropriate thing to do when your school advisor contacted you would be to explain the situation, tell them that you would like to submit your eras to all the psych programs, and then for the next month to two months do WHATEVER IT TOOK to make sure that MS psychiatrist sent in that letter. If you need to, you could even have personally emailed or called each program and explained the situation.......

or another alternative would have been to hurriedly schedule an early ms4 psych elective and get a LOR to send in from that through eras so that each school would have one shortly thereafter......

It's really amazing how incompetently you handled this. I hate to be so blunt, but you somehow managed to turn a minor inconvenience/stroke up a bad luck into a major catastrophe. and it was all your own doing.

when stuff like this happens, you have to be more proactive.

Really appreciate you kicking me when I'm down. I'm not going to lie in my interviews - that is totally unprofessional. I got advice (bad advice) from my school and I'm paying for the consequences. It sucks showing up to a psych hospital trying to get to the floor to meet your attending and not being allowed in because she's not there. I couldn't even speak to anyone on her unit to find out what the situation was. My preceptor (who didn't even remember me) threatened to report me to my school for trying to gain illegal entry into the hospital. I was basically told to give up on Psych altogether because I didn't have a core psych LoR.

Try understanding for a moment - or if not, give me a list of programs (including yours somewhere on the list) to steer clear from because I'm so grossly incompetent.

Thank you.

 

[vistaril]

Really appreciate you kicking me when I'm down. I'm not going to lie in my interviews - that is totally unprofessional. I got advice (bad advice) from my school and I'm paying for the consequences. It sucks showing up to a psych hospital trying to get to the floor to meet your attending and not being allowed in because she's not there. I couldn't even speak to anyone on her unit to find out what the situation was. My preceptor (who didn't even remember me) threatened to report me to my school for trying to gain illegal entry into the hospital. I was basically told to give up on Psych altogether because I didn't have a core psych LoR.

Try understanding for a moment - or if not, give me a list of programs (including yours somewhere on the list) to steer clear from because I'm so grossly incompetent.

Thank you.

see, this shows that you still don't even take responsibility for what happened: "I got bad advice from my school.............."

what?????

if you are honest about what happened, you definately shouldn't take this approach. Because when someone you interview with hears you ramble on about showing up at a psych hospital trying to get a letter and blah blah....they are going to automatically toss you out of consideration. Again, if you are going to be honest about what happened, accept ALL the blame. Say something like "I totally dropped the ball on my application. I was so disorganized and I know i need to work on that. Hopefully I've learned from this mistake as I have definately paid for it dearly"........that approach, if your being honest, is the only way to go.

because it will boggle the mind of anyone if you try to explain how you LOST A YEAR because you couldnt get a freaking letter. When the dmv makes an error processing your drivers license application do you just take the bus for the next 3 years and blame it on someone else???? Because thats basically what happened here.....

again, why didn't you try to do an elective early in your fourth year and get a letter that way? Thats the first thing that is going to pop in the mind of programs? And before you answer with some excuse, let me tell you what the right answer is: "your right, I should have done that. I really dropped the ball on this whole thing and am paying for it dearly. I have nobody to blame but myself".......

as for blaming your med school advisors or whatnot, thats ridiculous. Your in your mid to late 20s presumably and a med school graduate. When someone gives you completely ridiculous advice concerning YOUR future, you can't just blindly take it......dont ever tell a residency program thats what you did.

I'll send out a list of programs you should target later....are you looking to target the south/tx or are you looking to target the northeast?

 

[diagonal]

^are you an axe murderer? srs

 

[Lavenlian]

see, this shows that you still don't even take responsibility for what happened: "I got bad advice from my school.............."

what?????

if you are honest about what happened, you definately shouldn't take this approach. Because when someone you interview with hears you ramble on about showing up at a psych hospital trying to get a letter and blah blah....they are going to automatically toss you out of consideration. Again, if you are going to be honest about what happened, accept ALL the blame. Say something like "I totally dropped the ball on my application. I was so disorganized and I know i need to work on that. Hopefully I've learned from this mistake as I have definately paid for it dearly"........that approach, if your being honest, is the only way to go.

because it will boggle the mind of anyone if you try to explain how you LOST A YEAR because you couldnt get a freaking letter. When the dmv makes an error processing your drivers license application do you just take the bus for the next 3 years and blame it on someone else???? Because thats basically what happened here.....

again, why didn't you try to do an elective early in your fourth year and get a letter that way? Thats the first thing that is going to pop in the mind of programs? And before you answer with some excuse, let me tell you what the right answer is: "your right, I should have done that. I really dropped the ball on this whole thing and am paying for it dearly. I have nobody to blame but myself".......

as for blaming your med school advisors or whatnot, thats ridiculous. Your in your mid to late 20s presumably and a med school graduate. When someone gives you completely ridiculous advice concerning YOUR future, you can't just blindly take it......dont ever tell a residency program thats what you did.

I'll send out a list of programs you should target later....are you looking to target the south/tx or are you looking to target the northeast?

Trust me I've been kicking myself since match week - but it's been a blessing in disguise that I didn't match PM&R. Now I have another chance to go for what I actually want to do.

Aside from being honest - how else do I explain my numerous weeks of rotation in PM&R? As far as I'm aware, there is no rehab psych (outside of addiction). Sure, I saw orthopedic, chronic pain, TBI, and SCI pts. But how do I tie ALL that into Psych? If you can help me out with this, I would greatly appreciate it.

And I would prefer to target TX/South.

 

[vistaril]

Trust me I've been kicking myself since match week - but it's been a blessing in disguise that I didn't match PM&R. Now I have another chance to go for what I actually want to do.

Aside from being honest - how else do I explain my numerous weeks of rotation in PM&R? As far as I'm aware, there is no rehab psych (outside of addiction). Sure, I saw orthopedic, chronic pain, TBI, and SCI pts. But how do I tie ALL that into Psych? If you can help me out with this, I would greatly appreciate it.

And I would prefer to target TX/South.

I think you are thinking too much about the importance they will place on some extra rotations in pm&r......if they ask you, you can say you just were interested in it and wanted to learn more about it. You can even say you tried to match in in last year. I dont know that I'd go that route, but it probably wouldnt hurt you.

many of my fellow residents did not take a single elective in psych......it's not required, and it's not a big deal.

allright......here is a good starting point as a list of programs you should apply to from texas looping east through the southeast......

Texas A&M scott and white program
University of Texas-Houston
University of Texas-Galveston
University of Mississippi
University of Arkansas
University of Oklahoma
University of Louisiana-NO
University of Louisiana-Shreveport
University of Texas-San Antonio
University of Alabama-Birmingham
University of South Carolina(Columbia)
Medical College of Georgia
East Carolina University
Wake Forest
University of Tennessee-Memphis
East Tennessee State University

none of those programs are considered competitive in any way, shape or form. And some of them have a very hard time finding decent people. The most competitive of the bunch are probably South Carolina(easy schedule), Arkansas and Oklahoma(keep a lot of their own people).......

if you want some outside/long shot programs you could throw in places like MUSC, UTSW, maybe the florida programs.....

 

[TexasPhysician]

I think you are thinking too much about the importance they will place on some extra rotations in pm&r......if they ask you, you can say you just were interested in it and wanted to learn more about it. You can even say you tried to match in in last year. I dont know that I'd go that route, but it probably wouldnt hurt you.

many of my fellow residents did not take a single elective in psych......it's not required, and it's not a big deal.

allright......here is a good starting point as a list of programs you should apply to from texas looping east through the southeast......

Texas A&M scott and white program
University of Texas-Houston
University of Texas-Galveston
University of Mississippi
University of Arkansas
University of Oklahoma
University of Louisiana-NO
University of Louisiana-Shreveport
University of Texas-San Antonio
University of Alabama-Birmingham
University of South Carolina(Columbia)
Medical College of Georgia
East Carolina University
Wake Forest
University of Tennessee-Memphis
East Tennessee State University

none of those programs are considered competitive in any way, shape or form. And some of them have a very hard time finding decent people. The most competitive of the bunch are probably South Carolina(easy schedule), Arkansas and Oklahoma(keep a lot of their own people).......

if you want some outside/long shot programs you could throw in places like MUSC, UTSW, maybe the florida programs.....

As someone who applied to many of those programs:

Oklahoma fills many years with only internal applicants. I wouldn't waste my time.

UTMB takes only US MD/DO's and has the highest Step average in TX over the past 2 years. More competitive than UTSW lately.

Arkansas has been becoming more competitive as well. They are a diamond in the rough. Their internal moonlighting is quite nice. Worth trying though.

Least competitive in TX - Texas Tech, JPS, UT-Houston, Baylor. UTSA would be close as well. If you apply to Tech El Paso, I would call/email to let them know how badly you want an interview. They overlook good applicants because they know they won't go there.

 

[OldPsychDoc]

Really appreciate you kicking me when I'm down. I'm not going to lie in my interviews - that is totally unprofessional. I got advice (bad advice) from my school and I'm paying for the consequences. It sucks showing up to a psych hospital trying to get to the floor to meet your attending and not being allowed in because she's not there. I couldn't even speak to anyone on her unit to find out what the situation was. My preceptor (who didn't even remember me) threatened to report me to my school for trying to gain illegal entry into the hospital. I was basically told to give up on Psych altogether because I didn't have a core psych LoR.

Try understanding for a moment - or if not, give me a list of programs (including yours somewhere on the list) to steer clear from because I'm so grossly incompetent.

Thank you.

About the only advice I would be taking from vistaril is to find out where he is training and to stay the heck away from there.

Good luck on this application cycle. Advice is the same: apply broadly, look inland, don't necessarily count yourself out of all the top university programs, but you shouldn't need to reach deep into the malignant IMG mills, either. PM me if you want to talk midwest programs.

 

[OldPsychDoc]

Trust me I've been kicking myself since match week - but it's been a blessing in disguise that I didn't match PM&R. Now I have another chance to go for what I actually want to do.

Aside from being honest - how else do I explain my numerous weeks of rotation in PM&R? As far as I'm aware, there is no rehab psych (outside of addiction). Sure, I saw orthopedic, chronic pain, TBI, and SCI pts. But how do I tie ALL that into Psych? If you can help me out with this, I would greatly appreciate it.

And I would prefer to target TX/South.

There is a LOT of overlap with psych on these patients, and I think both fields are interested in a long-term, rehabilitative approach to patients' problems. Rehab is always consulting us, and I share a number of outpatients with PM&R.

You don't need to apologize at all. You can even say you were truly interested in PM&R but you found yourself more interested in the psychological side of patients than the physical. I had a colleague in residency that transferred out of psych to PM&R because she was more interested in the interventional pain piece, and she ended up replaced by a resident transferring the other direction.

 

[vistaril]

As someone who applied to many of those programs:

Oklahoma fills many years with only internal applicants. I wouldn't waste my time.

UTMB takes only US MD/DO's and has the highest Step average in TX over the past 2 years. More competitive than UTSW lately.

Arkansas has been becoming more competitive as well. They are a diamond in the rough. Their internal moonlighting is quite nice. Worth trying though.

Least competitive in TX - Texas Tech, JPS, UT-Houston, Baylor. UTSA would be close as well. If you apply to Tech El Paso, I would call/email to let them know how badly you want an interview. They overlook good applicants because they know they won't go there.

yeah...Im aware those are the least competitive.....they(jps and tt) are also really crappy as well. I think the op can do better. As long as he plays the lost year off decently......

as for arkansas and Ok filling with their own people....yes, this is true. But what we dont know is how many people from those schools will be going into psych. One year they may have 10....another 2. So obviously if its one of those years with low numbers, those two programs(although they are decent) are going to have trouble filling with all US allo grads.....they depend on their own grads to do that.

 

[vistaril]

About the only advice I would be taking from vistaril is to find out where he is training and to stay the heck away from there.

QUOTE]


oh he has nothing to worry about as my program, unlike most, doesnt require DOs or imgs/fmgs to fill. As someone who has screened people for interviews before, he wouldn't get an interview.

 

[digitlnoize]

the only advice I would be taking from vistaril is to find out where he is training and to stay the heck away from there.

So true. I wonder where it is?

OP, listen to everyone that's not vistaril. Especially OldPsychDoc. OPD knows what's up.

Apply broadly. It's not that expensive. Interview at a decent range of places. I still like the 1/3 rule. 1/3 top/reach places, 1/3 medium place, 1/3 safety/lower-tier places.

For safeties on the east coast, I'd look at Carilion Clinic in Roanoke and East Carolina. Both are decent places with nice folks, which have a good history of taking caribbean grads (esp. ECU) and not being too competitive, while still being a decent place to train. I interviewed at, and ranked both, although not very highly, but they're still decent places.

 

[vistaril]

So true. I wonder where it is?

OP, listen to everyone that's not vistaril. Especially OldPsychDoc. OPD knows what's up.

Apply broadly. It's not that expensive. Interview at a decent range of places. I still like the 1/3 rule. 1/3 top/reach places, 1/3 medium place, 1/3 safety/lower-tier places.

For safeties on the east coast, I'd look at Carilion Clinic in Roanoke and East Carolina. Both are decent places with nice folks, which have a good history of taking caribbean grads (esp. ECU) and not being too competitive, while still being a decent place to train. I interviewed at, and ranked both, although not very highly, but they're still decent places.

agree on ecu. Although you won't work with many american grads, from what I've heard it provides acceptable training. Cariion though, I would stay the heck away from. Have heard some truly bad things about it. Maybe one of the worst reps in the country.

 

[digitlnoize]

agree on ecu. Although you won't work with many american grads, from what I've heard it provides acceptable training. Cariion though, I would stay the heck away from. Have heard some truly bad things about it. Maybe one of the worst reps in the country.

Nope. I worked there for a bit, and I'm from Roanoke. Good faculty, nice people, nice facilities (very nice adult inpatient unit and staff), surprisingly diverse pathology for the area (it helps that Va has a severe shortage of psych units. It's not uncommon to ship patients HOURS from one ER to the only open bed in the state.)

The only negative things I can say are: The didactics aren't great. One of the C-L attendings likes to take the stairs (ugh). They have to trek across town to the VA sometimes. High % of FMGs, but most of these were quite good. One went on to fellowship at Yale. I've heard that no one there likes their Child rotation, and can only chalk this up to poor support staff, from what I've heard, but not a problem on adult. The program secretary was a horrible, horrible borderline-type, but she is now fired and replaced with someone much more organized and better.

There were a few AMGs there though who were extremely good. The PD is super-awesome nice, as are the adult attendings. They're involved in a decent bit of research projects, but it's obviously not a research power house. I wouldn't say it's a "cushy" place, but no one seemed worked to death.

Again, it's not a *great* place, but it's a good place. I'd trust someone who worked there and knows the people over word of mouth any day.

 

[2000 Man]

yeah...Im aware those are the least competitive.....they(jps and tt) are also really crappy as well. I think the op can do better. As long as he plays the lost year off decently......

as for arkansas and Ok filling with their own people....yes, this is true. But what we dont know is how many people from those schools will be going into psych. One year they may have 10....another 2. So obviously if its one of those years with low numbers, those two programs(although they are decent) are going to have trouble filling with all US allo grads.....they depend on their own grads to do that.

OK, I am curious, why is JPS "crappy"?

 

[TexasPhysician]

OK, I am curious, why is JPS "crappy"?

Crap is harsh. It doesn't have any fellowships and the diversity of sites nixed it for me. The DO stigma is probably not helping. Call isn't light either. Otherwise I love fort worth.

I think it's worth a look. If anything, it would be a good safety school.

 

[notdeadyet]

1) the OP will match without it. His chance to match if he applies reasonably approaches 100%. His chance to match if he applies reasonably and passes step3 before he applies also approaches 100%. The only thing that would bring his chances to match at significantly below 100% is if he does something like not apply reasonably or has a horrible day and fails step3. Thus, taking step4 is stupid.

I think you mean to say Step 3 here. But you're still wrong. You're talking about his application approaching 100%, but I'm curious where you're getting your data.

From Charting Outcomes, directly from the NRMP:

Independent applicants with Step 1's between 191-200: 71/230 (match rate of 31%)
Independent applicants with Step 2's between 201-210: 39/152 (match rate of 26%)

I wouldn't extrapolate from this that his odds of matching will be 26-31%. But I think saying his odds approach 100% is way optimistic. I think applying to a 100 programs might be overdoing it, but were I in his shoes, I don't think I'd just apply to 20.

Psych is one of the least competitive specialties out there. But if you're a DO, it becomes slightly more competitive. If you're a Carrib grad, it becomes more competitive yet. If you're a Carrib grad with low USMLE scores, it continues to increase in competitiveness.

 

[Doctor Bagel]

yeah...Im aware those are the least competitive.....they(jps and tt) are also really crappy as well. I think the op can do better. As long as he plays the lost year off decently......

as for arkansas and Ok filling with their own people....yes, this is true. But what we dont know is how many people from those schools will be going into psych. One year they may have 10....another 2. So obviously if its one of those years with low numbers, those two programs(although they are decent) are going to have trouble filling with all US allo grads.....they depend on their own grads to do that.

Traditionally lots of people from both those schools go into psych probably because psych is well represented/respected at both places. I don't know that either really take IMGs, and people in that region generally prefer DOs to IMGs. I might apply to both but not hold out much luck. OU-Tulsa is also out there, and they do have some IMGs now. They also didn't fill in this last cycle, so I'd check them out. Residents were pretty happy as of 2 years ago there.

 

[whopper]

nonsense.....any physician who agrees to participate in medical education and take on medical students enters into an implied agreement to do things like write letters for students who have spent significant time on their service when asked.

Oh boy. Any doctor in a any program are supposed to do things and sometimes they don't do them. They're human beings, in fact from personal experience, even at good institutions, I've seen top doctors forget to do these things either do to what I call Einstein Syndrome (they're so in the Heavens they miss small things that end up mushrooming into huge things), or they've allowed their entitlement to put them in a sense where they intentionally ignore things knowing the institution won't get rid of them.

Hardly any of my professors showed up to their office hours and the University did nothing to them because they pulled in millions in research. Were they supposed to be there? Yes. Did students complain? Yes. Did anything happen to those profs? Nope, at least as far as I could tell. If you asked them to write a LOR, they often forgot to do them. Now this was in undergrad, but I've seen this same thing happen in medschool.

Vistaril, your tone is highly accusatory against to the OP, and if he is telling the truth, he'd have every right to be upset with you. Even if some things appear to be occurring that are out of the ordinary that doesn't make them not true. If one were BS'ing this story-to what end? So we could give that person advice that would be of little use given that we were given false data?

oh he has nothing to worry about as my program, unlike most, doesnt require DOs or imgs/fmgs to fill. As someone who has screened people for interviews before, he wouldn't get an interview.

I'm wondering what program would that be?

 

[vistaril]

I think you mean to say Step 3 here. But you're still wrong. You're talking about his application approaching 100%, but I'm curious where you're getting your data.

From Charting Outcomes, directly from the NRMP:

Independent applicants with Step 1's between 191-200: 71/230 (match rate of 31%)
.

how many of these 230 were american citizens? Thats all that really matters.....Im betting most of them were not american citizens, and Im betting thatmany of the american citizens who didnt match went to non ross/sgu carrib schools......

one quick glance at many of the least competitive programs across the country shows that they are more than happy to get american citizen ross or sgu grads in psych.......in fact some mid tier university programs would prefer to fill the last slots with these people instead of what they actually end up having to go down to

 

[vistaril]

.

Vistaril, your tone is highly accusatory against to the OP, and if he is telling the truth, he'd have every right to be upset with you. ?

oh I think he may be telling the truth......my point was that when crappy bad luck happens to people on matters like that, you DONT just sit and take it. You get proactive and change it.....someone who doesnt apply to a specialty that they want and that they would probably get into because there was miscommunication on a letter of rec and their advising office said they should switch to pmr because they have some new electives they could take in that? LMFAO.....thats absurd, and thats completely dropping the ball.

 

[dl2dp2]

Vistaril, your tone is highly accusatory against to the OP, and if he is telling the truth, he'd have every right to be upset with you. Even if some things appear to be occurring that are out of the ordinary that doesn't make them not true. If one were BS'ing this story-to what end? So we could give that person advice that would be of little use given that we were given false data?

I find it concerning that he (i'm making assumptions) speaks in a way that demonstrates very little empathy for someone who supposedly will be embarking upon a career that depends so crucially on building an alliance with the ones he's working with. Clearly psychiatrist ought to be aware and responsive to how other people may feel about what we say and capitalize on that. Is it the awareness that's lacking or is it the wanton disregard for the potential of others being hurt?🙄 Psychiatrists are generally much more skilled in handling interpersonal relationships than this.

 

[vistaril]

I find it concerning that he (i'm making assumptions) speaks in a way that demonstrates very little empathy for someone who supposedly will be embarking upon a career that depends so crucially on building an alliance with the ones he's working with. Clearly psychiatrist ought to be aware and responsive to how other people may feel about what we say and capitalize on that. Is it the awareness that's lacking or is it the wanton disregard for the potential of others being hurt?🙄 Psychiatrists are generally much more skilled in handling interpersonal relationships than this.

one of the reasons Im very good at what I do is that I knew when to confront people and under what terms to do it.

In the case of the OP, to put it bluntly he needed a good kick in the pants. And I think he gets that now. This was a case where he, quite simply, dropped the ball in a BIG way and it is costing him. He dropped the ball secondary avoidance behavior, not being proactive, blaming others, etc.......that's a recipe for failure...well, in life in general.

The way to confront such people or pts is to confront them on it. An empathic statement like "oh that's such a shame that happened with your letter of rec...what bad luck" is just furthering the pt's denial into what happened and will only serve to propogate such behavior on his part, which would lead to more adverse consequences down the line......

there are times to make empathic and compassionate statements, and there are times to be confrontational and call someone out. This was most clearly one of the latter.

In fact, it would be dangerous not to do so. Can you imagine if he had shown up to interviews 4 months from now and started blaming others for what happened with that stuff? That would have been a disaster.....

 

[notdeadyet]

I'd be more likely to give you the benefit of the doubt on this point, vistaril, except for the fact that your postings skew waaaaaaaaaay more towards the confrontational. I'm not sure you've ever posted something empathic and compassionate on SDN.

 

[diagonal]

oh he has nothing to worry about as my program, unlike most, doesnt require DOs or imgs/fmgs to fill. As someone who has screened people for interviews before, he wouldn't get an interview.

well, I know that my program has a lower% of fmg residents than is the national average, so "broadening my experience" would likely only make the language/culture issues more prominent.....

hmmm

 

[whopper]

one of the reasons Im very good at what I do is that I knew when to confront people and under what terms to do it

Confrontation as a psycho-therapeutic technique is risky though I do think there's a place for it. That said, I don't think many people here would be agreeing with you that you're using confrontation here appropriately.

From what I've been seeing in your posts, I do think it's possible you're a very smart guy (in a good way) but you're coming off as a smart guy (in a bad way).

Anyways, I invite you to mention your program. Reason being is I've found people tend to mellow out when their real identities are known, and are thus held more responsible for their comments.

 

[dl2dp2]

The way to confront such people or pts is to confront them on it. An empathic statement like "oh that's such a shame that happened with your letter of rec...what bad luck" is just furthering the pt's denial into what happened and will only serve to propogate such behavior on his part, which would lead to more adverse consequences down the line......

there are times to make empathic and compassionate statements, and there are times to be confrontational and call someone out. This was most clearly one of the latter.

eh there's confrontation and then there's blaming. you can point out OP's mistakes and make helpful recommendations rather than evoke a certain tone of blame and lecturing, especially if your goal is to change behavior. You need to review Motivational Interviewing 101. I don't see how making the OP feel bad about himself per se is helpful for his future career. And as to confrontation as a psychotherapy technique, there's a place and a time and a therapeutic frame. This is a public internet forum. You lack basic internet etiquette. Knowing how to say something and where to say it is a basic skill of being a good psychiatrist--something you clearly lack.

 

[digitlnoize]

Knowing how to say something and where to say it is a basic skill of being a good psychiatrist--something you clearly lack.

I would add insight to this list.

It's funny, our forum used to feel like a happy, shiny place. Now it feels like one of those units that's got one too many borderlines at once.

Vistaril: Everyone here is trying to ask you nicely to try and be a bit nicer in your posts. Instead of getting defensive, how about realizing that we're all in agreement and change the way you're posting.

You say you can be a nice, insightful psychiatrist? Prove it.