Child and Adolescent Psychiatry Programs and Interviews

[blackberry13]

It's about that time of the year when we start interviewing for child and adolescent fellowship spots! I wanted to start this thread to get a handle for everyone on where they have received their interviews from, what they think of certain programs, and what programs are best. Also, if you are currently at a program, please tell us about your experience and whether you would recommend it to anyone else.

I have questions about the Harvards (MGH, Boston Children's, Cambridge), Yale, NYU, Columbia, Brown, Duke, UPenn, UCSD, USC, UCLA, UCSF, Stanford, Northwestern, Baylor, Vanderbilt, John's Hopkins (trying to hit the programs that many folks are interested in). Feel free to inquire about others.

So far, I have only received an interview from Columbia. I am interested in the east coast, west coast, and Texas area. How do the Harvard's compare with the Cali schools? How about vs. UPenn, Baylor and John's Hopkins?

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[billypilgrim37]

Based entirely on reputation (not actual quality of program, as I think this is pretty difficult to discern):

West Coast: Stanford probably has best reputation. UCLA probably close second. UCSF not as academically powerful and traditionally less prestigious, but folks I've talked to there have been very happy. You didn't mention UW, which is a very good program, probably the one I would personally rank (on limited information) second best in the West behind Stanford. I am not from the West Coast. I have never heard anything good or bad about USC or UCSD.

East Coast: Yale, NYU, Brown, and MGH are the best regarded programs you mentioned. Cambridge is a good program but very unique that emphasizes play therapy. Perfect program for some, but not for everybody. Boston Children's generally regarded as a less desirable program than the others, but I respect folks I've known that have worked there quite a bit. In general, Hopkins, Penn, and Duke programs are less well regarded than their adult programs. Columbia is much less well regarded than the adult program. I have a friend there who is miserable.

Fly Over: Northwestern (Chicago Children's) is probably the best regarded program in Chicago. It's a solid program. Baylor and Vanderbilt wouldn't necessarily be part of the same conversation for most people.

One difficulty with ranking child programs is that, even more so that in general psychiatry, there are more good programs than there are good candidates. The short list of the best regarded places by no means even catches all of the places for good training. A decent candidate can usually get a spot at a very good place. And many of these places give good training.

Other good places not mentioned would include UNC, Cincinnati, Pittsburgh, Michigan, and, as above, U Washington. I know less about MUSC, but I think it's well regarded generally.

 

[snarfer]

East Coast: Yale, NYU, Brown, and MGH are the best regarded programs you mentioned. Cambridge is a good program but very unique that emphasizes play therapy. Perfect program for some, but not for everybody. Boston Children's generally regarded as a less desirable program than the others, but I respect folks I've known that have worked there quite a bit. .

Why would Children's Boston be considered less desirable? It is one of the premier children's hospital in the world and I would think the clinical exposure would be unmatched elsewhere. Perhapt fellows are overworked?
I have met a few Yale trained CAP docs and they didn't have nice things to say about this program.

 

[billypilgrim37]

Why would Children's Boston be considered less desirable?

Like most things related to reputation, it's vague and unclear. It may be great training. The same argument would be made for CHOP, whose program is similarly not as well regarded as the rest of the hospital. Historically children's hospitals and child psychiatry departments may have developed very separately. At least as of a few years ago, most of the MGH/Longwood/Cambridge grads who stayed in Boston went to MGH or Cambridge. I believe Children's Boston is relatively FMG heavy. I know one faculty member there who is amazing and I would be thrilled to have him as an attending. I have one attending at my current program that graduated from there, and he is one of the most skilled clinicians in the department.

So, if anything, the GOOD news about child psychiatry for folks applying is that these programs that are "less desirable" still can provide very good, non-malignant training in cool cities.

Re: Yale, I know a few folks there, and there opinions range from "I am having the time of my life" to "I'm a little underwhelmed." One of my residency classmates graduated from Yale medical school and stated she would not have stayed there for reasons I didn't clearly understand. Andreas Martin is one of those very special rockstars in CAP.

 

[SmallBird]

I believe Children's Boston is relatively FMG heavy.

That is an odd statement when made about a fellowship program - what are you suggesting it means about the program for them to have a lot of IMG's - all of whom would have gone through at least three years of adult psych training?

 

[twright]

That is an odd statement when made about a fellowship program - what are you suggesting it means about the program for them to have a lot of IMG's - all of whom would have gone through at least three years of adult psych training?

Competitive residency or fellowship programs have no incentive to look at IMGs given that they generally have their choice of applicants to review and interview. So for a program to have a higher proportion of IMGs suggests, through revealed preference, that it is in general a less competitive program compared to a program with a lower proportion of IMGs.

 

[OldPsychDoc]

Competitive residency or fellowship programs have no incentive to look at IMGs given that they generally have their choice of applicants to review and interview. So for a program to have a higher proportion of IMGs suggests, through revealed preference, that it is in general a less competitive program compared to a program with a lower proportion of IMGs.

I disagree. The pool of IMGs entering child fellowships is already "refined". You're talking about a group that was already able to rise above the masses of other IMGs and match into US residency programs, and in addition has now demonstrated 3 years of clinical competence in psychiatry. I think that they are much more like other psychiatry residents at this stage, for good or ill.

 

[billypilgrim37]

The question really isn't whether MDs or DOs or IMGs or FMGs or LMNOPs or whatever are actually different. The question is whether there exists some biases among some program directors making rank lists. American medical grads get preferentially selected to more desirable residency programs, and residents from more desirable residency programs get preferentially selected to more desirable fellowships. It's no hard and fast rule, but it's a trend that certainly exists.

The trend is much weaker than it is for residency, though. A good friend from my general residency is an IMG, and he's doing a consult fellowship at MGH right now. One of my closest friend in my fellowship is an IMG. Whopper is an IMG, and he's clearly a superstar.

 

[twright]

I'm going to have to agree with billypilgrim37 on this one. Again, the point is not whether IMGs are of lower quality compared to USMGs, and the point is not whether child fellowship directors are exercising good judgment in screening out IMGs.

If you are a child fellowship program director at a highly competitive program, and you get more applications than you can feasibly screen, and you don't want to dilute your brand because you think that other applicants think that a high IMG:USMG ratio is a signal of lower program quality, then it would be reasonable to simply screen them out. I'm not saying this strategy will produce the highest average quality of child psychiatrists on a population basis. I'm not saying that this dance of circular reasoning between program directors and applicants makes sense. I'm just saying it is what it is.

I trained at a large program that is selective like crazy but often made (at least during the 2 years I sat on the selection committee) unjustifiable decisions when it came to protecting the brand or promoting diversity. I am aware of 1 IMG in 6-7 training cohorts above and below me, and she got ranked where she did only after a lot of discussion around the table about what this would mean for our program's brand (e.g., "if applicants see an IMG on our resident roster, will they think we're slipping?"). It is what it is.

The effect is probably weaker post-residency, as billypilgrim says, but my (non-data driven) guess is that the effect is still there.

 

[billypilgrim37]

The answer is clearly to clone lots of OPDs and have them infiltrate the program director offices of all programs! Mwhahahahaha...

The effect might also only be significant in cities with multiple programs. It's inevitable that among the locals there will develop some tiers of prestige that will cause drift to certain programs.

 

[SmallBird]

As long as we agree that whatever the reality might be, such discrimination is unwarranted

 

[billypilgrim37]

As long as we agree that whatever the reality might be, such discrimination is unwarranted

 

[deejayshakur]

Like most things related to reputation, it's vague and unclear. It may be great training. The same argument would be made for CHOP, whose program is similarly not as well regarded as the rest of the hospital. Historically children's hospitals and child psychiatry departments may have developed very separately. At least as of a few years ago, most of the MGH/Longwood/Cambridge grads who stayed in Boston went to MGH or Cambridge. I believe Children's Boston is relatively FMG heavy. I know one faculty member there who is amazing and I would be thrilled to have him as an attending. I have one attending at my current program that graduated from there, and he is one of the most skilled clinicians in the department.

So, if anything, the GOOD news about child psychiatry for folks applying is that these programs that are "less desirable" still can provide very good, non-malignant training in cool cities.

Re: Yale, I know a few folks there, and there opinions range from "I am having the time of my life" to "I'm a little underwhelmed." One of my residency classmates graduated from Yale medical school and stated she would not have stayed there for reasons I didn't clearly understand. Andreas Martin is one of those very special rockstars in CAP.

Define "special rockstar."

 

[billypilgrim37]

Define "special rockstar."

He's very talented, very charismatic, a very clear-thinking leader and scientist. Since I'm often sarcastic and playful with my words on here, I will clarify this was an unabashed compliment.

 

[Methenyr]

I looked into various programs for child and adolescent psychiatry. I ended up ranking Washington University as my top choice for a number of reasons. The facility is well know for its extensive work with regard to research, but also offers amazing psychotherapy training.

The selling factor for me, however, was the atmosphere and encouragement from the faculty. They really devote so much time and effort toward your individual goals. They will guide you in whatever direction you want to take whether it's research, clinical, academics or policy making. I have been sent to national meetings on the program's penny to advance my training. I have colleagues who have chosen programs at Emory, Mass General and Chicago and in comparison, I feel very confident that I made the best choice for me.

 

[member2721]

How would you compare MGH and NYU's child psychiatry program, especially in terms of clinical training for fellows? Which one has a more balanced treatment approach (mess vs therapy), a diversity of clinical training sites, better teaching and supervision, and higher workload?

My rough guess (as a medical student on the interview trail) was that NYU had more inpatient and residential clinical sites, and a greater range of rotations, with sicker patients and higher workload; while MGH has more academically integrated clinical sites and may benefit from having better supervision and more balanced approach. This is based on very very little substantive understanding of the programs, so please help me out!

 

[qt@qtc]

@snarfer ,
I was reading this thread once again since I was struggling about where to put Yale on my ROL. You had said in one reply from 2012 that you had met folks trained in CAP at Yale and they did not have good things to say about the training. Can you please elaborate on that.

 

[SmallBird]

@snarfer ,
I was reading this thread once again since I was struggling about where to put Yale on my ROL. You had said in one reply from 2012 that you had met folks trained in CAP at Yale and they did not have good things to say about the training. Can you please elaborate on that.

I also was interested to hear more about these comments, as I hope to pursuit CAP training at Yale. I have heard subsequently that some fellows complain about the organization of the outpatient clinics. But that appears to be of very limited significance given the breadth of clinical exposure, the quality of the faculty, the extensive research opportunities, and not insignificantly, a good lifestyle. The department has a rich history and continues to produce and house leaders in the field.

 

[getsetgo]

As one of the other posts have mentioned about Boston Childrens for child psychiatry, its a heavy IMG dominated child psych program overshadowed and simply in no competition with any of the surrounding programs. It is very busy with work hours being almost 2-3x as much, and the recognition just is not there given that Yale, MGH, and Tufts are right around the block. Research opportunities are almost nonexistent surprisingly. The pediatrics residents simply give no consideration and are sometimes flat out rude towards the child psych fellows feeling a sense of entitlement. there are many other great child psych programs over this, as this program is simply average.
However all this being said, the faculty are great, but they do expect you to be an independent learner and be efficient with multiple challenging cases every day. Just there are many other programs that an applicant can consider before looking at this one

 

[surffcs]

There are IMG residents at Boston children's. One will find strong IMG residents at all of the strong programs, including BCH, right on down the line. At Boston Children's, there seems to be a solid mixture of very strong IMG's (with awards and publications), along with US medical graduates.
I could be wrong, but to my knowledge residents have 2 psychopharm/medical patients and 2 strictly psychopharm patients at a time on the inpatient unit -- manageable. This is also regarded by many as one of the best training programs in the country for pediatric C-L psychiatry.
In addition, the call at Yale seems to be pretty close -- 2+ weekday short calls (no ER or Consults) + 1 (on average) to 2 (less typical) weekend calls per month, only now at Boston Children's there are more staff than previously (ED psychiatrist, new CL attending).

 

[getsetgo]

First of all, Harvard has no hospitals. It is loosely associated with a few hospitals where their medical students rotate. This can be proven with the fact that no where does Boston Children's state they are Harvard. In fact, a few years ago, when these hospitals had asked Harvard to become officially merged with them, Harvard turned down the request stating reasons that their primary goal is to educate undergraduates and graduates. Harvard itself, just like Princeton in many ways, does not want to expand beyond the realms of their institution.

There are many IMG's and let's face it- true there are many quality IMG applicants but there is a large variance in IMG's. IMG's from the Caribbean sure are different than IMG's from the UK. Traditionally, IMG's from the UK do not even apply to psychiatry, so majority of the IMG's in psychiatry are from the Caribbean. The US Students who go abroad to non-caribbean medical schools, tend to be very wealthy and have connections to many other fields and hence do not apply to psychiatry either. We all know, that Caribbean students could not even make into any US DO school, and a US allopathic school is far removed from even being a viable opportunity. As many caribbean students state, "we lost the right to be choosers, we will remain beggers" simply because of how competitive it is to match these days into anything and their just is a nasty stigma that is held for life against Caribbean graduates.

Boston Children's in the psychiatry world is known to be a hub for Caribbean IMG students. I have never stated that it is a bad program- however there are much better options than Boston Childrens. Even within Boston, it is regarded as the lowest tier child psych program in the city. The only reason I am saying to avoid this program is because, I personally know 2 graduates who could not find jobs in desirable places. Now whether it is because they are from Boston Childrens or not is something which I cannot answer, but the program was very unsupportive in their quest to find jobs. They also state the malice the pediatric residents displayed towards them, and sometimes almost sounded depressed.

The program is simply run of the mill- for those who want to be a child psychiatrist, and not many options are on the table, this is a program to be considered. I've done my research. I'm in my last year of child psychiatry at Mass General, and know a lot of inside details of Boston Childrens.

 

[surffcs]

It seems one would get solid training. A recent graduate is an attending at a top notch academic medical center. I assume that many would agree that training most places will land one a solid job in private practice. I assume most can agree that there are some great IMG physicians who have refined and tuned skills after becoming more serious and dedicated a little later in age.

 

[getsetgo]

It is not a bad institution for child psychiatry. However it is certainly no higher than simply average. People often tend to go here simply because they want to remain in this area of the country (largely because of family and/or local ties to the area), cannot match into any of the other local programs, and quite frankly miss out on better programs in the south and west. I would even recommend UCONN over this program, and it is very easy to match into UCONN so the only reason to select this program is simply bc of local ties to Boston

 

[getsetgo]

The residents list is out once again for boston childrens child psych program and it is filled with IMGs once again. Asian and caribbean majority. A program as unfair as it, is judged by how many american allopathic students are in the program. The more the better it is regarded. The less, the leas it is regarded. You ask youself that why do american med students not join boston childrens bur instead go to mgh, cambridge and tufts. Bc this program is the bottom of the pecking order in the northeast

 

[PistolPete]

I wouldn't say that Boston Children's is bottom of the pecking order... although they do have a brutal call schedule.

 

[BOSTONCAPFELLOW]

Looks like this is a little bit of an outdated post with significant misinformation. There was relatively little information about Boston Children's when I was on the interview trail and applying for fellowship and it seems that information such as the above was generally inaccurate. It seems that there is new leadership in the program and since this change occurred there have been additional changes to the call schedule, which previously seemed quite demanding and difficult. These changes occurred based around fellow requests and have made the call load much more manageable. In fact, it currently seems to be on par with call schedule at other stand alone children's hospitals where fellows are responsible for call without any adult residency program to field the majority of work. The leadership of the program is reasonable and well acquainted with the program, with much of the staff continuing following completion of fellowship - this was remarkable to me, and I though a singular occurrence in the frequency this occurred when comparing to other programs that I interviewed at. Didactics are a really neat feature about BCH, in that there are Thursday morning didactics that occur with 2 other programs from CAP in the Boston area. There are a number of residents from Harvard adult programs who have completed training at BCH and even some who have transitioned from MGH (though generally MGH-ers tend to stay at MGH). Another program strength is the 2.5 days in second year that are devoted to elective time, which is more than many programs provide. Psychiatry is well regarded in the hospital by other services who readily access the team of psychologists and psychiatrists for assistance in challenging cases; I have not heard of instances of people being down right rude, though this can happen at any institution. There is consensus in the psychiatry world that CL at BCH is among the strongest in the country and a pioneer in the field. In talking to attendings from my residency about this program, and others on the interview trail, BCH seemed to be a desirable and competitive program, no longer "bottom of the barrel" as described above. I suspect that much of the above information is based around misperceptions and egos. I personally would have preferred to be at BCH because of the institution, leadership and the city that it is set in than some less desirable cities such as New Haven, Providence or St. Louis, but much of this is personal preference! Hope that helps!