Comparing several residencies

[Cayetano]

Hello,

I’d like to seek input on a few residency programs, and hopefully contribute by trying to summarize my impressions based on reading program websites and searching SDN.

My wife is applying currently in ophthalmology, and I will be applying (in 2013 - MD-PhD program) exclusively in the city where she matches (I am aware of the risks of a limited application, but please understand this is the best option for me and my family). As a result, we are making her rank list together to take into account my prospects for a psychiatry residency.

As an MD-PhD I am interested in a program with good research options, but I’m not a lab rat – out of the two, great clinical training is still more important to me, and hopefully having a strong research background puts me in a good situation even if I end up at a program where research is available, but not emphasized. It’s hard to predict specialty interests so early in the game, but I’m more inclined towards a program with good C/L and modern psychotherapy, less so toward forensics and substance abuse. I’m also drawn to programs that have an international and/or intercultural focus, as one of the things that drew me to medicine was a strong interest in sociocultural perspectives on health. My career hopes are to remain in academic medicine, so prospects for doing so will be given strong consideration.

On a personal level I like good food & drink and the culture that goes along with them, and I abhor commuting, especially by car – the city of the program will definitely factor into our rankings.

Please do not take offense, as these are just the impressions I've cobbled together from limited input, and I'm purposefully trying to look at the positives AND the negatives for all of my options. I welcome any and all comments!

OHSU
Sssshhhhhh… too many people know about this one already! Honestly, if there’s any knock it’s that the reputation is really good but not truly stellar. For me this would be a minor concern, as the consensus opinion seems to be that it’s a happy, personable program that manages to be well-funded for research while maintaining a congenial atmosphere. Also includes an Intercultural Psychiatry program, which is intriguing though I haven’t heard much about it. And Portland is just about perfect for me.

Bottom line: Sounds like an essentially ideal program for me, in a great city, I have a very tough time identifying significant drawbacks.

U Washington
Very good reputation, and seems serious without being malignant. The program website suggests a well thought out training philosophy. Possibly more aggressive call schedule than other programs, though looks like they are well structured to lead gradually towards independent call in PGY3, i.e. are productive. I’ve only been to Seattle once, but it does seem to be a fairly expensive city for its size, and not quite as welcoming as Portland, though still great for the coffee & beer lover.

Bottom line: Looks like a great program as well, though the limited sample of SDN seems somehow not as enthusiastic about it.

U Wisconsin – Madison
Solid reputation in the region, known nationally. Presents itself well online, seems sincere in its desire to train residents. Quite balanced for an academic/research oriented site. Madison seems like a great town for the size, but maybe would feel quite small after being there awhile? Program seems very collegial, some have mentioned outpatient-oriented.

Bottom line: Solid in every category.

Cleveland Clinic
Surprisingly little info on SDN, but obviously the institution has a great reputation for examining the practice of medicine in general. Psych operates as part of a Neurological Institute with related specialties, though unclear on how much this really changes things logistically. Strong research focus, though website perhaps seems less patient-centered than other Psych programs. Several posters on the forum are residents here, and seem to be quite positive about the training.

Bottom line: A clinic that’s always looking to improve health care, dedicated physicians. Does this come through in the residency experience?

Wash U St Louis
I know that it’s really well respected and has great research, but having never been to St Louis it’s hard for me to have any understanding what the city and hospital system are like. The program is likely much better than my instinctive level of enthusiasm, which I freely admit is born of ignorance. I would very much welcome any personal accounts here, even just interview day impressions.

Bottom line: Stellar reputation, but somewhat cold impression; great research, but perhaps very basic science-oriented? Also perhaps the toughest match for me, as it is a very good program but the only established one in the city. (Just saw SLU has residency, but very new dept of neuro+psych)

Duke
Top training, seems that people come out very confident, though partially due to working significantly harder/longer hours than other programs. As has been pointed out in other threads, you have to be at work to learn, but there does seem to be a distinction between hard-working programs where the residents are content, and ones where they feel the hours are not quite worth it - and Duke’s impression on SDN is more towards the latter. Visited Durham recently and it seemed pretty nice, I’m sure I could find things here that I really like.

Bottom line: Strong enough reputation to go almost anywhere after training, plus UNC is nearby and with a very strong + family friendly reputation.

New York
I’ll group this as one category. NYC has several of the country’s most competitive residencies, some of which are indisputably top notch, others at least arguably so. In general, training seems to be fairly intense in NYC compared to psychiatry residencies in general, but I don’t see a lot of people reflecting negatively on this fact.

Bottm line: Great if you like New York (which I certainly do). Competitive but respected institutions. Basically, all doors remain open.

MUSC - Charleston
Very supportive environment, and a well funded dept that gets respect within the institution due to its research dollars. In general, a great place to go if you’re interested in research, but not necessarily a competitive environment. Charleston is lovely, albeit hotter than I would like, and probably not as diverse within the city itself as some other places on this list, and the state has a lot of budget (among other) issues.

Bottom line: Despite its being in S Carolina, I’ve gotten quite enthusiastic about this program.

UC-Irvine
Like St Louis, a city/school I know extremely little about. UCI seems fairly desirable from postings here, but that could be due to SDN coastal bias. What are the main draws of this program? Any glaring weaknesses? I’m in the dark on this one.

Bottom line: ???

George Washington
Doesn’t get discussed too often, and the reputation seems to be only okay. Their website looks great, however, and I’m really intrigued by their international/intercultural focus - somebody else posted on SDN awhile back asking about this, and I don’t believe there were any definitive responses. DC is not my favorite city (I think its a poor value, likely owing to the fact that money spent here on e.g. restaurants is paying for power, not food), but it has pockets that are very charming, and it does have a lot of young professionals.

Bottom line: Seems like it should have a better rep, maybe it is just underexposed.

Vanderbilt
Up & coming program, seems ambitious with new leadership. Good regional reputation, but coming originally from Texas I was largely unaware. Some positive very recent comments here, perhaps reflecting program changes in past 1-2 years, but general trend of discussion suggests program is somewhat malignant hours-wise without necessarily paying off in terms of compensation. I’ve been briefly to Nashville and found some places that seemed nice, but the area around the hospital/campus is somewhat bleak, and even the “nice” outdoor shopping/restaurant district is pretty small.

Bottom line: Pretty good program, and perhaps will be great in a few years (when I’d actually be applying), but a bit of a wild card at the moment.

---

Members don't see this ad.

 

[billypilgrim37]

Vanderbilt has been "up and coming" for a really long time. I wonder when the statute of limitations runs out.

 

[notdeadyet]

Vanderbilt has been "up and coming" for a really long time. I wonder when the statute of limitations runs out.

Good line. I also like, "It's up and coming... and always will be..."

 

[peppy]

I visited a few of these programs when I was applying a couple years ago so I'll throw in my thoughts...
When I interviewed there, the vibe I got from WashU was definitely more along the lines of "Brainy but not particularly friendly or touchy-feely" and that fits with its reputation of being extremely focused on the biological aspects of psych with a minimum of psychotherapy training. If you like psychotherapy, it's probably not the ideal situation for you, but for someone who doesn't have that interest the lack of psychotherapy might be a bonus.
There was a lot of controversy on this board a few months ago because some resident who had been terminated at WashU felt that they treated him unfairly, but none of us really know the truth about that situation and for all we know it may have been a justified termination. (Sorry for bringing that up again, guys, but I know when I was thinking about programs I was very interested to know if they had fired anyone recently).

As far as the city of St Louis, well, you could do worse but you could also do better. The area around WashU is nice but then a few blocks away you have extremely run-down ghettoes. They do try to spin this as "a good training opportunity" since you'll see the gamut of the socioeconomic scale that way (though honestly, I think any psych training program will see plenty of poor and homeless patients even if you aren't on the edge of the ghetto). Neighboring East St. Louis may quite possibly be one of the most dangerous places in America. and a lot of people say that skews the crime stats for St. Louis into making St Louis seem more dangerous than it really is.

I also thought MUSC seemed really good and nothing bad about the program itself stood out, though they seem to end up with mostly southerners in their residency classes (not sure if that's a regional bias on the program's part or just self-selection because northern applicants aren't interested in the south).
Charleston is definitely a lovely place, but the cost of living in Charleston seems to be on the higher end. It sounded like with all the tourists the traffic can be pretty bad too which makes it tough to commute if you live out of town. It's also kind of a small place and not sure if there is a ton to do there other than enjoy the beach.

I liked Vandy, and the people there were a good mixture of intelligent yet also extremely friendly in my opinion. I definitely was a little wary because of the hours issue though. One of the Vandy interns who spoke to my group made it obvious that she was stressed and annoyed that she had not had a "golden weekend" in a few months, but that situation could have gotten better since then. I'd definitely pay attention to what the residents say about what the working hours and workload are like these days if you want to go there.

 

[Sushirolls]

I interviewed at several of those programs but am too far removed to give good commentary on them. I can only say great things about the Cleveland Clinic though. Residents are extremely happy here. The attendings love their jobs and will freely tell you. I feel very fortunate I'm at such a wonderful program even when rough days happen. Having friends at other programs that aren't happy, or reading here on SDN, provide a contrast to what a wrong program can mean. What you seek can be found at the clinic. You'd be wise to have your wife pursue Cleveland. Good luck for you both.

 

[Cayetano]

Thank you all, I really appreciate the replies so far! Every bit of extra information really is helpful. If anybody has any opinions they'd prefer not to post publicly, I would of course be happy to receive by PM.

I'm particularly interested in any additional perspectives on WashU. It has a fantastic reputation in ophthalmology both in terms of prestige and in terms of friendliness, and if she were ranking independently it would probably be quite high on my wife's list. However, peppy's comments were consistent with the impression I had from other threads, suggesting it may not be the best fit for me culturally, despite the fact that I want to train at a strong academic program.

Comments on any schools continue to be welcomed, and once again thank you to everybody sharing their opinions and helping us to all be as well informed as possible while making these important decisions.

 

[SpiritiualDuck]

.

 

[psychphan]

From the description of your career goals and interests, it seems like Duke would be a pretty good place for you. They preach a strong international psych component, and I remember from my interview day they had multiple residents who spent time overseas. They also have very strong psychotherapy training, including tons of real time supervision. Research is also certainly there, and if you want a career in academia, well it certainly doesn't hurt to have the Duke name on your CV.

The only other program on this list that I interviewed at was MUSC. I absolutely loved this program, but it sounds like some other places may be a better fit for you in terms of your interest. One thing that I remember is that although there research dollars are huge (top 10 NIH funding), a lot of those dollars and the big name researches there are in addiction, which you said isn't really your thing. Plus, I don't remember any talk of international or intercultural focus. Still a great program, but from what you said it doesn't seem to match up as well with your personal interests.

 

[splik]

out of the programs you mention University of Washington would be best for someone who was interested in c-l psychiatry, modern psychotherapy (by which I assume you mean alphabet soup therapies rather than long term analytic/dynamic therapy), and cross-cultural psychiatry. I am really interested in academic c-l psychiatry and social/cultural psychiatry and UW is very high on my rank list as a result. They have various tracks so you can specialise early in C-L if you want, they do excellent work (research and clinical) with underserved populations and very strong on health services research and epidemiology in addition to neuroscience. also the PD Deborah Cowley is one of the most seasoned and highly regarded PDs out there and will go to great lengths to try and tailor your experience to fit your interests. Grace Thrall at Duke is also like this.

Is your wife not interviewing at any Boston programs because both Harvard Longwood and MGH/McLean are excellent for C-L psychiatry with many research opportunities and great therapy training. Cambridge Health Alliance has excellent outpatient C-L exposure, probably the best psychotherapy training anywhere (though less hot on CBT), and a strong focus on sociocultural aspects of mental health. There isnt much research at CHA but the research that is going on is basically trauma and cultural psychiatry, and you could do research electives at any of the Harvard affiliates which if you add them all up have more NIH funding than any other psychiatry department in the country.

Vanderbilt is excellent for medicine and thus has a well developed C-L service, but the psychiatry department is not as well regarded because it is not as well developed.

As an MD/PhD, assuming you dont have the personality of a snail and did well on your core rotations, you will have your pick of programs so choose wisely!

 

[OH SYNAPSE]

Hey there, just thought I'd throw in my 2 cents regarding Vanderbilt being that I'm a current PGY1 in the program. I interviewed at a number of places last year that are on your list and really enjoyed most of them. You can see my rank list from last year, but essentially my decision to rank Vandy first was based largely on my interview day, my strong interest in C/L psych, and the overall feeling I had regarding the trajectory of the program. Sounds like "up and coming" has been thrown out there for some time, so I'm not sure that I'll be very convincing on that front, but a lot of why that description has been out there is likely due to the lack of a dept chair for the better part of the early 2000s. Our current chair is starting his 5th or 6th year, so by now he has had enough time to make due on some of the goals he had when he first arrived. As he told me during our interview last year, his first goal was to build up the C/L service and follow the MGH model, as that is where he trained and he felt that in order to improve the dept's reputation and further opportunities for research collaboration, the dept had to have a strong presence in the med center. When he first started, we had one C/L doc. Now we have over 10 (3 are primarily child consult docs) including John Shuster, who just wrapped up his term as APM president, and a few that already have a strong subspecialty focus (one has an Ob/gyn mental health clinic, also have 2 that are psych onc and palliative care). At least one more C/L doc will be hired before this academic year is over. Given how busy the C/L service is and the quality of the consult docs that have been hired over the past few years, to me, this is not a wild card and is no longer "up and coming." The C/L service is there, and fortunately for me, will continue to get better as they continue to hire more folks that have specific clinical/research interests (ie someone with an interest mainly in cardiology). Child is very strong. When I interviewed, I felt that geriatric psych was an area that needed to improve. We hired a very well known geri psych doc earlier this year and have just hired another geri psych doc from Vermont who is going to head the new Center for Cognitive Medicine, so things have already improved.

All in all, I'm new here so I can't say for sure, but after 6 months of off-service rotations and 1 week on psych (plus various short calls while off service), I can say without a doubt that I'm happy I put Vandy first and would do it again if I had the option. Feel free to ask any questions or PM me with any concerns/thoughts about the program. Our current intern class is great and the upper levels have all been super supportive. I should also mention that my wife is an internal med intern, so we've interacted with a number of folks in different programs at Vandy. The overwhelming majority of people here are very nice and collegial. It really has been enjoyable for me working on different rotations as everyone treats you like one of their own. For someone that's academically inclined, there are endless opportunities here.

To comment on the malignant work hours and the lack of a golden weekend (might have been from another thread), work hours have not been an issue with the new work hour rules. No one is breaking 70 on psych and I never broke 80 on medicine. With the new setup of having a pgy2 and pgy1 on most inpatient teams, getting a golden weekend is much easier (was a problem that has been fixed), it just requires some planning, which is easy to do. Again, I love it here so far, it's not perfect but I don't think you can go wrong, especially with your interest in research and the fact that the ophtho program here is top notch. My wife and I live downtown - if you haven't been here in the last few years, you'll be pretty impressed by all the development downtown, in the Gulch, etc. Public transportation leaves a lot to be desired, so that's not ideal. I have not heard of any international psych opportunities, so my sense is that we don't have something currently setup, but upper levels have had a lot of success setting up their own rotations, and you might be able to hook up with the many international programs that other depts already have in place (for ex, ENT just went to Africa for 3 weeks) or start your own with plenty of support. Support for research is strong and the program encourages attendance at academic meetings. I went to APM last month to present a poster as an intern along with 3 pgy3s. The program paid for travel and counted those days as educational leave, separate from our 4 weeks of vacation. I'll shut up now, but obviously, I'm happy here!

FYI: I also interviewed at UWashington-Seattle track, Wisconsin, OHSU, and Duke (and a host of others like Northwestern, Longwood, Emory, Michigan, and Brown), so feel free to ask if you have any questions about them.

 

[Cayetano]

Thank you all for the thoughtful responses! It was very helpful to have these additional insights.

The rank list is in, so now it's just a week of waiting to hear the results. To anybody reading from this year's applicant pool: best of luck in March!