Concern about competency and motivation of future colleagues

[psychhopeful27]

---

Members do not see this ad.

Hi all,

I've known I wanted to do psychiatry since my first year in medical school, and now as I'm about to wrap up my third year and I'm looking a little more into the field I feel a little discouraged. From what I gleaned from this forum and other places around the net, a lot of people in psychiatry are there because of poor step scores or international status so they didn't have much choice as to what they could match into. My step 1 score is extremely high (95th percentile+), and I anticipate doing pretty well on step 2 and 3 too. I'm also at a top 25 med school and have pretty substantial research in psychiatry (for a medical student that is, haha)

The general gist of my question is, can I totally avoid being around people who "settled" and aren't passionate about the field by matching into a more competitive psychiatry residency? I can't see myself respecting a colleague who is just skating by and wishing they had matched plastics or ortho, when I'm putting my all into my work.

 

[notdeadyet]

The general gist of my question is, can I totally avoid being around people who "settled" and aren't passionate about the field by matching into a more competitive psychiatry residency?

Yes. At the better programs, you will be surrounded by people who are commited to psychiatry and likely could have matched into a lot of other great fields if that's what they had wanted.

The impression of psych residents being bottom feeders is mostly propagated by psych residents in programs attracting bottom feeders. Natch.

 

[BobA]

Go to a more competitive program and you will have co-workers like yourself.

You will have the option (if you choose) to become a leader in the field, and you will improve the lives of many, many people.

 

[peppy]

I would agree with those who say that if you go to a decent program, you will fit right in. There are plenty of intelligent high achievers in Psychiatry. Just because there is a stigma on mental illness that causes psych to be less competitive than average doesn't mean that it is an intellectual wasteland. 🙂

 

[JourneyAgent]

This concerns me too. Although I'm not nearly competitive as the OP. it's still something I think about.

Mainly because my experiences trying to communicate with community psychiatrists about their patients histories and discharge issues has left me wondering if psychiatry is not a haven for the mercenaries and shamefully callous miscreants of medicine.

So where's the break point? Of course the OP will land amongst psychiatry's outposts of excellence. But where are all these f@ck ups and slackers coming from? How far down on the food chain before they take over the culture of programs?

And what does it mean for our body politic? How many bad experiences are being created out there by these crappy docs such that they become more representative than good ones? And is it to the extent that we can even put forth a believable model of good practice?

 

[Daedra22]

It's very saddening to me, as well, when someone talks about psychiatry as a backup/last ditch option. Take heart that despite the segment of students who treat psych as a backup plan, there are still many future psychiatrists out there who feel the way you do. I don't have scores that are as impressive as yours, but psych is certainly not my "only" option - it's the field I am most excited about, and one that I am happy to be going into. I'm sure that you will be able to find a program with like-minded people to match into.

 

[PrideNeverDie]

medicine is full of people who pick their specialties for other reasons than love ... psychiatry isn't unique in that regard

you should be giving respect to any attending that was able to obtain a medical license in the US

don't lose focus on what is important: practicing the specialty you love to the best of your ability.

you can't change who your fellow residents are and why they picked psychiatry, so don't let it affect you negatively.

 

[JourneyAgent]

medicine is full of people who pick their specialties for other reasons than love ... psychiatry isn't unique in that regard

you should be giving respect to any attending that was able to obtain a medical license in the US

don't lose focus on what is important: practicing the specialty you love to the best of your ability.

you can't change who your fellow residents are and why they picked psychiatry, so don't let it affect you negatively.

Feel free if you must, but not my style. Respect, like friendship, is earned and not to be given sight unseen to any dirtbag with a degree.

There's a lot psychs I wouldn't want treating my pet ferret. A lot more than other specialties I've encountered. And I don't think we should be scouring every butt crack islamofascist theocracy east of Istanbul for scrubs to fill spots. I'd rather their be a shortage. And we just expand our reach with technology or American proxies.

I risk being offensive because I'm offended by the shady docs I've seen practicing sloppy medicine with people who are unlikely to complain or file suit. It should piss us off to be associated even by title with some people I've dealt with. And I'm a plebe. What does that say.

 

[LimbicResponse]

It's interesting that you go to a top school, have top scores, research and have no clue about the caliber of good programs. Terrible psych department?

I went to a top 5 school, with 99th percentile scores, top research and during my interviews at the top programs I was humbled by the quality of residents and fellow applicants. If you are indeed a top applicant , interested in the field of Psychiatry. Find the program that's doing the kind of work that you are interested in, apply and go there. I can guarantee you, that based on the description of your qualifications (top 25 school, 95th percentile scores, non md-phd, "research") you will not be the most qualified applicant at the top 5 programs. As a matter of fact, I hope you interview well so that you can get in.

 

[vistaril]

Hi all,

I've known I wanted to do psychiatry since my first year in medical school, and now as I'm about to wrap up my third year and I'm looking a little more into the field I feel a little discouraged. From what I gleaned from this forum and other places around the net, a lot of people in psychiatry are there because of poor step scores or international status so they didn't have much choice as to what they could match into. My step 1 score is extremely high (95th percentile+), and I anticipate doing pretty well on step 2 and 3 too. I'm also at a top 25 med school and have pretty substantial research in psychiatry (for a medical student that is, haha)

The general gist of my question is, can I totally avoid being around people who "settled" and aren't passionate about the field by matching into a more competitive psychiatry residency? I can't see myself respecting a colleague who is just skating by and wishing they had matched plastics or ortho, when I'm putting my all into my work.

well first, psych doesn't have people who had 'wished they matched plastics or ortho'.....the people that want plastics and ortho don't do psych. They do general surgery or something. After all, they are going to want to do something procedure/surgery related.

But the most important thing I would have you consider regarding psych is that your colleagues aren't just the people you work with during residency. That represents a small part of your whole career. I've been fortunate enough to work with people who I (mostly) like and respect, but over the next 30+ years I'll work with tons of different psychiatrists of all types. Those will be my colleagues. And even if you don't work with them, the psychiatrists in your town who put everyone on 2 mood stabilizers, an SGA, a benzo, and two AD's are still your colleagues in the sense that their way of practicing does impact you when their patients transfer care to another provider in the community(ie you) for a variety of reasons and you have to clean up the mess('but my Seroquel is what keeps me alive')

 

[Leo Aquarius]

Dear OP,

Your strong credentials will land you a great program with motivated and dedicated residents. So you will avoid people who settled. I was somewhat afraid of this but having come from a top 20 med school with top grades and a few publications, I matched well and now attend a strong program. My fellow residents work hard, but not obscenely hard (like surgeons do) and never act competitively. We even have a former surgeon in my program. So lack of motivation and work ethic is not an issue where I'm at.

The group of us from my med school class who went into psych went to famous well-known programs that are considered very strong. Any of us could have gone into other fields, but we all had one thing in common: genuine interest in psych patients and unusual mental pathology.

We also shared a healthy dose of self-respect, and we were the coolest crew. We said no to rounding for hours, getting our hands dirty with body fluids, getting yelled at by egocentric surgeons. We stood up for decent working conditions, and practicing medicine the way it's meant to be practiced = spending adequate time to talk to each patient and caring about their thoughts and emotions.

We were happy with our decision. And I still love my decision. Every day is fascinating, and rewarding, and challenging. Don't glide by, dig deep and you will learn.

 

[psychhopeful27]

It's interesting that you go to a top school, have top scores, research and have no clue about the caliber of good programs. Terrible psych department?

I went to a top 5 school, with 99th percentile scores, top research and during my interviews at the top programs I was humbled by the quality of residents and fellow applicants. If you are indeed a top applicant , interested in the field of Psychiatry. Find the program that's doing the kind of work that you are interested in, apply and go there. I can guarantee you, that based on the description of your qualifications (top 25 school, 95th percentile scores, non md-phd, "research") you will not be the most qualified applicant at the top 5 programs. As a matter of fact, I hope you interview well so that you can get in.

I apologize if I sounded pretentious. I was no way insinuating that I was the most qualified applicant, but regardless of the fact that you got 99th percentile I still feel like 95 is something to be proud of. I was just trying to say that I would probably be able to match into most specialties so psychiatry wasn't something I got boxed into.

My "research" is actually research. I have several publications. No they aren't dissertation level, but I'm not intending on spending my career doing research so MD/PhD didn't make sense for me. I don't need a top 5 program because I don't think I'll find myself trying to make tenure somewhere fancy, I just wanted to be somewhere where my fellow residents were as excited about the field as I was.

As far as for how clueless I am, you're probably right. I haven't done a lot of my research on residencies.

 

[LimbicResponse]

I didn't mean to come on too rough. Rest assured, if you have no geographic absolutes, and rank accordingly to program quality and fit, you will be somewhere with very similar applicants as yourself.

You are correct in saying the scum of the earth become psych residents, but unless you have to go to a non-popular program due to a geographic tie, you will end up with many co-residents similar in intelligence and qualifications as yourself.

 

[Jorje286]

There's a lot psychs I wouldn't want treating my pet ferret. A lot more than other specialties I've encountered. And I don't think we should be scouring every butt crack islamofascist theocracy east of Istanbul for scrubs to fill spots. I'd rather their be a shortage. And we just expand our reach with technology or American proxies.

Wow. I think having a healthy cross-cultural perspective and view of people from other cultures and backgrounds is just as critical for developing into a great psychiatrist. So maybe a little humility is in order.

 

[SmallBird]

Feel free if you must, but not my style. Respect, like friendship, is earned and not to be given sight unseen to any dirtbag with a degree.

There's a lot psychs I wouldn't want treating my pet ferret. A lot more than other specialties I've encountered. And I don't think we should be scouring every butt crack islamofascist theocracy east of Istanbul for scrubs to fill spots. I'd rather their be a shortage. And we just expand our reach with technology or American proxies.

I risk being offensive because I'm offended by the shady docs I've seen practicing sloppy medicine with people who are unlikely to complain or file suit. It should piss us off to be associated even by title with some people I've dealt with. And I'm a plebe. What does that say.

Risk being offensive? I would say it was pretty definite that you were offensive.

 

[JourneyAgent]

Cultural competence is a nebulous concept. Culture can be the limiting factor in human development and it can be crippling in addressing matters of science and medicine and communication in a modern western state. Competence in that sense is little more than a liberal feeling themselves morally superior at some vague notion of feigned sophistication.

What we have in psychiatry is a great many foreign docs who lack language and communication skill and who carry poor thought context into psychiatric practice. Hyper-religiosity and ancient, fixed, rigid culture is not any form of competence. And thinking ourselves competent for accommodating a large number of very poor psychiatrists just makes us foolish.

Maybe in your enlightened liberal spheres you're not seeing what I'm seeing in our poorer community. But how can you be an even adequate psychiatrist when it was just a pass to US practice for something you're not interested in, you barely speak the language, and you see mental illness in a religious context of possession by spirits?

Perhaps I should've said it like that.

But I feel the problem is 2 pronged, poor psychiatrists and a permissive culture of not screening out horrible candidates. The inflammatory innuendo was directed at the latter. Who'd rather be offended at me than the process by which this field sinks into incompetence and deserved ill repute. As patients are harmed daily by the thousands.

 

[Bartelby]

I also came from a top 25 school with step scores around the average for derm and I am very impressed with the people I train with. Psychiatry is a fascinating field and one in which I think good people are needed, I hope bad experiences with a couple of incompetent community doctors do not dissuade you from the entire field.

 

[Jorje286]

Cultural competence is a nebulous concept.

Trying to understand the core underpinning of the human psyche across cultures (which can be quite similar) while at the same time accounting for cultural differences is now a nebulous concept?

The fact is that you were being plain old xenophobic in the phrase I bolded. You dismissed and denigrated an entire group of people "east of Istanbul". Group thinking at its "finest". To me this does reflect a particular failure for any person (nevermind a psychiatrist) when it comes to the understanding of people in general. We all have things to work on, but I really hope you won't be deluding yourself that "cultural competence" is just a way for liberals to feel good about themselves.

 

[digitlnoize]

To me, this is exactly why you SHOULD do psych. In a sky of dim stars, yours will burn that much brighter.

I'm at a decent, but by no means "top" program in the SE. ALL of my colleagues wanted to do psych and are dedicated and competent. Even our two excellent FMGs and 3 DO's (in a class of 10).

Are there people out there who don't truly want psych? Sure. But programs are pretty good at figuring out whose heart isn't really in it, and those people wind up at the bottom programs, if anywhere. We specifically look for people with evidence of an interest in psych in their statement, letters, rotations, and interview. Most people who are applying to psych as a backup make it fairly obvious.

FWIW, I've met more dedicated and competent psychiatrists than not.

 

[TheSearch]

I too shared the OPs concerns. However, instead of being concerned with an actual deficiency in quality of psychiatric residents being true, I was more worried about the perception itself and that other medical professionals might assume that I was not competitive enough to be accepted into another specialty. This largely just came from my own insecurity. While stereotypes such as surgeons being mean or radiologists not liking social interaction are loosely based in truth (emphasis on “loosely”), they are more the exceptions than the rule. Plenty of surgeons are nice just as plenty of radiologists are quite social just as plenty of psychiatrists are very intelligent. I did fairly well in medical school with Step 1: 239, Step 2: 261, top 1/3 of class, and research and thus had many options for the specialty of my choosing. Even so, at my current program I am still surrounded by residents with better academic record and greater intellect than myself. Your fears can be assuaged by paying close attention to the residents when you interview. My bet is that you will easily find a program where the residents share you’re academic interests and motivation, and the field of psychiatry will only be bettered by having someone like you in it.

 

[vistaril]

I too shared the OPs concerns. However, instead of being concerned with an actual deficiency in quality of psychiatric residents being true, I was more worried about the perception itself and that other medical professionals might assume that I was not competitive enough to be accepted into another specialty. This largely just came from my own insecurity. While stereotypes such as surgeons being mean or radiologists not liking social interaction are loosely based in truth (emphasis on “loosely”), they are more the exceptions than the rule. Plenty of surgeons are nice just as plenty of radiologists are quite social just as plenty of psychiatrists are very intelligent. I did fairly well in medical school with Step 1: 239, Step 2: 261, top 1/3 of class, and research and thus had many options for the specialty of my choosing. Even so, at my current program I am still surrounded by residents with better academic record and greater intellect than myself. Your fears can be assuaged by paying close attention to the residents when you interview. My bet is that you will easily find a program where the residents share you’re academic interests and motivation, and the field of psychiatry will only be bettered by having someone like you in it.

again, residency is just a very small fraction of your career.....I wouldnt worry so much about this. Worrying about the state of psychiatry overall in the future is much more meaningful and productive than worrying about how intelligent or not the residents in your program are likely to be.

 

[hamstergang]

again, residency is just a very small fraction of your career.....I wouldnt worry so much about this. Worrying about the state of psychiatry overall in the future is much more meaningful and productive than worrying about how intelligent or not the residents in your program are likely to be.

But the OP is going to be going into residency now so that's what's important to him now. Four years is not an insignificant amount of time to be worried about something like this. Let him worry about the years after that when he gets closer and it's more meaningful to him.

 

[vistaril]

But the OP is going to be going into residency now so that's what's important to him now. Four years is not an insignificant amount of time to be worried about something like this. Let him worry about the years after that when he gets closer and it's more meaningful to him.

yes but I sense what the OP is also concerned about is how others(especially in other fields at his hospital) is going to view him as a psychiatrist, and the residents at his particular program are only going to make up a small part of that perception....

 

[kugel]

During my 3rd yr of Med School, I was quite concerned about some of the same things (though for different reasons). I went on a mini-interview tour in the couple weeks I had between 3rd and 4th yr. I contacted about 10 residencies and arranged pre-interview tours. Basically, this was my chance to interview them. I found about 6 that were willing to have 1-2 attendings and 2-4 residents meet with me to discuss their program. I got the opportunity to "practice" being interviewed, but my focus was on finding out enough to be able to discern what I wanted in a residency and how I can ask the questions that will get at that information - and not just be given a sales pitch. It was incredibly valuable when I started to actually chose my interview schedule.
I ended up choosing between a "second tier" and "third tier" residency because they were the two that were doing the kind of work I wanted with the kind of people that I wanted to do it with.

So omy advice: go to a bunch of residencies and look around, ask some difficult questions, and get contact info for people you think will be honest. You'll learn a lot about them, and you'll learn some things about what it is you want. All that will help you make sense of it.

Sent from my SCH-I905 using SDN Mobile

 

[Bartelby]

... and you see mental illness in a religious context of possession by spirits?

I have never seen anything like that, what kind of place are you talking about?

 

[SomeDoc]

Hi all,

I've known I wanted to do psychiatry since my first year in medical school, and now as I'm about to wrap up my third year and I'm looking a little more into the field I feel a little discouraged. From what I gleaned from this forum and other places around the net, a lot of people in psychiatry are there because of poor step scores or international status so they didn't have much choice as to what they could match into. My step 1 score is extremely high (95th percentile+), and I anticipate doing pretty well on step 2 and 3 too. I'm also at a top 25 med school and have pretty substantial research in psychiatry (for a medical student that is, haha)

The general gist of my question is, can I totally avoid being around people who "settled" and aren't passionate about the field by matching into a more competitive psychiatry residency? I can't see myself respecting a colleague who is just skating by and wishing they had matched plastics or ortho, when I'm putting my all into my work.

OP, chances are you are going to get a reality check. I too, like other posters here, have been humbled by the work ethic, and intellectual prowess of my colleagues. This is coming from someone with a 99 step, H's, etc, etc (I also hope that you will realize, like me, that once in residency, none of that matters much anymore, except for owning your material in clinical practice, being a caring physician, and rocking the specialty boards)

 

[vistaril]

anymore, except for owning your material in clinical practice, being a caring physician, and rocking the specialty boards)

ummm...'rocking the specialty boards'(whatever this means) matters? Since when? What in the world gave you the idea this matters?

 

[peppy]

We specifically look for people with evidence of an interest in psych in their statement, letters, rotations, and interview. Most people who are applying to psych as a backup make it fairly obvious.

Yes, while there may be some psych programs that have trouble filling, there are plenty of programs that do have standards. I've helped screen applications for my program and I have seen some applications that made it very clear that they were applying to psych as a backup. Regardless of their qualifications, those applications go into the trash at my program.

 

[nitemagi]

Regardless of how many bad or mediocre colleagues you have around you, you can stand out by setting your own bar, by being outstanding in any/every way you can, by not being satisfied with mediocrity.


...Be the change

 

[OldPsychDoc]

ummm...'rocking the specialty boards'(whatever this means) matters? Since when? What in the world gave you the idea this matters?

Well, passing matters, anyway.