getting trained out of state where you want to practice

[vitamin H]

Hi guys,

I'm a medical student on the interview trail and I'm trying to find ways of comparing programs. Though I want to eventually practice in CA, I've interviewed at a couple of OOS programs that I think are stronger then some of my CA programs. After I interview, I update my rank list and I find myself ranking OOS programs that are stronger then the CA programs I've interviewed lower on the list because I'm assuming it would be more difficult for me to be trained in an OOS program.

Given the forensic aspects inherent in psychiatry, is there a big drawback to being trained outside of the state you want to practice in? Or does good training cross state lines?

thanks!

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[666357]

Should be a simple, but lengthy, process of applying for licensure in whatever state you want. Or are you asking if academic programs won't look as favorably upon a candidate trained out of state? I don't think that matters much either unless you were in a stinker of a program- or if you're applying for a job in an academic center and trained primarily in a community based program, but even think I don't think it'd appreciably affect your competitiveness.

 

[wolfvgang22]

It doesn't matter much.

 

[OldPsychDoc]

It should not be a disadvantage. I changed states back in the day, and having a good social worker at my side took care of learning the differences.
I've had residents graduate from our program and find jobs elsewhere (including CA) and this was never an issue in the hiring decisions.

 

[Bartelby]

I agree with OldPsychDoc and wolfvgang, learning the new laws about commitment, duty to warn, etc. is not very hard. I also switched states after training.

The bigger loss is not having the entire network of people who know and trust you. Where I trained I know a lot more "inside" information about many of the available jobs, and I could start a private practice with dozens of psychiatrists (whose schedules are full) ready and willing to refer patients to me. I also knew all of the local facilities and options (partial programs, programs to assist patients, etc.). By moving I lost that.

With that said you can totally build new social networks and get to a know a new location, and to commit yourself forever to one location in order to avoid those things does not make much sense! I don't regret training in a different state at all, and in some ways getting to see how things are done elsewhere is an advantage.

 

[vitamin H]

I agree with OldPsychDoc and wolfvgang, learning the new laws about commitment, duty to warn, etc. is not very hard. I also switched states after training.

The bigger loss is not having the entire network of people who know and trust you. Where I trained I know a lot more "inside" information about many of the available jobs, and I could start a private practice with dozens of psychiatrists (whose schedules are full) ready and willing to refer patients to me. I also knew all of the local facilities and options (partial programs, programs to assist patients, etc.). By moving I lost that.

With that said you can totally build new social networks and get to a know a new location, and to commit yourself forever to one location in order to avoid those things does not make much sense! I don't regret training in a different state at all, and in some ways getting to see how things are done elsewhere is an advantage.

Thanks for all replies! I wasn't too worried about hiring opportunities after OOS training, I figured there are many opportunities for any psychiatrist. But what did concern me was touched on by Bartelby, concerning the ease of transition from resident to attending in a location where you didn't train. But it looks like its relatively easy to overcome.

 

[TexasPhysician]

The laws aren't hard to learn. Finding any job shouldn't be too hard, but the better jobs may be out of reach coming OOS.

Residency, like many non-medical fields, involves a level of networking. You can learn which desirable practices have unadvertised positions, who could use a partner, and which part of local cities could use another private practice psychiatrist.

When I finished training, I didn't need to apply for jobs in my city. I knew the better private practices, and they knew me. A phone call landed any of those desirable positions.

None of these practices ever had advertisements and none hire unknown psychiatrists. They wait for the right people.

Had I moved out of state, I would not have known anyone or known who to trust. I would have applied to listed openings which are rarely desirable.

 

[vitamin H]

The laws aren't hard to learn. Finding any job shouldn't be too hard, but the better jobs may be out of reach coming OOS.

Residency, like many non-medical fields, involves a level of networking. You can learn which desirable practices have unadvertised positions, who could use a partner, and which part of local cities could use another private practice psychiatrist.

When I finished training, I didn't need to apply for jobs in my city. I knew the better private practices, and they knew me. A phone call landed any of those desirable positions.

None of these practices ever had advertisements and none hire unknown psychiatrists. They wait for the right people.

Had I moved out of state, I would not have known anyone or known who to trust. I would have applied to listed openings which are rarely desirable.

This is a good point, thanks for chiming in. My long term goal is to be a partner in a private practice for child psychiatry. So, I guess it does help if you do your training in the same area so you can have the inside track on unadvertised positions. But to add to this, what if I did my general psych training out of state, but came back to CA for child fellowship. Would the 2 year fellowship be a long enough time to network?

 

[HarryMTieboutMD]

This is a good point, thanks for chiming in. My long term goal is to be a partner in a private practice for child psychiatry. So, I guess it does help if you do your training in the same area so you can have the inside track on unadvertised positions. But to add to this, what if I did my general psych training out of state, but came back to CA for child fellowship. Would the 2 year fellowship be a long enough time to network?

Yes. In general child psych fellowships aren't competitive, but UCLA/UCSF/Stanford take some pretty impressive people (from their own residencies and others). I would go to the best academic program possible so you can make connections with people important in AACAP who will write you strong rec letters (assuming you perform well, etc).

 

[SeniorWrangler]

Top tier program where ever is better than a mediocre in-state program IMHO.
On the other hand, the nicer parts of California are already well stocked with physicians of all sorts, so it might be more of an advantage to train in the place where you want to work and develop connections.

 

[slappy]

I agree with OldPsychDoc and wolfvgang, learning the new laws about commitment, duty to warn, etc. is not very hard. I also switched states after training.

I like posting this link: http://www.ncsl.org/research/health/mental-health-professionals-duty-to-warn.aspx

 

[vitamin H]

Top tier program where ever is better than a mediocre in-state program IMHO.
On the other hand, the nicer parts of California are already well stocked with physicians of all sorts, so it might be more of an advantage to train in the place where you want to work and develop connections.

A more specific question for you, I'm having trouble placing these 4 programs on my rank list given their differences in location and the fact that they are University vs. Community programs....

If my goal is child fellowship and practicing in southern CA, which is better for me:
University of New Mexico and University of Utah
OR
UCLA affiliated community programs (UCLA SFV or UCLA harbor)....both the community programs have their own child fellowship

?

 

[st2205]

A more specific question for you, I'm having trouble placing these 4 programs on my rank list given their differences in location and the fact that they are University vs. Community programs....

If my goal is child fellowship and practicing in southern CA, which is better for me:
University of New Mexico and University of Utah
OR
UCLA affiliated community programs (UCLA SFV or UCLA harbor)....both the community programs have their own child fellowship

?

What are your thoughts on community vs. university in general? Are you currently in the LA area and/or is that where you'd like to practice? What is it you like about Utah/NM over the other two? Depending on what the answer to that is it may or may not matter. And even if it matters, it may not matter very much.

 

[vitamin H]

What are your thoughts on community vs. university in general? Are you currently in the LA area and/or is that where you'd like to practice? What is it you like about Utah/NM over the other two? Depending on what the answer to that is it may or may not matter. And even if it matters, it may not matter very much.

What are your thoughts on community vs. university in general?
- I imagine that community programs have a better work life balance but I think that going to any university program will make it easier to get into fellowship

Are you currently in the LA area and/or is that where you'd like to practice?
- So cal native, and med student at southern California med school

What is it you like about Utah/NM over the other two?
- Utah/NM are university programs so I would think the training is more rigorous and that there are more child fellows/attendings around to do projects with and eventually get letters from

 

[st2205]

What are your thoughts on community vs. university in general?
- I imagine that community programs have a better work life balance but I think that going to any university program will make it easier to get into fellowship

Are you currently in the LA area and/or is that where you'd like to practice?
- So cal native, and med student at southern California med school

What is it you like about Utah/NM over the other two?
- Utah/NM are university programs so I would think the training is more rigorous and that there are more child fellows/attendings around to do projects with and eventually get letters from

Speaking as someone who isn't doing child fellowship, I don't think it'd make much an appreciable difference in where you trained among those with regard to fellowship. Do you have a specific program or location in mind for fellowship? If it's socal, I couldn't imagine Utah or NM adding to any leverage because they're university programs, any more so than many other variables. I'd kind of view this like the difference between a 229 and a 231 on USMLE. Where do you see yourself happiest for 3 years?

 

[Merovinge]

What are your thoughts on community vs. university in general?
- I imagine that community programs have a better work life balance but I think that going to any university program will make it easier to get into fellowship

Getting into child fellowships is not tough, even if you are looking at more competitive locations. I would think local ties and knowing PDs/attendings from places you are interested in would greatly outweigh mediumish academic program vs community. Make sure you go to your state/city's regional chapter of AACAP early on and that should take care of any concerns for getting into fellowship.

 

[TexasPhysician]

Most psych fellowships just require a pulse as long as you are flexible on geography.

I'd go where you are happiest, but local programs will likely give you a leg up on finding a local job.