Good News for Psych Hopefuls

[MADD!!!]

https://apps.acgme.org/ads/Public/R...entYear=2018&SpecialtyId=&AcademicYearId=2017

As predicted, Psych residencies are opening up like crazy. 22 new programs (well, a few were former AOA programs) opening up for next year!! Assuming a minimum of 4 residents/program, that's at least 88 more positions. I know there's a lot of scare as to Psych getting more competitive, but with new residency programs opening up, the number of spots is keeping up with demand. Don't panic too much ppl, just apply broadly. (My opinion).

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[yanks26dmb]

https://apps.acgme.org/ads/Public/R...entYear=2018&SpecialtyId=&AcademicYearId=2017

As predicted, Psych residencies are opening up like crazy. 22 new programs (well, a few were former AOA programs) opening up for next year!! Assuming a minimum of 4 residents/program, that's at least 88 more positions. I know there's a lot of scare as to Psych getting more competitive, but with new residency programs opening up, the number of spots is keeping up with demand. Don't panic too much ppl, just apply broadly. (My opinion).

I heard the rumblings, but two new programs in the Bay Area is awesome. Glad to see it worked out.

 

[Bad Moose]

Dang six new programs in Florida. I am glad for medical student but wonder how this will impact the reputation of Florida already being a competitive market for physicians.

 

[uhmocksuhsillen]

That's great to hear. Though only 4 spots per program seems a bit low no?

 

[MADD!!!]

That's great to hear. Though only 4 spots per program seems a bit low no?

Yea that’s a conservative estimate. I think there will be more spots.

 

[MADD!!!]

I heard the rumblings, but two new programs in the Bay Area is awesome. Glad to see it worked out.

Kaiser too! Good reputation. Even as a new program it’ll definitely be very competitive to get into.

 

[Nasrudin]

Kaiser too! Good reputation. As a new program it’ll definitely be very competitive to get into.

Kaiser has a good reputation in psychiatry in what universe? And new programs are difficult to get into for being ... new?

I mean. It's good news. But... just trying to reframe your expectations more realistically.

 

[splik]

Kaiser too! Good reputation. As a new program it’ll definitely be very competitive to get into.

lol kaiser is a great place to do psych residency to learn how to get your patients to kill themselves. Also they don't really treat patients with serious mental illness. But 1 in 4 people in the bay area have Kaiser insurance so there is that. I wonder where they will do their psychotherapy, C/L, emergency psych, community, and inpatient rotations. They will presumably have to have more sites than just Kaiser. Also the bay area programs receive far fewer applications than other programs because as desirable as the area is for some people (e.g. if you have a techy spouse, family in the area etc), it is too expensive for residents and most people with families cannot afford to live there. The first year of any new program they don't tend to match that well, and after that things will get more competitive.

The good news is just goes to show you that the government does not have to fund residency positions. clearly kaiser think it is in their interests to pay for this. drives me mad when people who despise socialism hypocritically demand that the government expand funding for GME. both sides of the political spectrum should be united against this nonsense, goverment should not fund residency training at all, it makes no sense at all.

 

[MADD!!!]

Kaiser has a good reputation in psychiatry in what universe? And new programs are difficult to get into for being ... new?

I mean. It's good news. But... just trying to reframe your expectations more realistically.

Edited it. I'm from CA and I just know that Kaiser has an excellent reputation for residencies, not sure about Psych specifically. But for CA standards it's a good name to have on your CV for training. Also @splik why the hate on Kaiser?

The Bay Area, for some reason, is SUPER competitive to get into for just about anything. I see Harvard students matching there for Family Medicine. I predict even the first year match for their program will be hard to match at. Yea it's more expensive to live there, but we're talking 8 or so residents.

Also that UCLA Olive View program is going to be just as competitive. Wouldn't be surprised if that program gets filled by just CA MD students alone. Usually CA is one of the few states where I notice more students apply for Psych than there are residency slots in the state.

 

[MADD!!!]

lol kaiser is a great place to do psych residency to learn how to get your patients to kill themselves. Also they don't really treat patients with serious mental illness. But 1 in 4 people in the bay area have Kaiser insurance so there is that. I wonder where they will do their psychotherapy, C/L, emergency psych, community, and inpatient rotations. They will presumably have to have more sites than just Kaiser. Also the bay area programs receive far fewer applications than other programs because as desirable as the area is for some people (e.g. if you have a techy spouse, family in the area etc), it is too expensive for residents and most people with families cannot afford to live there. The first year of any new program they don't tend to match that well, and after that things will get more competitive.

The good news is just goes to show you that the government does not have to fund residency positions. clearly kaiser think it is in their interests to pay for this. drives me mad when people who despise socialism hypocritically demand that the government expand funding for GME. both sides of the political spectrum should be united against this nonsense, goverment should not fund residency training at all, it makes no sense at all.

Yea that's been a question for me too in terms of how all of these new programs are opening and getting funding every year, in all these specialties, when the biggest scare of medicare funding being capped was that new GME growth wouldn't occur.

 

[uname943]

Also that UCLA Olive View program is going to be just as competitive. Wouldn't be surprised if that program gets filled by just CA MD students alone. Usually CA is one of the few states where I notice more students apply for Psych than there are residency slots in the state.

The UCLA Olive View program really isn't a totally new program. It's looks like a renaming of the UCLA-San Fernando Valley program, which rotated heavily through Olive View. The program director's the same.

lol kaiser is a great place to do psych residency to learn how to get your patients to kill themselves. Also they don't really treat patients with serious mental illness. But 1 in 4 people in the bay area have Kaiser insurance so there is that. I wonder where they will do their psychotherapy, C/L, emergency psych, community, and inpatient rotations. They will presumably have to have more sites than just Kaiser.

Kaiser put in a lot more money in mental health after a lawsuit they had several years ago. They are more capable of dealing with severe mental illness. Doing residency at Kaiser helps with acculturating to their way of doing things, making the jump to being staff there easy. My friends working at KP are making total bank.

 

[Nasrudin]

The UCLA Olive View program really isn't a totally new program. It's looks like a renaming of the UCLA-San Fernando Valley program, which rotated heavily through Olive View. The program director's the same.



Kaiser put in a lot more money in mental health after a lawsuit they had several years ago. They are more capable of dealing with severe mental illness. Doing residency at Kaiser helps with acculturating to their way of doing things, making the jump to being staff there easy. My friends working at KP are making total bank.

Bank yes. For what is the question. At what costs to the patient encounter.

It's lucrative. And also in my opinion. Like being the well-kept golden retriever of Satan.

It intones an ominous, cult-like death gong to psychiatry itself. And it all makes numerical sense.

Here you go America. This is the best you're going to get out your shrinks. Unless you're paying cash for it.

 

[yanks26dmb]

Bank yes. For what is the question. At what costs to the patient encounter.

It's lucrative. And also in my opinion. Like being the well-kept golden retriever of Satan.

It intones an ominous, cult-like death gong to psychiatry itself. And it all makes numerical sense.

Here you go America. This is the best you're going to get out your shrinks. Unless you're paying cash for it.

I've done a couple rotations at Kaiser, psych included. I'm not disagreeing with you, but what are they doing that is so bad? I likely don't have enough experience to pick up on those sort of things.

 

[uname943]

Bank yes. For what is the question. At what costs to the patient encounter.

It's lucrative. And also in my opinion. Like being the well-kept golden retriever of Satan.

It intones an ominous, cult-like death gong to psychiatry itself. And it all makes numerical sense.

Here you go America. This is the best you're going to get out your shrinks. Unless you're paying cash for it.

In my area, Kaiser provides a standard of care at or higher than the community practice. I'd rather send my family to Kaiser over the VA, the community mental health clinic, or a random private psychiatrist found on Google.

Paying cash doesn't mean better care. For example, as a health system Kaiser has been good at pushing their docs to cut down on benzo scripts and being on top of monitoring requirements. You can't always say the same about the local late career solo psychiatrist.

 

[Nasrudin]

Perhaps, I'm wrong. But I know the functional machinery of Kaiser. And it's powerful. It breaks down everything into it's cheapest possible components. And in that machine. We're strictly med managers.

If you're a psychopharmacologist. Who wants a comfortable sleep. It's paradise.

I don't disagree that's it's very effective at what it does.

I'm being hyperbolic with metaphor. But here's one thing I'm not the least bit exaggerating on.

Kaiser shrinks can't tie my f'n shoes now. Right now. As a graduating resident. And once I get into private practice, the difference will be light years. So. How ya like dem apples. F'n golden retrievers belong on leashes.

 

[FlowRate]

Things I don't necessarily agree with, but feel like contributing:

Psychiatry could make like urology, keep residency spots static for 30 years, drive down supply, and thereby increase the equilibrium price point.

People need access to psychiatrists who previously couldn't match into psychiatry.

 

[MADD!!!]

Perhaps, I'm wrong. But I know the functional machinery of Kaiser. And it's powerful. It breaks down everything into it's cheapest possible components. And in that machine. We're strictly med managers.

If you're a psychopharmacologist. Who wants a comfortable sleep. It's paradise.

I don't disagree that's it's very effective at what it does.

I'm being hyperbolic with metaphor. But here's one thing I'm not the least bit exaggerating on.

Kaiser shrinks can't tie my f'n shoes now. Right now. As a graduating resident. And once I get into private practice, the difference will be light years. So. How ya like dem apples. F'n golden retrievers belong on leashes.

by Kaiser do you mean the one in Fontana? Also aren't each of the Kaisers different from each other? Maybe they have a similar setup, but the hospitals are certainly different by geography, patient population, attendings, etc. Even the websites for Kaiser SoCal and NorCal make it look like they're more different than similar. I dunno.

 

[Nasrudin]

by Kaiser do you mean the one in Fontana? Also aren't each of the Kaisers different from each other? Maybe they have a similar setup, but the hospitals are certainly different by geography, patient population, attendings, etc. Even the websites for Kaiser SoCal and NorCal make it look like they're more different than similar. I dunno.

Look. I appear to be crossing an ocean to arrive at the shores of your perception. And that I may appear to be muttering in a strange tongue.

Psychiatry exists in cultural niches. It's not like other fields of medicine. Ortho in Kansas is ortho in LA. We are wielding culture and processing it. We thrive or dry up and blow away based on the richness of it. And whether it nourishes the strange, finicky, critical mass of species diversity in a certain ecosystem that can produce quality psychiatry training, is a serious consideration.

Kaiser delivers quality primary care at reasonable costs because they are both the insurance underwriter and the health care system delivery. It's wonderful for a PCP who can use that 15 minutes to pop an XR order in to have it done close by and get the results in house, and MRI, labs, refer to a specialist, etc, etc. And the health care aides can populate the visit with all of the screening questionnaires etc. etc. So for them it works.

For us. There's no substitute for the fully enriched clinical encounter. A PH-9 charted over months that shows a 15% reduction in sad points is perhaps better than your average burn out shrink who slings BDZ's like candy in PP. And because the machine moves efficiently to segregate your talking problems to a SW'er, your physical health to your PCP, and psych meds to your psychiatrist who see's you for 10 minutes to adjust the dose of your sad/anxioius meds based on the trend of sad/anxious points, I suppose it manages a consistent C-, to be generous. And maybe if you know what real psychiatry is and you check yourself into that mental nursing home ahead of schedule for the 3 large payout with sweet bennies to chunk out products on the assembly line, then maybe I can even sort of, non-player-hatingly, get it.

But you're talking about training. And if you think getting acculturated into psych nursing home work, by people who live at the nursing home is quality training. Then you're essentially an unambitious psych NP. Who see easy. Works easy. And doesn't see what the big deal is. You can do this just as well as anyone. Taking the easy route. Down easy street. Unaware of both the dangers and the wonders outside of the theme park you're living in.

If that sounds amazing! And you're super stoked! Then who am I to say otherwise.

 

[MADD!!!]

Look. I appear to be crossing an ocean to arrive at the shores of your perception. And that I may appear to be muttering in a strange tongue.

Psychiatry exists in cultural niches. It's not like other fields of medicine. Ortho in Kansas is ortho in LA. We are wielding culture and processing it. We thrive or dry up and blow away based on the richness of it. And whether it nourishes the strange, finicky, critical mass of species diversity in a certain ecosystem that can produce quality psychiatry training, is a serious consideration.

Kaiser delivers quality primary care at reasonable costs because they are both the insurance underwriter and the health care system delivery. It's wonderful for a PCP who can use that 15 minutes to pop an XR order in to have it done close by and get the results in house, and MRI, labs, refer to a specialist, etc, etc. And the health care aides can populate the visit with all of the screening questionnaires etc. etc. So for them it works.

For us. There's no substitute for the fully enriched clinical encounter. A PH-9 charted over months that shows a 15% reduction in sad points is perhaps better than your average burn out shrink who slings BDZ's like candy in PP. And because the machine moves efficiently to segregate your talking problems to a SW'er, your physical health to your PCP, and psych meds to your psychiatrist who see's you for 10 minutes to adjust the dose of your sad/anxioius meds based on the trend of sad/anxious points, I suppose it manages a consistent C-, to be generous. And maybe if you know what real psychiatry is and you check yourself into that mental nursing home ahead of schedule for the 3 large payout with sweet bennies to chunk out products on the assembly line, then maybe I can even sort of, non-player-haltingly, get it.

But you're talking about training. And if you think getting acculturated into psych nursing home work, by people who live at the nursing home is quality training. Then you're essentially an unambitious psych NP. Who see easy. Works easy. And doesn't see what the big deal is. You can do this just as well as anyone. Taking the easy route. Down easy street. Unaware of both the dangers and the wonders outside of the theme park you're living in.

If that sounds amazing! And you're super stoked! Then who am I to say otherwise.

Loll, the discrepancy lies in that I’m a first year med student who doesn’t know jack about how residency training really works or much else of what you mentioned. At my stage, I’m just hoping to 1) match and 2) as close to my geographically desired area as possible with 3) the best training possible. You clearly know much more about how Kaiser runs things than I do.

All I know from an outsiders perspective is I’d rather get training at Kaiser than some random community hospital. In my eyes it fits in that “community based, university affiliated” category. As time goes on and I get more experience, I’ll pickup more of the things you talked about here.

Tl;dr I’m not disagreeing with you, just don’t know what ur talking about. (We’ll just a tad, but that’s it).

 

[MacDonaldTriad]

In some ways "community based, university affiliated" can be the right nirvana, and Kaiser can miss both. Universities can be the end all, but also can lack substrate, or have overly unique substrate. "Community based" can give you the substrate, but may lack anything else. If Kaiser has the right teachers, it has good potential in terms of letting you see people managing cases you will need to know how to manage, but your teachers are probably not publishing much and may be to tied to the tread mill to have much passion for teaching.

 

[Nasrudin]

Loll, the discrepancy lies in that I’m a first year med student who doesn’t know jack about how residency training really works or much else of what you mentioned. At my stage, I’m just hoping to 1) match and 2) as close to my geographically desired area as possible with 3) the best training possible. You clearly know much more about how Kaiser runs things than I do.

All I know from an outsiders perspective is I’d rather get training at Kaiser than some random community hospital. In my eyes it fits in that “community based, university affiliated” category. As time goes on and I get more experience, I’ll pickup more of the things you talked about here.

Tl;dr I’m not disagreeing with you, just don’t know what ur talking about. (We’ll just a tad, but that’s it).

MacTriad makes an excellent point. The atmosphere on the other pole can be too stuffy, too hierarchical to try out your moves, and too cloistered to have access to proper "substrate." Mactriad also makes a further inference about the special relationship of young clinician to clinician mentor. This is also key. Put it this way. It's one thing to get a lecture in a therapy modality. It's another thing entirely to be working with your own cases in it and to bring tapes weekly for review by an inspiring and talented practitioner. who is helping you process your feelings in that role with another. Or to be in your own therapy with a real shrink. Or to be wading through a CPEP shift in which you're going full tilt, having to prioritize 5 different things, and negotiate the trickiest of interactions with psychotics, suicidals, malingerers, staff, muggle physicians, families, and to have an inspiring talented person to show you those ropes and then to be left to do it on your own. Or to be on a C/L team with a supersmart attending, where you work through the logic of differentials in a sophisticated way with. An so on, and so on.

The ability to produce real shrinks is a rare combination of quality "substrate"--both us and the patients--and the innumerable catalytic elements of which I mention only a few above.

I don't think Kaiser is equipped to pull together the right catalytic elements. And if they connect themselves with the right agents outside the Park to do it, I would be really surprised. What my guess is, is that you'll get a few talks in this or that, with no clinical dimension to make any of it real. Rotate a bit here and there. And get the right amount of benefits and lack of call so that the grads who are happy for the spots will say..."sure!....it's great." I don't think Kaiser is motivated to train because they believe in their training so much as they need service coverage and they want in-house recruits that are ready cogs for the machine. It's NP school, basically. Better, but, you get what I mean I hope.

Also MADD, here's the thing... I had similar ideas about never leaving a certain locale. And have spent 8 years in parts of the country I probably wouldn't have thought to go to if it weren't for the allure of better training. And now I return. Like a lion king. Ready to take my place in the home I left. At every interview, being confused by them being impressed with my resume. Being confused also by the plentiful opportunities everywhere. Such that. I need to tell you this in all sincerity. You can come back to where you want to be. Like a lion king. When you're ready. But you can only train once.

So don't worry about medical school and residency as a shrink. If you can get into great places for those locally, then great. Stay and kill it, while networking. But don't worry about a sojourn elsewhere either. A fully grown shrink. Especially a real one. Can go anywhere. And do whatever they want.

 

[MADD!!!]

MacTriad makes an excellent point. The atmosphere on the other pole can be too stuffy, too hierarchical to try out your moves, and too cloistered to have access to proper "substrate." Mactriad also makes a further inference about the special relationship of young clinician to clinician mentor. This is also key. Put it this way. It's one thing to get a lecture in a therapy modality. It's another thing entirely to be working with your own cases in it and to bring tapes weekly for review by an inspiring and talented practitioner. who is helping you process your feelings in that role with another. Or to be in your own therapy with a real shrink. Or to be wading through a CPEP shift in which you're going full tilt, having to prioritize 5 different things, and negotiate the trickiest of interactions with psychotics, suicidals, malingerers, staff, muggle physicians, families, and to have an inspiring talented person to show you those ropes and then to be left to do it on your own. Or to be on a C/L team with a supersmart attending, where you work through the logic of differentials in a sophisticated way with. An so on, and so on.

The ability to produce real shrinks is a rare combination of quality "substrate"--both us and the patients--and the innumerable catalytic elements of which I mention only a few above.

I don't think Kaiser is equipped to pull together the right catalytic elements. And if they connect themselves with the right agents outside the Park to do it, I would be really surprised. What my guess is, is that you'll get a few talks in this or that, with no clinical dimension to make any of it real. Rotate a bit here and there. And get the right amount of benefits and lack of call so that the grads who are happy for the spots will say..."sure!....it's great." I don't think Kaiser is motivated to train because they believe in their training so much as they need service coverage and they want in-house recruits that are ready cogs for the machine. It's NP school, basically. Better, but, you get what I mean I hope.

Also MADD, here's the thing... I had similar ideas about never leaving a certain locale. And have spent 8 years in parts of the country I probably wouldn't have thought to go to if it weren't for the allure of better training. And now I return. Like a lion king. Ready to take my place in the home I left. At every interview, being confused by them being impressed with my resume. Being confused also by the plentiful opportunities everywhere. Such that. I need to tell you this in all sincerity. You can come back to where you want to be. Like a lion king. When you're ready. But you can only train once.

So don't worry about medical school and residency as a shrink. If you can get into great places for those locally, then great. Stay and kill it, while networking. But don't worry about a sojourn elsewhere either. A fully grown shrink. Especially a real one. Can go anywhere. And do whatever they want.

+1. I’m from CA and moved to the Northeast for med school. Always looking for the best opportunity to train. But I seem to be more the exception than the rule. Most ppl want to stay close to their region and don’t seem to care about the training as much. I.E. would rather train somewhere worse but be local than train far but at a better program.

 

[Drrrrrr. Celty]

Things I don't necessarily agree with, but feel like contributing:

Psychiatry could make like urology, keep residency spots static for 30 years, drive down supply, and thereby increase the equilibrium price point.

People need access to psychiatrists who previously couldn't match into psychiatry.

I mean, it's not like there was really a high bar to matching into psych to begin with for almost all of its history. I think more importantly is offering people who actually have a talent for interpersonal skills and what not an opportunity which is being slowly taken up by people who see psych as more through the lens of a lucrative specialty with nice lifestyle perks.