Good residency program

[medslave]

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fdsf dsfse

 

[medslave]

anyone

 

[cleareyedguy]

You didn't get any responses for at least a couple of reasons.

First, your question lacks specificity (what in the world do those programs have in common aside from being residency programs?). There is no apparent link beyond them being "good" and in one of 50 cities in the country. Aside from the small number of programs that are in rural areas, virtually every program fits that bill.

Second, you don't seem like you'd be a very good resident and I doubt if the people on this board want you to be a colleague. I say this--presumptuous and unpleasant as it is intended to sound--because you are apparently ruling out Phoenix because you "heard they keep you pretty busy." You are planning to train in one of the most complex, challenging, and growthful areas of medicine--psychiatry--and you are ruling out a not-particularly-hard training program because it's too hard??

And so while I began by saying that almost all programs fit your criteria, I'm now saying that none do: you won't find a "good" psychiatry program that is as easy as you seem to desire.

I am purposefully erecting a strawman in response to your question, but I really do think you need to be prepared to put in some serious effort if you intend to be a competent psychiatrist.

 

[nancysinatra]

I suspect it is the second law of thermodynamics, entropy, that explains the lack of answers to this question right now. Right now a lot of 4th year med students who interviewed recently and were collecting related information are busy graduating, going on vacation, etc. But anyway, this board has produced some of the most work avoidant-threads the world has probably ever seen! I recall a thread once asking about programs with NO call at all.

I'm not saying it's an attitude to be proud of or a good way to choose your away elective. I'm just saying, this is SDN. You could probably find the name of a med school with no classes if you looked. Do a search.

 

[beezley]

Wow, cleareyed guy, that is really presumptuous and judgmental. I feel the same way as the original poster. I am a mother and looked long and hard for a program that would BOTH train me well but NOT kill me with work hours. I really don't think there is anything wrong with that. I ended up matching in what I hope is what I was looking for. Time will tell.

The attitude that your job has to be your entire life is not sustainable. I really think it is possible to be a good physician and also have a life. Are you sure you aren't a surgeon?

 

[ScienceMind]

Hey I am an intern at UIC and I would suggest applying here for residency. Just for comparison sake, I am from Los Angeles, California and felt strongly enough about the program to relocate here. I have had a positive esperience so far. Intern year is tough wherever you go, but I am almost done with Q5 call (while on psych inpatient). There are several people who are married in our program and more than a handful who have children. It is very child and family friendly, once you get done with intern year of course. I have learned a lot and feel that my training is strong thus far. We rotate at UIC and Jesse Brown VA during the first year, 4 months will be inpatient psych, 2 months will be psych ER; the other non-psych months will be spent doing 2 months of neurology (no call only have to round on weekends), 3 months doing IM or 3 months of Peds (2 months call), and one month of ER (14-18 shifts total). Also, we have lectures on Tuesdays, 1p-5p and a process group (group therapy for the interns) on Wednesdays for an hour. The residents for the most part are all very friendly. I enjoy hanging out with most of the residents. There is a lot of diversity in the patients you will see as well as in our program. Good luck researching programs. BTW, I also interviewed at the program in Phoenix (Banner Good Samaritan) and I liked it alot.

 

[rpkall]

It's a shame you want a major city. Usually life is a little nicer in some of the smaller community programs. Sometimes the patient population is smaller, services are more consolidated, and often there are enough residents in the "smallish" programs to spread the call thinner.

I just interviewed in the Northeast, so that's all I can contribute, really.

If you want a middle of the road type deal, look at smaller cities near major ones, like Worcester (UMass, excellent for child), or smaller cities farther away from major cities, like Syracuse (Upstate, great well rounded general psych education). Also, I think Hartford's Institute of Living has a great program, but I'm not sure what their call is like.

 

[FURY 161]

You didn't get any responses for at least a couple of reasons.

First, your question lacks specificity (what in the world do those programs have in common aside from being residency programs?). There is no apparent link beyond them being "good" and in one of 50 cities in the country. Aside from the small number of programs that are in rural areas, virtually every program fits that bill.

Second, you don't seem like you'd be a very good resident and I doubt if the people on this board want you to be a colleague. I say this--presumptuous and unpleasant as it is intended to sound--because you are apparently ruling out Phoenix because you "heard they keep you pretty busy." You are planning to train in one of the most complex, challenging, and growthful areas of medicine--psychiatry--and you are ruling out a not-particularly-hard training program because it's too hard??

And so while I began by saying that almost all programs fit your criteria, I'm now saying that none do: you won't find a "good" psychiatry program that is as easy as you seem to desire.

I am purposefully erecting a strawman in response to your question, but I really do think you need to be prepared to put in some serious effort if you intend to be a competent psychiatrist.

I would like to respectfully disagree with that posting. Residency training is supposed to be a learning experience, with well balanced clinical exposure, academic activities, reading and research. Residency training is NOT supposed to be scutwork for the sake of the hospital CEO, who does not want to pay for PAs, attendings, nurses and moonlighters.



TO MEDSLAVE:
I would suggest that the searching student AVOID community hospital based residency programs, and concenrate only on University BASED (not affiliated) programs, despite the location. Community hospital residencies have the money making machine mentality and don't care about education. These places are built to serve the community, not the residents' educational needs. Generally in such programs the classes are of very low quality, the attendings are less qualified, there is no research, the call schedule is heavier, the supervision is only on paper and you will have to learn by yourself, which is very difficult to be done in psychiatry. You need to grow in an academic environment, where people know what they are doing and know how to teach. And the diploma that you get from a university is more respectable than that of a community hospital.
A very important thing is the atmosphere of the program. When you interview, pay close attention to it - it tells a lot! Are the attendings and the residents honest, or they beat around the bush? Are the residents happy with the program? Look at the elective time in the 4th year. Do they have 6-8 months elective time, or only 1- 2 months? That tells a lot. If they have 1-2 months of electives, that means that the hospital is dependent on the residents for service and you want to avoid that place.
What is the call schedule? A q5 schedule for PGY 1 is normal. 3 calls a month for PGY2 is normal. If you have to do calls in PGY3 or 4, avoid the place, you have more important things to do at that time.

From the programs listed, I would recommend UT- Houston - a very strong program, with good reputation and nice atmosphere. And Houston is a nice place to live. Avoid New York and Boston - these cities are full of narcissists even in the most respectable institutions and the people there are not generally nice. Avoid places with a lot diverse immigrant populations - you need your patients to speak English, otherwise you will not learn much and it is extremely frustrating to use phone lines and interpreters. With translation, a lot of information is lost, you cannot appreciate the semantics, intonation, your understanding will be incomplete and it could be dangerous for the patients, frustrating for you and time consuming.

That said, choose wisely. Residency training is a crucial investment. Interview in at least 7-8 places. Good luck.

 

[whopper]

Wrote this in a past thread. You will find several previous threads that have already dealt with this question that can yield some helpful information.

Consider the following factors, numbered but not in order of importance which is up to you.

1) Geographic location: friends & family in the region? Do you like the weather there? What is the cost of living in the area? The geographic area may also influence the types of patients you see. In Upstate NY, expect to see more Seasonal Affective DO. In Miami Fl, expect to see more substance abuse.

2) Rural/Urban: aside from your own personal preference, the rural vs urban will change the types of patients you see. Rural has more Conversion DO, Malingering is higher in urban areas, as well as IVDA. Urban tends to have more multicultural patients. Amphetamine use is higher in the rural midwest. In general, urban areas present with more forensic oppurtunities. Different communities present with different challenges.

3) are there other psychiatric oppurtunities in the area? This will influence your choice of electives in PGY-IV, and if you settle down in the area, where you may work. Most residents by the time they graduate have well established connections in the area, and often times that anchors them to that area. If you move out to a new place, its often times like starting over again. NYC & Boston are a psychiatric meccas, with several oppurtunities for structured academics, but for the general psychiatrist--usually lower pay (unless you're one of the best), & harder work hours. Philadelphia has the Beck Institute for CBT. Ohio has Phil Resnick. NEI is in San Diego. NJ has the University Hospital Eating Clinic headed by Russell Marx, New Orleans is begging for psychiatrists and rebuilding is going on, several areas of the midwest are underserved & need other psychiatrists--so you won't have many colleagues or structured learning, but you will be in high demand.

4) call schedule

5) daily workload

6) general atmosphere of the program: malignant? stressful? Laidback?--if so too much by your standards?

7) research

8) quality of the facilities: does the facility have measures in place to protect against violent patients? What are your oppurtunities to get food while on call (& yes that is important). Is the psyce unit depressing (40 layers of paint on top of cinder block walls with security guards with criminal records?, or a brand new modern facility specifically designed to be a state of the art psychiatric facility?)

9) quality of the teaching (and factor in psychotherapy because some programs teach it more or less)

10) does the program have a fellowship you want to enter?

11) variety of the clinical oppurtunies: PACT/ACT teams, inpatient involuntary/voluntary, psychiatric emergency center, long term facility, short term facility, commitment/probate court, eating disorder clinic, forensic psychiatry, child offices, consult service, clinical research, ECT etc.
Several programs only offer some of the above, not all. Some offer more than others. Several programs for example do not have an involuntary unit, and thus those residents will almost never get an oppurtunity to see what it is like to commit a patient against their will, nor see the court procedure where committed patients get to argue for their release to a judge. Several programs do not have specialists to treat eating disorders. PACT/ACT teams are also another thing I've seen several programs not have.
Several programs don't have ECT.
Several programs have units that will only hold patients for up to a few weeks. The things to worry about in long term vs short term facilities highly differ. The longer term units for example will often times hold psychotic patients where nothing, not even Clozaril has worked for them, and ECT is used more often in these situations. Short term facilities only hold patients for a few weeks, and if they can't handle the situation, they transfer to the long term.

When you apply & interview at a program factor in all of the above, and ask about them. My first interview, I didn't know what to even look for. By the time I reached my 3rd interview, I started to get a clue as to what made some programs better than others.

 

[OldPsychDoc]

TO MEDSLAVE:
I would suggest that the searching student AVOID community hospital based residency programs, and concenrate only on University BASED (not affiliated) programs, despite the location. Community hospital residencies have the money making machine mentality and don't care about education. These places are built to serve the community, not the residents' educational needs. Generally in such programs the classes are of very low quality, the attendings are less qualified, there is no research, the call schedule is heavier, the supervision is only on paper and you will have to learn by yourself, which is very difficult to be done in psychiatry. You need to grow in an academic environment, where people know what they are doing and know how to teach. And the diploma that you get from a university is more respectable than that of a community hospital.
A very important thing is the atmosphere of the program. When you interview, pay close attention to it - it tells a lot! Are the attendings and the residents honest, or they beat around the bush? Are the residents happy with the program? Look at the elective time in the 4th year. Do they have 6-8 months elective time, or only 1- 2 months? That tells a lot. If they have 1-2 months of electives, that means that the hospital is dependent on the residents for service and you want to avoid that place.
What is the call schedule? A q5 schedule for PGY 1 is normal. 3 calls a month for PGY2 is normal. If you have to do calls in PGY3 or 4, avoid the place, you have more important things to do at that time.
.

I really have to disagree with your blanket dismissal of community-based programs, especially in light of your urging to "consider the atmosphere of the program". Many academic programs are malignantly full of themselves beyond belief, whereas you will find community programs that are strongly focused on mentoring and educating residents. Many are also run by non-profit hospitals, so the "money making machine" allegation is a distortion. (Also, keep in mind that there are "university hospitals" which are run as money-making enterprises.)

I'm an attending in a community-based program, and trained at a university program. The residents in our program are easily the equals of anyone I trained with. Frankly, the word on the street locally is that our residents are better prepared than those from the local university-based program.

I agree, pay CLOSE attention to the atmosphere and the statements of the residents about things like didactics, supervision, camaraderie. And DON'T dismiss community-based programs!

 

[chameleonknight]

I agree with OPD. I'm starting at a community based program and it was DEFINITELY a better atmosphere, better training than some of the University based programs I interviewed with (and didn't rank!) Judge each program on its individual merits and don't be blinded by a 'name' (or lack thereof)

 

[Doc Samson]

Also agree with OPD. For example: Cambridge, one of the more competitive and well-regarded programs in the country, is a community-based program.

 

[FURY 161]

I really have to disagree with your blanket dismissal of community-based programs, especially in light of your urging to "consider the atmosphere of the program". Many academic programs are malignantly full of themselves beyond belief, whereas you will find community programs that are strongly focused on mentoring and educating residents. Many are also run by non-profit hospitals, so the "money making machine" allegation is a distortion. (Also, keep in mind that there are "university hospitals" which are run as money-making enterprises.) I'm an attending in a community-based program, and trained at a university program. The residents in our program are easily the equals of anyone I trained with. Frankly, the word on the street locally is that our residents are better prepared than those from the local university-based program. I agree, pay CLOSE attention to the atmosphere and the statements of the residents about things like didactics, supervision, camaraderie. And DON'T dismiss community-based programs!

Just to clarify something. A not- profit hospital does not mean that it does not work for profit. It simply means that it does not distribute its surplus funds to owners, but retains them for its own improvement (which, of course is a legal maneuver to evade taxes) NPO is not for profit to evade taxes, because it is not profitable in the first place, so this is a way to survive. This all means that the NPO is dependent on funding from outside and with the medicare and medicaid cuts you can extrapolate what happens - not enough money to hire RNs, attendings, MH workers, PAs -which means scutwork for residents. Another thing is increasing workload for attendings and frequent resignations and high turnover, which means unstable curriculum, frequent changes in rotations and class schedules etc. Under the financial pressures, education of the residents is the first to suffer. This leads to unhappy residents and resignations. That is why in such places you will see high number of IMGs - they cannot resign, because they are on visas and it is much more difficult to transfer on a visa. These places cannot retain american grads, ACGME cites them for high rates of resident dropout and such hospitals learn to work around the problem by hiring IMGs on visas and giving prematches, so they can be trapped there. That leads to my next recommendation - avoid places with more than 50% IMGs, not because the IMGs are not good docs, but because they indicate that the program is in trouble. Avoid places with ACGME citations or probations, avoid places with high turnover of attendings. Avoid programs with pyramidal structure - 10 entering PGY 1 residents and 5 PGY4 graduating the program - that means high dropout rate, if not explained by the child track after PGY 3.Don't get fooled by individual examples of good community hospital programs. This is NOT the rule.