How big a difference between programs?

[uhmocksuhsillen]

I'm having a tough time with my rank list. I had an interview at a well regarded, very robust, huge academic program. Tons of funding, research, electives, amazing faculty, etc. It's in an amazing area too. Downside is they work really hard here, intern year in particular.

I have other options; some University programs, some community, also in desirable locations. Personally not into research, have no desire to ever work academics, and have a more chill personality and definitely value work life balance. I want to be a well prepared psychiatrist but if there's a less bumpy road to get there, I'd happily take it.

Wondering how much difference the training really is between programs. Would I be doing myself a disservice by choosing a chiller program and maybe bypassing an opportunity to rank the former higher?

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[NickNaylor]

Depends a lot on what you're interested in and what you want to do. In general, ACGME oversight ensures some degree of universal standardization that limits the variability of the core training experience. That's not to say that every program is going to be identical or that some aren't better than others, just that, in terms of the core training, you're likely to get a "good enough" experience at most programs, especially if you stick to university-affiliated programs.

Because of that, I think your own interests play a big role, perhaps the biggest role in making your rank list. Interested in psychotherapy? Research? Neuromodulation? A particular sub-speciality that you're seriously considering pursuing or wanting exposure to? Make sure that whatever is important to you is available. I also think that getting a sense of the culture, as much as you can, is important to ensure that it fits with what you want to do. Some people want to have their nose to the grindstone, others want a more "chill" experience. Figure out which is more important to you and rank accordingly.

Since you said yourself that you're not interested in academia, prestige probably isn't all that important, but I wouldn't advocate going to a dumpster of a program.

I think this idea that you can somehow get excellent training while working 30 hours/week is farcical. There are trade-offs to a "chill" training experience whether we want to admit that or not. I'm not saying that going for a grossly malignant training experience is somehow the best, but I do think it's important to acknowledge that less time working = less clinical time = less time to develop the clinical pattern recognition hardware that is your brain. There's certainly a point of diminishing returns IMO, but I think trying to seek out the "chillest" training experience is misguided IMO. Wait until you're an attending and in practice to pursue "chill," otherwise you're just going to be a substandard clinician. I don't know that that's a widely accepted opinion so YMMV.

 

[Mass Effect]

I'm having a tough time with my rank list. I had an interview at a well regarded, very robust, huge academic program. Tons of funding, research, electives, amazing faculty, etc. It's in an amazing area too. Downside is they work really hard here, intern year in particular.

I have other options; some University programs, some community, also in desirable locations. Personally not into research, have no desire to ever work academics, and have a more chill personality and definitely value work life balance. I want to be a well prepared psychiatrist but if there's a less bumpy road to get there, I'd happily take it.

Wondering how much difference the training really is between programs. Would I be doing myself a disservice by choosing a chiller program and maybe bypassing an opportunity to rank the former higher?

You're too early in training to know what you're interested in, in my opinion. I'd leave all doors open and I'd personally pick the well-regarded robust program over a community program any day. Yes, you're supposed to get a similar education anywhere, but I think we all know that doesn't happen. Part of that is what is offered at some programs with more resources/prestige, part is the caliber of faculty to learn from at those institutions, and another part is the caliber of colleagues you're working with (never underestimate how much you can learn from your fellow residents). Residency is finite. Your goal is to learn as much as you can so you can write your own ticket and do whatever you want at the end.

 

[Merely]

You absolutely will do a disservice to yourself goin to a “chill” program. The culture will not make you an excellent psychiatrist whether people admit it or not.

 

[uhmocksuhsillen]

You absolutely will do a disservice to yourself goin to a “chill” program. The culture will not make you an excellent psychiatrist whether people admit it or not.

Fair point. For instance there is a UC (California) program that's mid tier rank but much chiller hours than the program described above. Would your sentiment extend to even a program like this...or are you speaking moreso about a chill community program?

 

[TexasPhysician]

You absolutely will do a disservice to yourself goin to a “chill” program. The culture will not make you an excellent psychiatrist whether people admit it or not.

Ill semi-disagree. It’s important to have some volume and range of experiences, but many training programs push volume at the expense of reading/research/moonlighting. There is a point at which seeing another schizophrenic patient would be less valuable than in-depth reading over a fair number of patients.

With that said, my program had very limited exposure to ECT and TMS. I don’t have a desire to do either, but if I had, a larger program may have been better.

 

[uhmocksuhsillen]

Ill semi-disagree. It’s important to have some volume and range of experiences, but many training programs push volume at the expense of reading/research/moonlighting. There is a point at which seeing another schizophrenic patient would be less valuable than in-depth reading over a fair number of patients.

With that said, my program had very limited exposure to ECT and TMS. I don’t have a desire to do either, but if I had, a larger program may have been better.

So would you say its generally safe to assume a Uni program ranked 25 vs. 50 is essentially going to both provide solid education? One works you hard, the other, not so much..but I hear they get good diversity nonetheless..

 

[TexasPhysician]

So would you say its generally safe to assume a Uni program ranked 25 vs. 50 is essentially going to both provide solid education? One works you hard, the other, not so much..but I hear they get good diversity nonetheless..

By ranking only, I would consider these programs equal.

 

[Chimed]

To the OP, it is important to go to a program that gives you a wide range of patient and clinical experiences. It is also critical that you train somewhere where the attendings follow and teach evidenced based practices. Even though all programs have ACGME oversight, I'm not so sure you're going to have attendings training you that follow evidenced base practices. Also, I would really talk to the residents about the work load. Even though you might work harder at one program, in the long run, you might get better training at a place where the work load is a bit less but there is more teaching. There's a difference between a heavy work load and quality of teaching. They are not always the same.

 

[OldPsychDoc]

By ranking only, I would consider these programs equal.

Rankings are all made up anyway.

 

[FlowRate]

I go to a well reputed, big, high-workload program. Overall, the majority of faculty have been very bright and hard-working and great teachers. The few examples of poor learning experiences (specific attendings and coresidents who are not up to this standard) I've had--and the exposure I've had to residents and faculty in certain other programs in the area--increasingly strengthens my opinion that you want to go to the program where you think the average quality of colleagues and attendings is as high as possible. It's easy to get away with being pretty bad at psychiatry, even somewhere really competitive, and so you want to go to the place with as many people as possible who are good at it.

Of course, it's worth weighing the marginal increase in quality at "high stress high prestige program" vs. more time/energy to study on your own, less chance of feeling burnt out from working so much, and any location benefits at other programs.

 

[clausewitz2]

I go to a well reputed, big, high-workload program. Overall, the majority of faculty have been very bright and hard-working and great teachers. The few examples of poor learning experiences (specific attendings and coresidents who are not up to this standard) I've had--and the exposure I've had to residents and faculty in certain other programs in the area--increasingly strengthens my opinion that you want to go to the program where you think the average quality of colleagues and attendings is as high as possible. It's easy to get away with being pretty bad at psychiatry, even somewhere really competitive, and so you want to go to the place with as many people as possible who are good at it.

Of course, it's worth weighing the marginal increase in quality at "high stress high prestige program" vs. more time/energy to study on your own, less chance of feeling burnt out from working so much, and any location benefits at other programs.

In all professional training situations in life, you ideally want to make sure you are always the dumbest person in the room. This is how you guarantee you will be actually learning on a regular basis.

 

[J ROD]

It really is hard to have a clue about programs unless you know current residents in the programs. I did not go to my home program because I believed it was "too easy". No night float, easy rotations, about 40hrs per wk, etc. But overall decent teaching. Better than what I receive where I matched. However, the clinical training I have gotten is far superior. From just the number of patients I have seen. Tough consults, ED, night float. High volume. By yourself for much of it and having to call attendings. So you develop skills. Also, I prefer to read and teach myself so didactics are always whatever to me. Also, get good exposure to TMS and ECT. In your case, I would say avoid a place like Duke where they have the name but work you hard. I have read Duke has gotten better though. And take a lesser name but still clinically hard enough to be good. Also, some places may have a good academic name and not that great training. The best way to know is talk to current residents that do not lie about things. I found out after I matched residents were telling half truths about things because they were made to basically. I probably would have changed my rank list a little based on that. But, in the end, you do your best with information you have. You just need to match somewhere so you can move on from residency.

 

[sloop]

It is going to be difficult for anyone to answer this question well. The vast majority of people will only experience one program as a resident. Many of us will have points of comparison from time in medical school and fellows may have the perspective of being part of another program as a fellow, but that is often very different from the experience of the residents. Perhaps the most qualified would be program directors who trained elsewhere, but that’s also imperfect. Understand that comparisons between programs are almost universally coming from an outsider’s perspective to some degree.

This being said, my impression is that there are significant differences between programs. ACGME guidelines leave a ton of room to structure programs in very different ways. Some programs have a much heavier inpatient focus than others (which may be mainly outpatient/elective time by PGY-3). Some programs offer almost exclusively general psychiatry training while others have you rotate through many niche sub-specialties. Some programs have a heavy emphasis on VA populations. There is a great degree of variability to how call is structured and what resident responsibilities are while on call. Some places have several experts/big names while others have few. Perhaps more rare but still important is that some programs (mine being one) will take pride in a somewhat distinct way of forumulating cases.

With regard to “chill vs intense,” I would echo the sentiment that there is a trade off to programs with low work hours and patient volume. There simply is no substitute for seeing a lot of varied cases in terms of learning. Having said that, I go to a program that is pretty intense. While overall I do think there’s tremendous benefit to the intensity, there are times where I can go a week or so feeling like I’m not getting the most out of the work because I’m tired. This often happens if I haven’t had a vacation in a while or if there are coverage situations that are increasing the workload/call frequency.