stbdre

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greetings all...

how important is name, reputation, and the purported "strength" of a program? If one were to choose a smaller, less prestigious program for family reasons, what kind of impact would that have on fellowship opportunities, future career prospects, etc.? I ask because (obviously, I guess) I am in a similar situation - my husband is a PGY-1 in a different specialty at one program, which is 2 hours away from a couple of bigger name Psych programs, though his institution does have a psych residency. I don't want to sabotage my career in the beginning, but I don't want to cause undue and unwarrated stress in both of our lives either...

Additionally, how different are the levels of training between a higher tier school and a lower? In other words, am I going to turn out as a mediocre or even sub-par psychiatrist by choosing the smaller, less impressive program? Said smaller program does have a relatively impressive board pass rate, at least.

Comments, advice, musings will all be welcomed. Hope you all are having an easier time with your ROL's than I am as the hour draws nigh!
 

PsychMD

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This is more of musing...I guess it really depends on your "career" objectives, and it is hard because those "objectives" will inevitably change at some point or other down the road.

This is also somewhat harder, I think (although I may get in trouble over this!) for a female physician...because, inevitably, one really will have to make some very practical choices re. time/energy devoted to "profession" vs. time/energy devoted to family. Some doors will seem at times as if ending up being closed by some earlier choices. Obviously, one can always be very obstinate and conscientious (and most physicians ARE, regardless of gender!) and break through any "doors" or "obstacles" if one is strongly motivated to do so at any point in ones' career down the road...but it is this very motivation and energy that gets sometimes inevitably sapped/strained as one gets older anyway. So, practically speaking, some doors will remain inevitably closed, because there won't be any motivation/energy left to even attempt to break them open at some point!

I guess...you have sometimes to go with your gut feeling rather than fret on what seems socially fashionable or mainstream at some point in time. Those trends do change. Ultimately, regardless if one is male or female, my personal opinion is that one first owes to be faithful to oneself and to one's loved ones ahead of any career aspirations. It is a matter of priorities. It is also humane to always yearn and aspire for "more" and "better" (in both professional life and personal life), and to wonder at times if one's life, looking back on it, would have been "different" or "better" in any way, if one made "other choices" at some juncture or another. I went to a GREAT residency program, sort of "second tier" MAYBE, by today's "academic rankings" (if they even do actually exist, outside of the anecdotal and "spin"-realm), which was great for variety of clinical exposure and not too overwhelming re. scutwork. Thus I earned my clinician stripes and had absolutely no trouble passing the General Psych. board exam. Sometimes, when I look back, I feel there was maybe too little exposure to opportunities for research, and too little mentorship re. pursuing a subsequent academic career path...yet, I am pretty sure, looking back on it that if I had really been interested and motivated at THAT time for seeking such mentorship and such a career path, I would have found those opportunities or even CREATED them for myself. But I wasn't. My own "career" may be perceived by SOME as being in "shambles" by SOME current mainstream "objective standards", especially academic-career-type points of view, or even "earning-power" "market-place" points of view (coming from a rat-race private practice perspective), yet I am quite satisfied on a personal level, most of the time. I see patients, I work only part-time, I earn accordingly (very little, way below average!), I have and take LOTS of time off, etc. I sometimes feel the twinge of wanting to go back "to school", get back into some form of renewed academic exposure, yet I am myself hesitant about it, because I know how much energy and dedication it will require, and I'm somewhat doubtful re. whether I am really motivated for it at this time. (Plus I hate academic politics!). I do not have, however, any big doubts about my current competency level, as a clinical psychiatrist, I was able to build up on the core body of knowledge I obtained during residency, I continue to keep up with reading/learning, I plan to sit for a subspecialty certif. exam soon, etc. I just wanted to give you a personal perspective so you can easily see where I came from and whether this fits somehow with your aspirations and thoughts. It may not. If you are strongly motivated for a subsequent academic career, I guess it is better to forge ahead with some of the current "research power houses" (yet some of them may have some extra scut-work penalties you might have to bear at first). If you are interested in subsequent private practice "earning power", it really depends more on how much you want to work and how much business sense you have about the current type of system (which is always in some sort of flux and is regionally variable and fragmented anyway, especially in Psychiatry!) rather than on which residency program you attend. IMHO, most current accredited well established programs offer the basic core that one needs for acquiring the basic competencies. A lot of additional learning comes through individual interests and critical reading and subsequent post-residency real life practice exposure as well...so it is quite individual rather than program-based. I hope these musings were helpful.
 

OldPsychDoc

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stbdre said:
Additionally, how different are the levels of training between a higher tier school and a lower? In other words, am I going to turn out as a mediocre or even sub-par psychiatrist by choosing the smaller, less impressive program? Said smaller program does have a relatively impressive board pass rate, at least.
How did you feel about the smaller program on a "gut" level? Are they nice folks? Is the PD someone you want to "work for"? Are the residents happy?

Your training will be adequate. Mediocre or sub-par psychiatrists are made from *within*. The board pass rate at least tells you that they are either covering the right things in didactics, or that they know how to pick residents who can teach themselves.

Your training will be enhanced by being someplace where you are happy. Maybe you can be happy with a 1 hour commute...but my bias would be to "bloom where you are planted".
 
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stbdre

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OldPsychDoc said:
How did you feel about the smaller program on a "gut" level? Are they nice folks? Is the PD someone you want to "work for"? Are the residents happy?

Your training will be adequate. Mediocre or sub-par psychiatrists are made from *within*. The board pass rate at least tells you that they are either covering the right things in didactics, or that they know how to pick residents who can teach themselves.

Your training will be enhanced by being someplace where you are happy. Maybe you can be happy with a 1 hour commute...but my bias would be to "bloom where you are planted".

Thanks - my gut agrees with most of what you've written. And, I love the idea of "blooming where I am planted." Seriously, you've confirmed and articulated much of what has been muddled over (ad nauseam) in my own thoughts over the past few weeks...thanks again for your candid comments!
 

OldPsychDoc

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stbdre said:
Thanks - my gut agrees with most of what you've written. And, I love the idea of "blooming where I am planted." Seriously, you've confirmed and articulated much of what has been muddled over (ad nauseam) in my own thoughts over the past few weeks...thanks again for your candid comments!
Well I do hope that your decision truly does come from within, rather than being based on ACC basketball standings, as I earlier may have suggested to you... ;)

Seriously, best of luck to you.