How important is residency program prestige?

[Lexahope]

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Working on finalizing my rank list, and my wife and I are trying to balance the family friendliness of the location versus program factors. I have heard mixed messages about how important going to a more “prestigious” program would be for my career. (Currently debating ranking university of Vermont vs Dartmouth higher). Also ranking the University of Michigan, University of Utah, MUSC, University of Arizona Tucson, and others.

 

[splik]

It does matter somewhat but neither of the above are prestigious programs so I would just go to whichever you consider the best fit. I can tell you that Vermont does provide a very supportive environment for residents and their residents do not have problems getting into top fellowships etc. There is no such thing as an ivy league psych residency.

 

[Lexahope]

Thanks! I’ve also got U Michigan, U of U, MUSC and U of A Tucson in my top tier. Probably will put Michigan first but unsure about the rest.

 

[psych_0]

I work in what at least I would call a "desirable" location that pays well above the national average. None of my colleagues went to "prestigious" residency programs except maybe one. IMO, prestige only matters if your end goal is to work at a fancy academic facility after graduation. If your goal is outpatient or even cash pay, prestige means nothing. There are cash-pay NPs with 2-3 month wait lists in my area. No one cares about prestige outside of academia.

 

[TexasPhysician]

It depends on what your goals are. If you want to work in academia or teaching, I would go to Dartmouth.

If you plan to work a generic job, it likely won’t matter.

If you plan to live in Vermont after, I’d recommend going there.

 

[comp1]

It doesn't matter basically at all. Choose based on geography. You are both statistically likely to live where you match the rest of you lives. Think about how you like the weather, the city amenities, how close your families are, etc. The programs themselves are just a fraction of the rest of your lives where you match.

 

[Taddy Mason]

Echoing others that “prestige” doesn’t really matter and is inherently subjective. Based on the list you shared I would prioritize ranking where you would feel you and your spouse would be happiest. Of the programs on your list I’m familiar with: Dartmouth is not prestigious, Vermont is solid, UMich is probably the most “prestigious,” and I have a peer who went to Utah and has spoken highly of his/her training there. MUSC and U of A Tucson I’m not familiar with but my cousin owns a solid pizza restaurant in Tucson so there’s that I guess.

 

[Nontrad_FL_LGBT]

It does matter somewhat but neither of the above are prestigious programs so I would just go to whichever you consider the best fit. I can tell you that Vermont does provide a very supportive environment for residents and their residents do not have problems getting into top fellowships etc. There is no such thing as an ivy league psych residency.

UVM student here who's shadowed just about every Psych specialty in the system and agree. All the attendings and residents are very friendly and close knit, very supportive environment with great teaching attendings. The only crappy thing is the inpatient unit is in Plattsburgh, a ferry ride and ~1h15m drive away. They do put you up in an apartment when you're rotating there though from what I understand.

 

[Lexahope]

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Echoing others that “prestige” doesn’t really matter and is inherently subjective. Based on the list you shared I would prioritize ranking where you would feel you and your spouse would be happiest. Of the programs on your list I’m familiar with: Dartmouth is not prestigious, Vermont is solid, UMich is probably the most “prestigious,” and I have a peer who went to Utah and has spoken highly of his/her training there. MUSC and U of A Tucson I’m not familiar with but my cousin owns a solid pizza restaurant in Tucson so there’s that I guess.

Well now I wanna try your cousin’s pizza place (dunno why it’s so glitchy omg)

 

[Lexahope]

UVM student here who's shadowed just about every Psych specialty in the system and agree. All the attendings and residents are very friendly and close knit, very supportive environment with great teaching attendings. The only crappy thing is the inpatient unit is in Plattsburgh, a ferry ride and ~1h15m drive away. They do put you up in an apartment when you're rotating there though from what I understand.

How have I literally never heard about the Plattsburgh thing even once? Never mentioned in the interview

 

[Nontrad_FL_LGBT]

How have I literally never heard about the Plattsburgh thing even once? Never mentioned in the interview

I could be wrong, maybe just the med students go to Plattsburgh, but all of the psych-interested students are suggested to rotate there, which suggests there's some additional value to the site. The main child inpatient is also in Plattsburgh. You should definitely see if you can reach out to ask about any required satellite rotations.

I know there's some inpatient beds at the main hospital and the other adult inpatient center in Berlin is unfortunately getting closed due to political bs and funding issues.

 

[clausewitz2]

If you have an interest in critical psychiatry I know Sandra Steingard is up at Vermont. I also know a couple people up there on the clinical psychology side of things who are really into psychotherapeutic approaches to psychosis who are very solid and are open to collaborations, so if that's something that interests you, you could do worse.

 

[romanticscience]

I wouldn't worry about prestige unless you focus on a specific niche therapy-centric cash private practice in SF or NYC, where people care about those things. Some of my worst referrals were from people who sought me out based on pedigree (special patients need special doctors!).

Strongly consider which offers the broadest base of training. You don't know what you might get interested in later on. One of the things that's helped my forensic career was being able to at least not totally fib when asked if I've had any "experience" with a particular pathology!


One case = "I have experience"
Two cases = "I've seen this type of thing time after time"
Three cases = "I've seen this type of thing again and again and again."

 

[Lexahope]

I wouldn't worry about prestige unless you focus on a specific niche therapy-centric cash private practice in SF or NYC, where people care about those things. Some of my worst referrals were from people who sought me out based on pedigree (special patients need special doctors!).

Strongly consider which offers the broadest base of training. You don't know what you might get interested in later on. One of the things that's helped my forensic career was being able to at least not totally fib when asked if I've had any "experience" with a particular pathology!


One case = "I have experience"
Two cases = "I've seen this type of thing time after time"
Three cases = "I've seen this type of thing again and again and again."

Super helpful, thank you!

 

[Monocles]

Unless you are gunning for the top of academia, prestige is pointless and stupid.

Go somewhere with good work/life balance, close to family/friend support, nice cost of living, etc

Also this is complete hearsay and possible slander libel but I've heard that Dartmouth is "malignant"

 

[splik]

While a lot of people claim the residency doesn't matter, it does make a difference. It's just one of a number of factors. This myth that it is just matters for academics needs to be put to rest though. If it really didn't make a difference, people wouldn't fret about it so much. The good news is, where you train matters less the farther out from training you are.

• While you can have a successful cash practice regardless of where you trained, it is not coincidence that most of the people in major metro areas with successful practices went to top programs and heavily market their training.
• It also makes a difference in terms of opportunities like working with tech companies, consulting to fortune 500 companies, leadership opportunities (in tech, pharma, insurance companies, governmental, and even in big box shops like Kaiser)
• It does make a difference for forensic/expert witness work. Lawyers want fancy sounding experts. This of course depends on the region - An Alabama Jury is less likely to be impressed by a Harvard trained physician and may trust the UAB one more.
• It can make a difference for recruitment to more desirable positions. Even Kaiser in more popular locales is going to hire people from the better residencies.
• I can tell you I have had some pretty sweet gigs that pay well (e.g. >$500 for chart reviews that can take as little as 15 mins, $750 for a 30 min call etc.) - would absolutely not get those without the training and affiliations I've had.

But I am talking about where there is an actual discernible difference in the programs (e.g. MGH v Tufts, Stanford v Kaiser Oakland, Columbia v Jamaica Hospital). Dartmouth is not going to be more favorable than UVM, and won't help in academics either. Neither are top 40 schools - and UVM actually gets more NIH psychiatry funding than Dartmouth.

 

[Sushirolls]

It doesn't matter. It just doesn't matter. Most Big Box shops will replace with ARNP in a heart beat.

@splik is grossly the exception.

Real world medicine is more likely this: where patients don't even know what you are or do. And then their online therapist with Big Box Private Equity some how encourages them to see their prescriber with intent to poach.

Or your longstanding patient with depression/anxiety, gets a referral by their psychologist and PCP for psych testing - (not even a neuropsychologist) who diagnoses them with ADHD but yet gloss over their current social stresses/anxiety leading to their relative impairment all in the time span of one visit, when last visit they expressed doing great and talking about med reductions...

 

[Merovinge]

It doesn't matter. It just doesn't matter. Most Big Box shops will replace with ARNP in a heart beat.

@splik is grossly the exception.

Real world medicine is more likely this: where patients don't even know what you are or do. And then their online therapist with Big Box Private Equity some how encourages them to see their prescriber with intent to poach.

Or your longstanding patient with depression/anxiety, gets a referral by their psychologist and PCP for psych testing - (not even a neuropsychologist) who diagnoses them with ADHD but yet gloss over their current social stresses/anxiety leading to their relative impairment all in the time span of one visit, when last visit they expressed doing great and talking about med reductions...

This is clearly true for a number of people and (unfortunately) an increasing number of physicians are becoming cogs in the BBS, however there still remains a LOT of folks in psychiatry who are not part of BBS. There are solo practices, small group practices, physician owned practices, academia, industry, etc which are not at all an insignificant number of psychiatrists.

When I review CVs for folks to hire, I absolutely pay attention to where someone trained. One of my friends trained at a community program in the city where I trained at a traditional academic program and the differences in our training were... significant. I know there are plenty of solid community programs and I am very open to speaking to folks wherever they have trained, but to say that it has no impact on my mindset as a hiring physician would certainly be inaccurate. This is coming from someone who pushes zero beans and is exclusively focused on the clinical product put forth and remains 80% clinical 20% admin at my organization.

 

[comp1]

Yeah there are outliers as above, but IN GENERAL, it doesn't matter much. Most employers, good and bad, are absolutely desperate for anyone in mental health.

 

[FlowRate]

This is clearly true for a number of people and (unfortunately) an increasing number of physicians are becoming cogs in the BBS, however there still remains a LOT of folks in psychiatry who are not part of BBS. There are solo practices, small group practices, physician owned practices, academia, industry, etc which are not at all an insignificant number of psychiatrists.

When I review CVs for folks to hire, I absolutely pay attention to where someone trained. One of my friends trained at a community program in the city where I trained at a traditional academic program and the differences in our training were... significant. I know there are plenty of solid community programs and I am very open to speaking to folks wherever they have trained, but to say that it has no impact on my mindset as a hiring physician would certainly be inaccurate. This is coming from someone who pushes zero beans and is exclusively focused on the clinical product put forth and remains 80% clinical 20% admin at my organization.

I wish I was better versed in the fat middle spectrum of programs w/r/t quality of clinical training. We absolutely end up seeing differences once people show up and start work that are sometimes hard to suss out in interviews--especially since I feel like I've seen multiple people on here express the view that it's a yellow/red flag in psych for people to ask much by way of questions that might actually test clinical competence.

 

[comp1]

I don't know if it's a red or yellow flag to ask clinical questions of attending applicants. I definitely do on my standardized interview questions. The questions tend to be more about how you would approach a complicated interpersonal dynamic than about which SSRI or antipsychotic to use, though. As far as asking MS4's applying to residency clinical questions, I'm less in favor. They just spent 4 years mostly learning not psych. You might as well ask them whether to start someone on lisinopril or amlodipine. I care a heck of a lot more about how pleasant they are to be around during the interview. Clinical knowledge is literally what they are coming for.

 

[Stagg737]

This is clearly true for a number of people and (unfortunately) an increasing number of physicians are becoming cogs in the BBS, however there still remains a LOT of folks in psychiatry who are not part of BBS. There are solo practices, small group practices, physician owned practices, academia, industry, etc which are not at all an insignificant number of psychiatrists.

When I review CVs for folks to hire, I absolutely pay attention to where someone trained. One of my friends trained at a community program in the city where I trained at a traditional academic program and the differences in our training were... significant. I know there are plenty of solid community programs and I am very open to speaking to folks wherever they have trained, but to say that it has no impact on my mindset as a hiring physician would certainly be inaccurate. This is coming from someone who pushes zero beans and is exclusively focused on the clinical product put forth and remains 80% clinical 20% admin at my organization.

Sure, but the question wasn’t whether training at academic vs community will make a difference, it’s about “does prestige matter”. I think any employer that cares about clinical quality is going to be more weary of someone who trained in a small/new community program or a community program at a for profit hospital vs academia. That’s a big difference compared to does a graduate from Columbia vs Georgetown make a huge difference. For the latter, I’d say it does not for 95% or more of career goals.

 

[comp1]

Where are you people hiring that you have a fat stack of psychiatrist CVs that you can go line by line on to see if their training institutions meet your personal quality standards? I'm VERY lucky if I get two applicants to contrast for any given position, AMAZINGLY lucky if those two applicants didn't both assume that it was a 100% virtual position and decide to drop out when I have to explain that the listing is actually pretty clear that it's part time on site.

 

[Merovinge]

Where are you people hiring that you have a fat stack of psychiatrist CVs that you can go line by line on to see if their training institutions meet your personal quality standards? I'm VERY lucky if I get two applicants to contrast for any given position, AMAZINGLY lucky if those two applicants didn't both assume that it was a 100% virtual position and decide to drop out when I have to explain that the listing is actually pretty clear that it's part time on site.

I work at a PHP/IOP and we have several applications anytime we have an open position. It's a very in-demand LoC to work at, particularly when you have a track of record of clinical focus. Previous positions I have held were a scramble for a breathing body, it really depends on what the position is, who owns the company, etc. FWIW a classmate of mine from fellowship recently posted to hire their first CAP at her cash practice and interviewed north of a half dozen CAP for the one position so such a thing clearly exists in OP care as well.

 

[FlowRate]

Where are you people hiring that you have a fat stack of psychiatrist CVs that you can go line by line on to see if their training institutions meet your personal quality standards? I'm VERY lucky if I get two applicants to contrast for any given position, AMAZINGLY lucky if those two applicants didn't both assume that it was a 100% virtual position and decide to drop out when I have to explain that the listing is actually pretty clear that it's part time on site.

During resident job-hunt season (Oct-Mar), we end up having a lot of applicants, of varying residency quality, both local and out of state. Much more slim pickings when trying to hire over summer. You'd hope it wouldn't be necessary, but the employee I had in mind w/r/t wanting to ask clinical quality questions is more along the lines of actual medical treatment plan/diagnosis concerns, otherwise great in terms of soft skills. At least that stuff is sorta teachable, if a bit of a lift for their supervisor.

 

[mistafab]

When you ask how important it is - the question I have is, to whom?

Does it matter to other psych PDs and department heads? Yes
Does it matter to most outpatient clinics? No
Does it matter to most hospitals? No
Does it matter to you?
Does it matter if you want to be an academic psychiatrist? Kind of. It will definitely give you a boost.
Does it matter for a researcher? Yes, as prestige loosely follows research output, and makes you more coveted early career. Unfortunately, prestige (during residency, and affiliations after) likely contribute to grant approval.
Does it matter to your patients? Usually no. Most patients care more about where you went to med school since they don't really know anything about how training works.

 

[HaileyMed]

I'd say it depends on what you wanna do. If you want to go into business or something that's not psychiatry, residency prestige can be important/help. But if you just want to do psychiatry by itself, not very important.

 

[OldPsychDoc]

Over 18 months since my last post, and not only does this question keep coming up, but it's like the contour of the thread is the same every time:
OP--Does it matter?
splik: only a little, not that much.
14 more posts: yeah but not really except ....
splik: detailed list of forensic exceptions.
11 more posts striking the fear of CV impressions into innocent minds
OPD: <sigh> Nope. Doesn't matter.

 

[clausewitz2]

Over 18 months since my last post, and not only does this question keep coming up, but it's like the contour of the thread is the same every time:
OP--Does it matter?
splik: only a little, not that much.
14 more posts: yeah but not really except ....
splik: detailed list of forensic exceptions.
11 more posts striking the fear of CV impressions into innocent minds
OPD: <sigh> Nope. Doesn't matter.

Le plus ça change...

 

[Stagg737]

Over 18 months since my last post, and not only does this question keep coming up, but it's like the contour of the thread is the same every time:
OP--Does it matter?
splik: only a little, not that much.
14 more posts: yeah but not really except ....
splik: detailed list of forensic exceptions.
11 more posts striking the fear of CV impressions into innocent minds
OPD: <sigh> Nope. Doesn't matter.

Welcome back! Some things never change, lol.

 

[silkrhodescholar]

While a lot of people claim the residency doesn't matter, it does make a difference. It's just one of a number of factors. This myth that it is just matters for academics needs to be put to rest though. If it really didn't make a difference, people wouldn't fret about it so much. The good news is, where you train matters less the farther out from training you are.

• While you can have a successful cash practice regardless of where you trained, it is not coincidence that most of the people in major metro areas with successful practices went to top programs and heavily market their training.
• It also makes a difference in terms of opportunities like working with tech companies, consulting to fortune 500 companies, leadership opportunities (in tech, pharma, insurance companies, governmental, and even in big box shops like Kaiser)
• It does make a difference for forensic/expert witness work. Lawyers want fancy sounding experts. This of course depends on the region - An Alabama Jury is less likely to be impressed by a Harvard trained physician and may trust the UAB one more.
• It can make a difference for recruitment to more desirable positions. Even Kaiser in more popular locales is going to hire people from the better residencies.
• I can tell you I have had some pretty sweet gigs that pay well (e.g. >$500 for chart reviews that can take as little as 15 mins, $750 for a 30 min call etc.) - would absolutely not get those without the training and affiliations I've had.

But I am talking about where there is an actual discernible difference in the programs (e.g. MGH v Tufts, Stanford v Kaiser Oakland, Columbia v Jamaica Hospital). Dartmouth is not going to be more favorable than UVM, and won't help in academics either. Neither are top 40 schools - and UVM actually gets more NIH psychiatry funding than Dartmouth.

Agree with this 100%. It does matter, but only in certain practice environments/locations I trained at one of the programs you mentioned above. From my observation the most material differences are 1) Cash Pay private practice in large cities: Marketing is just a fact of human nature. When faced with a choice between a provider charging $500-$700 an hour from a less prestigious residency vs Harvard, most will choose the most prestigious brand in the absence of other information. 2) Non clinical opportunities: Agree with above. Have had some govt and private industry opportunities that my friends who trained elsewhere haven't had. Again probably a marketing/branding thing vs expertise thing.

 

[comp1]

Ultimately, the chance of it mattering to the OP is very low and the chance of them knowing for sure ahead of ROL time that it will matter is even lower, so focus on geography.

 

[Merovinge]

Ultimately, the chance of it mattering to the OP is very low and the chance of them knowing for sure ahead of ROL time that it will matter is even lower, so focus on geography.

Put another way, the data suggesting geography matters crushes any available evidence to support prestige mattering. It's not that prestige doesn't matter, geography just matters way more.

 

[clausewitz2]

Put another way, the data suggesting geography matters crushes any available evidence to support prestige mattering. It's not that prestige doesn't matter, geography just matters way more.

If I am making a fancy ice cream sundae, I probably have preferences for the kind of gummy candy that is put on top. I care a heck of a lot more about the flavor of ice cream they're being put on.

 

[HaileyMed]

I will say I think a lot of people here have been brainwashed into automatically saying geography is most important without deeper thought, maybe because it’s easy to point to charts and say people tend to stay where they go. However, they should also factor in that it’s hard to leave a program in the middle of your residency. Goodness of fit and culture of the program are often, in my opinion, more important than geography. Why spend four miserable or even “okay” years in a program if there is another program in a place farther away which will provide you with GREAT experiences, opportunities, friendships and support you in finding/pursuing your interests? That all comes down to the CULTURE of the program and how well you fit into it. Geography is important, especially if you have family and kids or something, but for many people I think culture should be just as or more important.

And going back to prestige, how much that should be weighed is not a blanket “important” or “not important” thing. It is more nuanced and depends on what you want in your future.

It’s hard to measure how “prestige” helps or harms people because you need a quantitative measure. Not everyone who goes to an ivy WANTS to make a lot of money, and my guess would be LESS people who go to an ivy or other such schools are driven by money because so many of them are focused on either academia, supporting disadvantaged communities, or entrepreneurship.

 

[comp1]

I'll rank culture above prestige definitely, but it's a very nebulous concept and super hard to firmly gather from an interview in person, much less on zoom. Geography, on the other hand, affects the majority of your day while not at work AND the rest of your life after residency. Prioritize geography.

 

[bGMx]

Geography shapes culture. New England (non Boston) and midwestern programs tend to be slower (chiller) and more outdoorsy/less focused on winning. The geography lends itself to this. NYC, Boston, LA/SF, are flat, boring, excellent harbors; so they are mercantile cultures that prioritize getting #$%^ done and being the best.

Now if by culture, you're talking about resident-dependent versus resident-independent... that I can agree with. I'd choose resident-independent cultures.