How Much Does Residency Program Matter for Employment?

[The Long Way]

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Greetings All,
So I am a 4th year and applying for residency this fall. I think that I am a relatively competitive applicant and could likely match at some pretty good programs in psych. However, my long-term interest is to return to the town where I grew up and where I have family. There is a small community-based psychiatry program there. I have met a number of the faculty and residents and it seems like a good program, however, it does not have the big name that some of the "top programs" have.

My long range goal is to open an independent practice in my hometown (where the progam is). I'm wondering if going to a "big name" program will help me attract patients, or if by training in the community, I will develop contacts and thus be able to establish an independent practice with less difficulty?

Also, as a side note (maybe should be a different thread) I am just starting to learn about the business side of medicine and am intrigued by a direct payment model. Does anyone have any experience with these patient self-pay practices?

Thanks in advance for your replies,
The Long Way

 

[fMRI]

However, my long-term interest is to return to the town where I grew up and where I have family. There is a small community-based psychiatry program there. I have met a number of the faculty and residents and it seems like a good program, however, it does not have the big name that some of the "top programs" have.
The Long Way

If the "small town" program is good, I see no harm of training there, but training elsewhere has advantages, too.

Training means you'll start "small" (PGY1 feels just like being a frosh and an M1 all over again, my partner says...) and you will learn from others. You will also get to know colleagues from other disciplines in town more naturally -- not just other doctors but social workers, psychologists, etc. This can be an advantage. If you train elsewhere, you'll bring new ideas and a different background and thinking to your town, that, too, can benefit your patients and professional community.

I don't think you can go wrong on either. Maybe you could let your partner do the ranking of all the places you'd consider matching at? Where would s/he like to live for the next couple of years? Would s/he be happy living in your home town for the years to come or for career reason rather live in 'big place' for a while? How about moving later? Any dependents having to be taken into account?

As another MD/PhD student, I am surprised that your goal is private practice and not academic med. For me, I'm fairly sure it will be (one day...) all about the programs where I could continue the line of research I'm in. But that's just me.

 

[psychotrope]

Greetings All,
Also, as a side note (maybe should be a different thread) I am just starting to learn about the business side of medicine and am intrigued by a direct payment model. Does anyone have any experience with these patient self-pay practices?

Thanks in advance for your replies,
The Long Way

I won't comment on the larger question(about the differences longterm between prestigous programs and smaller community programs), but in answering this question, I'd say you have little to no chance of opening up a self pay clinic in a small to medium sized town unless you are doing something very outside the box(and even then it would be tough).

To make as much as you would from working within the system in a small town, you would have to charge *a lot* of money out of pocket. There simply isn't a large enough pt base in most small to medium size towns who are willing to pay that.

 

[peppy]

If you're sure that you want to practice in the area where the small program is, and you feel the training at the small program would be satisfactory to you, it's my view that it might actually help you more to do residency where you want to eventually have your practice rather than training at a remote prestigious program.

I say that simply because of something I noticed in rotating through several small community hospitals as a student: sometimes the big name programs provoke a "reverse discrimination" kind of reaction in the docs who are at those small community programs.
A couple of times I heard docs say things like, "Sure, they do a lot of research at Big Name U, but they don't see the clinical stuff that we see here". That's not to say that is a universal reaction, but it just goes to show you can't assume that a big name will impress everyone. Being in the area for residency so you can network and build a reputation might end up doing you more good.

 

[whopper]

In clinical practice in a typical private practice or hospital, I have not seen many situations where people were turned down because of their program, though going to certain programs can open doors.

Personally IMHO, having graduated from a university program with a decent (though not top rep), the biggest thing is your reputation on the field. How good a job you do clinically will far outweigh what program you are from.

However going to a big name program will open far more doors in academia & research.

For me personally, its all about what I see from the person over the course of a few months. I've seen some attendings come from top programs..e.g. U Penn, MGH etc and scratch my head in disbelief about how bad they are, or see very good doctors having come from not so known programs. In general-of course the bigger name programs will more likely create a better doctor and have more oppurtunities to learn-but that's also dampened by the fact that in residency much is up to the individual resident. I've also seen too many exceptions to the rule. Also in psychiatry, at least at this point, several people could get into top fellowships even if they were bad residents. I mentioned this in another post but a resident who I (& several others) thought was terrible got into a top fellowship program. Several residents I knew who were far better got into little known programs.

 

[sunlioness]

My long range goal is to open an independent practice in my hometown (where the progam is). I'm wondering if going to a "big name" program will help me attract patients, or if by training in the community, I will develop contacts and thus be able to establish an independent practice with less difficulty?

My advice to you given your goals would be to train in the community you want to open your practice in. You will make a lot of invaluable contacts and will probably be able to keep a lot of the outpatients whom you begin seeing as a resident.

As to not taking insurance . . . That I can't advise you on. I think it would be very difficult to run a completely self-pay clinic without having established a reputation first. Someone I trained with has a solo self-pay practice, but she is also married to a cardiologist and thus doesn't have the pressure to make money right away to live on. She also took a part time job doing med checks at a facility while she is waiting for her practice to grow.

 

[Neurotica]

I agree with SunLioness. If you're eventually planning on practicing in a small town, I'm guessing that most people just go to the psychiatrist who can get them in quickest or whoever is closest. They're not going to know or care if you were trained at a top five place or the local community, they're just going to want to be seen. So you'll miss out on a couple of narcissistic patients who decide they must be seen by a doc from a top program? Who cares--will you really miss them? And you're going to be plenty busy regardless!

But don't get me wrong, I understand you dilemma. I'm getting ready to apply to fellowships, and there is a program that I am thinking about applying to that is tops in the field, whereas another is closer to where I think I will eventually end up and practice. However, I'm not as concerned about which will open doors, I'm more wondering would I truly learn a hell of a lot more at this top name program? If so, then it might be worth going there and trying to relocate when I'm done. If I decide I probably won't learn a whole lot more, why not go where I'm hoping to end up!