Importance of Residency Prestige

[Encephalopathy]

Will going to a top residency program open more doors after you enter the job market? Specifically, how much of a factor will it play in deciding whether you get a given job over someone else? And is there any correlation between strength of program and salary?

I've been told the only reason to go to a top program is if you want to do academics, which I don't, and that the demand is so great for psychiatrists that it doesn't really matter what program you went to.

It's just hard for me to believe that doing a top-ranked 65-hour/week Q4 program vs. a 45-hour/week home call program will not confer some sort of professional advantage, or else why would anyone want to do it?

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[PsychMD2100]

My take is that the top programs--even if you never do academics--equip you with the language and the process of academics and publication. Because they've got the academic focus, they'll likely devote more hours to learning to scrutinize a randomized clinical trial paper. It's a nice skill to have fully developed by the start of a private practice.

If you wish to open a boutique practice, then prestige will likely be a greater factor in attracting private patients. Paying customers will want to feel as though their psychiatrist trained with "the best".

 

[whopper]

This is tough to answer because psyche programs are ranked in several unreliable and invalid ways.

If you just want to practice somewhere I don't think the prestige matters. Its not like the patient is going to ask what residency you attended.

If you want to go up in psychiatric organizations, I think prestige can help, but I'm learning more and more that there's so many other factors.

E.g. I'm in a university program with a good rep, not the top, but decent--UMDNJ-Robert Wood Johnson. I ran for president of the NJPA and lost, but did get the VP position. The person who beat me for President goes to a program with lesser prestige. As far as I know, no one, including myself cares that my program has more prestige than hers. In the NJPA, I'm thinking we just want someone who'll do a good job, and if we do that good job, it'll thrust our individual reputations far more than the prestige of our program would ever do.

The past president of the APA was an FMG. There's teaching docs at several programs with good reps that didn't go to the "top" programs.

As for the "top" programs, several of them, including one particular Ivy Leaguer (I won't mention the name) has consistently gotten bad reviews on scutwork.com.

I would focus more on what the program offers than the "prestige". A lot of factors that make a program prestigious have little to do with the actual quality of that program.

 

[billypilgrim37]

Wowsers, are we so soft that we're scared of 65 hours/week of work?

 

[jjbmsiv]

...and you're referring to what, specifically?

 

[PsychMD2100]

I don't think anyone is saying that prestige of the program necessarily determines the quality of its resident/graduates.

The advantage of a name brand program is that it opens doors that would otherwise have to forced open through personal reputation. Unfortunately, psychiatry departments, professional organizations, and patients may not take the time to discover that a given doctor truly is exceptional. Instead, they may focus on brand recognition to make their choice.

Another benefit of a prestigious program is that they often are tertiary referral centers that draw some of the zebra cases. Although these can turn up anywhere, there tend to be more zebras at these top hospitals.

I also agree that 65 hours is nothing to fear. Programs can lawfully work people up to 80 hours a week and some still exceed that routinely. Although 40 hours is nice, psychiatry, like almost any other profession/skill, requires time and experience for mastery.

BTW, I checked out scutwork.com and the lowest rating for an Ivy League program appeared to be 4 out of 5 stars. I'm curious which Ivy League place got slammed. Can you please PM me with the place?

 

[jjbmsiv]

I'd guess it's UPenn or Hopkins.

 

[whopper]

I'm going to have to apologize for my previous post. I double checked the program I was referring to and now there's a few very good reviews and 1 bad review. Last few times I checked that program (& I checked about 2-3x per year) I remembered only bad reviews. Either memory's failing me or some of the older reviews have been removed.

 

[PsychMD2100]

Hopkins is not an Ivy League school, although it's often mentioned in the top tier.

 

[whopper]

Just wanted to mention again that I apoligize for my comment that technicallty wasn't true. PsychMD told me its cool, but just want to own up to my previous post.

 

[PsychMD2100]

No problem at all whopper,

Thanks for the clarification. We all make mistakes and I respect a person with the maturity to bring them up.

 

[Nika]

I'm going to have to apologize for my previous post. I double checked the program I was referring to and now there's a few very good reviews and 1 bad review. Last few times I checked that program (& I checked about 2-3x per year) I remembered only bad reviews. Either memory's failing me or some of the older reviews have been removed.

Where did you check this?

 

[whopper]

scutwork.com, already mentioned in my previous post.

 

[Nika]

OK! I got it. Thanks, I know this site.

 

[tennreb]

It seems that for every other specialty, patients could care less about where their doctor went to medical school or residency. Their primary concern is if they can talk to their doctor and if their doctor talks to them and listens to them. If a doctor does that, the patients will tell all their friends about how wonderful their doctor is. The second biggest factor is how well you get along with other doctors because they are the ones referring their patients to you. In my city, this means you have to be part of the good ole boys club.

 

[strangeglove]

Prestige aside, I think that where you do residency in psychiatry matters more than for other specialties, since the approach to psychiatry - for better or worse - is not only about science but also about philosophy. The primary factor is psycotherapy training, which differs significantly depending on where you do residency. A patient who is going to a psychiatrist and expecting to receive even a modicum of psychotherapy is better served by a psychiatrist who learned how to do psychotherapy in residency. It may be, however, that few patients are educated enough to know the difference between Pittsburgh and Cornell.

 

[PsychMD2100]

I agree strangeglove,

It comes down to options. If you go to a more "prestigious" program, then it gives you a higher likelihood of training with many of the current leaders in a given subspecialty. Oftentimes, the people publishing papers and writing textbooks on a given topic will be your attendings on the wards.

Some people think that prestige of residency is for one's patients but I would argue that it is just as much for yourself. Even if you never do a day in academics after residency, it's nice having seen and experienced the process.

As far as patients are concerned, there will always be people that don't know or don't care about where you trained. However, for the portion that does, it's also nice having the weight of a respected institution behind you.

 

[worriedwell]

one thing to note though... the people who are big time researchers and publishers are not synonymous with being great clinicians. in fact, I might go as far as saying they often are not very well rounded clinicians and often one track minded about publishing and propagating their career. and in psychiatry that is a dangerous game to play when pharma has such an impact on the field (and the research dollars) and also when the syndromes that we are diagnosing are only clinically distinguished.

that being said, if you are a smart and well rounded person yourself, learning about a particular specialty, for example, bipolar disorder or panic disorder, or certain therapeutic modalities like DBT, CBT, Psychydynamic psychotherapy etc from those who are "thought leaders" in the field has its merits. One just has to work hard to keep an open mind and be willing to not just accept what one is told by "thought leaders" as they are often charismatic and intelligent but just as often wrong as history has told us. you can develop your own style and beliefs about treatment based on taking what you perceive as the good things from each specialist.

as far as prestige, of course it helps to have a shiny impressive resume for career purposes and anybody who says there are no advantages to having "name" credentials is deluding themselves though. the extent of the benefits is debatable (as above discussed) and the price one has to pay to gain them is often quite high (with often grueling hours comparatively and having to jump through hierarchical loops in self obsessed ivory tower institutions). also, the company one keeps from attending to fellow resident isn't always "laid back". there is definitely a higher proportion of narcissists. then again, much of the company one keeps is inspiring and uplifting and valuable for learning even from ones peers.

 

[cleareyedguy]

"Prestigious programs" probably provide better teachers and peers, which can lead people to a stronger fund of knowledge and better habits of work and learning. Employers know this, and they also know that these programs are more selective, which reduces--but doesn't eliminate--the chances that they will hire a lemon. To my mind, you should have a really good reason to rank highly an academically weak program.

 

[Dartos Vader]

"Prestigious programs" probably provide better teachers and peers, which can lead people to a stronger fund of knowledge and better habits of work and learning. Employers know this, and they also know that these programs are more selective, which reduces--but doesn't eliminate--the chances that they will hire a lemon. To my mind, you should have a really good reason to rank highly an academically weak program.

Define "better". I think you are correct in some ways and incorrect in others. I agree that "Prestigious" programs are more likely to have more research and higher scores/gpas. As far as their ability to enrich your knowledge....that is assuming a lot. Some high ranked places foster a very collegial environment where the learning experience is enriched, as do some low ranked places. Some of the top names (not just in psych, but many other fields) offer you the chance to learn how to do scut work for some pompous jerk who doesn't give two sniffs about teaching, and not much else. I'm not slamming all top ranked programs by any means, or any in specific. I just think that you shouldn't generalize too much. Look into what program is best for you specifically.

That being said, top ranked places will CERTAINLY open a lot of doors just on name alone. If you hear that someone went to harvard, you assume certain things. And if you want to do academics, it certainly won't hurt to have some impressive credentials.