Interview at 10 programs but can realistically only see myself at 4 of them, how to rank?

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nyc12345678

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Help!
I have interviewed at 2 places so far, and have 8 more interviews but only 4 of the programs I've been invited for an interview are in the city I want to live in. Even though I am grateful for the interviews, I am not sure if I will be happy living any where outside of nyc. What should I do with the rank? Would ranking 4 programs be a bad decision?
thanks!
 
Psychiatry is getting more competitive as a field. I say if you'd rather be at a program than nowhere at all, then rank it. You can always move to the city you want to live in after residency. After all, it's just 4 years.
 
Would you rather be at program #5 or paying off your loans next year and unable to work as a physician or maybe be a prelim surg intern in NYC?

Alternatively, there are lots of programs in NYC. Start writing letters.
 
Your life, your career, do what you want. But only ranking 4 may seriously put you at risk of not matching, and these days, that may mean never matching into anything else after that. Are you willing to accept that reality?

Personally, I spent years in many different locations I didn't want to be in. But you improvise and adapt to the location. Find the positives, meet new people, explore new things, leave your comfort zone. It'll make you a better, broader person, and more able to adapt and relate to broader swath of society. You'll have years of life later on to settle into your comforts and become a narrowed minded grumpy person. You will be asking and urging patients to change - give it a go yourself, embrace the fear of the new unknown and process those feelings. Live.

NYC is scat, and there are so many other better places to experience.
 
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downwithDTB said:
Would you rather be at program #5 or paying off your loans next year and unable to work as a physician or maybe be a prelim surg intern in NYC?

Alternatively, there are lots of programs in NYC. Start writing letters.
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Sorry if this is a stupid question, but what do you mean by 'start writing letters'? Should I be emailing the 4 places after I interview that I am going to rank them high on my list?
 
nyc12345678 said:
Sorry if this is a stupid question, but what do you mean by 'start writing letters'? Should I be emailing the 4 places after I interview that I am going to rank them high on my list?
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Well, it certainly won't hurt to email the programs you want to be at and tell them that you'll rank them high.

But also, are there any other programs in NYC that you applied to and didn't get an interview? If so, writing them an email to express your interest can get you more invites in the city you want to live in.
 
nyc12345678 said:
Sorry if this is a stupid question, but what do you mean by 'start writing letters'? Should I be emailing the 4 places after I interview that I am going to rank them high on my list?
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Mostly what meow said. I would avoid an "I'm going to rank you ____*" statement, but maybe a "I really like your program because X Y and Z and the location in NYC is great because of reason that flatters program like caseload diversity AND I have an excellent support network here.

I was more suggesting that right now you should be doing what you can to drum up a few more interviews in NYC if you're really that committed to insane taxes and cost of living. Are there some lower tier programs that you could apply to late and have either a connected mentor send a letter or send a note directly to the PD expressing interest? Are they programs that you've applied to and haven't heard from that are at or below the level of programs interviewing you? Might as well say hi...

*Unless you say 1 and you mean it.
 
Ranking only four in NYC is a bad idea. Put those four at the top of your list and there is a good chance you will land one. If you don't, training in another city is likely to be less devastating than potentially derailing your career. Keep in mind that reapplying after a failed match will make it that much harder the next time around.
 
Yes ranking 4 is a bad idea. Matching anywhere would allow you to become a psychiatrist that can move back to NYC and live there forever. Not matching can be devastating and may require you take a position far from NYC, delay your ability to move back to NYC, and potentially close doors to becoming board certified which would prevent you from ever earning enough to live in NYC.
 
OP, have you ever lived outside NYC? For all it is an enormous and diverse place, y'all New Yorkers can be incredibly provincial in some ways. Even if you want to go back it may expand your horizons significantly to live outside of NYC for a while.

I mean, the overwhelming majority of people on Earth don't live there, so I reckon it's possible to pull it off.
 
Thanks for the responses. Incredibly helpful. I have lived outside of nyc but I feel pretty burnt out by medicine and derive most of my happiness from doing things in the city. I would survive in other places, but it may be damaging for my mental health. Also my SO works in nyc, so it would be nice to be with them.
 
nyc12345678 said:
Help!
I have interviewed at 2 places so far, and have 8 more interviews but only 4 of the programs I've been invited for an interview are in the city I want to live in. Even though I am grateful for the interviews, I am not sure if I will be happy living any where outside of nyc. What should I do with the rank? Would ranking 4 programs be a bad decision?
thanks!
Click to expand...

Yes, it would be a terrible decision. It's four years of your life versus an unusable medical degree and entering SOAP or next year's match with a big red flag on your back that will likely cost you even the programs you have interviews at now. Being an adult means experiencing new things. How do you know you wouldn't be happy living "anywhere outside NYC?" You don't. Most of us have to live places we wouldn't choose at least once in life. You adapt. You learn to make friends and get to know your new environment. Some people swear they wouldn't be happy in such and such city and then they end up putting down roots and settling down there. Seriously considering ranking only 4 programs because you don't want to leave NYC is a huge mistake and one that, if it ends in you not matching, will not garner any sympathy from anyone here nor any PDs in podunkville reviewing your app in the SOAP.

nyc12345678 said:
That sounds like a solid plan. Do you know how people manage to find open pgy2 spots?
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It actually doesn't sound like a solid plan at all. You need to rank places you're willing to stay for 4 years. And if you choose not to rank enough places, you have to be comfortable with not matching rather than thinking it's only a year and you can transfer. Putting aside the fact that you're screwing over the program and the colleagues at the program you match should you want to leave after a year, you're not guaranteed a PGY 2 spot in NYC and just looking is likely to ruffle feathers at your home program. Also, I would bet the open slots in NYC are generally at less-regarded/more malignant programs. Would you really give up working at a solid program somewhere else to work at a sweatshop just because it's in NYC?
 
I think the OP needs to have a very deep conversation with his/her SO. Transitioning into post graduate medical education is painful sucky business it is true. It is a competitive process and you may have a computer tell you which state you are moving to. The SO will need to hear the reality of what might happen and they have to decide if one is willing to uproot without bitterness, or can the endure a distance relationship. This needs to be talked about because hoping it doesn't happen and then having the conversation post match and out of state isn't the way to go. Medicine is a crazy career and this is one of the strangest parts.

NYC is big and they will have PGY-II slots, but Mass Effect is right, you will develop relationships with your class mates that will make it hard to screw them. You should also know that there are many more people wanting them than there are spots. There seems to be an endless supply of disaffected PGY-I psychiatry interns who want to change. Programs with PGY-II slots often take impressive converts from other specialties or people who want out of a combined programs. PGY-III positions are much more rare, but they avoid all of the out of psychiatry competition.
 
Mass Effect said:
. Would you really give up working at a solid program somewhere else to work at a sweatshop just because it's in NYC?
Click to expand...


New Yorkers tend to have some separation anxiety when it comes to having to leave their urine-smelling city filled with the rudest people imaginable. 🙂
 
I get the general sense that you all dislike nyc in some way or another but I think that the culture and opportunities for growth outside of medicine is really exciting here! Anyway, I know that 4 years is short v 20-30 years of working, but 4 years to me is still a good chunk of my life. I know this will make you guys go crazy, but I honestly can't imagine leaving all the different varieties of food, music, museums, shops, and culture that nyc has to offer. It can be smelly in the city, plus the high cost of living (esp on resident's salary) but the way the city makes me feel is worth the price. My SO is very understanding, and we will be fine long distance. We just value our time together!
I lived in a suburban college town in college and it was great in its own way, but definitely not what I would look forward to.
But I appreciate all the advice and it sounds like ranking 4 programs is not a good idea. I guess I will just rank the nyc programs highest and hope for the best!
I don't want to screw anyone over for pgy2, but I honestly would rather do sweatshop stuff in nyc. I'm ignorant, biased, and it's probably not logical, but I would do anything to stay!
 
nyc12345678 said:
I get the general sense that you all dislike nyc in some way or another but I think that the culture and opportunities for growth outside of medicine is really exciting here! Anyway, I know that 4 years is short v 20-30 years of working, but 4 years to me is still a good chunk of my life. I know this will make you guys go crazy, but I honestly can't imagine leaving all the different varieties of food, music, museums, shops, and culture that nyc has to offer. It can be smelly in the city, plus the high cost of living (esp on resident's salary) but the way the city makes me feel is worth the price. My SO is very understanding, and we will be fine long distance. We just value our time together!
I lived in a suburban college town in college and it was great in its own way, but definitely not what I would look forward to.
But I appreciate all the advice and it sounds like ranking 4 programs is not a good idea. I guess I will just rank the nyc programs highest and hope for the best!
I don't want to screw anyone over for pgy2, but I honestly would rather do sweatshop stuff in nyc. I'm ignorant, biased, and it's probably not logical, but I would do anything to stay!
Click to expand...

Rank all your programs. If you don't hit top 4 count your blessings you matched somewhere and then you can at least have a shot to transfer into pgy-2 sweatshopspots in nyc and you really only spend 1 year away from nyc. Check out the free nrmp match data for your odds of matching given certain stats at their website. Don't let your emotions blur your logic. You've worked incredibly hard to get to this point. If your meant to be in nyc you'll match in top 4 or transfer after 1 year.

Good luck.
 
finalpsychyear said:
I don't think i've ever heard a med student ask if ranking 4 programs would be a bad decision. I am a bit shocked honestly and if this isn't a troll job please see an advisor who deals with the match process at your school asap.
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Advisors have said to not do so, but wanted some opinions on sdn!
 
nyc12345678 said:
I get the general sense that you all dislike nyc in some way or another but I think that the culture and opportunities for growth outside of medicine is really exciting here! Anyway, I know that 4 years is short v 20-30 years of working, but 4 years to me is still a good chunk of my life. I know this will make you guys go crazy, but I honestly can't imagine leaving all the different varieties of food, music, museums, shops, and culture that nyc has to offer. It can be smelly in the city, plus the high cost of living (esp on resident's salary) but the way the city makes me feel is worth the price. My SO is very understanding, and we will be fine long distance. We just value our time together!
I lived in a suburban college town in college and it was great in its own way, but definitely not what I would look forward to.
But I appreciate all the advice and it sounds like ranking 4 programs is not a good idea. I guess I will just rank the nyc programs highest and hope for the best!
I don't want to screw anyone over for pgy2, but I honestly would rather do sweatshop stuff in nyc. I'm ignorant, biased, and it's probably not logical, but I would do anything to stay!
Click to expand...
I'm not entirely sure you'll have time to do much outside of residency. Especially if you're doing sweatshop stuff.
 
nyc12345678 said:
Thanks for the responses. Incredibly helpful. I have lived outside of nyc but I feel pretty burnt out by medicine and derive most of my happiness from doing things in the city. I would survive in other places, but it may be damaging for my mental health. Also my SO works in nyc, so it would be nice to be with them.
Click to expand...

It's gonna be worse for your mental health if you don't match.
 
Rule of thumb is that you can never underestimate location. So to me it's not "strange" that you're prioritizing NYC especially if that's where your SO lives. And yes, some of us lived outside NYC only to recognize even more how valuable the city is.

In your case though, as you correctly identified, you're burned out by medicine. Is it that bad that you're willing to forfeit your career if you don't stay in NYC. If that's the case, you probably need a break, time to reevaluate.
 
I think that local environment and significant other are two very important factors. Probably much more important than other things that cause people to rank programs: "feel", prestige, ect.

You're feeling burned out. Residency is harder than med school. You may wish to consider quality but humane programs around NYC with < 2 hour train access or even Philadelphia over an NYC sweatshop. Spending three full, rested weekends a month with your SO in NYC may be a lot better than living in NYC and working very hard 4 weekend days a month for 4 years, sometimes with more than 1 overnight per week
 
As others have said, it's a really dumb idea to only rank 4/10 programs. If you're that concerned that you will burn out/become too unhealthy if you're anywhere but NYC, I think you should step back and re-evaluate this career path as a whole. The BS parts of medicine don't stop after med school or residency and some of them only get worse. I think it's reasonable to highly prioritize location and do everything you can to end up there, but considering not ranking any programs outside a certain city would raise red flags to me if I were a PD (not that PDs will know this, but it brings up some worrisome questions).

nyc12345678 said:
I know this will make you guys go crazy, but I honestly can't imagine leaving all the different varieties of food, music, museums, shops, and culture that nyc has to offer.
Click to expand...

I mean, have you ever lived in any other city with a population over 1 million? These things exist in almost every major city in the country, and some of those cities put NYC to shame in some of those categories. Heck, the city I'm in is ~500k and has some world-renowned museums and an art scene that almost rivals NYC (which my wife was completely shocked by as she loves NYC).
 
About burnout: I may be the voice of dissension in that I found residency to be better in that regard than med school. Yes, you may work longer hours and have more responsibility, but you're finally doing medicine and making an actual difference, however small. You do feel needed, and you do feel like you own your work. As a med student, you're either isolated reading your books or awkwardly trying to not be dead weight on the wards. Also, psychiatry is *in general* better than medicine in general in terms of being supportive and not-toxic.
 
Here's another thing to consider: lots of people probably want to be in NYC for the same reasons as you. Just maybe not the people on this board, lol. So the point about finding more places to apply to later in the came in NYC or nearby is well taken. That way you can spend a solid, rested weekend in NYC every once in a while like someone else said.

You also didn't mention how competitive you feel for your programs. That's important in determining how much you need a backup option. That said, unless you're EXTREMELY competitive for your 4 NYC programs, the advice wouldn't change. If your chances at the 4 NYC programs are tenuous, I'd actually try for even more than 10 interviews total.
 
Well NYC comes with pros and cons just so you know. I don`t know about top programs like cornell but I am from a mid tier community program and it is my daily routine to deal with attitudes of ancillary staff who do not care about you, do not appreciate your work and do not treat you like a physician. Recently I was physically assaulted by a patient and harrassed by another one , instead of support from the ancillary staff they accused me of agitating patients who have antisocial personality disorder. On top of that, I was prosecuted by administration without even giving me a chance to defend myself ( well even if I was given it would not change anything) . In the mean time, nobody really cared If I was physically and mentally okay after the harrasement and assault.

Be careful about NYC! While trying to get a life outside , you can lose the sole one you have in the hospital. Just my 2 cents
 
Marasmus1 said:
Well NYC comes with pros and cons just so you know. I don`t know about top programs like cornell but I am from a mid tier community program and it is my daily routine to deal with attitudes of ancillary staff who do not care about you, do not appreciate your work and do not treat you like a physician. Recently I was physically assaulted by a patient and harrassed by another one , instead of support from the ancillary staff they accused me of agitating patients who have antisocial personality disorder. On top of that, I was prosecuted by administration without even giving me a chance to defend myself ( well even if I was given it would not change anything) . In the mean time, nobody really cared If I was physically and mentally okay after the harrasement and assault.

Be careful about NYC! While trying to get a life outside , you can lose the sole one you have in the hospital. Just my 2 cents
Click to expand...

What? That's atrocious. Are you a resident? And if so, what did your PD say? If you're not a resident, why would you work in such a malignant environment? I'd run from a place like that.
 
Mass Effect said:
What? That's atrocious. Are you a resident? And if so, what did your PD say? If you're not a resident, why would you work in such a malignant environment? I'd run from a place like that.
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I mean, based on what @Marasmus1 has said about their workload and call expectations, they are a) a resident and b) not in a place that seems to give a **** about their well-being or training.

It makes a lot more sense all of a sudden why they just want to escape training and get on with their life and are not big fans of talk of pushing yourself to do better. I am guessing there is a lot of that as admin doubletalk whenever complaints are raised.
 
clausewitz2 said:
I mean, based on what @Marasmus1 has said about their workload and call expectations, they are a) a resident and b) not in a place that seems to give a **** about their well-being or training.

It makes a lot more sense all of a sudden why they just want to escape training and get on with their life and are not big fans of talk of pushing yourself to do better. I am guessing there is a lot of that as admin doubletalk whenever complaints are raised.
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You're right. I forgot that was this poster! Yikes! Everything finally makes more sense now. @Marasmus1 training is finite. Get through it and get yourself out of that hellish environment. Not all psych is like that.
 
You need to be happy. You could apply for a transitional year as a back up at programs you could tolerate for a year. Or rank them all and try to find a PGY2 spot
 
Mass Effect said:
What? That's atrocious. Are you a resident? And if so, what did your PD say? If you're not a resident, why would you work in such a malignant environment? I'd run from a place like that.
Click to expand...

I am a resident, international medical graduate, I will be out at the end of the 3rd year. Yes I will runaway, I have enough CV to runaway now but I do not have enough power or leverage. There are couple of openings for PGY2 and PGY3s. However, my PD will do whatever it takes to prevent me from leaving because they are shortstaffed and it would have tremendous effect on the remaining resident (one of the other reasons why I want to wait for one more year)
 
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