looking for others in my boat

[knitwit]

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Hey all,
I am looking for others in my boat. I am applying for the match in psychiatry this year. Generally, I think I could match well. I'm a MD/PhD student from a reasonable medical school, step 1 score 232, honors or letter of commendation in everything but surgery and ob, strong letters of recommendation. I'm applying to all of the big names, looking for research strengths in programs, doing all of the "right things" but......

lately I've just been thinking that overachieving by going to a big name resume builder of a residency program is just not worth it. I'm happy where I live now, married, surrounded by family and picking up to move will be a major deal. It used to sound like an adventure, but now it just seems unappetizing. There is only one psych residency program in my area and its not a big name; the residents there seem pretty happy to me and there's a strong emphasis put on balence. My future goals in psychiatry right now involve a child and adolescent fellowship, but I recognize that this may change. I'm also interested in practicing in an academic setting. I could care less if my final destination is a big research kind of place or a small university affiliated hospital.

Anyone been here and done this that could offer advice or anyone out there thinking of taking the path less competitive?

 

[OldPsychDoc]

Hey all,
I am looking for others in my boat. I am applying for the match in psychiatry this year. Generally, I think I could match well. I'm a MD/PhD student from a reasonable medical school, step 1 score 232, honors or letter of commendation in everything but surgery and ob, strong letters of recommendation. I'm applying to all of the big names, looking for research strengths in programs, doing all of the "right things" but......

lately I've just been thinking that overachieving by going to a big name resume builder of a residency program is just not worth it. I'm happy where I live now, married, surrounded by family and picking up to move will be a major deal. It used to sound like an adventure, but now it just seems unappetizing. There is only one psych residency program in my area and its not a big name; the residents there seem pretty happy to me and there's a strong emphasis put on balence. My future goals in psychiatry right now involve a child and adolescent fellowship, but I recognize that this may change. I'm also interested in practicing in an academic setting. I could care less if my final destination is a big research kind of place or a small university affiliated hospital.

Anyone been here and done this that could offer advice or anyone out there thinking of taking the path less competitive?

Knitwit--you could have written my biography here, except that I did choose to move my family across country and tried doing an "academic" residency, with research, the whole deal, before realizing halfway through that I was much happier as a clinician. I'd be happy to PM with you re: specifics, but for now, yes there are others like you, and there is a lot of beautiful scenery and life satisfaction on the "path less competitive"!

Being happy and balanced as a resident and a person is grossly underrated in medicine. So many folks are obsessed with numbers, prestige, and US News rankings. It sounds like you are interested in clinical practice in an academic setting, as opposed to "academic practice" where you need to worry about tenure, grants, papers, etc., and see patients a minority of the time. There are plenty of ways to do the former without needing to bother with the latter.

 

[mosche]

I too have similar numbers, and have applied to many so-called "top tier" programs; however, I have really decided that I want to stay in the Midwest or South. Don't get me wrong, I'm still interviewing at the top programs--I've never been to Connecticut or Boston--and I figure that this is a perfect opportunity to do both. That having been said, I'm pretty confident that my top schools will be in Minnesota, Wisconsin, Michigan and Missouri!

BTW, OldPsychDoc, I will graduate with Honors in Research. However, the prospect of having to do research for the rest of my career(i.e. grant writing) gives me the willies ! While I do admire and, for the most part, respect those who love the scientific aspects of medicine, I will be content with an average practice in an average setting.

 

[scott222]

I don't even have a family as my excuse... I just don't want to spend all of my time in the hospital. I love psychiatry and couldn't imagine being as happy doing anything else, but I also love my life away from the hospital. I think that we, as future psychiatrists, need to develop a little insight into the pathology of the med student mind, and realize that it's okay to sacrifice prestige for balance if that's your preference.

That being said, I've also been told that there are a lot of psych residencies out there with pretty shotty training, so a certain level of selectivity is important.

So this is the first I've really heard about achieving a "clinical practice in an academic setting". I always assumed that if I wanted to teach clinical psychiatry I would have to go for the full-fledged "academic" practice which is out of the question for me (I tried research for 2 months... wanted to jab my finger into my eye to relieve the pain). Any tips on what sort of path to take to get the clinical practice in an academic setting?

 

[Anasazi23]

I don't even have a family as my excuse... I just don't want to spend all of my time in the hospital. I love psychiatry and couldn't imagine being as happy doing anything else, but I also love my life away from the hospital. I think that we, as future psychiatrists, need to develop a little insight into the pathology of the med student mind, and realize that it's okay to sacrifice prestige for balance if that's your preference.

I hear you. There's something to be said about wanting some time outside of residency to pursue personal interests...or just study psychiatry at your leisure, instead of going to a more "rigorous" program in a major city that gives you the privilage of seeing malingering drug addicts all hours of the night trying to scam you for a bed.

There are "best of both worlds" programs out there. Specifically, look for major university affiliated campus hospitals. They allow you to stay small most of the time, yet give you unhindered access to the nicities of the major academic center for research, populations, electives, etc.

You're definately not the first.

 

[MDgonnabe]

knitwit,

i don't have nearly the numbers or research experience you do. but as an undergrad, i worked in a neuropsychology lab and did an honors thesis. that experience alone was enough for me. everytime i felt like dropping out of med school, i looked back to the joys of being a personal slave to an associate professor rabidly trying to attain tenure. it sucked. i loved the purely academic aspects of it, the thought that you could really discover something amazing and contribute to science in a meaningful way... but the nitty gritty that you and psychdoc mentioned, that stuff really turned me off. so i'll definitely be happy "settling" for a lowly clinical job someday. i'll also probably do residency at my med school despite getting several interviews to other institutions. for one thing, my nuclear family lives here. having good social support is an often overlooked aspect of happiness in any situation let alone something as stressful as residency. furthermore, i know the attendings and residents here well and i can work with them. if you can't approach your attendings or fellow residents, it'll end up being a very long and painful 4 years no matter how low the weekly hours. you said you thought the residents at your local program were happy. that's a great sign. i'm also a firm believer that your education is mostly what you put into it. your program can set up as many didactics or grand rounds you want; but if you don't put your self-directed reading time into it, you'll ultimately retrain nothing. and nothing makes me want to avoid the books more than a crappy life outside work.

 

[OldPsychDoc]

knitwit,

....everytime i felt like dropping out of med school, i looked back to the joys of being a personal slave to an associate professor rabidly trying to attain tenure. it sucked. i loved the purely academic aspects of it, the thought that you could really discover something amazing and contribute to science in a meaningful way... but the nitty gritty that you and psychdoc mentioned, that stuff really turned me off.

amen amen amen AMEN!!!!

so i'll definitely be happy "settling" for a lowly clinical job someday..

no no no no. not "lowly". not "settling". saying this just plays into the mythology that there is something wrong with clinical work! You will be out there SAVING LIVES, putting broken minds back together. It doesn't happen everyday, but when it does happen it has a ripple of impact to families and communities. It's an impact that far outweighs and outlives an obscure, rapidly obsolete, citation in some esoteric journal out there! I figure 10 or 20 people in the whole world care about the papers I published--and that took like 5 years of my life. There are that many people every DAY now who count on me to show up for work to help them take their next step!
(And here's the funny part...clinical work pays better, too!) 😀

 

[OldPsychDoc]

So this is the first I've really heard about achieving a "clinical practice in an academic setting". I always assumed that if I wanted to teach clinical psychiatry I would have to go for the full-fledged "academic" practice which is out of the question for me (I tried research for 2 months... wanted to jab my finger into my eye to relieve the pain). Any tips on what sort of path to take to get the clinical practice in an academic setting?

a couple for starters--
1) clinical job affiliated with a "mid level", community hospital based residency program.
2) community job near a university affiliated program that needs places for its residents and students to rotate. (might even come with an "adjunct clinical professor" title, but probably not discounts on football tickets! 😉 )

 

[mdblue]

knitwit,
. i'm also a firm believer that your education is mostly what you put into it. your program can set up as many didactics or grand rounds you want; but if you don't put your self-directed reading time into it, you'll ultimately retrain nothing. and nothing makes me want to avoid the books more than a crappy life outside work.

Amen.... 👍

 

[knitwit]

Thank you all for your responses to my question. I appreciate multiple perspectives on the situation and will pm those of you who offered after I've mulled over it some more. In the meantime good health to you all.

 

[roady]

This is a great thread--excellent!

However, could someone explain to me why the decided emphasis here has been on academic clinical settings? Does everyone here want to teach, or is it that the people who come to an academic clinic will be a little on the "cleaner" (drugs and perhaps otherwise... literally!?)/ more varied pathology (why would that be, incidentally? is it because someone with a rarer pathology wouldn't typically go to a community clinic??)??

Also, how about a personal office based setting, or a community clinical setting--how come no one is mentioning those?

Thank you for elucidating!

 

[OldPsychDoc]

This is a great thread--excellent!

However, could someone explain to me why the decided emphasis here has been on academic clinical settings? Does everyone here want to teach, or is it that the people who come to an academic clinic will be a little on the "cleaner" (drugs and perhaps otherwise... literally!?)/ more varied pathology (why would that be, incidentally? is it because someone with a rarer pathology wouldn't typically go to a community clinic??)??

Basically, the emphasis is on the above, because the OP and myself took the emphasis that direction, having been trained with academic expectations but feeling that it wasn't entirely our cup of tea.
There are lots of people who enjoy the interactions and collegiality of academia without wanting to make a career of it, per se, or who enjoy teaching, but not necessarily research. So the "boat" that knitwit was looking for fellow passengers in was on an academic cruise, as it were.

Also, how about a personal office based setting, or a community clinical setting--how come no one is mentioning those?

These are always an option.
Go ahead and start a thread to ask more about them.

 

[2010]

I too am an MDPhD applying to top programs with research emphasis, hoverver I have excuded a few california places based on cost of living, and some east cost places MGH, Hopkins because they dont seem to have a big research track in spite of their big names and "dedication to research". Id rather be at a smaller non-maligant program, happy, and able to buy a house,as well as do some research.

 

[psych2b]

I'm with you, knitwit. I'm an MD/PhD, but actually NOT wanting to do research (my route was circuitous; PhD was prior to medical school - long story). My cv and everyone at my school are really pushing me to either (a) not do psych or (b) at least go to a big name ALL RESEARCH place. *sigh*

I have already decided to go the less "competitive" route, and hoping for a happy program that will train me well. There are some of us out there!

Hey all,
I am looking for others in my boat. I am applying for the match in psychiatry this year. Generally, I think I could match well. I'm a MD/PhD student from a reasonable medical school, step 1 score 232, honors or letter of commendation in everything but surgery and ob, strong letters of recommendation. I'm applying to all of the big names, looking for research strengths in programs, doing all of the "right things" but......

lately I've just been thinking that overachieving by going to a big name resume builder of a residency program is just not worth it. I'm happy where I live now, married, surrounded by family and picking up to move will be a major deal. It used to sound like an adventure, but now it just seems unappetizing. There is only one psych residency program in my area and its not a big name; the residents there seem pretty happy to me and there's a strong emphasis put on balence. My future goals in psychiatry right now involve a child and adolescent fellowship, but I recognize that this may change. I'm also interested in practicing in an academic setting. I could care less if my final destination is a big research kind of place or a small university affiliated hospital.

Anyone been here and done this that could offer advice or anyone out there thinking of taking the path less competitive?

 

[Poety]

why would they be pushing you to not do psych?

I wish I knew EXACTLY what i wanted to do - I have a huge interest in schizophrenia and I love working with them, but I'm also interested in some research aspects of the schizophrenia spectrum... then again, I like addictions too, I was lucky enough to do research on people with dual diagnosis disorders, but then again, theres forensics, which is fascinating as well.. but is it REALLY in practice? uggg... all the things I still have to learn in residency!

I just hope I get in "somewhere" at this point 🙂 You people have some wonderful backgrounds, good luck and I really do hope you find the perfect place for each of you! 🙂 😀

 

[psych2b]

Uninformed/biased individuals have made comments such as "you're too smart to go into psychiatry" or "what a waste of your skills"... Um, like we want stupid people taking care of the brain? ?