malignant vs benign psychiatry residencies?

[Sally Jizmitton]

Is there a consensus on "malignant" vs. "benign" psychiatry residency programs? It seems like I hear something different from everyone. For example, some people say Colorado is great while others regard it poorly.

I would be most interested in any comments regarding:

University of Washington
UCSF
UCSD
UCLA
UC Irvine

Thank you for any replies.

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[mosche]

Hey Sally, I have been pondering this same question -- since I am currently in the process of interviewing. While I know nothing about the programs that you listed, I will say that I have heard positive and negative comments about several of them on SDN.

One program that I interviewed at was Vanderbilt. Several people have posted that the program has problems; however, I found the program was quite good. Unfortunately, I left feeling that the residents and the attendings were all somewhat ashamed of the program. For example, everytime that I asked about the quality of the program, the response was something along the lines of, "It's getting better"! Yet everytime that I asked if they were happy, the resounding answer was, "Yes". In my book, if they're happy then it's a good program.

Ultimately, the quality of a program will depend on what you want from it. Nortomaso and I have actually discussed one such program today (I'll call it program X). I loved the program, and the residents with whom I spoke loved it too. Nortomas, on the other hand, had spoken with some residents who led him to form a different opinion -- not that they didn't love their program, they just had a different perception. In the end, Nortomas and I may want different things from a program; but that does not mean that the programs that we choose are in any way poor. To the contrary, it means that the programs do an excellent job of attracting the types of residents who would be happy there.

Just my 2 pennies.
mosche

 

[MDgonnabe]

exactly. everyone looks for different aspects of residencies. what one person considers "malignant," another may think a good learning opportunity. for example, i want to do c-l psych, so i'm looking for more medicine-heavy programs with a strong c-l component as well as the possibility of fellowship there afterwards. others may think i'm shooting for something that's "malignant" because of the heavy call schedule; but i'd personally rather suffer through residency and get out feeling capable of handling anything afterwards rather than leading a cush existence for the next 4 years then graduating on the slightly more ill-prepared side. others here might place preference on programs solely on location due to family. or perhaps they want programs that'll give them great psychotherapy experiences because they want to do outpatient someday. you get the picture. i say prioritize in advance what you want in a program, attend your interviews, and go with your gut feeling.

 

[nortomaso]

Sally, I have a less relativistic take on your question. Mosche is right in that we are all looking for different things from programs and so we will perceive them differently. But in answer to your use of the term "malignant", I would simply say that I haven't seen a malignant psych program nor have I really heard of one. Of the programs on your list, I have only visited UCSF and did not find it malignant. I think the word has a definate meaning in that most people would call a spade a spade: there definately are indisputably malignant programs in other specialties (particularly general surgery),and its not about how many hours you work but about how colleagues and superiors interact, but that is probably one danger that you have been spared by choosing psych.

 

[mosche]

exactly. everyone looks for different aspects of residencies. what one person considers "malignant," another may think a good learning opportunity. for example, i want to do c-l psych, so i'm looking for more medicine-heavy programs with a strong c-l component as well as the possibility of fellowship there afterwards. others may think i'm shooting for something that's "malignant" because of the heavy call schedule; but i'd personally rather suffer through residency and get out feeling capable of handling anything afterwards rather than leading a cush existence for the next 4 years then graduating on the slightly more ill-prepared side. others here might place preference on programs solely on location due to family. or perhaps they want programs that'll give them great psychotherapy experiences because they want to do outpatient someday. you get the picture. i say prioritize in advance what you want in a program, attend your interviews, and go with your gut feeling.

 

[MDgonnabe]

Sally, I have a less relativistic take on your question. Mosche is right in that we are all looking for different things from programs and so we will perceive them differently. But in answer to your use of the term "malignant", I would simply say that I haven't seen a malignant psych program nor have I really heard of one. Of the programs on your list, I have only visited UCSF and did not find it malignant. I think the word has a definate meaning in that most people would call a spade a spade: there definately are indisputably malignant programs in other specialties (particularly general surgery),and its not about how many hours you work but about how colleagues and superiors interact, but that is probably one danger that you have been spared by choosing psych.

i dunno. i've actually heard people calling some psych programs "malignant." and i bet sally's heard the same thing seeing as she's asking this question. now, you'll never attend a program where everyone gets along perfectly, anyway. there will always be office politics going on and whatnot. a work environment is a work environment. the important thing is to pick a program that has elements to counterbalance all of the stuff that you know will suck about residency. in other words: find a program to suit your needs from the get-go!

and i still believe that the "malignant" issue stems mostly from long hours, from people doing things they didn't want to do on the job. i loved my surgery rotation in general, but hated the pressure cooker environment the o.r. became. attendings and residents who were sweet as could be on the floors and in the classroom were monsters in the high stress of actual surgery. thus i chose psych. if some programs are structured in ways to let that stress boil over onto the floors or clinics, then i could see why people would call the program "malignant." also, some programs are "malignant" because they place emphasis on research, so people put their grants above their colleagues. but if it's a research institution, and you love research, then the clinical stuff wouldn't matter as much to you anyway. so, even in psych, if you become poorly matched at a program which isn't structured for your basic needs, then you too will become quite b!tchy in that environment. i think psych in general has fewer disgruntled residents/"malignant programs" because our hours are shorter than other specialties' and thus we can get away from the stress for longer than they can. savy?

 

[nortomaso]

MDgonnabe,

Sound reasoning, but do you really think it all can be reduced to hours worked and clinical versus research focus? I still like to think that those attracted to psych tend to be more empathic than procedurally oriented fields and that this mainifests itself in the way colleagues interact. Of course, if it is true that more and more graduates are choosing psych based on lifestyle, then individual characteristics become less of a factor, and your argument becomes foolproof.

With regards to clinical vs. research, I've noticed that the big name institutions which tend to be regarded as malignant in other specialties (Hopkins, MGH, etc) are primarily clinical programs in psych. And the really research-focused psych residencies (Pitt, Mich, Wash U) tend to be really laid back, friendly places.

As to rumors, I suggest that we expose them immediately. If anyone has heard that a particular program is malignant, might as well mention it here explicitly so that those with first-hand experience of the program can chime in and defuse or confirm the rumor.

 

[mosche]

Hey guys, while I do grant that my post was a tad bit "relativistic", I really think that malignantcy (sp?) is a relative term. Look, I've been on some med. school rotations with some very bright, but VERY LAZY students. I think that, while the numbers may be small, there are a few people who chose psych. simply because they assumed that they would NOT HAVE TO WORK! Imagine how surprised they must have been the first few times that they had to take overnight call, and they actually GOT CALLED . OMG, they say. "This program is malignant". Now they may only say it to a few friends from their pre-residency program; however, these nasty little rumors have a way of spreading (any doubts? Look at all of the nasty things that have been said about the Duke FM program. I was actually very cautious when I was interviewing for a psych. position there -- just trying to be sure that that program was not as bad as the FM program is reported to be -- it wasn't!). But a few well placed rumors can really do serious PR damage!

BTW Norto, have you already been to Michigan? If you have, please feel free to PM your impression. Is it a malignant program? It seems that we come away from these programs with very similar opinions; so, I would love to hear your take on the Michigan program.

 

[Hurricane]

I think sometimes people blur the terms malignant and intense. I interviewed at UCSF a couple weeks ago and loved it. The residents asked us all right off the bat if we had heard any rumors about UCSF so they could address them. Someone said they heard UCSF was "intense" and the residents agreed that you work very hard during certain rotations, esp the medicine months, and night float at the VA. But they were all very happy and enthusiastic about the program, and the faculty I met were very interested in training, and I sensed a lot of camaraderie between the residents and faculty. I did not get the feel that the program was "malignant" in any way. And honestly, if the "worst" thing about a program is that you have to work hard on your medicine months, I can handle an intense 4 months of medicine out of the next 4 years. But everybody's got their own priorities.

I had also heard some stuff about Duke being overly intense, but having interviewed there yesterday, I realized that all of the negative stuff I heard (which wasn't much) was referring to the medicine program, and had nothing to do with the psych program, which I loved. (I don't know how I'm going to come up with my ROL, since I love so many programs already, and I'm only halfway through interviews!)

And I echo what mosche said about Vanderbilt. They've been without a chair for a while, but a strong new chair is starting this Jan. The residents are extremely happy, and the PD is great, so I wouldn't consider it "malignant" in any way either.

Anyway, I haven't heard of any psych programs being truly malignant. When I think of malignant, I think of the kinds of things people are saying in the Duke family med threads. Which doesn't mean I think the Duke FM is malignant - I have no way of knowing, having never met anyone from that program - but nobody is saying those kinds of things about psych programs that I'm aware of.

I think the best prognosticators of malignancy are probably resident happiness and the PD. It's hard to have a malignant program with a good, responsive PD.

 

[nortomaso]

I think the best prognosticators of malignancy are probably resident happiness and the PD. It's hard to have a malignant program with a good, responsive PD.

Hurricane. That said, what's your take on the PD at UCSF?

 

[Anasazi23]

I think sometimes people blur the terms malignant and intense.

I agree completely. The term "malignant" usually refers not to an intense experience or hard work, but something very different...and much worse.

A malignant rotation (or program) is usually one in which there are abuses and other inappropriate happenings - at the expense of the residents. Examples would include 'punishments' by the administration or attendings for perceived shortcomings, inappropriate or unprofessional pimping, violation of work-duty hours with no recourse, and other types of aggravations. They tend to center around personality-disordered chief residents, attendings, program directors or other such administrators.

Don't be afraid to work hard. That's where you learn. Also know that there are reasonable limits, and that doing unreasonable scut work in your 3rd and 4th year, during which you learn nothing, is also unreasonable.

In my experience, it appears as though psychiatry is relatively free of truly malignant programs, though I'm sure exceptions do exist. They tend to center more around internal medicine, family practice, and surgery.

 

[MDgonnabe]

In my experience, it appears as though psychiatry is relatively free of truly malignant programs, though I'm sure exceptions do exist. They tend to center more around internal medicine, family practice, and surgery.

ah, but we psychs will have to interact with said specialties on our med months, on consult, and even just by being in the hospitals we rotate through. food for thought at the brand name institutions.

also, nort, i don't believe the vast majority of people who go into medicine go into it with a sadistic hatred of their colleagues or fellow man. doctors in general are caring individuals. that's part of the reason why sue-happy lawyers have taken advantage of our profession. not to say there aren't individuals you'll meet with genuine personality disorders. but those disorders are in contexts to almost justify their existence, ie the nature of the work we do, the stress we're under etc. it's hard to tease out what caused what, but at least this is the way i think of it so i don't react badly when people get on my case out of the blue. the negativity's gotta stop somewhere.

 

[psych2b]

I described my externship experience at a supposedly nurturing program in another thread, and anasazi23 suggested it might be an example for this thread, so I thought I'd post a link:
http://forums.studentdoctor.net/showthread.php?t=247012