Matched position 16

[OldPsychDoc]

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See this is fairly standard. Take is a lot less frightening than pass.

I agree--our institution requires residents in all programs to pass before they can be issued a PGY3 contract.

 

[Shikima]

Aren't most institutions employing this strategy now where Step 3 needs to be passed prior to promotion to PGY-3?

 

[Doctor Bagel]

Aren't most institutions employing this strategy now where Step 3 needs to be passed prior to promotion to PGY-3?

My residency program's GME rolled out a policy that requird that you take it by (I think) the end of 2nd year. This is supposedly coupled with help if you have trouble passing it. It's really in your best interest to take it early on because it gets harder the farther you are from your non-psychiatry work. People I know who've put it off have really regretted it.

 

[so721]

Hate to dump on the op but it sounds more like his problem than a problem with the program

Yes, it is partly my problem because I decided to do Psychiatry not only because I enjoyed it but also because I wanted to go into a residency that would give me the opportunity to see my kids and live a balance life somewhat. My father was a general surgeon and I have a lot of negative experiences with the way he missed out on a lot of our lives because of work.

 

[Kevin Baker]

I just got my contract for pgy1 and in it it states it's an ACGME rule to pass USMLE step 3 to be promoted to PGY3.

 

[notdeadyet]

Mine requires taking Step 3 by December of PGY-1 year and passing by conclusion of PGY-1 year.

 

[benlinus]

You should allow your family to live somewhere safe and you go to your residency. They shouldn't be forced to follow you into danger.

 

[benlinus]

God forbid, what if something happened to them? Would it be your fault? Could you live with yourself?

 

[Mass Effect]

God forbid, what if something happened to them? Would it be your fault? Could you live with yourself?

What's the matter with you?

 

[notdeadyet]

You should allow your family to live somewhere safe and you go to your residency. They shouldn't be forced to follow you into danger.

Unless Baghdad has an ACGME-recognized psych residency I haven't heard about, odds are very, very good that the OP can find a safe place for he and his family to live within commuting distance of the program he matched into.

This is just silly.

 

[TexasPhysician]

Unless Baghdad has an ACGME-recognized psych residency I haven't heard about, odds are very, very good that the OP can find a safe place for he and his family to live within commuting distance of the program he matched into.

This is just silly.

As a Texan, I can tell yalls that no wheres outside of Texas is safe. Just 1 state over yonder is a death trap. Louisiana is hurricane alleee. Oklahoma is tornado cuntry. New Mexico well.....nobodys wants to habitates that. North of Oklahoma is so cold that you may as swell move ter Russia. Jus roll over and await yer maker.

It really pains me to see yall matchin in states not named Texas. I'll pray fer yalls.

 

[MacDonaldTriad]

I like TexasPhysician, he seems like a really nice guy but he has set himself up for some serious Texas teasing.

All of the Texans I know are so fond of Texas; I have to wonder why they left. They seem to huddle together in expatriate groups and watch the Cowboys lose on Sundays while arguing which one of them can stack hay bales the highest. Off season, they can be found at grocery stores collecting signatures to nationally mandate the teaching of intelligent design in elementary schools. Seamless acculturation isn’t a very valued attribute among Texans outside of Texas as near as I can tell.

 

[TexasPhysician]

They seem to huddle together in expatriate groups and watch the Cowboys lose on Sundays while arguing which one of them can stack hay bales the highest. Off season, they can be found at grocery stores collecting signatures.....

When yer not anxiousing bout dyin, you gots more free time fer hay stackin and oder timeless sports.

 

[shojimoji]

As the accepting PD, would you expect me to just give you a position without knowing anything about your performance as a resident? Or vouch for your competence without knowing whether you've successfully completed the requirements for the PGY1 year?
Yes--you do NEED your current PD's letter.

what if someone is in a pgm that has a PD who is malignant and does not give them a letter, is a transcript sufficient?

 

[MacDonaldTriad]

I have heard of situations where the ACGME or maybe it was the NRMP people forced a PD to provide transcripts. They say contracts are binding, but when push comes to shove, slavery ended in 1865.

 

[so721]

God forbid, what if something happened to them? Would it be your fault? Could you live with yourself?

it's in a terrible area. but i'm not taking them because they have established a life here with contacts. its going to be hard on me as my wife is my childhood sweetheart and she has been my rock during med school. however, i don't want to disturb them.

 

[MLT2MT2DO]

Aren't most institutions employing this strategy now where Step 3 needs to be passed prior to promotion to PGY-3?

Most of the Idaho/UW residents hadn't taken there Step 3 until well into the third year or even the beginning of 4th. I'm guess having to move after second year of residency gives them more lenience.

 

[wannabie]

My program requires it by the end of pgy1 and gives vacation in one month blocks to encourage residents to study and take it in...I think that might be normal? My ortho resident roommate at Hopkins had to do it this way too

 

[DrBowtie]

Most of the Idaho/UW residents hadn't taken there Step 3 until well into the third year or even the beginning of 4th. I'm guess having to move after second year of residency gives them more lenience.

Why are you guys so scared of Step 3? Does the score matter for psych fellowships? It's seriously the easiest of the step exams.

 

[so721]

Why are you guys so scared of Step 3? Does the score matter for psych fellowships? It's seriously the easiest of the step exams.

COMLEX 3 is going phase changes so is unpredictable. USMLE 3 might be easy tho but we can't take it as DO's without having taken CS.

 

[so721]

Most of the Idaho/UW residents hadn't taken there Step 3 until well into the third year or even the beginning of 4th. I'm guess having to move after second year of residency gives them more lenience.

My program requires it by the end of pgy1 and gives vacation in one month blocks to encourage residents to study and take it in...I think that might be normal? My ortho resident roommate at Hopkins had to do it this way too

Your so lucky you get that leverage. No not in my program. Vacation time is what it is.

 

[so721]

the policy is to have passed step 3 within 6 months of PGY-3 year. it would be the exception if someone was doing it after that and they would get a sternly worded letter telling them to complete it asap but have never heard of anyone being fired/not progressing because of it.

most people DO complete step 3 in intern year because that is the best time to do it. also you cant moonlight outside your program (and possibly internly) until you complete step 3 so another thing to bear in mind.

There are places that dismiss u if it's not done by end of pgy2

 

[JustAGuy]

Why is a friend with below average status, multiple red flags, coming from a "lousy program", and barely passing tests putting the added stress of an expectation of a "top" C&A fellowship? Worry about being a good psychiatrist first during residency and then matching into C&A when the time comes. I wouldn't stress about getting a top program at this time. Seems unnecessary.

He grew up in a desirable locale and went to prestigious schools. I'm sure he's just looking for a way out of this mess he's gotten himself into. I can't blame him. If I matched where he matched, I would be looking for a way out, too.

 

[675015]

He grew up in a desirable locale and went to prestigious schools. I'm sure he's just looking for a way out of this mess he's gotten himself into. I can't blame him. If I matched where he matched, I would be looking for a way out, too.

I mean, he should just keep in mind, there is "a way out" of that situation with tons of C+A fellowships. Plenty of good ones out there that he can get. I don't know what his definition of "top" is but it seems like at this point its not worth the extra stress to worry about "top."

 

[MLT2MT2DO]

the policy is to have passed step 3 within 6 months of PGY-3 year. it would be the exception if someone was doing it after that and they would get a sternly worded letter telling them to complete it asap but have never heard of anyone being fired/not progressing because of it.

most people DO complete step 3 in intern year because that is the best time to do it. also you cant moonlight outside your program (and possibly internly) until you complete step 3 so another thing to bear in mind.

I'm just citing what I was told during my interview. I did find this a bit odd as this was really the only programs where this appeared to be the norm.

 

[ThoracicGuy]

it's in a terrible area. but i'm not taking them because they have established a life here with contacts. its going to be hard on me as my wife is my childhood sweetheart and she has been my rock during med school. however, i don't want to disturb them.

This is a mistake.

 

[MacDonaldTriad]

This is a mistake.

No kidding, I don’t care where he matched, how bad could it be? It isn’t like he is going to Sierra Leon in the middle of an Ebola crisis, or he matched into Damascus and will be next to an ISIS training facility. Everywhere will have some combination of hot or cold weather with some proportion of a meth epidemic, gangs and crime vs boredom, lack of cultural diversity and Hicksville. If there is a city with absolutely no acceptable public schools, they will have private schools. The attendings have to live somewhere and some of them have kids in school. I would like to think there is something unique and admirable in almost any cultural group, except maybe those Visigoths. I hate those G.D. Visigoths…

 

[Shikima]

.

 

[OldPsychDoc]

...I would like to think there is something unique and admirable in almost any cultural group, except maybe those Visigoths. I hate those G.D. Visigoths…

Racist.
"Then they came for the Visigoths, and I did not speak out— Because I was not a Visigoth."

 

[OldPsychDoc]

Yes, it is partly my problem because I decided to do Psychiatry not only because I enjoyed it but also because I wanted to go into a residency that would give me the opportunity to see my kids and live a balance life somewhat. My father was a general surgeon and I have a lot of negative experiences with the way he missed out on a lot of our lives because of work.

it's in a terrible area. but i'm not taking them because they have established a life here with contacts. its going to be hard on me as my wife is my childhood sweetheart and she has been my rock during med school. however, i don't want to disturb them.

Think about what you're saying here.

There were a fair number of negatives when I moved my family across 4 states for residency--but we found the positives. You need your family and they need you. There is a way to work this out together.

 

[so721]

Think about what you're saying here.

There were a fair number of negatives when I moved my family across 4 states for residency--but we found the positives. You need your family and they need you. There is a way to work this out together.

Yes, indeed, but if you are working 60+ hour weeks, especially when you're almost 40, do you think I will have any energy left to to spend time with them?

I should have gone with my gut instinct. Instead, I listened to my advisor who told me not to apply via the AOA match, and rank every single place I interviewed in ACGME. I mean it's very suspicious when you try and hide your FMG residents in a program.

 

[TexasPhysician]

Yes, indeed, but if you are working 60+ hour weeks, especially when you're almost 40, do you think I will have any energy left to to spend time with them?

I would hope so. I did lots of moonlighting and still made time for family.

You think AOA programs would be better?

I'm a little surprised that you expect residency to be easy. Time to find a way to turn your expectations around and make the best of it. Welcome to the real world of medicine.

I'm usually very positive on SDN, but you really need a wake up call in the nicest possible way.

 

[so721]

I would hope so. I did lots of moonlighting and still made time for family.

You think AOA programs would be better?

I'm a little surprised that you expect residency to be easy. Time to find a way to turn your expectations around and make the best of it. Welcome to the real world of medicine.

I'm usually very positive on SDN, but you really need a wake up call in the nicest possible way.

Actually, if you check out the AOA programs in Michigan, Oregon and Florida, they have very little call responsibilities, the residents and PD make an active effort to ensure that there is a good balance between work and life. They are actually "happy".

I did not expect residency to be "easy" but I expect that I would have some element of "chillness" compared to general surgery or IM. You would be surprised how many moms I met on the interview trail, who were cheif residents at Psych programs after switching from OB and FM due to the burnout.

Let me make this clear, I don't mind a tough schedule, as long as its of educational value. You can't just expect an MS4 to transform into a perfect intern overnight, it does require some effort on both parts.

 

[MacDonaldTriad]

Actually, if you check out the AOA programs in Michigan, Oregon and Florida, they have very little call responsibilities, the residents and PD make an active effort to ensure that there is a good balance between work and life. They are actually "happy".

.

This is going to sound a little like a curmudgeon argument involving walking to school uphill in both directions, but here it goes.

Does anyone else feel like the undergraduate and postgraduate medical education process is being decelerated by quite a bit? Undergraduate medical education is moving towards centralized not-on-site didactics and longitudinal ambulatory experiences such that medical students are not in the hospital half the time and it isn’t even possible to give them anything close to responsibility of care. With duty hours, interns are handing off care so fast, they too only share care responsibility making them glorified sub-Is. It seems like the PGY-II year is about what the PGY-I year used to be.

This really isn’t me describing the end of the world, more of an observation. If anyone tries to shorten training, I would think that our product quality would suffer and that patient safety would be worse. It really isn’t clear that duty hours have made anyone safer really.

 

[Doctor Bagel]

My program requires it by the end of pgy1 and gives vacation in one month blocks to encourage residents to study and take it in...I think that might be normal? My ortho resident roommate at Hopkins had to do it this way too

I wouldn't want to spend my intern vacation time either studying for or taking Step 3. Instead, study after hours on easier rotations and take few educational days (we actually got specific days in our contract on top of ed leave and vacation) to take it. You'll need your vacation for vacation.

 

[notdeadyet]

Yes, indeed, but if you are working 60+ hour weeks, especially when you're almost 40, do you think I will have any energy left to to spend time with them?

Yes. I turned 40 on a 24 hour shift on call in my intern year. I went to what is considered one of the call heavier programs out there. And I've had plenty of time for hobbies, family, fitness, etc. I've let many of these things go, sure, but that's on me.

60 hours a week is very manageable, particularly when it's not bound to be like that for 4 years. Particularly when it's going to drop dramatically down to about 40 hours for the rest of your life. Residency is a blip in which you are working the kind of hours some professionals work for their entire careers whereas after four years of this you will be earning among the top 4% of this country and potentially working less hours than someone on an assembly line.

If you made it through medical school, you'll make it through a psych residency fine with your family intact.

 

[OldPsychDoc]

...
If you made it through medical school, you'll make it through a psych residency fine with your family intact.

And you'll (usually, anyway 😉) be happy to have them to come home to.

 

[Indodo]

...the program is studded with FMG's from India and Pakistan. I honestly didn't think I would have to worry about it since it was the last on my ranklist. They were looking for DO's as well for some reason.

I honestly regret not going the DO match as I had some interviews where I would be able to at least work in peace, I honestly feel like I will be chewed alive. I know I brought this on myself though.

Maybe you matched at a lower end program because of who you are, your personality, your scores, your transcript? You should be happy you got this spot.
Your program doesn't sound malignant at all. Your attitude however doesn't inspire confidence.
The FMGs from India and Pakistan probably will chew you alive. They have worked very hard to get where they are and success is 99% perspiration. Sounds like His Excellency likes air conditioning.

 

[so721]

I wish i could afford a private school for the kids, but that's not an option. I am going to look into some Catholic schools though.

Also, I know that I am responsible for ranking this place in spite of malignancy, but honestly, how can you gather malignancy in real time from one interview day.

 

[birchswing]

I wish i could afford a private school for the kids, but that's not an option. I am going to look into some Catholic schools though.

Also, I know that I am responsible for ranking this place in spite of malignancy, but honestly, how can you gather malignancy in real time from one interview day.

Catholic public schools?

Also, I have to ask more generally, why this word malignancy (not just in this thread) is used to describe residencies? I understand the jargon (benign, malignant), but does it have a more specific meaning than "bad"? And do MDs apply it to other things, like bad restaurants, for example? Doctor A: "I got food poisoning from Chipotle." Doctor B: "I told you that place is malignant." I think I've only seen it used to refer to residencies. As an outsider, it appears rather reductive and even a bit odd.

 

[Shikima]

I wish i could afford a private school for the kids, but that's not an option. I am going to look into some Catholic schools though.

Also, I know that I am responsible for ranking this place in spite of malignancy, but honestly, how can you gather malignancy in real time from one interview day.

You'll never know. Just like the military, your life isn't yours for the next 4 years. Keep your head down, always say yes and have frequent beer rounds.

 

[DrBowtie]

Catholic public schools?

Also, I have to ask more generally, why this word malignancy (not just in this thread) is used to describe residencies? I understand the jargon (benign, malignant), but does it have a more specific meaning than "bad"? And do MDs apply it to other things, like bad restaurants, for example? Doctor A: "I got food poisoning from Chipotle." Doctor B: "I told you that place is malignant." I think I've only seen it used to refer to residencies. As an outsider, it appears rather reductive and even a bit odd.

Malignancy in residency is like gunner in med school. Everyone uses it very loosely but very few truly meet the definition.

 

[TexasPhysician]

Also, I know that I am responsible for ranking this place in spite of malignancy, but honestly, how can you gather malignancy in real time from one interview day.

The only program I interviewed at that was malignant made it pretty obvious.

Some details:
Major Academic Center
80+ hour work weeks during psych months
Even Pgy-3 & 4's took extensive overnight call.
Some months pgy-3's would do q3 overnight with a full am clinic the next day. They were post-call after am clinic to return by 8am the next day.
When a resident had visa or step 3 problems, other residents got to pick up more calls. This happened all too often.
Inpatient signs offs were critiqued by quality of a 3am eval, even when the patient spoke another language
Fast tracking to C&A fellowships were not allowed.
Moonlighting not allowed ever.

Unless you matched here, you did good.

 

[Mass Effect]

Yes, indeed, but if you are working 60+ hour weeks, especially when you're almost 40, do you think I will have any energy left to to spend time with them

First of all, no matter where you train, you're bound to have some 60-hour weeks. It's psychiatry. Once you get past the medicine months, it isn't going to be the living hell you're imagining.

Does anyone else feel like the undergraduate and postgraduate medical education process is being decelerated by quite a bit? Undergraduate medical education is moving towards centralized not-on-site didactics and longitudinal ambulatory experiences such that medical students are not in the hospital half the time and it isn’t even possible to give them anything close to responsibility of care. With duty hours, interns are handing off care so fast, they too only share care responsibility making them glorified sub-Is. It seems like the PGY-II year is about what the PGY-I year used to be.

This really isn’t me describing the end of the world, more of an observation. If anyone tries to shorten training, I would think that our product quality would suffer and that patient safety would be worse. It really isn’t clear that duty hours have made anyone safer really.

Have duty hour restrictions really affected psychiatry that much? How many psych residencies were working their residents over 80 hours a week before the restrictions? Obviously, I wasn't in residency during the period where there were no restrictions, but speaking as someone who pushed the 80-hour mark and at times went over it on medicine, I can say that it was the most miserable experience ever and not just because it's medicine. I have no idea how anyone working more than that could make competent life and death decisions toward the end of their shift.

Also, I know that I am responsible for ranking this place in spite of malignancy, but honestly, how can you gather malignancy in real time from one interview day.

You continue to call your program malignant, yet you have yet to list malignant characteristic.

Also, I have to ask more generally, why this word malignancy (not just in this thread) is used to describe residencies? I understand the jargon (benign, malignant), but does it have a more specific meaning than "bad"? And do MDs apply it to other things, like bad restaurants, for example? Doctor A: "I got food poisoning from Chipotle." Doctor B: "I told you that place is malignant." I think I've only seen it used to refer to residencies. As an outsider, it appears rather reductive and even a bit odd.

No, no one calls restaurants or anything else malignant. In terms of programs, the word refers to a place that doesn't really care about their residents, a place that makes residents lie on ACGME duty hour surveys, threatening ramifications if they don't, a place that uses intimidation and bullying to train residents, a place that routinely fires residents or makes several of them remediate rotations without actual reasons for why or a chance to improve. Malignancy does NOT refer to making someone take Step 3 before promotion to the next level or having a large number of FMGs or anything else like that.

 

[shojimoji]

why don't you just make

The only program I interviewed at that was malignant made it pretty obvious.

Some details:
Major Academic Center
80+ hour work weeks during psych months
Even Pgy-3 & 4's took extensive overnight call.
Some months pgy-3's would do q3 overnight with a full am clinic the next day. They were post-call after am clinic to return by 8am the next day.
When a resident had visa or step 3 problems, other residents got to pick up more calls. This happened all too often.
Inpatient signs offs were critiqued by quality of a 3am eval, even when the patient spoke another language
Fast tracking to C&A fellowships were not allowed.
Moonlighting not allowed ever.

Unless you matched here, you did good.

We r going to be taking care of human beings plz remember that. I matched into a program like u mentioned & sad 2 busy but glad to be continuing my career

 

[MacDonaldTriad]

malignant(məˈlɪɡnənt)
adj

1. having or showing desire to harm others
2. tending to cause great harm; injurious
3. (Pathology) pathol (of a tumour) uncontrollable or resistant to therapy; rapidly spreadingn
4. (Historical Terms) history (in the English Civil War) a Parliamentarian term for a royalist

: from Late Latin malīgnāre to behave spitefully, from Latin malīgnusmalign]

Clearly the fourth definition was of a Cromwellian origin, but I do begin to worry that a “malignant program” has become any training that makes people do something they don’t want to do. Every job does that at times. Drawing blood or transporting patients isn’t educational, and probably shouldn’t be relegated to residents regularly, but we now graduate doctors who don’t know how to start an IV. Pardon me for thinking there is something wrong with that.

 

[shojimoji]

malignant(məˈlɪɡnənt)
adj

1. having or showing desire to harm others
2. tending to cause great harm; injurious
3. (Pathology) pathol (of a tumour) uncontrollable or resistant to therapy; rapidly spreadingn
4. (Historical Terms) history (in the English Civil War) a Parliamentarian term for a royalist

: from Late Latin malīgnāre to behave spitefully, from Latin malīgnusmalign]

Clearly the fourth definition was of a Cromwellian origin, but I do begin to worry that a “malignant program” has become any training that makes people do something they don’t want to do. Every job does that at times. Drawing blood or transporting patients isn’t educational, and probably shouldn’t be relegated to residents regularly, but we now graduate doctors who don’t know how to start an IV. Pardon me for thinking there is something wrong with that.

I agree we should all have basic skills for emergency situation

 

[675015]

Drawing blood or transporting patients isn’t educational, and probably shouldn’t be relegated to residents regularly, but we now graduate doctors who don’t know how to start an IV. Pardon me for thinking there is something wrong with that.

To play devil's advocate, what exactly is "wrong" with it? Is it just because thats how things have always been and now they are changing? The physician will never be the person who is best at placing an IV. When nurses call doctors to say they can't get IV access, the answer is usually we actually don't need access or lets get a PICC. Its not, "Don't worry the doctor can do it." Most psychiatry residents don't realistically need to be placing IVs and if they are in a situation in the future where they do need to place them, I'm sure they can learn. Placing IVs is hardly what defines the medical profession.

 

[MacDonaldTriad]

It doesn’t matter if you are a CB or a cook in the Army, everyone learns how to shoot a gun.

 

[masterofmonkeys]

I am so, utterly confused right now. I keep hearing this word Malignant. I do not think it means what you think it means.

I could whine about my experience as an intern but let me put it this way; Regularly worked 80, regularly did 30 hours in a row, once went 43 days without a calendar day off (yay for the 24h period!). Internal Medicine Wards at the county hospital was the easiest rotation of the year. While we were one of the heavier call programs out there, we were by far not the only one. More programs had similar schedules to us than different.

If I hadn't just spent so much money I can no longer afford to put an offer on the condo I was planning on buying (literally), I would bet that you aren't working that much, in relative terms to what people did even 5 years ago, or in absolute terms for a young professional.

You should expect minimum 50 hour weeks, 1 day a week of weekday shortcall, and 2-4 weekend days of long call. It's also better than most have had it over the years. But, THIS IS NOT A LOT OF WORK. Not in engineering, not in law, not in early career scientist. Not in dedicated teacher. In no demanding professional field is this a lot of work. People rely on you as an expert, a support, and a lifesaver. 50 hours a week, 60 on rough weeks is simply not that big of a deal, especially as its just for a few years. You would be expected to do that in literally any demanding professional field.

As for the 'bad neighborhood', I literally fell out of my chair laughing. In the US there are a couple of easy ways to avoid murder: 1) Don't be in a gang 2) Don't live with someone in a gang 3) Don't use drugs 4) Don't sleep around or be with someone who sleeps around. Satisfy those criteria and your risk of murder is now less than your chance of winning the lottery.

As for overall violent crime and robbery, our crime rates are so much lower than 'civilized' Europe it's not even funny.

I'm sorry to be an a-hole but you're literally not responding to attempts at cognitive reframing, at all.