McLean et al vs. Random Community Programs

[funpebbles]

So there is a particular region I would like to stay in for residency and know my top 3 programs in the area. I'm really struggling with what to rank next. Without giving too much identifying info, suffice to say I didn't think I was a strong candidate (very low boards, mediocre clinical grades and comments) but managed somehow to get interviews at programs like MGH/McLean, Yale, Penn, you can imagine...

My question specifically is what am I "giving up" if I were to rank regional community programs over the "top" programs as 4,5,6,7 etc? How far down rank lists so psych candidates typically match? I'm particularly scared because despite interviews I'm pretty sure my application is not that strong and know many "stronger" candidates also ranking my top 3.

Thank you very much for any insight.

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[funpebbles]

Also when I say "random community programs" think programs with all IMGs where I had to email PDs to show interest and get invited. Again, I really don't want to "reveal" too much about myself but I have strong reasons for my geographical preference. Is it true that community programs are "exploitative" programs where "the other half lives" as one PD said on interview day? I imagine patient volume is higher, but which type of program is more stressful and has longer hours/call? Can I still get a good fellowship out of these programs?

 

[OldPsychDoc]

Also when I say "random community programs" think programs with all IMGs where I had to email PDs to show interest and get invited. Again, I really don't want to "reveal" too much about myself but I have strong reasons for my geographical preference. Is it true that community programs are "exploitative" programs where "the other half lives" as one PD said on interview day? I imagine patient volume is higher, but which type of program is more stressful and has longer hours/call? Can I still get a good fellowship out of these programs?

Massively distorted generalization, which becomes a self-fulfilling prophecy in some cases.
I'm not saying that there aren't "sweat shop" programs out there, particularly in the NE, but there are many community programs with less workload and better clinical training than some university programs. Judge each program individually.
Good fellowships are going unfilled year after year, and residents from many "community" programs are just as well prepared to enter them as a "big name" program.

 

[SmallBird]

I am someone who is not of the school of "programs are more similar than they are different" - which is to say, I believe that different programs can offer very different experiences in terms of both clinical and research exposure. However, I agree entirely with OPD that you can't generalize this based on community vs university; it depends on your own clinical and research interests, and which program will be able to best accommodate these.

 

[eastcoastdr]

Well what kind of a program would you want, ideally? And what about a program is really important to you? Location, prestige, research opportunities, etc? It sounds like you would only rank McLean because of its prestige, but you really prefer the geographic location and work-life balance of a smaller community program. I would prioritize what matters to you more. I know plenty of people that would pick McLean and tough out whatever challenges arise from doing residency at a well-known top program. I personally would place more weight on location because I want to be happy and have a good support system around me during residency. Many of the people I've worked with who have great careers in psychiatry and DIDN'T go to one of those top programs. Whatever you rank, just make sure you would be HAPPY there and that you genuinely liked the place.

 

[shan564]

Programs have many similarities, but I generally agree with SmallBird (as I usually do). Things that, in my opinion, are important to get good training in psychiatry (in no particular order):

• Patient diversity - different backgrounds in terms of education, income, ethnicity, religion, insurance status (the best programs will expose you to a lot of patients without insurance, which allows you to see what happens when a disease isn't treated appropriately), psychopathology, etc. I think you can get this if you're in a large hospital with a wide catchment area that includes areas that are super-urban and super-rural.
• Appropriate caseload - if you have a patient cap of 5, then you won't see enough patients. If you have no cap, then you might not get enough time to spend on learning and teaching. I think 10 is an appropriate cap - it allows me to spend enough time learning and teaching without being exhausted.
• Proximity to family/friends - if you have a good social support network, it'll make it easier to deal with the stresses of residency. This is even more important than you think it is. The hospital can be an immensely frustrating place, and it's great to come home and call a few of my college friends to come by and pretend like we're in college again for a while. It would probably be even better if I could drive to my parents' house for dinner and laundry, but I don't have that luxury.
• Rotations in as many subspecialties as possible - I think that your training will be compromised if you don't get dedicated experience with subspecialist supervision in geriatrics, ECT, consults (at a major hospital), ER, eating disorders, drug/alcohol, teaching/supervision, etc, with adequate time for electives. You should also work in internal medicine as a regular internal medicine intern (not a fluffy IM rotation that's different from what the IM people do).
• Exposure to a diverse range of faculty with varying areas of expertise - I think that this is very very important. In 4 months of inpatient psych, I've had the chance to work under a wide range of attendings with a wide range of styles, including a C/L+eating disorders expert, a forensics expert, an ER psych expert, and a guy who has been practicing for half a century and was in private practice for longer than I've been alive. While on nights and weekends, I've also admitted under (or rounded with) people from every other subspecialty that you can imagine. I've learned an amazingly wide range of different things from each of them with different perspectives that are helping me to formulate my own style of practicing psychiatry.
• Exposure to (and ability to practice) whatever is latest and greatest - when I was in med school, I had the impression that psychiatry has mostly been pretty stagnant for the past couple of decades. That impression was based on the way that psychiatry was practiced at my school - there were some excellent psychiatrists there, but they never did anything that hadn't been the standard of care since forever ago. There is a lot of cool new stuff to learn, and the best way to learn it is if your program makes an active effort to teach it to you. This probably isn't as important as the other factors that I mentioned, since you can essentially replace it by reading a lot.
• Good balance between biological training and psychotherapy training - this is important, but I think that a majority of programs offer it. Even the most biological of programs will expect you to learn psychotherapy to the extent that is required for most everyday practice (since most psychiatrists don't do too much psychotherapy), and even the most therapy-oriented programs will expect you to learn the basics of biological psychiatry (since even the most therapy-oriented psychiatrists should know when a patient needs an antipsychotic). It's true that CHA probably won't expect you to know when to order anti-NMDA antibodies and WashU won't expect you to know how to use the word "superego," but I think that those things will only affect your daily practice if you're working in a particular niche - and if you want to work in that niche, then you should definitely be using that to guide your program choice.

There are many other things that also matter to some people, but I didn't list them because they don't matter to most people. In my case, that "other thing" was research opportunities and academic career outlook.

If you go to MGH or Yale (or any other program affiliated with a "top 10" medical school), you can be fairly certain that you'll get pretty much all of those things to an appropriate extent... and that's why those programs are well-reputed. If you go to a community hospital in a large Midwestern city, you might get better patient diversity because there are more farmers in the Midwest, but you might compromise on the ability to get trained by multiple subspecialty experts. Some community hospitals might be large enough to provide you with more expert supervisors. Some of them might be small enough so that you take on more diverse tasks, which would probably also be beneficial to your learning.

So I guess that was my dumb long-winded way of saying that "there's no way to accurately answer your question and you can only decide by weighing the pros and cons as they apply to you."

 

[funpebbles]

Thank you all very much for your insights. My advisor said something similar, but all my friends outside of paych think I'd be crazy to rank Small Hospital X over MGH.

I wondering specifically how far down rank lists do psych candidates typically match? At what number did you guys rank? Also, what is this talk about "service driven" programs vs. i forget name for other. Anyone known what i'm referring to? One PD literally desribed it as "how the other half lives."

 

[Therapist4Chnge]

One PD literally desribed it as "how the other half lives."

So…the half that actually paid taxes…or the other half?

 

[peppy]

where "the other half lives" as one PD said on interview day?

One thing I've noticed is that you get some pretty in depth exposure to narcissistic personality disorder cases at some of the top programs. And I don't mean the patients.

 

[VMSmith]

Without giving too much identifying info, suffice to say I didn't think I was a strong candidate (very low boards, mediocre clinical grades and comments) but managed somehow to get interviews at programs like MGH/McLean, Yale, Penn, you can imagine...

Getting an interview at one of those programs could be a fluke (though unlikely, because interview spots are a precious resource that they don't squander on applicants they're not actually interested in). Getting an interview at ALL of those programs means you ARE a strong applicant, despite what you say about your board scores and grades.

Rank the programs how in the order you want, not in the order you think actually want you. Don't do their job for them. Let the programs decide if they want you, you just need to decide which programs YOU want.

Sent from my GT-N5110 using Tapatalk

 

[funpebbles]

Do most people get their top 3 choices?

 

[notdeadyet]

Do most people get their top 3 choices?

Depends on the applicant and their top 3 choices.

If you're an average allopathic MD from an average medical school with an average Step 1 placed in the middle of your class with a sincere interest in psychiatry, you would likely match at one of your top 3 choices, as long as your top 3 choices did not consist of what most folks would consider the top 10 or so programs in the field. You might still match at one of those programs, but no one could guess that with confidence. If you weren't applying to those 10 programs, the odds of the above applicant matching at one of their top 3 would be very good.

 

[OldPsychDoc]

Depends on the applicant and their top 3 choices.

If you're an average allopathic MD from an average medical school with an average Step 1 placed in the middle of your class with a sincere interest in psychiatry, you would likely match at one of your top 3 choices, as long as your top 3 choices did not consist of what most folks would consider the top 10 or so programs in the field. You might still match at one of those programs, but no one could guess that with confidence. If you weren't applying to those 10 programs, the odds of the above applicant matching at one of their top 3 would be very good.

Do you write GRE questions on the side?

 

[notdeadyet]

Do you write GRE questions on the side?

One unsung joy of going to medical school is never having had to even TAKE the GRE.

When I hear GRE I think of trains going in opposite directions and a whole lot of vocab, but I'm probably way off the mark.