Official 2019 Rank Order Lists

[MacDonaldTriad]

Trying to decide between. Stanford vs. UCSF for my number one.

UCSF: I love everything about the program except call schedule.

Stanford: More flexibility with what I can do with my time there.

Location wise I'm from the Bay so I can live anywhere in the Bay and be okay with it.

You seem to see this right. Any public mental health system will be more busy. This makes both better and worse than each other in different ways. It is up to you to decide what works best for your needs.

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[Psychish]

MD/PhD here, with research/academic interests. Trying to decide my top...
My "best interests" are with MGH. Great support and learning environment. Outstanding resources (i.e., mentors, funding) for research. Of course, prestige.
My "happiness" is at UMD/Sherppard Pratt. I LOVED the place, residents and administration. I received the best vibes in the whole interview season.
My "brain" is at Mount Sinai. Great support for research (i.e., funding, time) and the mentors I would like to work with are there.
My "heart" is at Emory. Great staff, wonderful residents. Great communication, hey have truly earned my heart. <3
Help...

 

[DrGoon]

I'm excited to see HSS on your list, current intern there. I've been really happy. Since I see it discussed above I thought I'd say - in PGY1 you spend 2months at Mclean hospital, 4 months at Mclean in PGY2, 3 months at Beth Israel and other non-VA sites in PGY2, 1/2 day per week in PGY3 at a non-VA site. We are VA heavy (being centered on a VA), but I have an optimistic view of the experiences I've had so far and those coming up. We get a lot of addictions exposure, but we're also the tertiary referral center for all VAs in New England, so we do still get diverse pathology. Obviously diverse pathology at Mclean hospital. And in addition to loving my co-interns and the places we work, I've also enjoyed rotating alongside the residents from the other Harvard-affiliated programs. Great people in Boston in my experience.

I'm glad we're on your list!

Good luck no matter what order you settle on!

Is there any sort of requirement for rotating through VA system during 4th year or can you rotate exclusively at other sites?

 

[plouf]

Hey, would you talk more about your impressions of baystate? There's not much info out there about them.

Hey All,

I need some help in ranking my first half of the list... Have immediate family in DFW (Texas), as well as NYC, SO's family lives in Canada

Important factors to me: Location (Texas (most family resides here), New York, Close proximity to Canada), Strength of Clinical Training and Variety of training Sites, Psychotherapy Emphasis (CBT, DBT, Psychodynamics), Collegial/Supportive Environment, Interested in CAP fellowship down the line.

First Half of the List Includes: (no particular order)... Please Help!

UT Austin
John Peter Smith (JPS)- i know this place doesn't have a lot of variety in training sites but the APD said their residents are "Highly Sought After" and I know that the program is work heavy, and does not have a great emphasis on psychotherapy.
Drexel University- interviewed for both general adult as well as the combined CAP. thoughts on the strength of their CAP fellowship!? so i can determine where to rank the combined program?
Penn State Hershey- Absolutely loved the PD and other faculty, residents seemed relatively happy.
Albany Medical Center- emphasis on psychotherapy, variety of clinical settings, close to NYC and Canada.
University of Buffalo (Interviewed for General Adult as well as Combined CAP program- 2 separate rankings)- feels like a solid program but do not like location (Buffalo winters/snow and lake effect) so feel conflicted.
UMMS-Baystate- not a lot of variety in training sites but got a great vibe from the leadership (PD, chair).

First preference is Texas but conflicted about ranking JPS (close to family) over other more balanced programs... what do you guys think? another part of me thinks that it doesn't matter how close i will be to family since i'll be busy working my life away, so why not go to a more balanced program? THOUGHTS?!?!

THANKS FOR THE HELP GUYS!

 

[intern_at_HSSpsych]

Is there any sort of requirement for rotating through VA system during 4th year or can you rotate exclusively at other sites?

Great question (might be good to ask staff at the program, like the PC)... I think you have to do some % of time overall at the VA, but I know that our 4th years spend time elsewhere. One is "geriatric chief resident" at McLean hospital in her 4th year for example.

I'd ask the program directly, and ask what any current pgy4s are doing.

 

[Drrrrrr. Celty]

So I just interviewed at Umiami. A lot of people on here for some reason seem to think it's malignant or something. I didn't get this impression at all. Did I miss something?

 

[clausewitz2]

So I just interviewed at Umiami. A lot of people on here for some reason seem to think it's malignant or something. I didn't get this impression at all. Did I miss something?

Nemeroff.

 

[Drrrrrr. Celty]

Nemeroff.

He left.

 

[@gainstAllOdds]

Hey, would you talk more about your impressions of baystate? There's not much info out there about them.

It is a tertiary care referral center for 3-4 small surrounding hospitals, so they see all spectrum of psychopathology. It seems like a strong clinical program and they do have an emphasis on psychotherapy as the PD did a Psychodynamic fellowship at Columbia I believe. They also encourage research and going to APA and other conferences and meetings, as the PD and Chair are very well known and involved in the APA. The PD seems very supportive of residents and like a father figure. I don't believe they rotate at many different sites, which is a weakness. I don't think they have a night float system but the residents we met seemed satisfied with the call schedule (will have to check my notes to remember exactly). The hardest part for them to sell is the location (Springfield in Western Mass), it may not be the best for singles but I believe it is a great place to raise a family. It can be considered a college town as there are 5 decent sized schools very near by. Night life isn't that great except for 1 strip not too far from the hospital. That's all i can think of right now. Let me know if you have any specific questions.

 

[ridethecliche]

I believe they're also trying to start a CAP program there. The peds experience there seems pretty good and I know that one of the child folks there had a big hand in developing mcpap in MA

 

[singler12]

So I just interviewed at Umiami. A lot of people on here for some reason seem to think it's malignant or something. I didn't get this impression at all. Did I miss something?

I really liked it as well

 

[Drrrrrr. Celty]

So I know how gut feeling isn't supposed to play a major role in this all. But have any of you ever wanted to rank a program lower on your list just because it seemed significantly that they had not actually bothered to read your application while you were interviewing there? Like I'm split between wanting to rank a program that I felt very comfortable with and also felt like they wanted me there because they knew me as an applicant versus another program that I originally wanted significantly more, but subsequently I felt more like a lesser applicant who had to really go out of their way to prove themselves?

 

[DrGoon]

So I know how gut feeling isn't supposed to play a major role in this all. But have any of you ever wanted to rank a program lower on your list just because it seemed significantly that they had not actually bothered to read your application while you were interviewing there? Like I'm split between wanting to rank a program that I felt very comfortable with and also felt like they wanted me there because they knew me as an applicant versus another program that I originally wanted significantly more, but subsequently I felt more like a lesser applicant who had to really go out of their way to prove themselves?

Feels. It felt like most interviewers at my top program didn't care at all and only asked me about areas in my application that they perceived as weaknesses.

 

[MacDonaldTriad]

Avis is #2, they try harder. How much do you need your program to try harder? It is nice when they do, but is it worth being #2? Probably, but it is up to you. How much people value name is very personal and usually silly and quickly pointless once you get there.

 

[yanks26dmb]

Can anyone speak to the call schedule at Mt. Sinai St. Lukes?

 

[SourceOfDenial]

So I know how gut feeling isn't supposed to play a major role in this all

It's not? Isn't that what it's all about? If it was just about perceived rank you wouldn't even need to interview.

 

[ridethecliche]

It's not? Isn't that what it's all about? If it was just about perceived rank you wouldn't even need to interview.

Not sure that's true from the programs side of things.

 

[SourceOfDenial]

Not sure that's true from the programs side of things.

My comment was intended for applicants--but I'd wager that many programs could make an imaginary rank list of the people who accept interviews and the final list wouldn't look that different. Someone should do that experiment.

 

[FFH]

So I know how gut feeling isn't supposed to play a major role in this all. But have any of you ever wanted to rank a program lower on your list just because it seemed significantly that they had not actually bothered to read your application while you were interviewing there? Like I'm split between wanting to rank a program that I felt very comfortable with and also felt like they wanted me there because they knew me as an applicant versus another program that I originally wanted significantly more, but subsequently I felt more like a lesser applicant who had to really go out of their way to prove themselves?

To me how much the program care about selecting the best possible people is a very big deal. It's not so much about gut feeling--residents are the future of the program, it takes a lot of time and efforts to find the best people, especially now given the volume of applications. Though exactly how much the selection process mean something to the department is hard to tell, but it is not difficult to spot the two extremes.

 

[Drrrrrr. Celty]

It's not? Isn't that what it's all about? If it was just about perceived rank you wouldn't even need to interview.

I feel like not reading my application or just skimming it is a significantly weaker interest in me than when you got to a program and all the interviewers have read your application down to the letters of recommendation.

 

[SourceOfDenial]

I feel like not reading my application or just skimming it is a significantly weaker interest in me than when you got to a program and all the interviewers have read your application down to the letters of recommendation.

I agree with you. Don't ignore your gut.

Prestige/rank is bull**** anyway. Every program has the same issues by and large. Go to aadprt or the terrytown chief conference and every place deals with the same crap.

 

[ridethecliche]

Some programs are trying to sell you on them vs others that are waiting for you to impress them imho.

 

[DrGoon]

Some programs are trying to sell you on them vs others that are waiting for you to impress them imho.

100% my experience too

 

[80wz34]

Currently trying to decide between UTSW and Emory for my top choice. I truly enjoyed both interview experiences and am looking for a program that offers a variety of training facilities, good emphasis on resident wellness, and the opportunity to get involved in research and/or public health advocacy. I got the sense that the residents at both are very well-supported and trained but that UTSW was less “workhorse”-ish than Emory. However, I didn’t get to meet as many residents there as at Emory, so I’m a little wary. Any input would be greatly appreciated!

 

[TexasPhysician]

Currently trying to decide between UTSW and Emory for my top choice. I truly enjoyed both interview experiences and am looking for a program that offers a variety of training facilities, good emphasis on resident wellness, and the opportunity to get involved in research and/or public health advocacy. I got the sense that the residents at both are very well-supported and trained but that UTSW was less “workhorse”-ish than Emory. However, I didn’t get to meet as many residents there as at Emory, so I’m a little wary. Any input would be greatly appreciated!

We may have many different ideas about what is desired in a program, but I ranked UTSW very highly and Emory very low. A common theme among Emory residents was that volume was too high at the expense of reading, etc. Disclaimer - This was years ago. With that said, Emory is generally supportive of residents into academia.

 

[yanks26dmb]

Can anyone shed light on Einstein in Philly? Think I liked it, but curious what others have to say/know about this place.

 

[FlowRate]

Currently trying to decide between UTSW and Emory for my top choice. I truly enjoyed both interview experiences and am looking for a program that offers a variety of training facilities, good emphasis on resident wellness, and the opportunity to get involved in research and/or public health advocacy. I got the sense that the residents at both are very well-supported and trained but that UTSW was less “workhorse”-ish than Emory. However, I didn’t get to meet as many residents there as at Emory, so I’m a little wary. Any input would be greatly appreciated!

Like Texas, I ranked UTSW higher than Emory. (I think 4 vs 6 or 7.) They're both probably still above-average workload, but Emory moreso and in a way that I didn't like (residents complaining that program had abused the definition of home call for a long time--supposedly that was changing but I still thought it was a turn-off.)

 

[XannyBarz]

I need some advice with the order of few programs. Interested in addiction and would like strong neuromodulation training. top of my list is fairly well set. Geography not really a strong factor for me. Would like a program that could possibly give me a route to academics. The programs I cant figure out order of are Mayo, Utah, UT Austin, LSU NOLA. Any insight?

 

[psychhunter]

any thoughts on GW?

 

[967047]

Hello! Longtime lurker here. I am an MS4 who recently finished up the interview season. I was very fortunate to receive interviews to several great places. Below are some of the programs I am trying to sort out. Taking location out of the equation, how would you rank the following programs and why:

University of Pennsylvania
University of Pittsburgh
Beth Israel Deaconess Medical Center
Icahn at Mount Sinai

Note: I am currently interested in child/adolescent psychiatry and possibly public psychiatry.

 

[FlowRate]

Hello! Longtime lurker here. I am an MS4 who recently finished up the interview season. I was very fortunate to receive interviews to several great places. Below are some of the programs I am trying to sort out. Taking location out of the equation, how would you rank the following programs and why:

University of Pennsylvania
University of Pittsburgh
Beth Israel Deaconess Medical Center
Icahn at Mount Sinai

Note: I am currently interested in child/adolescent psychiatry and possibly public psychiatry.

What's important to you other than location? Who do you want to be in 5-10 years?

 

[jrpeppertree]

MD/PhD here, with research/academic interests. Trying to decide my top...
My "best interests" are with MGH. Great support and learning environment. Outstanding resources (i.e., mentors, funding) for research. Of course, prestige.
My "happiness" is at UMD/Sherppard Pratt. I LOVED the place, residents and administration. I received the best vibes in the whole interview season.
My "brain" is at Mount Sinai. Great support for research (i.e., funding, time) and the mentors I would like to work with are there.
My "heart" is at Emory. Great staff, wonderful residents. Great communication, hey have truly earned my heart. <3
Help...

You can't go wrong with any of them. My own biases say that following your best interests/happiness/heart is better than brain, but that's just me.

Maybe the elo tool linked by @4malit above would be helpful?

 

[967047]

What's important to you other than location? Who do you want to be in 5-10 years?

I can possibly see myself doing a combination of academics and private practice in 10 years, though I’m still not 100% sure. I want a program with great mentorship that also allows me to keep my career options open.

 

[scarlett14]

anyone have any thoughts on mt sinai vs nyu? im interested in public psychiatry and adolescent psychiatry. got an mph during medical school so hoping to work with public health stuff in the future in addition to practicing.

my current thoughts: bellevue seems like it would be a great place to train since you'd see so much but nyu residents seem more stressed/overworked and the ones at mt sinai seemed pretty happy and more chill. and i like how mt sinai gives you a lot of elective time and more opportunities to explore your interests, while nyu seemed much more structured from what i could tell. but not sure about how i feel about doing 6 straight months full time at the VA 2nd year which mt sinai makes you do. they seem to be kinda va heavy which im not really that excited about.

thoughts anyone?

 

[FlowRate]

I can possibly see myself doing a combination of academics and private practice in 10 years, though I’m still not 100% sure. I want a program with great mentorship that also allows me to keep my career options open.

I don't know that much about Penn and Icahn but I'd imagine that you'll be well served in that goal at any of Penn/Pitt/BIDMC. I just know the least about Icahn, that's not to say you wouldn't also be well served there.

If you have any more specific interests, that might change the mix.

 

[yanks26dmb]

I need some advice with the order of few programs. Interested in addiction and would like strong neuromodulation training. top of my list is fairly well set. Geography not really a strong factor for me. Would like a program that could possibly give me a route to academics. The programs I cant figure out order of are Mayo, Utah, UT Austin, LSU NOLA. Any insight?

Interviewed at UT Austin...their addiction training is very weak (self-admitted). Can't speak for the others, but Tulane in NOLA had solid addiction training, I would imagine LSU does too.

 

[967047]

If you have any more specific interests, that might change the mix.

How might "specific interests" change how I rank these programs? Based on your knowledge, what are some of the unique strengths of the different institutions I named?

 

[FlowRate]

How might "specific interests" change how I rank these programs? Based on your knowledge, what are some of the unique strengths of the different institutions I named?

I don't have enough specific knowledge to give you an exhaustive overview of each program's relative strengths and weaknesses--it was your job as an applicant to try and gauge those things where relevant to you by asking good questions on your interview days and talking to mentors/faculty/residents at your institution.

 

[967047]

I don't have enough specific knowledge to give you an exhaustive overview of each program's relative strengths and weaknesses.

That’s all you had to say.

 

[clausewitz2]

How might "specific interests" change how I rank these programs? Based on your knowledge, what are some of the unique strengths of the different institutions I named?

You are going to get better answers if you put some cards on the table. It is okay if you have no idea what you really want to do ultimately (plenty of people don't at this stage!) but between CAP, public, academic and private practice as the routes you want to go down you have described 80% of psychiatry.

Quick, there's a gun to your head, what would you be saddest to give up?

 

[SourceOfDenial]

How might "specific interests" change how I rank these programs? Based on your knowledge, what are some of the unique strengths of the different institutions I named?

Do you want to live in Boston? Philly? Pitt? NY? That's your rank list. None of those programs will close doors, all will have good mentoring.

 

[Evidence Based]

That’s all you had to say.

I brought this up in the (sadly extremely quiet) interview review thread but will mention it again- if you want help with programs you should pay it forward and give your impressions about the programs you've interviewed at. To be generous there are maybe ~20 active residents and attendings on this forum. Most of us have only gone to one program and have foggy memories of the others we interviewed at. You all are each other's best resource, and it would be incredibly helpful for everyone if people who wanted opinions about programs also posted reviews or at least some impressions about the programs you've interviewed at.

I'm not trying to be snarky, I really just have no idea how to answer the "I'm interested in X very broad area and want advice on these 7 programs" posts that have been happening here. It's much easier if we can read your impressions, hear what you like and didn't like about programs, and something more specific about your interests. That way you all can help each other as well!

 

[Evidence Based]

For anyone with specific questions about programs, I strongly recommend you check out the 2017-18 review thread thread.

And then if you find those reviews helpful, consider paying it forward and leaving a review of your own on this year's thread.

 

[Evidence Based]

In the spirit of practicing what I preach, I've gotten a few PMs asking me about Boston programs since I (extremely obviously) interviewed at several of them. Here are some of those impressions from last year, albeit with a HUGE caveat that I obviously don't attend all of these programs. The person I was talking with was specifically interested in CAP, global health, and community psychiatry, so if that applies to you I hope this helps. This specifically compares CHA, BIDMC, and BWH per a request. I didn't interview at MGH, and I left reviews for Tufts and BMC on last year's thread.

CHA: No question the strongest in community psychiatry on this list, as it bills itself as "academic community psychiatry." You'll get broad exposure to treatment with low income folks, serious mental illness, sexual and gender minorities, immigrants, refugees, etc. Global health exposure seems decent but not incredible; however, it is incredibly easy to get linked up with other places in the Harvard system for research or elective time. CHA is well known for its therapy training and you'll be hard pressed to leave without being an excellent therapist. If your'e really gunning on a career as a department chair at a huge hospital with a basic science or clinical research backbone this is probably not the place for you, but CHA certainly trains plenty of leaders in health systems, advocacy, therapy, etc. Finally, I would say the child exposure is really excellent. Everyone gets inpatient child and adolescent during our PGY-1, and get outpatient child and family therapy cases as PGY-3s. People place extremely well for fellowship.

BIDMC and BWH are a little harder to differentiate given that they were united as the Longwood residency until the split two years ago (which all the current residents I talked to were super bummed about).
-Both definitely train lots of leaders in psychiatry, so it would be a great place to be if your goal is to do lots of research or become a department chair
-Communitry psychiatry [Edited to reflect posts below] is certainly not the main focus, but you do great great exposure through Mass Mental (a state DMH run clinic/PHP/shelter) with three months of DBT or CBT partial during PGY-2 and halftime outpatient during PGY-3
-Lots of exposure to medical students, at least in the first two years.
-Don't know remember the exact breakdown of the child exposure, but I believe you'd rotate on the Children's Hospital inpatient unit. You'll match anywhere you want for child fellowship.

Quick differentiating impressions:

BI seemed a little more homey/humanistic, and somewhat more therapy focused. I think you can get excellent training at either program, but tbh I was a little thrown off by how biologic the BWH PD was. While I'm sure the training is great, it seems like they're really trying to move the program into a more "medical psychiatry" model in the future. Not sure how far it will go, but I think the orientation of a PD says a lot about the future of the program. BWH as I remember has excellent global health linkages with the departments of Global and Social Medicine (Paul Farmer is still on faculty there I believe, and I think even attends on the wards occasionally).

All this said, at big name programs you can basically do whatever you want, it's more of a question of which way the current is flowing and how hard you'll have to work to swim against it. These are all wonderful programs, and I know folks at all of them who seem pretty happy.

 

[FlowRate]

-Both are weak in community psychiatry, as they're based at tertiary (or even quartenary) referral centers. Both residencies (along with CHA) rotate at Mass Mental (a state partial program with intensive DBT and CBT teams) which is an awesome experience, but you'd have to go a bit out of your way to get more exposure besides that. I'm sure you could do it, but I don't think it's the focus

Longwood did 6 months half-time outpatient at MMHC and BIDMC is doing something similar (in addition to PHP). Pretty sure that should count as a significant community exposure. Not sure about BWH. Also, the outpatient departments (primary care and psych) of both systems treat a huge proportion of the community at large. I don't think there's a huge difference between a quaternary center and otherwise when it comes to outpatient work except that the quaternary centers have more medically complex patients on average.

 

[Evidence Based]

Longwood did 6 months half-time outpatient at MMHC and BIDMC is doing something similar (in addition to PHP). Pretty sure that should count as a significant community exposure. Not sure about BWH. Also, the outpatient departments (primary care and psych) of both systems treat a huge proportion of the community at large. I don't think there's a huge difference between a quaternary center and otherwise when it comes to outpatient work except that the quaternary centers have more medically complex patients on average.

Thanks for clarifying! Is this halftime outpatient during your PGY-3 in addition to three months during PGY-2? If so that's more substantial than I had recalled from my interview day and I can update my post

 

[Amygdarya]

Thanks for clarifying! Is this halftime outpatient during your PGY-3 in addition to three months during PGY-2? If so that's more substantial than I had recalled from my interview day and I can update my post

Yes, 6 months of 2.5 days/week of Mass Mental continuity clinic in PGY-3 in addition to the 3 months of 5 days/week of Mass Mental PHP in PGY-2. That's pretty substantial. Not to mention that, as FlowRate pointed out above, both BWH and BIDMC serve a broad range of patients including a good number of low SES. BIDMC ED in particular is apparently known to a good number of patients to be more lenient in terms of allowing people to hang out in the ED overnight, and BIDMC inpatient psych unit treats a good number of severely ill Mass Mental clients. I don't know for sure about BWH/Faulkner but imagine it's something similar (though I hear BIDMC ED tends to be busier).

In general, your impressions are similar to mine. I would also add that, while some people may see a more "biological" direction of BWH as a negative, it's a great place for someone interested in C-L because you may get to see cases you won't get to see anywhere else (like consulting on a face transplant patient).

 

[Evidence Based]

Yes, 6 months of 2.5 days/week of Mass Mental continuity clinic in PGY-3 in addition to the 3 months of 5 days/week of Mass Mental PHP in PGY-2...
In general, your impressions are similar to mine. I would also add that, while some people may see a more "biological" direction of BWH as a negative, it's a great place for someone interested in C-L because you may get to see cases you won't get to see anywhere else (like consulting on a face transplant patient).

This is good info, I've updated my vague impressions summary above.
And I completely agree, the more "biological" direction is certainly not a negative for all people, and it is certainly doesn't mean that aren't great opportunities in other areas. As always it's an issue of fit, and that orientation just didn't fit as well with my interests.

All goes to show there is no "best program" for every person!

 

[FFH]

Correct me if I'm wrong. The word biological focused used to suggest psychopharma focused or exclusively basic neuroscience focused. It probably has its place some decades ago when certain programs disregard the psychosocial aspects of the care, or not recognizing the efficacy of behavioral and cognitive therapy, or purely emphasis on basic neuroscience research. This does not describe any of the programs I've interviewed at so far.

For BWH, the chair is a neuropsychiatrist sure, but his interest in neurocircuitry includes using it to study how therapy and meditation work. They are quite some distance ahead of the game when it comes to the "Medical psychiatry model", but it doesn't mean provide psychiatric care using only medication, rather it means psychiatrists become specialized in treating patients with different [Edit: medical] comorbidities using whatever modality appropriate, including therapy. This is something that Pitt has also been doing and they have great results for patients with IBD for example--one of the psychiatrists developed a total care model for these patients using telepsych, groups, therapies, social workers etc.

 

[clausewitz2]

Correct me if I'm wrong. The word biological focused used to suggest psychopharma focused or exclusively basic neuroscience focused. It probably has its place some decades ago when certain programs disregard the psychosocial aspects of the care, or not recognizing the efficacy of behavioral and cognitive therapy, or purely emphasis on basic neuroscience research. This does not describe any of the programs I've interviewed at so far.

For BWH, the chair is a neuropsychiatrist sure, but his interest in neurocircuitry includes using it to study how therapy and meditation work. They are quite some distance ahead of the game when it comes to the "Medical psychiatry model", but it doesn't mean provide psychiatric care using only medication, rather it means psychiatrists become specialized in treating patients with different comorbidities using whatever modality appropriate, including therapy. This is something that Pitt has also been doing and they have great results for patients with IBD for example--one of the psychiatrists developed a total care model for these patients using telepsych, groups, therapies, social workers etc.

Approaching psychiatric distress as composed of a series of discrete, categorical disorders afflicting the individual which require specific and sensitive diagnosis before being intervened upon by a team of trained specialist is frankly paradigmatic of the medical model and not at all a departure.