Prestige in psychiatry residencies

[DO_or_Die]

If you were planning to be an outpatient private practice psychiatrists and had to choose between doing residency at a home institution vs ideal geographical location vs Yale/Harvard.. Would the more "prestigious" institution matter in terms of future job prospects?

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[comp1]

So it's super likely you will stay where you do residency. The large majority of residents do. So what is your home institution? What is your ideal geographic location? Are you planning to practice in Boston or New Haven? It is absolutely not a requirement to do a prestigious residency to have a private practice. Remember, there are vast shortages of all mental health providers most places, particularly those that take insurance. If you plan to open a cash only practice in a VERY psychiatrist dense location like Boston, New Haven, SF, NYC, etc...then sure, it matters a little. Still probably not worth 4 years of horrible weather, though.

 

[DO_or_Die]

So it's super likely you will stay where you do residency. The large majority of residents do. So what is your home institution? What is your ideal geographic location? Are you planning to practice in Boston or New Haven? It is absolutely not a requirement to do a prestigious residency to have a private practice. Remember, there are vast shortages of all mental health providers most places, particularly those that take insurance. If you plan to open a cash only practice in a VERY psychiatrist dense location like Boston, New Haven, SF, NYC, etc...then sure, it matters a little. Still probably not worth 4 years of horrible weather, though.

Are people more likely to stay because of local connections made, or is there a specific reason? My plan was to eventually move to the west coast and move my parents with me. I do know that planning never really goes as planned (for me anyways). Thank you.

 

[Atreides]

I don't think prestige matters much, if at all, in private practice. Even for cash pay practices. I've seen graduates from "non-prestigious" programs charge 750/hour in SoCal and fill up.

Also, regional reputation can trump nationwide reputation. I have a colleague who did residency at MGH and then opened up a cash practice in LA. He realized after some comments from patients and referral sources that many of his patients would prefer someone trained at UCLA over MGH. One patient even told him as much lol.

 

[TexasPhysician]

Are people more likely to stay because of local connections made, or is there a specific reason? My plan was to eventually move to the west coast and move my parents with me. I do know that planning never really goes as planned (for me anyways). Thank you.

After 4 years and maybe some moonlighting, you have hopefully built connections, know who to relatively trust, know where/what the good local jobs are, know where the demand is highest if you want to start a private practice, know the state laws to be ready for inpatient/forensic roles, maybe moonlight at a place that wants to keep you while you build a private practice, know who to avoid, have maybe built referral sources, know the real estate market for private practice, etc.

Also at this level, a MD after your name is already prestigious. In years of private practice, I’ve had 2 patients ask about my training and both seemed satisfied with the local name.

The average person is not going to know which programs are prestigious and which aren’t. In my area, Stanford, Harvard, and Yale are probably known by most as prestigious schools outside of Texas. The initials MGH means nothing with non-physicians in my area. I’ve talked to educated people that were surprised that UPenn is a well-regarded Ivy and not the community college to Penn State, believe UCLA (and most of Cali) is a bunch of crazy hippies, Dartmouth is a made up name, and anything with a Big10 affiliation is not prestigious because who would choose to be in the Midwest. Physicians have likely meticulously researched the best undergrad to get to medical school, interviewed and researched the best medical schools, and now spend time on SDN to better understand the better psych training programs that may lean toward different therapy trainings. It seems like more common knowledge to us because we have lived this game for years, but the average person applied to a random few colleges, went wherever they felt happy during 1 tour, or attended whatever school was the cheapest/provided scholarships. A recommendation from a trusted source goes much further than the name on your degree when it comes to someone choosing a doctor.

I would recommend going to somewhere that emphasizes training. If your preferred location only has a terrible training program, id rethink my local recommendation. Being a top 25 training program is not required to be a good training program either.

 

[Merovinge]

After 4 years and maybe some moonlighting, you have hopefully built connections, know who to relatively trust, know where/what the good local jobs are, know where the demand is highest if you want to start a private practice, know the state laws to be ready for inpatient/forensic roles, maybe moonlight at a place that wants to keep you while you build a private practice, know who to avoid, have maybe built referral sources, know the real estate market for private practice, etc.

Also at this level, a MD after your name is already prestigious. In years of private practice, I’ve had 2 patients ask about my training and both seemed satisfied with the local name.

The average person is not going to know which programs are prestigious and which aren’t. In my area, Stanford, Harvard, and Yale are probably known by most as prestigious schools outside of Texas. The initials MGH means nothing with non-physicians in my area. I’ve talked to educated people that were surprised that UPenn is a well-regarded Ivy and not the community college to Penn State, believe UCLA (and most of Cali) is a bunch of crazy hippies, Dartmouth is a made up name, and anything with a Big10 affiliation is not prestigious because who would choose to be in the Midwest. Physicians have likely meticulously researched the best undergrad to get to medical school, interviewed and researched the best medical schools, and now spend time on SDN to better understand the better psych training programs that may lean toward different therapy trainings. It seems like more common knowledge to us because we have lived this game for years, but the average person applied to a random few colleges, went wherever they felt happy during 1 tour, or attended whatever school was the cheapest/provided scholarships. A recommendation from a trusted source goes much further than the name on your degree when it comes to someone choosing a doctor.

I would recommend going to somewhere that emphasizes training. If your preferred location only has a terrible training program, id rethink my local recommendation. Being a top 25 training program is not required to be a good training program either.

Is that actually true for Texans paying $500+ an hour for psychiatry? Really pushing some stereotypes if that's the case.

I agree that name brand recognition is quite overrated by applicants, but almost all of my patient's families at least know which schools are Ivys and have heard of very powerful universities outside of the Ivys in addition to all the local universities.

 

[comp1]

So here's the thing...med school is very competitive and so you go where you get in. Residency location is kinda chosen for you by the algorithm. So if it tells you you're moving, you're moving. After that, nobody is telling you where you have to live, BUT you're relatively old to finally be making your own decisions, approaching 30 if not there already. You might have bought a house (if you're in the middle of nowhere) or got a local spouse even. Maybe that spouse has a job. Regardless, you know the people around you and most people aren't constantly seeking change. Learning a new EMR is rough, but learning a whole state's psychiatric laws? Rougher. And you even have to get a new license. It's all just messy. Easier to find a local job. Heck, far too many people just stay on as attendings at their residency location or where they moonlit, by far the path of least resistance, your insurance and retirement plans don't even have to change if you work where you did residency.

 

[TexasPhysician]

Is that actually true for Texans paying $500+ an hour for psychiatry? Really pushing some stereotypes if that's the case.

I agree that name brand recognition is quite overrated by applicants, but almost all of my patient's families at least know which schools are Ivys and have heard of very powerful universities outside of the Ivys in addition to all the local universities.

I’m not saying all Texans have that stereotype, but there are certainly Texans that have all said those things with college degrees and the funds for cash only psych. Many that pay cash only are executives and business owners that worked their way up. Most are not physicians and attorneys in my experience.

 

[Stagg737]

Is that actually true for Texans paying $500+ an hour for psychiatry? Really pushing some stereotypes if that's the case.

I agree that name brand recognition is quite overrated by applicants, but almost all of my patient's families at least know which schools are Ivys and have heard of very powerful universities outside of the Ivys in addition to all the local universities.

Having money and power does not make one educated. The general public hears names like Harvard and Yale and assumes they must be the best. Iirc, there was a survey years ago about what people thought about Princeton's med school and it was unanimously positive, but people didn't realize that Princeton actually doesn't have a med school. People just heard the name and assumed. Ask people who aren't in medicine what the "best" programs in the country for any given specialty are and they'll probably all say the same places.

More anecdata: I rotated through a cash only PP in med school and the clientele (including professional athletes and fortune 500 execs) was just as ignorant about "elite" psych training as the general pop. They often cared more about where one went to med school than where they did psych residency and even regional powerhouses (U Chicago and Wash U being the closest to where the rotation was) were unimpressive. Only regional name that impressed was Menninger, and those same patients didn't know that it's not a medical school and moved 20 years ago.

 

[dl2dp2]

PP is not a job. In a PP you care more about what patients think and want.

Would prestige matter in terms of lifestyle, yes. Prestige always has value. Two identical CVs at a 3rd location, a prestige CV will get noticed statistically more frequently. This effect is much smaller if the location is on one of the 2 on the CV. This is generally the case for a job.

Hiring managers might interview prestige candidates, but they often aren't a good fit for a job. As a hiring manager, this happens all the time. There's a critical candidate-to-job fit issue that prestige doesn't really address.

Would prestige matter enough to relocate for 4 years in your 30s just so you can move somewhere else? No. If you have an ideal geographical location outside of the prestige centers, the prestige matters far less.

I've observed that people who graduate from prestige residencies actually often don't make as much money as you'd think in PP. It's really not a one-to-one sort of thing.

 

[kookfu]

People who didn't go to prestigious programs: "it doesn't matter"

People who went to prestigious programs: "it kinda matters"

Hipster who went to prestigious program: "it doesn't matter"

Hipster who didn't go to a prestigious program: "it kinda matters"

 

[mistafab]

If you want to move west, my advice is go to a program in the west during residency.

The local network you can build from a program is worth much more than prestige in pp. In addition, if goal is PP, you can jump start PP as a resident if your program allows (pgy4).

Just don’t skimp on the training. The training really matters. If a programs training sucks, you’re going to suck unless you take it upon yourself to get better.

If you suck, eventually it will catch up with you.

 

[MacDonaldTriad]

Totally agree with Mistafab above. I will add that going West doesn't limit your ability to apply to "prestige" programs. There are plenty and you will still have the ability to get into or fail to get into the program you shoot for so geography isn't that different. We make a big deal about what we think prestige is but that melts away very quickly once you have done good work and referral sources trust you. You can come from a box top great place and irritate the psychiatric community in a New York minute, and you can do a good job and prove your utility from an unknown program and become highly valued and patients will not ask. Patients like referrals from doctors they trust and the transition to a workable doctor patient relationship is everything. Do residency where you want to live and all will be well. Most of the quality of training comes out of the learning contract and is more up to you than anything else.

 

[PuffBlueCat]

If you want to move west, my advice is go to a program in the west during residency.

The local network you can build from a program is worth much more than prestige in pp. In addition, if goal is PP, you can jump start PP as a resident if your program allows (pgy4).

Just don’t skimp on the training. The training really matters. If a programs training sucks, you’re going to suck unless you take it upon yourself to get better.

If you suck, eventually it will catch up with you.

What would you say is the best way medical students can figure out if a program has “good”training? Are there any resources out there? Or does this information primarily come through speaking to residents during interviews? I’m only in my second year at a DO school, so I have a while before needing to evaluate residency programs, but I am very interested in psychiatry and would love to start investigating this.

 

[comp1]

It is indeed hard to judge a program from a distance. It's even harder now with virtual interviews. Personally, geography was a lot more important than the specific program to me and I think that is the case for a lot of people, but I could see how quality matters too, particularly within a given area. I think it is OFTEN the case that newer programs have more challenges and might have slightly worse training on average. Of course the best new program is still better than the worst long time established program. There are no definites in this game. I also think that programs which rely heavily on residents as workhorses, ie very extensive in house overnight call...tend to have just literally less time available to teach those residents and the residents definitely have less energy to learn. But that's just my opinion. People who went to those workhorse programs definitely justify it to themselves as you needing those hours to "get good." Also, training is not globally good or bad. Everywhere has something they are good at and often many things they are bad or simply non-existent at. Even during your clerkships you can start to conceptualize what your practice might be like and look for a program with strengths geared towards that kind of practice. But yeah, you basically talk to residents and ideally do externships at places you are interested in.

 

[Merovinge]

What would you say is the best way medical students can figure out if a program has “good”training? Are there any resources out there? Or does this information primarily come through speaking to residents during interviews? I’m only in my second year at a DO school, so I have a while before needing to evaluate residency programs, but I am very interested in psychiatry and would love to start investigating this.

It may seem overwhelming but realistically the geographic area you will be interested in training and have the credentials to match at will likely limit itself to a manageable number of programs to investigate further. It's very hard to get an accurate idea of how good training programs are without talking to people who are alumni or currently at the program or at least work/train in the same city/geographic area of the program. You could use US news rankings or a list of programs by NIH funding to give a very rough sketch but there will be many exceptions to the overall strength of programs that differ from that.

 

[clozareal]

Prestige matters, but how much? Some of my patients do get impressed with the programs I went to and choose me because of that. You go get that institutional transference though which heightens their expectations. I would say that a small proportion of my patients chose me because of my pedigree though.

I think what is more important is making connections. If you know you would rather be at a certain location without a prestigious residency vs going to Harvard/Yale and then moving to that other location, I would probably do the former. The reason why is because you get to network with therapists, have a referral source from the current residents, alumni, and therapists you work with, you provide clinical care to patients and collaborate with their therapists/PCPs who you can tap into for a referral source. These connections matter much more than a prestigious residency. I agree with @TexasPhysician on this.

I honestly think college football teams matter more than university/residency prestige for patients.

If your goal was academia or an employed position, it would be different.

 

[clozareal]

Is that actually true for Texans paying $500+ an hour for psychiatry? Really pushing some stereotypes if that's the case.

I agree that name brand recognition is quite overrated by applicants, but almost all of my patient's families at least know which schools are Ivys and have heard of very powerful universities outside of the Ivys in addition to all the local universities.

Have you seen some of the home prices in Austin, especially around Westlake?

 

[mistafab]

What would you say is the best way medical students can figure out if a program has “good”training? Are there any resources out there? Or does this information primarily come through speaking to residents during interviews? I’m only in my second year at a DO school, so I have a while before needing to evaluate residency programs, but I am very interested in psychiatry and would love to start investigating this.

I think asking about / looking at the track record of post-residency grads is a method to ascertain this. If everyone takes a fellowship (forensics and CAP excluded), that would be a red flag. If a mix of people go straight to work (VA, PP, employed), do a fellowship or go academic, or do some admin role, that’s at least reassuring that people feel confident enough to work in varied settings.

It would be a red flag also if no one ever does a fellowship as that might mean the program just sucks and interests are not fostered.

A bit like reading tea leaves I know. I’d at least ask the pgy3s and 4s how they feel the quality of the training is. However, some programs may be more honest than others so ymmv.

All I can say is best of luck. I got lucky with my training where I’m at and all the mentorship I got, plus the moonlighting. Not sure I’d be as good if I had gone elsewhere, but I’ll never know.

 

[zenmedic]

Question for you all. Recently I told one of my attendings my interest in starting a cash only practice after I graduate. He said it would be very difficult for me given that I am a DO and the stigma is still present. Any thoughts on this? I thought the stigma was present more in residency application and not necessarily in the consumer market. I was going to try and market my DO degree to my advantage after I graduate as being more wholistic (even though I know there's no difference). For reference I am a PGY-1 at a program around NYC.

 

[Bartelby]

I think cash PP has a lot to do with your business abilities and ability to connect with and retain patients. I suspect you can make it work as a DO.

Personally I would avoid highlighting the holistic angle as if a DO practices some kind of alternative medicine versus an MD. If you do choose to provide more holistic care (that is still evidence-based) that is fine but I would leave the DO part out of it.

 

[zenmedic]

I think cash PP has a lot to do with your business abilities and ability to connect with and retain patients. I suspect you can make it work as a DO.

Personally I would avoid highlighting the holistic angle as if a DO practices some kind of alternative medicine versus an MD. If you do choose to provide more holistic care (that is still evidence-based) that is fine but I would leave the DO part out of it.

Thanks!

 

[clozareal]

Question for you all. Recently I told one of my attendings my interest in starting a cash only practice after I graduate. He said it would be very difficult for me given that I am a DO and the stigma is still present. Any thoughts on this? I thought the stigma was present more in residency application and not necessarily in the consumer market. I was going to try and market my DO degree to my advantage after I graduate as being more wholistic (even though I know there's no difference). For reference I am a PGY-1 at a program around NYC.

If you can network well and build a good reputation, then you can make it work. The NPs who do this well are killing it in my area.

 

[4AM123]

Thank you for the great responses everyone, this has been a very helpful thread.

What if my goal was to start a solo practice in a specific big west coast city with a presumably competitive market, but I would like to use residency as a time to experience a completely different part of the country? Would that be a foolish career decision, i.e would I be setting myself back too much living for 4 years in a part of the country I likely won't settle in?

 

[clozareal]

Thank you for the great responses everyone, this has been a very helpful thread.

What if my goal was to start a solo practice in a specific big west coast city with a presumably competitive market, but I would like to use residency as a time to experience a completely different part of the country? Would that be a foolish career decision, i.e would I be setting myself back too much living for 4 years in a part of the country I likely won't settle in?

You can do whatever you want to do. I don't think it would be foolish. Lots of people do it. It might be your last chance to live somewhere new before you settle down. It would just take you longer to build your reputation and connections, know the local referral sources, which would then lead to taking longer to fill up.

 

[smalltownpsych]

Prestige and psychiatry? My first thought is that is an oxymoron. 😁
Half the time I am not sure if it’s worse when people mock me for being a psychologist and not a real doctor or confuse with being a psychiatrist and not a real doctor.

As far as career or job opportunities go, from my perspective as a psychologist most people are just looking for a competent practitioner. For most of the psychiatrists I know and refer to, I can’t recall where they went to school or did their residency. One that I am closer to personally went to George Washington for med school and I think Loma Linda for residency, but I could be wrong because he talks a lot about his training at GW so that might have been his residency and Loma Linda being first job as an attending. I have always worked out in the real world and most of it private pay so it could vary if pursuing a career in academic settings.

 

[J ROD]

You can't spend prestige. I would worry about the money. West coast has higher cost of living, etc. In the end, that perceived prestige is more in your head than patients.