UTSW-Dallas and UTMB are easily the most competitive. Dallas has great sites, many sub-specialties, and focus on education over scut. UTMB has low call and allows for residents to explore their own interests. Faculty are very supportive.
I'd argue UTSW-Austin is now 3. It's Austin plus UTSW improving the training/resources.
Multiple programs in TX probably tie for #4.
I've recently finished interviewing across the South, and I can't really disagree with you any more. In terms of competitiveness I'd say BCM, UTSW, and Emory are all tied at the top. Maybe we value different things. I was initially wary of the Baylor program because you have a long history of negative posts toward it but you must have interviewed a long time ago. I actually think the description given in the OP isn't far off the mark. For what it's worth, here are my quick impressions of some southern programs (I dropped MUSC):
UT Houston - HCPC is large and there seem to be research opportunities aplenty at this program which seems to have a biological focus. The program leadership is currently in a transition phase but I think that things will overall be okay, everyone seems pretty supportive. The non-HCPC rotations felt a little lacking to be honest, but I suppose coming from a program in the South with a large VA, county, and university hospital this is to be expected. I didn't get the feeling that these non-HCPC rotations were really valued by everyone, but they do have MD Anderson which is awesome for people interested in Psycho-Onc. Houston is a fun and diverse city, the weather is pretty good/swampy, and it's still affordable even though it's getting more popular. It's not a pretty city like Austin or Nashville but as my Uber driver said, "People come here to work hard" and I kind of appreciated the grit, it felt real. HCPC is not in the same league as WPIC when you consider comparing the two largest standalone psych facilities in the country, but if you liked the
idea of that level of patient pathology and that volume/dataset at Pitt but weren't enamored with the city (which I liked, tbh)/the cold, you could consider UT Houston. Wasn't a big fan of some of the questions I got asked on interview day (don't ask me how I'm going to rank you).
UTSW - Very similar to Emory and BCM in terms of the volume, pathology, types of sites, program size, and therapy training. Brenner is warm and fuzzy and seems to be a good ally to the students, they're a friendly program overall that seems to, like Emory and BCM, draw a lot of bright people moving or returning to Texas after doing medical school elsewhere. C/L is an area they're addressing here because it used to be a rough service. The new Parkland is gorgeous. They have tons of electives and seem to have a pretty flexible schedule. Of Emory, BCM, and UTSW it has the best pay and the easiest call schedule. To me, it's a little
too laid back but for people with families/starting families you get a program where you won't be held back in any way career-wise and is fairly cushy. Excellent therapy training. Residents seem to go kind of evenly into academic/PP/and fellowship after finishing and were easygoing and a lot of fun. Dallas is an OK city IMO. Don't have too many notes on this program because it was my first, sorry.
BCM - You get the 3 hospitals
plus Menninger, which is as much a Disneyland of Psychiatry as WPIC but in a totally different way. There aren't many places left like this in the country, it's quite a unique experience. There's a strong psychodynamic tradition here and many of the residents cited this as a reason for choosing Baylor over other programs. They've also started a Research track, which makes sense given the abundance of resources in the Texas Medical Center. Some cool stuff being done in addictions research here. Facilities are older than UTSW or Emory but the diversity and pathology make up for it - probably the widest range of patient diversity outside of some NYC and LA programs (ethnically, socially, and economically). C/L here is weaker than UTSW or Emory because there is no dedicated fellowship, although the friendly and supportive PD/leadership (I interviewed with all of them) and residents assured me that because of their location they get all sorts of crazy consults. A recent alum also just graduated from the Brigham Psychosomatic fellowship for what that's worth. There's also Texas Childrens if you're interested in child psych and a state hospital rotation which will be useful for anybody interested in Forensics (Dr. Stolar the PD is also Forensics boarded). I was worried about the negative rep of this program from SDN so I asked about the call schedule and when it was presented on interview day it didn't seem that different from any other program (UTSW excepted), and I think it was lighter than Emory (rough PGY1) and definitely better than Duke where I wanted to give the residents a hug because they looked so beat. The Baylor program also recently lessened call responsibilities on one of the harder PGY 2 rotations (Methodist) and residents have been very receptive to the change. Pay isn't as good as UTSW but the city is a lot better for young adults. Residents go evenly into academic/PP/fellowship, and seem to be bright, fun, and enjoy each others company.
UT Austin - Man, I was excited about this place. I really was. I love Austin! But I totally disagree with proclamaitions of it being a top program. Not even close. It is still very much a community program. Austin is smaller than these other cities, and unlike Vandy which has a big catch area, there are other places to go in Texas, so I don't know if you'll get the volume, diversity, or psychopathology you would in other programs. The new faculty hires have very impressive pedigrees - clearly people want to move here and they have the money to make some nice acquisitions. The new hospital should also be quite nice. But there weren't enough old-hat attendings there for my liking, you know, the ones with serious experience. There was a lot of promise and buzzwords about the future, felt like I was in an episode of
Silicon Valley. I don't care to hear about the Cardiac Cath lab's location in your new hospital or your medschool's "innovative" curriculum that's about 8 years behind the curve. Until this stuff happens, it's just words. They want to be a tier-1 institute in 10 years. If it happens, I'll be the first one to applaud, until then, it still feels like a community program. There's nothing wrong with this on face value, but that's not how it's sold. They pitch it as the opportunity to get in on the ground level of something big and make your mark - but I think you can do that anywhere if you're motivated. They talk about their Silicon Valley ties. The truth is, most things in SV don't turn into Twitter or Uber. They fizzle out with a whimper. Medicine needs to modernize in several ways but there's also a reason we do things the way we do, it was kind of cringe-inducing to hear experienced leaders ignore all of this in the face of buzz-y copy. Wasn't impressed by the residents either, compared to these other programs. I want this program to be good, I really do - because I'd love to work here in 10 years, but right now it's not a place I want to gamble my training on. And yeah I realize this program has been in place for a very long time, but that's just not how they're pitching it anymore, and so that's not what I felt or feel comfortable going on. Also, although TXPhysician said UTSW is supporting the program, this does not at all appear to be the case. They are a UT and the primary affiliate of UT-Austin and hope to be the flagship UT medical center in some time, but that is going to be a difficult mantle to steal from UTSW.
Emory - I feel like I'm repeating myself after UTSW and BCM. The key differences between the 3, aside from location, are that Emory has the Geri facility and the new "brain building" (I forget the real name). Big city with lots of patients and great pathology. They seem to have a lot of $$$. Residents were bright, I only met one PGY1 because apparently most of them are working quite hard and tired from their schedule (It's Grady - like Parkland and Ben Taub I expect the off-service months to be rigorous but also pretty incredible and educational. As a downside, I beliiiiieve this is the one southern program where you spend all 4 IM months doing inpatient, both BCM and UTSW let you do some outpatient, some electives/consults/palli) and for some people the idea that Psych residents will be doing med-clears in the ER is a negative (I like it). PD is pretty friendly, she's also C/L boarded and actively involved at APM. You can do med-psych rotations! A number of people come here because of an interest in Forensics. Another big, fun, affordable (relatively speaking) city with great weather. The residents didn't seem as warm or close knit as UTSW or BCM but it may have just been my interview day. Therapy was not really mentioned at all on interview day but apparently they have a psychotherapy track, not as important as at UTSW or BCM. If you want to do counseling for uni students they only let 2 residents a year do this, which was a small negative for me. All in all, a good program in a cool city.
Vandy - okay this is getting long. The small size of Nashville compared to the above 3 cities is made up for by the catchment area. Vandy has a standalone Psych hospital, 88ish beds! This is great because you'll get a unique training experience here in addition to their VA and university hospital. I really loved Nashville, it's a place I want to live in. I got the vibe that if you like the county feel of Grady et al. you won't get that sort of patient here, to be honest. They do this weird thing on interview day where they make it a point to orient you to their horrible EMR. The APD Dr. Fleisch is such an awesome woman and she has built a great community psych program from the ground-up in 3 years so she'll be a great mentor to anybody interested in program/business development or public psychiatry, I hope I get to work with her someday. The PD seems quite opinionated and dominated our conversation in a way that bothered me. He also seems to set the tone for the "evidence based therapy" focus (read: he went off on psychodynamic theory during our interview) at the program, which is a shame because they're all useful. I thought maybe this was just a thing they said until the lunchtime psychiatric case formulation in which the resident gave a very compelling psychodynamic (as well as social and biological) formulation for a patient and the (iirc) Chair pointed out to him that that's just one of many perspectives. PGY2 call schedule may have been a little rough IIRC. The residents seem to have fun and go out, they're also very diverse (like Emory and all of the Texas programs I went to) which appealed to me as a minority.
Duke - Durham is alright. It's better than when I was last here but still... you need Raleigh and Chapel Hill to have enough stuff to call this a fun place to live. Doesn't come close to the cities above in my opinion, but the weather is phenomenal in NC, the cost of living is great, there are nice beaches, forests, mountains, and just lots to do in this state which appeals to me. I liked the PD a lot, we had a great conversation and her being IM/Psych we talked a lot about the great C/L training here. This was another program where I tried to get to the truth behind a negative SDN reputation. Sadface. Not mine, okay well I too felt kinda sad after coming here but the residents just seem beat. The residents have a really high patient cap on inpatient (10? where most places were 6) and that plus a rough call schedule leads to them openly admitting the first two years are rough. They tell you in the AM intro that the program is front-loaded...
every psych program is frontloaded,
this is like driving a semi backwards through traffic. Psych residents are among the perkiest that you come across so it was just jarring. I think you get fine training here, I really don't remember a whole lot because it was cold and after seeing the residents I kinda checked out and knew I didn't want to come here.
MUSC - cancelled, i got tired. Charleston is AMAZING, I almost went just for the city.
Other programs in the South - didn't apply
Overall, the South is a pretty cool place to do residency; it's affordable to live in a true metropolis, the weather is nice if you can stand the heat and humidity, and the programs on the whole seem well-rounded and will give you excellent training. It's mostly a matter of where you prefer to live as I met very intelligent, friendly, and enthusiastic folks at every program and for the most part (duke, a little) none lived up to any of their negative reps on SDN.
Of the ones I interviewed at, I liked BCM the most and UTSW and Emory would probably be tied for second, but this is largely personal preference. Vanderbilt is a nice program with lots of MGH/BWH psychosomatic-boarded people, a standalone hospital, and a great APD but I didn't really hit it off w/ Dr. Cowan the PD and my issues w/ their therapy training were sticking points for me, otherwise I'd rank it higher.
