Programs with best combination of prestige and lifestyle?

[Armadillos]

Basically Im wondering which programs are the "anti-Duke" if you will. I have the grades/scores to have a great chance at any psych program in the country and I obviously want great training, but at the same time I'm not willing to be so exhausted that I ignore my family (and self) for 4 years.

Seems like a lot of the things that can really significantly improve lifestyle wouldn't necessarily detract much from your training. So are there any big name places out there that are known to have the best call schedules, most golden weekends, etc?

---

Members don't see this ad.

 

[Psychotic]

Are you a year away from this process? I ask because if you read these forums, your questions seems a bit naive, and I think nobody is replying because this is really not a very important question in the scheme of things, at least not in psychiatry where truly malignant programs are almost non-existent, and fabulous lifestyle programs are fairly limited, too, but a few do get bandied about here on SDN. Also, in general, the more prestige = the more work, and the real problem is that being hung up on prestige is a dumb thing to care about. Eliminate the worry about prestige and focus on what really matters.

Look at programs in locations that suit you for family, significant others, etc. There really are not that many programs with truly favorable lifestyles, but there are many, many programs with perfectly acceptable lifestyles and workloads - your medicine months may suck, but after that, fairly smooth sailing.

Frankly, I am finding many more similarities between programs than differences, at least in terms of workload / lifestyle / hours. The more important decision, to me at least, is one of location - where do I want to live for the next 4 years, and possibly after that? And all that goes into that decision (family in tow?, significant other?, living near parents or other family, climate, transportation issues, outdoorsy vs big city, region of the country, ocean vs mountains...these are your own criteria that no one else can help you with, and worrying about prestige is a big waste of time for 98 percent of applicants).

Are you in the other 2 percent? Based on your question, not likely, because those folks aren't worried about lifestyle - they are so focused on prestige that they can't see anything else, and I am avoiding them and the programs that attract them like the plague.

Edit: I am not changing my post, but further down the thread the OP has toned down his request for "prestige" programs with a good lifestyle, a somewhat oxymoronic request that led to what I wrote here.

 

[3882370]

Good response! And true.

 

[Armadillos]

Thanks for the response, I know it doesnt seem like it, but I have thought about a lot of these things already. At this point I would say I'm probably 95% certain I will go to one of about 3 programs based on a combination of geography and my interest in a career in academics. With this post I'm just casting a wide net to maybe catch a program I would have never considered. Seeing as I'm so certain I will go to one of these couple programs (one of which is my home program), I'm going to be fairly selective in where I apply elsewhere so Im looking to see if there is anything really eye catching out there that would be enough to make me consider leaving my home program.

For example, Ive heard rumors that historically Duke and Emory have way worse hours than say Brown and Dartmouth.

 

[Psychotic]

Thanks for the response, I know it doesnt seem like it, but I have thought about a lot of these things already. At this point I would say I'm probably 95% certain I will go to one of about 3 programs based on a combination of geography and my interest in a career in academics. With this post I'm just casting a wide net to maybe catch a program I would have never considered. Seeing as I'm so certain I will go to one of these couple programs (one of which is my home program), I'm going to be fairly selective in where I apply elsewhere.

For example, Ive heard rumors that historically Duke and Emory have way worse hours than say Brown and Dartmouth.

As for Duke and Emory, and more to point of your original post, I don't think of these as overly prestigious programs, or certainly they are no better than other programs right in their own region (like UNC, MUSC, and even SDN punching bag Vanderbilt). Nationally, almost none of these southeast programs is considered "prestigious" along the lines of places like MGH, UCLA, Columbia, et al. If you are looking for true prestige, there are 5 to 10 programs, tops, that are considered prestigious academic powerhouses, and to the best of my knowledge none of them are thought of as lifestyle friendly programs.

Without knowing your geographic preference, I can't recommend anything specifically to you. But if lifestyle matters to you, out west look at San Mateo, and in the southeast look at USC Palmetto - but if you spend a lot of time here on SDN, you would already know those names.

 

[Armadillos]

Nationally, almost none of these southeast programs is considered "prestigious" along the lines of places like MGH, UCLA, Columbia, et al. If you are looking for true prestige, there are 5 to 10 programs, tops, that are considered prestigious academic powerhouses, and to the best of my knowledge none of them are thought of as lifestyle friendly programs.

Thanks, this is really the heart of what I was getting at.

 

[shan564]

Seems like you're using the terms "prestige" and "great training" interchangeably. I think that's probably a fallacy.

As a rule, you'll have to work hard to get better training. You won't necessarily get better training if you work harder, but it's impossible to be "lifestyle-friendly" and get the best training.

That said, you can definitely look for "best lifestyle" associated with a particular feature in a program that interests you.

Also, I think that there's a certain satisfaction that you get from the feeling that you're getting great training in exchange for your hard work. At my program, I feel like we work harder than most programs, but our work-to-learning ratio is very favorable.

I do have some opinions on specific programs, but I'm too lazy to type it out right now. I'll come back and do it some other time.

 

[Shikima]

Prestige and pedigree are a thing of the past in the majority of circles now. This started about the mid-90s IMO.

 

[st2205]

Great training and great lifestyle look no further than MCW (no, this isn't my program).

 

[SmallBird]

Basically Im wondering which programs are the "anti-Duke" if you will. I have the grades/scores to have a great chance at any psych program in the country and I obviously want great training, but at the same time I'm not willing to be so exhausted that I ignore my family (and self) for 4 years.

Seems like a lot of the things that can really significantly improve lifestyle wouldn't necessarily detract much from your training. So are there any big name places out there that are known to have the best call schedules, most golden weekends, etc?

I'll stick out my neck and say that I actually think this is a pretty reasonable question. There are certainly differences between the workloads at the strong academic programs, and one does hear of people choosing programs based on their goals of having succesful academic careers, but then find the clinical duties to be overburdensome.

That said, it would probably not be good to speculate about specific programs, lest we spread rumours, but if anyone has direct experience that would be helpful. I will say that I chose my program (Yale) based on where I thought I would have the broadest clinical exposure and research opportunities (and I was certainly happy with the location), and have been very happy about having a high stipend, a reasonable call schedule (q11) and dedicated time off for research. To me that equals good lifestyle, and whilst I don't think of the word prestige, I do feel I am at a very strong program with excellent research and clinical programs.

 

[Nasrudin]

I think small bird has a great point. And I question the adage that more patient care duties equals better training. I mean if that were the case why don't we work as hard as neurosurgeons where 80 hour weeks are really "80 hour weeks." We don't because we like to think about things, develop deeper insight, and so forth. I don't think psychiatry can be learned by repitition in the same way that procedures can. But I'm not developed enough in it to stake to a claim along such lines. It's just there seems to be a whole theoretical framework of psychiatry that is completely unaddressed in medical curricula that I wonder how much I could learn by repeating algorithms from manuals on the fly in a survival mode of case after case after case without some educational augmentation.

 

[Psychotic]

I think small bird has a great point. And I question the adage that more patient care duties equals better training. I mean if that were the case why don't we work as hard as neurosurgeons where 80 hour weeks are really "80 hour weeks." We don't because we like to think about things, develop deeper insight, and so forth. I don't think psychiatry can be learned by repitition in the same way that procedures can. But I'm not developed enough in it to stake to a claim along such lines. It's just there seems to be a whole theoretical framework of psychiatry that is completely unaddressed in medical curricula that I wonder how much I could learn by repeating algorithms from manuals on the fly in a survival mode of case after case after case without some educational augmentation.

I just want to be clear about my posts. I care most about the ratio of training and learning to service, and in the programs I have interviewed at and expect to rank highly, I sought in the very least a reasonable balance of workload requirements (hours, call schedules) vs learning/training, didactics, quality of teaching from attendings, quality of staff support, and moonlighting opportunities, and all of this is driven by my desired city attributes and geography tied to climate, quality and cost of living, and nearness to family.

What I don't care about is prestige for prestige's sake, and I was trying to challenge the OP's concept of prestige, or the overall importance of prestige in the scheme of things for the vast majority of applicants. I do think there are a handful of truly prestigious programs, and more power to the people who desire those programs, but I place a higher value on location and lifestyle issues and programs that emphasize learning above service.

Finally, all of this reasoning may be self serving since while I consider myself a good if not above average candidate in psychiatry, I am not a superstar applicant, and I am a self aware applicant who has shown little evidence of interest in academics or research in medical school or in my personal statement. Thus I did not bother to apply to the most prestigious academic/research programs (often because of location, but certainly in some cases because of the hard work reputation of certain of these programs), but I did apply to some upper tier programs (such as Smallbird's and one or two others based on location) and I did not receive those interviews. Am I disappointed? Not really; my cup runneth over this interview season, and I am thrilled with the choices I have for my ROL.

 

[Shikima]

Look for a program which has a strong teaching component, teaching some form of Motivational Interviewing and has a lot of unique pathology with excellent supervision.

Too much to ask for? :/

 

[notdeadyet]

Look for a program which has a strong teaching component, teaching some form of Motivational Interviewing and has a lot of unique pathology with excellent supervision.

Too much to ask for? :/

- Strong teaching varies by program. No real correlation with academic reputation. There are some big name programs with lousy teaching and some awesome teaching at smaller community programs. And vice versa.
- Motivational Interviewing will be taught everywhere and it doesn't take much training. Easy stuff. And you'll get lots of chances to utilize it and get good at it almost everywhere.
- Unique pathology is going to be more common at program that function as tertiary care psychiatric centers. This is one advantage academic programs typically have: refractory cases get sent there by community providers. That said, in some geographic areas, there aren't any and community programs take on this role.
- Excellent supervision also varies by program, and you won't see a lot of correlation with size or reputation. About the only generalization that I would make is that it seems the more psychodynamic programs seem to emphasize supervision more. Probably a reflection on the model.

 

[digitlnoize]

Keep in mind too, that prestige, at least among your average patient, tends to be very regional. Around here, patients will think much more highly of someone who trained at any Virginia school over somewhere like MCW or Stanford.

 

[Armadillos]

Thanks for the input everyone, I think I sorta derailed this thread by some poor wording from the beginning. I didn't realize "prestige" was such an emotionally loaded word, what I really meant was programs that are "highly regarded/respected in the psychiatric community"

 

[Psychotic]

Thanks for the input everyone, I think I sorta derailed this thread by some poor wording from the beginning. I didn't realize "prestige" was such an emotionally loaded word, what I really meant was programs that are "highly regarded/respected in the psychiatric community"

In that case there are lots of those, perhaps even the majority of programs? And they are in all regions of the country, so no matter what your geographic preference, there are probably multiple programs close at hand.

Energy is better spent making sure you avoid the handful of truly malignant programs, and that is easy to do using SDN as your chief resource. The well regarded/respected programs are discussed here constantly. The big name "prestige" programs with heavy workloads are also no secret.

Good luck. Search this forum for "hidden gems" - at one time such a search yielded threads that talked about programs that aren't always at the forefront of the discussion but are nonetheless very worthy of consideration.

 

[notdeadyet]

Thanks for the input everyone, I think I sorta derailed this thread by some poor wording from the beginning. I didn't realize "prestige" was such an emotionally loaded word, what I really meant was programs that are "highly regarded/respected in the psychiatric community"

It's good to clarify, because people who care about prestige care about different kinds.

There's the layman prestige that will make your parents say, "my daughter is in residency at AXME!" Typically it has no relation to the psych residency itself, or even necessarily the medical school. It's most often a result of general university branding, often via athletics.

There's patient prestige, with the logic that you want a prestigious program to attract patients to your private practice because AC,e's name in your ad will draw them in. The private practice folks can answer this better than I but this flies in the face of typical health economics. If you're in an under served area or take insurance, it really won't have much impact. If you're in a well served area or are cash only, you'll likely find patients are much more interested in wait time and parking. People just don't choose psychiatrists like heart surgeons. At the end of the day, you get the most patients by positive word of mouth and this comes from being a knowledgeable psychiatrist with good bedside manor. What sort of program will get you to this point is highly individualistic and has little to nothing to do with research prowess at a residency.

And lastly is employment prestige. You'll find that like likes like. If you want to work as an academic at an academic program, going to a great academic program known by your employer is a smart move. If you want to get a job doing inpatient county work, going to a program known for this will kick open doors. But you know what trumps all? Connections. If you're interested in job in Topeka, knowing employers and being known in Topeka will get you a job far more than Acme's name on your diploma.

It's not that prestige is such a loaded word, it's just as it is so vague as to be meaningless. As for the flavor you're describing, programs only have "prestige" in their ability to produce clinicians a PARTICULAR employer is looking to hire. And this is going to vary a lot by type of employer and locale. The image folks have of employers saying, "she went to ACME!" and being universally impressed is largely myth. At most, it merits a "huh" and will be far outweighed by a good recommendation from someone known personally or a track record of good work. All of which is to say go where you're happiest. The sooner you lose interest in things like "prestige" and trying to divine what other people care about, the sooner you'll be able to really focus on yourself and make choices that will authentically make you happy.

 

[whopper]

- Strong teaching varies by program. No real correlation with academic reputation. There are some big name programs with lousy teaching and some awesome teaching at smaller community programs. And vice versa.

Yep. Some powerhouse places or attendings have/are great for teaching. Phil Resnick, Henry Nasrallah, Doug Mossman, etc., are some of the nation's (and hence world's) best psychiatrists and are excellent teachers.

Others, that I will not name, yes they may be publishing powerhouses, but don't have a passion for teaching, or at least don't show it. Some of them are very difficult people, along the lines of Sheldon Cooper, being a master at what he does but not being able to relate to others, having a big and sensitive ego, and emotionally abusing those under him. Some programs may have top researchers there who have almost little exposure if at all to the residents, and when they do, the residents don't have a good experience.

Where I did residency, my then PD was one of the best teachers I ever had and it had almost no research going on.

As for lifestyle, this is a general term. IMHO residency should be tough but fair. There is a difference between being tough vs malignant. Malignant (at least IMHO) is the program is not following rules in a detrimental manner (sometimes not following certain specific rules can be beneficial-as you will learn if you already haven't), residents are being mentally abused, and they are in fear even if they are doing their jobs well. I've seen programs with hours not so bad that I'd consider malignant. I've seen programs where the hours were tough that were not malignant.