Psych programs known to have resident burnout

[member2721]

Hi,

Wondering whether there are certain top programs known to have a higher than average rate of residents burning out, due to factors such as heavy yet unrewarding workload, bigger program with less camaraderie, less faculty support with traditional hierarchy, less emphasis on education/well-being, poor location, multiple distant training sites:

From reading this forum, these are some of the top programs that may have one of the above factors (disclaimer: all based on third hand knowledge from forum posts), so I am unsure about the overall situation:

Hopkins (formal)
Longwood (big program, hard PGY3)
MGH (formal)
NYU (busy workload)
Columbia (stiffer personalities, administrative hurdles)
Yale (Location?)

UCLA (big program)
Harbor (heavy workload)
University of Washington (busy, less cohesive class)
UCSF (lack of support, administration)
UCSD (busy workload)

Other programs I may have missed...

Greatly appreciate anyone's insight, especially if recent. I apologize if I am simply propagating untrue rumors from previous posts, but this thread may help clarify the real situation, especially if it has changed significant in recent years.

Thanks!

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[geripsyched]

I have seen a couple residents transfer out of University of Oregon, which supposedly has a somewhat intense call schedule the first 2 years. Per discussions on this board, however, it sounds like the situation may be improving.

 

[member2721]

I heard a UCSF resident transferred out a few years ago. Possible due to busier workload with more independent learning style at the program?
I also heard that a Cornell resident was unhappy, possibly being psychoanalyzed too much, but this was more than a few years ago.

 

[markglt]

somewhat biased, from ct....
concerning yale.....new haven is not that bad, you have ur rough hoods like any city, but not all bad....and nyc is a stones throw.

 

[TexasPhysician]

I know some from Baylor.

 

[splik]

i think it is a bit of a leap from large program/not so hot location to resident burnout.

I am at one of the programs on your list (you can guess or pm me) which is supposed to be 'hard work'. I can tell you that whilst there is more call than one might like, I have found the workload to be much less than was made out, have made some great friends, and have wonderful support from the administration to pursue various projects as a PGY-1 including overseas electives.

 

[notdeadyet]

Top programs = hard work. There's no real getting around it. That's how they become top programs.

I can't speak for the east coast programs well, but I ranked all the west coast ones on your list and got to know them fairly well. Any of the UC programs can seem to have a less than personal administration, because it's the University of California, and if your background is going to a private or small state medical school, it can be an adjustment going to UC. Some of the programs (like UCLA and UCSF) are large, no getting around that. All work hard and all have busy services.

If you want a cush residency, don't apply to the top programs. The folks I've seen most dissatisfied with residency seem to be going to the top or bottom programs. At the top programs, some applicants somehow thought they had "arrived" and could rest on their laurels and were shocked to find their education was really just starting. At the bottom programs, well, they're bottom for a reason.

 

[twright]

If you want a cush residency, don't apply to the top programs. The folks I've seen most dissatisfied with residency seem to be going to the top or bottom programs.

I don't have any experience with programs at the bottom of the heap, but in agreement with this I would expect that a resident who works hard at an MGH/UCSF is having a very different experience compared to a resident who is working hard in a New Jersey or Philadelphia sweatshop.

 

[shan564]

I don't have any experience with programs at the bottom of the heap, but in agreement with this I would expect that a resident who works hard at an MGH/UCSF is having a very different experience compared to a resident who is working hard in a New Jersey or Philadelphia sweatshop.

Is there something I need to know about New Jersey or Philadelphia?

 

[lucyernaga]

Is there something I need to know about New Jersey or Philadelphia?

wondering the same thing, especially re: Philly

 

[twright]

Is there something I need to know about New Jersey or Philadelphia?

Maybe I should have written "Oahu" and "Daytona".

 

[member2721]

Top programs = hard work. There's no real getting around it. That's how they become top programs. .

Thanks notdeadyet, you make a good point. I definitely appreciate that psychiatry, like any other specialty residency program, at a top program should be hard work, given that is how you can be exposed to different types of patients and you learn by doing.

I am wondering more about the other factors that come into play in combination with hardwork that can make the difference between a happy and an unhappy resident. And I am sure current residents will know much better what those factors are.

I wonder whether factors such as unnecessarily difficult call schedule, unrewarding scut work, unsupportive environment, poor supervision, difficult to find balanced life due to time/peer environment/location, unresponsive administration, etc.... have in your experiences caused a higher rate of unhappy residents or even attrition at particular programs.

 

[SmallBird]

Yale (Location?)

So, I can only speak from personal experience - I'm on the medicine part of my intern year at yale, this weekend I drove up to Boston for the day, watched the waterfire show in Providence, then came home to my beautiful apartment. Sunday I drove to Essex and had ice cream with some friends, and then went for dinner at one of the most famous pizza restaurants in the northeast...

Not everyday is like that, but in all honesty, you are very unlikely to suffer burnout purely from being in New Haven

 

[alina_s]

I transferred into U. of Washington and it's true that there are large classes, 2nd year admission spots, and the Idaho track that interfere somewhat with class cohesion. They also have more call than a lot of programs, including some in 4th year, but I knew alll that going in. I really think that it's the quality and not the quantity of call that matters- when there wasn't an attending on-site, it was the expectation that you would call the attending about every case, not an option. And the call frequency was partially residents' choice because call was intense enough at some sites that residents chose to take 12 hour shifts. Some of the call was training sessions too, because everyone gets multiple training calls at every site. I really felt that the amount of support made the call experiences a lot more educational.

 

[MDchouette]

Top programs = hard work. There's no real getting around it. That's how they become top programs.

....

If you want a cush residency, don't apply to the top programs. The folks I've seen most dissatisfied with residency seem to be going to the top or bottom programs. At the top programs, some applicants somehow thought they had "arrived" and could rest on their laurels and were shocked to find their education was really just starting. At the bottom programs, well, they're bottom for a reason.

Couldn't agree more with this.

Our PGY3 year at Longwood is not all outpatient like some others, but I'm still only on call Q15 and am working less than my husband and most of my non-medical friends. Every year our former PD gets contacted by graduates to tell him how well-trained and confident they feel after finishing at Longwood. I don't think you can get there without some work. Also, our PDs are very supportive, and personality is a major factor in resident selection. I would argue that these last two factors are equally important if not more important than hours worked per week or frequency of calls.

That said, if there is a unicorn program out there without any burnout, I'd love to hear about it.

 

[MDchouette]

OP, to address your other concern about Longwood: Big program = fewer calls, more variety in your classmates, and less crisis / division of labor per resident if another resident gets sick or goes on maternity leave. If anything, I think it would be protective against burnout.

 

[Doctor Bagel]

I transferred into U. of Washington and it's true that there are large classes, 2nd year admission spots, and the Idaho track that interfere somewhat with class cohesion. They also have more call than a lot of programs, including some in 4th year, but I knew alll that going in. I really think that it's the quality and not the quantity of call that matters- when there wasn't an attending on-site, it was the expectation that you would call the attending about every case, not an option. And the call frequency was partially residents' choice because call was intense enough at some sites that residents chose to take 12 hour shifts. Some of the call was training sessions too, because everyone gets multiple training calls at every site. I really felt that the amount of support made the call experiences a lot more educational.

There are so many variables that make it really hard as an applicant to figure out what's up with a program before matching. You're right that the amount of call is only one part of the equation -- support on call, educational value of call and busyness all figure in. UW does seem to do a pretty good job about being upfront about who they are as a program, though, which might make for happier residents.

And honestly as a resident, it's hard to have perspective because most of us only train at one place. And we only know our program based on the years we've been in training, and I've got to say my program as a 3rd year looks way different than my program as a 2nd year did because of the shift from inpatient to outpatient. I guess it generally works out OK regardless.

 

[member2721]

Also, our PDs are very supportive, and personality is a major factor in resident selection. I would argue that these last two factors are equally important if not more important than hours worked per week or frequency of calls.
That said, if there is a unicorn program out there without any burnout, I'd love to hear about it.

Thanks for the comment, you raise an interesting point. I am curious as to what you mean by personality as important to both selection and burnout- do you mean folks who have good balance and good perspective, are motivated for the right reasons, work as team players, have good sense of humor etc etc.

Also, are there programs where PDs are known to be less supportive?

As for unicorn programs... Based on reviews here, perhaps San Mateo (40 hr weeks?)or Cambridge ('magical')?

 

[Doctor Bagel]

Thanks for the comment, you raise an interesting point. I am curious as to what you mean by personality as important to both selection and burnout- do you mean folks who have good balance and good perspective, are motivated for the right reasons, work as team players, have good sense of humor etc etc.

Also, are there programs where PDs are known to be less supportive?

As for unicorn programs... Based on reviews here, perhaps San Mateo (40 hr weeks?)or Cambridge ('magical')?

Programs have different resident personalities. Maybe she means Longwood does a good job selecting applicants who fit with the Longwood personality and are hence happier in training. My hunch is that residents who are competitive, confident and like hard work do better at the bigger name places. Residents with more relaxed or passive personalities might struggle more.

I agree with MDchouette in that I think burnout is a universal phenomenon amongst residents in all specialties.

 

[notdeadyet]

Big program = fewer calls,

That might be true with Longwood, but I wouldn't use that as a general rule.

Big program can also mean more clinical training sites which can mean more call.

My hunch is that residents who are competitive, confident and like hard work do better at the bigger name places. Residents with more relaxed or passive personalities might struggle more.

I'd agree except for the competitive part. Might be true for medicine and the like, but there are plenty of relaxed and chill residents at the top psych programs. There might be a lot of hyper-competitive psych residents out there somewhere, but I don't think they're the norm at even the top programs.

 

[splik]

I'd agree except for the competitive part. Might be true for medicine and the like, but there are plenty of relaxed and chill residents at the top psych programs. There might be a lot of hyper-competitive psych residents out there somewhere, but I don't think they're the norm at even the top programs.

 

[Doctor Bagel]

That might be true with Longwood, but I wouldn't use that as a general rule.

Big program can also mean more clinical training sites which can mean more call.

I'd agree except for the competitive part. Might be true for medicine and the like, but there are plenty of relaxed and chill residents at the top psych programs. There might be a lot of hyper-competitive psych residents out there somewhere, but I don't think they're the norm at even the top programs.

Or you guys are a little more competitive than you think you are. I would argue that you need some competitive instinct to make it through medical school in general and especially to end up at any sort of top program in any field. It doesn't mean you're not nice people.

 

[notdeadyet]

Or you guys are a little more competitive than you think you are. I would argue that you need some competitive instinct to make it through medical school in general and especially to end up at any sort of top program in any field. It doesn't mean you're not nice people.

Do you think so? Maybe we're using competitive differently. It may also depend on the med school. Mine wasn't curve grading (which would be awful). There were definitely folks who we competitive in school, but it just seemed sad and evidence of low self esteem. Med school is a hike, not a race, you know?

I'll buy that folks at top programs skew towards ambitious (why subject yourself to more call and longer hours for a only slightly better training experience if not ambition?), but I don't see the competitive thing. I lump that in with the high USMLE = poor interpersonal skills thing. And I'd love to believe that because I had woeful steps.

 

[NYCMS2]

I'll buy that folks at top programs skew towards ambitious (why subject yourself to more call and longer hours for a only slightly better training experience if not ambition?), but I don't see the competitive thing. I lump that in with the high USMLE = poor interpersonal skills thing. And I'd love to believe that because I had woeful steps.

Since I am not "ambitious" as the term is used here, and since I have already been scarred by a call heavy medical school experience, I have eliminated most of these so-called "top" programs from my app list, or at least I have ranked them so low in my mind that if interviews are offered I may not attend if the rest of my apps go swimmingly.

 

[Doctor Bagel]

Do you think so? Maybe we're using competitive differently. It may also depend on the med school. Mine wasn't curve grading (which would be awful). There were definitely folks who we competitive in school, but it just seemed sad and evidence of low self esteem. Med school is a hike, not a race, you know?

I'll buy that folks at top programs skew towards ambitious (why subject yourself to more call and longer hours for a only slightly better training experience if not ambition?), but I don't see the competitive thing. I lump that in with the high USMLE = poor interpersonal skills thing. And I'd love to believe that because I had woeful steps.

You know, competition is not inherently unhealthy, and it doens't necessarily create a toxic environment. I seriously believe that if most of us do some introspection, we'd find a somewhat competitive nature. Signing up to train at a program with a big name gives you bragging rights (and hence the chance to feel better than others). Going to medical school does the same thing. Competitive isn't a bad word, even though I get why you don't want to use it in front of your applicants.

 

[twright]

Do you think so? Maybe we're using competitive differently. It may also depend on the med school. Mine wasn't curve grading (which would be awful). There were definitely folks who we competitive in school, but it just seemed sad and evidence of low self esteem. Med school is a hike, not a race, you know?

I'll buy that folks at top programs skew towards ambitious (why subject yourself to more call and longer hours for a only slightly better training experience if not ambition?), but I don't see the competitive thing. I lump that in with the high USMLE = poor interpersonal skills thing. And I'd love to believe that because I had woeful steps.

I think one of the problems is that people on SDN tend to conflate competitiveness, prestige, and call burden. This is a mistake. You can go to a prestigious program where there isn't much competitiveness between residents and the call burden is low. You can go to a low-prestige program where there is a lot of competitiveness (e.g., because everyone thinks s/he will be the next to get arbitrarily dismissed or non-renewed) and the call burden is high. etc.

There is also a lot of reverse snobbery underlying dismissals of high-prestige programs and their high call burdens, i.e., "These MGH/UCSF/Columbia residents think they're so hot. But really what matters is whether or not you are a compassionate person. 5/10/15/50 years from now, none of your patients will be asking you where you trained. I'd rather have a life."

I trained at a program that is, by all accounts, one of the most competitive to match into. I never had any experience where I thought my co-residents were trying to out-compete with me. Now I am an attending at an equally, if not even more, competitive program. And again I just don't see it.

 

[MiddleRoad]

You know, competition is not inherently unhealthy, and it doens't necessarily create a toxic environment. I seriously believe that if most of us do some introspection, we'd find a somewhat competitive nature. Signing up to train at a program with a big name gives you bragging rights (and hence the chance to feel better than others). Going to medical school does the same thing. Competitive isn't a bad word, even though I get why you don't want to use it in front of your applicants.

I hate to get all semantic, but I agree with ndy about the competitive vs. ambitious distinction. Competitive is outwardly-focused, e.g. concerned with beating everybody else. Ambitious is inwardly-focused, oriented towards pushing oneself towards achievement, often requiring hard work to achieve difficult goals. I've seen only a few people who fit into this first category going into psych at any program.

My experience as a resident training at a "big name" program and going to medical school at a less "prestigious" place challenges some of the assumptions often discussed in this forum. I find that my current colleagues work hard, vent occasionally, but are oriented towards helping each other and doing the best they can to achieve their goals. At my medical school I saw more complaining and disappointment among residents about their workload, perhaps because they were expecting a cushier lifestyle going in.

 

[notdeadyet]

Nice description of ambitious vs. competitive, MiddleRoad. Wish I were so articulate.

 

[MDchouette]

Thanks for the comment, you raise an interesting point. I am curious as to what you mean by personality as important to both selection and burnout- do you mean folks who have good balance and good perspective, are motivated for the right reasons, work as team players, have good sense of humor etc etc.

My main point is that your day-to-day happiness in residency has a lot to do with whether you like your co-residents, can laugh with them when you need to, and can come to them for advice/venting when something is difficult. Or at least, that has been my experience.

 

[Doctor Bagel]

So the competitive word has generated some affect. While I agree to some extent with the ambition/competition dichotomy, I still think lots of us in this field have competitive instincts. We might tamper them down, and it doesn't mean we're jerks, but we also don't want to be outdone by everyone around us and sometimes we want to be the best. Things like athletics have a clear competition element, and they're not inherently unhealthy or bad for participants. I agree, though, that when you're already in a more prestigious place, there's less need for in-fighting because everyone can do OK. If you go to Yale Law School, you can do great regardless of your class rank. If you go to a 4th tier law school, you'll be lucky to make $30k/year if you're not in the top 10% of your class. I'm sure the latter can breed some ugly competition.

Anyway, though, I guess we can go back to discussing malignant programs.