Quality of Life vs. Prestige in Psych Residency

[PsychMD2100]

Greetings All,

I'm interviewing this year and I've been fortunate enough to have some invites from some top programs in the field. The catch is that my most prestigious programs are in less desirable areas, ie tough inner cities or smaller towns. My less prestigious programs are in great city or suburban settings. These slightly less prestigious places also have lighter workloads. I would like to do a fellowship but I'm still undecided. Pretty much all the programs I'm considering have recognizable names and will train me well.

How much does the name really matter in the end? Advice? Thoughts?

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[sga430]

first it depends on if u want to do research or be a clinician. a lot of prestigious programs are great at reasearch but not as good at clinical training compared to less prestigious. also it depends on whether u r happy or not. this is important as well. fellowships r not competive in psych so this is not a prime concern.

 

[JMD]

I hear ya, PsychMD2100. I am realizing that ranking is going to be really tough given my fondness of certain cities vs. programs, etc. I told my self that "prestige," of programs wouldnt play too big a role in my decisions. The thing is, I have been extremely impressed with a few of the big-name programs and how great their residents, attendings, etc. are. I leave almost every program I have interviewed at thinking "Wow, I could really see training here for so and so reason."

Best of luck... It seems like this crazy process tends to work out and, for the most part, people end up in places where they are really happy.

Sorry for not providing any actual advice .

 

[PsychMD2100]

Thanks for the replies, everyone.

I'm leaning towards being a clinician but I want to leave the door open for an academic post if private practice isn't what I expect.

I find the places that I've really liked have been Top 20 programs whereas the most prestigious places are Top 5 programs. I know some of these Top 5 places work their residents pretty hard. It's not that I fear working hard, it's that I have many interests outside of psychiatry.

It's good to know that getting a psych fellowship isn't terribly competitive. This puts my mind at ease for looking more closely at these Top 20 places.

If I decide to go academic and I get a great fellowship, will they care much about where I did my general residency?

 

[atsai3]

I'm leaning towards being a clinician but I want to leave the door open for an academic post if private practice isn't what I expect.

I find the places that I've really liked have been Top 20 programs whereas the most prestigious places are Top 5 programs. I know some of these Top 5 places work their residents pretty hard. It's not that I fear working hard, it's that I have many interests outside of psychiatry.

It's good to know that getting a psych fellowship isn't terribly competitive. This puts my mind at ease for looking more closely at these Top 20 places.

If I decide to go academic and I get a great fellowship, will they care much about where I did my general residency?

1. Harder to go from private practice to academia, vs. the other way around.

2. If you go to a 'Top 20' program, then you'll be fine for fellowship placement. If you do your residency at Boondock University Medical Center, it would still be possible to land a good fellowship, but it would be much harder since (presumably) your supervisors would be less connected.

3. Again I would strongly encourage you to look at overall program fit rather than perceived prestige.

Cheers
-AT.

 

[whopper]

Work you pretty hard?

Also factor in the quality of the work.

Is it scutwork? Is it work that'll really make you learn?

 

[drwatson]

Hey everyone,

So people talk about, and it seems to be easy to find, rankings for academic psych programs. What about the clinical aspect? Are there any "rankings" or "ratings" that look at the clinical aspect of training? I would hope there is something more than Dr.Blahblah is a great clinician and he/she trained at XYZ ergo XYZ must be good.

 

[OldPsychDoc]

Hey everyone,

So people talk about, and it seems to be easy to find, rankings for academic psych programs. What about the clinical aspect? Are there any "rankings" or "ratings" that look at the clinical aspect of training? I would hope there is something more than Dr.Blahblah is a great clinician and he/she trained at XYZ ergo XYZ must be good.

There aren't.
It's even more subjective than the academic prestige beauty contest.
And besides that, truly,
NO ONE CARES.
You're either a great clinician or not.

In my group, people have trainied in Ivies, in our own program, in other university programs, in other community programs. What matters is that they are good teammates, reliable clinicians, trustworthy colleagues.

 

[PsychMD2100]

There aren't.
It's even more subjective than the academic prestige beauty contest.
And besides that, truly,
NO ONE CARES.
You're either a great clinician or not.

In my group, people have trainied in Ivies, in our own program, in other university programs, in other community programs. What matters is that they are good teammates, reliable clinicians, trustworthy colleagues.

Hey OldPsychDoc,

You mention that no one cares about prestige inside of your group practice. When might prestige play a factor, if at all, when interacting with patients as a solo practitioner?

If what you say is true about prestige not mattering, then what is all the hype about? Why are so many of us getting bent out of shape about the name of the program?

Thanks for your time since hearing what it's like on the other side is very eye-opening.

 

[i61164]

Hey OldPsychDoc,

You mention that no one cares about prestige inside of your group practice. When might prestige play a factor, if at all, when interacting with patients as a solo practitioner?

If what you say is true about prestige not mattering, then what is all the hype about? Why are so many of us getting bent out of shape about the name of the program?

Thanks for your time since hearing what it's like on the other side is very eye-opening.

Hype? I am not aware of any hype. It's probably just an extension of the "hype" created by the USNEWS med school rankings, but it only exists in your mind.

 

[OldPsychDoc]

Hey OldPsychDoc,

You mention that no one cares about prestige inside of your group practice. When might prestige play a factor, if at all, when interacting with patients as a solo practitioner?.

Maybe when treating a patient narcissistic enough to want to say to his neighbor "Oh your doctor trained at Community Hospital? Well, I just LOOOVE my doctor, and HE trained at Fulluvourselves University--isn't that SOOO much better? And by the way, he drives the same Lexus that I do..."

If what you say is true about prestige not mattering, then what is all the hype about? Why are so many of us getting bent out of shape about the name of the program?.

Why indeed, 2100? Why indeed?
Sometimes hype is just hype...
This is America. We're addicted to it.

Thanks for your time since hearing what it's like on the other side is very eye-opening.

 

[PsychMD2100]

Good points all around, although I would drive something better than just a Lexus

 

[whopper]

I don't mind being worked hard if I learn. Repeating myself but this time with more detail.

My first year I actually spent more hours in the unit than I had to do because I was learning. My 2nd year I already learned most of what the unit had to offer so I didn't care to do more work then.

If a program works you hard, its only enjoyable and worth it if its work worth doing.

As for the name, it doesn't matter unless you want to do something where the prestige matters. Clinicians don't have to go to a more prestigious school. However if you're realistically gunning for a top research position or a something like President of the APA then it may help, but its not the real thing that matters.

Leon Smith MD, a top recognized ID doctor intentionally went to one of the most run down areas-Newark NJ because he wanted to make the biggest dent against disease. He could've gone to areas more prestigious, but he chose the trenches.

The guy's one of the top doctors and did groundbreaking working in HIV research--and Newark is an area where HIV has hit hard.

You can't keep a good man (or in this case-Doctor) down. If you really want to do good work, prestige shouldn't matter, and its not the most important thing. Make sure the residency you go to has the tools you need to be the best doctor. That's the most important thing. Any program with "prestige" that doesn't teach well isn't worthy of that prestige.

Quality of life is important-and how much you learn does affect quality of life. Prestige IMHO isn't as important, but if you can find a balance, that's also a thing to consider.

 

[PsychMD2100]

Thanks whopper,

I just interviewed this week and I kept your comments in mind as I went through the program.

I'm finding that some benefits of a prestigious program are the extensive resources and the quality of classmates--both of which contribute to the quality of learning that you mentioned.

I hope my one-day impressions are accurate since the same program can look and feel quite different depending on the day.

How much do you recommend second-look visits?

 

[nitemagi]

Something else to consider is if planning a private practice (brought up at a recent interview), you'll probably want to train in the same city you want to stay. In such situations coming from a bigger name place means getting referrals comes much easier, and being connected to all those resources. That can make transitioning much easier down the road, and may dictate the type of patients you have (i.e. how much choice you have in the matter).

 

[cleareyedguy]

There is a reason that some places are "prestigious" and other places aren't. The top places do more research, which means that, in addition to the clinician-educators around whom you do most of your training, there are accomplished researchers who don't do a lot of day-to-day teaching but who are available for mentorship. Most psych residencies have very few of these grant-supported independent researchers; the top places have dozens of them.

This relates to money, and the prestigious places clearly have more money for bringing in outside lecturers and to bridge funding gaps for faculty who are between grants. This may not matter directly to residents, but it is huge for your teachers.

A more controversial/sensitive issue is that the top places demand a level of professionalism and effort that simply isn't demanded at less prestigious places. This may sound harsh, but I think it's true. These top 10 or 20 or (maybe) 30 places can recruit residents and faculty who have demonstrated a high level of competence. You can define this in a bunch of ways--grades, board scores, letters, research, etc--but the top programs are packed with people who are dedicated to being very competent. This means that they are willing to work into the evening and on weekends in order to do the basic work in a very thorough way and so that they can add in some research or writing on the side, and they are all people who have been doing this--more or less--since they were teenagers. Within these top places, it is not acceptable to skate out of work as early as possible, to not finish paperwork, or make unprofessional comments about patients. They happen, of course, but there is strong peer and faculty pressure to operate at a high level. The prestige thing is not so much about snobbishness--though there's some if it--but rather about the pursuit of excellence. Less selective places also pursue excellence, but they do so with folks who are often trying to master a foreign culture or with trainees who would be bridle at the expectation of long hours and a high level of performance. This doesn't mean that residents should look bleary eyed all the time, but hard work often accompanies success.

Having said that, there are some great psychiatrists who trained in crummy places, and some crummy psychiatrists who trained in great places. But if I were betting on the outcome, I know where I'd bet. And if you have the chance to train in a great place, you better have a solid reason to choose some place that is widely seen as mediocre (and that reason shouldn't be based on one bad or good encounter or one bad or good rumor).

 

[Adam_K]

A more controversial/sensitive issue is that the top places demand a level of professionalism and effort that simply isn't demanded at less prestigious places. This may sound harsh, but I think it's true. These top 10 or 20 or (maybe) 30 places can recruit residents and faculty who have demonstrated a high level of competence. You can define this in a bunch of ways--grades, board scores, letters, research, etc--but the top programs are packed with people who are dedicated to being very competent. This means that they are willing to work into the evening and on weekends in order to do the basic work in a very thorough way and so that they can add in some research or writing on the side, and they are all people who have been doing this--more or less--since they were teenagers. Within these top places, it is not acceptable to skate out of work as early as possible, to not finish paperwork, or make unprofessional comments about patients. They happen, of course, but there is strong peer and faculty pressure to operate at a high level. The prestige thing is not so much about snobbishness--though there's some if it--but rather about the pursuit of excellence. Less selective places also pursue excellence, but they do so with folks who are often trying to master a foreign culture or with trainees who would be bridle at the expectation of long hours and a high level of performance. This doesn't mean that residents should look bleary eyed all the time, but hard work often accompanies success.

I think that you are confusing indentured servitude with "professionalism" and "competence". Despite your claims, working residents to a blearly eyed state at ridiculously low wages has little to with either "professionalism" or "competence".

Such programs are simply trading on their name and using residents as cheap labor.

Plenty of "lesser" programs recognize this and are neither unprofessional nor incompetent.

But, you are, of course, welcome to your beliefs.

 

[RustNeverSleeps]

A more controversial/sensitive issue is that the top places demand a level of professionalism and effort that simply isn't demanded at less prestigious places. This may sound harsh, but I think it's true. These top 10 or 20 or (maybe) 30 places can recruit residents and faculty who have demonstrated a high level of competence. You can define this in a bunch of ways--grades, board scores, letters, research, etc--but the top programs are packed with people who are dedicated to being very competent. This means that they are willing to work into the evening and on weekends in order to do the basic work in a very thorough way and so that they can add in some research or writing on the side, and they are all people who have been doing this--more or less--since they were teenagers. Within these top places, it is not acceptable to skate out of work as early as possible, to not finish paperwork, or make unprofessional comments about patients. They happen, of course, but there is strong peer and faculty pressure to operate at a high level. The prestige thing is not so much about snobbishness--though there's some if it--but rather about the pursuit of excellence. Less selective places also pursue excellence, but they do so with folks who are often trying to master a foreign culture or with trainees who would be bridle at the expectation of long hours and a high level of performance. This doesn't mean that residents should look bleary eyed all the time, but hard work often accompanies success.

I found your post interesting, as I attend medical school at a top-rated school with a rather intense psych program and have been interviewing at a range of programs. I think your views of top 10-30 versus other programs is rather elitist, though. At the highly-ranked program at my school, there will still be some unprofessional comments about patients and residents will still want to leave early. Stereotyping people who don't attend that select group of programs (and see if you can get people to agree on what the top 10 even are) as less hard-working and professional seems somewhat unprofessional and elitist. For instance, some people you may otherwise consider as professional as yourself have geographic preferences and family situations that may lead them to prefer lower-ranked programs.

I recognize this kind of attitude about working long hours from my medical school. Some people may romanticize this as learning or being professional, etc., but it does seem like the residents are often just used as cheap labor. These ideas about people who have more relaxed call schedules during second and third year not learning as much or being less professional sounds like a rationalization.

 

[PsychMD2100]

Thanks cleareyedguy, Adam-K, and RustNeverSleeps,

This is precisely the kind of dialogue that I was hoping for when I started this post. I appreciate you guys chiming in.

I think prestige does have its purposes, although I'm just not sure how I'm going to interpret that purpose in my life as a resident. I can sense that many residents work much harder than they need to with little additional educational benefit. I also must say that having a culture of excellence does drive me, for one, a little bit further.

In the long-run, prestige seems to be a quick and dirty way to cut back on uncertainty. If, for instance, I want to stay in a nice hotel in a city that I've never visited before, I'd look for the nearest Marriot, Hilton, etc. Even though Clearwater Inn may be just as good, there's a gamble involved with staying there.

At this point, having seen a number of programs, I'm trying to pick from among my prestigious places with an eye toward a decent quality of life.

Just for the sake of discussion, I've cut and pasted the "Top Ten" psych departments, according to US News and World Report. If you guys had to rank these places based on quality of life, what would your ranking be?

1 Massachusetts General Hospital, Boston 43.6
2 Johns Hopkins Hospital, Baltimore 26.4
3 New York-Presbyterian Univ. Hosp. of Columbia and Cornell 22.3
4 McLean Hospital, Belmont, Mass. 19.2
5 UCLA's Neuropsychiatric Hospital, Los Angeles 18.8
6 Menninger Clinic, Houston 15.1
7 Yale-New Haven Hospital, New Haven, Conn. 14.5
8 Stanford Hospital and Clinics, Stanford, Calif. 12.4
9 Sheppard and Enoch Pratt Hospital, Baltimore 12.4
10 Duke University Medical Center, Durham, N.C. 12.3

 

[Afrikyn]

I am torn between the Mt Sinai program in the UES of Manhattan and the Cambridge and Harvard Longwood programs. The Harvard programs are excellent. I have absolutely no complaints about the programs, the faculty is great, and the educational and perceived professional opportunities are exactly what I am looking for. I am just not a fan of Boston, it is one of the most segregated and racist places I have ever seen and I am from Georgia. To be clear, I did NOT get these kind of feelings at the programs themselves. I felt very welcomed and comfortable at all times. All of the Black and Hispanic residents I spoke with told me that they never felt discriminated against and in fact said they felt very supported by the programs. I like the Mt. Sinai program a lot as well. I love the location. I think that it would be a lot of fun to live in NYC at this point in my life. I am single, no kids, 26yo Black female. I am planning to do second looks at each of the programs in the next week or two to make sure that I really like them all as much as I think.

My question is this. Would I be a fool to pass up Harvard training for Mt. Sinai? I am planning to be a forensics psychiatrist and I understand that is a pretty competitive fellowship to attain. I also wonder if I decide to do expert witness testimony, would I really need the "brand name" for those purposes?

I am not sure of the reputation of Mt. Sinai in psychiatry on a national level. As we all know there is no real place to find a real list of residency program rankings. I think that NYC is so much more congested than Boston and it may be harder to make the kind of connections I would need to make while in residency to further myself professionally. Is this a reasonable concern?

Sorry this is so long but any advice would be appreciated.

 

[PsychMD2100]

Afrikyn,

Good points and a tough decision. I guess the question that you've also got to ask is for who's eyes are you seeking prestige?

To a lay person, you could drop the Harvard name by training in Boston at Cambridge or Longwood. However, in the psychiatric community, MGH-McLean is considered Harvard's flagship program--it's the one with the academic prestige.

I get the feeling that if you wanted to stay in the northeast, then you would be able to go where you wanted in the Tri-State area for fellowship after training at Sinai. If you wanted to leave your region, then you might have to consider going to Boston.

With so many factors, don't underestimate your gut instincts. If one place is more prestigious than another but you know you'll be miserable, then don't go there. I think the key is finding balance between quality of life and prestige.

I agree that ranking systems are often flawed and skewed. Nonetheless, I cited in my last post the most widely known rankings used by the general public.

 

[cleareyedguy]

I was--to some extent--trying to be controversial, but I think I still believe what I said. There are places that "scut" people, I suppose, but most scut in psychiatry consists of diligent follow up, acquisition of collateral, checking of pertinent labs, a thorough mental status, and well-done transfers. To do these well takes time and effort, and, while not the same intellectual experience as attending a lecture on BDNF, they do represent an aspect of professionalism. I wasn't trying to denigrate people whose residency program isn't very well known or imply that residents at Ivy League programs don't like to get home early. I also wasn't trying to define which programs make the top tier (for example, the US News rankings are not rankings of departments but rather inpatient clinical care based on reputation. This leads to huge bias. For example, Mass General always wins, but who would think that their non-c-l services are really the best in the country? They win on reputation. Of course, MGH residents also train at McLean, and if you combine the two, then the lofty ranking may be reasonable. NYPH is composed of Cornell and Columbia, and if you combine their faculties and resources--both of which were top 5 before the merger--then NYPH should probably be the clear number one. On the other hand, aside from the child and forensics fellowships, the two NYPH departments don't really interact all that much, so it doesn't seem fair to combine them. You can go on. How does Methodist in Houston rate a top 20 spot when it has a ten bed, nonacademic inpatient service? These clinical sections are only tenuously related to the academic portion of a department or to a resident's experience, but my hunch is that the voters may be asked to rank clinical care but take into consideration the department's entire offerings and then subconsciously lump MGH with McLean and Baylor with Methodist and subconsciously disentangle Cornell and Columbia, though it's true that I haven't yet been granted access to their subconscious minds. I purposely didn't try to rank them but would say that any of the departments/hospitals listed in US News would be seen as top tier and that any one of them might be ideal for any particular resident.

Anyway, there are plenty of reasons to go to a lesser-rated program, and they include lifestyle and geography. I do believe, however, that your 4 years of psychiatry training are vital in the formation of an infrastructure for learning and that you should have a real good reason not to go to the most challenging, intellectual place that you can get into. It is not so much about the acquisition of information but the learning of habits and process, and I think these are found at higher levels in the so-called prestige programs. These programs may also breed elitism, snobbism, and competitiveness, but I think those stereotypes are overdone (ie, narcissistic pathology is not confined by Ivory Towers, and you'll find jerks everywhere). Perhaps the best reason to go to a lesser program is if you feel a special fit with a place, particularly if that fit is going to lead to better training and not just to an immediate sense of comfort (since I am biased that it is useful to get out of your comfort zone while learning a new skillset).

 

[PsychMD2100]

cleareyedguy,

Good points as well. Just a point of clarification, Menninger Clinic is on that US News Top 10 list--not Methodist Hospital. Both Menninger and Methodist are free-standing facilities with academic affiliations with Baylor College of Medicine.

The Menninger Clinic in Houston, TX has 130 psychiatric beds serving 6 specialty treatment programs. While I don't know as much about Methodist Hospital, I will say that Menninger has most definitely earned its place on that list.

 

[PsychMD2100]

Hey all,

I've got my search down to 2 programs. One is a Top 20 program in an area where I've got family ties; it also has a lighter call schedule. The other is a Top 5 program in a less desirable area where I've got no ties; it has a reputation for having a tough workload.

Interview-wise, I had great experiences at both places. I felt comfortable with the faculty and residents. I'm still undecided if I'm going academic or private practice, fellowship or not.

My id says take the easy path and go Top 20. My superego says push through the pain and serve society as a Top 5 graduate. My ego is asking you all, what would you do?

 

[atsai3]

My id says take the easy path and go Top 20. My superego says push through the pain and serve society as a Top 5 graduate. My ego is asking you all, what would you do?

The answer is going to be very individual and is going to depend on your tolerance for pain and whether your desire to be from a "Top 5" program can carry you through.

When I went through the rankings process, I faced a somewhat similar decision. Program X and Program Z were very similar in workload and overall "fit". (On the interview trail, people were talking about how much call the programs have. Personally, I don't think the call at either program is bad at all, but you do take call all 4 years at both programs. Many other programs have no call during PGYIII & IV.) In terms of quality, both Program X & Z would be considered "elite". However, I have fairly specific research and practice interests, and there was much more flexibility built into Program X -- where the professional opportunities more closely matched my interests (although Program Z did have some interesting resources as well). On the other hand, I had more and much stronger personal ties to the area where Program Z is located, vs. some and fewer personal ties to the area where Program X is located.

Anyway, to make a long story short, I matched at Program X. I've been having a fabulous time, it turned out to be a great fit, my experiences have confirmed its awesomeness as a program, and IMHO I think our PD is one of the top two PD's in the country (the other being Grace Thrall at Duke). But I'm realizing that personal factors matter quite a bit more than I had anticipated. (Residency training is tough. "Even" psychiatry.) So I'm transferring to Program Z this summer. I still have doubts, since I'm giving up quite a bit of flexibility, but I'm sure I made the right decision. Program Z will be a great place to be, and several people inside and outside the program tell me that the residents are a fantastic bunch.

The Top 20 vs. Top 5 stuff is crap. There is a fairly large econometric literature on rankings and report cards and what not. Unfortunately, no matter how much the econometrically aware do their part to chip away at this rankings crap, we just can't seem to dispel the US News & World Report mystique. It's like hammering gophers with a mallet. An op-ed that Austan Goolsbee wrote in the NYT a few years ago pretty much sums it up. I posted the full text in another forum: "How Rankings Rate", NYT 4/12/04.

However, to pursue this thread further -- How much of a "Top 5" program is the program you're looking at, and how much of a "Top 20" program is the other one? I understand your need to be vague in the interest of preserving your anonymity. Looking at the most recent USNWR, is your "Top 5" program Columbia, MGH, or Hopkins, and the "Top 20" program Cleveland Clinic? Even considering the research that Austan Goolsbee cites in that NYT op-ed, one might be able to argue that MGH and CCF are far enough apart in quality that despite very generous confidence intervals on the "rankings", Columbia would still compare favorably in a statistical sense. Or maybe you're thinking about Pitt -- an institution where some might argue that the distance betweeen "#1" and "#10" isn't large enough (at least as far as psychiatry goes) that the confidence intervals couldn't plausibly overlap. But any number of other factors could enter the equation here. Being a resident at MGH involves lots of commuting, which economists have found to severely dent your overall happiness. (I don't care how ambitious you are. Traffic sucks.) Being a resident at Columbia involves living in New York, which is not everybody's cup of tea. Being a resident at Hopkins involves living in Baltimore, which... is definitely not everybody's cup of tea. Etc, and so on and so forth.

I'm not suggesting that you choose the "Top 20" program. All I'm doing is casting a vote (N=1) for you to assign greater weights to other factors in your decision calculus, that's all.

Cheers
-AT.

 

[PsychMD2100]

Thanks atsai,

I've been in touch with people I trust about this decision. I agree that the decision has to be made holistically. Thank you for sharing about your upcoming move.

One thing I forgot to mention in my last post is that the Top 5 place is likely to train me better than the Top 20. Top 5 has better resources, more likelihood of seeing rare cases, and better-known teachers. The catch, of course, is that I don't have ties to the area of Top 5 and I would be looking at a significantly heavier workload.

How much does free time play a factor in getting the most out of residency? I see it both ways. We always want to be seeing patients but we also need time to read and decompress.

In light of the fact that Top 5 will work me harder but probably train me better, how does that affect your opinion?

 

[JWhite]

I am curious as well, struggling with the same sorts of questions.

 

[whopper]

you'll probably want to train in the same city you want to stay.

Maybe too late to benefit the person who asked, but I've found this out as well by living it.

Currently in the Cincinnati/Northern KY area. When I left residency, I had a general "lay of the land"--knew several practices that wanted to hire me, made a lot of good local connections, knew some people who wanted me to join their practice which was very profitable with the clear intention that they would put in me in track to take it over.

So I move to the new area, liking it, but the place I'm working at is rather isolated from the rest of the clinical community (a forensic inpatient unit), and I got no idea what the psychiatric network is like in the area because of that isolation. The place I'm working at now, I don't think I want to stay here long term, though for the 1 year as an attending its been a very good learning experience. The thought of going back to NJ has also crossed my mind because my parents aren't getting any younger and they may need some help from the son as they get older. I could develop some very good connections here by the end of fellowship, and then who knows....leave again.

Bottom line-if you end up practicing where you did residency, you probably would've established connections that could've taken months to years to build. You set up shop elsewhere, you got to start over again in that department. That could create a setback of up to a few years career wise.

In light of the fact that Top 5 will work me harder but probably train me better, how does that affect your opinion?

If the harder work is geared toward better training, go for it. That'd be a plus IMHO.

I'm not suggesting that you choose the "Top 20" program. All I'm doing is casting a vote (N=1) for you to assign greater weights to other factors in your decision calculus, that's all.

Very much agree.

 

[SpiritiualDuck]

Maybe I'm wrong, but who cares about the prestige of a program. If you guys are so worried, I'm guessing you wouldn't have gone or being going into psychiatry.

Prestige and psych are not compatiible. If you want prestige, choose Neurosurg. If you want to do psychiatry, choose it based upon if it meets your needs in regards to education, quality of life, location, etc.

 

[whopper]

Hmm, well I've been one to agree that prestige is not everything, and have encouraged several to not include it as the only factor, something I have seen some do. I guess medical training in general tends to push things like prestige & elitism.

That being said, some places with good names earned the prestige they have.

As was mentioned above, you can still have some good doctors coming out of crummy programs, bad doctors out of good. I have also stated that I've seen some highly respected people, notables in the field, who did some outstanding work but didn't really seem to care to teach or be able to teach well. Not much point in working under the top guy in the field if that person did nothing to make you a better doctor.

But if someone had the oppurtunity to get into a prestigious program, especially one that was offering good teaching, and you had the oppurtunity to work with someone in the field that was highly respected, and hopefully willing to teach well, that oppurtunity should be investigated.

My advice is don't list a program just because of prestige. Check out the program, try to figure out if its a good fit-atmosphere, lifestyle, teaching, work environment wise among other factors. If it is, and its prestigious, all the better.

 

[Doc Samson]

Prestige and psych are not compatiible.

Depends who's definition of prestige you're working with. I'd say that the Chief of Psychiatry at MGH is probably held in higher esteem than the Chief of Neurosurgery at Community Podunk Hospital.

 

[Moxie Floxacin]

In weighing a few programs that are each a good fit for me, I found myself wondering more than once what one particular name-dropping socialite acquaintance of mine would think if I chose a less prestigious school because of vibe and location.

So I called him.

Over phone tag, he said, "Man's Greatest Hospital sounds like a lot of fu-un!"

When we chatted and I explained my thoughts, he told me to go where I would be happiest.

I wasn't sure I believed him (he is the biggest name-dropper EVER), so I asked, "You wouldn't be disappointed in me if I didn't go to Man's Greatest Hospital?"

His response was, "Sweetie, I'd be *proud* of you for making a choice based on what would make you the most happy."

Which goes to show that not only do you have little *control* over what other people will think (about you, your competence, your perceived work ethic, or your perceived ability/willingness to go to the "most challenging and intellectual" program) you might not have *any* idea of what they think at all. So trying to please/impress them may not be that great a guiding principle.

So, maybe the answer is to base decisions based on things you know are real. Like... what your gut tells you; whether you can be near people you love for those days where you feel terrible, stupid and fat; and the fact that - for no reason you can pin down or articulate, you've always hated LA, and Atlanta traffic makes you pissy more than Chicago traffic does.

I'm in the same boat, and trying to make the best choices for the right reasons.

I think that the University of Anystate Psychiatry Training Program probably has a curriculum that will teach me what I need to know - just like U Anystate undergrad prepares folks for med school about as well as Yale. Looking at my med school classmates, I certainly can't pick out the Ivy kids based on dedication to excellence.

I wonder how much of the top tier discussion is about impressing Joe Patient or Josephina Jurygal, and how much of it is us convincing ourselves/our parents/some guy on SDN that we're at the top of the heap.

 

[cleareyedguy]

I think that the University of Anystate Psychiatry Training Program probably has a curriculum that will teach me what I need to know - just like U Anystate undergrad prepares folks for med school about as well as Yale. Looking at my med school classmates, I certainly can't pick out the Ivy kids based on dedication to excellence.

.

A different way of looking at this issue is that Joe the Great PreMed who goes to and performs well at Anystate U is likely to be very similar to his twin who went to and performed well at Yale; both are likely to succeed in medical school, where they will appear indistinguishable (that was certainly my experience, where the top kid in my med school class went to Samford, which, when he said it, everyone always assumed was Stanford). The difference is that Anystate U is likely to produce a relatively small number of Joe the Great PreMeds, while Yale produces them by the score, which is why top 20 med schools have a lot of people from schools like Yale.

Interestingly, the rise of US News has led schools to be more willing to accept students from lesser known schools, at least those with straight A's, since rankings are partly based on GPA but not undergrad school.

A final issue that may or may not be important to your decision: selection committees are looking to be reassured and excited. If you are from a school that is relatively unknown to them, your chances get hurt. If you come from a program or school that is a feeder school to your program, they know what they're getting, or at least they think they do. If you're going into private practice, it doesn't really matter, but if you are looking ahead to academics or a fellowship, it matters a lot.

 

[OldPsychDoc]

...The difference is that Anystate U is likely to produce a relatively small number of Joe the Great PreMeds, while Yale produces them by the score, which is why top 20 med schools have a lot of people from schools like Yale. ....

I would just disagree with one thing: neither Anystate U nor Yale PRODUCES a Great PreMed. The schools can be said to credential academic prowess which is likely already present at undergrad matriculation. If more top 20 med schools have a lot of Yale grads, it's because Yale has attracted those high-aptitude students in greater numbers, and has kept them on their path to med school for 4 years.

 

[eforest]

I think that teaching and training are really important in psychiatry- not prestige for the sake of prestige.

 

[Doc Samson]

I think that teaching and training are really important in psychiatry- not prestige for the sake of prestige.

Here's the rub of the whole argument - I can't think of any program that anyone would consider prestigious that doesn't also have excellent teaching and training.

 

[2tall]

Here's the rub of the whole argument - I can't think of any program that anyone would consider prestigious that doesn't also have excellent teaching and training.

but aren't there many more programs out there with both ETnT yet lacking prestige than prestige programs with inherent ETnT...2:1 maybe? In most cases, ETnT seems ensured.

Doesn't seem like influence or recognition would help or hinder.

Are we saying a Lexus ain't just a Toyota?

 

[billypilgrim37]

Prestige matters to some, not to others. If it doesn't matter to you, it doesn't exactly behoove you to think that other people are silly for wanting to be part of programs that obviously offer better opportunities than others. If those "opportunities" aren't things that are important to you, good for you.

And just remember, no program you go visit is going to tell you they don't have excellent teaching and training. It's much easier to sell a program's supposed virtues than it is to actually run a quality program. There's some wisdom in crowds, and prestige is just one of many imperfect proxies that goes beyond an affable PD and a few motivated interviewers.

 

[masterofmonkeys]

I would just disagree with one thing: neither Anystate U nor Yale PRODUCES a Great PreMed. The schools can be said to credential academic prowess which is likely already present at undergrad matriculation. If more top 20 med schools have a lot of Yale grads, it's because Yale has attracted those high-aptitude students in greater numbers, and has kept them on their path to med school for 4 years.

As an ivy alum currently at a state medical school, I'd have to say that sounds about right. I have known some extremely smart people from all walks of life with and without university educations at all levels of quality.

There are benefits to a prestigious undergrad, but they certainly aren't to be found in the 'quality of the premed' they produce, at least in the sense that most adcoms think of it. As for research opportunities, and more importantly a well-rounded and diverse liberal arts education, that's perhaps a more valid argument. I personally wouldn't have traded my ivy experience for any amount of money. But as I near graduation, I don't think it prepared me for medical school any better than State U prepared my fellow students.

 

[OldPsychDoc]

..I personally wouldn't have traded my ivy experience for any amount of money. But as I near graduation, I don't think it prepared me for medical school any better than State U prepared my fellow students.

Except inasmuch as it may have prepared you for the crushing debt!
It bugs me immensely to see students STARTING med school with a six-figure student loan debt!
(Yes I know that well-endowed ivies often can provide more financial aid...but it's kind of like the perennial Celexa vs. Lexapro question--if you have to pay for it out of pocket, is it REALLY worth paying 5-10 times more?)

 

[Doc Samson]

but aren't there many more programs out there with both ETnT yet lacking prestige than prestige programs with inherent ETnT...2:1 maybe? In most cases, ETnT seems ensured.

Certainly - my point is that prestigious programs shouldn't be dismissed as uppity prestige-focused establishments that elevate themselves "above the trenches." All prestigious programs I'm aware of are quite firmly rooted in the trenches (well, maybe except Cornell).

 

[whopper]

IMHO, there are several benefits of an Ivy League undergraduate education.

However when I compare the experiences of several friends who went to different Ivys, they tell me of very different experiences.

My friends who went to Cornell who were premed tell me it put their premeds through a vicious weed out process that they dreaded. My friends who went to Princeton told me their classes had excellent teaching, and there was no weed out process. They felt they learned the material incredibly well, but in a manner that made them enjoy the process.

I'd choose the latter--but both were Ivy League. I didn't hear any positive comments about the weed out process in any school-Ivy League or not. I'd rather go to a supportive pre-med school that was non-Ivy than a weed out Ivy. But hey, if you can go to an Ivy, or school of similar prestige that is supportive, by all means go for it. (If you can afford it).

As for Psychiatry residency that's a very different thing than the premed process. In that process, prestige IMHO would matter more, because it could have more of a direct effect on the professional outcome of the individual than which school they chose to go for undergraduate, but so too would the fit of the program with the individual. Several by residency are married, may have more pressing family concerns, and are more comfortable with settling down and doing residency in an area they want to live for the rest of their lives.

As OPD mentioned, there's also the monetary aspect-almost all high prestige schools are expensive. The school you went to in undergraduate can make a substantial difference in a heavily connection based field such as business. Going to a high prestige school for pre-med, I'm not sure how much if any difference it would make in the medical field. Someone cite some data if they have any on this effect.

 

[notdeadyet]

However when I compare the experiences of several friends who went to different Ivys, they tell me of very different experiences.

Agreed. The phrase "I went to an Ivy League school" tells me very little about your actual education. Princeton is radically different from Harvard which is radically different from Columbia.

Ivy's differ from one another just as state schools do. I can say that "I went to a state university" but the experience at UC Berkeley and Florida State are two different animals.

As OPD mentioned, there's also the monetary aspect-almost all high prestige schools are expensive. The school you went to in undergraduate can make a substantial difference in a heavily connection based field such as business. Going to a high prestige school for pre-med, I'm not sure how much if any difference it would make in the medical field. Someone cite some data if they have any on this effect.

I'd agree with you quite a bit here. I think some of the ivies with more supportive environments and smaller classes would have a leg up on the 500 student science classes you'll get at some of the cheaper schools, but I don't think there's anything magic in the sauce.

At the end of the day, you pretty much build your reputation based on your last educational experience. If you meet a doctor still bragging about going to Columbia for undergrad, it's a sad sight indeed.

 

[nancysinatra]

Can someone tell me what the most prestigious hospital in the whole WORLD is? Or in Europe, at least? Do they have some ranking process similar to ours? The Karolinska, The Salpetriere, Broadmoor, The Kremlin Hospital--how would each of these hospitals rank if US News were to open up, say, a Euro edition? (Guy's Hospital in London is the tallest hospital in the world, I've heard, if that counts for anything.)

And what about Australia and Japan? They must have some prestigious hospitals as well. Does anyone know what some of them are?

Also, how come people always seem to focus solely on Ivy League schools when discussing the prestige of undergraduate schools? What about the really good liberal arts colleges? I think the teaching and education is really the best at some of those schools. The classes are small, professors pay close attention, and critical thinking skills are truly emphasized. Yet they are so often left out of these discussions. Isn't it a bit declasse to just generically substitute "Ivy League" for "prestigious" in this manner--as if nothing else prestigious existed? (Seriously, if your dream was to study ballet, and you were accepted to Dartmouth and Juilliard, would you really choose Dartmouth??)

Sometimes the best programs in a certain field are often found at what may otherwise be seemingly lowly institutions. One of the most renowned creative writing programs in the world, for example, is at the University of Iowa, which is not Ivy League by a long shot. It's--gasp!--a state school!! Or within medicine--how many people would know about Johns Hopkins if not for its famous medical school? That's not Ivy League either.

 

[TheWowEffect]

OK, here is how I see it-

When you are in high school, people brag about their parents- The car they drive, the job they have, the toys they got you.

In college, people brag about the great high school they went to, and the great experience they had there.

In medical college, the college they went to has some importance.

As you are trying to get into residency or once in residency, people brag about their medical school. Six months or a year into residency, college suddenly becomes unimportant and your evaluations start to count.

Starting job/practice, quality of residency training matters. I don’t think ivy-league or non-ivy league matters that much. Even if you want to go into research, what you did matters more than where you did it. A couple of years into it, everybody forgets about where you trained, and you work ethic, patient care or if you are in academics, your last research project or publications start to matter. May be at an occasional grand rounds or social party, you get to brag about it but that is it. Life takes its own form and everything in the past seems a lot less important. Unless of course, you want to continue bragging about these things on an internet message board......

Disclaimer- I went a very prestigious high school and college, middle tier medical school and currently in a middle tier residency program, and am about to join as staff at a very nice suburban hospital. I had a choice between a prestigious (non-ivy league) university hospital and the above but made this choice for monetary reasons. I'll let you all know how it turns out. Who knows I may end up at the university hospital eventually because I want to be involved in research/academics, but for now, it’s the suburban hospital for me.

 

[whopper]

Also, how come people always seem to focus solely on Ivy League schools when discussing the prestige of undergraduate schools?

The mind can only take in so much in terms of categorizing what are the better places.

The Ivy League is a name brand label. That being said, in several aspects, they are academic powerhouses. But the name brand can sometimes unfairly overshadow other places of excellence such as Swarthmore, Bryn Mawr.

Or it can overshadow places that are specific for their field as the best. My brother for example went to the best school for what he wanted to do in art--work in movie & video games. He could've gotten into several Ivy League artschools, and my parents didn't understand why not since they were stuck into that "Ivy League or bust" mentality. That's not what he wanted to do, and his art teacher at the time, a highly respected artist with a Ph.D. in the field had to arrange a dinner with them to explain to them that they were locked into a limited view that could have potentially bad consequences for my brother.

They listened, they seemed to come around, then next day it was back to "Ivy League or bust". (Hey my parents were born into a culture where they want to be able to brag about a name brand school to their friends). They actually made comments like "what will our friends think when we tell them are (edit-"our" man I type too fast--faster than I think sometimes) son could've gone to an Ivy League but he didn't?".

Actually in my own application process their attitude actually nicely sabotogued my college application efforts. No it wasn't me who sabotogued it to rebel against them (except in the case of Cornell-a place I possibly could've gotten into, my scores were on par for it, I intentionally did not do the 2nd part of the application).

Is someone from the Ivy League always better? No. Of course not. That's a mentality I'd debate. (Hey look at our past president--oops sorry to inject politics). I actually know someone who was pretty bad who got into a top Ivy League fellowship. How bad? Pretty bad......

Certainly for psychiatry residencies, places like MGH & Columbia are some of the top places, and deservedly so. If anyone wanted to go there, and they feel the fit is right for them, I'd defintely tell them to go for it. I certainly don't like the Ivy League tunnel vision, but we at the same time we should respect that for in our field, the above places truly have produced some excellent advancements in our field, and produced some excellent psychiatrists. I would say the above 2 programs are some of the best & deservedly so in our field. I would only tell someone to reconsider such a place if they didn't feel the personal fit was right for them.

Ivy's differ from one another just as state schools do

Of course. Rutgers--where I went for undergrad was a weed out school. Several other state schools are not.

 

[nancysinatra]

The mind can only take in so much in terms of categorizing what are the better places.

The Ivy League is a name brand label. That being said, in several aspects, they are academic powerhouses. But the name brand can sometimes unfairly overshadow other places of excellence such as Swarthmore, Bryn Mawr.

Exactly. But put too much trust in brand name labels, and you get, for example, our notorious American cuisine, with our ubiquitous Dairy Queens and Taco Bells. There are good brands too, but slavish devotion to brands in general seems to generally seems to lead in a downward direction for everyone.

There is a downside to the Ivy League schools as well. Some people would argue that their mission (not stated, of course) is to ensure that the powerful and wealthy classes maintain their grip over society. A kid from a wealthy family, whose parents went to an Ivy League school, is FAR more assured of a place at an Ivy League school than some kid of the same or even better intelligence, who's from a poor family, whose parents went to Anystate U or to no college at all; who has less access to the whole commercial enterprise that has sprung up around college admissions, and might not even think of applying in the first place. Would that kid's admission or lack of admission to the Ivy League school be truly related to his intelligence? If not, then where is the prestige of the Ivy League schools coming FROM? Is it purely academic when the smarter kid can't necessarily get in? Some of that prestige seems like it is class-based.

Regardless of anyone's opinion about different schools and types of schools, or anyone's beliefs about prestige, I think it's more useful and interesting when people compare specifics, rather than "brands."

 

[notdeadyet]

The Ivy League is a name brand label. That being said, in several aspects, they are academic powerhouses. But the name brand can sometimes unfairly overshadow other places of excellence such as Swarthmore, Bryn Mawr.

Good analogy with the name brand. And it's name brand like wine is a name brand.

There are cheap wineries that produce low end stuff. Good value for the price, but you're not getting anything special. There are lots of colleges like this.

There are cheap wineries that produce some good wines. Wines you taste and say, "Wow, that was from where?" We have colleges like these too. Like nancysinatra's example of Iowa's writing program, a college that is not a huge name gets a world class faculty and produces an amazing product.

There are great labels that are past their prime. They produced some great wines back in the day and are resting on their laurels. People still grab the bottles off the shelf because they know people ooh and aah over the name, but the taste now may be just good, no longer fantastic. The Ivy League list is unchanging, though the quality of many of the schools have changed over time and some not for the better.

There are great labels that are still in their prime. They produce fantastic wine, some of the best. But no winery bats a thousand. There have a few misses. Don't presume because the college has a great name that an individual program is perfect for you.

At the end of the day, when you choose a wine, think about the drinker, the meal, then the winery. In that order. A funky little known label from South Africa might be perfect for a specific dinner party, even though it's half the cost and has a fraction of the reputation of the "top notch" vintner from Sonoma. And shivering through a winter in Iowa as you struggle to find your writing craft or pounding keys at the Pasadena School of Design as you collaborate to make the next Doom would quite possibly give you light year's better experiences than doing so suckling at the bosom of Mother Harvard.

 

[whopper]

But put too much trust in brand name labels, and you get, for example, our notorious American cuisine, with our ubiquitous Dairy Queens and Taco Bells.

When I see parents who appear to have an Ivy League or bust mentality for their kids, I sometimes ask, "Do you know why its the Ivy League?"

I usually get the answer, "because its excellent". Even some answers like "schools like MIT aren't as good because they are not Ivy League".

I answer, well they are excellent schools, anyone getting into one should be proud of their accomplishment, and the name has outgrown the sports league, but its a collegiate sports league.

I often get the some type of frowning facial expression like I don't know what I'm talking about. I often get some answer back that only the best schools got together, and made themselves the Ivy League based on academic excellence, and that any school of excellence can enter it based on those merits, but that's why they can't enter the Ivy League.

My own alma mater-Rutgers was part of the Ivy League & helped to codify the Ivy League's founding rules. Well it has respect as a good school with a cheap tuition, but hey, even if it maintained the Ivy status, I would reccomend any pre-med considering going to a school that espouses a weed out process to think about what they're getting into. My friends who went to Cornell often said the same.

But again, for you Ivy Leaguers--be proud. They are great institutions. Doc Samson, who trained at Harvard, well hey, we're all blessed that someone of his talent & skill is willing to offer his talents to help someone on the board.

 

[masterofmonkeys]

IMHO, there are several benefits of an Ivy League undergraduate education.

However when I compare the experiences of several friends who went to different Ivys, they tell me of very different experiences.

My friends who went to Cornell who were premed tell me it put their premeds through a vicious weed out process that they dreaded. My friends who went to Princeton told me their classes had excellent teaching, and there was no weed out process. They felt they learned the material incredibly well, but in a manner that made them enjoy the process.

I'd choose the latter--but both were Ivy League. I didn't hear any positive comments about the weed out process in any school-Ivy League or not. I'd rather go to a supportive pre-med school that was non-Ivy than a weed out Ivy. But hey, if you can go to an Ivy, or school of similar prestige that is supportive, by all means go for it. (If you can afford it).

This is very true, the weed out process of Cornell was miserable to go through. And I got very sick of defending my 'low' 3.6 Dean's List GPA in interviews. The non-pre-med experience though, was stellar. And I'd wager that in excess of 3/4 of my time was spent on that.