Residencies that may be an excellent fit?

[walleeee]

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Hello everyone!

I am an MSIII who will be applying for Psychiatry! I have a few factors that I consider especially important for considering residencies. I would greatly appreciate your time and feedback in finding out which residency programs would fit!

My Step I score about average... I have generally superb comments in my narratives, am looking to hopefully publish a case report, and average grades (do not think I will have honored any rotations). I will be looking at research opportunities for my fourth year. I live a relatively well-balanced life, hence the lack of honors. Thus I'm looking for well-balanced programs and not specifically 'prestige.'

1) Psychotherapy - This is clear by SDN searches... however it is the combo of this factor with #2 that I find very important.
2) I am striving to live a healthy and environmentally sustainable life. I want to go to a residency program where I can commute car-free (by bike, or public transport - ideally subways/rails!).
3) I would eventually like to have some free time to pursue my interests... not only the fun stuff, but pursuing knowledge and experiences in public (and mental?) health and legislation regarding mental health and medicine. I want to eventually get involved in public health, mental health, and medical politics.

May I have some recommendations of residency programs that may be a good fit for me, or some guidance to finding such?

I sincerely appreciate everyone's time and consideration!

 

[masterofmonkeys]

With regard to 2, most of your big and older cities will be walkable.

As a rule of thumb any city that wasn't built before the dawn of the automobile is not going to be friendly for the self-powered commuter.

That said, there are other factors to consider such as the separation of the sites. Even though boston is supremely walkable soem programs have sites that are miles and miles apart.

And there are some more modern cities that wouldn't be terrible to do an unpowered commute in. In Denver (where I'm headed), the sites are all two miles apart or so. And there is plenty of housing available within two miles.

As for number 3, the two that come to mind (that I interviewed at anyway) are Yale and UW-Seattle, both of which seemed to stress flexibility in planning your own training curriculum. And I met quite a few people who seemed to have done just that.

 

[beezley]

What geographic region are you from OR what geographic region do you see yourself training in? I interviewed at some programs in the midwest and ultimately ended up matching at one that seems to fulfill all your requirements. If the region floats your boat why not look at U Michigan or UW-Madison?

 

[whopper]

Consider the following factors, numbered but not in order of importance which is up to you.

1) Geographic location: friends & family in the region? Do you like the weather there? What is the cost of living in the area? The geographic area may also influence the types of patients you see. In Upstate NY, expect to see more Seasonal Affective DO. In Miami Fl, expect to see more substance abuse.

2) Rural/Urban: aside from your own personal preference, the rural vs urban will change the types of patients you see. Rural has more Conversion DO, Malingering is higher in urban areas, as well as IVDA. Urban tends to have more multicultural patients. Amphetamine use is higher in the rural midwest. In general, urban areas present with more forensic oppurtunities. Different communities present with different challenges.

3) are there other psychiatric oppurtunities in the area? This will influence your choice of electives in PGY-IV, and if you settle down in the area, where you may work. Most residents by the time they graduate have well established connections in the area, and often times that anchors them to that area. If you move out to a new place, its often times like starting over again. NYC & Boston are a psychiatric meccas, with several oppurtunities for structured academics, but for the general psychiatrist--usually lower pay (unless you're one of the best), & harder work hours. Philadelphia has the Beck Institute for CBT. Ohio has Phil Resnick. NEI is in San Diego. NJ has the University Hospital Eating Clinic headed by Russell Marx, New Orleans is begging for psychiatrists and rebuilding is going on, several areas of the midwest are underserved & need other psychiatrists--so you won't have many colleagues or structured learning, but you will be in high demand.

4) call schedule

5) daily workload

6) general atmosphere of the program: malignant? stressful? Laidback?--if so too much by your standards?

7) research

8) quality of the facilities: does the facility have measures in place to protect against violent patients? What are your oppurtunities to get food while on call (& yes that is important). Is the psyce unit depressing (40 layers of paint on top of cinder block walls with security guards with criminal records?, or a brand new modern facility specifically designed to be a state of the art psychiatric facility?)

9) quality of the teaching (and factor in psychotherapy because some programs teach it more or less)

10) does the program have a fellowship you want to enter?

11) variety of the clinical oppurtunies: PACT/ACT teams, inpatient involuntary/voluntary, psychiatric emergency center, long term facility, short term facility, commitment/probate court, eating disorder clinic, forensic psychiatry, child offices, consult service, clinical research, ECT etc.
Several programs only offer some of the above, not all. Some offer more than others. Several programs for example do not have an involuntary unit, and thus those residents will almost never get an oppurtunity to see what it is like to commit a patient against their will, nor see the court procedure where committed patients get to argue for their release to a judge. Several programs do not have specialists to treat eating disorders. PACT/ACT teams are also another thing I've seen several programs not have.
Several programs don't have ECT.
Several programs have units that will only hold patients for up to a few weeks. The things to worry about in long term vs short term facilities highly differ. The longer term units for example will often times hold psychotic patients where nothing, not even Clozaril has worked for them, and ECT is used more often in these situations. Short term facilities only hold patients for a few weeks, and if they can't handle the situation, they transfer to the long term.

When you apply & interview at a program factor in all of the above, and ask about them. My first interview, I didn't know what to even look for. By the time I reached my 3rd interview, I started to get a clue as to what made some programs better than others.

 

[BobA]

First, it is going to be a real challenge to find a program where you don't need a car. You might re-think this.

I also considered many factors other than prestige when making my rank list. Some programs that I
thought would provide a great blend of psychotherapy training and work/life balance would be Cambridge, Penn, MUSC. I think they all have about 4months of "real" medicine first year, so none of these programs are a complete walk in the park (there are some programs with outpatient only, etc). But over the course of 4 years the workload seemed to be more than reasonable. MUSC has night float, which I think makes life much more pleasant. Charleston's also a rad city to bike in. I thought Dartmouth was also really cool, had good psychotherapy training, and you might find many like-minded environmentally conscious people in that area than you would in other areas. When it's not biking weather, you can ski everywhere 😉

 

[walleeee]

Thank you, everyone, for the excellent advice! This gives a great overview to how I should go about this process!

beezley,
I have so far considered the North East and Mid-Atlantic area, but am very open to considering the Midwest. I will definitely take a good look there!

BobA,
I will have to consider the programs you mentioned! Where did you match to?

whopper,
This is a bookmark!

masterofmonkeys,
Thank you for the input... especially about taking into consideration different sites!

This is going to be a good challenge... 65 prelimary programs on my FRIEDA list!

Again,
Thank you!

 

[kugel]

Consider Univ of New Mexico in Albuquerque.
Residency:
Good overall training. Lots of Nat'l/Int'l known attendings.
Lots of research you can get involved in.
Residents treated humanely. Reasonable work load. Reasonable time off.
You work at the Univ Medical Center and the VA, so you see plenty of pathology variety. When I was there, we had specified time on the Geriatric inpt ward in 2nd year and we had specified time working at drug treatment clinic (which included a methadone clinic) and in a distinct Dual Dx clinic in 3rd year - so you got specific training in Substance Abuse and in Gero-psych. Sone psychotherapy training, but you can get more. You can put together most any type of 4th year that you want. You can moonlight at the Univ PES or several private or correctional sites.
Downside:
Didactics were often weak in 3rd and 4th year, but that has likely changed some. My pager pulled me out of didactics many times (that's my story and I'm sticking to it!).
Overall: I tend to be VERY critical of adult educational systems, but I was reasonably satisfied most of the time at UNM.

Community:
Lots of other environmentally conscious people. Clinical and educational sites not too far apart. You might need a car to make the trek back and forth in some rotations, but certainly not all. Lots of reasonable housing. A smallish city, but with a catchment area of ~ 1 million. LOTS of hiking and outdoor things to do. ABQ side of mountains is desert, the eastern side is an Alpine forest. Ski resort on top of the Mt visible from the center of ABQ, sort of like it is in Tucson. Not a lot of water sports...duh.

Downside: The Land of Enchantment quickly becomes The Land of Entrapment. Other than Santa Fe, most everything else is a minimum $200 plane ride away. Santa Fe is great... the first half-dozen times. After that, about all that was left for me was the great restaurants. Some GREAT ones. It IS close enough to go for dinner if you're willing to drive 60-75 min. No way you can decide on Friday afternoon to go to a CME conference and just go across town or even jump in the car or onto a train Sat morning. A lot of angry and rude young men and women in Abq, regardless of ethnicity. If you get really angry about people who don't speak English, don't go there. Most of my patients spoke enough English for us to work together.

 

[HCE]

Thank you, everyone, for the excellent advice! This gives a great overview to how I should go about this process!

beezley,
I have so far considered the North East and Mid-Atlantic area, but am very open to considering the Midwest. I will definitely take a good look there!

BobA,
I will have to consider the programs you mentioned! Where did you match to?

whopper,
This is a bookmark!

masterofmonkeys,
Thank you for the input... especially about taking into consideration different sites!

This is going to be a good challenge... 65 prelimary programs on my FRIEDA list!

Again,
Thank you!

Also check out Dartmouth and UVermont.

 

[tennreb]

Hello everyone!

I am an MSIII who will be applying for Psychiatry! I have a few factors that I consider especially important for considering residencies. I would greatly appreciate your time and feedback in finding out which residency programs would fit!

My Step I score about average... I have generally superb comments in my narratives, am looking to hopefully publish a case report, and average grades (do not think I will have honored any rotations). I will be looking at research opportunities for my fourth year. I live a relatively well-balanced life, hence the lack of honors. Thus I'm looking for well-balanced programs and not specifically 'prestige.'

1) Psychotherapy - This is clear by SDN searches... however it is the combo of this factor with #2 that I find very important.
2) I am striving to live a healthy and environmentally sustainable life. I want to go to a residency program where I can commute car-free (by bike, or public transport - ideally subways/rails!).
3) I would eventually like to have some free time to pursue my interests... not only the fun stuff, but pursuing knowledge and experiences in public (and mental?) health and legislation regarding mental health and medicine. I want to eventually get involved in public health, mental health, and medical politics.

May I have some recommendations of residency programs that may be a good fit for me, or some guidance to finding such?

I sincerely appreciate everyone's time and consideration!

Consider the Medical University of South Carolina. The program was formerly very pharmacology oriented but has become much more balanced in the past five years or so. Psychotherapy training is significant, and many faculty specialize in it. Charleston is a great town. The university is in the center of downtown, which is very walkable. Many do not even own cars here. I personally bike to work daily. The neighborhood around the university is full of restaurants, bars, college students, wealthy retirees, families that have lived here since Charleston was poor, and a good bus system. There's even express bus service from the university to several suburbs. You can take the bus (or bike) to the beach. Since the city is surrounded by water, there are tons of recreational opportunities. The program tends attract people that are smart but like to have a full, well-rounded life. While there isn't a particular setup with politics, it should be too hard to get involved since this is the dominant medical center in the state (and only about an hour flight to Reagan National).

 

[walleeee]

Thank you everyone for the information! This is very helpful!!

 

[ilikepsych09]

I would also recommend Michigan and Brown. Both will provide solid training but neither will work you to death, and certainly there are research opportunities available. I know Michigan's program is pretty flexible, and they (at least on my interview) implied that it wouldn't be hard to find a mentor in the school of public health or the law school there for the type of research you're talking about.

 

[BobA]

I would also recommend Michigan and Brown. Both will provide solid training but neither will work you to death, and certainly there are research opportunities available. I know Michigan's program is pretty flexible, and they (at least on my interview) implied that it wouldn't be hard to find a mentor in the school of public health or the law school there for the type of research you're talking about.

I agree. I thought Michigan and Brown were as strong as any program in the country.