Residency strength vs preferred location

[bio-Psych-social]

I interviewed at MUSC and thought that the strength and lower amount of call was really great on top of the fact that I also have family very close by. The program had everything I was looking for. However, I'm really, really tired of South Carolina because I have been dreaming of moving somewhere with the mountains/outdoors and access to skiing for years. I have done everything here there is to do and I'm sick of the place. I interviewed at the program in portland and V.C.U in richmond and thought that the programs themselves weren't necessarily as strong for what I'm wanting and had a lot heavier call and heavier taxes (portland I'm looking at you as the taxes are through the roof for high income earner). I could ski the entire ski season on my off days and have things to do in the summer. They are less than ideal in terms of diverse training sites, patient population and therapy training but are awesome in terms of geography + lifestyle and are where I could potentially see myself living long term (or possibly leaving to Colorado from after if I don't like them or can't afford the taxes in portland).

Should I go to a place that might be ideal in location, at the sacrifice of close family, training quality plus heavier call.. or should you go somewhere proven to be strong with family around but it's boring and there's nothing enjoyable to do?.. This feels impossible. Thank you!

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[Sushirolls]

You won't be recreating that much.
From what you posted, MUSC is the winner.
Go play post residency.

 

[ObsequiousAplomb]

This is ultimately your call.

If I were in your shoes, I would go with MUSC. It's a great program. I think the pay is better at MUSC than those other two programs, as is the cost of living. If you go to MUSC, you could probably afford to take one or more week-long trips each year to go somewhere more interesting, even skiing. That way you can enjoy your vacations without needing to commute through snow or mountains to a lower quality program while missing your friends and family.

Having done my residency in a major metropolitan area, I can say that 60% or more of my mental and emotional energy each day was devoted to the commute. Any complications to the roadways made my days much worse than the addition of four new borderlines to my census ever could.

 

[TexasPhysician]

I can tell you how I decided. I’m happy with my decision, but this is your life.

I looked at all of the programs I interviewed at, and I decided that I wanted to attend somewhere with above average training. Estimating the quality of training is hard, but I wanted to go in feeling like this was well worth it. I split the programs I interviewed at in 1/2 by quality of training. Everywhere in the top half was ranked first. Accurately ranking #1-5 by quality of training is an impossible metric by the average med student. It can’t be done. If I had to estimate rank of faculty by quality of teaching after my interview date at my program, I would have been VERY wrong.

Now I turned to location and call schedule. In what order, did my top 50% of programs land me somewhere I may want to live forever and keep call tolerable.

That is it. I figured if I maximize happiness while getting better than average training, I’ll have made a good decision for me. I could have ended up somewhere more prestigious if I made that a priority, but I wouldn’t change my strategy if I went back in time.

 

[mistafab]

Id say clearlu MUSC is strongest in your list acadmically. I’d put vcu next and portland last in terms of ideal training/life/location balance.

It would be fine to do any of the three. just go where you want to be. This is your rank list and life, after all.

 

[When is graduation again?]

You should go where you would be happiest. It's 4 years of your life that you can't get back. We're always taught to sacrifice years of our lives for the perception of prestige, but most of an individual's expertise/capability is self-driven. If you're not content in life, you're not going to want to spend time studying or pursuing enriching opportunities. Unless you want to do something really niche that only MUSC would enable you to do, I'd go somewhere else.

Also don't underestimate the advantage of doing residency in a place you would want to live long-term. I moved after residency, and while doable, there are a lot of opportunities and connections that you'll only get by training in a place. Even starting private practice for instance. I had co-residents who had their first patients as patient's they treated in residency as well as a ready referral network. Both of which are huge advantages, especially in early private practice days, when there is already a lot of uncertainty about building something on your own.

 

[Cath Up]

I suppose I’m in a pretty relaxed community program, but I have time for recreating. PGY1 I worked a weekend day q5 weeks. Averaged maybe 50-60 hours during on service months. This year is more in the 40-50 hour range. Training quality doesn’t feel horrible but it’s not academic-program rigorous.

I bring this up to say that in a psych residency you’re likely to have more time compared to other specialties. Outside of brand new programs, the consensus I’ve heard from many is that most programs will get you to where you need to be (outside of niche interests). I felt I’d be miserable in a town closer to family versus a city way farther from family, and while I miss family sorely for these 4 years, I suspect the day to day benefits of city training I take for granted in some way. It was probably the right choice.

If you resent the place you’re training at I think it could really impact your life for those four years, even if the training quality is great. OHSU is no MUSC apparently but it’s still an academic program with some rigor. Short of caring about prestige and 100% wanting an academic career (even then I suspect OHSU would be solid) you’d become a great psychiatrist at either program.

Obviously I lack the perspective of valuing “connections” in a region to obtain a psychiatrist job as I have not been through that yet, but I’d argue that psychiatry has possibly the best job market it has ever had right now and is among the easiest to move around with.

 

[Stagg737]

Should I go to a place that might be ideal in location, at the sacrifice of close family, training quality plus heavier call.. or should you go somewhere proven to be strong with family around but it's boring and there's nothing enjoyable to do?.. This feels impossible. Thank you!

The two bolded items are at odds with each other. What's the point in going to a place where you think you'd like living if you never get to experience a decent work/life balance?

I agree with the point of going somewhere that you actually want to be. It's 4 years, you don't want to be miserable all the time. That being said, you are going to be spending a significant amount of time at the hospitals/clinics and at work. A program where you are working significantly harder and have more call (especially if it's very frequent) isn't going to leave you as much time for yourself and miserable during the work hours. This is part of why I hate the shift to virtual interviews. It was hard enough to gauge this during a day or two of interviews, I can't imagine having any idea what a program is actually like, especially the facilities and cultures without physically going there.

 

[clausewitz2]

The two bolded items are at odds with each other. What's the point in going to a place where you think you'd like living if you never get to experience a decent work/life balance?

I agree with the point of going somewhere that you actually want to be. It's 4 years, you don't want to be miserable all the time. That being said, you are going to be spending a significant amount of time at the hospitals/clinics and at work. A program where you are working significantly harder and have more call (especially if it's very frequent) isn't going to leave you as much time for yourself and miserable during the work hours. This is part of why I hate the shift to virtual interviews. It was hard enough to gauge this during a day or two of interviews, I can't imagine having any idea what a program is actually like, especially the facilities and cultures without physically going there.

To say nothing of the impossiblity of replacing the real scuttlebutt you'd get on a program at the evening functions once the residents got a couple beers in them.

 

[Stagg737]

To say nothing of the impossiblity of replacing the real scuttlebutt you'd get on a program at the evening functions once the residents got a couple beers in them.

Exactly, there were 2 programs I interviewed at that I was really excited about but after talking to the residents in person it significantly changed my opinion and where I ranked them. I remember one in particular the residents seemed really worn down/burnt out. It was a stark difference from how the chief and the faculty interactions went. Another seemed pretty solid online and from everything I could research but was extremely underwhelming and disappointing when I visited and the residents were very clear that the facilities/hospitals left quite a bit to be desired.

 

[clozareal]

Go to MUSC and then go to nature/mountains and ski during your vacations or weekends. If you have less call and will be less burnt out from residency while also getting top tier training, a 5 hour drive to NC to ski on the weekends will definitely be doable.

 

[annoyedpsychiatrist]

MUSC has a huge number of residents each year which is interesting. I think its more competitive if you want to practice in that area after, because its a highly desirable area to live in the state, and even in the SE. The city is very pretty and im sure jobs get a bit more applicants there.

 

[dl2dp2]

MUSC has a national reputation in academic psychiatry concerning research, etc., which is also why I think people here favor MUSC. There are some especially strong areas (substance abuse, which is probably in the top 5).

OHSU is decent, but I think you are talking a community program in Portland?

 

[clausewitz2]

MUSC has a national reputation in academic psychiatry concerning research, etc., which is also why I think people here favor MUSC. There are some especially strong areas (substance abuse, which is probably in the top 5).

OHSU is decent, but I think you are talking a community program in Portland?

If poster is not talking about OHSU but about Good Samaritan, they may want to look at a map. Corvallis is not really reasonable commuting distance from Portland so they will need to be okay with a less urban experience (which might be fine if skiing is their big thing).

FWIW if this board is to be believed Charleston SC is one of the few markets that seems to be genuinely saturated with psychiatrists to the point that making a go of it in private practice seems more difficult.

 

[annoyedpsychiatrist]

FWIW if this board is to be believed Charleston SC is one of the few markets that seems to be genuinely saturated with psychiatrists to the point that making a go of it in private practice seems more difficult.

i believe it because they graduate a large number of psychiatrists, and the city is very very nice (at least in my opinion), compared to many other SE cities. So its not hard to believe that many people would want to practice in that area. Greenville SC is another very nice area that can be hard to get a job at. In my opinion, greenville and Charleston are the nicest cities in SC, and probably two of the nicest cities in SE in general.

 

[comp1]

Where do you want to live after graduation. Few people move away.

 

[Merovinge]

If you are talking about OHSU, it's a plenty strong program for good training. If your people are outdoorsy/mountain/ski people that would make way more sense to me than staying in an area you feel stagnant at. That said I have only heard good things about MUSC so you are not exactly choosing between great and bad, just two good options in very different cities.

 

[whopper]

I remember seeing several residents in NYC programs be told what a great place to do residency cause you can have fun in NYC.

Then I remember all of the 2nd year residents, and all of them told me they've done zero partying in NYC except a few nights before residency started cause they had no time otherwise.

 

[dozitgetchahi]

I’m kinda intrigued that people are talking so much about “recreating” during residency.

My residency was in internal medicine, so I guess I can’t speak to what it’s like in a psych residency, but I can say with authority that I barely had time to do much of anything else and that my location truly wouldn’t have mattered much. (And I actually liked my location quite a bit.)

My personal recommendation is to balance “prestige” with practical considerations such as cost of living. One thing that *will* make you miserable, for instance, is paying $2k/month in rent while making $50k/yr. Portland is an extremely expensive place to try to get by on a resident salary, so that would get it moved way down the list for me. Get through training, get a job where you want to be, and then get on with your life and do whatever you want. I currently live and work hundreds of miles away from where I did residency and fellowship. None of my co fellows currently work in the same state(s) they trained in. In my experience, lots of people move around after training and barely anyone stays in the same place afterwards.

(Also, don’t discredit the value of having family nearby - this can be VERY helpful during medical training. I think this is much more important than having ski slopes etc nearby.)

 

[Stagg737]

I will reiterate, pick a program where you like the actual program/residents/facilities. You will spend most of your time there. Being somewhere you like outside of work is wonderful, but it will still be a miserable 4 years if you hate where you work and you can always take vacations and move after residency.

 

[whopper]

Several residents, and I heard actual figures from a study, but when I last saw it was years ago, tend to stay in the area where they trained. By the time you finish training you may choose to settle down for several reasons. E.g. you may have dated someone in the area, and the relationship has long-term promise, you know the professional landscape, or may have enjoyed your time at a specific institution and don't want to leave it.

By the time I left Cincinnati, about 2 years after fellowship, I had a great rep among the local judges. I knew if I left I'd have to start from zero cause this type of rep doesn't travel with you.

 

[shoenberg3]

I am finding plenty of time to "recreate" on the weekends, despite only being on off-service rotations thus far as current PGY1.
I am at a Midwest program, but being originally from West Coast I do miss having access to mountains, beaches, and outdoor activities. So, I am trying to fill my time with other activities.

I am very happy with the program, otherwise. If I were at a true work-horse program, I would imagine that I would not have this "problem" in the first place.

 

[comp1]

There are definitely chill residencies where you could have plenty of time to enjoy the surrounding area. It's a consideration (the chillness more than than activities in the surrounding area). I still think the biggest consideration should be if you plan to remain in the area post graduation because statistically...most people don't move. It's really a lot harder than graduation from med school where you're just ordered to move.

 

[Riptoe]

OP, I went to medical school in VA. Things may have changed but when I was applying last year - ppl told me not to go to VCU's program because a few residents were miserable there - I'm talking not one good thing to say. Admittedly, N=1. I love richmond thought and think it's an awesome location otherwise.

 

[mcatqueen]

OP, I went to medical school in VA. Things may have changed but when I was applying last year - ppl told me not to go to VCU's program because a few residents were miserable there - I'm talking not one good thing to say. Admittedly, N=1. I love richmond thought and think it's an awesome location otherwise.

I interviewed at VCU and thought their residents seemed to be a nice and close knit group and the PD seemed kind. I didn't meet anyone who was miserable (but maybe they were on call during my interview and that's why I didn't meet them and they were miserable? lol)

 

[reca]

I interviewed at VCU and thought their residents seemed to be a nice and close knit group and the PD seemed kind. I didn't meet anyone who was miserable (but maybe they were on call during my interview and that's why I didn't meet them and they were miserable? lol)

Lol, VCU is the program that got blasted on reddit last year. Apparently they've had a resident quite every year for the last four years (or at least the last four years when that post went up) because of abuse. The program coordinator wrote a detailed email that got leaked where she detailed the racism and toxic nature of the department.

 

[mcatqueen]

Lol, VCU is the program that got blasted on reddit last year. Apparently they've had a resident quite every year for the last four years (or at least the last four years when that post went up) because of abuse. The program coordinator wrote a detailed email that got leaked where she detailed the racism and toxic nature of the department.

wow!! link?

 

[reca]

wow!! link?

There was another post that seems to have been deleted but this one is still up:

 

[MacDonaldTriad]

to steal from the real estate industry, Location Location, Location. This is what most people decide.

 

[whopper]

I interviewed at VCU and thought their residents seemed to be a nice and close knit group and the PD seemed kind. I didn't meet anyone who was miserable (but maybe they were on call during my interview and that's why I didn't meet them and they were miserable? lol)

Lol, VCU is the program that got blasted on reddit last year. Apparently they've had a resident quite every year for the last four years (or at least the last four years when that post went up) because of abuse. The program coordinator wrote a detailed email that got leaked where she detailed the racism and toxic nature of the department.

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When the coordinator outs the problems, unlesss it's a fake message, then there's something seriously wrong. As for the residents seeming nice, very rarely will a resident admit a program sucks. They want good new blood for themselves to have good colleagues even in a toxic program.

 

[my existential crisis]

I interviewed at MUSC and thought that the strength and lower amount of call was really great on top of the fact that I also have family very close by. The program had everything I was looking for. However, I'm really, really tired of South Carolina because I have been dreaming of moving somewhere with the mountains/outdoors and access to skiing for years. I have done everything here there is to do and I'm sick of the place. I interviewed at the program in portland and V.C.U in richmond and thought that the programs themselves weren't necessarily as strong for what I'm wanting and had a lot heavier call and heavier taxes (portland I'm looking at you as the taxes are through the roof for high income earner). I could ski the entire ski season on my off days and have things to do in the summer. They are less than ideal in terms of diverse training sites, patient population and therapy training but are awesome in terms of geography + lifestyle and are where I could potentially see myself living long term (or possibly leaving to Colorado from after if I don't like them or can't afford the taxes in portland).

Should I go to a place that might be ideal in location, at the sacrifice of close family, training quality plus heavier call.. or should you go somewhere proven to be strong with family around but it's boring and there's nothing enjoyable to do?.. This feels impossible. Thank you!

This sounds like a future situation that I'll be in... I currently live in Downtown Greenville and just got accepted to UofSC medical school in Greenville with my fiance and plan to go there because of the location instead of going to MUSC... (fyi, I went to Clemson and moved to Charleston after graduating, and I was shell shocked by the lack of outdoor activities to do), and am super excited to move back to the Greenville area where there is lots of things to do outdoors nearby.

On that note, I started doing CrossFit this past year, and it 100% quenched my thirst for outdoor activities like hiking and trail running. If you do go to MUSC for psychiatry residency (I want to do psychiatry too!), I would highly recommend checking out Iron Bridge CrossFit. It's a great place to meet new people, and CrossFit is really tough but rewarding. All in all, Charleston was an adjustment, and I'm excited to move away from here, but it's not too bad. FYI, don't live downtown, it costs me and my fiance an arm and a leg to live there (so she could walk to MUSC for her research assistant job), and it's still not worth it.

Good luck on your decision! PM me if you'd like some additional info on the Charleston area