San Francisco Residencies

[kingfisher89]

Hi, I'm really sorry if this is the wrong place to post this, but I'm trying to get more of an idea whether or not this is a realistic thing. I'm trying to get into a residency in San Francisco to be able to move with my SO who is going there for a grad school, but I'm having trouble gauging how truly competitive it is and where I actually fall in terms of competitiveness.

So, I'm a rising MS4 at an allopathic school on the east coast (one of the best for primary care, not sure where it is in other rankings) and I want to do addiction psych/general psych primarily with the homeless population. Step 1 is 233, taking CK at the end of this month. I have some research experience in ID, but no publication yet. I'm doing a project starting a free footcare clinic for the homeless in the city where I'm at. Years 1-2 were Pass/Fail and I passed everything. For MS3 rotations I got a mix of honors (surgery, IM, neuro, hopefully psych) and HP (ob, family, peds). I'm hopefully doing an away at UCSF in the early fall.

Is it insane for me to try to get to the Bay Area? I'm really mostly just interested in being in the area vs. being in a specific program out there.

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[splik]

UCSF is one of the most competitive programs in the country. Doing an away (ideally something like inpatient psych at the general) and making a good impression can go a long way. Like other top programs they are really looking for people who are going to be leaders in the field, and while the department seems to be more on a research kick and has been getting more residents interested in research, having some sort of track record in leadership, administration, education, policy, public service etc are all relevant too.

CPMC is the other SF program and is much smaller (4 residents per year) and as a non-academic program is less competitive. Historically it has been very psychodynamically oriented but is moving away from that (similarly, UCSF has also moved away from being as psychotherapy heavy). They try to interview everyone early, so planning on interviewing there early is the best way to get in there.

Programs in the bay area are sensitive to the astronomical costs and the fact that many people will not choose them by virtue of the area being almost unlivable (particular if you have a family and a non-working partner). As such having a clear reason to want to be there is an important consideration though of course does not make up for any deficiencies in your application.

You should also check out san mateo given your interests in community psychiatry. This is a small program like CPMC but unlike CPMC is a county program. it historically has a very good reputation for clinical training and the fact they have no call and can internally moonlight in the PES for about $175/hr overnight.

Stanford is a little further afield, and nowadays is a really excellent program though community psychiatry is a massive weakness of the program. However, they are sensitive to this, and there is enough elective time and connection with local community organizations to carve something of interest out. Again it is a pretty competitive program, but less so than UCSF. They also pay better and have really good benefits and have really good psychotherapy training.

I would see if you can also do an away rotation at San Mateo or CPMC so you can get a better sense of those programs especially if you are motivated to match into a program in the bay area. Also schedule your CS exam in the next few months - the sooner you can have that pass score in, the better.

 

[kingfisher89]

Thank you for the advice! I'll try to get an away with CPMC or San Mateo as well!

 

[NickNaylor]

I interviewed at San Mateo and will second that program. I was pretty impressed with it. It is extremely small (4 residents/year when I interviewed), but it is VERY amenable to lifestyle. The residents and program leadership proudly declared that you will never work than 40 hours/week during your training there. This makes me wonder how good the clinical training could possibly be - at some point, you simply need to see lots and lots of patients - but nonetheless that's a huge benefit. Most of the residents that match there are from high-caliber institutions, for whatever that's worth.

Certainly an interesting program. If you're interested in a nice lifestyle during training and/or community work, I would definitely throw this program on your list.

 

[slappy]

UC Davis is an option as well, albeit you'd realistically only see your SO during the weekends.

 

[WingedOx]

The residents and program leadership proudly declared that you will never work than 40 hours/week during your training there.

That scares me to read.

 

[NickNaylor]

That scares me to read.

This was sort of my response, too. Well that's my response now - as an applicant, it sounded pretty sweet. In retrospect, I'm not sure that that's the kind of environment I would've wanted to be in.

 

[3lefts]

This was sort of my response, too. Well that's my response now - as an applicant, it sounded pretty sweet. In retrospect, I'm not sure that that's the kind of environment I would've wanted to be in.

I think how I felt about the environment would depend a lot on my co-residents. If they were intellectually curious and had full, enriching, lives outside of training, less hours could be a positive (at least vs scut). I would use extra time to read relevant literature and nourish my relationships. However, I don't think it would be very inspiring or rewarding to be in a residency where I was surrounded by people primarily motivated by minimizing their effort.


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[WingedOx]

I think how I felt about the environment would depend a lot on my co-residents. If they were intellectually curious and had full, enriching, lives outside of training, less hours could be a positive (at least vs scut). I would use extra time to read relevant literature and nourish my relationships. However, I don't think it would be very inspiring or rewarding to be in a residency where I was surrounded by people primarily motivated by minimizing their effort.


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I don't deal with residents much nowadays, but as faculty, lazy residents aren't great to deal with from that perspective either, and yeah, psych does tend to attract quite a few. I was having a long conversation with a faculty friend at one of the "top" psych programs today about the attitude problems of the residents there and how frustrating that can be.

Though it's not so much hours as volume. You can take all the independent time you want for reading, but you really need to be seeing a lot of cases to pick up real world experience in handing what to do. If you're only working 40 a week, you're certainly not seeing enough cases on call to be good at triage and assessment. As a med student hearing about programs that ease you into residency and make things easy during PG1 sound great, but in practice, you really should be thrown into the fire and seeing patient after patient. It'll help your confidence as a clinician immensely when you finally feel like you can assess and triage cases, which really helps your morale throughout the rest of training. I see late PG1s and PG2s who haven't worked enough to feel confident in their skills when I'm supervising them on call and it's kind of frustrating, or worse the ones who are overconfident and create problems when they don't realize what they're doing wrong...the latter I had to clean up in a big way last week.

 

[Blitz2006]

That scares me to read.

Not only scary, but sadly gives psychiatrists a rep for being 'lazy'. And also attracts candidates who may not actually like psych, but just entering the field to do 'minimal', 40 hour/week work...

 

[notamindreader]

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[Blitz2006]

Right. I wasn't singling out this program. I don't know anything about it.

Im just saying in general, I think a major reason why psych is becoming more competitive is mainly for lifestyle reasons, with genuine interest being secondary. Obviously I'm generalizing, but that's the trend I've personally noticed...

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[notamindreader]

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[Blitz2006]

Well said

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[MacDonaldTriad]

I wish we had more easy programs around ours. That way no one ends up here because they needed our geography but couldn't find an easier place. I hope someone builds three of them in town. They will not be draining away anyone we want. I can see the argument that if you use the extra time to study, easy can be OK, but you still need to see a lot of patients.

 

[thomasina]

I haven't really heard of specifically cush programs. That said, it did seem that some programs were more friendly towards the idea of having children during residency than others.

I had heard of some workhorse programs such as NYU, but at interviews it seemed like nobody really openly emphasized how *little* one worked and certainly nobody cited it as a reason to rank their program higher...

 

[notdeadyet]

San Mateo encourages moonlighting, so if you feel you're not getting enough clinical exposure, you can always supplement. Frankly, I think at a certain point, your clinical skills advance more quickly via moonlighting vs. directly supervised work due to lack of safety net.

San Mateo Co replaced PDs a little while ago, but the policy used to be a certain number of hours per month were to be spent moonlighting or doing socially/community-oriented volunteering. This may have changed, but I liked it.

 

[WingedOx]

San Mateo encourages moonlighting, so if you feel you're not getting enough clinical exposure, you can always supplement. Frankly, I think at a certain point, your clinical skills advance more quickly via moonlighting vs. directly supervised work due to lack of safety net.

San Mateo Co replaced PDs a little while ago, but the policy used to be a certain number of hours per month were to be spent moonlighting or doing socially/community-oriented volunteering. This may have changed, but I liked it.

I don't know.... I agree that in general "direct patient contact >>>studying" in terms of what's going to bring you along, but if anything advances clinical skills, it's solo call that does it for you, and it's especially important for junior residents/psych interns. I don't really care if a PG4 is working 40 hours, but for a PG1 or 2 that's just going to create inexperienced residents. Moonlighting can be very hit or miss in terms of what you're actually seeing. My residency moonlighting gig just basically wanted someone to write "CPM" with an MD's signature in the chart book so they could bill for the weekend and give us a cut of it.

 

[sazerac]

I haven't really heard of specifically cush programs. That said, it did seem that some programs were more friendly towards the idea of having children during residency than others.

That would be UMass(Worcester). They even joked about the "doubling time" of their residency program. Visibly pregnant residents interviewing visibly pregnant applicants on my interview day.

My wife had a bump and it probably added points to my dinner interview.

 

[slappy]

I think it's a myth that training in places with higher volume equates to better training. Proper graduated autonomy likely does a lot more.

 

[WingedOx]

Proper graduated autonomy likely does a lot more.

You're not wrong, but the easiest and fastest way to put that into practice is a boatload of call.

It was interesting during my chief year following the lower level residents at two programs that shared a call site and seeing how they compared side by side in terms of skills. Both programs bringing in similar quality students, but Program A had a very heavy intern call burden with a more relaxed PG2, whereas Program B had a pretty relaxed intern call burden that was about even between the two years. Late-year PG2s and early PG3s were pretty even between the two programs, but Program A's residents at the start of PG2 were WAY ahead of program B in terms of knowing how to handle themselves and assess and triage difficult cases.

 

[MacDonaldTriad]

I don't think anyone would argue that progressive responsibility isn't key. You do have to get there though.

 

[notdeadyet]

[QUOTE="WingedOx, post: 18919650, member: 36089]Moonlighting can be very hit or miss in terms of what you're actually seeing. My residency moonlighting gig just basically wanted someone to write "CPM" with an MD's signature in the chart book so they could bill for the weekend and give us a cut of it.[/QUOTE]
Good point. When I'm thinking moonlighting, I'm referring to working solo in a busy PES or inpatient place, managing the unit, intakes and discharges.

I think your description of moonlighting being hit or miss applies a lot to call too.

 

[SmallBird]

I couldn't agree more. I think it's pretty evident that there is a bimodal distribution within this specialty with lots of lazy, uninterested people mixed in with plenty of bright, curious ones as well. Having met many future residents on the interview trail, I can confidently say that both of those pools of people are alive and well. Frankly, I think you do a great disservice to your patients and to the specialty as a whole if you elect to pursue Psychiatry based on lifestyle reasons.

Nobody wants a doctor who is lazy and uninterested. And yet choosing psychiatry partly because you hope to enjoy a good work life balance is completely legitimate. As long as this is paired with a commitment to become clinically competent, there is nothing wrong with people looking for training experiences which will allow them to have as much time for family and other pursuits as possible. Some of the residents I know that are most assertive about getting out on time and doing as little call as possible are also extremely available for their patients and clinically skilled.

 

[WingedOx]

I think your description of moonlighting being hit or miss applies a lot to call too.

While this is true, a major difference is that in general, call is done early in residency, moonlighting is done later when the routine stuff isn't routine anymore and you actually know what you're doing. The educational value of the former is a lot higher just because of when you have to do it.

 

[scruffy821]

It's definitely possible to match to a Bay Area program with a 233 Step 1 and your solid clinical grades, but it's important to know that the area is randomly competitive, particularly UCSF, Stanford, and San Mateo. I know people with 240+ Step 1s who didn't get interviews at any of these programs, but I also know people with sub-230 Step 1s who did and matched, so it's really is about your holistic application. They do care a bit about board scores (always helps to do great on Step 2 CK!), but they also look for a true passion for psychiatry, strong clinical grades and LORs, an interest in leadership, and usually some experience with research.

An away in this region could help you get your foot in the door. UCSF has matched multiple students that did away rotations in the past. Both UCSF and Stanford have away rotations available in addiction psych. SF programs like students who have demonstrated connections to California, so make sure to let them know that your SO is in grad school here too.

In terms of competitiveness, I think that UCSF and Stanford are the most competitive and comparably so nowadays -- I know applicants this season who got invites from UCSF but not Stanford, and vice versa. I also know applicants who ranked Stanford over UCSF and vice versa, so it really comes down to personal preference and fit. I agree with splik that UCSF and San Mateo County would offer the most robust experience in community psychiatry, though Stanford is improving in that area with their increased affiliations and rotations with local community and county organizations and hospitals. All three of these programs would offer strong training in addiction psychiatry.

 

[Candidate2017]

Right. I wasn't singling out this program. I don't know anything about it.

Im just saying in general, I think a major reason why psych is becoming more competitive is mainly for lifestyle reasons, with genuine interest being secondary. Obviously I'm generalizing, but that's the trend I've personally noticed...

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On the bright side, I'm just glad med students are now judging the attractiveness of psychiatry with the same criteria they apply to other specialties: least work, most money.

 

[3lefts]

On the bright side, I'm just glad med students are now judging the attractiveness of psychiatry with the same criteria they apply to other specialties: least work, most money.

Ha. Yeah, you've got a point- maybe it means that stigma about the field is down. Not quite sure why so many of my classmates think working with the chronically mentally ill and other folks during the hardest and most painful periods of their lives is suuuuuch a breeze though


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[notamindreader]

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[WingedOx]

Ha. Yeah, you've got a point- maybe it means that stigma about the field is down. Not quite sure why so many of my classmates think working with the chronically mentally ill and other folks during the hardest and most painful periods of their lives is suuuuuch a breeze though


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This week in clinic would scare away even the most idealistic med students, and it's only Tuesday.