Serious: Psychiatry Residency Programs to Steer Clear Of

[moto_za]

Please share your thoughts of programs to avoid if it all possible. Feel free to PM your thoughts and I can post it anonymously as well.

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[really_realistic]

From what I’ve heard, arrowhead (CA) and duke (NC) are miserable

 

[TexasPhysician]

From what I’ve heard, arrowhead (CA) and duke (NC) are miserable

I interviewed at Duke and ranked them highly. Clinical hours may be on the higher side, but their teaching and technology they use are fantastic. Faculty were very personable. Certainly not a program that I would avoid.

 

[Not_a_psychic]

A quick search of LSU Shreveport on this forum will give you all the info you need to know about why to avoid.

 

[Taddy Mason]

Programs that are okay with residents ending statements in prepositions.

 

[clausewitz2]

Programs that are okay with residents ending statements in prepositions.

Sentence-final prepositional phrases have been a robust feature of English and other West Germanic languages for many centuries (you will find plenty of examples in Shakespeare, for instance), and any proposed prohibition against their use is purely an aesthetic judgement that is arbitrary and utterly without any objective basis. It is also baffling, as attempting to avoid this makes many very grammatical and unobjectionable sentences extremely awkward.

 

[Roxas]

Sentence-final prepositional phrases have been a robust feature of English and other West Germanic languages for many centuries (you will find plenty of examples in Shakespeare, for instance), and any proposed prohibition against their use is purely an aesthetic judgement that is arbitrary and utterly without any objective basis. It is also baffling, as attempting to avoid this makes many very grammatical and unobjectionable sentences extremely awkward.

Such as:

"Psychiatry Residency Programs of Which to Steer Clear?"

Can confirm. Not a fan.

 

[really_realistic]

I interviewed at Duke and ranked them highly. Clinical hours may be on the higher side, but their teaching and technology they use are fantastic. Faculty were very personable. Certainly not a program that I would avoid.

Guess you were a better fit for Duke than the people I’ve talked to. I know someone who left the program after a year and transferred to a different psych program. He wasn’t alone. Others have echoed the residents are overworked and unsupported.

 

[WisNeuro]

I would pick residency programs in university settings based purely on how much I hate their fan base. So in this instance, Duke can suck it. So, put me up for a no vote on Duke.

 

[MacDonaldTriad]

Old joke, but fairly good.

A snobbish English teacher was sitting in an Atlanta airport coffee shop waiting for her flight back to Connecticut, when a friendly Southern Belle sat down next to her.
"Where y'all goin' to?" asked the Southern Belle.
Turning her nose in the air, the snob replied "I don't answer people who end their sentences with prepositions."
The Southern Belle thought a moment, and tried again.
"Where y'all goin' to, BITCH?"

 

[OldPsychDoc]

I would pick residency programs in university settings based purely on how much I hate their fan base. So in this instance, Duke can suck it. So, put me up for a no vote on Duke.

Well, that would take your (presumed) alma mater right out of the running then.
(And would be most unfair to an excellent PD and group of residents.)

(Eh--for that matter the residency program where I trained is sponsored by an institution with an even more obnoxious fan base...)

 

[WisNeuro]

Well, that would take your (presumed) alma mater right out of the running then.
(And would be most unfair to an excellent PD and group of residents.)

Go GREEN!

 

[Broloft]

The ones that misdiagnose BPD as Bipolar.

 

[phonyreal98]

I would pick residency programs in university settings based purely on how much I hate their fan base. So in this instance, Duke can suck it. So, put me up for a no vote on Duke.

I like where this thread is going!

 

[Stagg737]

Well, that would take your (presumed) alma mater right out of the running then.
(And would be most unfair to an excellent PD and group of residents.)

(Eh--for that matter the residency program where I trained is sponsored by an institution with an even more obnoxious fan base...)

Huh, I didn't know Norte Dame had a psych residency...

 

[ridethecliche]

Such as:

"Psychiatry Residency Programs of Which to Steer Clear?"

Can confirm. Not a fan.

Some word choice changes can fix that...

"Serious: (Which) Psychiatry residency programs to avoid (?)"

 

[birchswing]

Hogwarts psychiatry residency is said to be a real donnybrook of mischief and mayhem.

 

[notdeadyet]

It is also baffling, as attempting to avoid this makes many very grammatical and unobjectionable sentences extremely awkward.

To what do you refer?

 

[clausewitz2]

Some word choice changes can fix that...

"Serious: (Which) Psychiatry residency programs to avoid (?)"

This does forgo a perfectly good complete sentence for a sentence fragment for no particular reason, but it does sound better if having a period next to "of" or "with" makes you see red for some reason.

Where do you think that rage comes from?



Yes I know what I did

 

[Taddy Mason]

Sentence-final prepositional phrases have been a robust feature of English and other West Germanic languages for many centuries (you will find plenty of examples in Shakespeare, for instance), and any proposed prohibition against their use is purely an aesthetic judgement that is arbitrary and utterly without any objective basis. It is also baffling, as attempting to avoid this makes many very grammatical and unobjectionable sentences extremely awkward.

I was being sarcastic and have no disagreement.

I had a prof. for two different (non-language) courses in undergrad who refused to acknowledge you if you said something to him that ended in a preposition. A friend of mine asked him a question ending in “at” and he didn’t respond. After the 3rd or 4th time asking the prof. turned and said to him, “I’ll acknowledge your f***ing question when you quit dangling your prepositions in my face.”
On any written assignments or exams he would take off points anytime a sentence ended in a preposition. It’s been hard not to notice sentences ending prepositions since. One of my friends from med school goes out of his way when texting me to end sentences with prepositions or really awkward prepositional phrases.

 

[nitemagi]

I was being sarcastic and have no disagreement.

I had a prof. for two different (non-language) courses in undergrad who refused to acknowledge you if you said something to him that ended in a preposition. A friend of mine asked him a question ending in “at” and he didn’t respond. After the 3rd or 4th time asking the prof. turned and said to him, “I’ll acknowledge your f***ing question when you quit dangling your prepositions in my face.”
On any written assignments or exams he would take off points anytime a sentence ended in a preposition. It’s been hard not to notice sentences ending prepositions since. One of my friends from med school goes out of his way when texting me to end sentences with prepositions or really awkward prepositional phrases.

I'm a professional writer and I don't give a **** about things like this.

 

[st2205]

The ones that misdiagnose BPD as Bipolar.

So most of them.

 

[ridethecliche]

This does forgo a perfectly good complete sentence for a sentence fragment for no particular reason, but it does sound better if having a period next to "of" or "with" makes you see red for some reason.

Where do you think that rage comes from?



Yes I know what I did

 

[Shufflin]

All this angst against. All this anxiety regarding programs you may get into. What's it all about? Every program has something to be frightened of. And in every program there's much to be pleased about. Imagine the pressure you'll be under. You have to ask yourself, what qualities are you interested in? If you wind up in a truly awful program, be sure to find someone to study with.

 

[erg923]

I'm a professional writer and I don't give a **** about things like this.

I was being sarcastic and have no disagreement.

I had a prof. for two different (non-language) courses in undergrad who refused to acknowledge you if you said something to him that ended in a preposition. A friend of mine asked him a question ending in “at” and he didn’t respond. After the 3rd or 4th time asking the prof. turned and said to him, “I’ll acknowledge your f***ing question when you quit dangling your prepositions in my face.”
On any written assignments or exams he would take off points anytime a sentence ended in a preposition. It’s been hard not to notice sentences ending prepositions since. One of my friends from med school goes out of his way when texting me to end sentences with prepositions or really awkward prepositional phrases.

And people think academics are arrogant and out of touch with the rest of America. Hmmm

 

[st2205]

I saw these guys last week.

 

[Taddy Mason]

I saw these guys last week.

Did it inspire you to purchase a walk in humidor?

 

[MedMan80]

Should get a sense of how the program is from what the residents tell you, unless they're too frightened to talk up; which could give you clue if they all seem to be acting happy/giddy. I was always sure to tell the truth about my program to applicants, in a round about way, if clinical services were resident heavy, if calls were heavy..its only the truth and no reason to sugar coat. Unfortunately during my interview I only met with the chiefs/attendings and so got the sugarcoated version..

Important thing to remember is that while most programs have pluses and minuses, there are workhorse driven programs out there that are funded poorly and therefore have a focus on resident run services vs education..saying that doesn't make them malignant...that's a different story all together.

 

[rjs2131]

Guess you were a better fit for Duke than the people I’ve talked to. I know someone who left the program after a year and transferred to a different psych program. He wasn’t alone. Others have echoed the residents are overworked and unsupported.

Current Duke resident here. It's surprising (and unfortunate) how some of the common misconceptions about the program from when I was applying are still circulating --- Duke has definitely been a front-loaded program historically and I wouldn't call the first 2 years easy by any means, but I'm not aware of anyone that has left the program since I've been here for anything other than personal reasons (i.e. spouse finds job on west coast, program supports resident in transitioning to another program). That said, I don't think the first two years are significantly more difficult than your average psych program and in the last ~5 years or so, the residents and PD have driven a ton of change to promote wellness...you can probably find the exact call schedule/hours/etc on another thread but it typically averages to ~40-50% of weekends off the first 2 years and then >90% of weekends off as an upper level. I averaged around 50 hrs/week my first 2 years (now it's more like 30-40). Definitely wouldn't describe the program as "unsupportive" - in fact I'd argue the opposite as we have a PD who is a proponent for resident wellness and is constantly looking for mechanisms to improve the resident experience.

Happy to answer more specific questions, but I'd definitely come back if I had to choose again

 

[ridethecliche]

I saw these guys last week.

I didn't realize that Smashing Capsids was still touring!

 

[Monocles]

Trying to guide this thread back to what was intending.

Even though we're on an anonymous forum, I think there's a lot of social stigma against residents and faculty speaking out about the flaws of their own programs, or other programs that they've heard about. (Because we are all nice people and don't want to badmouth other programs, especially if we don't go to them)

My general advise for OP is to go to dinners beforehand and talk to the SOs/spouses of current residents and fellows and ask how happy their partners are. Even though residents generally will try to put on a happy face at any dinner they attend (selection bias of the most motivated/happiest), I think SOs are generally more forthcoming if their medical partners are overworked and downtrodden from training.

Or straight up ask trainees if they are happy and read their microexpressions. If there's a pause or a sudden gaze away, maybe inquire more.

 

[pbdoctor1]

I think it's important to figure out which programs fire residents and are malignant.

According to ACGME there's one program on probation in psychiatry and i would be weary if it were malignant or has had a history of firing residents or a hostile PD which can destroy or cause you to lose your medical career!

 

[Mass Effect]

I think it's important to figure out which programs fire residents and are malignant.

According to ACGME there's one program on probation in psychiatry and i would be weary if it were malignant or has had a history of firing residents or a hostile PD which can destroy or cause you to lose your medical career!

I think the plural ("residents") is very, very important. A program terminating a resident isn't necessarily a red flag. Look for programs on probation, multiple resident firings, or hostile PD.

 

[MacDonaldTriad]

Trust me, it could be argued that over all programs fire less residents than they should be fired. I'm sure there have been unfair firings, but think about the consequences of not firing people who are outright dangerous, sociopaths or unremediable despite multiple efforts. Training is the last stop before unleashing havoc to the world. Undergraduate medical education isn't prone to over weeding and nor are we, but when we have to be, we better be able to end a career. Everyone has heard of it happening. I have seen it in our program twice in three decades. I have done it once. If the ACGME gets too trigger happy on sanctions for this, there will be other consequences you don't want. It is an ugly, yet real reality.
Yes, there is a flip side that supports the ACGME keeping an eye on the reasons for resident termination that I also agree with.

 

[LABrondo]

Trust me, it could be argued that over all programs fire less residents than they should be fired. I'm sure there have been unfair firings, but think about the consequences of not firing people who are outright dangerous, sociopaths or unremediable despite multiple efforts. Training is the last stop before unleashing havoc to the world. Undergraduate medical education isn't prone to over weeding and nor are we, but when we have to be, we better be able to end a career. Everyone has heard of it happening. I have seen it in our program twice in three decades. I have done it once. If the ACGME gets too trigger happy on sanctions for this, there will be other consequences you don't want. It is an ugly, yet real reality.
Yes, there is a flip side that supports the ACGME keeping an eye on the reasons for resident termination that I also agree with.

Shouldn’t the program change who they choose to interview/rank if that is the case, if it’s over a number of years?


Sent from my iPhone using SDN mobile

 

[OldPsychDoc]

Shouldn’t the program change who they choose to interview/rank if that is the case, if it’s over a number of years?

Well it would be really thoughtful of applicants to declare ahead of time--like on the interview day-- that they are a) habitual sociopaths; b) planning to develop a raging substance abuse problem; c) expecting to use their patient panel as a dating pool; or d) not interested in following basic expectations of performance. Unfortunately, applicants aren't always forthcoming with that information, and generally are pretty good at covering it up for a day or two.

 

[MacDonaldTriad]

Shouldn’t the program change who they choose to interview/rank if that is the case?

The fewer interviews a faculty member is willing to do is directly proportional to how likely they will say this to me.

 

[FFH]

Trust me, it could be argued that over all programs fire less residents than they should be fired. I'm sure there have been unfair firings, but think about the consequences of not firing people who are outright dangerous, sociopaths or unremediable despite multiple efforts. Training is the last stop before unleashing havoc to the world. Undergraduate medical education isn't prone to over weeding and nor are we, but when we have to be, we better be able to end a career. Everyone has heard of it happening. I have seen it in our program twice in three decades. I have done it once. If the ACGME gets too trigger happy on sanctions for this, there will be other consequences you don't want. It is an ugly, yet real reality.
Yes, there is a flip side that supports the ACGME keeping an eye on the reasons for resident termination that I also agree with.

For an example of the ugly, real, and deadly reality of resident program brings too lenient and protective, I recommend Dr.Death, a podcast about a neurosurgeon who graduated with having done less than 100 procedures yet still able to graduate from U of Tennessee and was recommended as “one of the best graduates” to hospitals

 

[clausewitz2]

For an example of the ugly, real, and deadly reality of resident program brings too lenient and protective, I recommend Dr.Death, a podcast about a neurosurgeon who graduated with having done less than 100 procedures yet still able to graduate from U of Tennessee and was recommended as “one of the best graduates” to hospitals

Didn't it take two years for him to lose his license despite paralyzing people with routine surgeries and showing up to the OR manic and/or high?

 

[deleted736562]

The problem is that residents should also have the right to "fire" a residency programs i.e having the option of switching residencies i.e jobs. the power dynamic is so one sided so let's not kid ourselves here.

 

[Crayola227]

Didn't it take two years for him to lose his license despite paralyzing people with routine surgeries and showing up to the OR manic and/or high?

he wasn't manic, he was high on cocaine

there's a thread in SPF about it that's worth reading, would love to get a psych's viewpoint on in

 

[clausewitz2]

he wasn't manic, he was high on cocaine

there's a thread in SPF about it that's worth reading, would love to get a psych's viewpoint on in

Fair enough - article I actually read about him was from when he was still practicing (!) and there was just rampant speculation

 

[pbdoctor1]

Well it would be really thoughtful of applicants to declare ahead of time--like on the interview day-- that they are a) habitual sociopaths; b) planning to develop a raging substance abuse problem; c) expecting to use their patient panel as a dating pool; or d) not interested in following basic expectations of performance. Unfortunately, applicants aren't always forthcoming with that information, and generally are pretty good at covering it up for a day or two.

On the flipside which malignant programs will disclose that they are abusive, hostile program directors, disorganized, on probation with ACGME to applicants during interviews? I'm sure programs will hide that as much as they can.

Nothing stops residency programs to refuse to renew contracts of outlier problem residents. However normal residents have limited to NO recourse to outlier malignant programs if they simply just don't like you. This power dynamic allows abusive behavior to proliferate since there is an unspoken silence of bad residency or risk you career. A (pathological) PD can blackball you from another residency program since most program directors talk and meet annually. They can literally end your career which most medical applicants dont have knowledge of which programs do that until it's too late, so choose wisely!

Also we've seen our share of doctors who are unprofessional, unqualified, but are "sociopathic" and learn to kiss butt during medical school interviews, residency and play politics to graduate residency. Some of them become the toxic environment of burnt out attendings or worse a personality disorder aka narcessitic program director in these places thereby continuing the cycle of malignancy!

Plus ACGME typically never intervenes on malignant programs and only puts residencies on probations that are overtly bad. Medical applicants simply don't know which programs are bad. ACGME and asking around is the bare minimum way to help inform medical applicants to have insight and not risk their careers!

 

[Monocles]

I think it's important to figure out which programs fire residents and are malignant.

According to ACGME there's one program on probation in psychiatry and i would be weary if it were malignant or has had a history of firing residents or a hostile PD which can destroy or cause you to lose your medical career!

This is good, but there should also be a way to search when residents voluntary leave their programs. If a program has high attrition (maybe 1 resident leave every class) then applicants should be doing more research. For instance, friend of mine from cross the city recently had one of their pgy-3s quit. Through the grapevines we finally find out that their PD was placing people on leave and forcing state board mandated psych evals on their "problem residents"! Never would have thought of that even though our programs are right across the city from one another.

 

[pbdoctor1]

This is good, but there should also be a way to search when residents voluntary leave their programs. If a program has high attrition (maybe 1 resident leave every class) then applicants should be doing more research. For instance, friend of mine from cross the city recently had one of their pgy-3s quit. Through the grapevines we finally find out that their PD was placing people on leave and forcing state board mandated psych evals on their "problem residents"! Never would have thought of that even though our programs are right across the city from one another.

Wow!

There has been discussions about this before at other residencies and this seems like one common tactic by malignant program directors by illegally arm chair diagnosing "problem residents" and forcing a formal evaluation of the residents for their supposed "mental health" problems and documenting it as opposed to the reality of the abusive programs themselves. Worse if it's a psychiatric residency they knowingly made a significant ethical violation. Obviously these are outlier situations not reflective of all residencies but enough of these tactics and malignant programs exist that that this seems like a common practice.

Residents quitting, transferring, or fired should be a big red flag for medical applicants but it is just not known or recorded or too radioactive to even be discussed without jeopardizing residents' medical career.

There is a link for access to ACGME programs under probation if you google "ACGME probation status" that will help guide medical applicants.

Hope this helps future colleagues and reduces physician burnout and suicides. Maybe more physicians come forward to disclose these maignant programs that may not be under this list before they quit or become fired or blackballed from programs.

 

[ryerica22]

There is no program to truly steer clear of in my opinion. It is better to match somewhere than nowhere at all.

 

[pbdoctor1]

There is no program to truly steer clear of in my opinion. It is better to match somewhere than nowhere at all.

There are discussions that some applicants match in a malignant residency and get blacklisted or fired and can never match or become a physician again with some wasting years of their lives and ending their careers permanently.

Program directors talk to each other and have annual meetings.

 

[Stagg737]

Wow!

There has been discussions about this before at other residencies and this seems like one common tactic by malignant program directors by illegally arm chair diagnosing "problem residents" and forcing a formal evaluation of the residents for their supposed "mental health" problems and documenting it as opposed to the reality of the abusive programs themselves. Worse if it's a psychiatric residency they knowingly made a significant ethical violation. Obviously these are outlier situations not reflective of all residencies but enough of these tactics and malignant programs exist that that this seems like a common practice.

Residents quitting, transferring, or fired should be a big red flag for medical applicants but it is just not known or recorded or too radioactive to even be discussed without jeopardizing residents' medical career.

There is a link for access to ACGME programs under probation if you google "ACGME probation status" that will help guide medical applicants.

Hope this helps future colleagues and reduces physician burnout and suicides. Maybe more physicians come forward to disclose these maignant programs that may not be under this list before they quit or become fired or blackballed from programs.

Nice link, I'd mention that not all the "probation" programs seem to be because of violations though. My med school started a psych residency (current PGY-1's are first class) and they are listed as probationary. Idk the details of getting on that list, but just think people should look into why those schools are on the list before jumping to conclusions.

 

[pbdoctor1]

Nice link, I'd mention that not all the "probation" programs seem to be because of violations though. My med school started a psych residency (current PGY-1's are first class) and they are listed as probationary. Idk the details of getting on that list, but just think people should look into why those schools are on the list before jumping to conclusions.

Good point and I agree take things with an additional information point for applicants and when you go to the residency interview you can make your best judgement. This is just a first step for applicants with limited information.

Any other suggestions for applicants to get better information to avoid malignant programs as those requested by OP feel free to share!

 

[MedMan80]

I've also seen PD's try to strong arm their residents by threatening random UDS tests, although nobody seemed like they were obviously impaired at work. Such a blanket threat is likely more of a strong arm tactic to keep resident's, because if there truly was suspicion the PD could always test that individual resident without threatening everyone..