Should you do residency where you ultimately want to live?

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Psychczar

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How important is it to go to residency locally? I want to eventually settle down where my family now is in Texas. I am in a competitive medical school in a different state, and I wonder whether it is worth it to move again for a nationally-recognized psychiatry program in the northeast versus a program with a strong regional reputation in the same city as my family. Both programs are pretty comparable in and of themselves, and I genuinely liked both but preferred the NE program just slightly more, and I do think the training of the northeast one is superior in terms of actual "metrics" (i.e. not just reputation/name). I have a few more interviews to go on, but I think I will rank these two programs at the top and would like to get some thoughts.
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Post graduate training is the time of life when people settle down. Residents often tell parents they will be back in a few years and then they stay where they train. Moonlighting gigs evolve into career opportunities; you get invested in real estate, you meet someone with a career going, and boom you stay. I say, if you want to live in Texas, you might as well start living there now. I have nothing riding on this, but if the Texas program is only slightly inferior, the difference doesn’t seem to justify the move.
 
I think this sort of thing is very common for people to face, don't disappear, let us know how you end up deciding!

I think there are a lot of variables to consider- does your family need you around to help face tough life situations? How old are you? Are you married?
If your married and have kids the answer is probably really easy to stay
If your not married, your not tied down now so leaving may be easy, but you could easily become tied down to somewhere else as McD said so i think its kind of a wash overall.

What about the NE program do you like better?

I think its most important for people to do what makes them content. Problem is for some people moving across to the country to a big name place makes them content and for others staying near home and getting on with life makes them content. Some people are content with anything, which makes life easier
 
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Thanks for the responses. I also meant to ask -- is there something to lose by NOT going to residency locally? Could it be a disadvantage to miss out on local networking opportunities, working with residents you will probably go out in practice with, getting to know the mental health system statewide, or being an outsider when applying for academic or community jobs?

Armadillos, I am a traditional applicant (went straight through, mid20s) married without kids (we plan on starting a family towards the end of residency when hours are better and are more financially stable). My spouse is open to moving, though it does mean another job and then another if we go to the NE program.

The NE program had a bigger, more well-funded department with many superstar faculty members, a more flexible schedule, and more interesting elective options. I guess it had "more" of everything, though the TX program had all this this in lesser numbers. The biggest difference I noticed was the didactics didn't seem as well thought out at the TX program (though as a student, I'm not sure what is sufficient here, a rundown of the DSM?). The NE program also had an intellectual/university feel which I think comes somewhat from the fact that it seems most TX medical centers are not affiliated with any undergraduate/graduate university system. Both offered a breadth of sites and a supportive environment.
 
Speaking of myself only, I did training to complete it. I did invest in property as the training length of time was sufficient and it was better option for me to buy a house. As a side note, I do rent the house out as an investment property. I feel there are enough opportunities to explore that one may or may not stay around the area which they train. Keep your eyes and ears open and network at the national conferences.
 
A psychiatrist in town is talking with me about possibly inheriting her practice in a couple years.

These are the kind of connections you will either cherish if you stay, or feel torn over if you move away. So I recommend going to residency where you want to make connections.
 
Psychczar said:
Thanks for the responses. I also meant to ask -- is there something to lose by NOT going to residency locally? Could it be a disadvantage to miss out on local networking opportunities, working with residents you will probably go out in practice with, getting to know the mental health system statewide, or being an outsider when applying for academic or community jobs?
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Yes, you will likely be at a disadvantage for years. By moonlighting, networking, etc, I am much better prepared to know which places are malignant, who pays what, what groups are better, who has connections, what therapists have the better skills, which psychiatrists to trust, what jobs will lie about benefits, etc.

While I live in Texas, I've thought about moving to another city in the state, but I've set things up so well so far that I'm not sure I'll ever leave right now.
 
I'm in strong agreement with making connections and setting up locally over going for academic bells and whistles. But then ironically I didn't take my own advice. And even went to the less academic program in the NE so that my SO could have exciting opportunities.

So now I'm looking at resetting all over again if I want to go back to California. It's setting in exactly what I've done now. Human networks set up over 4 years of training with all those local connections really does set you back years by comparison as an outsider. This would weigh even heavier in other specialties with tighter job markets.

I'm satisfied with my decision, but realize now the costs of it.

Given your SO would actually be set back, I can't see any reason not to go to Texas. Minus a desire for a nationally renown academic career those things don't matter to the vast majority of us. I think sdn has a huge selection bias towards giving a crap about these things over the vastly more practical goals of setting up properly in Texas or Oklahoma or Utah or wherever.
 
Just go where you want to be for the next 4 years. it's not really going to matter a lot down the line. live in the moment, and don't overthink things like you are doing now. They'll be a job for you when you graduate, and it will probably look a lot like the job for you had you stayed in a certain area. All this talk about networking in residency is overrated imo- to the extent you may be 'behind' someone who had been in the area the last 4 years, it wouldn't take long to catch up- practicing psychiatry isn't like the local real estate market or whatever where being there is essential. Trust me the Seroquel you prescribe your patients in Texas is going to give them diabetes just as much as the Seroquel you sling at them in ny. Also, do what *you* want to do. it's your life, not your wifes.
 
vistaril said:
. Also, do what *you* want to do. it's your life, not your wifes.
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From the standpoint of someone who has been happily married for awhile this is terrible advice. Its not "your life" nor is it "your wifes", its both of your lives now. I wouldn't want my wife to take a job in some random city without having me 100% on board, why shouldn't it go both ways?
 
Armadillos said:
From the standpoint of someone who has been happily married for awhile this is terrible advice. Its not "your life" nor is it "your wifes", its both of your lives now. I wouldn't want my wife to take a job in some random city without having me 100% on board, why shouldn't it go both ways?
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just because you are in a long term relationship with someone or married or whatever doesn't mean your life isn't completely yours and their life isn't completely theirs.

As to your last question, why should it go both ways? Just because one partner in the relationship desires A doesn't mean the other partner also desires A.
 
vistaril said:
Just go where you want to be for the next 4 years. it's not really going to matter a lot down the line. live in the moment, and don't overthink things like you are doing now. They'll be a job for you when you graduate, and it will probably look a lot like the job for you had you stayed in a certain area. All this talk about networking in residency is overrated imo- to the extent you may be 'behind' someone who had been in the area the last 4 years, it wouldn't take long to catch up- practicing psychiatry isn't like the local real estate market or whatever where being there is essential. Trust me the Seroquel you prescribe your patients in Texas is going to give them diabetes just as much as the Seroquel you sling at them in ny. Also, do what *you* want to do. it's your life, not your wifes.
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I'm a little surprised by your response as you claim to have difficulty finding good jobs.

The value of residency in your future city of employment is contingent on someone actually moonlighting or networking or something. If you just stay home with your spouse all the time, then it doesn't matter where you train. The more you network, the better value you receive by staying in the same region.

I've spent a lot of time moonlighting and networking, and this is one of the main reasons I am NOT moving. I know that there are jobs in this city that appear good on paper but are actually horrible gigs. If I move, I risk getting temporarily stuck in a job where I am miserable.

I've been able to find and obtain great opportunities because of my networking. If I change jobs, I know a lot people that I could call to determine the desirability of new jobs. I know what people are getting paid in this area, and what I can negotiate. I can absolutely call BS when a hospital makes some claim about how "everyone around here does it this way". They will try this. Subsequently I'm getting paid a higher rate than most salary polls to do enjoyable work. No way I would have found this job without my networking.
 
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TexasPhysician said:
I'm a little surprised by your response as you claim to have difficulty finding good jobs.

The value of residency in your future city of employment is contingent on someone actually moonlighting or networking or something. If you just stay home with your spouse all the time, then it doesn't matter where you train. The more you network, the better value you receive by staying in the same region.

I've spent a lot of time moonlighting and networking, and this is one of the main reasons I am NOT moving. I know that there are jobs in this city that appear good on paper but are actually horrible gigs. If I move, I risk getting temporarily stuck in a job where I am miserable.

I've been able to find and obtain great opportunities because of my networking. If I change jobs, I know a lot people that I could call to determine the desirability of new jobs. I know what people are getting paid in this area, and what I can negotiate. I can absolutely call BS when a hospital makes some claim about how "everyone around here does it this way". They will try this. Subsequently I'm getting paid a higher rate than most salary polls to do enjoyable work. No way I would have found this job without my networking.
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I don't have any difficulty finding jobs that appear just as good as the jobs I see anyone else working. I also do contract work and make a higher than average rate(compared to salaried jobs), but there are downsides to such arrangements as well.
 
MacDonaldTriad said:
Wild guess here, but I'm thinking Vistaril is single. I'll have to look for the psychology journal I saw this in, but looking at sucessful marrages, the key to happiness was to do what ever she says.
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At my own wedding, all of the older men in my family, most of whom have been married for over 50 years, all said the two most important words to remember are, "Yes, dear." and they also said happy wife = happy life
The research is clear that men who are married live longer, but they also have higher rates of depression. Makes a lot of sense if you think about it.
 
MacDonaldTriad said:
Wild guess here, but I'm thinking Vistaril is single. I'll have to look for the psychology journal I saw this in, but looking at sucessful marrages, the key to happiness was to do what ever she says.
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well I've been married before and didn't like it, and the key to happiness for me is doing what makes *me* happy. To each their own.
 
Doing residency in an area will give you a big leg up on getting desirable jobs in that area, assuming you are good. This is not controversial.


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Some people value relationships, some people value independence. I think the most miserable men covet whichever one they don’t have at the time.
 
MacDonaldTriad said:
Some people value relationships, some people value independence. I think the most miserable men covet whichever one they don’t have at the time.
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no reason people can't have relationships and independence.
 
notdeadyet said:
Doing residency in an area will give you a big leg up on getting desirable jobs in that area, assuming you are good. This is not controversial.


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A lot of it is going to depend on what sort of jobs one wants- the qualities that one setting looks for may be completely different than another setting. Some people find VA jobs desirable. Some people find certain academic jobs desirable. Some people find health system community jobs desirable. And each of these settings is going to value different things to some degree.
 
What if you are interested in someone who doesn’t agree to an open marriage? Isn’t that at least one reason you can’t have it both ways?
 
MacDonaldTriad said:
What if you are interested in someone who doesn’t agree to an open marriage? Isn’t that at least one reason you can’t have it both ways?
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sure.....but that sounds like oneitis type thinking. It's my opinion that, even for people very desirous of being in a relationship, there are plenty of people out there they would be happy and compatible with who feel the same way about them. So pick one that you aren't going to have red flags with just because you think they are 'the one'(because there are a ton of others who you could likely feel the same way about)
 
vistaril said:
A lot of it is going to depend on what sort of jobs one wants- the qualities that one setting looks for may be completely different than another setting. Some people find VA jobs desirable. Some people find certain academic jobs desirable. Some people find health system community jobs desirable. And each of these settings is going to value different things to some degree.
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Not all VA, academic, or whatever jobs are the same.
 
vistaril said:
A lot of it is going to depend on what sort of jobs one wants- the qualities that one setting looks for may be completely different than another setting. Some people find VA jobs desirable. Some people find certain academic jobs desirable. Some people find health system community jobs desirable. And each of these settings is going to value different things to some degree.
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Most of this is true, and none of this is contradictory to what I wrote.

Any job to look for, will be helped by having a local reputation. You have a better chance of getting hired by a particular VA if you rotated there as a resident and excelled. You have a better and getting that County mental health clinic job if you there, and know the attending's. You will have a better chance setting up a private practice for joining a successful one, if you to a local residency and have recommendations from people be hiring managers know.


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TexasPhysician said:
Not all VA, academic, or whatever jobs are the same.
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true, not all.....but they tend to be more similar to each other than other types. I've worked or rotated through 4 different VA settings now in psych(in 3 different states), and all were remarkably similar. The jobs I see advertised for most VA positions(and after to the recruiters about them) give me a pretty good idea what to expect as well based on my previous experience there.
 
One nice thing about the field of psychiatry is that it is in demand throughout the US so I don't see how it would be much of a problem to do residency in one area and then return to where you want to live and still have a thriving career. Of course, it could be a bit easier or open a few more doors to have the residency in that same area, but having better training will also make you better wherever you are at. A good psychiatrist will do well regardless of this type of choice. We could use a good one here, maybe even a mediocre one would do. 😉
 
It's relative to desirability of the location as anything. You guys could probably use a good tap dance instructor too. Small towns are kind of as advertised in that sense. You don't remain stolidly opposed to a over a century and a half of human migration without these drawbacks. And benefits if you're want to be there, of course.
 
Nasrudin said:
You don't remain stolidly opposed to a over a century and a half of human migration without these drawbacks.
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what the heck does this even mean?

Additionally, I don't live in a small town but in my experience there are small towns where it is very difficult to find work as a psychiatrist(not because psych services aren't provided...just because the need is already taken care of by an entrenched provider(s) who have no plans to leave).
 
Nasrudin said:
It's relative to desirability of the location as anything. You guys could probably use a good tap dance instructor too. Small towns are kind of as advertised in that sense. You don't remain stolidly opposed to a over a century and a half of human migration without these drawbacks. And benefits if you're want to be there, of course.
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Like my wife likes to say, we get the bottom of the barrel! In metropolitan areas there is much more competition and this can bring the cream of the crop. Of course, I worked with some people in LA that were pretty far from competent, the difference being that you could always go somewhere else. We can't even do that with restaurants here!
 
Yes.

By the time you finish residency you'll have a grasp of the playing field in the area. A lot of what you get is based on your rep and that too will be somewhat developed by the time you graduate. Most residents have opportunities to work outside their program in the local area will have a rep.

This rep and meeting people will develop your network and open doors or close them. Despite the nation-wide shortage of psychiatrists (with exceptions in some areas), I remember one resident that graduated a year ahead of me that did not do good work and no one in the area wanted to hire him.

A disadvantage of staying in an area is it can lead you to being a product of intellectual incest. That is you did it the way it's done where you work but there could be far better ways of doing things.

I learned a heck of a lot at U of Cincinnati working with top people in the field that I did not learn in residency. Where I did residency no one there knew that you could push Zyprexa past 20 mg Q HS, or any of the following phenomenon-Benign Ethnic Neutropenia, When to push Depakote past the 125 level, how and when to use Clozapine blood levels, among a lot of other things. I learned a lot working in the St. Louis Jail that I did not learn at U of Cincinnati.
 
whopper said:
Where I did residency no one there knew that you could push Zyprexa past 20 mg Q HS, When to push Depakote past the 125 level, how and when to use Clozapine blood levels, among a lot of other things.
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jesus was anyone at your residency program even trying I wasn't a very good med student and even I learned those things on med school psych rotations.
 
In a perfect world, it would be great to do residency in an area we planed on settling down.

In this world: I'll take a psychiatry residency pretty much anywhere, LOL!
 
jakeislove said:
In this world: I'll take a psychiatry residency pretty much anywhere, LOL!
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huh? Do you have a lengthy arrest record? Go to Saint whatever in the carrib for med school? If the answer is no to both of the above why in the world would you take 'pretty much anywhere' in psych?
 
Once again, another trying-to-be-informative post that's devolved into a Vistaril vs. Everyone else daytime talk show.

Not saying it's not entertaining though.
 
jesus was anyone at your residency program even trying I wasn't a very good med student and even I learned those things on med school psych rotations.
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Lots of things learned are location-dependent. Certain attendings have a practice style. Residents tend to emulate certain attendings. Most psychiatrist I know still don't know what benign ethnic neutropenia is.
 
Thanks for the input. It sounds like there is agreement on the advantage of establishing yourself locally in residency. On the other hand, are there any advantages to either coming from a different institution or having an Ivy name on your resume? Whopper mentioned gaining a broader idea of practices vs "intellectual incest." From those who moved somewhere new after training, are any of these advantages as significant as those of being local?
 
Psychczar said:
Thanks for the input. It sounds like there is agreement on the advantage of establishing yourself locally in residency. On the other hand, are there any advantages to either coming from a different institution or having an Ivy name on your resume? Whopper mentioned gaining a broader idea of practices vs "intellectual incest." From those who moved somewhere new after training, are any of these advantages as significant as those of being local?
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Ive been moving around the country for undergrad and medical school and now residency. I don't know....I trust whopper's judgment. But the crucial years for this are the final years of training and your first few jobs that enables you to make this assessment. I don't think incest applies too well to undergraduate and medical school training, which are more uniform in experience. Unless you can go big time with it...hell yes...Ivy league degrees make a difference. Although you could well ask yourself..what do my future patients care about it? Private practice on the upper west side of Manhattan vs medium sized town in Texas with a mix of patients. Your mileage varies. I wouldn't alter my plans for the handful of patients opinions in the latter case.

I don't think just generically different institutional experience offers anything comparable to the eyes on the ground Intel and network building that TP is suggesting.

Up to you.

Where you and your team want to live would probably trump all of this.
 
Psychczar said:
Thanks for the input. It sounds like there is agreement on the advantage of establishing yourself locally in residency. On the other hand, are there any advantages to either coming from a different institution or having an Ivy name on your resume? Whopper mentioned gaining a broader idea of practices vs "intellectual incest." From those who moved somewhere new after training, are any of these advantages as significant as those of being local?
Click to expand...

It really depends who you ask and what your goals are. I think the only reason it would really matter to go to the big name places are for certain types of academic careers or trying to start a big money cash practice in Manhattan/Boston/etc., Even within academics it depends who you ask, I was in a similar situation. I did a lot of networking that I think gave me some insights you maybe dont see on this board. Invariably the people lower on the academic ladders (program directors, assistant program directors, clinical instructors, etc.) were more focused on where I wanted to live, pointing out most first faculty positions are at the residents institution so going to residency somewhere kind of fast tracks you into their faculty, etc. However people on the higher end (chairmen, leaders in national psych organizations, a university president, etc.) all seemed to think there was a lot of value in going somewhere else to see how medicine is practiced there and then returning to "home" as a bigger fish in a smaller pond. The bigwigs also pointed out that in the end it may not matter either way, because if your really good then people want to hire you regardless of if you trained far away or nearby.
 
TexasPhysician said:
Ivy League pedigree would help you gain an academic position at another Ivy League institution which may help you obtain grant money for research.
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It's not the mere label of an Ivy pedigree that will determine whether or not you obtain grants--it's a history of mentored research and publications under someone else's auspices, and the willingness to labor at a post-doctoral level after residency in order to do so. Such a history is clearly easier to obtain at an Ivy or major research institution (e.g. WPIC, Michigan, WU-StL, UW, UCSF...), but it is not going to be the name on the residency certificate that excites the NIMH reviewers.
 
Sometimes I think NIMH reviewers have an over represented incidence of arousal dysfunction.
 
OldPsychDoc said:
It's not the mere label of an Ivy pedigree that will determine whether or not you obtain grants--it's a history of mentored research and publications under someone else's auspices, and the willingness to labor at a post-doctoral level after residency in order to do so. Such a history is clearly easier to obtain at an Ivy or major research institution (e.g. WPIC, Michigan, WU-StL, UW, UCSF...), but it is not going to be the name on the residency certificate that excites the NIMH reviewers.
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Unfortunately because funding is so poor, especially in the basic sciences, it's killed an entire generation of potential physician scientists. I think some of the most valuable clinician scientists are those who start their residencies with intentions of being pure clinicians, then develop their own clinical questions and pursue careers in research. Some of the biggest names in academic psychiatry began their careers that way. Now, the expectation is that in order to launch any sort of reputable academic career, you are an MDPhD who was getting training grants in medical school and have 10+ publications. This is an exaggeration, of course, but not that far off. And I'm doing my residency at one of the top medical schools in the country, and I have had multiple conversations with MDPhD students who (again, MSTP at a top 10 medical school) think that a research career looks too bleak and are just going to go into private practice after residency.
 
I don't have goals to do cutting edge research and all that comes with it. I hope to be on the clinician/educator/administrator track, starting out in academia and perhaps in the future moving into the private sector. So it sounds in that sense, departments hire from within and the big-name institution doesn't matter as much in academia outside of being on research or tenure track. Any thoughts on leadership in private hospitals/healthcare systems?
 
OldPsychDoc said:
It's not the mere label of an Ivy pedigree that will determine whether or not you obtain grants--it's a history of mentored research and publications under someone else's auspices, and the willingness to labor at a post-doctoral level after residency in order to do so. Such a history is clearly easier to obtain at an Ivy or major research institution (e.g. WPIC, Michigan, WU-StL, UW, UCSF...), but it is not going to be the name on the residency certificate that excites the NIMH reviewers.
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Agree. The institution name where you are working really only contributes a little to your score, and probably next to no one is looking at where you actually went to school. NIH review committees are stacked with people who did their PhDs or currently teach at UConn, MSU, etc (at least in the committees where I send my grants). I find that my Ivy League pedigree matters very little at this point. (That's not to say that it didn't matter at some point earlier in my career.)

Bringing it back to an earlier part of the thread, I agree with most of the commenters: happy wife, happy life.
 
OldPsychDoc said:
It's not the mere label of an Ivy pedigree that will determine whether or not you obtain grants--it's a history of mentored research and publications under someone else's auspices, and the willingness to labor at a post-doctoral level after residency in order to do so. Such a history is clearly easier to obtain at an Ivy or major research institution (e.g. WPIC, Michigan, WU-StL, UW, UCSF...), but it is not going to be the name on the residency certificate that excites the NIMH reviewers.
Click to expand...

Exactly. Looking only at the numbers, someone from MGH is much more likely to enter a research academic career than someone from UTSW-Austin. Just a few years ago prior to the UTSW purchase, the Austin program was doing 0 research. During my interview there, I was actually told by faculty to avoid it if I was interested in any research. Granted a research desiring person is unlikely to match at that Austin program, but not everyone has their life well planned.

Matching at a major research institution/Ivy makes one more likely to be exposed/begin quality research work that can lead to a research oriented academic career which leads to grant money.

Therefore, the mere name of an MGH grad is much more likely to obtain a grant over a UTSW-Austin grad - in very simplified terms.
 
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