So you want to interview in psychiatry?

[OldPsychDoc]

Musings as we brace ourselves for September 15th--

1) Please make sure your application reflects that you really are committed to psychiatry.
Does your personal statement demonstrate this? What do your extra-curriculars look like? Past employment?
If you're an IMG, do you have US clinical experience in psychiatry? Do you have letters from this experience?

2) Do your letter writers indicate that you're interested in psychiatry and that they think you'll make an excellent psychiatrist? Would they want you as a resident in their program? (I know that you probably waived your right to see what they wrote, and that's a good thing, but it might help to remind them. A non-psychiatrist's letter carries a lot more weight in my mind if the writer says something like: "I wish I could have convinced him/her to train here as an internist/OB/plastic surgeon/radiologist, but it was clear that they are set on a career in mental health, and my observations would indicate that that is the right choice for them.")

3) If you want to go to a particular region, please let us know that, and your reasons why. We're a lot more likely to extend an interview slot to someone who really wants to be here.
And keep in mind that that isn't always obvious to us!
ERAS doesn't tell us a lot of things--it won't tell us that you went to high school here before going out of state for undergrad and med school, that your parents live here, or that you spent all of your happiest childhood summers at Grandma's vacation cabin nearby, or that your spouse's extended family is firmly rooted here, or that you've just always wanted to live in some particular author's hometown ever since you read his novel in high school. (I don't care all that much what the reason is...but I do like reasons.)

4) It's OK to email us and ask us to look at your application (especially in the case of #3 above), but please wait at least a couple of days until the dust clears! (And fair warning: if the email is addressed "Dear Program Director," it has a higher than average risk of being deleted unread. Oh, and it might also help your cause if it is mostly grammatically correct, and if the font of the salutation is the same as the body of the email. And that the name of the program isn't pasted in in a different format...)

Good luck---

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[MacDonaldTriad]

As is often the case in psychiatry, the anticipatory anxiety can be worse than the disease. I wish we could get this thing going. I feel like one of those polar bears on New Year ’s Day about to jump into the ocean.

 

[vistaril]

I think part of the problem with mentioning less than obvious ties(or soft ties)to an area is that they really can't be verified. OPD mentions a grandmothers summer vacation house, for example.....short of pulling the grandmothers name and property records(which nobody is going to do), there is no way to tell that the applicant isn't just making these up.

I also don't understand the insistence that applicants prove they are devoted to and interested in psychiatry.....them applying to psychiatry residencies isn't proof of that? If they weren't interested in psychiatry, they would be doing something else. I think what a lot of people actually mean here is that they want to see the applicant is interested in psychiatry for what they perceive are the right reasons.....which is a fair point I guess.

The obvious gramm errors and dear program director stuff....I think that is near 100 percent non-us fmgs. And amongst this set I think the presence or absence of these grammar and etiquette errors really speaks more to how fortunate the applicant was to have US insider help than anything else(meaning someone familiar with the process of applying to US residencies).

But you know you are getting old when you can't even remember half the places you visited anymore on interviews.

 

[MacDonaldTriad]

These connections to the area things are way over emphasized. Frankly, if you apply to a program without any obvious reason, they are going to rank you just above the applicant you are slightly better than and just below the guy who is slightly stronger. If you rank that program low and they blow by your name on their list, they don’t care if they get the guy below you. No harm no foul either way. If you really like them and rank them #1 they will be pleasantly surprised to get you.

“I didn’t think he would come here, lucky us”. Lowering applicants because you don’t think they are interested in your program is folly for a director. If you are more interested in how your match looks than in getting the best talent, you don’t belong in the director business.

 

[Monkey House]

I think part of the problem with mentioning less than obvious ties(or soft ties)to an area is that they really can't be verified. OPD mentions a grandmothers summer vacation house, for example.....short of pulling the grandmothers name and property records(which nobody is going to do), there is no way to tell that the applicant isn't just making these up.

It is not too hard to get a sense if an application rings true or sounds embellished. Especially in this day and age of the Internet - it is rather easy to quickly do a cursory check. Yes no one knows if you went to grandmother's house - but that is also not going to make or break your application either.

 

[OldPsychDoc]

These connections to the area things are way over emphasized. Frankly, if you apply to a program without any obvious reason, they are going to rank you just above the applicant you are slightly better than and just below the guy who is slightly stronger. If you rank that program low and they blow by your name on their list, they don’t care if they get the guy below you. No harm no foul either way. If you really like them and rank them #1 they will be pleasantly surprised to get you.

“I didn’t think he would come here, lucky us”. Lowering applicants because you don’t think they are interested in your program is folly for a director. If you are more interested in how your match looks than in getting the best talent, you don’t belong in the director business.

It's really more of an issue of deciding who to invite for interviews, not how we rank. When you get over a thousand applications, as we do, we really do want to give our limited attention to those who have a tie to our region, especially as a part of our mission is the training of psychiatrists for our region.

 

[MacDonaldTriad]

Thanks, I had not considered the training people for your area logic. Everywhere needs psychiatrists, but we are near multiple programs so this isn’t much of a mandate. I get the difference between granting interviews and ranking. I didn’t mean to suggest that you ranked by interest. I think a lot of residents and applicants think we do some of this. A lot of junior residents on selection committees say things like; “can’t we rank him higher? I really think he wants to come here.” The answer is not any higher than applicants we perceive to be better. He will end up here unless X number of applicants above him get in.

This does reinforce our plea that people cancel early. If you know you are not interested in us, please don’t come. I have seen applicants mention going to other programs and then thinking better of revealing that they add “I really don’t want to end up there, I only interviewed there for the practice”. It usually makes me think that the other program would sure not like hearing that.

 

[vistaril]

These connections to the area things are way over emphasized. Frankly, if you apply to a program without any obvious reason, they are going to rank you just above the applicant you are slightly better than and just below the guy who is slightly stronger. If you rank that program low and they blow by your name on their list, they don’t care if they get the guy below you. No harm no foul either way. If you really like them and rank them #1 they will be pleasantly surprised to get you.

“I didn’t think he would come here, lucky us”. Lowering applicants because you don’t think they are interested in your program is folly for a director. If you are more interested in how your match looks than in getting the best talent, you don’t belong in the director business.

agree with this completely....regardless of how many total applications most programs get, the numbers are very much tilted in favor of the applicants here in the end. Just because a typical program may get 100-150 'good' applicants applying does not mean they will even have 20 both interviewing and ranking that program in their top 5. And given the number of psych applicants that get their top 3(which is even higher for the better applicants). well....do the math. The reality is your typical program that has say 10 slots doesn't get 10 people every year they consider 'good'. Maybe they get 3 they really love, 3 they sorta like, and 3-4 that they are only sorta 'meh' on(and decided to go with instead of having to scramble). It doesn't make sense to cull out potentially good on paper applicants just because they don't have an obvious geographic connection. Simply because that may have been a candidate that ended up replacing one of those 3-4 'meh' candidates.

I think OPD does have a point in a way that programs don't want to waste interview slots.....but they are coming at that from a position of weakness and not strength. Basically, I do agree that if one is a good applicant who maybe grew up in central texas and would love to go to Texas A&M because of that, but all that is showing up on their eras is that they went to California for undergrad and med school......yeah, I'd find a way to drop that in with a contact somehow.

Another common scenario is a good candidate needing to be in a certain spot because of a spouse or partner. Spouse is doing something competitive, and he is a pgy2 for example there. Applicant would never consider going there without spouse being there, but because spouse is there she has to go there. In that situation I think the applicant should make sure her spouse touches base with someone in the program who knows the situation just so the program will make sure she gets that spot.

 

[MacDonaldTriad]

Vistaril has this right, except for the part about OPD coming from a position of weakness. All of us get a thousand applications. Everyone applies everywhere. I don’t know OPD personally, but I am convinced his residents are both selected and lucky to have him. Just from what I hear and all….

 

[vistaril]

Vistaril has this right, except for the part about OPD coming from a position of weakness. All of us get a thousand applications. Everyone applies everywhere. I don’t know OPD personally, but I am convinced his residents are both selected and lucky to have him. Just from what I hear and all….

I didn't mean opd or his program personally.....I meant for programs in general(ie not at the very top and not at the ones to avoid). The fact that there are 1000 or so spots to fill(and far fewer 'good' or 'quality' candidates) guarantees this.

The point about everyone applying everywhere is a good one(although its not quite that extreme....it's more like lots of people apply lots of places, or most everyone in a certain region applies to most places in a certain region) and actually contributes to this. The typical program saying "we get a thousand apps" is sorta like the typical guy in los angeles saying "gosh there are 2 million single women in this area looking for husbands".(yes one difference is that the candidates paid a nominal feel to add it onto eras I guess, but that's hardly a sign of great commitment or interest....which sorta goes to one point on why to limit interviews to some) Yes, there are 2 million single women, but a lot of them right of the bat aren't dateable. And the ones who are dateable are much more likely to be very selective. When you start slicing and dicing and really getting down to the numbers, there are still a lot of single guys in los angeles who probably have trouble finding decent girls. Just like there are a lot of programs who can't fill with 'good' people. The numbers themselves mandate that.

And as I said earlier people can disagree on what the total number of 'good' applicants is every year. But there is no way that ratio is near 1:1 by any standard.

 

[OldPsychDoc]

agree with this completely....regardless of how many total applications most programs get, the numbers are very much tilted in favor of the applicants here in the end. Just because a typical program may get 100-150 'good' applicants applying does not mean they will even have 20 both interviewing and ranking that program in their top 5. And given the number of psych applicants that get their top 3(which is even higher for the better applicants). well....do the math. The reality is your typical program that has say 10 slots doesn't get 10 people every year they consider 'good'. Maybe they get 3 they really love, 3 they sorta like, and 3-4 that they are only sorta 'meh' on(and decided to go with instead of having to scramble). It doesn't make sense to cull out potentially good on paper applicants just because they don't have an obvious geographic connection. Simply because that may have been a candidate that ended up replacing one of those 3-4 'meh' candidates.

The reality, at least in my actual experience, is that we have 200-300 "good applicants", out of which we need to select 70-80 to interview, out of which we get 10-15 we "really love", 25-40 we really like, and at least 30 that are "better than SOAP"--though most recently we haven't even dipped into that end of our list. The really hard part is figuring out which of the 1000 are the right 70-80 to invite, and always wondering if we left someone awesome on the table.

...Basically, I do agree that if one is a good applicant who maybe grew up in central texas and would love to go to Texas A&M because of that, but all that is showing up on their eras is that they went to California for undergrad and med school......yeah, I'd find a way to drop that in with a contact somehow.

Another common scenario is a good candidate needing to be in a certain spot because of a spouse or partner. Spouse is doing something competitive, and he is a pgy2 for example there. Applicant would never consider going there without spouse being there, but because spouse is there she has to go there. In that situation I think the applicant should make sure her spouse touches base with someone in the program who knows the situation just so the program will make sure she gets that spot.

Both reasons basically what I was saying in #3 above. I'm also just saying that if such applies to you for a given program on your list, that's sufficient reason to drop a short, polite, and personal introductory email to the PD and coordinator to let them know.

Vistaril has this right, except for the part about OPD coming from a position of weakness. All of us get a thousand applications. Everyone applies everywhere. I don’t know OPD personally, but I am convinced his residents are both selected and lucky to have him. Just from what I hear and all….

You're too kind...

 

[vistaril]

Im not really disagreeing with what you say....I just think everyone has a different idea of what a good applicant represents. To me that would be someone who fits the following profile: allo amg. not in the bottom 35% compared to other allo amgs on step 1, no academic or clinical red flags(failing a big class, remediating a big rotation), an mspe that objectively doesn't rate in the bottom 25% of other amgs at school(and in todays climate a fairly bland mspe in rotation after rotation certainly would). Those qualifications certainly aren't special or noteworthy, and I think it's safe to say they would also eliminate the student from many other fields completely. Setting that as the bar for what a 'good' applicant represents is reasonable imo.

Alternatively, it could also be someone who falls short in one of those but blows everything else out of the water. Because there are obviously a ton of dos/imgs who are brilliant and do great work. For example an img with great communiation skills and an awesome app.

So if that is ones definition of what a good applicant represents, I wonder how many of those apply to psychiatry in any given year? Looking at the charts(and obviously not being privy to all the info), I would guess 180-230 of the first group and then however many of the second one would include. For over one thousand slots. So then the question becomes- what percentage of these applicants apply to any given non usual suspect school? Given the uneven distribution of these 'good' applicants applying to certain schools(probably 90% of 'good' west coast applicants by this standard apply to ucsf and the like and probably 90% or more of the same east coast apps apply t Columbia, yale, etc), is it really more than 15-20% for the typical program? And then keep doing the math....15-20% of 180-230(plus the others), and that's just apps...not apps who are offered and actually show up for interview.

that's all I meant by psych programs being in a position of weakness in the match. The hard cold numbers make it so. Now perhaps the more relevant question is "what percentage of all the other candidates/applicants end up being good psychiatrists?" Hell if I know. I have no idea what the correlation is between step 1 score, 3rd year evals, and other typical metrics to ultimately helping mentally ill people. I can say for certain that my med school performance was a disaster in every way.....just eye poppingly bad. I wasn't within 5 miles of any metric for what I would consider a 'good' applicant...and yet I do think I made positive contributions as a resident and out of residency. And likewise I know people who probably were good applicants who don't seem to practice evidence based psychiatry today, do sloppy work, etc.....so take that for what it's worth.

tl; dr version: being a good applicant means different things to different people.

 

[vistaril]

another caveat to these numbers(at least from what I hear med students saying these days) is that scores are totally different now. I overheard someone who made a 241 on step 1 worry lamenting the fact that he would now have to 'step it up' on step2 to improve his competitiveness for his field. 241 today must be like 226 of a decade-15 years ago(I don't know the exact equivalence)

 

[WingedOx]

It's really more of an issue of deciding who to invite for interviews, not how we rank. When you get over a thousand applications, as we do, we really do want to give our limited attention to those who have a tie to our region, especially as a part of our mission is the training of psychiatrists for our region.

Probably a good thing. Every time we got a California applicant at the interview dinners in late November or December, you had to hold back from asking them, "so, you're not really comfortable in cold weather, are you?"

 

[Monkey House]

We are a Boston program, but don't hold location against anyone. If you are applying from California that is great. Local to Boston, great too! So don't let "I am from X and that program is in Y" hold you back at all.

 

[675015]

another caveat to these numbers(at least from what I hear med students saying these days) is that scores are totally different now. I overheard someone who made a 241 on step 1 worry lamenting the fact that he would now have to 'step it up' on step2 to improve his competitiveness for his field. 241 today must be like 226 of a decade-15 years ago(I don't know the exact equivalence)

The mean match score for all specialties in 2014 was 230. I don't know what it used to be? On my Step 1 (3 years ago), my score reported stated the average for that exam was a 227. The score for passing keeps going up as well. I'm think. I'm sure if I'm wrong someone will correct me.

 

[thoffen]

This matches I think well what my program was saying in our evaluation committee last week. Applicant #s have gone up, but only because people are applying to more places than they used to. Since it costs a lot & you have to arrange faculty time for interviews, spots are limited so you can't simply expand the # of interviews. Thus, it's really important to target the right people to interview. Therefore, if you have a particular interest in a program let them know!

 

[kirkirkir]

Can this be pinned please?

 

[OldPsychDoc]

Here we go again.
Tropical Storm ERAS, 2016, arriving in 24...23...

 

[OldPsychDoc]

Ugh--need to reiterate #4 after going through my inbox this morning:

4) It's OK to email us and ask us to look at your application (especially in the case of #3 above), but please wait at least a couple of days until the dust clears! (And fair warning: if the email is addressed "Dear Program Director," it has a higher than average risk of being deleted unread. Oh, and it might also help your cause if it is mostly grammatically correct, and if the font of the salutation is the same as the body of the email. And that the name of the program isn't pasted in in a different format...)

 

[MacDonaldTriad]

Dear OPD,

It is with the most extreme humility that I ask for you to review my application for entrance into your most esteemed educational institution….

I refer you to the multiple letters from preeminent physicians about my qualities who just so happen to have the same last name as myself. Most of them have known me since I was a child and one of them has even seen me since I grown up….

Please be aware that I always have known that I wanted to be a psychiatrist. Although I don’t have any particular experience in psychiatrist, I did ask to try and shadow several….

(…and if you wire the money right away, your inheritance check will be coming soon).

 

[OldPsychDoc]

845 applications at the opening bell...
Gonna be a looong month.

 

[Shikima]

845 applications at the opening bell...
Gonna be a looong month.

I wish Vegas offered betting...

 

[OldPsychDoc]

I wish Vegas offered betting...

I'll take the over.