University vs community psych programs??

[PsyMD]

Sounds silly, and forgive my ignorance but I want to know what are the different kinds of psych programs out there as in university, university affiliated and community program?? Their strengths and differences in terms of clinical training, patient population and exposure and also the impact that it has on shaping up the career in future?? Does seeing more patient and having vast range of exposure on community programs makes one clinically more competent or on university program with heavy focus on research, academics and didactics would sharpen the skills?? Can someone please highlight the pros, cons and the impact these type of programs have on one’s clinical acumen, academics and research abilities and the overall lifestyle on residency and beyond as a whole?? Thanks in advance.

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[Shufflin]

have you ever asked someone the meaning of life and they kinda hesitate, not sure where to begin?

 

[nexus73]

University/academic programs are usually filled with the smartest residents and you get exposed to really smart attendings. Sometimes. Often more clinical pathology and you may have a national or world renowned expert on a given topic presenting your didactics. There can be a bit of ivory tower know it all sense about the place however.

The academic downside is you don’t necessarily get exposed to people who know how the world works in the private sector (aka the real world). So limited exposure to approaching contracts, how do you get paid (RVU/salary), and how busy you’ll really need to be to earn a good paycheck.

 

[Shufflin]

any answer will be a gross generalization, and you'll find stellar community former-private-practice psychiatrists in academic programs, and great academic leaders in community programs, and everything in between. your question is really too broad.

 

[Sushirolls]

have you ever asked someone the meaning of life and they kinda hesitate, not sure where to begin?

42

 

[clozareal]

Why limit yourself to one or the other? Try to find a university program associated with a community hospital/clinic. Don't forget about the VA. There are lots of them around.

 

[Psych19]

All ACGME accredited programs have a "community psych" requirement. For us it was at least 6 months of a longitudinal outpatient clinic in a community setting. There were lots of opportunities to bolster this experience with other electives if this is your jam. I expect lots of "university-based" programs will offer this variety.

I think the best way to get community psych experience is moonlighting. Go get in trenches, make hard decisions, become autonomous, and get paid to learn.

 

[Stagg737]

42

But what's the question?!?!

 

[clausewitz2]

But what's the question?!?!

Turns out it's "what is six times nine?"

Ford Prefect at that point remarks "I always thought something was fundamentally wrong with the universe."

 

[Merovinge]

The above responses are doing a great job of dancing around the fact that for residency training you tend to the get the best training at academic centers. You'll be able to verify this as all the best applicants want to go to academic programs. One will have access to more research/researchers, a higher tier of instructors (both attendings and for didactics), more refractory/unusual cases (critical part of training), and an overall structure built towards education and providing the best of level of care (both in psychiatry and from other disciplines).

That's not to say no gets good training in community programs, but if you have a choice you almost certainly want to pursue an academic center for training. It's a bit like asking whats the difference in going to Harvard or University of New Mexico (sorry first random state I thought of) for undergraduate. Unless there are significant geographic/family reasons to go to New Mexico, everyone is realistically choosing Harvard.

 

[psychacad]

The above responses are doing a great job of dancing around the fact that for residency training you tend to the get the best training at academic centers. You'll be able to verify this as all the best applicants want to go to academic programs. One will have access to more research/researchers, a higher tier of instructors (both attendings and for didactics), more refractory/unusual cases (critical part of training), and an overall structure built towards education and providing the best of level of care (both in psychiatry and from other disciplines).

That's not to say no gets good training in community programs, but if you have a choice you almost certainly want to pursue an academic center for training. It's a bit like asking whats the difference in going to Harvard or University of New Mexico (sorry first random state I thought of) for undergraduate. Unless there are significant geographic/family reasons to go to New Mexico, everyone is realistically choosing Harvard.

I had the chance of going to residency at both a community program and a top tier academic program so I have seen both sides. I don't agree with this perspective. Residency is 80% what you make of it. You can get great experience at community programs, especially if one is motivated. You have to consider each program separately.

I would actually prioritize location and where you want to practice, but again there are no easy answers. You have to consider each case and each program separately.

 

[Merovinge]

I had the chance of going to residency at both a community program and a top tier academic program so I have seen both sides. I don't agree with this perspective. Residency is 80% what you make of it. You can get great experience at community programs, especially if one is motivated. You have to consider each program separately.

I would actually prioritize location and where you want to practice, but again there are no easy answers. You have to consider each case and each program separately.

Lets take the undergrad parallel here, New Haven is a probably one of the last places on Earth I would want to live, but if the choice is get an education at Yale or go to UCSD (most people agree one of the more desirable locations in the country), money is no concern (since we are talking residency no tuition), 90+% of people are going to do better going to Yale.

Now are there benefits to going residency where you want to live? Absolutely. But really residency is the time to learn best practice of your craft and get the foundation for your entire career.

Again, if you have family or life reasons to be somewhere, you can absolutely become a good clinician going to a community program. But don't give up Yale for no reason just because you don't want to live in New Haven for 4 years.

 

[psychacad]

Lets take the undergrad parallel here, New Haven is a probably one of the last places on Earth I would want to live, but if the choice is get an education at Yale or go to UCSD (most people agree one of the more desirable locations in the country), money is no concern (since we are talking residency no tuition), 90+% of people are going to do better going to Yale.

Now are there benefits to going residency where you want to live? Absolutely. But really residency is the time to learn best practice of your craft and get the foundation for your entire career.

Again, if you have family or life reasons to be somewhere, you can absolutely become a good clinician going to a community program. But don't give up Yale for no reason just because you don't want to live in New Haven for 4 years.

The problem is that you're making an 'undergrad parallel'. The analogy is not correct. So much of the learning in residency is self-directed. I'm just speaking from my experience after seeing both sides. Where the difference might be bigger is in therapy training, but that can be compensated with outside education (psychotherapy institution...etc). Of course there are cases where community programs really do suck and you can't make that up, but I think that also applies to some university programs.

BTW, I would absolutely give up Yale or whatever, for UCSD if I want to practice in SD. The one thing I'll say though is that ironically throwing the 'prestige name' bomb (Ivy name) still matters quite a lot for lay people if you're thinking about a private practice or even colleagues in the field. But this is really for all the wrong reasons.

 

[Dalemane]

Better question might be what do employers or patients care about? Do they check your cv or do they care more about your knowledge and bedside manner?

 

[robellis]

Better question might be what do employers or patients care about? Do they check your cv or do they care more about your knowledge and bedside manner?

they care about who will prescribe them a benzo and smile

 

[PsyMD]

Better question might be what do employers or patients care about? Do they check your cv or do they care more about your knowledge and bedside manner?

I guess, employers care about CV and patient about knowledge and bed side manners. But the question is, do university programs makes your CV better and community programs with huge patient load equip you with bedside manners and clinical acumen??

 

[notamindreader]

I guess, employers care about CV and patient about knowledge and bed side manners. But the question is, do university programs makes your CV better and community programs with huge patient load equip you with bedside manners and clinical acumen??

University programs can help make your CV better for academic jobs, but again, this is not a black and white thing. I have several colleagues who graduated from community programs who piloted various projects throughout residency and who are now in academic positions. It's almost impossible to say what employers are looking for across the board because it will be somewhat job dependent. Someone who has local connections might be preferred over someone with a training background from a prestigious institution. Some employers might prefer a 'known known' versus an 'unknown' when it comes to this. I interviewed at academic programs and two community programs. I ultimately chose an academic program that had ample community exposure, but this decision was also more driven by geography and personal focus than anything else.

 

[Merovinge]

The problem is that you're making an 'undergrad parallel'. The analogy is not correct. So much of the learning in residency is self-directed. I'm just speaking from my experience after seeing both sides. Where the difference might be bigger is in therapy training, but that can be compensated with outside education (psychotherapy institution...etc). Of course there are cases where community programs really do suck and you can't make that up, but I think that also applies to some university programs.

BTW, I would absolutely give up Yale or whatever, for UCSD if I want to practice in SD. The one thing I'll say though is that ironically throwing the 'prestige name' bomb (Ivy name) still matters quite a lot for lay people if you're thinking about a private practice or even colleagues in the field. But this is really for all the wrong reasons.

Fine to agree to disagree. I firmly disagree that 80% of learning in residency is self-directed. I just don't know how you can diagnosis more exotic illnesses without seeing them and have someone explain them to you (especially neuropsychiatic disorders and I'm constantly aghast at how bad some psychiatrists are with diagnosis of catatonia). I do not think most people out of medical school will have the correct ability to decode literature without EBM gurus doing journal club. The legal subtly of the field is much different when you attend rounds with lawyers and bioethicists. I don't think reading CBT manuals is the same as being taught by someone who spent their in PhD and career practicing nothing but CBT. I too have also seen both sides with one of my now best friends going to a community program in the same city I went to an academic program, and our training was so dramatically different that I cannot wrap my head around someone finding equivalency between them.

 

[FinleySt7]

have you ever asked someone the meaning of life and they kinda hesitate, not sure where to begin?

Yes, it's true

 

[psychacad]

Fine to agree to disagree. I firmly disagree that 80% of learning in residency is self-directed. I just don't know how you can diagnosis more exotic illnesses without seeing them and have someone explain them to you (especially neuropsychiatic disorders and I'm constantly aghast at how bad some psychiatrists are with diagnosis of catatonia). I do not think most people out of medical school will have the correct ability to decode literature without EBM gurus doing journal club. The legal subtly of the field is much different when you attend rounds with lawyers and bioethicists. I don't think reading CBT manuals is the same as being taught by someone who spent their in PhD and career practicing nothing but CBT. I too have also seen both sides with one of my now best friends going to a community program in the same city I went to an academic program, and our training was so dramatically different that I cannot wrap my head around someone finding equivalency between them.

The assumptions you're making about community programs aren't true across the board. You don't learn CBT from the manual (there are psychologists with CBT training who supervise residents), there are forensic trained attendings and hospital lawyers, who, yes, attend rounds and give lectures. There are attendings who love teaching, including teaching about zebras (and yes, some awful ones too, and these exist in university programs as well). You're really supposed to learn how to appraise medical literature in med school; regardless, we had quite a few 'lectures' around that in the community program, as well as a journal club. Also had a few talented psychologists who gave very good supervision, but since I was in a major metro, also got out of my shell and went to a therapy training program, and it was the best decision I made (my guess is that your average university program would struggle to give the same quality of therapy training). At the top tier academic place, there were obviously some stellar residents, but I had my share of encounters with shocking 'duds' (couldn't tell adjustment d/o from MDD, one recommended giving an SSRI for a pt complaining of anxiety in the ER!) - these residents were obviously sitting in the lectures, but since they didn't do the work at home, doesn't really amount to much; As well as some horrible personality-disordered attendings which the administration did attempt to 'hide', nonetheless, people still had to be supervised/interact with them. Let's face it, clinical academic appointments aren't the most competitive positions out there even at 'big name' places (and these places do seem to attract a particular narcissistic type willing to let go of higher pay just for the name).

I think you're right if we are talking on averages. But personally I'd be careful of making sweeping statements about community vs university programs. It's not an automatic pick by any chance, and I would definitely weigh other factors (location primarily). And I do think education in residency is a lot more what you put in it and what you can make with the opportunities you have. But it's clear we've had different experiences.

 

[LimpSpatula]

BTW, I would absolutely give up Yale or whatever, for UCSD if I want to practice in SD. The one thing I'll say though is that ironically throwing the 'prestige name' bomb (Ivy name) still matters quite a lot for lay people if you're thinking about a private practice or even colleagues in the field. But this is really for all the wrong reasons.

If that’s what you’re differentiating as Academic v. Community programs I could see why you and Mero have vastly different opinions.

 

[AD04]

If your learning is limited to the 4 - 6 years of residency and fellowship, then you may learn more in a university setting just because you'll more likely be surrounded by good people. But the people who are good enough to get to the top programs most likely engage in life-long learning and deliberate practice. So they will do well no matter where they go, especially after training when they are no longer artificially constrained.

It is individual specific and not organization specific. This has been true from my experience in college, medical school, residency, and afterwards.

 

[Merovinge]

The assumptions you're making about community programs aren't true across the board. You don't learn CBT from the manual (there are psychologists with CBT training who supervise residents), there are forensic trained attendings and hospital lawyers, who, yes, attend rounds and give lectures. There are attendings who love teaching, including teaching about zebras (and yes, some awful ones too, and these exist in university programs as well). You're really supposed to learn how to appraise medical literature in med school; regardless, we had quite a few 'lectures' around that in the community program, as well as a journal club. Also had a few talented psychologists who gave very good supervision, but since I was in a major metro, also got out of my shell and went to a therapy training program, and it was the best decision I made (my guess is that your average university program would struggle to give the same quality of therapy training). At the top tier academic place, there were obviously some stellar residents, but I had my share of encounters with shocking 'duds' (couldn't tell adjustment d/o from MDD, one recommended giving an SSRI for a pt complaining of anxiety in the ER!) - these residents were obviously sitting in the lectures, but since they didn't do the work at home, doesn't really amount to much; As well as some horrible personality-disordered attendings which the administration did attempt to 'hide', nonetheless, people still had to be supervised/interact with them. Let's face it, clinical academic appointments aren't the most competitive positions out there even at 'big name' places (and these places do seem to attract a particular narcissistic type willing to let go of higher pay just for the name).

I think you're right if we are talking on averages. But personally I'd be careful of making sweeping statements about community vs university programs. It's not an automatic pick by any chance, and I would definitely weigh other factors (location primarily). And I do think education in residency is a lot more what you put in it and what you can make with the opportunities you have. But it's clear we've had different experiences.

It's great to hear other people's opinions and I think a strong contribution to the board for aspiring trainees. Just as I have generally seen that US MD > US Caribbean grad, I generally see academic residency psychiatrist > community program psychiatrist, but I do agree there are plenty of exceptions. I will say I was pretty biased against DOs prior to residency but have worked with such good ones subsequently that this disappeared for me and maybe I would feel differently if my relatively small N was mixed differently with community trained psychiatrists.

I would end my argument that in general I do not think location for the sake of location (that is, you prefer the weather, like the politics or size of the city) is worth choosing a place that may have less training acumen, experiences, or resources for residency. One has already given up so much for the pursuit of medicine and this is your last big push towards 4 years of foundational professional development. It is so easy to move and get a job anywhere in psych even without connections as an attending. That said if one does end up at a program that does not check all the boxes, it's good to be inspired by all the ways you can still grow into a capable or even exceptional psychiatrist.

 

[psychacad]

It's great to hear other people's opinions and I think a strong contribution to the board for aspiring trainees. Just as I have generally seen that US MD > US Caribbean grad, I generally see academic residency psychiatrist > community program psychiatrist, but I do agree there are plenty of exceptions. I will say I was pretty biased against DOs prior to residency but have worked with such good ones subsequently that this disappeared for me and maybe I would feel differently if my relatively small N was mixed differently with community trained psychiatrists.

I would end my argument that in general I do not think location for the sake of location (that is, you prefer the weather, like the politics or size of the city) is worth choosing a place that may have less training acumen, experiences, or resources for residency. One has already given up so much for the pursuit of medicine and this is your last big push towards 4 years of foundational professional development. It is so easy to move and get a job anywhere in psych even without connections as an attending. That said if one does end up at a program that does not check all the boxes, it's good to be inspired by all the ways you can still grow into a capable or even exceptional psychiatrist.

You can get a job, but I do think the 4 years of residency give you ample opportunity to build roots, and the connections you make will give you a significant edge in terms of quality of job, knowledge of the market...etc. It's also quite mentally difficult to break the connections you made in one geographical area during residency, change roots or so to speak and move somewhere else, especially if you also want to address personal matters (having a SO, family, home ownership...etc). Most people will be making those changes in their 30s, making the process even harder. That's why a lot of people end up practicing where they did their residency training, even though it may not have been their favorite location when they first moved in. At the end of the day, this is a very personal issue, but the gist of what I am saying, motivation/individual initiative is a huge part of what makes one an excellent psychiatrist, and perceived institutional shortcomings can be compensated for in the right environment. On the flip side, someone who coasts through in a great program is not guaranteed to end up great or even competent.

 

[reca]

BTW, I would absolutely give up Yale or whatever, for UCSD if I want to practice in SD. The one thing I'll say though is that ironically throwing the 'prestige name' bomb (Ivy name) still matters quite a lot for lay people if you're thinking about a private practice or even colleagues in the field. But this is really for all the wrong reasons.

TIL that UCSD is considered a community program.

Plenty of people would "absolutely give up Yale or whatever, for UCSD", regardless of where they want to practice.

 

[solitarius]

The above responses are doing a great job of dancing around the fact that for residency training you tend to the get the best training at academic centers. You'll be able to verify this as all the best applicants want to go to academic programs. One will have access to more research/researchers, a higher tier of instructors (both attendings and for didactics), more refractory/unusual cases (critical part of training), and an overall structure built towards education and providing the best of level of care (both in psychiatry and from other disciplines).

That's not to say no gets good training in community programs, but if you have a choice you almost certainly want to pursue an academic center for training. It's a bit like asking whats the difference in going to Harvard or University of New Mexico (sorry first random state I thought of) for undergraduate. Unless there are significant geographic/family reasons to go to New Mexico, Everyone is realistically choosing Harvard.

FTFY.

 

[psychacad]

TIL that UCSD is considered a community program.

Plenty of people would "absolutely give up Yale or whatever, for UCSD", regardless of where they want to practice.

It's not. But it was mentioned in the post I replied to in a comparison to Yale.

For example, Harbor UCLA is a community program (despite the UCLA name to it). I rotated there as a med student. The teaching was phenomenal.

 

[Stagg737]

FTFY.

Nah, I chose a DO program for med school over a mid-tier MD program d/t location and cost (as well as a couple other lesser factors). Not everyone chases the name.

 

[tr]

TIL that UCSD is considered a community program.

Plenty of people would "absolutely give up Yale or whatever, for UCSD", regardless of where they want to practice.

Yeah I raised my eyebrow at this too. The UCs are disproportionately competitive vs other state AMCs and UCSD in particular has a pretty strong psych program. Maybe Yale has the reputational tip but this is strongly regional. If I were choosing between these two for residency I'd probably lean UCSD just for the better weather. I don't think the quality of training would be significantly different. (Maybe more biological at UCSD, Yale seems to be full of these elderly psychoanalyst types. Yale probably better for child specifically given their Child Study Center though.)

I'd guess given this choice, people from the East Coast would lean Yale and people from the West would lean UCSD. Nobody from California wants to live in New Haven and if they end up there it is usually because they didn't get in anywhere in CA. (CA has 12% of the US population but only 12 medical schools = 8% of 155.) I notice there is local reputational inflation where people perceive top universities that are geographically close to them to be 'better' than top universities that are geographically distant from them.

 

[Merovinge]

Yeah I raised my eyebrow at this too. The UCs are disproportionately competitive vs other state AMCs and UCSD in particular has a pretty strong psych program. Maybe Yale has the reputational tip but this is strongly regional. If I were choosing between these two for residency I'd probably lean UCSD just for the better weather. I don't think the quality of training would be significantly different. (Maybe more biological at UCSD, Yale seems to be full of these elderly psychoanalyst types. Yale probably better for child specifically given their Child Study Center though.)

I'd guess given this choice, people from the East Coast would lean Yale and people from the West would lean UCSD. Nobody from California wants to live in New Haven and if they end up there it is usually because they didn't get in anywhere in CA. (CA has 12% of the US population but only 12 medical schools = 8% of 155.) I notice there is local reputational inflation where people perceive top universities that are geographically close to them to be 'better' than top universities that are geographically distant from them.

I choose UCSD only because of it's location in one of the most desirable cities on earth and Yale for it's location in one of the places I think most people would not want to live (outside of vague NYC proximity). I was not referring to these psychiatric programs but the difference in their reputations for undergraduate strength as a point of comparison. I see this wording did not come in well from all the above posts. I'm very far removed from either coast, just trying to pick cities that were 0 and 10 on a likert scale with known Universities.

 

[asdf123g]

If your learning is limited to the 4 - 6 years of residency and fellowship, then you may learn more in a university setting just because you'll more likely be surrounded by good people. But the people who are good enough to get to the top programs most likely engage in life-long learning and deliberate practice. So they will do well no matter where they go, especially after training when they are no longer artificially constrained.

It is individual specific and not organization specific. This has been true from my experience in college, medical school, residency, and afterwards.

Reasonably safe assumption in many cases. but like Mero said, lot of preconceived bias against DO's. The most qualified don't always get the position because of that. To say nothing of connections. If there ever was an "equity" (not equality) issue that was prevalent, it'd be in academia IMO. Theres a glass ceiling for many.

It's great to hear other people's opinions and I think a strong contribution to the board for aspiring trainees. Just as I have generally seen that US MD > US Caribbean grad, I generally see academic residency psychiatrist > community program psychiatrist, but I do agree there are plenty of exceptions. I will say I was pretty biased against DOs prior to residency but have worked with such good ones subsequently that this disappeared for me and maybe I would feel differently if my relatively small N was mixed differently with community trained psychiatrists.

I would end my argument that in general I do not think location for the sake of location (that is, you prefer the weather, like the politics or size of the city) is worth choosing a place that may have less training acumen, experiences, or resources for residency. One has already given up so much for the pursuit of medicine and this is your last big push towards 4 years of foundational professional development. It is so easy to move and get a job anywhere in psych even without connections as an attending. That said if one does end up at a program that does not check all the boxes, it's good to be inspired by all the ways you can still grow into a capable or even exceptional psychiatrist.