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Unofficial WAMC Psychiatry Residency Thread 2023
- Thread starter drm5t
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Strongly recommend doing some away rotations at programs of interest. Also if you haven't already, reach out to the psychiatry careers advisors at your school to discuss your application in more detail. This forum is more helpful for students at schools where there are no psychiatry careers advisors. It is not a substitute for having someone review your situation in depth. If you haven't already, also recommend joining AGLP (free for med students) as they frequently organize events related to applying for residency etc for LGBTQ+ applicants.
I would be worried if I were you and consider applying to a backup specialty psychiatry has increased in competitiveness quite a bit in the last 5 years. My program is fairly low tier and I was told nearly everyone we interviewed has scores in the 240s/50s.
That failure is a very big red flag and the easiest way programs wean down the massive amount of applications they get is by score cutoffs.
That failure is a very big red flag and the easiest way programs wean down the massive amount of applications they get is by score cutoffs.
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I might suggest adding University of Kentucky and University of Louisville on to your list if they are not already there given the geographic area. I had a generally positive impression of Louisville back in the old days of 2015. UK is no great shakes but if Hispanic means Mexican in your case you will not lack for potential community in Lexington. Plenty of native Spanish speakers regardless. Lexington is also extremely LGBT friendly, had an openly gay mayor for almost a decade. I think neither of those places is going to screen you out completely because of a failed Step I, especially UK.
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Stay calm. It is easy to start dwelling on the match statistics and freak yourself out. You are applying to a lot of programs. You are right in thinking this is something of a numbers game. What programs want most of all is to fill. If you think you will have trouble matching, I think you can end up getting in one of two ways. 1) Get your foot in the door, as splik suggested. 2) apply to a lot of programs. In any given year, some of the residencies will just happen to have a batch of graduating MS4s from the associated medical school who aren't particularly interested in psychiatry or interested in staying in the area. Those programs will have to fill from somewhere. With your background and the number of programs you're applying to, you will get interviews. Take all of them, it will be expensive. Interviewing well goes a long way. You might not be on 100% completely even ground with the people with great grades/scores/whatever, but it gets a lot closer.. once you get the interview.
...How? The average step 1 score for matched psych is sub 230. Same average holds true for many mid tier schools. As for top tiers, Vanderbilt says their average step 1 is 240.
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I don't mean to scare the OP, because I agree that they will likely match somewhere, especially with respect to the advice given earlier in this thread. That said, I also agree with the person you're replying to.
I can't speak to the national statistics, but the program I work with is also not at all a high-tier program. It's a community program that is the lowest paid and possibly has the lowest reputation in this major metro in recent years. Every person who matched this year had a Step 1 score > 241. You had to have a very compelling reason to get an interview without it, and apparently none of those people ended up matching. This is a program that historically had at least half of its residents as IMGs (this year 3/8 were extraordinarily well-qualified IMG/FMG candidates, like step 1 > 270, 10+ publications, was a practicing psychiatrist in their home country, etc).
The past two years have been a major anomaly for this type of program.
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This thread is absolutely terrifying as an IMG trying to match psychiatry this year.
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I don't think that data is out yet.
Good match data is usually here:
Match Data
Core to the NRMP’s mission is the development and distribution of data reports and publications that inform national conversations about the transition to residency and advance understanding of the…
www.nrmp.org
Table B2: USMLE Step 1 and Step 2 CK Scores of First-Year Residents, by Specialty
USMLE Step 1 and Step 2 CK Scores of First-Year Residents, by Specialty
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Do you want DM me or post here your stats? I am an IMG that matched last year, for reference.
My program goes in the other way as most of this topic. We are a very large program and last year they started doing blind evals, now showing the scores to the reviewers. I guess we just don't think that high scores = good psychiatrists. I would guess that average score was around 230, since program is pretty competitive, but that was not the main thing that made people match there.
Im just relaying what my program director has told us this is data from the 2021-2022 match, we’re in a desireable location so maybe that has something to do with it. The OP asked what their chances are and I’m being realistic. A below average score is one thing, a failure is quite another. Why would a program take someone who failed step one when there are plenty of other applicants with similar applications without that failure that interview just fine? (This is where an away rotation could be a big deal). Good scores to not make good doctors, but when you’re dealing with 1000+ applications for anywhere between 4-16 positions per class everything on your application will be highly scrutinized.
Would also clarify that Vanderbilt, despite having a recognizeable name is not a top program for psychiatry residency. But thats besides the point.
@drm5t I wish you the best of luck in the ratrace that is the match. Im not saying its impossible for you to match by any means, just than your chances are lower than the average applicants.
Can corroborate what dedzo99 and obsequiousaplomb are saying. Those sub-230 applicants usually have very compelling reasons to interview them nowadays, and that’s not something you can really show in Charting Outcomes. Also, I am pretty sure the Vanderbilt website is not up to date cuz when I applied years ago it was a 240 then…I think other good southern programs (UNC, Duke, etc.) are probably mostly interviewing people with 240+ now and unfortunately OP is not likely to match there.
OP, if location is important to you, consider dual applying to FM or IM. Adding on a few programs in another specialty is actually cheaper than adding on more psych programs once your list starts getting pretty long. It’s better to apply to too many programs than to not match.
I don't think that data is out yet.
Good match data is usually here:
Match Data
Core to the NRMP’s mission is the development and distribution of data reports and publications that inform national conversations about the transition to residency and advance understanding of the…
Table B2: USMLE Step 1 and Step 2 CK Scores of First-Year Residents, by Specialty
USMLE Step 1 and Step 2 CK Scores of First-Year Residents, by Specialtywww.aamc.org
Average psych step 1 was 224 for the 2021 people. There were also fewer psych applications this past year compared to that previous year. Seems kind of bizarre that the step average supposedly increased that much, especially considering the overall step average is low 230s, and 30-40% of people at top schools will score below 230 step and still match where they want
Better to know sooner tbh. Seems like there may have been a marked uptick in score averages for the past cycle that has not yet come to light
For reference my mid tier academic program in an admittedly great city got 1600 apps for 8 spots. Loads of ivy applicants and high scores across the board. Think we whittled the list down to 110 interviewees. It's tough out there.
Nope. But they do look for people who they think want to be in this city. This is why I think letters of interest are so important. When I applied I sent a bunch....if I were applying today I'd probably send them to damn near every program.
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Mine does, a lot. Everyone that matched had strong ties with the city (under grad, grad, family, living there, etc)
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It is tempting to read into the numbers like tea leaves. Don't go down the rabbit hole. The match rate for US allopathic applicants is 93%, psychiatry is the next-to-least competitive specialty.
There are programs that want the highest scores for their applicants. Foreign psychiatrists with 270s. There are programs that have no interest in that.
There are programs that want the highest scores for their applicants. Foreign psychiatrists with 270s. There are programs that have no interest in that.
D
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Something to take into consideration with all of this is how the Supplemental application and signaling is going to play out.
If OP is strategic they can get interviews with each of those signals. And like @SubzDoc said, numbers are only one part of the picture. For some programs it's the big mountain in the middle of the landscape, for others it's a few happy little trees.
Hey @drm5t , I've been talking to a number of residents at various Psych programs. I've gotten some good info and I can share it with you if you want. Same for anyone else. I'm going to be general about what I learned, but it will be more than "show a devotion to psychiatry" in what programs are looking for.
If OP is strategic they can get interviews with each of those signals. And like @SubzDoc said, numbers are only one part of the picture. For some programs it's the big mountain in the middle of the landscape, for others it's a few happy little trees.
Hey @drm5t , I've been talking to a number of residents at various Psych programs. I've gotten some good info and I can share it with you if you want. Same for anyone else. I'm going to be general about what I learned, but it will be more than "show a devotion to psychiatry" in what programs are looking for.
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With the blinding of programs to step 1 scores, this will predictably move the emphasis to other measures, but it will probably harden the bias against those that fail step I. There is no data yet about this as this will be the first cycle, but this is my prediction.
As for psych being the second least competitive, there is a real logical dyad. 10 years ago we were the second least competitive specialty, but things are changing. The acceptance to unmatched ratio was close to derm's and people started talking about psych being the new derm. This was also ridiculous and the general applicant pool to derm is not very similar to the applicant pool applying to psych. The truth is of course, somewhere in between. Psych is more competitive, and IMGs are dropping some in terms of match rate, but the number of IMGs applying to psych is also down a little and psych isn't considered a back up or the easy way in as much as it was. Scores have drifted up some but are still below average. Our scores were the lowest 10 years ago so this isn't the sky falling.
I agree that it is easy to fall into the rabbit hole if you are applying and read the statistics. Apply where you want to go, but have a range of competitiveness on your list. Very good students go unmatched if they shoot too high, and bland applicants can get lucky with high power matches so you should try and you should be realistic. Another dyad, but it isn't a surprise that this is the reality.
Best of luck everyone,
As for psych being the second least competitive, there is a real logical dyad. 10 years ago we were the second least competitive specialty, but things are changing. The acceptance to unmatched ratio was close to derm's and people started talking about psych being the new derm. This was also ridiculous and the general applicant pool to derm is not very similar to the applicant pool applying to psych. The truth is of course, somewhere in between. Psych is more competitive, and IMGs are dropping some in terms of match rate, but the number of IMGs applying to psych is also down a little and psych isn't considered a back up or the easy way in as much as it was. Scores have drifted up some but are still below average. Our scores were the lowest 10 years ago so this isn't the sky falling.
I agree that it is easy to fall into the rabbit hole if you are applying and read the statistics. Apply where you want to go, but have a range of competitiveness on your list. Very good students go unmatched if they shoot too high, and bland applicants can get lucky with high power matches so you should try and you should be realistic. Another dyad, but it isn't a surprise that this is the reality.
Best of luck everyone,
I think what could be happening is the more desirable programs are being significantly more stringent about score requirements, thereby possibly creating something of a bimodal distribution. It’s like what diagnostic radiology used to be throughout the 2010s
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Why is psych becoming more competitive?
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More domestic grads are going into it. There is probably some regression to the mean since it couldn't have become much less competitive than it was already. The demand has risen and of course the pay has gone up as a result.
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FWIW OP, I think going to (?Stanford, ?UCSF) helps in a way that is hard to quantify with more generic match statistics. Not so much that you shouldn't consider all of the earlier advice, but enough that I wouldn't assume you're going to have as hard of a time as someone from a lower-tier MD or DO school w/ equivalent stats.
True but location he said matters to him. I'm confused why he doesn't just want to stay in the bay area lol. Networking at his home program seems like an absolute must
Because its a really cool specialty that many people ending up really liking when they rotate in it
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Yeah I agree. But that doesn't account for the increase in competitiveness in recent years. Why has it become more competitive just recently? Either some change must have happened that has made it more attractive to recent applicants
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I think psych is a great field for US grads too. I mean, you can get 300k year working from home and doing 60min intake and 30min follow up. If you like outpatient, that sounds much better than 250-300k doing 15-20min follow ups and being a PCP.
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How much could you make as a psychiatrist doing 15 minute follow ups?
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No idea, as I am still in training. According to other threads, actually, less (or potentially less) than 30min follow up due to therapy add-ons.
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Pretty sure you have asked this in other threads. I encourage you to look at those. I do not want to derail this thread and instead want to just answer your question so we can get back to the topic at hand.
99214 x 4 = $500-600 / hour depending on the area and insurance mix. Add-on therapy is ~70 per, but due to minimum time requirements would mean 99214 + 90833 x 3, which is more like $600-700 per hour of follow-ups.
The big difference from a PCP is the overhead as a solo psychiatrist. Fewer staff, smaller office space, more money in your pocket.
As to why psychiatry is getting more popular: ask the people applying to psychiatry. Their varied answers will give you a few hints.
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Thank you for the straightforward answer. That sounds like a reasonably healthy hourly rate. Now back to the WAMC thread!
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Interestingly, this doesn't seem to be as true as it as used to be. In the past med school of origin was definitely a big thing that was taken into consideration. Now it is not unheard of for students from said schools to go unmatched in psych if they have red flags (which unfortunately includes failing step 1, rotation failures, leaves of absence due to illness etc)
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For sure but I think it does give a tangible bump vs someone with all the same issues but from a no-name school. Particularly at some of the places that still run in the pool of wanting students from top-20's on their "current residents" pages but might not have the same location advantages as some of the most competitive spots.
Edit: Also in line with what MacD said, I do think there is a spectrum of quality of clinical training that may not translate to test scores but does translate to clinical acumen and knowing how to interact with the healthcare team.
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I think medical school quality still counts. Is the applicant's medical school running a hospital system with clinical rotations and known faculty, or do their medical students have to go out and find their clinicals? Are their pre-clinicals being taught by PHDs and PHD students about anatomy, biochem, embryology, etc.. Are theses schools part of a larger university system with undergraduates, graduates, research infrastructure, or are they small and for profit? It does make a large difference. There is a big difference between professional medical educators and systems where they ask doctors to "please show these students what you do". Honestly, the biggest problem that keeps reasonably run medical schools from being given the credit they are due is a lack of grading consistency because they have no standardization for the recently factualized teachers to have any anchor points to guide them. No wonder Dean's letters are now generic.
I have said many times that the best students from the less than impressive schools will always out perform the lower students from the best schools, but as medical schools numbers are exploding, there is a new cliff or edge of a water fall where this has become less true at the lowest end of quality of medical schools.
Before you tell me I'm wrong, of course there are phenomenal exceptions. I am speaking in generalizations, but if generalizations are not true, they are not well generalized. When used appropriately, generalizations are generally true. They are not evil unless poorly supported. I have no hard data, and no empiric data exists so this is my best guess.
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This is why there is a match, you don't have to pick a single place. If you want them rank them first and let them know you are doing so.
You listed 4 northeast options (pittsburgh is really midwest) and UCSD, why UCSD?
Can't tell you much about research, I do clinical and education but no research. Your experience looks good to me but when I review CVs of MD/PhD colleagues, I am always amazed at how much research they managed to cram into pre-graduate years.
You're a better applicant than me but just curious, how did they let you finish the PhD without any primary research publication? My gut tells me they may ask you about that. Give your PI a nudge on the manuscript if you can
Also what will your "approximate" class rank be? Top programs which probably have other applicants from your school may be able to rank you themselves by comparing clinical grades among your classmates
On a somewhat related note, many of those community programs take primarily IMGs with high step scores
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Why should the program be more open about things when the applicants are applying to 70+ programs? It is clearly the fault of there being 10x, 100x, or 1000x number of applications per spot with no other methods of parsing out qualified applicants and not that the community programs are conspiring to waste your time. In fact, the applicants applying to any more programs than they have legitimately researched and are interested in attending are the ones wasting the time of the programs.
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I don't think the people applying to 70+ spots bother reading the websites for the programs. I can say that even those with phenomenal step scores clearly haven't read the websites based on the stuff they write in their personal statements and say at interviews.
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At one point the UT Austin program had a line buried deep in its program description that specified that a certain sentence had to be in an email sent to the chair in order for a candidate to be invited for an interview.
An elegant solution, even if it will only work the one time.
US-citizen IMG
Red flags: had an attempt on a step exam, had to withdraw from pathology during basic sciences and retake it the next term, failed immunology but passed with an A the second time
Undergrad: I have a liberal arts degree and later got a BS in chemistry
School: Caribbean IMG
Preclinicals: They ranked me in the top half, but only because they factor year-3 rotations into the GPA, my basic sciences GPA was low
Clinicals: Straight A’s with one B in OB/GYN.
Step 1: 208
Step 2: 221
LOR: 1 from psychiatry, 1 from peds, 1 from family, I tend to think they will be good, I had As in these rotations and was well-liked
Research: 1 case report, not psych related
EC: participated in health drives on my Caribbean island
Other: Have ties to MD, FL, VA, MI. I think I would have a better chance to match if I had rotated with residents but my school only had rotations at peripheral training sites for US residency programs. Most of the hospitals I did the other rotations at did not have their own psych program.
I am obviously worried about not matching. I am applying to most programs except those in California, Texas and Puerto Rico. I think my stats reflect that I am much better at clinical medicine than I am at didactics or standardized exams. I am a hard worker and easy to get along with.
My top choices would be anywhere in the Florida, Alabama, Louisiana region. I am honestly just curious what readers think my chances are to match into ANY psychiatry residency. I would take any and I mean ANY program.
Red flags: had an attempt on a step exam, had to withdraw from pathology during basic sciences and retake it the next term, failed immunology but passed with an A the second time
Undergrad: I have a liberal arts degree and later got a BS in chemistry
School: Caribbean IMG
Preclinicals: They ranked me in the top half, but only because they factor year-3 rotations into the GPA, my basic sciences GPA was low
Clinicals: Straight A’s with one B in OB/GYN.
Step 1: 208
Step 2: 221
LOR: 1 from psychiatry, 1 from peds, 1 from family, I tend to think they will be good, I had As in these rotations and was well-liked
Research: 1 case report, not psych related
EC: participated in health drives on my Caribbean island
Other: Have ties to MD, FL, VA, MI. I think I would have a better chance to match if I had rotated with residents but my school only had rotations at peripheral training sites for US residency programs. Most of the hospitals I did the other rotations at did not have their own psych program.
I am obviously worried about not matching. I am applying to most programs except those in California, Texas and Puerto Rico. I think my stats reflect that I am much better at clinical medicine than I am at didactics or standardized exams. I am a hard worker and easy to get along with.
My top choices would be anywhere in the Florida, Alabama, Louisiana region. I am honestly just curious what readers think my chances are to match into ANY psychiatry residency. I would take any and I mean ANY program.
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Why not Puerto Rico? I know little about this, but doesn't finishing there get you ABPN eligible? Isn't their license a gateway into all 50 states? I think you will need to be flexible. As a Caribbean graduate with 2 repeats and a step failure, you should be very broad in your acceptance of potential programs. I'm not trying to scare you, but you will need to have some radical acceptance as to you application list. You should still try for some of your dreams, but don't neglect the compromises without looking towards backups. I just want you to match and on the flip side, depending on your circumstance, don't need a position so badly that you will do something that will make you miserable. Best of luck and be smart about this.
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Red flags: None
Undergrad: Ivy League
School: Top 20
Preclinicals: P/F
Clinicals (chronological order): Neurology= Pass, FM= High Pass, Surgery= Pass w/ remediation, Peds= High Pass, OB/GYN = High Pass IM= Honors
Step 1: 220
Step 2: 238
LOR: 5 from Psych (3 inpatient, one from 3rd year clerkship and the other from two psychiatrist from sub-I, 2 from my psych mentors ), 1 from IM research mentor. Definitely overkill on the LORs but two of the LORs are likely weak, so I got extras from my Sub-Is
Research: 2 from post-bacc (basic science, not psych focused, 4th/5th author [I was a lab monkey]), 1 poster presentation at APA, 1 ongoing clinical research project unrelated to psych, more related to IM. The research is unique and will help me stand apart, have had several psychiatrists evaluate my app and they all commented on this. The mentor who helped me with the poster presentation at APA also wrote one of my psych letters
EC: Volunteering with homeless and incarcerated... president of of psych interest group. Other ECs that are unique but not psych related
Other: Black male...seems like there's a dearth of us going into psych
Hoping that the upward trend in clinical grades work in my favor. Clinical evals generally comment on how I'm a hard worker, easy to get along with, how I improve with feedback, and would be a pleasure to work with as an intern, confidence that I will make a strong clinician. Nothing stellar but thankfully nothing negative. Many positive comments on my professionalism, which I think goes a long way in a professional setting.
My main interest is pursuing inpatient psych and forensic psychiatry. Also interested in eating disorder and personality disorders. Long-term goals would be inpatient adult psych w/ private practice psychotherapy/psychoanalysis + forensics on the side...slowly transition from employed work to full-time PP with an emphasis on psychotherapy and forensics and a sprinkling of med management. No interest in living in a mega city such as NYC/Chicago/LA/Miami, prefer 2nd and 3rd tier cities.
I will have substantial debt (~200k) so PSLF and reasonable COL is paramount. Moonlighting is also important to me. The earlier the better.
Targeting the South and the Pacific West for the most part. Family ties in the South. Kind of at a loss as to which programs I should signal. There are two that I'm for sure signaling, but then the last three are a toss up. Would it make sense to signal programs like UNC, Emory, Vandy? I'm in their bottom 25% of applicants Step 1 and Step 2 scores. None of them I would say are my "dream" programs.
I've read online here that MUSC is a sleeper pick w/ great research opportunities and clinical training. I fear that the city may be a bit small for my tastes though. What's there to do there?
Right now leaning towards MUSC, Emory, and UNC because they have forensic psych fellowships. Nashville would probably be a fun place to live. I heard that you don't need a car at Vandy, is that true?
Also considering Georgetown, George Washington, and VCU. I prefer cities where you don't need a car, but I also don't like cold cities. UC Davis and OHSU are also on my list. Not too keen on midwest programs simply due to location.
Any programs that I should consider that I'm simply overlooking?
Undergrad: Ivy League
School: Top 20
Preclinicals: P/F
Clinicals (chronological order): Neurology= Pass, FM= High Pass, Surgery= Pass w/ remediation, Peds= High Pass, OB/GYN = High Pass IM= Honors
Step 1: 220
Step 2: 238
LOR: 5 from Psych (3 inpatient, one from 3rd year clerkship and the other from two psychiatrist from sub-I, 2 from my psych mentors ), 1 from IM research mentor. Definitely overkill on the LORs but two of the LORs are likely weak, so I got extras from my Sub-Is
Research: 2 from post-bacc (basic science, not psych focused, 4th/5th author [I was a lab monkey]), 1 poster presentation at APA, 1 ongoing clinical research project unrelated to psych, more related to IM. The research is unique and will help me stand apart, have had several psychiatrists evaluate my app and they all commented on this. The mentor who helped me with the poster presentation at APA also wrote one of my psych letters
EC: Volunteering with homeless and incarcerated... president of of psych interest group. Other ECs that are unique but not psych related
Other: Black male...seems like there's a dearth of us going into psych
Hoping that the upward trend in clinical grades work in my favor. Clinical evals generally comment on how I'm a hard worker, easy to get along with, how I improve with feedback, and would be a pleasure to work with as an intern, confidence that I will make a strong clinician. Nothing stellar but thankfully nothing negative. Many positive comments on my professionalism, which I think goes a long way in a professional setting.
My main interest is pursuing inpatient psych and forensic psychiatry. Also interested in eating disorder and personality disorders. Long-term goals would be inpatient adult psych w/ private practice psychotherapy/psychoanalysis + forensics on the side...slowly transition from employed work to full-time PP with an emphasis on psychotherapy and forensics and a sprinkling of med management. No interest in living in a mega city such as NYC/Chicago/LA/Miami, prefer 2nd and 3rd tier cities.
I will have substantial debt (~200k) so PSLF and reasonable COL is paramount. Moonlighting is also important to me. The earlier the better.
Targeting the South and the Pacific West for the most part. Family ties in the South. Kind of at a loss as to which programs I should signal. There are two that I'm for sure signaling, but then the last three are a toss up. Would it make sense to signal programs like UNC, Emory, Vandy? I'm in their bottom 25% of applicants Step 1 and Step 2 scores. None of them I would say are my "dream" programs.
I've read online here that MUSC is a sleeper pick w/ great research opportunities and clinical training. I fear that the city may be a bit small for my tastes though. What's there to do there?
Right now leaning towards MUSC, Emory, and UNC because they have forensic psych fellowships. Nashville would probably be a fun place to live. I heard that you don't need a car at Vandy, is that true?
Also considering Georgetown, George Washington, and VCU. I prefer cities where you don't need a car, but I also don't like cold cities. UC Davis and OHSU are also on my list. Not too keen on midwest programs simply due to location.
Any programs that I should consider that I'm simply overlooking?
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Excessive.
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GW and GT won't help you get into forensics, or psychotherapy or psychoanalysis, really. Have you considered DC DBH Saint Elizabeths? It's also in DC, is a forensic setting for several rotations, has a forensic fellowship, and leans far more heavily on psychotherapy than GT or GW. The DC DBH residents also share some call at GW and share the VA site with the GT residents. Overall, there's much more diversity in patient population, treatment settings, and clinical caseloads at the DBH one than any of the other psych residencies in DC.
OSU in Columbus isn't bad. It's not good, either. Cincinnati is a lot less snowy than Columbus and has a strong analytic lean. Cleveland Clinic Akron General and Summa Akron pay their residents more, are in a very low cost of living area, and moonlighting is very common. Plenty of people buy a house and pay off all their loans while in residency there.
