What factored into your residency program choice?

[rhiannon777]

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I'm an MS4 applying to psych residencies. I was just wondering what factors residents used to select where to apply. I've been looking at various programs' websites, but other than geographical location and number of residents, all the programs I've looked at seem fairly similar. Thanks!

 

[Doc Samson]

For me it was location, exposure to various forms of psychotherapy, had to feature a large general hospital since I knew I wanted to be a CL doc, and had to have a track record of graduates with flourishing academic careers since I knew I wanted to stay in academia.

It's a different recipe for everyone.

 

[maranatha]

*I wanted a program that was large enough and had enough depth that I could feel supported in any area of psychiatry I might end up liking.
*It had to be an academic center that supported research if I wanted to do it, but would also be perfectly fine if I only wanted to pursue clinical skills.
* Also wanted a place that had good exposure to all the various evidenced based therapies--CBT, IPT.
* A program that did not push any one view point such as biological vs. psychodynamic, but would be open to me developing my own integration.
* Program had to have a good child psych fellowship.

 

[OldPsychDoc]

It's a different recipe for everyone.

Exactly. I needed first--a city my family would be comfortable in; secondly--the type of training I thought I needed at the time (being prepared to have your life-direction change along the way, in case you needed something else to worry about...); thirdly--positive morale among residents and faculty.

Ultimately I was very happy with my choice and got a lot out of it--though I've ended up in a rather different setting than I expected when it all started.

 

[peppy]

Fellowship opportunities, a city that my family and I would enjoy, and reasonable work hours (above all, being very careful to avoid any whiff of a malignant atmosphere). No regrets. I am happy more days than not. Life is too short to spend some of the best years of your life in a malignant program.

 

[billypilgrim37]

In the wise words of Better Than Ezra, "If it feels good, do it." You'll hear over and over again that you should pick the place that feels like the best "fit." Like psychotherapy, there is no clear active ingredient, just lots of intangibles. Two people on this board matched at my med school's program because it was the best fit for them. I left the same great program. So it goes and so it went. Get to know programs when you visit, scour their websites and this board, figure out where you want to live, and enjoy the ride.

 

[Manicsleep]

I looked at the track record of the program. Stable programs with consistently good residents with strong inpatient, outpatient with psychotherapy and community mental health in a University based setting that had a lot of fellowships. I also wanted a VA experience (got it) but it wasn't necessary.

Suprisingly that is getting harder to find as psychiatry is getting turfed to community hospitals for the inpatient work. I would strongly recommend not going to a program where there isn't a very strong inpatient unit.

I wanted a program director/chair that was motivated, an obvious leader and had a clear mission. I also wanted them to be about the residents and I wanted to see this with clear action not words.

 

[st2205]

I would strongly recommend not going to a program where there isn't a very strong inpatient unit.

I'm hoping you could expand on this statement. I was under the impression that each program would have to at least have a decent inpatient unit, if not multiple. I know that as a medical student you can get garbage inpatient experiences or even no inpatient experience at all, but I couldn't imagine a psychiatry residency would lack for at least one strong inpatient unit. This is an honest question of curiousity and not a challenge, so I hope you could clarify.

 

[OldPsychDoc]

I'm hoping you could expand on this statement. I was under the impression that each program would have to at least have a decent inpatient unit, if not multiple. I know that as a medical student you can get garbage inpatient experiences or even no inpatient experience at all, but I couldn't imagine a psychiatry residency would lack for at least one strong inpatient unit. This is an honest question of curiousity and not a challenge, so I hope you could clarify.

Many university medical centers have spun off their inpatient services to private sector entities due to the inflated costs inherent in academic hospitals. It's true that you must have inpatient months in an ACGME accredited residency--they just don't necessarily have to occur at "University Hospital".

 

[st2205]

I guess where I'm getting caught up is when he says a "strong" inpatient unit. Is it implied that a community hospital inpatient unit is less strong than a university-based one?

 

[OldPsychDoc]

I guess where I'm getting caught up is when he says a "strong" inpatient unit. Is it implied that a community hospital inpatient unit is less strong than a university-based one?

Personally, I think that the community hospital unit I work in now is "stronger" in many ways than the university-based one in which I trained.

 

[Sneezing]

As a medical student I discovered how much I despised the VA. It was dissapointing and I now often question the rational our country uses to justify funding this completely seperate healthcare entity. It is a bastion of inefficiency and ineptitude - state hospitals (another government entitity) at least have a collection of severe pathology making them worthwhile.

I ranked programs much higher with minimal to no reliance on the VA system as a training ground. I also noted the programs that didn't rely on the VA so much, were often more fiscally sound, which means you'll less likely feel the pressures of financial tightening.

 

[Manicsleep]

By strong, I mean a few things.

1) Has an ER onsite. This creates pressure. It makes you decide what needs to stay and what needs to go. This type of pressure forces the less ill to be discharged as opposed to the ones deemed ready to discharge by insurance.

2) Sees a lot of SMI patients. Without this you never truly get an idea of what mental health really is. Even most community programs have this.

3) The consult referrals are real and med psych component if not a complete ward. This is where the community programs often suffer. Their CL service is at the university hospital while they are at the community hospital. Something gets lost as a result.

A strong inpatient unit must have a strong bio component. They must be able and willing to treat all the neuro patients, the ones coming straight from the ICU, post op, cancer patients etc.

Are their advantages to a community program? Definitely. Especially if you are a patient or an attending but I would have a hard time believing there are significant things a resident would learn there that they couldn't learn in an intense inpatient environment, especially when they combine this with solid outpatient and elective training.

 

[Manicsleep]

As a medical student I discovered how much I despised the VA. It was dissapointing and I now often question the rational our country uses to justify funding this completely seperate healthcare entity. It is a bastion of inefficiency and ineptitude - state hospitals (another government entitity) at least have a collection of severe pathology making them worthwhile.

I ranked programs much higher with minimal to no reliance on the VA system as a training ground. I also noted the programs that didn't rely on the VA so much, were often more fiscally sound, which means you'll less likely feel the pressures of financial tightening.

Unfortunately, your point is not true outside of psychiatry...actually I should say mental health because where a lot of money is wasted is not actually on physicians.

VA healthcare is actually quite efficient and spends significantly less per patient with equal or better morbidity/mortality (don't ask me to pull the data because I have no idea where I have it). The problem is that you see the inefficiency right in front of you as opposed to being in the in the bureaucracy of managers, HMOs, medicare etc that is invisible with the private hospitals.

 

[erg923]

As a medical student I discovered how much I despised the VA. It was dissapointing and I now often question the rational our country uses to justify funding this completely seperate healthcare entity. It is a bastion of inefficiency and ineptitude - state hospitals (another government entitity) at least have a collection of severe pathology making them worthwhile.

I ranked programs much higher with minimal to no reliance on the VA system as a training ground. I also noted the programs that didn't rely on the VA so much, were often more fiscally sound, which means you'll less likely feel the pressures of financial tightening.

I'm a psychology grad student (almost done), not a psychiatrist, but just wanted to comment that I find this very interesting. My VA expereicne during training was a surprise as well, but in the opposite direction. Albeit, I was at probably placed at one of the top VAs in the country (here in northern cal), but I was surprised by the quality of my supervisors (leaders in the field and top resesrchers) as well as the thoroughness of the care and evals we (psychology service) gave to the veterans. We did C&P evals and never felt any push or political pressure from anyone either. It was a gold mine for research data/productivity for me as well. I had heard the horror stories from my own family's experience with a couple VAs back east, but was very surprised that I found none of that (rude employees, subpar care, impersonal care) in psychology service or inpatient psychiatry at this VA. I suppose this is really dependent on location. However, i am interested to hear your experience. You can PM me if you like.

 

[notdeadyet]

As a medical student I discovered how much I despised the VA. It was dissapointing and I now often question the rational our country uses to justify funding this completely seperate healthcare entity. It is a bastion of inefficiency and ineptitude - state hospitals (another government entitity) at least have a collection of severe pathology making them worthwhile.

I wonder if talking about The VA and painting them all with one stroke has much value. There's a lot of variance in the quality of care, the patients/pathology seen, and the leadership at different VAs. I've heard horror stories from some VAs and heard great things of others. I've done a couple rotations at the VA affiliated with my med school and enjoyed it, particularly the psych rotations. Same is true for most of my fellow med students I've talked to. But I've talked to other folks at distant med schools who had very different experiences.

It's a bummer when folks say, "The VA sucks!" when I think what they really mean is "The Northern Arizona VA sucks!"

I also noted the programs that didn't rely on the VA so much, were often more fiscally sound, which means you'll less likely feel the pressures of financial tightening.

Interesting idea. I had figured the opposite. If Acme University does most of its clinical training at their home hospital, if belt tightening occurs, you get crushed and lose out on clinical opportunities. If they have affiliations with the VA and other outside organizations, you're spreading the risk.

 

[notdeadyet]

VA healthcare is actually quite efficient and spends significantly less per patient with equal or better morbidity/mortality (don't ask me to pull the data because I have no idea where I have it). The problem is that you see the inefficiency right in front of you as opposed to being in the in the bureaucracy of managers, HMOs, medicare etc that is invisible with the private hospitals.

Good observation. Agree with this. From what I've seen of our county hospital and the local VA, there's huge bureaucracy at both, it's just better hidden from clinical staff at the county hospital. Residents seem taken aback by a lot of the paperwork and whatnot that becomes more apparent at the VA.

 

[rhiannon777]

Thanks for all the great replies so far! I know my ultimate ranking decision will be based largely on the "feeling" I get interviewing at various places. Right now, I'm trying to figure out where to submit my Eras application. I've been looking at programs' websites, but they all seem to have the same basic curricula and emphasize pretty much the same strengths. I'd be interested to hear how one can tease out the differences between programs based primarily on the info on their websites. Thanks again!

 

[notdeadyet]

I've been looking at programs' websites, but they all seem to have the same basic curricula and emphasize pretty much the same strengths. I'd be interested to hear how one can tease out the differences between programs based primarily on the info on their websites.

I'm with you, rhiannon. I'm getting ready to flip the switch and send my app out later today. I've spent the last few weeks reading the websites of programs in areas I'm interested in living.

All programs seem to emphasize their commitment to community psychiatry with a balanced psychotherapy/psychopharmacology approach as well as having a robust and accessible research arena. All programs work hard to make an environment where residents feel well-supported and their opinions are highly valued by the administration.

At the end of the day, websites are essentially digital brochures, regardless of the product being sold. There will be some useful data (rotations, sites, call schedule, etc.), but the marketing stuff is often fluff.

I'm finding residents the most useful source of information. I've sat down with several of my programs psych interns and asked for info on different programs and if they had any contacts. I also tracked down several recent alum from my school now at programs of interest. I found many residents to be a much better source of information than faculty, as they didn't have so many years removed.

Good luck in your hunt...

 

[OldPsychDoc]

All programs seem to emphasize their commitment to community psychiatry with a balanced psychotherapy/psychopharmacology approach as well as having a robust and accessible research arena. All programs work hard to make an environment where residents feel well-supported and their opinions are highly valued by the administration.

At the end of the day, websites are essentially digital brochures, regardless of the product being sold. There will be some useful data (rotations, sites, call schedule, etc.), but the marketing stuff is often fluff. ...

It's like the college commercials they show at halftime...picture of idyllic campus...cut to ground-breaking research as earnest student pipettes something...cut to stately library...concerned professor looks over student's shoulder at computer screen that is showing, something....cut to happy students laughing as they walk to class...dynamic minority-appearing professor teaches amazed students (amazed because the prof showed up that day for the film crew shoot?)... show famous alumnus being hugged by plush mascot...excited crowd on game day...athletic triumph!...cue university name and symbol...slogan: blah blah something future something.

 

[st2205]

It's like the college commercials they show at halftime...picture of idyllic campus...cut to ground-breaking research as earnest student pipettes something...cut to stately library...concerned professor looks over student's shoulder at computer screen that is showing, something....cut to happy students laughing as they walk to class...dynamic minority-appearing professor teaches amazed students (amazed because the prof showed up that day for the film crew shoot?)... show famous alumnus being hugged by plush mascot...excited crowd on game day...athletic triumph!...cue university name and symbol...slogan: blah blah something future something.

Sounds about right.

 

[Manicsleep]

Talk to residents from all years.
PGY3s and PGY4s or fellows who did residency there are probably your best resource. However make sure you speak to residents who are not in the administration (this is coming from a former VP of the residents association and chief resident) because these people will often try to sell you the program. I love the question "what are 3 things that you could change about this program." If a resident can't come up with anything real, they are lying to you.

Same goes for training directors, chairs etc.
Honest attendings are those who you catch while on tour. The ones who don't have anything prepared and are somewhat blindsided because they are busy doing something else.

I once went to an interview where I was being promised all this new construction and brand new offices, didactics etc to be ready in 1 year. On the gero-psych ward I asked the attending what she thought of the new projects and when they were gonna be done, she said "who knows" and also indicated that the administration would probably take something away as a result. I didn't go there and new construction began at that program at the end of my PGY3 year. I had a friend go there a year after me and it was a good program anyways but my point is not to drink ALL the kool aid.

 

[sella turcica]

It's like the college commercials they show at halftime...picture of idyllic campus...cut to ground-breaking research as earnest student pipettes something...cut to stately library...concerned professor looks over student's shoulder at computer screen that is showing, something....cut to happy students laughing as they walk to class...dynamic minority-appearing professor teaches amazed students (amazed because the prof showed up that day for the film crew shoot?)... show famous alumnus being hugged by plush mascot...excited crowd on game day...athletic triumph!...cue university name and symbol...slogan: blah blah something future something.

I got a kick out of that. So true. 😀

 

[nitemagi]

For me it's about having the structure to learn the fundamentals to be a good clinician, but a variety of opportunities to pursue and customize my education how I wanted. For example I wanted research opportunities as an add-on.

 

[Psychiatrypd]

You want a program that will give you a broad assortment of inpatients and outpatients with all types of diagnoses. You want to have sufficient time to talk with your patients. Ask how many outpatients you see each week, and how many 15 minute (should not be any), 30 minute, and 1-hour appointments. Ask what type of supervision the residents get. Make sure they are giving you supervisors for psychopharmacology, cognitive therapy, and psychodynamic therapy, and enough time with enough patients to learn these modalities of therapy. Ask how many cognitive therapy patients you get, how many psychodynamic therapy patients you get, and how many psychopharm patients you get. When you get an interview, make sure you get to talk with enough faculty and residents. Look at the rotation schedule. If you have specific questions, email the PD's

 

[ieatmop]

If you don't care where you go, staying at your home program is really awesome. You already know the culture of the hospital, the area, the people, the computer system. It makes things really easy.

 

[OldPsychDoc]

If you don't care where you go, staying at your home program is really awesome. You already know the culture of the hospital, the area, the people, the computer system. It makes things really easy.

Assuming, of course, that the home program, culture, area, people, and computer system all meet your personal criteria of "awesome"...😉