Medical Education US

Hello, I was wondering if i could get some advice on how to choose the right psychiatry program..

I have read that in psychiatry, the competitiveness of the program you get into doesnt matter so much for your prospects, but how do you find programs that are best matched to what you actually want to be doing in your career?

Do some med and psychiatry programs offer more emphasis on biological/med maintenance than others? do some offer more comprehensive training in aspects of psychology than others?

is there any book or website that describes the emphasis of each of the psychiatry programs? I have seen books like this for psychology.

also, is it very common that people complete their med school and psychiatry residency at different places? In psychology for instance, it looks like its fairly common that post-doc clinical internships are done in different places than the phd was recieved. is it similar for psychiatry?

about me: Like a number of other people on this board, I am interested in providing talk therapy, like psychoanalysis or cog behavioral, along with having the ability to prescribe meds as necessary. I am also a mid life career changer and am looking into going back to school to take classes that i will need, but i am getting a little intimidated by the amount of science classes some of the more competitive med schools require for admission.

Thank you so much, whoever replies.

By all means, don't look for a program that excels in med maintainance. Any program should equip you for that. That would be like looking for a baseball camp for your kid that will work on how to bat. I can only tell you what not to look for; I'm not up enough on which programs offer good psychotherapy training. To me that is what would distinguish a program from the others these days. (Unless you are looking for a research career.)

There are many different factors to consider in choosing your psychiatry residency program. I'm not aware of any books that outline all of the nuances of residency programs. However, the website that stands out most in my memory (I don't believe it started until after I was into my residency) is Scutwork.com (this link will take you to their psychiatry residency program listings). It is basically a site with links to all of the different residency programs, and then people can post comments about each program. They did a promotion when they first started their site giving away free shirts to people who wrote reviews - so I think most programs got at least one or two reviews explaining a resident's perspective of their program.

I really don't know how current the stuff is though.

As for what factors to consider in a psychiatry residency program:

1. Pharmacotherapy training - I mostly agree with the above post that any program will teach you med management. My own sense is that programs with good "med management" training are those programs with a heavy emphasis on empirically based treatments / evidence based medicine. My own thought is that the key isn't to learn the specific medicines of choice (as they change all the time), but rather understanding how to go about evaluating which treatments are currently the best options, and then knowing how to think through which treatment is best for a specific patient.

2. Psychotherapy training - depending on what type of practice you think you'll have will help you decide how important this is. More and more psychiatrists in practice are doing pure med management and little if any psychotherapy. It's a result of the market forces at present. There are some psychiatrists who do more therapy, but my own sense is this is a minority - my own training at a biologically based programs probably biases my view. The important things to find out are how many psychotherapy cases you'll be able to follow, and how many hours of supervision you should expect to get during that time. Also, you'll want to make sure there are some people who have a good reputation for teaching and supervising therapy.

3. Training in diagnosis - this is something that doesn't get talked about much, but it is actually the factor that I personally feel is probably most important. My own sense is those programs with a strong biologically based program are going to be stronger in teaching / supervising diagnosis of different disorders.

4. Good mentors / supervisors. You want to go somewhere where you get to work with and observe how good psychiatrists work.

5. Research - if you want a research career - the above means little relative to who you get to do research with

6. Lifestyle factors - for many people, this winds up being a primary decision maker. People want to go to a program where the calls are not too busy, and not too often. Also, some people want to know they will have a lot of opportunities for moonlighting to help pay off those med school loans. I think it's very important to go to a program where the residents like their residency director. In general, your life will be much happier at a program where you know your program director (and other mentors) will support you during tough times.