Medical Education US

In response to a post in another thread:

is there any specific reaosn its not too competitive? Are there a lot of residencies available, or is that most med grads will go for other fields? Which fields do you find to be most competitive? thanks

Psychiatry is generally not that competitive for a few reasons. My opinions:

- there are a decent number of open slots for psychiatry residents because there is a need for psychiatrists.

- psychiatry has a stigma about it - both for patients and practitioners, and many doctors don't want to be associated with that stigma.

- at this time, it is known that psychiatry is not that competitive, and so some doctors assume that someone who pursues psychiatry may not have been able to match in another field.

- many doctors find it difficult to work with mentally ill patients, and therefore, prefer other fields.

- many medical schools don't do a good job of incorporating psychiatry into their medical school curriculum - and the students don't get an accurate perception of psychiatry, and wind up turned-off about the profession.

- medical students might percieve that psychiatry is not as well reimbursed as other fields (which is not accurate).

As a result, many of the psychiatry residency positions are fill with international medical graduates. While many IMG's are excellent, it is extremely difficult for residency programs to accurately screen IMG's - their training is different, letters of recommendation are not as uniform, and the US programs are generally not as familiar with the international medical schools. It is a general perception (sometimes true, often not true) that programs with a large number of international medical graduates are not as desirable. It has kind of been a domino effect - more international medical grads = less US applicants interested. This trend seems to be reversing some in recent years.

While the above is clearly my own opinion, the bottom line is that there are more openings in psychiatry than there are good US applicants. As a result, if you are an average US medical school graduate, you will have an excellent selection of good psychiatry training programs to attend. If you are a good US graduate, you can probably match at one of the top US psychiatry programs.


Regarding the other question - what are competitive residency program fields? The main ones that come to my mind are:

Orthopedic surgery
Dermatology
General surgery
Plastic Surgery
Ob / Gyn
Emergency Medicine
Radiation Oncology

I'm sure there are others I've missed.

[ Edited by Admin on 2004/9/26 10:48 ]

- psychiatry has a stigma about it - both for patients and practitioners, and many doctors don't want to be associated with that stigma.

what kind of stigmas are associated with the patients and practitioners?

I think the stigma is a little different from each person's perspective. The main ideas that come to my mind are that people with mental illness are somehow inferior people. That people with depression somehow can change that if they just tried hard enough. That all people with serious mental illness are dangerous. Essentially, the general public tends to view people with mental illness as inferior to people with other types of medical illness.

Some of the stigmas that the practitioners seem to get are that they are odd, eccentric, and even mentally ill themselves. Basically that psychiatrists are somehow inferior to other types of doctors.

I'm actually not someone who has studied much about stigma, but I'm sure if you did an internet search on stigma in mental illness, you'd find a huge amount of information.

Agree in general with many points. Some comments:

[there are a decent number of open slots for psychiatry residents because there is a need for psychiatrists. ]

A corrollary is that the number of slots available often correlates more with the service needs of the training institution rather than the broader numbers of physicians needed in that field.

[- medical students might percieve that psychiatry is not as well reimbursed as other fields (which is not accurate).]

Psychiatry is not poorly reimbursed compared to pediatrics, family medicine, and internal medicine, but if earnings are one's motivator, psychiatry is going to be toward the bottom. Surgery and the surgical subspecialties, anesthesia, radiology, dermatology, almost any field in which the practicioner performs a procedure, all tend to pay more, often considerably more.

[- psychiatry has a stigma about it - both for patients and practitioners, and many doctors don't want to be associated with that stigma.]

Many MD's share that sense of stigma about psychiatry, which makes it natural that they'd choose to avoid the field.

About stigma and the choice of psychiatry:

Another point I'd offer is that working with mental illness can be stressful emotionally. Especially when working with very disturbed patients, one becomes aware of and must interact with aspects of mental life that many would be more comfortable avoiding. People often react with anxiety to severe psychiatric disturbances. Also, working with very disturbed individuals can challenge one's own coping, and can at times result in one's own usually well-functioning methods and patterns of coping not working as well.

All this is somewhat less difficult when one is pretty comfortable with one's self. I think that some of the stigma associated with psychiatry has to do with how uncomfortable severe psychopathology can make people. And especially if one is less comfortable with oneself or with one's own emotional reactions, the more one can see psychiatry as alien or frightening, and consequently the stronger the motivation to avoid the field.

Where might I find info about the most competitive psych residencies?