So this post won’t apply to everyone reading, but I actually get a decent amount of search traffic to this blog from terms like “should I go into psychiatry” (along with “medical school sucks,” but that’s a post for another time). So to give some helpful information to all the future psychiatrists out there, here’s some advice about the process of applying to residency in psychiatry.
First things first, if you’re wondering if psychiatry is right for you, you can read about the process I went through when I made the decision, and see some of the common concerns medical students have about the specialty and why you shouldn’t let those concerns deter you.
If you’ve already decided on psychiatry for certain, then congratulations! You’ve made an extremely intelligent decision. Trust me, in a few years your general surgery friends will be wistfully asking you about your 8-5 workdays and non-sucky lives. So now what?
Scheduling 4th Year Rotations
The first thing you’ll probably want to tackle is scheduling your 4th year rotations.
These rotations will fall into a couple of categories, including psych vs. non-psych, as well as pre-Deans letter and post-Deans letter. You’ll definitely want to do a psych rotation or two in order to get letters and get more experience under your belt, but don’t go crazy thinking you need to replicate your psychiatry residency in your 4th year of medical school. Take advantage of your elective time to explore other areas of interest and learn about things you won’t get a chance to in residency.
I did two psychiatry rotations in my 4th year, both away rotations at other programs. I did this because I knew I didn’t want to go to my home program and because I already had some letters lined up from my 3rd year psych rotations. If you want to be in the running for your home program or need to get a psych letter (and can’t get one from your 3rd year rotation), it’s good to sign up for one Sub I (that’s sub internship) at your home program.
I recommend doing away rotations, both the make an impression (preferably a good one) at a program you might want to match at, and to see how psychiatry is practiced at programs other than your own. I did an adult inpatient rotation at UCLA and a forensics rotation at UCSF.
If your main goal is to make a great impression at the program, it’s probably better to do a rotation where you’ll be interacting with a lot of residents and attendings, such as inpatient or Consult & Liaison (C&L). But don’t lose out on the opportunity to do something really cool like forensics or addiction if that’s what interests you.
I credit the fact that I matched at my top choice program with the fact that I kicked ass on my away there (if I do say so myself).
You will want to schedule your psych rotations earlier in the year so you can get letters of recommendation and so that your grade blurb will end up in your Deans letter. September is probably the last month you could do an away and have enough time to get a letter of recommendation into ERAS before application deadlines. I did have a friend, though, who couldn’t schedule her away rotation until November and still was able to have her attending write a letter that was put in her file at that particular program. This is a good option if you can’t schedule a rotation earlier in the year.
As far as pre-Deans letter and post-Deans letter, to state the obvious, once you pass November and your Deans letter is in your grades DON’T MATTER. I’m not advocating irresponsibility or poor patient care, but really, any gunner-ish tendencies after this time will be pointless.
Letters of Recommendation
Different programs will require different letters of recommendation, but you can’t go wrong with having two letters from psychiatry rotations and two from non-psychiatry rotations. Some programs will only require 3 letters, but some will require 4, so better just to get those squared away. I specifically remember that UCSF required 4 letters with 2 being psych and 2 being non-psych.
If you do an away rotation, you can get one letter from your home program (either from a 3rd or 4th year rotation) and one from your away rotation.
Also, ERAS allows you to send different letters to different programs. For example, I got a letter of recommendation from both my UCLA and my UCSF rotations, and sent the UCLA letter just to UCLA and the UCSF letter just to UCSF.
My non-psych letters were from my medicine rotation and from my urology research mentor (since I did switch last minute from urology to psychiatry).
I think psychiatry is one of the few fields where the personal statement actually matters. It’s your chance to show some uniqueness and personality. I remember that my medical school recommended writing a personal statement completely devoid of personality and substance. If you want to play it ridiculously safe and come across as someone who is boring and doesn’t have basic writing skills, than by all means follow this advice. But I found that having a descriptive and interesting personal statement made a big difference in my interviews. All of my interviewers had read my personal statement and almost all mentioned specific parts of it in my interview.
Start writing your personal statement early, because chances are if you wait for some magical spring of inspiration, you’ll be waiting for a long time. It’s better to write a little bit each day and have the time to tweak it rather than waiting until the last minute and needing to write the whole thing at once.
If you’re not sure what to write about, think about these questions:
- Why made you choose psychiatry? Experiences with family? College classes? Third year rotations?
- How do your personal interests (sports, art, writing, whatever) tie into your career interests?
- Did you always want to go into psychiatry? If so, how did you know early on? If not, why did you switch fields?
- What sort of extracurricular activities did you participate in during medical school that were either directly or tangentially related to psychiatry?
- What are your career goals within psychiatry?
Don’t be afraid to be interesting, but avoid saying anything too freakish that could be misunderstood.
I’ve heard that spending the whole personal statement talking about a specific patient that influenced you to go into psychiatry (such as “I’ll never forget the day I met Mr. Smith. I knew from that day forward psychiatry was for me…” etc, is a little tired and cliche in the eyes of program directors – perhaps avoid this technique.
If you’re interested, you can check out my own personal statement as an example. I used it as an opportunity to talk about how I went from being a gung-ho future surgeon to a future psychiatrist.
The process of choosing which programs you want to apply to is a personal one. There are a lot of ways in which psychiatry programs vary, such as:
- Emphasis on inpatient versus outpatient training
- Community versus academic
- Psychotherapy training
While psychiatry is becoming a more competitive specialty, and the top programs are very competitive, overall it’s not too hard to match in psychiatry. While your orthopedic surgery and dermatology friends may be applying to upward of 50 programs only to get a handful of interviews, you will not have this problem.
As long as you have a decent application you can probably safely apply to 10-15 programs (although check with your advisor on this). I applied to 14, got interviews at all of them, and went to 10 of the interviews.
The first way you will probably narrow down programs is by location. You might already know you want to stay in a specific city or state or keep in to the coasts or major cities. I only applied to programs on the West coast because I knew I wanted to stay here. If you’re couples matching, you might need to apply more broadly, but you could choose to stay within major cities where there are multiple programs. Unlike some other more competitive specialties, you can usually safely apply to a limited geographic area if that’s your preference.
Second, you should ask yourself if you’re looking for a larger, more academic program, or a smaller, community-based program. There are advantages and disadvantages to both. An academic program will probably be more prestigious (if that’s important to you), and you’ll have more opportunities for research. For me, I knew I would feel more at home at a larger program with more fellow residents. I also like to environment at UCLA – there are tons of amazingly intelligent people at the forefront of their fields.
I did interview at some community programs, though, and see the plus side of being at a smaller program with more personal attention and likely more opportunities to customize your experience. If you’re interested in fellowship or research, you probably want to go in the academic direction. But if you’re interested in practicing adult private practice psychiatry, a community program might be better for you. It depends on your preference and career goals.
Take a look at the program’s schedule and training emphasis. While the ACGME mandates that all psychiatry programs meet certain requirements, there are still some key scheduling differences between programs. For example, some are more inpatient heavy, while others have a more predominant outpatient experience. Some are front-loaded, and some have the more time-intensive rotations spread out among all four years. Some give you the opportunity to start psychotherapy training in your 2nd year, while for others you need to wait until your 3rd year.
You’ll probably want to take a look at the program’s call schedule, too. I wouldn’t recommend having it be your #1 decision-maker, but it does matter. Honestly, call sucks. I’m at a call-heavy program and sometimes I wonder why I did that to myself. The call schedule is something to consider when it comes to assessing the general quality of life of the program. Call is temporary, though – most programs have little to no call in the third and fourth years – so don’t let it sway you too much.
All the psychiatry interviews I went on were friendly and low-key. All the interviewers had read my personal statement and gone over my application. They asked general questions about my interest in psychiatry and more specific questions about my experience in medical school and my personal interests. You should think about this process as interviewing for a job rather than for school. While looking good on paper doesn’t hurt, no one is going to want you at their program if you demonstrate any douche-like qualities – no matter how impressive your application is.
You don’t want to sound overly-formal or overprepared, but i found it helpful to jot down notes about the most common questions I thought I would be asked. Things like:
- Tell me about yourself (a stupid question, but you will get asked it. I used this as an opportunity to say a couple sentences about where I grew up, went to school, some basic stuff about my family, and a little bit about my outside hobbies and interests).
- What are you looking for in a program?
- What do you like to do in your spare time?
- Tell me about your research (if applicable).
- Describe your strengths and weaknesses.
- What did you think of X college? X med school?
- Why psychiatry?
- Why medicine?
- Why did you switch from X specialty to psychiatry (if applicable)?
- Do you have a specialized interest within psychiatry?
- Tell me about an interesting patient and what you learned from it (I got asked this a couple of times).
- Tell me a joke (I never got asked this, but I hear that some people do).
- What’s the last book you read?
- What psychiatry rotations have you done? What did you like about them?
- What kind of practice do you see yourself in after residency? Fellowship? Future plans?
- Why are you interested in X program? Would you live in X city?
- What did your parents/friends/classmates think about your decision to go into psychiatry?
You will also inevitably get asked, “Do you have any questions?” I once was asked this as my first question in the interview! (Which to me is a little lazy, but no one ever said psychiatrists were good job interviewers). Have a list of questions prepared that you can ask – and ideally questions that are somewhat specific to that program (such as, “I noticed your program starts psychotherapy training in the second year. What is that experience like?).
Here is a list of questions you could consider asking faculty and residents. Keep in mind, you may seen disinterested if you ask a question that can be obviously found out on the program’s website, so do a run-through of the resources available online so you can tailor these questions to the specific program:
QUESTIONS TO ASK RESIDENTS
- What is life like in this city/area?
- What do residents do for fun around here?
- What advantages are specific to the location (climate, low cost of living, etc)?
- Disadvantages to location?
- Where do residents live? What are housing costs like?
General Program Questions:
- Would you choose the same program again?
- How do you like the hospitals you train at? Pluses and minuses?
- What’s the patient population like? Ethnicity? Socioeconomic status?
- What is the quality of the attendings? Do they get along?
- Do you get along well with your faculty members?
- How much autonomy do residents have?
- How many residents have left?
- Do you have enough time to read?
- Does your program help you prepare for boards?
- Does your resident group get along well together?
- How do you feel about the size of your program?
- What are your future plans?
- What do most residents do after graduation? Private practice? Fellowship?
- What fellowships are available?
- Opportunities to teach medical students?
- What would change about your program?
- Moonlighting opportunities?
- How do you feel about case conferences, grand rounds, didactics?
- How does the program respond to resident complaints?
- How is the curriculum set up? What do you think of it?
- Inpatient training
- Outpatient training/clinics
- Therapy training
- How are the residents evaluated?
- How many conferences/week are there? What about grand rounds/journal club?
- What do you think of the lectures/didactics? Is this time protected?
- What is your schedule like on the different rotations?
- Call schedule?
- First year: breakdown between med/neuro/psych?
- Second year: Inpatient vs outpatient?
- Third year: Clinics?
- Fourth year: Electives?
- Vacation time? Sick leave?
- Cafeteria? Money for food or free food?
- Library? Computer Access? Call rooms?
- Resident retreat?
- Educational leave?
- Moving allowance?
QUESTIONS TO ASK FACULTY
- What are some recent changes that have happened with the program?
- Any changes that you are anticipating?
- What is the balance between psychopharm and psychotherapy training?
- How does therapy supervision work? How many hours/week?
- What other therapy training is there? When does it begin in the curriculum?
- How is the curriculum set up? What do you think of:
- Inpatient training
- Outpatient training/clinics
- Therapy training
- Opportunities to teach medical students?
- What hospitals do residents work in? Patient population?
- Why have you stayed at the program?
- What are you looking for in an applicant?
- What would you change about your program? What are your favorite aspects?
- Do you have an introductory course or orientation for new residents?
- How is your Grand Rounds set up?
- Are there other conferences that residents attend?
- What is the relationship between faculty members and residents?
- What is it like to live in this city?
- Are residents exposed to any administrative training?
- How much reading time do residents have?
- What type of research do residents participate in?
- How much time do residents spend doing research?
- What percent of residents go on to do fellowships, go into academics, etc.?
- Does your program offer fellowships?
- Do you have a journal club?
- What journals do you read for journal club?
- Do you sponsor any visiting lecturers?
- How have your residents done on in-training examinations?
- Are there non-clinical responsibilities (research, projects, writing, administration)?
- Is this program especially strong or well-known in any special areas?
- Will I get hands-on training dealing with insurance, billing, contacts, hiring?
- Is there a mentor/advisor system?
- Do you help your graduates find jobs?
Filling out & Submitting your Rank List
Congratulations! When you’ve gotten this far, you’re on the home stretch. There are only a couple of key points to remember at this juncture:
- First, rank programs in the order in which you want to go to them. Even though the match system is fairly transparent, some applicants still misunderstand how you should rank programs. There is no advantage to ranking a program higher on your list just because you think you have a better chance at matching there. Rank the programs purely in your order or preference. You will match at the highest one that also matched you highly. The programs won’t know how you ranked them.
- Second, rank every program that you interviewed at, unless you would prefer NOT to match at all rather than to match at that program. Even if you didn’t like a program, ask yourself if you would rather take your chances scrambling for an open spot rather than going to that program. Even if you don’t think you’ll go that far down your rank list, you never know.
Lastly, enjoy your 4th year! Seriously – it doesn’t really get any better than 4th year after you’ve submitted your rank list and then matched. You have tons of vacation, no stress, and a solidly guaranteed spot in residency. Make sure to take full advantage.