Applying for Psychiatry Residency

By Marcia Verduin, MD (American Psychiatric Association)
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Congratulations! You’ve chosen one of the most exciting fields in medicine. I may be slightly biased, but I love my job as a psychiatry resident, and I think that says a lot about this field of medicine.
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SCHEDULE

You should consider doing at least one psychiatry elective in your 4th year to demonstrate your interest in the field.  I highly recommend a rotation which allows you to experience an array of psychiatric experiences, including outpatient clinics.  I don’t know which electives at your school allow you to have the richest experience, but I’d talk to other students and residents who have taken psychiatry electives at your particular institution.

If you are interested in research, there are plenty of opportunities, either as an elective or in your free time (believe it or not, that does exist as a 4th year!).  If you are considering an academic career, it might be a good idea to have some exposure to research.  However, if you are not interested, it is probably not crucial for matching at the program of your choice.

It also is probably not necessary to do an externship in psychiatry unless you really want to get a feel for the politics of a place.  If you really want to check out a particular program, though, go for it.
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CHOOSING PROGRAMS

There are a million psychiatry programs, but fortunately you have a few good resources.  My first recommendation is to talk to the Psychiatry Training Director at your institution.  S/he will give you a list of programs you should consider, and will probably be able to give you a couple of details about each program, as well as their strengths and weaknesses.  My next recommendation is to do a little research on FRIEDA. Look at location, program structure, number of foreign graduates, etc.

Psychiatry is interesting in that it also has a couple of combination programs that allow you to be board-certified in psychiatry and another field.  For example, med/psych, peds/psych, neuro/psych, and family med/psych.  There are many options, but beware that not all of the combination programs are accredited.  Make sure you consider your reasons for doing a combination program is it because you have heard people say that psychiatry isn’t “real medicine?”  Are you planning to go into an academic position that will require mastery of both fields?  (There are plenty of opportunities for academic psychiatrists who did not go to a combination program.)  Do you really see yourself practicing in both fields?  If you are considering a combination program, I would try to speak with some of the current residents in that program to learn more.
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APPLICATIONS

Fortunately, psychiatry has finally become a part of the ERAS system.  This will make your life much easier.  I recommend setting a deadline of October 1 for submitting your completed ERAS application.  This means you should begin working on your application as early as possible (July or August).
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LETTERS OF RECOMMENDATION

Most programs require 3 letters – at least one from psychiatry and one from medicine (or pediatrics).  An early psychiatry elective will give you the opportunity to ask attendings to write letters for you.  Ask around to find out which medicine or pediatrics attendings write good letters.  Some programs either require or prefer one letter to be from the chairman of psychiatry.  If you want to apply to these programs and don’t know the department chairman at your institution, make an appointment with him/her and bring your CV and personal statement.  One program I applied to wanted 4 letters:  2 psychiatry and 2 nonpsychiatry.

I recommend making an appointment with the attendings you’d like to ask for letters.  Do this in August if possible (so they have 1.5 to 2 months to work on the letter).  Show up with a copy of your CV and personal statement if it’s finished (or even if you have a rough draft).  This gives them a little more information to include in their letter.  The appointment also allows you to talk to them about your particular interests in psychiatry, and helps with setting deadlines for the letters to be finished.  Again, I recommend telling them you’d like the letters to be sent out by October 1.  Make sure they know where to send the letter to get it in ERAS.  Also tell them that you will give them a call/email 2 weeks before your deadline to make sure everything will be ready.  Follow up again a few days after the deadline, otherwise they may totally forget!
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PERSONAL STATEMENT

This is probably the most difficult part of the application process (at least it was for me).  I recommend starting as soon as possible – definitely have a rough draft finished by the end of August.  Everyone has a different idea about writing personal statements.  I chose to use a theme for my statement  I wrote about seeking balance in my life and how the career of psychiatry is an extension of that.  I also chose to mention some personal experiences which influenced my decision to go into psychiatry.  There’s no problem with doing this, as long as you’re comfortable talking about them on interviews.  Anything mentioned in any part of your application is fair game for interviewers.  I think it is important to mention how your interest in psychiatry developed and your plans for your career in psychiatry.  Have your friends and advisor read your personal statement.  I made the mistake of asking too many attendings and residents to read mine, and I received conflicting suggestions.  If too many people read it and make recommendations, it no longer sounds like something you’d write!  Many schools also have someone available to help you with your CV and personal statement if you make an appointment.
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INTERVIEWS

Scheduling.  Interviews usually run from early-mid November through the end of January.  I chose to take November as my interview month.  That gave me the first 2 weeks to relax and prepare for my interviews, and the last 2 weeks to actually begin interviewing.  I was very glad that I had all of my interviews completed by the beginning of January.  However, many people prefer to take January off so that they have time to schedule their interviews in clumps.  It’s a good idea to try to get all of your interviews in one area of the country done in one trip, but don’t get too crazy.  More than 3 interviews in a week severely limits your ability to care about the impression you make, not to mention that all of the programs start to run together.  I also recommend interviewing at your favorite schools in the first half of your interview trail, because I promise you’ll burn out at the end and start canceling interviews!  I had planned to do 12 interviews (which is on the high end for psychiatry) and ended up canceling 4.  Make sure you schedule your interviews within a week of receiving your invitation – many of the more prestigious programs fill up fast.

Travel tips.  Drive to as many interviews as possible to save money.  If they are far away, I found that having a travel agent was very useful.  They were able to get me the cheapest fare on both flights and car rentals.  I was also able to get a coupon for cheaper airport parking by using a travel agent.  Many people also use the internet travel websites.  As far as hotels go, try to find one that offers a continental breakfast.  Many programs don’t provide breakfast at interviews, and I was always starving by lunch time.  Some programs will offer discounts at local hotels.  Some hotels will even offer a shuttle to/from the airport and to/from the hospital.  These are great, because then you won’t need to rent a car.  Another option is to ask the program if any residents are willing to host applicants.  Some programs are receptive, some aren’t, but it doesn’t hurt to ask.  This can save you quite a bit of money.  I actually stayed at the program director’s house for one of my interviews!

Preparation.  Fortunately, most residency interviews are much more laid back than medical school interviews.  In fact, the most difficult part was coming up with enough questions to ask the interviewer about his/her program.  Most schools interview within one day, and some will schedule a dinner with residents the night before.  Though this feels more casual, be on your best behavior.  The resident(s) who take you out to dinner often give feedback to the program about the time they spent with you.  A few programs actually have 2 day interviews.  I interviewed with anywhere from 2 to 9 interviewers in one day.  Remember that psychiatry is largely a buyer’s market.  Most programs are trying to sell themselves to you.  Basically, they want to make sure that what they see on paper matches you in person, and they want to make sure you have appropriate social skills.  Make sure you come up with 2 or 3 psychiatry patients you found interesting or challenging. I was asked about that a number of times.  What did you learn from the patient?  How did they influence your decision to go into psychiatry?  Also know why you chose the field of psychiatry.  Know your career goals well.  I recommend setting up a practice interview with an attending or resident  that was by far my most difficult interview.  Also create a list of questions to ask both residents and attendings.  At the beginning of the interview trail, I actually pulled out my list and referred to it.  By the end of the trail, I knew it from memory. Below are examples of questions to ask:
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Questions for Attendings

1.  What are the strengths/weaknesses of this program?
2.  Is the emphasis of the program more biological or psychotherapy based?
3.  Do you foresee any changes in the near future?  (If the chairman is leaving, it could signal trouble for the program.)
4.  How active are faculty members in teaching?
5.  Do the faculty publish?
6.  Are there any research opportunities for residents?  Is research required?
7.  How do the residents seem to get along?
8.  What are you looking for in an applicant/resident?
9.  Do you have specialty clinics (eg, mood disorders, anxiety disorders, eating disorders, med/psych clinics)?
10.  How are the residents’ PRITE/board scores?
11.  What do your residents do when they graduate?  Fellowships?  Private practice?  Academics?
12.  How well do faculty get along with each other?  With residents?  With other departments?
13.  How are residents evaluated?
14.  How does psychotherapy supervision work here?  Do residents get to choose their supervisors?  How many hours of supervision do they have per week?
15.  How diverse is your patient population?  What is the socioeconomic mix of the patients?
16.  Do you have a journal club?  Are faculty members involved?
17.  What are the job opportunities for my spouse/significant other?
18.  How many hospitals do residents work out of, and how far away are they?  Which hospital do residents base their outpatient clinics out of?  (It’s nice if you can work in a variety of settings, such as a private hospital, psychiatric hospital, VA.)
19.  How well do residents do on their internal medicine and neurology rotations?
20.  What is the average length of stay of patients?
21.  Can I see a copy of your psychotherapy curriculum?  Do residents gain experience in short- and long-term psychotherapy, CBT, group/family therapy, etc?
22.  How much ECT experience do residents receive?
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Questions for Residents

1.  How much supervision do you have?
2.  Why did you choose this program?  What other programs did you look at?
3.  What are the strengths/weaknesses of the program?
4.  Any regrets about your decision to come here?
5.  Has anyone quit?  (a very revealing question – always ask why)
6.  Are you happy here?  Do you know anyone who’s unhappy here?  Why?
7.  How’s call?  Is there a nightfloat system?
8.  How’s PGY-1 morale?  PGY-4 morale?
9.  How well do residents get along?  Do you get along with faculty?
10.  Do you feel well-respected among other departments?
11.  How much teaching do you get?  Conferences?  Core teaching programs?
12.  Are didactics protected?
13.  How diverse is your patient population?
14.  How much psychotherapy exposure do you get?
15.  How much influence do you have on your curriculum?
16.  What books do you use?
17.  Do you have time/opportunities for research?
18.  How’s parking/transportation?
19.  What’s the cost of living?  Where do most residents live?
20.  Do you have time/opportunities for moonlighting?
21.  How are the facilities?  Library?  Call rooms?  Resident lounge?  Computer system?  Cafeteria?
22.  What benefits do you have: insurance, vacation, sick leave, educational leave, educational money?
23.  How many residents have babies during residency?  How accepted is this?
24.  Food allowance?  Laundry?  Lab coats?
25.  Climate?  Recreation?  Work out facilities?
26.  What are the job opportunities for my spouse/significant other?
27.  What do residents do for fun?  Do you have any free time?
28.  Is there low fee psychotherapy for residents?
29.  What are your community psychiatry experiences like?
30.  Would you come here if you had to choose again?

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POST-INTERVIEW

Write thank you letters to the program directors, letting them know how interested you are in their program.  Most people send thank you notes to most (or all) of the people they interviewed with.  Some people send typed letters, others send hand-written notes.  Regardless, write them as soon as possible after the interview.  I found it very helpful to jot a few notes down about what we talked about between interviews.  When you have an average of 5 interviews per school, it’s easy to forget what you talked about with each person.  I usually used a similar thank you note for each interviewer at a particular school, but made modifications to include our discussion.  I also jotted down a few pros and cons about each school on the flight/drive home.  This made it easier to compare programs down the road.
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RANK LIST

Everyone agonizes over this – you’re not alone.  I think the most important thing is to go with your gut.  Even if you can go to a more prestigious program, it may not be worth it in the long run if you’re going to be unhappy or overworked.  As my advisor told me, happiness breeds success, so go where you’ll be happy!  Make sure you send a short letter to your top 3 or 5 programs to let them know they’re in your top 3 or 5.  Don’t be bullied into telling any program where you’re going to rank them, though.  If a program director calls you post-interview and you’re not interested in the program, just thank them and let them know you don’t have any questions right now.  If you are interested, let them know.
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Dr. Mary Verduin  was a PGY-5 Fellow in Addiction Psychiatry at the Medical University of South Carolina when she wrote this guide. She is now an attending at the same institution.

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Additional resources for applying to residency programs:

AMA: Freida Online

AAMC: Careers in Medicine