Guide to Applying for Psychiatry Residency
By Marcia Verduin, MD
Congratulations! You've chosen one of the most exciting fields in medicine. Not only are psychiatrists uniquely trained to consider the patient from a “whole person” perspective, but the field also includes a wide range of practice settings and diverse opportunities for subspecialization.
- Choosing Programs
- Letter of Recommendations
- Personal Statement
* Questions for Attendings
* Questions for Residents
- Rank List
- Sample Thank You Letter (opens a PDF file)
- Application Organizer (opens a PDF file)
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, such as outpatient, inpatient, and emergency psychiatry. I don’t know which electives at your school allow you to have the richest experience, I encourage you to 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.
Externships, or away rotations, are also great options to consider. While probably not necessary in order to match into psychiatry, away rotations do give you an opportunity to “audition” for the program (particularly if it is a “reach” program for you) and to get a feel for the politics of a place.
There are many excellent psychiatry programs to consider, and deciding which ones to apply to can feel overwhelming. Fortunately, you have a few good resources to help you. 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 and program websites. Consider location, program structure, didactics, diversity of training experiences, supervision, etc. It could also be helpful to consider the accreditation status of a program, which you can find through the ACGME website.
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.
In general, you should submit applications to programs in three categories – reach, middle of the road, and safety. Which programs are in which category will be different for every applicant, depending on your unique academic and personal qualifications. “Reach” schools are those for which you think matching might be a stretch for you, “middle of the road” are the programs for which you think you are a solid candidate, and “safety” programs are those for which you think you have an excellent chance of matching. In order to determine your individual reach, middle of the road, and safety programs, talk with an advisor at your school and review the most recent edition of the NRMP’s Charting Outcomes in the Match publication.
You will apply to psychiatry programs via the AAMC’s ERAS system. The first step to completing the ERAS application is to compile a strong curriculum vita (CV) – once your CV is ready, then it will be much easier to complete the ERAS application. You will also need to write a personal statement. I recommend beginning your ERAS application between June and July of your application year. You should plan on releasing your application on September 15 (the earliest ERAS release date).
LETTERS OF RECOMMENDATION
Most programs require 3-4 letters - at least one from psychiatry and one from medicine (or pediatrics). An early psychiatry elective will give you the opportunity to ask faculty to write letters for you. Ask around to find out which medicine or pediatrics faculty 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.
I recommend making an appointment with the faculty you'd like to ask for letters. Do this in July or August if possible (so they have 1.5 to 2 months to work on the letter). During the meeting, bring 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. I recommend telling them you'd like the letters to be uploaded to ERAS by September 15. You may not be able to get all of the letters in by this date, but you definitely want to have 1-2 letters uploaded by the application release date of September 15. Any remaining letters should be in by mid-October at the latest. Make sure your letter writers know how to upload their letters into ERAS. Also tell them that you will give them a call/email 2 weeks before the deadline to make sure everything will be ready.
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 July. 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 family experiences which influenced my decision to go into psychiatry. There's no problem with doing this, as long as you're comfortable talking about those experiences 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 you wrote it. Many schools also have someone available to help you with your CV and personal statement if you make an appointment.
Scheduling. Interviews usually run from mid-October through the end of January. Most schools allow students to take 1 month off for interviews. When choosing this month, keep in mind that you will want to build in time to prepare for the interview – review each program’s website, do a mock interview with an advisor, etc. 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 concerned about that. 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 you will likely burn out at the end and start canceling interviews. Make sure you schedule your interviews as soon as you receive the invitation - many of the more prestigious programs fill up very fast.
Travel tips. Drive to as many interviews as possible to save money. If they are far away, there are many travel websites that enable you to find the best fares. Also, it can be very costly to part at the airport. Many airports have nearby “parking companies” that allow you to park for a discounted rate and take a shuttle to the airport. Just make sure that the area is safe. As far as hotels go, try to find one that offers a continental breakfast. Some 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 options allow you to save money, because 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.
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. Basically, the faculty want to make sure that what they see on paper matches you in person, and they want to find out if you are a good fit for their program. 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 mock or practice interview with an attending or resident – that was by far my most difficult interview of all. 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. Make sure you don’t ask anything that is readily available on the program’s website. Also, be careful about asking too many “lifestyle” questions (e.g., about benefits, vacation time, etc.), or else you may look like you are more focused on benefits than education/training.
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 a period of transition or instability for the program.)
4. How active are faculty members in teaching?
5. Do the faculty publish?
6. What are the research opportunities for residents?
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 (if not clear on website)? Do residents gain experience in short- and long-term psychotherapy, CBT, group/family therapy, etc?
22. How much ECT experience do residents receive?
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. How many residents have babies during residency? How accepted is this?
23. Food allowance? Laundry? Lab coats?
24. Climate? Recreation? Work out facilities?
25. What are the job opportunities for my spouse/significant other?
26. What do residents do for fun? Do you have any free time?
27. Is there low fee psychotherapy for residents?
28. What are your community psychiatry experiences like?
29. Would you come here if you had to choose again?
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 emails, 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 I talked about with each interviewer in the down time 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.
Everyone agonizes over this - you're not alone. I think the most important thing is to go with your gut. Happiness breeds success, so go where you'll be happy! Send a brief email to your top 3 or 5 programs to let them know they're in your top 3 or 5. Don’t feel pressured 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, definitely let them know.
Dr. Marcy Verduin is the Associate Dean for Students and Professor of Psychiatry at the University of Central Florida College of Medicine.