The Interview Diaries

DISCLAIMER: I am writing this for 1.25 reasons. The major reason is for myself. I keep hearing that at the end of the interview season, things are all meshed together in your mind and you end up ranking on your gut feelings. Well I’m not paying all this money and spending all this time away from home just to forget the experiences. That said, I’ll be documenting tons of my experience, typically a few days after the interview so it’s had some time to settle and I can separate myself from any artificial feelings of goodwill. When it comes time to match, I’m sure gut feel will have its role. I just want more info than that. The other 0.25 of a reason is for you, dear anonymous reader. If you’re intellectually curious of my experiences, just plain bored, or have some affinity towards me that has led to a desire for some insight and shared experience, here you go. The real point of this disclaimer, though, is to warn you I’ll be documenting direct quotes, praise, off-color remarks, criticism, etc, that will best help me evaluate a program and its interest in me when the time comes to make a ranklist. If it seems at times self-serving, it is supposed to be. If it seems like a journal of braggadocio, then well, congrats to me, as I must be hearing good things. I hope things are similarly going well for each of you, both personally and professionally.

Note: I don’t want to hear comments about me bitching of program’s workloads. These are relative to my expectations of a psych residency, notorious for high quality of life. If you don’t like it, don’t do medicine, surgery, etc. Thanks.

Note #2: Please don't talk about this blog. I wrote this for the above stated reasons. The 0.25 reason is not worth this blog falling into the vision of the wrong people. If there are concerns about something written here, please take it up with me personally.
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Charleston, South Carolina (The Holy City…crap)
Medical University of South Carolina (MUSC)
1.29.07

Am I really in the dirty dirty? Seriously? I’m sitting in a Starbucks on King St in the small but vibrant downtown scene of Charleston. I just completed my last interview and have 2 or 3 hours to kill before my dreadful overnight train ride back to Charm City. And, frankly, I’m a little confused. Confused about my future. Confused about my day. For the first time, there’s a little uneasiness about the uncertainty that accompanies the Match. Let’s start from the beginning…

In the summer when I first started thinking about programs, the idea of the internationally reknown Pitt program came up. Next, of course, then came the understanding Pitt involves living in the past-its-prime—yet somehow still acclaimed by many—Steel City. This was welcomed by no one in our house of two, and a rule quickly formed: we will live no further from the ocean than we do currently, roughly 150 miles. There were some easy choices to select along the west coast, and then some others in the northeast. I then turned to the southeast. There’s not a lot to choose from down there. I threw out the blasphemous—in Maryland, at least—option, “How about Duke?” This was pushing the 150 mile rule (as well as perhaps the stability of my impending marriage). So no Duke. Part of me was relieved. Emory? Also too far. Florida schools? No chance of staying there after residency with its horrendous situation regarding malpractice. UNC? Pushing the rule and just not that interesting. South Carolina…do they even have a program? They do. It’s called MUSC and the ratings at scutwork.com were phenomenal. Almost all 4s and 5s (out of 5). Weird. Student-Doctor Network also with some good reviews. US News and World Report (July 2003) listed the hospital to be 25th in the country in treating psychiatric disorders. June 2004 found the Department of Psychiatry to be ranked 17th nationally in NIH funding for research. But in South Carolina? So I pitched it to Christine. “I don’t want to live in the South”. But actually Charleston doesn’t much seem like the south. Supposed to be a liberal town hopping with great restaurants and bars, minutes from several beaches, steeped in history, with a reasonable cost of living. “We should give it a shot,” I say. We go back and forth. She hears there is a terrible public education system, and worries about how administrators in the bible belt will affect her ability to teach science the way she wants. But then she starts asking around, as do I. Public schools are crap down here. But there is a burgeoning biotech industry for bench research, and there are private schools that pay tremendously. There’s a surfing scene. Apparently it’s a top notch place for young couples who like the beach and want to do things outdoors year round. I dangle the carrot of a weekend together to check it out—“a vacation”. And that’s how I’m in Charleston.
We left about 3:30pm on Thursday to drive the 600 miles. Traffic sucked in the beginning, and we made it to the hotel about 2am. The hotel’s hot water something apparently broke at 10pm that night, so we had to make due until the morning, we were told. We woke up around 9 and I went for about a 12 mile run around the waterfront, through the city’s good and bad parts, and over the Cooper River bridge into neighboring Mount Pleasant (“mount p”). I learned the city very well, as it is mostly contained in a few square mile area on a peninsula. I made it back home and hoped I would just die instead of paying the knee and hip punishment from my run, but no such luck. Also out of luck was I with the hot water situation, still not fixed. I managed to clean up anyhow and we drove downtown to start walking around. We found a cool pizza place for dinner and went to a place Christine read about, Kaminsky’s for dessert and drinks. Fairly ingenious, this place. They offer alcohol, desserts, and a combination of the two. They were very busy. We had fun.

Saturday we did more of the same...walking, eating. We also drove to nearby Folly Beach, one of several in the area. We met up with a resident and her husband for drinks and dinner around 8. The program has a policy where they don’t pay for alcohol. I’ve commented on this before (See: UW Interview, 11/20). I think it’s crap to have people pay hundreds of dollars to evaluate a program for goodness of fit and then not pay for their drinks. However, at least they were up front about it, and it is the Holy City after all (note: but it’s okay to drink wine in church on Sunday mornings). This resident seemed a little unhappy with the program, having been a transfer from Hopkins when her husband had to relocate because of his job. But overall she seemed happy and loved the city. He was also very cool. We drank (too much) wine and ate a ton of great Thai food in a small, loud, overcrowded hotspot. Now there were five things I asked Christine to avoid talking about at this dinner: sex, drugs, alcohol, politics, and religion. These are my stay-aways in arenas requiring professional conduct. With their prodding and some wine and beer, my loving wife finished the night at 60%. Fortunately, this other couple completed the evening at a paltry 40%, thanks to some half-drunk awkward sexual advances/jokes by the husband (a college professor…no shock), including a transition from, “Why buy the cow when you can get the milk for free?” to “But the milk is better now that I’ve paid for it”. I watched his wife’s half-amazed, half-drunk, fully awkward, silent reaction. Awesome. Despite the objective criteria being fairly damning, I think the experience was more bonding, and showed an ability to hang out personally, which I hope and believe will translate into a sound evaluation from her if asked.

Sunday Christine drove home. I went to a nicer hotel (the program paid for half of it, but just for one night). Let me say this: king size bed, real blankets, walk-in closet, free wine and sherry, silver platter breakfast in bed, wireless internet. It was nice. I watched Tiger win his seventh in a row on tv, the Wiz roll in Boston on the internet, ordered in pizza, grabbed some wine, then went out for a night tour of Charleston’s “darker side”. The mercury fell and the wind kicked up as this tour of about 10 of us wandered through the eerie streets of Charleston. We learned about the city’s history of brothels, pirates, executions, worst crimes, and revolutionaries against the British and American governments. We walked through the oldest graveyards, saw round churches (“because the devil hides in corners”), and hid from the wind by the “four corners of law”, a unique intersection where you can find on each of three corners a judicial building from the city, state, or federal system. On the fourth stands a large church, the fourth law, “the law of God”. It was a pretty cool tour. And if you are ever in a port city and see a heart somewhere, typically carved in brick near the entrance of an old building, that building likely served as a house of prostitution.

I said served, Neil. Keep it in your pants.

Monday I made it to the Psychiatric Institute, a stand alone building which serves to house much of the residency program. There are a cluster of hospitals in a few block radius, so there are other services in other buildings, such as the ER or any of the VA services. Everyone all day was very friendly, though I can’t say overwhelmingly brilliant-seeming. Nor did anyone really exhibit any large desire for academics, with everyone selling the quality of life and “resident-driven” program. Great, but am I selling myself short? I spent much of the day with the residency coordinator, who was helpful and pleasant, and a source of good conversation. I first met with a recent grad, now an assistant professor. She spoke a lot about research and substance abuse, areas that totally miss the mark when trying to sell a program to me. However, she really came across as being sweet and genuine and happy. The interview went fairly well. I next met with the Training Director. If it did not say this on my interview schedule, I likely would still not know. He was so unassuming and friendly. At one point, I was talking about the variability one would find in the state of Maryland. He pulled up Google Earth and asked me to point out these characteristics (like the mountains, skiing, ocean, cities, suburbs, rural areas, access to other destinations) as well as where he could find UMBC. Really, we spent ten minutes talking about this. He was very interested in the CAPP program, as I found out many people were today. It’s strange, too, because this was my tenth interview and most people don’t much care about it, though it’s an invaluable experience and a leg up. I felt this interview went really well. I next met with an intern. It was the first time he had interviewed anyone. It wasn’t smooth. I finally stopped trying to directly answer his questions or to push my agenda and fully focused on making the interview just smoothly transition from one random topic to another. It wasn’t so helpful, but he’s probably a nice guy. I next met with the interim chair. Interim anything-high-up is normally scary. I was assured many times over that the last chair left “for the opportunity of a lifetime” at a brand new hospital in Texas, and that the next chairman will share in the current vision. I hope so. This interim chair was very cool though. An older gentleman, very polite, very easy to speak with. He made it easy to bring up the points I like to mention throughout an interview day. Time ran over too quickly. I think this interview also went very well. In fact, he mentioned, “I expect you to be a very competitive applicant in this program”. I went to lunch with an athletic PGY-3 going into child. He talked to me a lot about the flexibility of the program, especially after the second year, but even at times after the first year. He seemed very happy at this program but I couldn’t shake the feeling that he wouldn’t know any better even if the program was crap. He talked a lot about the NFL and intramural sports and we ate burgers and had a fine time. I met with the associate director next. I was fat and happy with my day, freshly out of questions and ready to keep rolling. This guy was just looking for me to ask questions though. Damn. It was pretty awkward at times as I reached for new questions and received mostly canned clichés for responses. I just wanted him to ask me a question. It didn’t happen though and I was released after 30 minutes. I met with a first year C&A fellow next, and she was excited to hear about my interest in the field. She hadn’t read my application but was at least open and apologetic about it. We only had about 20 minutes so I took half and told her my story. She seemed impressed at my commitment, and asked the follow-up questions I get most interview days. My answers were quick and polished and I left feeling my mojo was back. I would have liked more time to talk with her about the program though. I finished up my day with a cursory tour around campus by a PGY-2. He was a cool guy and we spent a good deal of the tour laughing, which is solid. I asked about paperwork, which can be heavy at times and is mostly manual. And I asked about perks. There is $1000 book stipend over the 4 years. There is a night float 2 months of the year. Your call is about 15 days over each month during that stretch, from 5pm to 8am. If you work past 2pm on any of those days, or any postcall day, you earn a comp day, transferable later for a free day off. Call is pretty light after that. You get about 3 weekends off, 1 on. Call on medicine and neuro are oddly q6 or so. That’s very light. Other perks include free parking, a monstrous gym that includes weights, cardio, racquetball, a rock climbing wall, and an indoor Olympic size pool. Moonlighting is abundant after intern year. Step 3 must be taken the intern year. Moonlighting is near and far. Some people drive as far as Greeneville, NC or Savannah, GA. This is up to 3 hours, but—it was said—“At 41 cents per mile and $100 per hour, I’m smiling all the way there and back”. Well, okay. The didactics are said to be weak by some. Time is not protected. The curriculum is pretty standard. I left feeling happy, but within a cloud of confusion.

I knew entering the day this program would not be top three. I have tried to ignore prestige when possible, but MUSC can’t hang with San Mateo or Harvard, and is questionably in the ranks of UCI or Brown. But the satisfaction level would be super high here. At least the satisfaction of easy days and surfing year round. But pride in the competitiveness of your institution is an inherent component of satisfaction of residency. Selling yourself short now, after all this work, for some beach time is a bit foolish. Especially when you can get beach time in SoCal. So MUSC can’t be top 3. But it will be 4 or 5, likely. So Brown or MUSC? I can’t yet say. I’ll have to do some more analysis and return to the topic later.

Strengths of the program:
-lifestyle (55 hours per week or so, live at the beach, great bars and restaurants), affordable cost of living, reasonably close to friends and family, very happy residents, good money to be made in moonlighting, fellowships if I wanted to stay

Weaknesses of the program:
-possibly selling myself short here; possibly not so great professionally for Christine; poor didactics; though close, airfare is more expensive than to Cali or the northeast

Whole grade:
Immediately — 8.4

I normally make some kind of definitive statement here. But as I’ve said, I’m a bit confused. About it all. I think it should be San Mateo, Harvard, UCI, Brown, MUSC, CalPac, Harbor-UCLA, Maryland. No rank of UCSF or UW. But really, now I’m questioning Harvard as high as #2. I question Brown as a 4 or a 5. I question any order of MUSC, CalPac, and Harbor-UCLA at 4 through 7. I’m fairly certain I should rank Maryland last, though it was a fine choice. I’ll have to get to writing a review of Harvard if I can remember enough, then start sending out more emails. One thing is for sure: by 2/21 at 9pm, this list will be certain, one way or another.

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San Mateo, California
San Mateo Medical Center
12.13.06

I wasn’t going to do much of a review of this program. However, since I’m now sitting in Chicago awaiting my connecting flight that has been twice delayed after the flight from San Jose included a security breach delay that went unsolved and then an entire flight without service because of turbulence for 1400 miles…after all this, I’ll jot down a few thoughts and stop bitching about airfare stuff.

San Mateo. It’s my top choice by far. Going back there was so great. I was stopped in the halls by security guards, MAs, nurses, attendings, and the chairman. These people spoke so nicely to me. Then I saw the interns I’d worked with and the residents and the other attendings and the program coordinator. Everyone was so warm. Many patients I had seen in my four weeks were back. It was a really nice day. People commented on my excellent choice of apparel—thank you Macy’s Union Square. It was just an awesome day.

I woke up feeling like total crap. I stepped out into the rain and dropped my suit jacket into a puddle. I uttered a solid string of muttered obscenities in my sick morning, gruff voice (that was later commented to be a “good phone sex voice”). After some cleaning/drying, I was en route.

I was fortunate not to interview with anyone I knew too well. I was worried about the formality of such an occurrence. I met with the associate director, who I had not yet met because he is usually running his clinic in a different part of the county. I was told he is “a tough nut to crack”. Perhaps. He was post-call and had not read my application very thoroughly but I tried my best to keep him awake. (Of note, when I looked in the mirror before I left, though super excited, my normally stoic face had morphed even further into one of contempt. Hmm, not what I’m going for, I say to myself. I try some things…thinking about happy things, exciting things…no dice. Uh oh. And I uttered a few words…terrible sounding. I would not hire me. Solution: I drove the whole way singing songs on the radio, trying to hit notes I knew I couldn’t, smiling profusely (at times using my hands to force my face into positions). Don’t forget I’m wearing a suit in a blue minivan. Most entertaining guy on the road, I bet. Best part? It worked!) So this interviewer, he kept talking about how they want residents who will participate in community action roles. Eventually I had to feed him the best I could with what I had to work with. I left not feeling super about it, but when I saw him later he gave me a huge smile, so who knows?

I then got to do a 90 minute lunch with my old colleagues. It was nice.

Then the big interview with the PD. And I believe I nailed it. I said everything I wanted to do. I smiled. I showed I was listening. I said what I wanted before he could say what they wanted, so he could piece that congruence together himself. And though he is known to be a very tough read in his own right—none of the interns this year felt strongly they would match at San Mateo despite voicing it as their top choice—he threw me more of a bone than I expected. “Jeremy, we would be very happy to have you here. It’s tough to say how things will turn out, but please call me in January if you intend on this being your top choice. I think you would do very well here, and we would be happy as well.” The man could have said he loved me and I would have been no less dumbfounded at that point. Awesome, awesome, awesome!

I walked into my last interview with the medical director, a woman who I had also not yet met. She was nice. She didn’t strike me as an administrator as much as someone who would frantically be running an underserved clinic somewhere all by herself. I asked her some questions about herself which opened her up to me right away and then we hit it off for the next hour. It all went just great.

Then I went home. I grabbed a quick nap and went out to Palo Alto where I had some Venezuelan hot chocolate with chile pepper, then grabbed penne and a syrah at a nearby wine bar and restaurant. I met a nice woman who frequents the restaurant almost every night after she finishes her business of financing loans. I went home and packed and now I’m almost home! …for good!

Strengths of the program:
-lifestyle (hours, caseload, call), sick patients, fully integrated network of psychiatric resources, warm friendly people, emphasis on balanced therapy, always finish in the top 3 of the national therapy exam, do well on the PRITE, get strong fellowships (including a new one in the works: joint community-child with Stanford), the office runs smoothly, palo alto is near enough to live an awesome life, half moon bay is as well if we choose the action surfing route over the young married adult route, etc etc etc!

Weaknesses of the program:
-people are great at work but they don’t work much, so they end up going home, resulting in a weak ready-made social support system for us to fall into. SF bay weather isn’t super.

Whole grade:
After externship – 9.3
Before interview – 9.1
Day after interview – 9.2

I don’t see how the #1 ranklist position could be usurped from San Mateo unless either Cambridge next month is really as amazing as I hear and then some, or unless the friendly folks at UCI can find a way to repackage their already great product into something even more appealing. What a great feeling.
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San Francisco, California
California Pacific Medical Center
12.12.06

I’m writing this review from the airport in San Jose two days after my interview. I’m sitting in the early morning darkness of the Bay Area’s winter weather: 50 degrees, fine mist interspersed with bouts of rain, and heavy purplish clouds that fill the sky three dimensionally. This is the first review I’m doing with another interview intervening in the processing of the program currently I’m reviewing. I went to San Mateo, widely known as my top choice, yesterday and I’m finding that my initially very high feelings of Cal Pac (aka CPMC) are lesser so today, likely a result of that San Mateo experience. Hopefully sifting through the details here will help me refocus on that initial impression.

Those close to the minutiae of my traveling experiences know I’m a huge proponent for the website Hotwire.com. I’ve always, and I mean always, ended up with a hotel much better than I should for the price I pay. People shy from this website because you are not choosing the hotel, but rather choosing areas in the location you are visiting as places to search hotels. From these—typically 4—areas you are given unnamed hotel selections that include the price per night, a star rating out of four, amenities, which area of the hotel is in, and some are listed as customer favorites. Additionally, you see what their star ratings are equal to on another part of the website. There are 8 tiers, ½ star up to 4 stars. This part of the website will tell you a 2 star hotel is equal to La Quinta, Comfort Inn, or Days Inn, for example. Now usually I don’t go below 2.5 stars, and typically I go with 3 stars. These end up being places like Marriotts and Sheratons and Holiday Inns. The rooms are huge, I often get free internet, showers are great, and the beds are super comfortable. There is usually a gym, and often a pool/hot tub. However, now feeling the financial stretch of my loan check at the end of a semester that included a wedding, honeymoon, and three months of almost constant travel, I looked into hotels at my last location—the San Francisco area—knowing I needed to stay cheap. I also knew this to be my most expensive location. However, I couldn’t see myself paying even $80/night plus rental car expenses for these three nights. There were many 2.5 star hotels available for well over $100, which I expected, so I decided I’d really gamble on this website I’ve come to trust and go bottom of the barrel. I booked the room for $36 a night next to the airport in South San Francisco (SFO). Yikes. Car rentals started at $44/day + tax in this area. Yikes again, since I’ve been paying around $14/day up to this point. I will not be denied, however, and long story made short, I left the lot with a minivan for $20/day and checked into my Travelodge in South San Francisco. It was what I expected, which is tons better than I feared. The room was a fine size, the bathroom met my needs, it was clean, it did not smell of smoke or sex, and was relatively quiet. Because I’ve been sick, I’ve had quite a bit of trouble sleeping lately, so the one deficit in the room was the comfort of the bedding, of which I’ve become quite spoiled lately. Some hotels have amazingly comfortable beds. This one had some flimsy padding beneath the sheets that easily crinkled and lumped as I tossed and turned. The thought struck me in the early morning hours that my bed was like the guy who wears a condom that’s too big: it also crinkles and lumps, ultimately resulting in a bedmate who is irritated and unsatisfied…I’d assume.

So I spent most of the night coughing and fighting a bleeding right nostril suffered from a lot of nose blowing coupled with the previous few days of SoCal aridness. I awoke at a reasonably early time to set off into the rain towards San Fran for my CPMC interview. I was surprised to find the traffic heavy but moving and couldn’t help but compare it to some of my recent LA experiences. If it rained like this down there, you might actually starve to death in your car.

I made it through the city without surprise and had some nice recollections of times spent riding the buses with Christine on our honeymoon. I found out how little respect a minivan gets in traffic as well. I parked in Cal Pac’s garage, as instructed, and easily found my way up to the 7th floor psych office. I was struck by the calmness of the city even in its weather-darkened urban setting complete with people moving in all directions. SF is an experience unto itself. Everyone should visit. The program coordinator was friendly and thanked me for coming, which was nice. As I was asked throughout the day how a student from Baltimore ended up interviewing at this small community program in SF, I’ll use this time to explain how I did end up at this place that no one reading this has probably ever heard of. Simply, Cal Pac was listed as a residency program in the bay area. I didn’t know a thing about it, couldn’t find out a thing about it other than their website (which I generally don’t trust from programs, by the way), and no one I asked knew anything about it. That seemed like enough reason for me to check it out. I’m not looking for a program that is full of intense research and world famous faculty as much as somewhere I’ll get the training I demand with the lifestyle Christine and I want. This could be a diamond in the rough, I thought, though probably it would not be. Alas, I went, and first met with the chairman.

He was very friendly, and you could feel his psychodynamic orientation easily just from the way his office was designed. He tried to sell me on the program, but though he was quite genuine, he was telling me things that many people would: we want residents who have good people skills, who understand the power of warmth and genuineness. That’s good. I appreciate those qualities in my colleagues as well, but is it enough basis to make a decision about residency? Not really. The hospital, being a community site, is doctor-driven and things tend to get done quickly. It reminded me of Mercy in Baltimore—at least from what I’ve been told—as I’ve never worked there myself. The program only takes 4 people a year from—and this was a surprise—over 300 applications. Part of me is skeptical of that since I know San Mateo to be well known on the West Coast and highly respected, but they get about 200 applications for their 4 spots. However, it is plausible as other things became known, such as their residents that left last year for fellowship all went to UCSD, UCSF, Stanford, and one went to the prestigious child program at Mass General. You can’t fake that kind of power. Oh, almost forgot. One of the first things the chair said to me was, “You sound like you come from a rural area. One thing interesting about San Francisco is that nobody, and I mean nobody, puts up with any kind of prejudice or intolerance* around here.” I decided right then and there to hold off on all my gay jokes until my next interview. Man, was I disappointed.


*Note: In fact, I’ve found that San Franciscans are incredibly inflexible and intolerant to those who do not share in their beliefs, which is typically some leftist yammering on about something or other. This is especially true in regards to those who show intolerance to race and sexual preference. I’m not saying they’re wrong by any means. I’m just saying don’t tout your great life views of live-and-let-live if you stoop to your opponent’s level whenever they spout their own gibberish.

I left the chairman’s office feeling—well, still sick as I hadn’t yet gotten past the morning congestion/headache/achiness period—but surprised and a little excited. I next met with a PGY-4 chief resident who took me out for coffee down the street. We had a great talk. He read my application thoroughly and made several strong arguments for how we were very similar and how those characteristics helped him thrive in the program. They seem to have very light schedules their first year, which gets heavier in 2nd year, which is interesting. Call is Q5. Caseloads are something like 6 patients as an intern. Very mild. Then 4 patients as 2nd year in half-time as you also have a few therapy patients in outpatient clinics. Since it is a busy urban center, the psych emergency room (not dedicated) is usually pretty busy, but it’s said residents normally get to bed by 1am. Oh, and this ain’t bad….call is from home!!! As long as you can reasonably get to the hospital within one hour, you can hang out at home unless you need to come in for something. This resident and I got along very well. There appears to be a great social support network amongst the residents. He dropped me off with a PGY-2 in Grand Rounds, where I would sit for 20 minutes to get the feel before we went to lunch.
Grand Rounds was a talk about psychiatric illness with HIV. Is it just me or is anyone in SF not there for something to do with HIV/AIDS? It was a good talk and I learned some things in my brief stint there. People seemed to be paying attention, and it truly was a doc’s hospital. Most of the audience was older. There were 5 or 6 wall-mounted HDTVs for the powerpoint presentation placed around the room for easy viewing from all seats. Very nice. Instead of making me scarf down cafeteria food, they took me to a nearby newly opened French restaurant where I ate very little, still feeling fairly sick. The conversation was good, though, and the resident was friendly and informative. She told me about moonlighting opportunities, which are available after achieving licensure, typically done late in 2nd year. Many people do not moonlight, however. This struck me oddly, as salary was $43k in one of the most expensive areas in the country to live. It turns out most moonlighting opportunities are about 30 mins drive away. That’s fair. I can see that as being prohibitive for people who don’t need the money, and reasonable for those who do.

By the way, since my San Mateo interview was the next day, and since I was feeling a little burned out towards interviews and finding my answers to questions were sounding a little more canned, less genuine, and less creative, I decided this was going to be a practice day for San Mateo. And though under the weather, I felt on fire all day after my meeting with the chairman. I was coming across as articulate, interested, and genuine. I was able to highlight my experience effectively. The residents were responding in line with my hopes for the things I was saying and it was smoothly setting up other points I wanted to make. I was really pleased.

I next met with another PGY-2. He was the epitome of what I just described. We had a nice conversation. I got the impression he decided really late in the game to do psych. I don’t know why exactly I feel that way, but it probably has to do with some weird dynamics that went on. He was easily won over, and then I felt a sense of deferment to my knowledge and experience, which was certainly odd and unexpected. When I explained to him my view of a current issue in psych that was recently elucidated in the CATIE study—Clinical Antipsychotic Trials of Intervention and Effectiveness—he actually called me sir. As Ricky Bobby would say, “THAT JUST HAPPENED!” It then happened again a few other times later in the interview. Maybe I just look old and weary? In any case, he got really excited and started to say that if I wanted to go there to email him later and he would corner the director and make sure it happened. He then said he couldn’t say that for ethical purposes and recanted. I think lawyers do that in court as well:

Lawyer 1: Miss Studebaker, this is case about Fraud….butisn’ttrueyouusedtobeaprostitute?????
Lawyer 2: Objection! Irrel—
Lawyer 1: Withdrawn!
Judge: The jury is instructed to disregard the previous statement.
Jurors 1-12: [writes on notepad: “Hooker!! Can’t be trusted!]

See what I’m saying? Good thing he can’t say that. Now I’ve totally forgotten about it. This reminds me of something else earlier I’d forgotten. The chief resident, when I’d returned from making my coffee less masculine, wrote down his personal cell phone number for me to call. “I don’t give this out. But you’re strong, this program is a great fit for you and vice versa, and I want you to come here.” The flattery portion of tonight’s competition now completed, we can move onto the bikini contest…

I next met with the program director, the absolute make-or-break meeting of any interview day. Another psychodynamic guy with whom right away I found myself talking in vague, guarded, entirely positive terms about my family dynamics within minutes. Otherwise, things all went well, though he gave off a weird therapy-is-the-past-present-and-future vibe. Now I’m more pro-therapy than just about everyone I’ve ever met, but if this viewpoint that came across is really his genuine belief that he touts, he’s gonna scare off a lot of people, me possibly included. But ultimately by this point I knew I was impressed by the program and wanted to rank it somewhere in the top five, so instead of presenting anything confrontational to his possibly firm belief system, I went into my float-like-a-butterfly-sting-like-a-bee routine. This is where I rely on a few basic principles that I know will show interest and make me come across well. The rest is improv. I see what the interviewer really wants with their questions and I feed it to them. Then I take subtleties from earlier in the conversation, repackage them, and re-present them later, showing at the very least I’m a good listener. It’s the gamesmanship of the interview process. And though I’m not interested in the dirty games that accompany the last minute ranking stuff, there’s nothing wrong with doing a little flirting with the girl next door while the supermodel you asked out yesterday is mulling things over.

Then my day was over. Supposed to be at least. The program director asked me if I was in a rush. I was not. He asked me to interview another faculty member. Tired, but intrigued at what that meant, I said yes. It was pretty boring and standard, the typical product of an interview of someone who hasn’t read your application and wasn’t necessarily prepared to spend their web-surfing time interviewing a kid in a suit with something to prove. I met with the chief resident thereafter to ask him to show me a few things I felt I needed to see before I left. He said the extra interview means they’re really interested and it’s an insurance interview of sorts to make sure their read on me is what they believe it to be. Excellent.

I left and immediately got lost, which is what I’d do in my closet if it were big enough. I suck. Then something awesome happened. Something I’d wished I could do my 5 weeks previously in the bay area but being sans car, I could not. I drove down Lombard Street, known as “The World’s Crookedest Road”. In a dodge caravan. In the rain. It was awesome. I continued to Union Square, which was all decked out in holiday cheer, parked, and decided to walk around. I was feeling like I still hadn’t found the right shirt/tie combo for the money pinstripe suit and I really wanted to look good—for the look good à feel good à be more impressive phenomenon—the next day at San Mateo. I also knew money is super tight. But with holiday cheer, er, sales, I managed an awesome combo for the price of a downtown dinner for one and opted to eat at IHOP that night to make up for it. I then got lost again, because, as mentioned, I suck tremendously. It was a great day back in Shaky Town.

Strengths of the program:
-excellent social scene, reasonable work hours, tremendous outflow to top notch fellowships, San Francisco is fun, they want me…and I think it’s like when you see a girl across the bar and you know she wants you but she looks coyly away until you show your hand first. (Wow, I’m full of analogies and whatnot today that are sure to rub people the wrong way…that’s what happens when you sleep on a Magnum condom for three straight nights, I guess)…also home call.

Weaknesses of the program:
-San Fran is super expensive relative to the $43k salary, I get the deep feeling there may be more work than they let on; though nice and friendly, these aren’t exactly the people I seek as friends; I worry about the emphasis on psychodynamic therapy without appropriate focus on other more useful styles; I don’t think I necessarily want to live/commute in/out of SF everyday.

Whole Grade:
Two days after: 8.6
1.29.07—8.4 (The location is really turning me off. I think back to the interview day and it has a gray filter all over it).

I think I could be happy here, but I think this is going to end up fitting between Brown and Harbor-UCLA. I know I keep saying this, but why gamble when there are sure things?



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Orange, California
UC-Irvine (Second Look)
12.7.06

Because I had canceled interviews and wanted to feel I was spending most of my time productively, and because on the adolescent unit while on externship at UCI I did not get much exposure to what an intern’s life is like on the adult unit, I spent a Thursday morning doing what ultimately counts as a second look. Unfortunately the PD, Dr. Maguire was out of town during this time. Ultimately, though, I really just wanted to observe what the interns did with their mornings and get another look at rounds with the impressive Dr. Nguyen.

I arrived a little after 8am and found them already present. They were cheerful and relaxed. They saw their patients quickly and were free to discuss the program, the intricacies of the new patients, and anything else that popped up. Fortunately for me there were no other med students on the unit, which due to scheduling occurs 2 of every 8 weeks. I was given a lot of attention and felt sharp enough to place a lot of input on the current dilemmas of the unit.

Rounds were quick; about 30 minutes. Things just happened to be really stable that day. After, I just watched the interns get their work done. It was slow, granted, but life seemed pretty good. I stuck around for lunch and Dr. Nguyen took me and an intern out for Japanese. It was excellent, as was the conversation. I was impressed that he paid for our meals, just as I was that an intern—Gina—would not let me pay for my coffee earlier in the morning. As we parted, I was invited to a dinner to be held later in the evening. My current plans were to watch football at a bar by myself, so I couldn’t really say I had anything better to do.

I fought the traffic—SoCal rush hour really makes you pay for making a wrong turn—and it took 70 minutes to travel the 10 miles. Fortunately I was prepared for this by now and I arrived exactly on time. I was really impressed by the restaurant’s regal structure, and by the people’s dress inside. Jeans, dress shoes, and a French-cuffed dress shirt put me in the bottom tier of acceptable attire, though I can’t really say I knew better ahead of time. No one there really cared anyhow. People were very nice and I was able to meet some people I had not yet met, and interestingly, I found out they have held meetings to discuss applicants—I guess—and so everyone there knew of me; and said positive things. It was very humbling. The wine was excellent. The steak was lean and huge. The chocolate cake with raspberries is hard to make badly. I spent a good deal of time talking with the chairman, and we had great discussions about old-time psych and where the field is headed. Then I wandered over to talk with more of the residents. A glass of wine brought out some—fortunately—well-timed comedy and I felt really comfortable in this room of somewhat evaluating not-so-strangers. The chief resident had 4 gifts to give out to the residents. They were Christmas cards created by psychiatric inpatients and then marketed. She presented one of these sets to me, “our special guest”. I tried once to turn it down, feeling humbled, but at her insistence I chose to take the route of sincere appreciation. Eli-Lilly, the makers of Zyprexa were paying for the event and they gave us all umbrellas, which is a weird gift for Southern California. No less odd, however, is that now they’re calling for rain on Sunday. I guess I’m prepared.
As the evening wrapped up with games and wine and laughter, an intern offered to take me out for a drink for further candid question and answer time. I took him up on it because he is very sincere and I don’t believe he has an agenda. He wouldn’t let me pay for my scotch and we talked about a number of things. The one unfortunate thing I learned was that though moonlighting is allowed as a PGY-2, there aren’t really any places to do it. That’s pretty disheartening since that’s important to me. There is a relationship being formed with a jail now, but otherwise most opportunities don’t arise until PGY-4. That really sucks. Oh well. It was a really great day at UCI. They made me feel recruited, wanted. They were first class all the way. We would be really happy being apart of this social group of residents with their light schedules, decent pay, and in this beautiful weather.

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Torrance (Los Angeles), California
Harbor-UCLA
12.5.06

I’m writing this on December 6, 2006, on a pier in Huntington Beach. It’s early afternoon and the sun is so bright, I have to turn askew just to view this screen. But that’s just fine. I intended to sit in a Starbucks a few blocks from the beach until this was completed, but what a waste that would be, I decided. It is in the 70s today throughout the area, but here the wind kicks off the ocean pretty strongly, and it feels much more like the low 60s. But, again, that’s just fine. The lampposts on the pier have large snowflakes hanging from them, which light up beautifully at night. Intellectually, I know Christmas is near, but I have difficulty reconciling the feelings it’s more a Christmas in July. I have tried to be productive with my days here, and though I canceled half my interviews from this trek, I am strengthening my relationship with programs of interest in those off days. But today is a rare day off entirely, to do with it my choosing. My choosing tends to lead me to the beach, I’ve found. I come here and I start to think right away of Christine. I always feel like calling, but it’s hard to talk of its beauty here to those back home without sounding like I’m just trying to rub it in. I then usually start to think of my other friends. My mind starts to spin, concocting schemes designed to bring them all to me to share in this together. To prevent the toughness of the decision to move from so many of those who I rely on for support. But what’s best for me certainly cannot always translate directly into what’s best for them, so I let my schemes fall unfinished in hopes that things will work out for everyone in the end. So I’m on this pier at my favorite spot, just shallow to where the waves break, with the view of the surfers clumped together, their eyes to the horizon in hopes the big one will soon step forward. It’s a calm day on the water so their rides are slow and short-lived, but to them, again, that seems just fine.

My first interview at Harbor-UCLA was rescheduled from 10am to 9am. The hospital is about 30 miles from where I’m staying in Orange. Having learned firsthand about traffic in the mornings here (see: Brown interview, traffic to LAX), and also at Steve’s (my generous roommate) advice, I left at 6:30 to get there by 9:00. Traffic turned out to be heavy but moving, and I arrived at the hospital at 7:15. I was pretty tired so I grabbed some coffee, checked in, and went to evaluate the cafeteria. In this brief period, I learned some things, which I’ll describe in a moment.

So I mentioned I’d canceled a bunch of interviews, including big names like UCLA and USC. Why did I do that? They were either too academic, or they were too reliant on the residents being killed with work. I know I’m not going into a career in academia. I know also that I’ll hate my life regardless of geography if I’m overworked. So adios to those; I’m happy enough with other choices. I opted to keep my interview with lesser known Harbor-UCLA because it is a community hospital. It’s a program much like San Mateo in that it throws the residents into the mix and they learn abundantly. I want the sink or swim environment. I’m ready for that. I’ve primed myself to get the most of my psychiatry residency. I don’t want my hand held. I just want good support for when I need it. This is what Harbor is about, I’d heard.

As I drove up, it was definitely an urban setting, as much as SoCal has an urban setting. Pretty busy area. As I walked in, I had to go through a metal detector. My fancy suit didn’t seem to matter. Off came the belt, emptied were the pockets, and then I was wanded. Plus, there were a lot of looks of disdain by the patients sitting around waiting for their clinic appointments in the front of the hospital. Yikes. Then I had the privilege of redressing myself in that same lobby. Awesome. The population was heavily latino. Note to self: I really need to pick up Spanish again. I walked through the hospital and I saw doctors hugging each other. Interesting environment. Then the strangest thing happened. I got the feeling I was watching “Scrubs”. I guess that’s a good thing? I met the office staff, who were very nice and informative. I was introduced to the program director (poor eye contact, no handshake at that time). This turned out to be a theme for the day with him. He was a young guy. I’m not sure if he was disinterested in the process or just overwhelmed with his duties, but I feel it is one of these things.

The interviews were of the hour long variety, which I’ve come to dislike. At least you can usually expect the opportunity to sell yourself, which some of the 30 minutes ones don’t afford at times. The problem is that if things aren’t clicking, it’s a terribly long awkward hour. I first interviewed with an outpatient attending. She was nice but hadn’t read my application, which really pisses me off. We talked a lot about what she seemed interested in: social roles in psychiatry, and politics. I also was able to ask a billion questions, which she answered pretty well. I left the interview thinking the hospital to be well-funded, which contradicts some with the low salary (~$37k). I’m all about funding being in place for a hospital and its patients, but when the UC schools are paying ~$43K, someone in charge of this hospital’s residency program needs to recognize that it puts it at a competitive disadvantage. When the hospital willingly eats imaging studies that cost a few grand all the time, they should recognize the return on their investment they’d receive by pumping a few grand more in salary to each of its residents. Anyhow, it seems a lot of good things are in place or being set up for the patients, and the hospital as a community facility has great investments in continuity of care, which I feel is super important. The patients seem very sick, and as such provide the best learning experiences. Call is reasonable at Q5 or Q6 the first two years. Moonlighting occurs in the second year once you get licensed, which most residents don’t seem to get around to until the second half of the year. Too busy? Not likely. Not prepared?? They say no. Hmmm.
My next interview was with the program director, Dr. Burgoyne. The chair was out of town so I didn’t get to meet with him. Dr. Burgoyne was pretty young for the role but seemed accomplished. He shook my hand finally and answered my questions handily. He had read my application, but didn’t ask me anything that really showed any interest. In the end of the interview, he said, “I’m not a guy to wink at applicants or tell them I’ll rank them. We have good residents here, and they want to be here. We tend to match halfway down our list anyhow, and any program that says they aren’t the same is lying to you. If you’re interested and want to take a second look later, I encourage it, but do it for you. It won’t impress me anymore. But ask the residents questions and take a good look and see if this is a program that fits for you. If it’s in your top two choices, rank us. If it’s fourth or fifth, don’t bother. We only want the people who really want to be here.” Thank you, Mr. Sunshine. Way to make me feel like a superstar. So I feel like he doesn’t care who matches other than that they’re not grumpy disgruntled bastards. Would this guy have my back if I needed him or would he cover his own ass? That’s an easy one. Points docked, sir.

At this point, I’ve met with two people who didn’t seem to care much about me, and I’m not exactly returning the favor. I like the program in structure, but the people were killing it for me. Then I met a PGY-2. And he was awesome. We got coffee and sat in the sunshine for an hour. We talked about the nuts and bolts of the program. He seemed really happy with his choice. He spoke of the autonomy he has in clinics. He keeps his own book and sees patients whenever as an early PGY-2. Great. The structure of PGY-2 is inpatient in the morning and outpatient in the afternoons. He said the hours were about 40 hours as an intern plus call. Even less hours as a second year. Nice. He introduced me to lots of people and when they weren’t giving me enough attention, he would drop things like, “Jeremy here is a very strong applicant. You should tell him about _________”. Or, “You would do really well at this program. It’s setup for people just like you and sounds like what you’re looking for”. He had read my application. We had a lot in common and he kept describing the program as exactly what I’m looking for. Many of the residents live at or near the beach. He goes on my list of people I wish I could work with in the future for sure.

I then met with an outgoing PGY-4 for lunch. He was from Argentina and we mainly talked about soccer, but the main thing I learned from him—his major gripe—was didactics. They aren’t super. Apparently you need to really be motivated to learn on your own. That’s cool. I’d like didactics, but I can totally learn on my own. I see it much like preparing yourself for the future, which is really what a community program is all about.

I finished up with an attending who had spent a year doing a child fellowship at UCI, knew of San Mateo, and did his residency at UCSD. He was into research, which is surprisingly strong at Harbor. He had also ready my application and did a good job or reiterating all the key points I’d heard from the residents. He also did a good job of making me feel competitive, which I’ve described previously as being really important in making me like a program. Just as programs want residents who want to be there, applicants want programs that want them to be there. He said a few things, such as, “If you rank us, you should have no problem matching here. Your application and attitude should put you among the top of our applicant pool.” This guy needs to be PD.

I went back to the PD’s office to tell him of the things I’d learned about the program and how it fits my expectations of a residency program, and how I hope they do rank me highly despite what he’d said. He was gone from the office for the day, unfortunately, so I exchanged some of that sentiment with the program coordinator and plan on passing this info along to the PD via email soon.

Strengths of the program:
-Really very much of what I’m looking for overall. It has autonomy and support, it prepares you for a career in psych. The hours are low, moonlighting is available, the people seem nice. There is a child fellowship present, though it’s not a good one. There a few in the area that are reputable though, so we wouldn’t necessarily have to relocate.

Weaknesses of the program:
-Didn’t much care for the security needs, didactics should be better, the PD didn’t overwhelm me, I don’t like the area so much, traffic is unbearable, pay is terrible. No child until PGY-3 year.

Whole Grade:
Immediately – 8.5
A few days later – 8.5
1.29.07 – 8.3 (The money issue is killing me).

This is a poor man’s (and County’s) San Mateo. There would be challenges, and this would likely feel more like a legitimate residency experience than most of the other places I’m considering. There would be challenging times and hardship, failures with patients, and great learning experiences. I would feel alone at times and part of community at others. Ultimately, I’d come out ready to take on the world, which is really the goal of residency. For that I’m ranking it above Maryland, and for the beachiness, likely above Brown, despite it being more difficult and with less happiness. Christine would surf here. I can’t say it competes with UCI, though it may be better training. And as a direct comparison with San Mateo, it can’t compete. I’m glad I went though, and it’s a decent backup plan. Now I’ll be dropping by UCI tomorrow for some schmoozing, then a 3 day weekend, a flight up to San Jose, then two interviews in that area next week.

Take care, everyone.

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La Jolla (San Diego), California
University of California San Diego
12.1.06

This was a bit of a reach interview from the outset. Most of you know Christine and I spent a summer living in San Diego in 2003. It was about 10 weeks. We lived in a beautiful area near Balboa Park in a historic apartment building on the outskirts of downtown. It was quiet and amazing. I think of it as the best summer of my life. And secretly, whenever things in med school got really stressed and I wanted to crack a bit, I went back in my mind to Mission Beach in the summer and bathed in the not-so-hot kind of heat San Diego is renowned for, letting the sounds of the beach wash over me. It was my happy place. About my second year of med school, I started to get an idea of what I wanted in a psych residency program. UCSD, though another top 5 program, just didn’t seem like the best fit type of training for what I want in a career, and personally as a resident. I heard it was research-focused. I heard it was too biologically-oriented. I heard residents weren’t social and worked too hard. However, it was San Diego. And I’ve also heard—and this has been recently validated—that programs’ reputations are often based on outdated program missions and false inferences. So away I went, leaving home again, this time after a lengthy 10 day stay.

I flew into SD on a nonstop flight with cloud cover for the first half of the flight. Near Denver things cleared up, showing the expected array of snow-laden Rocky Mountain awesomeness. Then the desert, parched, with large cracks, ravines, and gorges. More mountains, then SoCal in that typical ash-green and brown collage you see south of Orange County.

The airport is actually pretty much downtown with amazing views of the harbor, downtown, and the outskirts (I could see our old apartment building on the approach). It was overwhelmingly sunny and 65, a classic San Diego winter day. Things went smoothly with the travel nonsense and I was at the hotel and had knocked out a five mile run before 3pm. I scoped out the local sportsbar scene and found Junior Seau’s restaurant, aptly named “Seau’s”, to be a mile away and a highly rated place to catch the Thursday night Bengals-Ravens game. In short, I recommend the place to visitors. Tons of tvs with good sight angles, and a 25 or so foot long projection of pretty good quality. Cheapish food of good quality, friendly service. I was incredibly exhausted when I got home so I ironed my stuff and got some sleep.

I should note the hurdles in the day leading up to this lovely dining experience. So on Wednesday I was talking with Harish, who was a strong gust of wind from coming out to SD from Dallas instead of just going home to NY for the weekend. He asked me when I’d be done on my interview on Friday. I was gathering all that info together at the time, so I went to my Outlook where all my catalogued interview stuff is, but—uh oh—I don’t see my schedule for UCSD. I call them. They say they don’t have me on their schedule. Shit. I have a flight paid for, a car reservation no longer within the cancellation period, and a nonrefundable hotel paid for. I look at the reply I sent on October 9th, hours after their interview request. I don’t see a confirmation email. Shit. I acknowledge to them I made a careless mistake but forward the reply I sent them back on 10/9 to show that I did indeed reply and they lost that email. She went to “review the situation with Dr. Zisook (the program director),” which I took to mean “review this guy’s application again to see if he’s worth rearranging our schedule”. Fortunately I was. I mean, I would have been fine vacationing in SD for a weekend, and it would have been cheaper than staying home and changing my flight to Monday, but I had deep hopes for this program despite its unlikelihood of being the best fit for me. On Thursday, an applicant had to reschedule, so it all worked out anyhow. Not the best first impression though. Damn.

I wake up, fight through moderate traffic, and get to the program in the last third of people (but not the last!) before the 9am start time. 9am seems good, I’m thinking (see: correlation of start time and workload, Maryland interview), though this is considered early on the west coast. One guy tries to do introductions. People seem friendly but not really interested in all this right now. I’m one of them. Pleasant good mornings are what I do to people. We’ll all do introductions in a minute anyhow when all the important people show up. Dr. Zisook started off the day with a 90 minute powerpoint presentation. Yikes. However, being well-rested, feeling good vibes, and having an awesome breakfast of pineapple, melon, strawberries, coffee, and OJ; I had no problem listening to the man.

UCSD prides itself on its reputation and its composition of people. Faculty and residents are recipients of many prestigious awards and have the acclaim and recognition that comes with this. Residents average about 30 points above the mean on the PRITE at each year of training, 20% above the national mean for first time boards pass rate (>80%), >50% of graduates go onto fellowship (though not at UCSD! No fellowships!), 25% of grads go into private practice (>90% stay in SD…it’s so nice and there’s so much professional opportunity). It turns out their program is VA-based. Yikes. I hate the VA. I mean, I like the computer system so much it makes me want to work there for a month or so at a time, but I hate the nurses and the patients are a heterogeneous group of assholes. How varied would my psych education be? Would I be an expert on PTSD, depression, and dual diagnosis (psych illness plus substance abuse)??? Why not just stay in Baltimore? Okay, maybe getting carried away. But this is a huge drawback.

Zisook then did a slide called ‘myths, misconceptions, and partial truths’. Good idea. #1 was “too much time at the VA”. 2 months in first year, 6-8 months in 2nd year, none in third, selectives in 4th. Hmm, seems like a lot to me. Next of note was “too much basic research emphasis”. Turns out that this isn’t necessarily true. “Research is big in the psychiatry department here, but that is not what your residency training is supposed to be about. 80% of residents here have no interest whatsoever in research”. Good to know. Next, “no elective time”. Electives are replaced by selectives (see: Maryland interview for definition). Booo. Plus, these are in 4th year mostly. It seems this schedule is pretty rigid, though you can do some peds months as a PGY-1 if interested in child. Next, “too much work”. “This is a working residency…It has a harder 3rd year than most but you leave it knowing your psychotherapeutic skills are superior to others’”. Hmmm, not sure how I feel about that. Next, “not enough psychotherapy training…too biologically focused”. This they claim to be very false. The reputation is supposed to stem from being a west coast program with strong psychopharm. It was assumed that if it is very strong in psychopharm, then the natural deficit would be in therapy. Okay then. They specialize in CBT. They claim—like everywhere does—that the supervision is great.

There was a VA tour. Need I comment further on this one?

The first interview was with the cheerful chief resident. She loves the program and loves the people and just had a little girl and loves her and loves the world and isn’t everything just so great? She was nice, but—and big fuckup in my book—hadn’t read my application. First time I’d seen this. Are you just too busy? Too arrogant? Don’t care? Hmmm. It went fine except I challenged her some on the VA population, to which I think she got a little defensive. I just needed to see how the La Jolla VA differed from the downtown Baltimore one. I guarantee you they’re different, despite most people saying—and with good reason—“a VA is a VA is a VA is a VA”. La Jolla and Baltimore though are different enough to challenge this concept. She said they were all alike. She also said she’d never been to Baltimore. I noticed the nurses were friendly and smiling, and it was quiet. That’s all I’m saying.

I then went to the associate director, Dr. Lunn for a 20 minute interview. She was very personable and asked good questions. We had a fast-paced, we-want-to-talk-but-both-feel-the-time-constraints interview. She made me feel warm and fuzzy about coming to the program despite all I’d just heard. She could be a really solid mentor. The one question she did ask that I wasn’t prepared for—though sure as hell should have been—was about my strengths and weaknesses. Now this is tricky. You need to name a strength that is unique and not haughty. If it’s not really strong, you seem like you have nothing to offer. If it’s arrogant, that’s all that comes across. If it’s standard, you seem like you have nothing unique to offer the program. The weakness part is similar. If it’s really weak, you just ‘fessed up to your judge exactly what you’re concealing. Why? Because they asked you to. If it’s not weak enough or you don’t offer anything juicy, you seem like you have no ability to introspect, not so hot when you want to do psych. Fuck. I think I handled it all fine, but it wasn’t glorious. I need to think this one through before my next big interview (san mateo). And oh yeah, she hadn’t read my application yet either!

Next to Dr. Zisook, whose name is really difficult to type. He came across in the morning as being very in control and paternalistic, but a softie deep down. He mentioned walking on the beach with his wife on Sundays and commenting on their good fortune to be living with each other in paradise. Sentiment from my own heart! He started off the 20 minute interview by excusing himself to peruse my application, as “It’s been a several days since I read the applications”. Well, not several days since you read mine since I just got the interview less than 48 hours ago. So either he’d never read it, glanced at it in early October, or read it when the interview debacle occurred on Wednesday. Not pleased he wasn’t prepared. The interview went pretty vanilla. He tried to tell me more about the program and ask about my questions. Dammit, I have a lot to say. I’ve worked hard since undergrad to build up this application that sets me apart from my colleagues. Ask me about it! I spent the last minute trying to build a rapport that could extend into the future by citing something he’d said to me a few years ago. He says, “Oh, okay then. Good.” Doh.

Lunch at the faculty club. Watching the residents with us wander around unsure of things, I ascertained they don’t get to come here often. People were friendly though seeming a little stressed. And they all ended up having to leave “to go get all my work done”. Hmmm. I used the time to really get a feel for why these residents had chosen UCSD. “It’s just so nice here”. “It’s really well-ranked”. “The people were really friendly”. Well, okay then. That’s fine. Prestige is great. I want prestige. But only if it fits in with the rest of what I want. I want to live at the beach. I don’t want to sleep at the beach and work all day near it, despite people being friendly at work.

Some other details. Call is q6 through the first 2 years. It is about q5 weeks as a PGY-3. None as a PGY-4. Hours are 70ish, 60ish, 45ish the first 3 years. Medicine and Psych are not in 6 month blocks, like elsewhere. They are in 2 months blocks that intermix. I like that idea. Also, the first month is always inpatient psych, so interns may bond and this is called a “crash course”. Didactics are half a day. They are protected. No one goes while on medicine though. “Not enough time”. Hmmm. Moonlighting is typically started in 3rd year. It can be done in 2nd year, but no one is. They’re either too busy or the opportunities aren’t worthwhile. Oh. Salary is almost $43k.

I had one other interview that was fine. He was older, nice, and we had a nice chat. Only guy who read my application, by the way.

We went to La Jolla as part of the tour. Word is they used to do this in a limo. We went in a van, which is supposed to be more comfortable. Comfort be damned, I say. We got out near the children’s pool, which is now inhabited by seals. It was beautiful out, of course. The air smelled of salt and the sun made us squint. We walked out above the ocean atop the retaining wall. What an amazing selling point. San Diego is beautiful in a way that nowhere else I’ve been can compete. I love Orange County as well, but it’s just so different. Oh well.

I went to the happy hour. We were all very tired by this point. We socialized and a resident almost talked me into not canceling my USC interview. Of course he transferred to UCSD from USC as a PGY-2 so I missed his real argument. Though terribly fatigued, I realize the potential of a Friday night in San Diego. I tried to rally the troops for a night out in the gaslamp district….to…no…avail. “I’m so tired,” was the general consensus. Crikey. I considered going alone. Couldn’t do it. I didn’t want to be the creepy married guy on a business trip talking to people in bars on a Friday night. The girls would think, “Is this married guy flirting with me?” The guys would think, “I can’t have sex with this person”. It just wouldn’t work out. I went to Dr. Dunn’s dinner party instead. I went with a girl named Adry from Indianapolis. She was nice. It was her first interview and I gave her heavy doses of opinion, upon request. She asked for my breakdown of the day and I did so in a way that I hope helps her with her own analysis as she experiences more programs. We were very tired and did not stay long. I went back to the hotel and had the lamest Friday night in San Diego history. A shitty ending to a not-so-awesome day.

The strengths of the program:
-San Diego, home of the greatest summer of all-time. I still think I want to end up living there permanently one day. It’s a top notch program according to any rankings system. It’s easy to get into a fellowship and get a great job. The people were friendly, and appeared happy despite the workload. They are a talented group, from which I could really maximize my learning. They all do well on the PRITE and boards. Faculty is tremendous. I really like the intermixed medicine and psych blocks. I like the idea of a free year of psychotherapy. I think it would be a good introduction into learning of the experience. And after spending 70-75 hr/wk dealing with psych patients, I may need it.

The weaknesses of the program:
-I don’t really like the idea of working at the VA that much. I don’t like that much call and that kind of workload. I want to moonlight earlier. I’m pissed they didn’t care to read my application beforehand. I’m also not sold that they take psychotherapy that seriously. We’d have to relocate after 3 years if I wanted a child fellowship.

Whole Grade:
Immediately – 8.3
A few days later – 8.2

Ultimately, this program is not right for me. Would I be happy here? Probably not so much. Why am I ranking it, and ranking it higher than Maryland then? Because I cannot get beyond the idea of living in San Diego. It’s so money. The highlight of my day was Dr. Dunn. She was the only person who seemed to care if I came or not. I’m an attention whore. If you tell me you want me, it makes me feel good. I then have additional positive feelings in regards to your program. I then want to be a part of it more. This whole interview started off on the wrong foot with the miscommunication. I figured it was a dealbreaker but went forward with it anyhow. There were no surprises. Maybe the next big earthquake will move UC-Irvine into the San Diego area.
============================================================================
Baltimore, Maryland
University of Maryland
11.28.06

Ahh, the courtesy home interview. I originally scheduled this program as my first interview…for practice. Things got turned around and I ended up having many of my favorites beforehand. Oops. I considered canceling, this program being #13 or so in my pre-interview rankings, but the match is a scary entity that makes you do strange things. With Christine working, all I’d end up doing is sleeping in and then watching tv in my boxers until she came home anyways. Might as well break out the new suit (pinstripes…money) and my blue crab tie (what did I have to lose?) and see some old contacts from UMB psychiatry.

I forced myself to wake up before 11am, which was a task and a half, sadly, as I’ve found a remarkable stubbornness in adjusting back to east coast time. I opted out of reading about the program, and watched poker on tv instead until it was time to go. The interview was at 7:45am, which I think is on the early side. I’m wondering about a correlation of early interview times to resident workload. I need to start paying more attention to this. Anyhow, I wandered over to 701 W Pratt, the fourth applicant of seven to arrive. I was impressed by the portfolios they put all our info in. I was not impressed that the “contract” inside had the following:

Salary: ____________________________


Um, guys? Fill that shit in. You’re naïve to think no one cares.

The terrible intros began as I surveyed the room. An anxious DO chick; a dude with a stern look on his face, poor eye contact, and the appearance of disdain for others when speaking; a cool volleyballer named Matt from UC-Irvine; and a few other boring people I’ve already forgotten. I started to wonder if it was too late to cancel. Then Solomon walked in. Saving grace. We started talking about plenty of things Marylan- and non-Maryland while others awkwardly eavesdropped, which was fine. What was not fine was anxious DO chick’s attempts to strike up conversation. I mean, I give her credit for effort alone, but how many poorly timed, poorly constructed, failed efforts does it take before you fold your hands and sit in silence like the rest of the people? You could say we weren’t meshing as a group.

On the bright side, only two interviews were scheduled. This is much better than the 6s and 4s from earlier on the interview trail. It also said to me, “we’ve already made our rankings. Express interest and you’ll move up, but mostly say or do something demonstrating some psychopathology yourself and you’re out.” So it wasn’t an interview. It was a screening out process. Maybe I shouldn’t have worn my blue crab tie. Or left every few minutes to go wash my hands while muttering barely audibly, “nothing is clean, nothing is clean”.

The program director, Dr. Luber, came in to do an informal presentation about the program and the city. It was fine save for a few points. Mainly, my bullshit detector was going off. I don’t even know why. He spoke eloquently and demonstrated a sense of humor and really came off as being quite personable. This was different than a meeting I had with him last spring. At the time, he was a little gruff. He had also been very little help in seeking information about other programs. I wondered if he didn’t know or if he was obstructing me in my search to increase the chances I’d stay home. If that’s the case, though, you’d imagine he would have been nicer. Hmmm. Anyhow, he claimed Baltimore to be a very safe city and cited some statistics and a New York Times article. Then he asked Solomon, who wants to go there (!), if he was telling the truth. Good thing he didn’t ask me. I don’t even try to lie, it comes off so badly. An interesting thing he did, which was entertaining though I think a bit inappropriate, was go around as each person introduced themselves, and take a minute to give further introduction of that person, showing off from memory what he had learned from their CV, personal statement, and dean’s letter. That’s cool he learned it, but show that to me in person, please. “This is Todd. His CV says he’s an astronaut. His weaknesses are injured puppies and the show ‘Top Chef’. Welcome, Todd”. See? Now Todd wants to die.

Another interesting thing. The tour didn’t come next. It came last. First time I’ve seen that. So now to knock out the two interviews.

The first interview actually didn’t go so well. The questions were all what-am-I-thinking questions. I don’t know, fucker. I understand the role of well-placed ambiguity in questioning in the field of psychiatry. I also understand if you want to know something, sometimes you need to just ask it. Anyhow, the conversation devolved into him asking my opinion on curricular changes in the first two years of med school that would lead to greater interest in psychiatry at University of Maryland. I was glad when it ended. Though these interviews were of the speed-dating duration—30 mins—I learned that even some speed dates must seem to last forever. I can’t say it went badly. I just didn’t leave with that fuzzy, excited feeling I normally do.

The second interview went incredibly well. It went with the well-established principle of kiss my ass and I’ll respond to you. Sad, but true. It was a faculty member who I already knew, and who speaks off the cuff, and for that I knew it would be a fun 30 minutes. He started off with, “Jeremy, this interview isn’t for you to sell yourself. You don’t need to do that. This time I feel like it’s my responsibility to sell the program to you. Do you want me to do it formally or informally?” Excellent. I was able to ask the hard questions. The things I didn’t agree with Dr. Luber about, such as reputation amongst other fields in the hospital. Dr. Luber said psychiatry was well-respected at Maryland. Bullshit. I’ve been on the wards. I wouldn’t, and for that matter, couldn’t defend psychiatry many times in their interdisciplinary battles. They simply did not demonstrate sound medicine, nor sound judgement at times. Fortunately, this interviewer agreed. I got a lot of the dirt I was seeking, and for that I hold this particular doctor in higher esteem than previously.

I get back and find out my first interview experience was soundly beaten out by Solomon’s.

“She asked me to present a patient”.
“What?”
“She said, ‘Pick a patient from your past and formally present them. It doesn’t have to be from psych. Just any interesting patient from your past’”.
“You should have left”.
“I want to go here though”.”Oh.”

I understand that when selecting a doctor that will be working in your program, he/she must be capable of basic tasks expected to have been mastered as a medical student. However, this should be addressed in his academic records. Solomon is no idiot. He goes to a solid medical school affiliated with this residency program. Don’t bust his balls in an interview. You should be massaging them gently so he’ll want to make the smooth transition into this program, strengthening the partnership between school and residency programs, and showing others that the students here want to stay!!! Poor form.

We went to Sheppard Pratt, where I’ve actually never been. It was pretty awesome. Dr. Sandson, who I really like, gave an overview. It was in an old boardroom with very old books and shiny dark furniture everywhere (and a chandelier). I almost fell asleep. It was terribly boring, despite Dr. Sandson’s very sharp wit. Then the tour, which reminded me of a collage of horror movies. Then back for lunch. Lunch was chicken, fettucine alfredo (I hoped no one was still nervous!), salad, cookies, soda/juice/water. A fine assortment. The residents seemed fairly happy, though a little overworked. I found out moonlighting starts in second year now, whereas I had been told previously it began as a PGY-3. Good news, indeed. Also, the call wasn’t quite as bad as I remembered hearing. And free parking. Caseload was as bad as I remember, though, up to 9 patients. Salary is not so hot at $41k. And worst, didactics, though said to be protected, apparently are not when on medicine—4 months long in the first year. If I need to pass my boards and take the PRITE (in-service exam), I’d better be allowed to go to lectures. The tour was fine. Actually, trying to look at it through a visitor’s eyes, it was very nice. The facilities at Maryland are actually pretty good. The computer system is above average. The architecture and sightlines are beautiful. The cafeteria is also…and I say this begrudgingly…quite…good. And of course, Donna’s and the cookie stand, of which I need not say a thing.

The day ended pretty early. This is also where it got most interesting. Things wrapped up with a 5ish minute meeting one-on-one with Dr. Luber. He asked where I was most interested in going. I didn’t want to kill my chances with Maryland as my safety school so I made up some line about Maryland being in the mix because it was home and I’d missed a lot of things while I had been away on externship. He bought it. Then—this is fun—he bashed San Mateo and UCI (how is that possible?). To pique my interest even more, he said, “But Brown, I can’t say anything about Brown. That’s just a quality program.” Wha??? They’re all quality programs!!!! Anyhow, he says very firmly, “I want you to come here. What can I do to make you come here?” I reply, “Well, like I said, there are some things about the program that make it a good fit for me and I’ll be considering that when making my ranklist in a few months…” He then goes on. “I really want you at University of Maryland. Maryland needs more people like you. Let me see if I can sweeten the deal.” So here’s where years and years of being a sports fan come into play. I start thinking of the Maurice Clarett and Reggie Bush scandals. Am I the next Chris Webber? (How many timeouts do we have?!). The movie “Blue Chips” pops into my head. And this is all in milliseconds. I get nervous and excited. Is he going to put me in a position of ethics? Because one, I won’t believe it if he offers me something illegal—though I guess technically it’s immoral and against the rules to say Maryland would even rank me prior to the match having occurred. And two, there’s not much he could offer to make me more interested in Maryland than my top 3 choices. And three, who am I kidding? I’m not a bribe kind of guy. Legally, sure, companies can bribe me with coupons and discounts. But bribes that could fuck me professionally? I’d never do it. Anyhow, I won’t get into the details of what he offered because I don’t know who’s reading this. But let me be very clear about this. His offer was not immoral or illegitimate beyond the fact of the implicit we’re-going-to-rank-you-highly that would go with such an offer. Of course it was explicitly stated as well, but he’s not the first to do so, so I’m not exactly offended by his candor. The offer was, however, very humbling. And if there’s a match day catastrophe and I slide to Maryland on my ranklist, at least I know there are perks.

The strengths of the program:
-it’s home! I get to stay near friends and family, which no other program I applied to can offer. It’s also a system with which I’m familiar, in an area where I know the layout and the real estate game and the traffic patterns and the best places to eat/shop/etc. It’s also a fairly strong program for the area. And there’s a very strong child fellowship attached. Sheppard Pratt used to be the top-ranked residency in the country before the merger with Maryland in the mid-90s (due to some funding issue). Therapy training is reasonably strong. I could get solid supervision, do research if so desired—even at MPRC, which has international acclaim. Plus, there’s the “deal sweetener”.

The weaknesses of the program:
-it’s Maryland!!! Plus, they work hard for not a lot of money without an abundance of moonlighting opportunities. They are friendly but don’t know each other that well. The loss of 100% protected time for didactics is a huge negative for me.

Whole Grade:
Immediately – 8.1
A few days later – 8.0 (It’s Maryland!)

All in all, this is a fine program, where I could really carve a solid niche for myself. The transition would be almost seamless. I know I would do well on medicine. I also know I could keep my medicine fresh, and feel I could make a positive impact on the program as well. However, I don’t care to work that hard for that amount of money. And we’re looking for more of a life-changing experience. Renting in federal hill and buying a new car isn’t exactly as life-changing as we’re expecting. That said, the match is tricky and we want a safety program rather than facing any chance of scrambling. I’m canceling programs I’d rather go to than here, based on the fact that I expect to match in my top two choices and I’d rather go to the beach or exploring than interview almost everyday for a two week stretch in Cali (I’m writing this at BWI en route to San Diego for 3 days, Orange County for 6, and the Bay area for 6). I will rank Maryland, and it will do if match day falls apart. Here’s to hoping March 15th goes much more according to plan. Cheers until next week.

================================================================
Seattle, Washington
University of Washington (“you-dub”)
11.20.06

I flew into Seattle mid-day on a Saturday. It was a city where I’d never visited but always heard good things. UW is a top 5 program pretty much any way you slice it rankings-wise. I was excited about the Monday interview, the weekend to go explore a new city, and the fact that my curricular work was complete until 2007. The forecast said rain. Lots of it. The first day could be partly cloudy, but then it’s rain for at least the next 9 days. Uh oh. It gets better. Seattle is in the midst of its…rainiest…month…in…history. Sweet. So flying in…it’s clear! And incredibly beautiful. Mt Rainier is impossibly large, and the view from Seattle is a three hour drive still to reach its base. So there’s this monstrosity covered in snow with two other smaller mountain ranges in sight, also snow-capped. There is water everywhere. The foliage is an abundant mixture of fir and brightly golden deciduous trees (cedar?). The hills softly roll until they hit the water’s edge, which is never too far away. The view from above shows a land being taken over by a creeping body of water, attacking from all angles.

There were the usual travel problems that I don’t feel like getting into but a couple hours later I’m meeting Ketaki at the car rental agency. She was in WA doing a month of her rural medicine (AHEC) rotation, and having it completed, was on her way to Vancouver, BC, with a weekend’s stopover in Seattle. We quickly headed downtown, fighting the fading daylight as we rushed to the space needle. We mostly lost our race, but the view was still incredible. 605 feet over a city that is beautifully designed with a concentrated downtown area and all the natural benefits I just described. We made it around and found some dinner, got a bottle of Columbia River merlot, then hit the University district for a night out. Let’s just say we weren’t impressed. At least smoking in bars is illegal.

Sunday brought the return of Seattle rain and cloud cover. The awesome hotel view of Mt Rainier was lost to the weather—which never returned during our stay. We made it downtown and did touristy things in a cold, windy, wet adventure. In short, Pike Place Market was very cool. The underground tour of the city that described its seedy origins and early history was worth the $11, though I can’t say I’m overwhelmed by it in retrospect. I looked into the Qwest Field (think Seahawks) tour, but was disappointed to find it only happens on Fridays and Saturdays. Doh. Found a pizza place for dinner, had a quiet night. Interview in the morning.

I awoke early and stumbled around the darkness getting ready, listening to the steady sound of rain outside. I managed to get across the street to the shuttle that would take me to UW Medical Center (UWMC) by 7:15am. The interview letter said continental breakfast at 8:15 and opening remarks at 8:30. My schedule said interview at 8. Confused, I called. Apparently I got a special appt with the program director for 8am. Why? Dunno. But so much for getting my head straight with bagels and coffee before the day truly began. Then something fun happened. The shuttle turned onto I-5 (“the five”) and headed towards downtown. Uh oh. UWMC is about a mile from the hotel and does not require freeway access. 20 mins later I’m at the sister hospital. I ask around and find out this shuttle swings downtown, waits (!), picks up more people, heads back to University district (“the U”) where I was just picked up, picks up those people, then goes to UWMC. I have to call and say I’m going to be late for my meeting with the program director. They’re very nice about it, and though I can’t say I’m terribly upset (UW being #8 on my list before the interview), I’m not trying to make this whole trip a waste of my time either. I make it to the hospital, navigate up to the 16th floor, apologize again, and we’re off!

Dr. Cowley’s office was amazing. Views of the space needle, great water (including “sleepless in seattle”’s houseboat, which apparently is a huge sightseeing destination) and foliage. Heading a top 5 program should have its perks, I guess. She was nice but not overwhelming. I told her the program’s reputation of extreme biological focus worries me about my psychotherapy training. I could have schmoozed some more, I suppose, but I didn’t go all the way up there to not ask the big questions. She actually did a surprisingly good job of alleviating my concerns. The interview ends and we make it over to the conference room where 6 other applicants were hanging out and mostly topped off on bagels and coffee….bastards*. And though it’s only about 10 feet from me, I don’t get a chance to eat for another hour.

*note: I knew and liked two of them from previously. Fumi interviewed at San Mateo on my last day of externship. Dan was one of my colleagues at the Brown interview who I first met (see: Brown University interview, resident dinner mishap).

Some things I learn in that hour: UW is the only medical school in the WWAMI region (WA, WY, AK, MT, ID…3rd grade geography….you know them). So since these areas are pretty rural, there needs to be a heavy primary care (PC) and consult-liaison (C-L) focus to their program. Research, of course, is also huge. And in the last few years, their psychotherapy is starting to gain acclaim. Okay! Unfortunately, I don’t much want further PC education and I don’t care much for C-L either. Off to a fantastic start.

Then I interview with a doc who is a PGY-2 who transferred after being faculty in Ob-Gyn. (Good for him). He wants to talk about my Ob-Gyn experience. Why??? At least he was nice. Then to lunch, which wasn’t super. I think I had a cold turkey and zucchini sandwich. Half of one. Less than half of one. And a coke. Guiltily*.

*note: the Ob-Gyn guy I’d just interviewed with had made a careless comment a minute earlier about something that would relate to no one but me, that I chose to sheepishly admit to. I forget the exact thing now. Then as I was sitting, he says, “We need more diet soda. No one drinks regular anymore!”—To which Dan and I smiled as I, again, sheepishly pulled out the regular (nay, Classic) Coke and placed it on the table. He apologized…again.

Then a great interview with the head of the geriatric fellowship, though I can’t say we really talked about me or UW as much as if we were just meeting on the shuttle and hanging out for a half hour. Then I got a mocha latte and watched the rainfall. Oh, by the way, this rain was new. I mentioned the rain in the morning, but then it inexplicably cleared and was beautiful all morning. This led to a lot of, “oh how lucky you guys are” comments. It was still cold and windy. Things still weren’t going super.

Another interview, a few more tours, time to go home!

Except there was a happy hour. Well, since I liked the other applicants and they were going, I agreed. We walked for 5 minutes in a really heavy rain in really expensive clothes. One person thought to bring an umbrella to seattle in their rainy season. I was not one of them. Oh, and she wasn’t with us yet. It was awesome. We got drinks before the residents got off work to meet us. Then they arrive and tell us they don’t pay for alcohol. “It looks bad as a business expense”. Know what looks worse, douchebag?

We get food and all start eyeing the door as more residents show up. Then an intern shows up and asks where a guy is from. Except he’s not an applicant. He’s a senior resident. Her senior resident!!!! Okay, so the residents don’t know even each other. The applicants agreed none of us were going here, we shared contact info, and we fled into the darkness…away from the clutches of the UW psychiatry residency program.

The strengths of the program:
-prestige, prestige, prestige. Programs this competitive don’t normally go out of there way to impress people, I guess. Also, great psychopharm, and—it appears—decent therapy. Seattle has fun things to do. And I could kayak to work. That is all.

The weaknesses of the program:
-call heavy. I don’t plan on being on overnight call during my 3rd and 4th years unless I’m getting a monster moonlighting check. Call it spoiled. Call it snobbish. But this is psych, and I’m not losing sight of that. If I can get the same experience but on a voluntary and additional pay basis, then that’s my angle. Also, seattle has a terrible cost of living and traffic. I know Cali does as well, but those should be trade-offs for quality of life. If I want cold and rainy in the winter, I could stay at home in Baltimore. I’ve said it a million times: if it’s cold, it had better be snowing. A few other reasons this place won’t work out: despite their efforts to say they were happy, they certainly didn’t smile much. Plus, they didn’t even know each other! And when asked if they hang out ever (obvious answer, right?....this is like a validity check question on an personality inventory…don’t try to lie to beat the system!), they said sure, but not during first year…”no one has the time”(!). I could probably go on and on. I know people feel cool saying U-dub all the time, but instead of doing that with presumed colleagues at 2am in a group let’s-say-u-dub session, I’d rather be home with my wife. Call me old-fashioned.

Whole Grade:
Immediately – 7.9
A few days later – 7.4

Hard to say this, but I think I may prefer even Baltimore to Seattle, especially with the laws to remove smoking in bars being pushed through. Talking with the locals reminded me a lot of their big dumb trees. Trees were prettier though. I can’t imagine I’m ranking this program. And that’s why we interview.

============================================================================
Irvine, California
University of California-Irvine
11.13.06

So I did a month at this location. I wanted to do child psychiatry but it turns out they consider their adolescent unit a child psychiatry unit—likely because they don’t have a child unit on site. I was a little unhappy about this. I walked in my first morning to find a bunch of sixteen year old girls wearing too much makeup and exhibiting various displays of perceived entitlement. The true problem with this externship was that it missed the point. I left my life behind. And I like to think I did this to evaluate a place for our future and to solidify a spot in that regard if we so desire it. The best way to evaluate a program is to be in the presence of those before you. Are they happy? Overworked? What are their challenges and how do those challenges relate to my desired experience in residency. Externships are valuable things. Unfortunately, and this is ultimately my own fault, I didn’t get to see much of that. Child and adolescent psychiatry in academia is the place for those completing fellowships. Call schedules are different than residents, and if a resident is present, it is usually a PGY-2 (second year resident) anyway. Now to get a PGY-2’s advice is great, but less immediately important to me at this time.

I was disgruntled for the first two weeks. I had been away from home for a long time and it was starting to burden me. I was stuck dealing with adolescents all day with psych and behavior problems, most of which were linked to a southern Californian culture of rich daddies, crystal meth, and an I-deserve-this-give-it-to-me-now attitude; most of which I was not that familiar with. The traffic going home sucked some days. Then I went back East for the Brown interview and my grandfather’s funeral. I was lucky and caught decent weather most of the trip, but the last day was really nasty. Raining and in the 40s. Pretty typical Baltimore November weather. I should be used to it by now. I landed at LAX around 10pm. It was 73 degrees. The next morning was sunny and warm and calm. It was just another SoCal day. I appreciated it a little more. The next day was my interview day at UCI. It reached into the 90s. Most of the interviews were outside. And finally finally finally, I got to see what a UCI psych residency is all about. And it was exciting.

The day consisted of overview, tour, brief observation of rounds, 2 interviews, lunch, 4 more interviews. There was one other applicant, a nice enough guy from UT-Galveston that I didn’t get to know too well. One thing I haven’t mentioned yet is the program director. His sincerity, charisma, drive, and dedication—to the program and to the residents—are really compelling. He’s hands on, funny, and puts you at ease. His pressuring me to come to UCI would probably make a difference, but that’s not his style. “We get good applicants each year,” he said. “We’ll have excellent fits come match. I want you to like it here. From what I hear, we would really be lucky to have you here. If you think this program is a good match for you and your wife, we would love to have you.” He later followed it up with, “If your wife has any questions or concerns…about life here, jobs for her, what your job would be like, what your lives would be like…tell her to call me. I’d love to talk with her.”

The associate program director, a young attending five years out of training, is named Dr. Nguyen. I’d heard good things but only spoken with him briefly after an excellent grand rounds he conducted. He runs the inpatient psychiatry unit where interns spend four months. What I sat in was awesome. His timing is great. So is his management style. To students, he said, “What’s your plan with this patient?” Word is, he may have his own opinion but if the plan given by a student or resident is solid, he’ll approve it. He makes sure you can’t mess up, and makes sure you don’t miss a chance to learn, either by looking at something from a different perspective or allowing you to test out your own treatment hypotheses. When I met with him individually for my interview, he said things like, “You’ve proven to be the self-starter that excels in this program. I hope you find this program a good fit for you. You need to be very careful how you rank programs. And I mean this broadly in the sense of your top three. But I really mean this specifically in the sense of your top choice. Expect to match there”. Well, okay, that’s good to know.

From the co-chair of psychiatry, “If you choose to want to go here. Make sure you are very clear about that to Dr. Maguire (program director). We’ve all been hearing a lot about the work you’ve done here.”

An aside: I am guilty about the work I did there. Well, not so much the work as much as the effort. Psych makes sense to me. You learn a few basics about management and the rest is all instincts. But since it’s been important, I’ve always really overdone it effort-wise. Well after being disgruntled and not pleased with traffic and having been away from home for so long, I didn’t feel like I was doing that well. Things were getting done and my patients were happy, and were generally getting better and going home. However, there were a lot of students on service (so less work for each), and I was limited by the system on the unit to where I wasn’t able to place orders for co-signing and my notes weren’t generally worth anything because the fellows just dictated their notes independently of the quality of my note written in the chart. Anyhow, I ended up with honors and perfect score on my—now meaningless—evaluation. Because it was an unhappy, half-hearted effort most of the way, I feel guilty.

Back to my evaluation of the program.

The interns I spoke with were all very happy. No one seemed like they’d rather be working anywhere else. The sub-I on the adult unit also seemed very happy. His interests in psych seemed new, but his instincts were sharp and he had excellent people skills. I would be really happy working with him. Many of the residents live near the beach. As in one block or so from the beach. I began to envision weekends of waking up at 11 and rolling out to the beach to go surfing with christine…75 degrees in December. That’s some kind of life as an intern.
Ultimately, that’s what this program choice would come down to. The money is okay. The training is good, but not the best I could get. But the lifestyle? Perhaps only San Diego would be a better fit for us, and that program likely isn’t as good a fit. As a whole package, UCI is an excellent choice for 3 years, 5 years, or more.

The strengths of the program:
-amazing lifestyle choices (live at the beach, warm weather year round, close to skiing/hiking), moderate amount of moonlighting available at start of second year (hours that peak about 40-45hrs 2nd year onward), could do a mixed child/adolescent and psychotherapy track including specific training and clinics geared towards that, excellent faculty and administration, psych is very respected in the hospital/med school (50% of 2006 awards from med school went to psych dept, last two years’ faculty of the year was Drs. Maguire and Nguyen), there is a great social network here (residents are like a family. Many are displaced easterners and Midwesterners so they understand the challenges of relocation. The program is a good size—8 people—so there is a group feeling but also the opportunity for each person to have their own niche), SoCal!!!!

The weaknesses of the program:
-intern year could suck more than at other programs I’m considering (60ish hrs/wk on psych, 80hrs for the 6 months of medicine and neuro), cost of living (though better than in the bay area), traffic (apparently bad here this time of year for some reason and partly a result of construction on a freeway that should be complete in a month or so), training may be a bit more academic than what I’d ideally like.

Whole Grade:
Immediately – 8.9
A few days later – 8.9
11.30.06 – 9.0 (creeping up after being away from the beach)


I slipped away for about 15 minutes at 11am on my last day. I bought a giant warm cookie and sat on a bench in front of the neuropsychiatric center. I wore sunglasses because it was bright. It was warming up…low 70s at that point. I felt the sun’s warmth, I stared at the row of orange trees lining the left side of the NPC’s entrance, and I slowly placed gooey chocolaty chunks of cookie into my mouth. I could have all this and more. And with Christine, maybe we will.

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Providence, Rhode Island
Brown University
11.9.06

I’m writing this a few days after my Thursday 11/9/06 interview at Brown University. Being the first of what is 20+ scheduled interviews around the country, I’m not exactly sure how I should start to wrap my brain around the experience. Let’s just start with locale. Or perhaps for your entertainment, how I got to the locale.

I woke up around 4:30am (thanks, beanz) pacific time, gathered my things, and was on the road by 6. It was 38 miles from Orange to LAX. I needed to drop off the rental car that was rear-ended a couple days earlier—also relieving me of paying for parking or having to burden Steve for dropoff/pickup responsibilities for my excursion. We can pinpoint this time as the moment when I truly learned of SoCal traffic. Christine and I had sat in some LA nastiness during a vacation previously, but it was vacation—where else did we really need to be on time? The closer I was to LA, the more congested the traffic. No accidents. Just stoppage. Well, except for the carpool lane, which became less and less occupied by multi-person vehicles as time elapsed. I thought and thought about it, but just couldn’t execute the movement one lane to my left. The threat of a nearly $400 fine did its job. I reached the rental agency at 8am. That’s right, 38 miles in 2 hours. You do the math. I dropped off the car, but not before they needed further description of the accident—like my hustled shorthanded account would trump the police report also in hand. I missed the shuttle. Another was waiting, but he wouldn’t leave until more people were onboard. His attempt to increase his tip from others thoroughly destroyed his chance to get one from me and a few other stressed out riders. We reached the airport about 8:20. There was a short line at sky cap so I just figured I’d check my bag there, holding onto with dear life the carry-on containing my suit. “Oh, you’re flight is canceled. You were going to phoenix first and we can get you on a flight there for your outbound connecting flight, early even!” It was in 20 minutes. I hustled through—thankfully—very light security traffic and made it on board as one of the last few passengers. The flight to phoenix was cramped but quick and relatively painless. I made my flight into providence from there, knowing things had to go like clockwork, as I’d RSVP’ed for a 7pm dinner with a 6:40pm flight arrival time. This being the case, and since RI is generally not in the same weather category as LA or phoenix, I wore jeans and a sweater to both airports, receiving quizzical looks by many, some of which were rich old ladies with little dogs in their purses, so I wasn’t exactly too self-conscious. Flight was on time into a cold sideways-raining providence. The baggage claim area didn’t mark which flights the bags were coming from so it was general chaos. After about 25 minutes of walking back and forth and back and forth, I found the sole attendant who says my flight’s bags are all done. Sweet. I go to the lost bags area, rushed and pissed. They take note, blah blah. I hustle over to the rental car counter where I have a reservation. No one. All the other companies, attendants present. Dollar? Nah. I use the phone and call them about the shuttle, which is coming. I sit as best I can outside, remaining mostly dry until the shuttle arrives. We make the short commute to the agency’s lot. And it’s all apologies. No cars left. They point to the backboard, site of a billion keyholders, all empty. Jerm is not happy. Reservation in hand gets more crinkled. I make them take me to another agency, Thrifty, who only has minivans. Sweet. A brown minivan and I’m super late. I take off into the windy wet darkness towards downtown providence. It takes about 15 minutes before I’m so lost I need to start calling people. The roads in providence are full of curves, hills, one-ways, and random name changes. One road actually changes from Ridge St to Pidge Ave, I kid you not. How is that not the naming commission trying to fuck with visitors? In a town historically known to be run by the mafia, how could I be surprised? Justin via mapquest gets me to the restaurant around 8:30. I walk in wet, apologetic, and hopeful they’re all still there. Turns out there are two applicants. Residents all no-showed. Not looking so good for Brown. Fortunately, they were friendly applicants and the food was fantastic. By 3am I had my luggage from the airport, courtesty of the attendant who was willing to drop it off after he was off work (since no paid drivers were willing); and I had found sleep. If 3 hours of sleep can be described as perfect, this is the case. Turns out the applicants had changed the restaurant and had a miscommunication with the program coordinator. These things happen, I understand, and was impressed by their embarrassment, sincerity, and attempts to make up for it the afternoon after the interview.

Now the locale. Providence is great for food. It’s a pretty standard small northeast city. I think of it like Worcester but not as hopeless. It pales next to Boston and New York obviously, but it seems there’s enough to do to keep you occupied. I feel its confusing nature would easily pass with a few weeks of navigation.
The Brown interview started at 7:30am at Butler hospital, a psych hospital built in 1844 and known for its humane treatment of psych patients even in the asylum era. Part of it looks rich with history and design. Part of it just looks really old. The exterior is largely renovated to keep the original structures prominent, but with expansion. The patient areas inside are as modern as anywhere else I’ve really seen. Sterile, well-lit. The Brown program is a multi-site facility with shared time at several area hospitals, but none more than 20 minutes apart from one another. There is private (Brown), public/poor (RIH), the VA, a dedicated children’s hospital (Bradley), and more. Varied experiences. This is definitely a positive. The downside here is probably the largest downside of the program though. Every few months, you go somewhere new and have to get new passwords and learn how new systems work. People really complain about this. Of course, people will really complain about something regardless, so maybe it’s a positive note for the program that this is what residents choose to harp on.

The interview’s first few hours were powerpoints about the program, the standard nuts and bolts lectures, the research opportunities (which is another awesome aspect…tons of clinical research. Do none. Do a little. Do a lot. All up to you. Want to dabble, as I do? This is the place). Then was the tour of the hospitals mentioned above. Then a reasonable closed door lunch with the residents. They seemed very nice, very sociable, very friendly. I know they’re supposed to be, but it wasn’t superficial. As a psychiatrist, I will have to trust on one my strengths—the quick read; my gut feel for people. These residents were happy. They liked their jobs. They liked their lives. They did not regret their choice, except for maybe one resident, who admitted it was his second choice with a few well placed questions to break down the salesman act.
Then came the interviews. SIX OF THEM. I was expecting three of four. Six? I guess I know what speed dating is like now. 30 minutes a pop. What I loved though was that each, quite incidentally I found out, picked a different part of my application to talk about. Some tried to play good cop. Some tried to play bad cop. In the end, everyone was satisfied on both sides of the table, I think. The program director in particular, I feel, liked me. We share some contacts and she really took interest in some of side projects. The associate PD was scheduled to play bad cop with me, but we got to talking about hockey, so that never really materialized. One resident stated, “You should have your pick of any program you want”. That’s a good boost for the ego. She later offered me a place to stay in her encouragement of me coming by for a second look. I think I’ll take her up on it.

After the interview, they rallied the troops and took us all out to an amazing downtown bar where we drank high end wine and scotch and ate expensive food. They were getting ready to go a resident’s house later that night, where they all meet on Thursdays to watch tv. Their workloads seemed pretty reasonable.

The strengths of the program:
-low work hours (probably 50-55 as intern, 40-45 thereafter), ability and opportunity to moonlight starting 2nd year, varied settings of experience, very friendly and social residents, good city setting, double the time doing child psychiatry (4 months as opposed to the almost universal 2 months; very exciting since I’m considering a child fellowship after residency), associated highly reputable child fellowship where they take all residents who are interested, ability to dabble in research with tons of interested faculty, very heavily focused therapy training, short commute from everywhere, relatively close to friends and family, close to lots of other fun cities, chance to play recreation ice hockey, reasonable cost of living with chance to own a home, christine would get to play in the snow during the winter and enjoy the beach during the summer, close to low quality ski resorts, close to the airport, I could wear a polo with popped collar and a faux hawk and no one would care. Okay, maybe not no one.

The weaknesses of the program:
-the struggles of learning all the systems in a multisite program, I really didn’t like the old rooms some of the residents had their teaching in, the weather (the summers are great but short. It’s so close to the water, snow is probably less likely than rain for much of the winter), something else intangible…likely related to the fact that it’s not California.

I would be very happy at Brown, at least for the 3 or 4 years I would be required to be there. It would be nice to go to a reputable program, make some money towards loans, buy a house, spend part of my life in the northeast, gain more experience with child psych and research, and be close enough to friends that visitation would be reasonable. Plus, everyone was just so nice and happy. Who wouldn’t want to be a part of that?

Whole Grade:
Immediately – 8.6
A few days later – 8.9
11.9.06 – 8.6 (The northeast can’t hang with SoCal for lifestyle!)
11.30.06 – 8.7 (Keep hearing good things about this program and the people were just so happy and friendly)