How to Match in Psychiatry

(or, Where to Match in Psychiatry?)

The field of clinical psychiatry is growing at a much faster rate than the number of trainees entering it. The sheer statistics of the Match in psychiatry determine that nearly everyone will match. So, fortunately for you applicants, the question leading up to Match Day is not whether you’ll match, but where you’ll match. And while the top programs are quite competitive, most applicants from reputable medical schools and who have solid communication skills will be in the driver’s seat during the application process. For those who enjoy being in control, this fact takes the stress out of the Match and makes the process quite fun. For those who are comforted by fate, the process can be a challenge to identify what you really want. Either way, finding honest answers to two questions should lead you down a path of success.


I. How am I doing?

Your answers to this question will provide some basic factual information, as well as some more future-oriented information.

First, the basics. How did you do on Step I?
The anxiety this question creates is inversely proportional to its value. For the most competitive programs, strong scores certainly help. But psychiatry in general is much less concerned about Step I scores than other specialties, not because it’s a “softer science” (it’s not), but because scores have minimal relevance to clinical acumen. It’s always difficult to quantify a definitive range, but it seems like the high 190s/low 200s is a good, average range. Strong Step II scores are valued and noticed, probably because Step II speaks more accurately to your general clinical skill set. USMLE scores rarely (if ever) come up in interviews and in general, are not used as the deciding factor in ranking one candidate over another.

Are you following the general timeline of most other specialties?
If you and your friends are finishing personal statements and obtaining letters of recommendation according to similar deadlines, then you’ll be just fine. A good place to check on some of the nitty-gritty details of programs is the website of the American Association of Directors of Psychiatric Residency Training (aadprt.org). There are links to almost all of the residency training programs through this site and by going to the websites of the individual programs, you can also find out more specific information about many things, including special deadlines.

Do I come recommended?
Letters are highly valued. Typically 3 letters are required, but 4 for certain programs. Programs will have specific instructions on letter writers, typically requiring one from psychiatry, one from medicine, and one from any specialty. Again, the website of the American Association of Directors of Psychiatric Residency Training (aadprt.org) is a great resource for figuring out which programs want which types of letters. Writers should know you personally and have worked with you. It’s more important that the person knows you personally than that they have a “big name.” In general, psychiatrists are very excited about helping future psychiatrists getting into good training programs, so don’t be shy about asking for letters. You might not think that your attending knows you well personally, but it may actually turn out that they’ve observed a lot more than you think they have.

Now for the most important point. Find a mentor.
In general, psychiatrists are very excited about helping future psychiatrists get into good training programs. But is also true that psychiatry is such an interdisciplinary field that there are very different types of work in which you can specialize. It’s helpful to think out loud about the next few years. It is also extremely helpful to speak to recent grads from your med school who decided to go into psychiatry. They are often your best resources since they usually have the most up to date information on the different programs, know who the current program directors are, know what psychiatry programs are currently looking for, etc… Also, it can’t be said enough how much of a family the “psychiatry world” really is. As you interview at programs, many program directors and faculty members will tell you something along the lines of “wherever you end up training, feel free to use me as a resource and a mentor, even if you don’t end up training here.” These are not empty words. If you make a connection with a psychiatrist at a particular program, but have no interest in going to that program, still feel free to consult with them—especially if they offer it!


II. Where am I going?

Where you match can be guided by your self-knowledge and honesty. Again, the numbers make the Match less competitive, and so programs don’t have to rely on measures like Step I scores to sort applicants. They like to relay on honest information you give them. As a result, there is much less “game playing” than your friends in the surgical specialties might have to participate in.

What are programs looking for?
A good fit. Programs know that the vast majority of applicants will match at their first or second choice. As a result, they want the best students with the best fit at their program. Programs are also looking for applicants that are dedicated to the field of psychiatry and are not just using it as a “safety” residency since it is less competitive. Psychiatrists are GOOD at ferreting this out and can tell when someone’s heart isn’t in it. Finally, programs are looking for people with enthusiasm, intellectual curiosity, and dedication to being a “lifelong learner.” More so than in some other fields, psychiatry programs are also looking for well rounded people with interests, passions, and experiences outside of medicine.

What to do during fourth year?
Advice typically is to use fourth year to do whatever you want—with certain goals and work ethic in mind. If that’s a lot of psychiatry, with maybe an away rotation, then fine. But consider doing a good bit of medicine because psychiatrists in general always wish they had more medicine experience, and your internship will be much more developmental and enjoyable if you feel comfortable. Away rotations are not necessary and, if you come from a good med school, present a much higher chance of hurting than helping you. Away rotations can be helpful if you are strongly considering a certain geographical area. Get your sub-internship(s) done and hone your intern skills. The sub-I can be in psychiatry, medicine, or surgery. If you choose to do your only sub-I in something besides psychiatry (and this is actually considered to be advisable by many), just make sure that you have at least one letter of recommendation from a psychiatrist (either from your third year clerkship faculty or from an away rotation).

Am I having fun on the interview trail?
Sure, interviewing is tiring, expensive, and stressful at times. But you know you are going to match, so you should recognize that the people you meet, competing applicants included, are your new colleagues. Interviews themselves are very program specific. The only common theme is that most interview days are friendly experiences during which residents and faculty just really want to get to know the applicants. But remember that you’re interviewing them as much as they’re interviewing you. Make sure you get the information you need to know if that program is a good fit for you. You will be surprised (and flattered), by how many interviews start off with something along the lines of “what can we say to get you to come here?” No joke!

How do I evaluate and rank programs?
At the end of each day, jot down a quick list of pros and cons, even though you’ll be tired and won’t want to do this. You can use the rank list feature on this site for a little organizational help. Remember that excessive analysis can quickly become burdensome and unhelpful. The “gut factor” becomes more important than you might think, particularly as you visit more programs. For many applicants, the bottom line is determined by “gut feeling” during the interview day, geographical location (e.g. climate, proximity to metro areas, proximity to family, friends, spouse), and specific interests (research interests in a particular area, etc.). The structure of most programs is quite similar, although internships can vary. Applicants are closest to internship and so often ask a lot about it. Be advised that call schedule during internship, work load during medicine rotations, and other factors that seem like “big stuff” are very much small stuff and will not mean much at the end of the day if you’re happy (or unhappy) where you are. Think big picture.

III. Pearls
Know what you want.
Go out and get it.
Have fun doing it.

IV. Resources
1) American Assoc. of Directors of Psychiatric Residency Training website (aadprt.org)
2) Guide to Neuropsychiatric Therapeutics. Coffey CE. 2006. (Excellent combination of meaningful background and high yield at-the-point-of-care guidelines.)
3) Pocket Medicine. (Every resident should have it.)