Career Advising

Frequently Asked Questions about applying to Psychiatry Residency and Career in Psychiatry

Q: Why do I have this odd feeling of happiness when I’m doing my Psychiatry clerkship? Why is there a spring in my step? I never felt this way before! 
A: Maybe you like what you’re doing! Perhaps you should consider a career in Psychiatry.

Q: I’m planning to apply in Psychiatry. Is there something I should be doing that I’m not doing? 
A: There are no special requirements that you have to worry about fulfilling in order to apply to Psychiatry residency. There is no absolute need for electives or sub-internships, however since Psychiatry has become more competitive in the recent few years, doing an elective rotation early in the fourth year may help you, especially if you have not received Honors in the core rotation. There is a variety of choices, and you can discuss your options with your advisor. Regarding research or publications, there are also no requirements (though having these under your belt will look very impressive on your CV).

Q: What are the required parts of application to Psychiatry? 
A: A personal statement in which you should explain why you want to be a psychiatrist and 3 letters of recommendation (one from Psychiatry, two from preceptors who feel that you’re an excellent medical student). It’s OK to have 2 letters from Psychiatry and one from another specialty, as well. Occasionally, some programs will ask for 4 letters, one of which will need to be from the Psychiatry Department at the UW; please let Dr. Shah know if you need such a letter. We will help.

Q: What are the possible electives that I could do in Psychiatry? 
A: If you would like a sub-internship type of experience in order to get an extra letter of recommendation or an early fourth year grade, consider doing a rotation in July or August, on any of the Consult-Liaison services, or an inpatient sub-internship at the VA. You can also do these rotations any time of the year, just for fun. Other popular options include Psychiatry Emergency Services at Harborview, an outpatient Psychiatry rotation at the VA, Geriatric Psychiatry, Child Psychiatry, and Addiction Psychiatry. If you have a special interest other than those listed above, let us know and we will work to match you with the right service. If you’re at all interested in applying to the Spokane residency program, we recommend doing a sub-internship there.

Q: How many residencies should I apply to? 
A: Depends on your goals and your competitiveness. The fact that you’re coming from UWSOM speaks highly in your favor, and you’re already competitive in comparison to other applicants. However, Psychiatry has become a more competitive specialty over the last 3 years and we recommend applying to more programs than we have before, as well as not putting all your eggs into one basket (applying to different tier programs for safety, no matter how competitive you may be). Discuss with your advisor what the reasonable number might be for you.

Q: There are so many programs! How do I choose where to apply?
A: Start geographically. Where do you want to live? Where would you prefer not to live? Once you’ve narrowed your list to just the programs in the places you could envision yourself living for 4+ years, consider the size of the program (big or small), setup (academic or community-based), whether it offers fellowships (if your goal is to specialize, you may want to be at an academic program that offers fellowships), and whatever other factors that may be important to you. Doximity.com is a good unofficial source of information about residency programs that may help guide you. Residency program websites are underused sources of information that you should definitely utilize in your search.

Q: What if I got “just a P” in my Psychiatry clerkship? 
A: Given the competitiveness of the specialty, this could make your journey more challenging, but it’s not impossible. Please contact Dr. Sina Shah as soon as possible to discuss your application and your options.

Q: Are there fellowships in Psychiatry? 
A: Yes! You will have a number of options. After a 4-year general residency, you may want to do Geriatric Psychiatry Fellowship, Psychosomatic Fellowship, Addiction Psychiatry Fellowship, Forensic Psychiatry Fellowship, to name the most common ones. Child Psychiatry Fellowship is usually 2 years long and it can begin after 3 years of general residency. There are other options that are less common and more esoteric, which you may wish to seek out.

Q: Do I have to talk to a career advisor? I feel like I know what I’m doing. 
A: We appreciate that you probably have all the components for a successful application. You’re a pro. Still, while we can’t force you to talk to us, we highly recommend it. When the Match Day comes around, we will be looking out for you and all other students applying to Psychiatry. We will be the ones to help if you don’t match. And knowing who you are will help our mutual success. Further, you may need at least a little bit of guidance – to review your personal statement, to advise on the number of programs you should apply to, and to just have a cheerleader along the way.

If you’re still reading this document, you’re probably searching for more specific answers, which means that you need an advisor. Please contact Dr. Sina Shah to get matched with one.

Anna Borisovskaya, MD

I came to medical school with a specific goal of becoming a geriatric psychiatrist. At the time, my perception of this profession amounted to the idea that I’d understand people, their drives and desires. While I specifically wanted to learn more about old age and dementia, I also pictured myself in a tastefully decorated office, with a patient on the couch, listening in fascinated silence to their innermost thoughts. Perhaps, it’s not surprising that my life turned out differently. I’d like to think that my office is tastefully decorated, but it’s at the Veteran’s Hospital, where I work with my colleagues and my trainees, and instead of doing psychoanalysis, I’m doing electroconvulsive therapy (ECT). And, while I understand people a lot better than I did prior to doing the Psychiatry residency, I also come across daily reminders about how much more I have to learn about human brain, behavior, and human desires. And that is one of the reasons why Psychiatry is and always will be a fascinating endeavor – to strive to know the hearts and minds of my patients, and to dare change them, away from sickness and back to health.

While I was interested in a variety of other specialties (Neurology, ER, Internal Medicine), it was only during the Psychiatry rotation that I finally felt at home, surrounded by “my people.” Here, hope was palpable, recovery was possible, and frightening things like frightening whispers in an empty room or shadows in the corner of your eye were controllable. My very first patient suffered from paranoid schizophrenia. As he spoke to me about his fears of the vast, unpredictable, frightening world in which he lived, I was filled with sympathy – but also with happiness. I had a real schizophrenic patient! I knew then, irrevocably, that Psychiatry was what I’d live and breathe for the rest of my life. It’s with no small measure of pride that I was able to say that even as a medical student, I contributed to a good outcome for this patient, simply by being there, by listening, by encouraging him to take a medication, and by offering a different framework for his experiences – once he was able to have such a conversation.

Little has changed since I graduated from the residency, geriatric psychiatry fellowship, and in my work as a clinician-educator and ECT Director at the VA. No matter how irritated I am by the bureaucracy (which has become inevitable in medicine – but it’s up to you, young ones, to change this), how long my day is, what other concerns I have on my mind, I still feel the same compassion and exercise the same patience when I take care of people.

In my career, I’ve focused on the treatments that lead to the best outcomes. To that end, ECT has been an impressive tool in my belt. I’ve seen it lead to miraculous cures; I know that it prevented suicides and other poor outcomes for my patients. I’ve also completed psychodynamic psychotherapy training, which gave me deeper appreciation of child and adult development. I know that words, deceptively simple as they seem, can heal. And this profession gives me time and opportunity to get to know my patients, and to help them build a better worldview and a better life. They may start slowly, and only get better bit by bit, but there are appreciable changes that I can see – month after month, year after year, as they take their steps toward recovery. I’m humbled to say that I had been a part of this process.

Psychiatry is both old and new. Psychoanalysis has not “gone out of fashion,” and therapeutic skills will always be needed. At the same time, new treatments for depression, schizophrenia, and bipolar disorder are being developed – and our patients stand to benefit from improvements in repetitive transcranial magnetic stimulation, ketamine infusions (which we just used at the VA!), and from newly approved medications (such as lurasidone for bipolar depression). There are discoveries waiting to be made, if you want to be a researcher. There are eager students who need your wisdom, if you want to be an educator. And there are scores of people who desperately need compassionate therapists, knowledgeable psychiatrists, and advocates. Good life and health are impossible without the mental health component, and it’s a relief to see that general public, politicians, and media are beginning to understand this. I hope to grow old doing this work, and I hope I never stop evolving and adapting. Perhaps my dream of a tastefully decorated office (probably in Madison Park, that’s where all the analysts work!) will come true after all, once I get tired of ECT (though I don’t see this happening). But then again, that’s another advantage of Psychiatry – it’s a career where you can reinvent yourself and find the precise job that suits you best, depending on your personal and professional goals.

Consider a commitment to helping the dispossessed, the disenfranchised, and those who’ve fallen out of step with the rest of the world. Show them a glimpse of a life that’s possible, and help them make this glimpse a reality. As a psychiatrist, you will make a difference, and that’s one thing that I can promise you without reservations. The rest will be up to you.

1. Things are getting more competitive. With the increasing numbers of medical students in general, and increasing interest in Psychiatry across the board – but no commensurate increase in residency spots – competition is tougher. Last year there were only 3 unmatched residency spots before the final results of the MATCH were released. This isn’t meant to frighten you, just help you focus on the goal J

2. Please utilize your advisor. This is the person who has a lot of experience in reviewing personal statements and helping you make the best of your application. Use their expertise.

3. Spread your applications across a variety of residency programs. Think of it like investing – you wouldn’t buy stock with just one company, or with just one type of company. You may want to apply to some schools that you have a realistic chance of matching to, some safe schools, and some exceptional schools. The number of schools may be less important than having a good reason why you’re applying to a certain school. Because the programs have a higher number of applicants to choose from, nowadays, they may be selectively inviting students who have a connection to the city or the school.

4. Consider an away rotation in another institution, if you’re particularly interested in it. It can go both ways – if you impress them, it will give you much higher chance of matching there. If you don’t impress them, your chances will be lower than they would be otherwise. But perhaps that is just what was meant to happen.

5. If you got a Pass or High Pass in Psychiatry during the third year, definitely consider doing a Psychiatry rotation earlier on in the 4thyear, so you can get Honors and maybe a great letter of recommendation.

6. Please consider doing a Mock Interview or two. The School of Medicine will arrange these for you, take advantage of this opportunity.

7. Invest the time and energy into your personal statement. Make it stand out, make it memorable. Explain why Psychiatry is your passion. Hopefully, it is your passion!

The interview day

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You probably know exactly what to do. Still, it helps to hear it one more time…

1. Get good sleep the night before so you’re at your best. Wear appropriate professional clothing. You don’t want to stand out too much from the crowd; flamboyant or wrinkled clothing, in this moment, will hurt you. When you matched there, you can probably get back to your normal style. Interview is a different matter – your interviewers will judge you based on your application as well as based on your appearance.

2. Your interviewers may appreciate your interest in their research, and their work. They will also be happy to tell you about the program, the call schedule, how long they’ve been with the department, and why they’ve stuck around. They don’t necessarily want to hear more personal questions. Consider whether what you’re asking them is appropriate, and don’t be intrusive. Researching the program, rather than your interviewers, will probably give you a better leg up during the interview day. Look at the list of good questions to ask during the interview (below).

3. Present yourself equally well to everyone you encounter during the day. A person who brings you coffee may have more sway over the decision of the program’s Admission Committee than you realize. A resident you exchange a few jokes with during the social hour may be on the Admissions Committee. Everything – EVERYTHING – gets conveyed back to the program director. Behave accordingly.

4. Observe boundaries. Don’t be too humble, but don’t talk yourself up either. Both behaviors are a red flag, especially to psychiatrists, who are well-versed in reading people’s behavior and judging whether their personalities will mesh well with the program.

5. You’re coming from a great school; remember your worth and have fun during the interview day.

   ​Interview Q&As

   Interview Day Tip

Sina Shah, MD
Acting Assistant Professor, Psychiatry and Behavioral Science, UWMC
Director, Career Advising in Psychiatry, UWSOM
Attending Psychiatrist, Psychiatry and Behavioral Medicine Unit, Seattle Children’s Attending Psychiatrist, Children’s Autism Center, Seattle Children’s
sinashah@uw.edu VAMC

Anne Thomas, MD
Associate Clerkship Director, Psychiatry and Behavioral Sciences
Primary Site Bozeman MT
anne50@uw.edu

Christopher Varley, MD
Past President, American Association of Directors of Psychiatric Residency Training
Professor, Psychiatry and Behavioral Sciences, UWMC and Seattle Children’s Medical Center
cvarley@uw.edu

Sharon Romm, MD
Associate Professor, Psychiatry and Behavioral Sciences, UWMC
Medical Director, Psychiatric Intensive Care Unit, Harborview Medical Center
Director, Continuing Medical Education, UWMC
sromm@uw.edu

Jonathan Buchholz, MD
Assistant Professor, Psychiatry and Behavioral Sciences, UWMC
Medical Director, Inpatient Psychiatry, VAMC

Laura LaPlante, MD
Assistant Professor, Psychiatry and Behavioral Sciences, UWMC
Laura.laplante@va.gov