Interview season
Originally posted by squid314 on January 21, 2012:
I have spent the last month on a some-expenses-paid tour of the nation's psychiatric hospitals.
...doing job interviews. You did realize that was what I meant, right?
I finish medical school this May (hopefully!) and would very much like to take a job in psychiatry when I graduate. Such jobs, like all other medical apprenticeships, are distributed by a complicated computer algorithm called the National Residency Match Program.
Yes, we are living in a dystopia. Or at least I've always been told that we would know we were living in a dystopia when our jobs were assigned us by a computer.
But this is a friendly computer, and operates mostly based on the weights I give it, and the weights different programs give me. So I am traveling around the country, investigating different hospitals and universities and allowing them to give me terrible interviews in which psychiatrists who supposedly spend their entire lives assessing people by asking them questions run out of non-repetitive questions after a couple of minutes.
So far I have visited six hospitals, with a seventh coming up in a few days. I've been very impressed by all of them, which probably means I am gullible. Just as I am trying to make myself look like a brilliant and professional doctor so they will take me, so they are trying to make themselves look like world-class hi-tech sparkling-new hospitals so I'll want to work there.
Listening to psychiatric hospitals boast about themselves is a strange experience. Some boast about their prestige. One of my interviews was at the sinister-sounding "Institute of Living", whose odd name is probably still better than their previous moniker, the Connecticut Retreat For The Insane. They told me quite proudly that they were one of only thirteen members of the "Ivy League of mental institutions", an entity whose existence I had managed to stay totally unaware of until that time.
Others boast of the interesting patient populations they serve. Maimonides Medical Center, in a very Jewish neighborhood of New York, focuses on Orthodox Jewish patients and is a center for the study of obsessive-compulsive disorder, which apparently assumes some of its most florid forms among that population. Who would have thought that having 613 rules that govern every facet of your daily life and whose infractions must be atoned for with complicated rituals could turn someone OCD? Hennepin in Minneapolis, on the other hand, has a large population of Vietnamese, Hmong, and Somalis - one of their specialties is post-traumatic disorders from war and refugee experiences. Three or four of the hospitals have boasted of serving the poorest of the poor, a subgroup known for their complicated and difficult mental conditions. Hartford takes a different tack, and boasts of their clinic serving super-rich insurance company executives - a group who apparently have a whole spectrum of their own psychological problems.
Still others boast of their methods. Long Island is known for its expertise in electroconvulsive therapy; Hartford says they have not only ECT machines, but one of the few direct transcranial magnetic stimulation machines in the country. Bay State, for their part, offers a Hypnosis elective for apprentice doctors there who want to learn about hypnotherapy (YES) and a sensation room (a little bit like snoezelen) full of weird lights and textures for patients who need a little stimulation.
And some boast of all the different fields of psychiatry available. There are the normal things like Child Psychiatry or Geriatric Psychiatry, and then there are ones I'd never heard of before which make me want to stop the interview right there and make my interviewer tell me as much as ey can about eir own specialty. One man I met was a Palliative Care Psychiatrist. Palliative care refers to patients who have been diagnosed with terminal diseases and who are on their way out; his job was to make sure these people didn't get depressed and were able to come to terms with their approaching mortality in a healthy way (I have a feeling he and my more transhumanist friends would mutually hate each other).
A few others were less interesting in and of themselves, but had great job titles. I remember meeting in Ireland a man who introduced himself as something like the chairman of pain - a perfectly reasonable title, as pain medicine is an important medical specialty and needs a department chair just like everyone else - but the name amused me, and made me wish I could introduce myself as a chairman of pain (or better, a Chairman of Pain) one day. There were no Chairmen of Pain at any of the hospitals I interviewed at, but one did have a Sleep Fellow. This ended up making perfect sense: a Sleep Fellow is someone pursuing a fellowship in Sleep Medicine, which treats insomnia, hypersomnia, sleep apnea, and various other sleep-related medical conditions. But that's another one where getting to introduce myself as "Dr. Scott Alexander, Sleep Fellow" would be the highlight of my life (and sleep medicine is actually pretty interesting).
There is a joke in most psychiatric hospitals; the specific answer changes, but the point is always the same. It's something like "What's the difference between a psychiatrist and a psychiatric patient?" and the answer is "A white coat" or "A stethoscope" or "One of them has the keys". And certainly I have seen some strange things in my travels. I think my favorite was the Institute of Living's Festivus exhibit. I was there just after Christmas, and in one of the lobbies they had an exhibit on holiday traditions around the country, and along with Christmas, Hanukkah, and Kwanzaa exhibits, they had a beautiful and professional Festivus exhibit, complete with a Festivus Pole and Grievance Box.
And the interviewers themselves ranged from weird to wonderful. I have rarely met a demographic that is so consistently intellectual and up on interesting trends as hospital psychiatrists. Just to give an example, when I mentioned I was interested in the application of artificial intelligence to human cognition, one interviewer unprompted asked me "Do you believe in the Singularity and when do you think it will occur?" I've had conversations with other interviewers about everything from Daniel Dennett to Libet's free will experiment to Joseph Campbell, to the validity of the Myers-Briggs test to Himalayan Buddhism. Pretty sure I would never get those kinds of conversations talking to orthopaedic surgeons, or to shipping managers or vice-presidents of human resources, for that matter. It's that kind of thing which really makes me think psychiatry is the right field for me (among many other things).
They're also all really, really interested in their patients. I shouldn't have to say this to anyone who's been paying attention, but the old stereotype of psychiatrists as people who throw tranquilizers at their patients until they're sedated, then go off and play golf has pretty much zero basis anymore. These people are super bright and compassionate, super dedicated to doing as much for their patients as possible with as little medication or invasive procedures as possible. One of the things I love about medicine in general and psychiatry in particular is that doctors have always been their own worst critics, and that they're always on the forefront of the fight to change medicine, and nearly all of the people I've met have seemed like they're embodiments of that.
Not that there haven't been some...uh...less enthusiastic interviewers. I remember one person who sat in front of me, clearly with no idea who I was, holding a checklist with statements like "RATE PRESTIGE OF INTERVIEWEE'S ACADEMIC AWARDS 1 TO 5". He'd ask in a monotone "Did you win prestigious academic awards?" and when I started to answer "Yes, I..." he just said "Okay, good" and circled the "5". Repeat for about ten other questions. One of the residents at the hospital revealed that he was actually a quite famous forensic psychiatrist who spends all his time with the criminally insane and has adopted a brusque and impersonal manner to deal with them. I don't know how that ties in with his tendency to trust everything everyone says at face value, though.
Most interviewers have asked exactly the same questions, those being:
"So why are you interested in psychiatry?" (I've had to come up with an answer more coherent than just kind of sitting there being like "But...but...how could someone not be interested in psychiatry??")
"So are the medical schools in Ireland good?" (Of course I would say they were, but everyone seems to think asking this question has value.)
"What field of psychiatry do you want to go into?" (???)
"Do you have any brothers or sisters? What do they do?" (They're obsessed with whether I have brothers or sisters. I don't know why. I always tell them I have one brother who's a jazz musician, but I feel bad about it, because I'm afraid they use that to draw conclusions like that if I have a hip, cool brother I must myself be cool and hip. This would be inaccurate, to say the least.)
"I see your father is in medicine. How has that affected you?" (inspiration, role model, here I tell a funny little family story about a picture in the photo album of me wearing a bib saying "Future Doctor" at age 1)
"Why are you interested in our program?" (The secret is to say anything other than "Well, I applied pretty much everywhere, and you were one of the ones that accepted me." Which is too bad, because I'm not good at lying.)
I've also gotten the occasional more meaty question, like "How do you handle conflict?" or "What is your biggest concern about your medical ability?" or "Do you really see yourself living in Memphis?" (only in sleep, during my nightmares). But mostly I think I'm a pretty good interviewee and able to promote myself pretty fluently and I usually have funny stories that keep people interested if nothing else.
Also the dreaded "What questions do you have for us?", which is tough, because even if you think of ten questions before coming, by the time you've gotten through a full interview day with four or five interviewers, you're all out of questions, and you're not supposed to say that or else you sound like you're not genuinely interested in the program.
I usually start with "What's the balance in this program between training in the use of psychiatric drugs and training in the use of talk therapies?". This question is hilarious, because everyone always answers it the same way. They answer: "You know, every hospital that you ask that question at is going to answer it the same way. They'll all say they have a balance between the two. But that's actually quite rare, and this is one of the few hospitals that actually does have a balance between the two, thanks to the work of Dr. X on staff, who is a well-trained psychoanalyst." I'd kind of like to see if by publicizing this pattern, I can get them to recurse another level, and go to "Well, all hospitals answer this the same way. They all say that all hospitals answer this the same way, then say that unlike those hospitals, they really do have a balance because of the work of some doctor on staff. But unlike those hospitals, we really really have a balance." If any hospital were to do that, I think I'd sign up immediately.
Other than that, I ask about research opportunities (usually there if I want them, which by the time I do all my work and call and stuff I may not), pay (usually between $45000 and $55000; Memphis blew my mind by saying that if you wanted to work overtime on the nightshift you could make an extra $1500 a night, which is about as much as I've ever made in a month at any other job), call schedule (usually about once a week, but a surprisingly good number of them are "home call"/"beeper call") work-life balance (hahahahahahaahahaaaha), and the local area (which they always insist is Full Of Culture And The Arts And Cuisine And Several Sports Teams, even though really all I want is enough educated young people that I will have a decent chance of meeting at least one girl I can relate to on an intellectual level - even though my standards for "relate to on an intellectual level" may be kinda high).
I have one interview left, that at the University of Cincinnati on Monday. After that my next deadline is February 15th, by which I must have input my preferences into the NRMP computer in the form of a list of programs from favorite to least favorite. Right now I am thinking of putting Institute of Living in Hartford as my first choice (I promise it's not just so I can introduce myself as "Dr. Scott Alexander, Institute of Living", even though that would be pretty cool) but Zucker Hillside in Long Island might beat it out by the time I've finished all my research. Then it's the six other hospitals in one order or another in case I get rejected from my top choice. If I get rejected from all seven, which is unlikely but certainly possible (there are usually about 150% more medical school graduates than spaces available for this kind of thing) then it's hunting for something to do for a year until I can apply again next winter.
And then in the middle of next week, I fly back to Ireland to finish up medical school, which at this point is annoying. I've had a month to get excited about the idea of being a real doctor practicing a specialty and treating patients and making money, and now I've got to go back and do the whole student thing and pretend to care about obstetrics and gynecology. At least I'll have the terror of final exams to keep me in line. Speaking of terror, I still have to have passed a licensing test I took in December for this to even work. And also speaking of terror, I hear back about whether I got a job or not in mid-March.
I have spent the last month on a some-expenses-paid tour of the nation's psychiatric hospitals.
...doing job interviews. You did realize that was what I meant, right?
I finish medical school this May (hopefully!) and would very much like to take a job in psychiatry when I graduate. Such jobs, like all other medical apprenticeships, are distributed by a complicated computer algorithm called the National Residency Match Program.
Yes, we are living in a dystopia. Or at least I've always been told that we would know we were living in a dystopia when our jobs were assigned us by a computer.
But this is a friendly computer, and operates mostly based on the weights I give it, and the weights different programs give me. So I am traveling around the country, investigating different hospitals and universities and allowing them to give me terrible interviews in which psychiatrists who supposedly spend their entire lives assessing people by asking them questions run out of non-repetitive questions after a couple of minutes.
So far I have visited six hospitals, with a seventh coming up in a few days. I've been very impressed by all of them, which probably means I am gullible. Just as I am trying to make myself look like a brilliant and professional doctor so they will take me, so they are trying to make themselves look like world-class hi-tech sparkling-new hospitals so I'll want to work there.
Listening to psychiatric hospitals boast about themselves is a strange experience. Some boast about their prestige. One of my interviews was at the sinister-sounding "Institute of Living", whose odd name is probably still better than their previous moniker, the Connecticut Retreat For The Insane. They told me quite proudly that they were one of only thirteen members of the "Ivy League of mental institutions", an entity whose existence I had managed to stay totally unaware of until that time.
Others boast of the interesting patient populations they serve. Maimonides Medical Center, in a very Jewish neighborhood of New York, focuses on Orthodox Jewish patients and is a center for the study of obsessive-compulsive disorder, which apparently assumes some of its most florid forms among that population. Who would have thought that having 613 rules that govern every facet of your daily life and whose infractions must be atoned for with complicated rituals could turn someone OCD? Hennepin in Minneapolis, on the other hand, has a large population of Vietnamese, Hmong, and Somalis - one of their specialties is post-traumatic disorders from war and refugee experiences. Three or four of the hospitals have boasted of serving the poorest of the poor, a subgroup known for their complicated and difficult mental conditions. Hartford takes a different tack, and boasts of their clinic serving super-rich insurance company executives - a group who apparently have a whole spectrum of their own psychological problems.
Still others boast of their methods. Long Island is known for its expertise in electroconvulsive therapy; Hartford says they have not only ECT machines, but one of the few direct transcranial magnetic stimulation machines in the country. Bay State, for their part, offers a Hypnosis elective for apprentice doctors there who want to learn about hypnotherapy (YES) and a sensation room (a little bit like snoezelen) full of weird lights and textures for patients who need a little stimulation.
And some boast of all the different fields of psychiatry available. There are the normal things like Child Psychiatry or Geriatric Psychiatry, and then there are ones I'd never heard of before which make me want to stop the interview right there and make my interviewer tell me as much as ey can about eir own specialty. One man I met was a Palliative Care Psychiatrist. Palliative care refers to patients who have been diagnosed with terminal diseases and who are on their way out; his job was to make sure these people didn't get depressed and were able to come to terms with their approaching mortality in a healthy way (I have a feeling he and my more transhumanist friends would mutually hate each other).
A few others were less interesting in and of themselves, but had great job titles. I remember meeting in Ireland a man who introduced himself as something like the chairman of pain - a perfectly reasonable title, as pain medicine is an important medical specialty and needs a department chair just like everyone else - but the name amused me, and made me wish I could introduce myself as a chairman of pain (or better, a Chairman of Pain) one day. There were no Chairmen of Pain at any of the hospitals I interviewed at, but one did have a Sleep Fellow. This ended up making perfect sense: a Sleep Fellow is someone pursuing a fellowship in Sleep Medicine, which treats insomnia, hypersomnia, sleep apnea, and various other sleep-related medical conditions. But that's another one where getting to introduce myself as "Dr. Scott Alexander, Sleep Fellow" would be the highlight of my life (and sleep medicine is actually pretty interesting).
There is a joke in most psychiatric hospitals; the specific answer changes, but the point is always the same. It's something like "What's the difference between a psychiatrist and a psychiatric patient?" and the answer is "A white coat" or "A stethoscope" or "One of them has the keys". And certainly I have seen some strange things in my travels. I think my favorite was the Institute of Living's Festivus exhibit. I was there just after Christmas, and in one of the lobbies they had an exhibit on holiday traditions around the country, and along with Christmas, Hanukkah, and Kwanzaa exhibits, they had a beautiful and professional Festivus exhibit, complete with a Festivus Pole and Grievance Box.
And the interviewers themselves ranged from weird to wonderful. I have rarely met a demographic that is so consistently intellectual and up on interesting trends as hospital psychiatrists. Just to give an example, when I mentioned I was interested in the application of artificial intelligence to human cognition, one interviewer unprompted asked me "Do you believe in the Singularity and when do you think it will occur?" I've had conversations with other interviewers about everything from Daniel Dennett to Libet's free will experiment to Joseph Campbell, to the validity of the Myers-Briggs test to Himalayan Buddhism. Pretty sure I would never get those kinds of conversations talking to orthopaedic surgeons, or to shipping managers or vice-presidents of human resources, for that matter. It's that kind of thing which really makes me think psychiatry is the right field for me (among many other things).
They're also all really, really interested in their patients. I shouldn't have to say this to anyone who's been paying attention, but the old stereotype of psychiatrists as people who throw tranquilizers at their patients until they're sedated, then go off and play golf has pretty much zero basis anymore. These people are super bright and compassionate, super dedicated to doing as much for their patients as possible with as little medication or invasive procedures as possible. One of the things I love about medicine in general and psychiatry in particular is that doctors have always been their own worst critics, and that they're always on the forefront of the fight to change medicine, and nearly all of the people I've met have seemed like they're embodiments of that.
Not that there haven't been some...uh...less enthusiastic interviewers. I remember one person who sat in front of me, clearly with no idea who I was, holding a checklist with statements like "RATE PRESTIGE OF INTERVIEWEE'S ACADEMIC AWARDS 1 TO 5". He'd ask in a monotone "Did you win prestigious academic awards?" and when I started to answer "Yes, I..." he just said "Okay, good" and circled the "5". Repeat for about ten other questions. One of the residents at the hospital revealed that he was actually a quite famous forensic psychiatrist who spends all his time with the criminally insane and has adopted a brusque and impersonal manner to deal with them. I don't know how that ties in with his tendency to trust everything everyone says at face value, though.
Most interviewers have asked exactly the same questions, those being:
"So why are you interested in psychiatry?" (I've had to come up with an answer more coherent than just kind of sitting there being like "But...but...how could someone not be interested in psychiatry??")
"So are the medical schools in Ireland good?" (Of course I would say they were, but everyone seems to think asking this question has value.)
"What field of psychiatry do you want to go into?" (???)
"Do you have any brothers or sisters? What do they do?" (They're obsessed with whether I have brothers or sisters. I don't know why. I always tell them I have one brother who's a jazz musician, but I feel bad about it, because I'm afraid they use that to draw conclusions like that if I have a hip, cool brother I must myself be cool and hip. This would be inaccurate, to say the least.)
"I see your father is in medicine. How has that affected you?" (inspiration, role model, here I tell a funny little family story about a picture in the photo album of me wearing a bib saying "Future Doctor" at age 1)
"Why are you interested in our program?" (The secret is to say anything other than "Well, I applied pretty much everywhere, and you were one of the ones that accepted me." Which is too bad, because I'm not good at lying.)
I've also gotten the occasional more meaty question, like "How do you handle conflict?" or "What is your biggest concern about your medical ability?" or "Do you really see yourself living in Memphis?" (only in sleep, during my nightmares). But mostly I think I'm a pretty good interviewee and able to promote myself pretty fluently and I usually have funny stories that keep people interested if nothing else.
Also the dreaded "What questions do you have for us?", which is tough, because even if you think of ten questions before coming, by the time you've gotten through a full interview day with four or five interviewers, you're all out of questions, and you're not supposed to say that or else you sound like you're not genuinely interested in the program.
I usually start with "What's the balance in this program between training in the use of psychiatric drugs and training in the use of talk therapies?". This question is hilarious, because everyone always answers it the same way. They answer: "You know, every hospital that you ask that question at is going to answer it the same way. They'll all say they have a balance between the two. But that's actually quite rare, and this is one of the few hospitals that actually does have a balance between the two, thanks to the work of Dr. X on staff, who is a well-trained psychoanalyst." I'd kind of like to see if by publicizing this pattern, I can get them to recurse another level, and go to "Well, all hospitals answer this the same way. They all say that all hospitals answer this the same way, then say that unlike those hospitals, they really do have a balance because of the work of some doctor on staff. But unlike those hospitals, we really really have a balance." If any hospital were to do that, I think I'd sign up immediately.
Other than that, I ask about research opportunities (usually there if I want them, which by the time I do all my work and call and stuff I may not), pay (usually between $45000 and $55000; Memphis blew my mind by saying that if you wanted to work overtime on the nightshift you could make an extra $1500 a night, which is about as much as I've ever made in a month at any other job), call schedule (usually about once a week, but a surprisingly good number of them are "home call"/"beeper call") work-life balance (hahahahahahaahahaaaha), and the local area (which they always insist is Full Of Culture And The Arts And Cuisine And Several Sports Teams, even though really all I want is enough educated young people that I will have a decent chance of meeting at least one girl I can relate to on an intellectual level - even though my standards for "relate to on an intellectual level" may be kinda high).
I have one interview left, that at the University of Cincinnati on Monday. After that my next deadline is February 15th, by which I must have input my preferences into the NRMP computer in the form of a list of programs from favorite to least favorite. Right now I am thinking of putting Institute of Living in Hartford as my first choice (I promise it's not just so I can introduce myself as "Dr. Scott Alexander, Institute of Living", even though that would be pretty cool) but Zucker Hillside in Long Island might beat it out by the time I've finished all my research. Then it's the six other hospitals in one order or another in case I get rejected from my top choice. If I get rejected from all seven, which is unlikely but certainly possible (there are usually about 150% more medical school graduates than spaces available for this kind of thing) then it's hunting for something to do for a year until I can apply again next winter.
And then in the middle of next week, I fly back to Ireland to finish up medical school, which at this point is annoying. I've had a month to get excited about the idea of being a real doctor practicing a specialty and treating patients and making money, and now I've got to go back and do the whole student thing and pretend to care about obstetrics and gynecology. At least I'll have the terror of final exams to keep me in line. Speaking of terror, I still have to have passed a licensing test I took in December for this to even work. And also speaking of terror, I hear back about whether I got a job or not in mid-March.