Q: Ok, wait. So is it the Institute of Living or is it Hartford Hospital? What do I list in the Match?
A: We are officially listed as Hartford Hospital in the Match. We know it’s a little confusing at first, but it’s really both. The Institute of Living (IOL) was a stand-alone psychiatric hospital (one of the oldest in the country) for a long, long time and Hartford Hospital, which is literally across the street from the IOL campus, had its own psychiatry department. There was a loose affiliation, but they were basically separate. In the 1990s, the IOL became part of the Hartford Hospital system. Hartford Hospital, though it houses the psychiatric ED, CL and Palliative Care Services, the HIV Community Ambulatory Clinic and some of the Integrative/Embedded Care settings, no longer has separate psychiatric inpatient units nor psychiatric outpatient clinics – the IOL now serves as Hartford Hospital’s Department of Psychiatry and provides the myriad services listed on the IOL website. This allows for even more diverse learning opportunities for the residents across all 4 years.
Q: Are you an academic medical center?
A: While we are not a medical school academic medical center, as a division of Hartford Hospital we are an integral part of an institution which is very much an academic medical center. Hartford Hospital is the major teaching hospital for most of the UConn residency programs and, in addition, sponsors several residency programs directly - our psychiatry residency and its fellowships among them. Hartford Hospital has a large research enterprise and, within Hartford Hospital, the Department of Psychiatry holds the largest portfolio of federally funded grants - predominantly in the neurosciences. Our institution works closely with both UConn and Yale in domains including collaborative research projects and education. We are a training site for the UConn medical students and UConn and Yale faculty are involved in our resident education. IOL teaching faculty holds UConn faculty appointments and teach at the medical school while faculty from the Olin Neuroscience Research Center generally hold Yale appointments. In sum, we are a psychiatric facility that is a division of a top-notch tertiary care teaching hospital (with a Level I trauma center, numerous training programs and a growing research enterprise) with close connections to two top tier medical schools.
Q: How old is the residency program?
A: While the current incarnation of our program “began” in 2003, the IOL has a long and rich history of training psychiatrists and housed one of the first residency programs in psychiatry in the US established in the 1940s.
Q: How many months of medicine, and what is it like?
A: You spend 6 months total of first year on psychiatry, 2 months on neurology, and 4 months on either medicine or a combination of pediatrics and medicine for those in the 5-year Adult/Child-Adolescent Program. The neurology months are spent on the inpatient consult team, so you see a good variety of neurologic illness. If you are an adult-treating sort, you’ll spend 3 months on general inpatient medicine where you will cover regular floor patients and some step-down (less acute than ICU, more than general floor) patients on a team with a second or third year resident. Often, you also get a co-intern on your team. Census maximums are reasonable on inpatient medicine and you never cover the ICU’s. The final month of internal medicine is spent doing outpatient medicine clinics; mornings are in a general primary care clinic and afternoons are at a variety of specialty clinics. These clinics generally serve a very diverse population and provide an excellent community medicine experience with patients who often have psychiatric co-morbidities. If you do spend time on pediatrics instead, you spend two months on general inpatient adult medicine and two months on outpatient pediatrics.
Q: What are your other rotations?
A: In the first year, there are the 6 months on medicine/pediatrics/neurology, 3 months of general inpatient psychiatry, 2 months of biopsychosocial psychiatry (where you have a limited patient census and focus on formulation), and one month of addiction psychiatry. Second year is 2 months each of geriatrics, consult/liaison, child/adolescent, psychotic disorders (inpatient), and more advanced inpatient psychiatry. One month is spent in the psychiatric emergency department, one is spent on a teaching rotation, one month is spent in advanced inpatient psychiatry and one month in an elective experience chosen by the resident. During second year, residents also start work with long term dynamic psychotherapy outpatients. The third year is entirely outpatient and community psychiatry, with the residents each with their own office, housed together on a floor with an attending available; residents provide medication management and a variety of psychotherapies such as CBT, supportive, family/couples, group, and continuing with their long term dynamic patients. One afternoon a week is spent seeing patients at Hartford Hospital as an embedded psychiatrist within the HIV clinic and residents also work with a patient with chronic mental illness who lives on the Institute grounds. Fourth year, for those not pursing child/adolescent, has a few requirements including maintaining some outpatients, but is largely elective blocks.
Q: Do you get experiencing with ECT? How about TMS?
A: Experience conducting ECT is provided during the geriatric rotation in second year and in the fourth year one can opt to do two full months of ECT that allows qualification to become certified to provide ECT. (This certification additionally requires an approved set of external seminar classes.) There is some exposure to TMS available during the geriatric rotation for those interested and one can gain further experience during the fourth year ECT elective.
Q: What is the forensic experience like?
A: Forensic experience is provided across the 4 years in a variety of settings. For those committed to a career in forensic psychiatry we arrange a case study elective within driving distance.
Q: Vacation/conference time? Limitations on when?
A: We get 4 weeks (20 days) off per year, one of which is technically designated as “conference time.” This is the time one would use for vacation and conferences. The limitations vary by year, but basically you can take no more than one week per rotation (for rotations 2 -3 months long). We all are highly encouraged to take all our vacation time every year. Vacation/conference time cannot be held over until the next year. If not used, it is lost time. For those whose academic work is accepted for presentation at a national meeting, the department will support travel/lodging/meal expenses for that portion of the meeting the resident is presenting.
Q: What if there is a day I really don't feel well, get the flu, etc.?
A: Then you notify the proper people and you stay home to get better. We have sick days and can use them if we are actually sick without pressures from the program or other residents to come in anyway.
Q: What if I have a doctor’s appointment?
A: While some personal care appointments can be arranged evenings/weekends (haircuts) doctor’s work when we do. So you can go to your doctors, while working around the core part of your rotation and didactics.
Q: What are your didactics like?
A: Our didactics are one of the many bright, shining points in our curriculum. We receive excellent, comprehensive, varied didactics with just the right amount of redundancy. Our classes challenge us regularly and are taught by an interested, curious, excited and engaging faculty. Didactics vary by year except for Grand Rounds on Thursdays which is attended by all classes. In addition, residents have an individual supervisor every year with whom they meet weekly.
During first year, you have a Tuesday afternoon block of didactics from noon until 4:15pm which is protected on all rotations. Additionally there is a Friday conference from noon until1:30pm. These blocks cover your basic first-year review of psychiatric fundamentals (Tuesdays), contain an ER/CL conference time (Fridays) and also include your first year process group (two Tuesdays a month). While on psychiatry rotations, you also have a group for processing patient interactions called “Reactions to Patients,” a case conference and a diagnostic/psychopharmacology tutorial weekly. On the biopsychosocial (BPS) rotation, you have a weekly meeting for case formulation.
Second year you have a didactic of some sort most days of the week because all rotations are within the psychiatry program. Mondays there is a noon conference for PGY2 and PGY3 residents on a rotating set of topics including neuroscience, neuropsychiatry, neuroimaging, geriatrics, addictions, forensics, culture and other topics. On Tuesdays, twice a month there is process group, and every week there is a psychopharmacology course and a course on patient interview techniques. On Wednesdays PGY2s attend the same case conference as the PGY1s. Thursdays include a course on long term psychodynamic psychotherapy for the entire year and for a few months also a child and adolescent psychiatry series. On Fridays, PGY2’s attend the ER/CL conference with the PGY1’s.
PGY3 year is chock full of didactics including full-year courses in CBT, psychotherapy skills, group therapy, marriage and family therapy, advanced psychopharmacology, as well as a weekly case conference, bi-monthly community psychiatry group supervision, our individual and group Quality Improvement Curriculum and projects and a variety of other educational meetings and supervisions.
Q: Is the time for didactics really protected? How does it work when I'm an intern and on medicine?
A: Your didactic time is protected. Period. On psychiatry, on medicine, on pediatrics, on neurology…no ifs ands or buts. Our attending’s and chiefs take our didactic time seriously, as well. You continue to attend the bulk of your psychiatry didactics and your first year group even while on medicine or neurology.
Q: What are your rotations? How much traveling do you have to do for rotations?
A: Almost no traveling required. Other than our addiction, community and pediatric rotations and any off-campus electives you choose fourth year, everything is at the Institute of Living/Hartford Hospital campus where everything is no more than a 5-10 minute walk away, for the remainder of the residency with some occasional exceptions. All of medicine, neurology, emergency psychiatry, and consult- liaison psychiatry are at Hartford Hospital. The consult-liaison component of the child and adolescent rotation is at Connecticut Children’s, which is on the same shared campus. All other rotations during first and second year are at the IOL. Your third year office is in the outpatient clinic at the IOL. You go off site to Rushford, which is about 30-40 minutes away in Middletown, for addictions. Pediatrics is in the neighboring towns, a fifteen minute drive away. Fourth year you spend a month as a psychiatrist at a local community mental health agency and may spend time at a college or other site. Sometimes you might have supervision with a psychiatrist in the community who is not on-site, but this will rarely take you more than 20 minutes away from campus.
Q: Do you get to teach medical students?
A: Yes. We are a major teaching site for psychiatry for the UConn School of Medicine. You will also interact and help teach UConn med students as well as PA students from local colleges while on medicine and consult-liaison.
Q: How much is the salary?
Our salary allows for residents to live comfortably and many are homeowners. Learn more about the salaries and benefits available to participants of the Graduate Medical Education Programs sponsored by Hartford Hospital.
Q: Other compensation?
A: Our health insurance, dental, vision, and disability insurances are mostly paid for and we elect plans to suit our needs for which we pay a small amount each month. You can have dependents on your plans. Insurance coverage begins on July 1. Our malpractice for our work at all clinical sites is 100% covered with a tail. Each year the program supplies us with many books and we also receive reimbursement for some book purchases of our choosing. We receive a yearly stipend for on-call meal expenses. There are retirement plans for residents. The program also covers APA dues and the cost of your medical license and renewals.
Q: Can you moonlight?
A: Yes. Once you get your own license during your third year (Connecticut requires two years of residency for a license), you may moonlight as long as you are in good academic standing, adhere to duty hour regulations, keep the program informed as to where/when you are moonlighting, and it does not interfere with your residency performance. If you moonlight as the inpatient in-house psychiatrist at the Institute or weekend daytime rounder, your malpractice is covered with tail. If you choose to seek external moonlighting, your coverage from the program/hospital does not follow you.
Q: Do people actually moonlight? Is there really time?
A: Yes. In fact, most people moonlight relatively regularly during third and fourth year. It’s an excellent learning experience and encouraged by the program.
Q: What do you do about parking?
A: We have free parking on campus all the time, no restriction, as well as free parking at Rushford (the site for the addictions month), the pediatrics offices and the community mental health centers.
Q: Do you have to have a car?
A: While there are buses in and around Hartford and Uber/Lyft, all residents tend to have cars. Those that start without one, or with a need to learn how to drive, manage to do so within the first year.
Q: What is there to do in the Hartford area?
A: We have the oldest art museum in the country, excellent theater options, a symphony, movie theaters (even art-house ones), bowling alleys, golf courses, bookstores, karaoke nights, nightclubs, dancing, a wide selection of restaurants, pubs, etc. Being a smaller city, there are admittedly fewer of each option, but most options available in a larger city are available here. We are also close enough to both Boston and New York for day and weekend trips if you need a little more excitement. We also have good camping, hiking, skiing, road and mountain biking and the beach near enough for an unplanned trip.
Q: Where do people live? Can people manage to buy houses in the area while in residency?
A: People live in many different places and settings, depending on their preferences. Many choose to rent, but some people do buy homes or condos. Some people live in Hartford downtown, many live in nearby West Hartford, some live in other towns such as Windsor, Newington, Wethersfield, Rocky Hill, Manchester or Glastonbury. It is easy to find any of a variety of settings, from large modern apartment buildings downtown, to duplexes/triplexes in surrounding towns, to renting or buying a home with land in either a suburban or a relatively rural area and still be able to get to work easily in under 20-30 minutes.
Q: What is cost of living like?
A: Middling compared to national standards but much more affordable than you’d be used to if you’re coming from a large city like New York, Boston, D.C., etc. We are compensated more than adequately to live comfortably relative to the cost of living in the area.
Q: For people with children: How are schools?
A: Connecticut has some of the best public school systems in the country, and there are also multiple local options for private education, including some of the oldest and most prestigious private schools.
Q: To what extent does the program emphasize resident well-being? What opportunities for practicing “wellness” are there?
A: Our residency emphasizes and encourages resident wellness both in the workplace and our personal lives. There are 2 retreats annually that incorporate wellness activities. Our program encourages residents to pursue their hobbies and personal interests as well as maintain relationships with their family and friends.