Only once in 10 years has my educational coordinator felt the need to intrude on my vacation. That was in early August 1993 when, in response to frantic calls from several Timberlawn residents asking if we had any positions available, she frantically called me. That was how we in the University of Texas Southwestern Medical Center's Department of Psychiatry learned of the demise of the only other psychiatric residency within 150 miles. Twenty-four residents were being left high and dry. The instincts that Dr. Mark Blotcky, a friend and colleague for many years, in his accompanying commentary so ably describes overtook me despite the fact that these were not my residents. The fact was that many of them had interviewed with us, and some we had heavily recruited, cursing Timberlawn's success.

Tara is an appropriate metaphor for the environment and image that had been carefully cultivated over the years at Timberlawn. Many applicants had been drawn to its feeling of sanctuary epitomized by its physical layout, reminiscent of a Swiss sanatorium. Although the Timberlawn educators were very busy private practitioners, the residents tended to see them strolling along the beautiful grounds or discussing cases with them on the units, appearing to have unlimited time to do so. Timberlawn cultivated, both among residents and staff, the image of being a family.

What the residents and all but a handful of staff in key leadership positions could not see was that Timberlawn was a family on the verge of bankruptcy. In fact, the leadership was split into two factions about whether to continue the training program or cut it as a cost-saving move, and a ferocious battle had been waged for several months out of sight of virtually everyone but the principal parties. I certainly had no clue. To give everyone a sense of the suddenness and shock involved, one resident had closed on a house 3 weeks earlier, and another was on her way to close on a house when the news came down.

What many of the residents never knew was that, in some ways, we were all very fortunate. In any other year, I would have been able to do no more than Dr. Blotcky did: to get on the horn, call my friends and colleagues, and place the residents as best we could. But we were, fortuitously, in the very beginning of an elective downsizing of our own residency, which I knew made some stipends available—how many I did not know and could not figure out while vacationing 1,500 miles away. I also did not know what the situation was with each Timberlawn resident in terms of needing/wanting to stay in Dallas, quality of performance, potential ties elsewhere in the country, immediate financial situation, etc. In addition, I knew that we would be able to accommodate some, but not all, residents in our program and would need time to take a very close look at our budget to see how we might be able to stretch money to take care of the largest number.

I asked my coordinator to convey to the Timberlawn residents not do anything impulsively, anxious though they were, that offers would be forthcoming, and that I was aware of enough other good programs that had openings that everyone would get placed (could it be that the recruitment crisis in psychiatry at that time had at least one silver lining?). Knowing that there would be at least two stipends, I authorized offers to two brand new postgraduate year (PGY)-1s who I knew were very good and who had strong ties to Dallas. One accepted, and one had already left town to take another PGY-1 position elsewhere! This was within a week of Timberlawn's announcement.

I returned to Dallas a few days later to discover that these two offers, which I had considered as hopeful signals to the Timberlawn residents, had had quite the opposite effect. Rumors and anxiety were flying wildly, and everyone who did not get an immediate offer (22 individuals) assumed that we were not interested in helping them. And to top things off, our own residents were getting stirred up about whether the Timberlawn residents might be getting "special deals." Had things not been moving so quickly, a meeting including Dr. Blotcky, all Timberlawn residents, the leadership of the Southwestern residents, and me would have been in order. But once the Timberlawn administration had made its decision, it began putting ruthless pressure on the residents to end their financial burden to the hospital.

The first call I made on my return was to Mark Blotcky, who had lost everything he had worked for in his career, and who was fighting with the administration to fulfill its obligations to the residents, trying to help the residents find slots, keep some semblance of orderliness in the mess, and grieve for his own losses. I immediately promised him and all teaching faculty at Timberlawn that they would have clinical appointments with us (some already did have significant roles in our program). Naturally, there was "enlightened self-interest" in this offer. I was not about to let the opportunity to significantly increase our teaching resources slip away. This also served to help the Timberlawn faculty settle down somewhat about their own futures and put them in a better position to help stabilize the residents, some of whom we knew were facing months of uncertainty.

In talking with Mark, it became clear that the five senior residents (some general, some child) were taking care of themselves. They had simply changed the timing on their development of future plans. Knowing that PGY-4s who had already met all of their requirements would be the least attractive to other training directors (myself included, I must confess), I passed on the advice that they grab any opportunity they could that moved them in the direction they wanted to go with their careers. By early September, all of them had found slots, including their general chief resident, a graduate of Southwestern who had lived in Dallas for 20+ years, to whom we felt a strong obligation. She joined our program. This move turned out to have other valuable benefits. I sought her advice in understanding each of the Timberlawn residents and their needs. She, in turn, was accepted as a leader by the other residents and was able to work with them in their searches and in understanding the work all of us were doing to help them.

Within a week after returning from vacation, Mark and I made a very difficult decision. We determined that the remaining interns would be the most attractive to other training directors; they had the least intense ties, both to Dallas and Timberlawn. They would have to be placed in other programs. I think Mark had the sad task of informing them, but within 2 weeks all three were beginning new programs. In the same manner, though I was not actively involved, our child and adolescent training director worked with Mark to place all but one of the child residents. That left five PGY-2s, five PGY-3s (the Five Amigos), and the child resident.

By now I had calculated that I had four more stipends, and the possibility for another three to four the following year. Immediately, one stipend was transferred to our child program for the lone remaining Timberlawn resident in that area. Mark and I, knowing that the variability in programs made the PGY-3s potentially difficult to fit in, decided that his job would be to try to hang on to them, thus leading to the moves and negotiations described in the two other accompanying commentaries. My job was to work with the PGY-2s.

And thus began one of the most difficult periods in my years as training director: five residents, three stipends. To complicate matters, another program, with a strong new chair and training director, entered the fray. Just when I was about to make some offers, the entire remaining group went up for a visit. While this change had the potential to take me off the hook, these were very good residents and I wanted to help at least some of them. I felt like I was in a recruiting war! Upon their return, additional pressures began to mount: the ex-chief resident had her wishes, Mark had his evaluations and sense of loyalty, the psychoanalytic institute had accepted one of the Timberlawn PGY-2s and wanted me to keep him in town, and each resident pled his/her case. I did the best I could balancing all the needs involved, including what I saw as the Southwestern program's needs. The most difficult phone conversations I have ever had were with the two residents to whom I made no offers. They both wanted to come to us, but they were also the only two that already had other options. By early October 1993, it was all settled. The Five Amigos had negotiated another year of training at Timberlawn; all other residents had been placed in good programs; and a year later four of the Amigos joined our program to complete their training. Not a bad 2 months' work. Eventually, 10 of the 24 residents joined Southwestern's program. I'm proud of that. It was not easy to accomplish.

But it was not over! The American Board of Psychiatry and Neurology frowns upon split years of training, so letters and documentation had to be exchanged. Integrating the Timberlawn residents into a different program posed some interesting problems (some were enraged at Timberlawn, some still yearned for Tara, some had learned some hard lessons and tried to bargain with me as if I were the administrator who had coerced them before, some had trouble believing that they were now secure, and our own residents had various issues, most notably the worry that Southwestern's program might have some hidden fragility).

In reviewing this commentary, I, like Mark, have found myself reliving the events now 6 years past. The process has informed me of events and actions that were unknown to me at the time and helped me to gain a broader perspective on the entire process. We owe a debt to the Five Amigos whose initial submission spurred the idea to present three different perspectives on the same events. This is a cautionary tale of how quickly things can go badly wrong. But it is also an example of how a tough group of residents and two dedicated training directors can work together (at times unknowingly!) to manipulate budgets, fight political battles, learn hard lessons, harness economic forces, call in markers from colleagues near and far—and make a difference.