culture of residency

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What is the residency culture like in psych? Is it different from other specialties?

Is there a feeling of "we're all in this together" or is it more sink or swim?

Does it change over the years?

Are psych residents generally a happy bunch (after the first year?). Not to be banal, but well-- what kind of happiness is available during residency? Is this a period that leaves room for a lot of big life decisions?

Do psych residents have time for side projects like say... starting a family?

Thanks for any thoughts!

Depends on the program as some are more work intensive than others. If you're in a sink or swim situation with your colleagues at least it's in shallow waters when you compare it with other specialties. 1st + 2nd year of residency I averaged 40-60 hours per week. 3rd year averaged 40 hours per week. 4 year is typically less than 40 hrs per week depending on your electives. It's really nice. The hours alone are a huge selling point. I believe pathology also has really good hours and limited call.

Originally Posted by F0nzie

I believe pathology also has really good hours and limited call.

The more competitive path residencies can be pretty absurdly intense, but I think it drops off pretty fast after the top 10 or so.

I'd say in general, psychiatry is less malignant than other programs because to be in one just increases the likelihood you could point out mentally unhealthy pathologies. It's also a field that unlike others, such as surgery, don't become difficult because of late-night wake up calls, but more on the order of being in very grey situations and having to make decisions based on limited information.

But as was said above, it's really program specific. There are malignant psychiatry programs out there.

As a general rule, Psych is one of the more laidback and family-friendly specialties.
I have met malignant people in psych, but they are very rare compared to other specialties.Psychiatrists are usually pretty nice and friendly in my experience.

If having a baby in the near future is one of your goals, you should probably try to find a way to ask at interviews about how the residency handles situations like when a resident gets sick or someone is on maternity leave. Some programs are better at handling that kind of stuff than others are. Some residency programs rely more on residents than others do.
Even though it's not politically correct, the reality is that if you're at a program where the absence of a resident causes a burden on the other residents, your colleagues WILL resent you for getting pregnant even though (most likely) nobody will say it to your face.
However, of all specialties, I think psych is one of the easier ones when it comes to balancing family with work.
I think at most programs, having a baby during the last year of residency (which is usually very heavy on electives) probably would be easy to do without causing a lot of waves.

The culture is going to be extremely program specific. There are some laid back programs that have you working 40 hours per week, but there are also many that have you working 60-80 hours the first two years and 40-60 for the last two. Most of the top programs skew towards longer hours, but many of the most malignant programs skew that way too.

Residents are a good source of information on this. Most programs are pretty up front. I always tell interviewees the truth, that my program is one of the harder ones in terms of hours. I think most folks are pretty honest. Trust me, one of the worst fates is to be stuck with a bunch of colleagues whining about their surprise they have to work 50 hour weeks. Honesty really is the best policy.

Originally Posted by peppy

Even though it's not politically correct, the reality is that if you're at a program where the absence of a resident causes a burden on the other residents, your colleagues WILL resent you for getting pregnant even though (most likely) nobody will say it to your face.

Very true. Though I don't think that's pregnancy-specific. There will also likely be the resentment if you have an extended absence for illness, military service, or pretty much anything else. The fact is that when a resident leaves for a reason that they are not replaced, the call is split amonst the remaining colleagues. It takes a big person to suck that up.

I'm curious if there are many residencies in which an absence for pregannacy (or anything else) doesn't cause a burden on other residents. There may be some that hire locum tenens but I have a hunch that's a perk that may go the way of the dodo with most program's budget crisis.

Peppy's point on 4th year is a great one. You'll always find it easiest to take maternity leave when call is lightest. Pregnancy during intern year would be nigh on impossible most places.

The IM program attached to my residency had a female resident that gave birth and was incontinent for weeks after her birth. Her PD forced her back to work despite the incontinence. Due to other complications related to the birth she also could not do call but the PD didn't excuse her.

Her fellow residents took up her calls and none of them complained. They actually were close enough with each other to do this without any resentment, at least as far as I could tell. They were all telling me how they were ticked off with the PD and they thought he was being too headstrong and a dictator but never took out their frustrations with her.

That surprised the heck of out me because there was an abundant level of dysfunctional BS going on in my residency program, and lo and behold the IM residents who had work schedules much harder than mine and my colleagues as a whole showed courage, loyalty, and resilience on stress.

Originally Posted by whopper

That surprised the heck of out me because there was an abundant level of dysfunctional BS going on in my residency program, and lo and behold the IM residents who had work schedules much harder than mine and my colleagues as a whole showed courage, loyalty, and resilience on stress.

That's nice to hear. I notice that some psych residents are pretty call-obsessed to the point of ridiculousness. Many specialties seem to see call as a cost of doing business, but some psych applicants I've talked to seem to see it as an intrusion into their life.

Originally Posted by printscreen

What is the residency culture like in psych? Is it different from other specialties?

Is there a feeling of "we're all in this together" or is it more sink or swim?

Does it change over the years?

Are psych residents generally a happy bunch (after the first year?). Not to be banal, but well-- what kind of happiness is available during residency? Is this a period that leaves room for a lot of big life decisions?

Do psych residents have time for side projects like say... starting a family?

Thanks for any thoughts!

Really depends.

One of the things that is a little different, on average, from the other specialties is there is less of the "team" feeling. On medicine, surgery, etc you rotate in teams, you are led by a senior resident, etc. On inpatient and consult psychiatry, in general the attending (or possibly a fellow) leads the PGY1 or PGY2. The PGY3's and PGY4's are generally spending much of their time learning therapy (say, in direct supervision from attendings).

Originally Posted by notdeadyet

That's nice to hear. I notice that some psych residents are pretty call-obsessed to the point of ridiculousness. Many specialties seem to see call as a cost of doing business, but some psych applicants I've talked to seem to see it as an intrusion into their life.

That's because it is.

It may be a cost of doing business, but that makes it no less intrusive in one's life.

Originally Posted by kdur

That's because it is.

It may be a cost of doing business, but that makes it no less intrusive in one's life.

Sure, showing up for work in the morning is intrusive too. Just part of the job. Having to do the occasional overnight or weekend shift is part of the job too and shouldn't take anyone by surprise. Psych seems to have a pretty disproportionate whine-level about call compared to the amount that actually has to be done. But to each their own...

Now exactly does "resentment" play out? Like would other residents give you dirty looks or would there be an actual formal complaint?

I hate to ask because it's such a downer, but granted that kind of thing is never limited to one kind of job, or industry, and I dislike it so much...

Originally Posted by kdur

That's because it is.

It may be a cost of doing business, but that makes it no less intrusive in one's life.

That's the difference between "having a job" and "joining a profession".
Not saying it's wrong to have boundaries, and compartmentalize a bit--but to some extent, being a professional means being "always on".

Originally Posted by OldPsychDoc

That's the difference between "having a job" and "joining a profession".
Not saying it's wrong to have boundaries, and compartmentalize a bit--but to some extent, being a professional means being "always on".

Sadly professionalism is a dying concept. I think the rot set in with the baby boomer generations obsession with professions as a method of social climbing. Compounding factors have been professional bodies acting more like trade unions and western society having swallowed whole the logic of the market place where everything has a price rather than a value. This last element has created the space for managerial pressure to exert itself and control what doctors do (a bit of a chicken and egg senorio here imo) and treat them a like any other employees.

What is left is none of the charcteristics that defined professionalism and just the status that went with them. Of course one can't exist without the other. Add in the death of deference in society (probably a good thing in other contexts especially class bound societies) and there is next to nothing left. Cue patients answering text messages in your ward rounds and clinics as a symptom of this.

Professionalism still exists in medicine more than any where else being the epitome of a profession and will probably be the last place its orginal meaning finally dies but the rot has set in. It's a pity but maybe it is inevitable. Just how I see it.

Originally Posted by twright

Really depends.

One of the things that is a little different, on average, from the other specialties is there is less of the "team" feeling. On medicine, surgery, etc you rotate in teams, you are led by a senior resident, etc. On inpatient and consult psychiatry, in general the attending (or possibly a fellow) leads the PGY1 or PGY2. The PGY3's and PGY4's are generally spending much of their time learning therapy (say, in direct supervision from attendings).

I think this is the hardest thing about psychiatry residency and maybe about work as a psychiatrist after residency. We have one rotation where all the residents work side by side in the workroom even though we don't co-manage patients and technically have our own team. While this rotation is our hardest in some ways it's the most fun because we get to actually work with other residents. On our other rotations, we're usually either alone with an attending or with an attending and medical students. Right now, I'm working with 2 other residents on the same rotation, but we have different attendings, work rooms, students, etc., so we have to make an effort to see each other.

About call intruding on life, it does. I don't feel unprofessional for saying (or thinking) that either. I get that it needs to be done, but it also makes me less healthy, interferes with my marriage and interferes with my life in general. Maybe people attracted to psychiatry see value in these other things, which is why we have these resentments. BTW, it also cuts into my psychotherapy training because fatigue makes therapy (and empathy) hard. Maybe there's some value in learning this, but I'm pretty happy about coming to the end of my being on call all the time life (provided my program can replace a departing resident ).

Regarding pregnancy and taking time off for various things, your fellow residents will resent you for it if you're in a call intensive program. What this means is they'll be some negative talk behind your back. This of course doesn't mean you should make life decisions about this. No one is so perfect, though, that they don't resent doing extra work even for someone else's good news or bad news (illness).

And about all the other stuff, it really depends on where you are. I think it certainly is a spot where you can make "big decisions" and find "personal happiness" and all that stuff. If the residents are really stressed, they might be less supportive of each other. If they're not, they'll probably be more supportive, like anything else.

Originally Posted by F0nzie

Depends on the program as some are more work intensive than others. If you're in a sink or swim situation with your colleagues at least it's in shallow waters when you compare it with other specialties. 1st + 2nd year of residency I averaged 40-60 hours per week. 3rd year averaged 40 hours per week. 4 year is typically less than 40 hrs per week depending on your electives. It's really nice. The hours alone are a huge selling point. I believe pathology also has really good hours and limited call.

I think work hours might be more variable in psychiatry than about any other specialty. All surgeons, ob/gyn, peds and IM residents work a lot. Some psych residents average 40 (or fewer) hours a week throughout their training. At some programs, you're pushing 80 and doing call a lot. Going over 80 anywhere is probably rare, though, so in some ways we're better off than colleagues in the hard specialties.

Where I'm at, I work anywhere from 40 to 70 hours a week depending on the rotation and my call schedule. On inpatient university wards, it's about 50 hours/week exclusive of call and up to 70 (or even 75) with call, which happens about every other weekend. On VA wards, it's maybe 40 hours (not less) without call and again up to 70 (or even 75) with call. Consults work out about the same, with VA being easier than university primarily because you have more support. When I look at my hours logging system, my average hours seem to be around 55 to 60 hours. Honestly, it's enough for me. I just had vacation and realized how completely and entirely beat I was before that with work and call.

Originally Posted by Doctor Bagel

I think work hours might be more variable in psychiatry than about any other specialty. All surgeons, ob/gyn, peds and IM residents work a lot.

That's an interesting point. That might also be contributing to why many in psych are so focused on the amount of call they do. Because there are always those rare programs that have little to no call.

And the fact that our call, even at the heavy call programs (mine is one), is light compared to most fields in medicine likely contributes. We focus on the 1 weekend shift we work every two weeks because without it we'd have completely free weekends. I don't hear a lot of obsession with call from my medicine colleagues because they have so little wiggle room. It'd be like a swimmer complaining about being wet.

No takers for my question? Just thought I would give it another poke.

Originally Posted by printscreen

No takers for my question? Just thought I would give it another poke.

It seems like you're worried about something specific -- can you say more about where your question is coming from?

This study by the American Medical Association really freaked me out. I mean, 81 percent of students report shouting and yelling... 55 percent sexual harassment, 18 percent hitting.... (and the sidebar near the end of the article that pregnant residents have special difficulties didn't really help). http://www.ncbi.nlm.nih.gov/pubmed/1926843. I get that no job is perfect, but as a med school hopeful, I'm really frightened by the very elevated and official nature of those stats!!!!

Originally Posted by printscreen

This study by the American Medical Association really freaked me out. I mean, 81 percent of students report shouting and yelling... 55 percent sexual harassment, 18 percent hitting.... (and the sidebar near the end of the article that pregnant residents have special difficulties didn't really help). http://www.ncbi.nlm.nih.gov/pubmed/1926843. I get that no job is perfect, but as a med school hopeful, I'm really frightened by the very elevated and official nature of those stats!!!!

That's an old study, and I do think that the medical culture has become a bit more mellow than it used to be. Plus just because someone has experienced an incident at some point doesn't mean that it happens on a frequent or constant basis.
For example, I would have to say that I experienced "Shouting and yelling" during med school, but it wasn't really that big of a deal. I was yelled at by OR nurses a few times during my surgery and anesthesia rotation (the nurses get yelled at by the surgeons, you see, so they take it out on med students). Public humiliation? Well, yeah, "Pimping" can be humiliating coming from certain types of docs, but it's one of those things everyone goes through so it's really not that bad.
Oh, and there were a few times during the surgery rotation when a surgeon's mean comments ALMOST made me cry a couple of times...but yet in a weird way I think back on it fondly as "part of the surgery experience" rather than anything traumatic.
Yes, people do act unprofessional and obnoxious in medicine at times, but I wouldn't say it's constant browbeating or torment.

Originally Posted by peppy

Yes, people do act unprofessional and obnoxious in medicine at times, but I wouldn't say it's constant browbeating or torment.

I had a couple of people make dick comments at various times. For example, on one surgery rotation I missed that a new antibiotic had been started on a patient (we used several systems at that time and I missed that it was on one system and not another). The senior resident basically said "why didn't you mention the antibiotic" and then "well that's what happens when all you do is copy yesterday's note over every day." He knew I was there prerounding early and working hard, and he said it in front of the entire group on morning rounds anyway. He did similar and worse to probably everyone else present though!

I also had an ortho attending insult me (a mix of lighthearted and serious) for most of an entire day for wanting to go into psych; the whole OR team joined in.

I have had scrub nurses make unnecessarily aggressive comments as well. For instance, standing across the room: "hey MED STUDENT! this is MY sterile table, don't you come over here and contaminate it!" "Uhhh, okay, thanks."

I have never, though, had someone seriously just stand there screaming at me. I have never felt unsafe. I have certainly never been hit by someone, and I have never even heard of someone else being hit (except by patients). Stats like the ones above sound really bad, I wouldn't classify any of my mildly bad experiences into "yelling," and certainly not into sexual harassment or physical violence.

Originally Posted by printscreen

No takers for my question? Just thought I would give it another poke.

Your question is tougher to answer than you'd think.

It's very hard to generalize. Psychiatry as a whole is not a competitive specialty. Some programs are going to be made up of folks who made it through med school by the skin of their teeth, while other programs will have the best and brightest of their class. Some programs will be populated by folks who went to the most competitive medical schools in the world, while other programs will have a big proportion of folks who went to schools whose main acceptance criteria is a B.A. and a cleared check. You will have folks whose passion is to deliver care to the underserved, to do research on unsuspecting mice, or to push the boundaries of psychotherapy. It's easier to generalize about competitive specialties, since the actual matching residents are a very select group. Psychiatry is a much more diverse group.

That said, people are people and doctors are no different. We very roughly fall into bell curves. For your question about starting a family and how it will be viewed, people will fall on that bell curve. At one end, you will have Big Hearts, who will say, "Congrats, PrintScreen! That's so exciting! I'm more than happy to cover your call for four months. Let me know if there's anything else I can do!" You will also have No Hearts, who will say (behind your back) "Oh, Christ, just because you choose now to breed, I have to give up bowling club for half a year? Great..."

Most of us will be in the middle of that bell curve. We'll be happy for you and the big life change you and your growing family are about to make. But the insightful among us will also be aware that on some level we're a little irritated at having to take more call (and time away from our own families). We'll do it, but no one in their right mind likes less time with their family.

How can you deal with it? Just keep it in mind and be appropriately respectful and thankful for the fact that the four months that you have with your baby is being sponsored by your fellow residents spending less time with theirs. This time should be realistically be covered by locum tenens or faculty paid to do overtime, but very few programs do that and the burden instead falls on your co-residents. Most of us in the middle of the bell curve (we all like to think we're the Big Hearts, but realistically most of us aren't) will be very, very happy for you. But we have to make a sacrifice too. As long as you respect that fact, you'll be in good shape.

Originally Posted by notdeadyet

...Most of us will be in the middle of that bell curve. We'll be happy for you and the big life change you and your growing family are about to make. But the insightful among us will also be aware that on some level we're a little irritated at having to take more call (and time away from our own families). We'll do it, but no one in their right mind likes less time with their family.

You haven't met my family...!

(Seriously--my social worker & I were just reflecting how much more relaxing and peaceful it is being at work...where people listen to us and are grateful for what we do for them, and are happy to see us...)