3 year psych residency?

[BobA]

Is there any movement towards making psych residency 3 years instead of 4?

It seems that years 3-4 are mostly "elective" time which could easily be condensed into one year. This seems especially warranted in the face of more people doing fellowships, and less people doing psychotherapy.

I propose that dropping a year off the residency would actually INCREASE the quality of psychiatrists because it would attract better people. Any thoughts?

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[Anasazi23]

That's an uphill battle, I would think. All medical specialties (there may be a couple of rare exceptions) are 4 years in length at least. The three primary care specialties (peds, IM, FP) are three years.

I agree that in many cases, at least some time could be shaved off. Residencies will fight tooth and nail to keep it this way though. They need the bodies.

 

[notdeadyet]

I propose that dropping a year off the residency would actually INCREASE the quality of psychiatrists because it would attract better people.

Curious as to your logic here. I would think that the kind of people that would say, "4 years is too long, but I'd choose this very different career path if you cut off a year of training" would not exactly qualify as "better".

 

[BobA]

Curious as to your logic here. I would think that the kind of people that would say, "4 years is too long, but I'd choose this very different career path if you cut off a year of training" would not exactly qualify as "better".

I see what you mean there. That someone not willing to go that extra year might be less committed and hence less qualified.

However, money talks. A year less of residency is a year that someone's earning a real salary, plus the miracle of compound interest early in one's career. Are dermatologists in it for the love of skin lesions? The best minds of our generation are curing acne. It's not idealistic, but it's true. A shorter psych residency would mean increased earning potential which would attract better candidates.

In terms of most specialties being 4 years - as much as I love Psych, it's not brain surgery. More importantly, 3rd and 4th year are mostly elective time most places and that's time that could easily be condensed.

However, the point that most programs would fight to keep it four years is well taken, as most programs do indeed need the bodies.

 

[michaelrack]

I agree that the intellectual info of a psychiatry residency could be easily learned in 3 years. There is much more to learn in a 3 year IM or FP residency than in a psychiatry residency. I think one of the reasons for a 4 year psych residency is to get more longitudinal experience, especially with psychotherapy.

 

[Doc Samson]

I think one of the reasons for a 4 year psych residency is to get more longitudinal experience, especially with psychotherapy.

Amen.

 

[BobA]

How many psychiatrists actually practice psychotherapy?

Not that I wouldn't want to do therapy, but with re-imbursement as it is I'm under the impression that most psychiatrists can't afford to practice psychotherapy. Is this naive?

 

[Doc Samson]

How many psychiatrists actually practice psychotherapy?

Not that I wouldn't want to do therapy, but with re-imbursement as it is I'm under the impression that most psychiatrists can't afford to practice psychotherapy. Is this naive?

There's obviously some geographic variance based on patient interest (if patients want something covered badly enough, insurances will eventually start to cover it), but yes psychiatrists can and do practice psychotherapy. Throw in private-pay patients and it can actually be lucrative.

 

[maybepsych]

So I am wondering how much the discrepancy is between doing a med check and a visit of psychotherapy. How could I find out the different reimbursements?

 

[PsychedUp]

Quote:
Originally Posted by michaelrack
I think one of the reasons for a 4 year psych residency is to get more longitudinal experience, especially with psychotherapy.

Agreed. Continuing adult psychotherapy training was one reason I gave some thought, albeit not extended thought, to finishing a 4th year of general residency before beginning C/A fellowship. In hindsight, I'll have plenty of opportunity for doing therapy with adults (via family sessions) the rest of my career.

Additionally, some enjoy the 4th year as a "chief year", in which to develop leadership skills and/or persue specific academic/clinical/research interests.

In terms of most specialties being 4 years - as much as I love Psych, it's not brain surgery. More importantly, 3rd and 4th year are mostly elective time most places and that's time that could easily be condensed.

At least in my general residency program, there was no elective time in the 3rd year. The 3rd year was quite busy, with extensive time on C/L services and doing emergency psychiatry in a crisis setting. The 4th year, however, is essentially entirely elective time.

 

[PsychedUp]

Quote:
Originally Posted by michaelrack
I think one of the reasons for a 4 year psych residency is to get more longitudinal experience, especially with psychotherapy.

Agreed. Continuing adult psychotherapy training was one reason I gave some thought, albeit not extended thought, to finishing a 4th year of general residency before beginning C/A fellowship. In hindsight, I'll have plenty of opportunity for doing therapy with adults (via family sessions) the rest of my career.

Additionally, some enjoy the 4th year as a "chief year", in which to develop leadership skills and/or persue specific academic/clinical/research interests.

 

[michaelrack]

How many psychiatrists actually practice psychotherapy?

?

http://www.medscape.com/viewarticle/578684

there's been several articles on this recently. google "psychiatrists practicing psychotherapy"

 

[deleted77919]

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[marshmallows]

i wouldnt mind 3 years,

 

[CaMD]

Darn -- I clicked on this thread hoping there were some 3 year programs I didn't know about!!!

For what it's worth, I would definitely let a 3 year residency sway me towards one program over another. Sure more training is better, but the first couple years of practice post-residency are training/experience, too, just well-paid training!

 

[Doc Samson]

Darn -- I clicked on this thread hoping there were some 3 year programs I didn't know about!!!

For what it's worth, I would definitely let a 3 year residency sway me towards one program over another. Sure more training is better, but the first couple years of practice post-residency are training/experience, too, just well-paid training!

Do not underestimate the value of good supervision. 4th year lets you spread your wings and try treatment approaches that you wouldn't have the confidence to do as a PGY-3 but would probably be too hesitant to do without the safety net of good supervision.

 

[plainfacts]

Do not underestimate the value of good supervision. 4th year lets you spread your wings and try treatment approaches that you wouldn't have the confidence to do as a PGY-3 but would probably be too hesitant to do without the safety net of good supervision.

I'll take the 120 000 $ and buy myself som supervision.

 

[Doc Samson]

I'll take the 120 000 $ and buy myself som supervision.

Folks do that even after PGY-4.

 

[ogrady72]

i think there are some residencies that will allow you to begin your fellowship during your fourth year. doesn't exactly get you out there making $$$ but cuts a year off if you were planning to do the fellowship anyway.

 

[michaelrack]

i think there are some residencies that will allow you to begin your fellowship during your fourth year. doesn't exactly get you out there making $$$ but cuts a year off if you were planning to do the fellowship anyway.

Maybe someone more involved in academics than I am can verify this, but doesn't ACGME prohibit you from counting residency rotations towards fellowship requirements?


On a side note, during the last 3 months of my (psychiatry-based) sleep fellowship I was made an assistant prof of psychiatry and my salary was increased in return for helping out with the C+L program, but this was before sleep medicine was a recognized ACGME fellowship.

 

[OldPsychDoc]

i think there are some residencies that will allow you to begin your fellowship during your fourth year. doesn't exactly get you out there making $$$ but cuts a year off if you were planning to do the fellowship anyway.

Only true for child and adolescent psychiatry.

 

[Doc Samson]

Maybe someone more involved in academics than I am can verify this, but doesn't ACGME prohibit you from counting residency rotations towards fellowship requirements?

Yup.

 

[ogrady72]

Only true for child and adolescent psychiatry.

yeah, the person i know is doing a child fellowship.

 

[nancysinatra]

The best minds of our generation are curing acne.

Ok, I just want to challenge this view somewhat. Yes, derm is competitive. You gotta have high board scores and good grades. But I don't think that high board scores and good medical school grades necessarily = "the best minds of our generation." First of all, the best minds of our generation are probably not ALL in medical school, since medicine is largely applied science, which "the best minds" might not like to be doing. Second, doing well on the boards and shelf exams is a great a reflection of studying and memorization skills. But I would not use it as a yardstick for determining who "the best minds of our generation" are. It's not an IQ test.

Anyway, do you really think the quality of psychiatric care would improve if a lot of would-be dermatologists went into psychiatry instead? I'm really curious why. Who knows what their reasons for going into derm were? Maybe they'd be poorly suited for psychiatry. I'm curious though!

 

[BobA]

Ok, I just want to challenge this view somewhat. Yes, derm is competitive. You gotta have high board scores and good grades. But I don't think that high board scores and good medical school grades necessarily = "the best minds of our generation." First of all, the best minds of our generation are probably not ALL in medical school, since medicine is largely applied science, which "the best minds" might not like to be doing. Second, doing well on the boards and shelf exams is a great a reflection of studying and memorization skills. But I would not use it as a yardstick for determining who "the best minds of our generation" are. It's not an IQ test.

Anyway, do you really think the quality of psychiatric care would improve if a lot of would-be dermatologists went into psychiatry instead? I'm really curious why. Who knows what their reasons for going into derm were? Maybe they'd be poorly suited for psychiatry. I'm curious though!

The line "the best minds of our generation are curing acne" has a hint of sarcasm in it. The sarcasm might not have come through since it was written and not spoken. (this line also has some sarcasm in it.)

But sarcasm can sometimes hold within it some truth. Do I think that the quality of psychiatric care would improve if the most intelligent and professional medical students (like the ones who often go into something like Derm) chose to go into psychiatry instead? Yes, I do. Who wouldn't want those players on their team?

I think that as future doctors these students would be less likely to be duped by drug companies into thinking that every little personality quirk was a disease, every emotion a diagnosis, that every ill needed a pill. I think they would be fluent in English. I think that they would read literature diligently. I think they would be respectful and professional.

A shorter residency, and hence increased earning potential, would increase the quality (or at the very least quantity - since only 1/2 of spots are filled by AMG's) of psych applicants and thereby improve patient care.

 

[Doc Samson]

Do I think that the quality of psychiatric care would improve if the most intelligent and professional medical students (like the ones who often go into something like Derm) chose to go into psychiatry instead?

Depends entirely on their personality. FWIW, I wouldn't let very many of the folks in my medical school class who ended up in derm/ophtho/ortho or whatever other lucrative specialty anywhere near a patient with mental illness.

 

[notdeadyet]

FWIW, I wouldn't let very many of the folks in my medical school class who ended up in derm/ophtho/ortho or whatever other lucrative specialty anywhere near a patient with mental illness.

In fairness, I've also met a couple psych residents that I wouldn't want anywhere near a patient with mental illness.

Maybe I'm wrong, but I would think that the more people interested in psychiatry, the more of a talent pool to draw from, no?

And isn't the stereotype that folks who go into derm/ophtho/ortho lack social abilities/empathy just as bad as when folks assume that people who go into psych lack clinical ability/book smarts?

 

[Doc Samson]

In fairness, I've also met a couple psych residents that I wouldn't want anywhere near a patient with mental illness.

Maybe I'm wrong, but I would think that the more people interested in psychiatry, the more of a talent pool to draw from, no?

And isn't the stereotype that folks who go into derm/ophtho/ortho lack social abilities/empathy just as bad as when folks assume that people who go into psych lack clinical ability/book smarts?

My point is (and others have cited this thousands of times on these threads) is that of all the specialties, clinical performance in psychiatry is least likely to be predicted by board scores. Add into the mix that higher board scores likely equal more obsessive studying to the detriment of other activities/interests, and I'd even go so far as to say that there's probably an inverted U-shaped curve in play when you plot board scores against later cliinical performance.

BTW, the stereotype I was going for wasn't that folks in derm/ophtho/ortho lack social skills, rather that they're in it for the money (and that REALLY makes for a bad psychiatrist).

 

[notdeadyet]

My point is (and others have cited this thousands of times on these threads) is that of all the specialties, clinical performance in psychiatry is least likely to be predicted by board scores.

That makes sense. I hear the same from emergency medicine and surgery. I can see how performance in some fields aren't well predicted by board scores.

I can see how board scores are poor predictors, just not that low/mediocre board scores are indicative of good performance and high board scores are indicative of poor performance.

Add into the mix that higher board scores likely equal more obsessive studying to the detriment of other activities/interests, and I'd even go so far as to say that there's probably an inverted U-shaped curve in play when you plot board scores against later cliinical performance.

Interesting. From what I've seen, most of the high board scores folks are pretty well adjusted, social types that are the most active in outside hobbies and student government. Some of the low board score folks are too busy sucking marrow out of life's bones, but for most it seems to either be a matter of ability or poor study habits.

The big bump in the middle has a few great minds that would rather spend time on activities and life instead of studying for a standardized test, but most seem to be folks who work their tail off on the test and just hit their ceiling.

Is it a regional thing? I've heard this stereotype a few tims of the top of the pack somehow being socially ill-equiped bookworms that don't explore the rest of life, whereas I've found more of those at the bottom of the deck. Most of the folks I've heard the stereotype from seem to be from midwest or backeast. I'm wondering if it's regional.

Or maybe it's type of school. I'm in a pretty mid-tier med school. Maybe this type of thing is more common at the top 20 schools or bottom 20 schools.

BTW, the stereotype I was going for wasn't that folks in derm/ophtho/ortho lack social skills, rather that they're in it for the money (and that REALLY makes for a bad psychiatrist).

Ah, I read your comment differently. This makes more sense to me now. I can see how a field like psychiatry, that depends so much on diligence and empathy, would be a bad fit for a clock puncher.

 

[BobA]

I agree with Not Dead Yet. Most of the people I know who are going into derm/optho/ortho are actually pretty awesome people. "some of my best friends are Radiologists."

It might just be a factor of my school. Unprofessional people don't do well here because written exams never count for more than 30% of any grade while behavior counts for the rest. So the people who excel don't just do well on tests, they do well on tests AND EVEN BETTER on the wards - interacting with patients, the team, etc. And you need more than good board scores to get into competitive specialties, you also need honors in rotations.

I'd love to see these people go into psych. Unfortunately, most of them have been programed since birth to be an optho/derm/ortho doc. And to contradict myself, I guess you'd want someone with more introspective abilities to go into psych.

 

[demayette]

This is an interesting thread... Before getting into med school, I thought psych was a 3-year residency and I was shocked when I learned it was 4 years... If EM is in most cases a 3-year program, why psych can't be done in 3 years?

 

[MacDonaldTriad]

Most ER medicine programs are growing to 4 years not. Psychiatry’s RRC is thinking of allowing fast tracking into one year fellowships like C&A psych does. There are a lot of problems with this suggestion in that everyone will be doing fellowships because why not? It would be very hard on small programs with fewer fellowships to offer.

As far as the OP’s comments, hopefully psychotherapy training has hit a low and will be coming back up. We have made ourselves ancillary enough to the treatment team in my opinion.

I don’t see how dropping a year off of training would increase the quality of trainees. I could argue it would backfire by attracting residents who, shall we say, are not prone to fits of ambition and energy. I don’t think good medical graduates are avoiding psychiatry because the current training is too rigorous.

I don’t see our PGY-IIIs as ready for independent practice and there isn’t all that much elective time any more, especially given all of the night floating people are injecting into the schedule.

 

[psychked]

forgive my ignorance but how was C/A fellowship allowed to get residents in their PGY4 year.

 

[MacDonaldTriad]

Because it is a two year fellowship. “Fast-tracking” essentially means using your first year of fellowship to complete the time requirement of your general adult training. Think of it as a lot of elective time that happens to be spent on child psychiatry.