Day In The Life

[Anotherwin]

Hello everyone. I am a third year med student interested in psychiatry, and I would greatly appreciate if you could talk a bit about what a day in your life looks like in terms of practice, hours worked, and your overall satisfaction with your current set up. If this thread already exists, please let me know and I will delete it.

---

Members don't see this ad.

 

[rjs2131]

I'm sure you can/already have looked at various threads on SDN that describe different work setups, but here are some things to think about:
- Lots of variability in practice (inpatient vs outpatient, private practice vs community mental health vs hospital-based practice, academics vs not, CL, forensics, CAP, etc); lots of people out there doing some combination of things as well; there are also non-clinical/research avenues you can pursue
- If you are genuinely interested in psychiatry and enjoy the work (i.e. getting to know patients on an intimate level, spending more time with patients than the typical physician, learning/incorporating therapy into your work, working with diagnoses that are less cut and dry but often more interesting, etc) it's a great field overall...I don't personally know of anyone who has gone into psychiatry and regretted it and know of a number of people who have switched into psychiatry from other fields

Personally - work as an outpatient private practice psychiatrist and really enjoy this so far. Lots of autonomy in my current set up, where I can essentially decide what patients I see, how long I see patients for, how much I bill patients, etc. Currently aiming for ~30 clinical hours/week with business hours (i.e. 830-5) with about 2 hours of admin time each day. No nights/weekends, split phone call coverage with other MD's. I spend 90-120 minutes with new patients, 30-60 minutes with follow-ups (vast majority are 90 and 30). I have pretty solid office staff which I've heard can make a huge difference in work flow.

I would do some electives in psych your 4th year (especially if you have a particular interest or haven't seen outpatient psych as part of your normal rotation) to get a better sense of things. Good luck!

 

[Roxas]

I thought back on this post frequently throughout medical school, and even now as a PGY-2 in psych.

Hahahaha Bronx you liar...

A day in the life of IM: Rush in to work around 6:30am, run up and down stairs (because elevators are just too slow) to find your 8 patients. Print out all patients. Track down each nurse to get a quick report. Grab the chart and read through it for any overnight events. Check the computer - running slow - for vitals and lab results. Scribble those down fast. Time is ticking because you have 30 minutes left before your team expects you to be at the resident's lounge at which point you're expected to know everything about each patient. 8 divided by 30 gives you a little under 4 minutes per patient. "You idiot, you should have arrived by 6:00am but you're too exhausted." You round with your team at 7am. You're 2 minutes late to and they let you know you're 2 minutes late. The team goes through all 20 patients in a rather faster-than-comfortable manner. By 8am you're back on your feet running up and down the stairwells to place orders, make phone calls, write notes, don't forget to place your consults first in 5 different ways because GI consults requires a separate form from Cards remember? Today you're "long call" so you accept new patients up until 10pm. Your pager beeps. New patient. You run up to see the new patient. It takes 45 minutes to talk to family, interview the patient, write orders, talk to nurse. Pager beeps again. New patient. You run down the stairs to see the new patient but, oh no, pager beeps. Please clarify your orders to the pharmacy. "Order of bactrim ds needs ID's approval." Now you have to see a new patient, page ID and talk to them, and see current patients. Wait, it's 10:00am, time for rounds with attending. you look stupid in some strange way. Now it's 11:55am. Lunch time. Should I eat today, or keep working? Maybe that old candy bar from yesterday is still in my pocket. It is! Nice! Keep working.... repeat this regimen until 6pm but include all the hassles of discharging patients too. It's 6pm. Now you just hang out and wait for your pager to beep for new intakes. Pager beeps. New patient. Pager beeps, New patient. It's 9:45pm but you have to finish up your new intake. Ok. done by 10:30pm Now I go home. Be sure to wake up 30 minutes earlier to get to work by 6am tomorrow Idiot. Repeat for 3 years.

A day in the life of a psych resident: Arrive by 8:30am. I'm 10 minutes late, but nobody cares. I round on my 5 patients who are all in the same locked ward and make it to rounds by 9:15am comfortably. Around 10:30am rounds end. Attend to the orders, notes, and the rare consult for those patients. Go to lunch. Eat for an hour. Back around 1pm. Continue my work on the 5 patients. Discharged one. Down to 4. Tomorrow I'll be back to 5 patients. Done by 4:30 or 5pm. Home. Repeat for 1 year. Next year it's outpatient office work and hospital consult work.

Now, you tell me which one is borderline easy?

And it's not that I'm lazy. Psychiatry is just....awesome. Everything about it. No gross or stressful procedures, needle sticks, codes. Eff that. I love talking to patients. Depressed, manic, psychotic. Doesn't matter, it's all fun to me. The psychopharmacology is very interesting as well. And it's funny to see how uncomfortable the IM residents or hospitalists are with the stuff we do. We are magicians in their eyes. This is a double edged sword however, as it leads to them consulting us for pretty ridiculous things. Somewhere along the line they forgot how to ask a patient if they're having suicidal ideations, apparently only psychiatrists can do that. Or remind a patient that mild anxiety won't kill them and they don't need Xanax for that, but I digress.

Inpatient psychiatry is great. You get to work at your own pace, as your patients certainly aren't going anywhere. As long as you have good support staff and especially social workers, life is grand. Seeing a floridly psychotic or a manic patient stabilize and become a normal person again feels pretty good. We take plenty of L's in other cases, but no worse than other specialties. I can't speak much personally as to outpatient, but from this side the grass looks pretty green there as well.

 

[Ironspy]

I have a varied schedule and do something different each day. TMS, ECT, ketamine, outpatient consults, community mental health and research. I also have a small cash only private practice. Total hours worked around 40/week with fewer than 30 patient care hours. Start at 8-9 and am usually done 3-4 but sometimes as late as 430-5. My work is mostly interesting and rewarding and have lots of time for my kids and hobbies. I have worked no nights, no weekends and no holidays since residency.I have my gripes about bureaucracy, unreasonable patients etc but have good support staff and 9/10 would I this again

 

[Monocles]

I'm inpatient w/ kids and teens. I ADORE my co-workers and my patient population. If you work on a functional unit w/ supportive SWs and nursing staff, everything runs like a dream. Every day I show up, check in on my kiddos and shoot the **** with them about memes, music, and mental health stuff. Everything happens during the 9-4 hours. I negotiated myself out of calls and weekends. basically it's like show up to work, do a good job w/ the kids, then go home and live your life and forget about medicine. Of course there are rare cases that are a complete psychosocial dumpster fire but that's when you rally and work w/ your coworkers and do the best you can within the physical limitations of the universe.

Tbh this is probably the happiest I've been since M4 year. I'm lazy tho and don't want to work forever so I'm still saving plenty of money for retirement in case my job ever becomes "less good". But now I can foresee myself being here until retirement...

 

[deleted456421]

I'm lazy tho

You're not lazy, everyone else in medicine is simply deluded or beaten. There's nothing wrong with having enough time and energy to spend with our patients.

 

[deleted456421]

I thought back on this post frequently throughout medical school, and even now as a PGY-2 in psych.




And it's not that I'm lazy. Psychiatry is just....awesome. Everything about it. No gross or stressful procedures, needle sticks, codes. Eff that. I love talking to patients. Depressed, manic, psychotic. Doesn't matter, it's all fun to me. The psychopharmacology is very interesting as well. And it's funny to see how uncomfortable the IM residents or hospitalists are with the stuff we do. We are magicians in their eyes. This is a double edged sword however, as it leads to them consulting us for pretty ridiculous things. Somewhere along the line they forgot how to ask a patient if they're having suicidal ideations, apparently only psychiatrists can do that. Or remind a patient that mild anxiety won't kill them and they don't need Xanax for that, but I digress.

Inpatient psychiatry is great. You get to work at your own pace, as your patients certainly aren't going anywhere. As long as you have good support staff and especially social workers, life is grand. Seeing a floridly psychotic or a manic patient stabilize and become a normal person again feels pretty good. We take plenty of L's in other cases, but no worse than other specialties. I can't speak much personally as to outpatient, but from this side the grass looks pretty green there as well.

This is my problem with psychiatry: there are too many damn good options. I love inpatient work and I love outpatient work. I enjoy exploring deep psychodynamic issues and I really enjoy considering psychotropic options for my patients.

 

[Monocles]

You're not lazy, everyone else in medicine is simply deluded or beaten. There's nothing wrong with having enough time and energy to spend with our patients.

Thanks! That is very kind of you to say. Even after more than a decade in healthcare, I am still baffled at some of the things people will accept, in like a "martyr complex" sorta way. Maybe I've never adopted the classical "physician identity" but I think it's nuts to miss out on family gatherings and your kids' school plays for a job lol. But maybe that's just me.

 

[ridethecliche]

Thanks! That is very kind of you to say. Even after more than a decade in healthcare, I am still baffled at some of the things people will accept, in like a "martyr complex" sorta way. Maybe I've never adopted the classical "physician identity" but I think it's nuts to miss out on family gatherings and your kids' school plays for a job lol. But maybe that's just me.

Sounds like you're not really dedicated to your work.

Signed,
Administrator
(Sent from my iphone at the lunch cocktail hour at the MBA Lounge)

 

[Dave1980]

We are magicians in their eyes.

lol what?

 

[TexasPhysician]

I’m outpatient private practice (no insurance). I work 25-30 clinical hours each week. I typically do 1-5 admin hours/week. I have a few clinicians.

Downside is that some weeks I can work 40+ hours just admin if something crazy happens. It’s not common though. Recently I bought a building and moved the clinic. Transporting everything, additional furniture, set-up, etc destroyed my entire weekend. I’m sitting here typing this post as some electrical is being addressed (don’t ask). While doing that, they punched a hole in the wall. The clinic is now dirty again. I’m losing my Friday over this.

That said, being involved in real estate is something that I am a big proponent of.

 

[deleted456421]

I’m outpatient private practice (no insurance). I work 25-30 clinical hours each week. I typically do 1-5 admin hours/week. I have a few clinicians.

Downside is that some weeks I can work 40+ hours just admin if something crazy happens. It’s not common though. Recently I bought a building and moved the clinic. Transporting everything, additional furniture, set-up, etc destroyed my entire weekend. I’m sitting here typing this post as some electrical is being addressed (don’t ask). While doing that, they punched a hole in the wall. The clinic is now dirty again. I’m losing my Friday over this.

That said, being involved in real estate is something that I am a big proponent of.

Did you use any specific resources to guide your commercial real estate purchasing? I eventually want to open a private practice and keep wondering if owning the office building is worthwhile (and how to approach it).

 

[deleted456421]

Since I never answered the question: I work on a 20+ bed unit at a state psychiatric hospital. Hours are 8-4. Spend 30 minutes-hour in the morning getting overnight report (I need to work on increasing efficiency since this can drag on), usually see a couple patients with urgent issues afterward. Depending on the day we'll then have 3-4 treatment plan meetings or meetings with outpatient providers and/or hospital administrators. I don't round on every patient every day, which is nice. The hospital still uses paper charts so I also spend a few hours copying and pasting my various notes from one piece of software into another, until I eventually print them out to never be read again.

It can be incredibly stressful if unit acuity is high, plus I really hate all of the administrative garbage. However, I really enjoy working with this population and I often feel like I'm making an immediate impact on my patients' lives. Plus I usually have at least a couple half days a week to just read about patients or formulate really solid treatment plans. The pay is good, though it's 1099 so I rely on my wife's benefits. I'm sure I'll burn out after a couple years, at which point I'll probably pick up a chiller inpatient gig or consider private practice.

 

[Monocles]

It can be incredibly stressful if unit acuity is high, plus I really hate all of the administrative garbage.

I'm sure I'll burn out after a couple years, at which point I'll probably pick up a chiller inpatient gig or consider private practice.

Why wait a couple of years instead of switching to a more chiller gig now? It sounds like you are already well on your way to burnout.

 

[TexasPhysician]

Did you use any specific resources to guide your commercial real estate purchasing? I eventually want to open a private practice and keep wondering if owning the office building is worthwhile (and how to approach it).

There are a lot of real estate resources. If you are just beginning, start reading up on Biggerpockets

 

[Monocles]

There are a lot of real estate resources. If you are just beginning, start reading up on Biggerpockets

Texas I'm curious to know what your returns have been in real estate vs investing in "the market" (ex: VTSAX or sp500). In reading a lot of the physician finance blogs, in their old posts a lot of them rave about real estate but I am curious to know if it's still as lucrative given the covid crisis and a lot of renters/homeowners not being able to pay rent/mortgage.

(Sorry if this is too off topic!)

 

[Ludwig2000]

I have a varied schedule and do something different each day. TMS, ECT, ketamine, outpatient consults, community mental health and research. I also have a small cash only private practice. Total hours worked around 40/week with fewer than 30 patient care hours. Start at 8-9 and am usually done 3-4 but sometimes as late as 430-5. My work is mostly interesting and rewarding and have lots of time for my kids and hobbies. I have worked no nights, no weekends and no holidays since residency.I have my gripes about bureaucracy, unreasonable patients etc but have good support staff and 9/10 would I this again

How did you swing this? Is this an academic position plus your own small private practice? Seems pretty ideal to me but I'm unclear on how possible it is.

 

[NickNaylor]

I work as an inpatient doc at an academic institution.

I typically get up around 6, sometimes to finish work or, like this morning, screw around for a bit while my brain fully gets online. I try to get on my way by 7:30 in order to get to the hospital by 8. I read about patients, respond to emails, etc. and start seeing patients around 8:30-9. I see most if not all of my patients by 11, attend our interdisciplinary team meeting until about 12, and then staff cases with the trainees I’m working until about 1. Our teams cap at about 6 patients per team, so the workload is very reasonable and allows for plenty of time for teaching and to discuss cases in a fair amount of detail with the trainees. I very rarely cover on the weekends as the other faculty like working so the need is pretty low. Each of us does overnight call one weekday/week, but the residents are primary so we rarely get paged.

Depending on the day, I’ll either head home at that point and finish anything there or go back to my office to finish notes, call families, etc. How much additional work I have to do depends on the strength of the resident I’m working with. Right now, the resident I’m working with is outstanding, so he essentially runs the service and does a great job. For residents that aren’t as good, I’ll have to spend more time doing these auxiliary tasks.

I do a few other non-clinical academic things, but the inpatient schedule is extremely flexible so fitting this stuff in isn’t challenging. That really is one of the blessings of inpatient work - I love the flexibility. I always feel trapped when I’m in clinic.

I try to be done with all my clinical work by 2:30-3 - most of the time I’m successful. I’m in psychoanalysis, so I’ve got an hour of therapy, usually from 4-5, and am home after that. I hang out with my family and, onve my wife and baby go to bed (usually by 9), I either get in some gaming or do other academic tasks for an hour or so before I go to bed. Last night I spent that time reviewing an article for a journal and was in bed by 10:30, which is pretty typical. Rinse and repeat.

Our inpatient faculty also covers our neuromodulation service, so every few months I do that instead for 4 weeks. Mondays/Wednesdays/Fridays are ECT procedure days. Usually I get to the hospital by 8am and am done for the day by 1-2pm, maybe earlier depending on the census for the day. I have a half-day in clinic from 8-12 on Tuesdays and a full day of clinic from 8-5 on Thursdays which includes a mix of esketamine treatments, TMS mappings, and 2-hour evaluations. I’ll usually spend another hour or so on Thursdays finishing documentation once I get home.

I also work in the ED on Sundays from 7-7 for extra cash.

 

[Ludwig2000]

I work as an inpatient doc at an academic institution.

I typically get up around 6, sometimes to finish work or, like this morning, screw around for a bit while my brain fully gets online. I try to get on my way by 7:30 in order to get to the hospital by 8. I read about patients, respond to emails, etc. and start seeing patients around 8:30-9. I see most if not all of my patients by 11, attend our interdisciplinary team meeting until about 12, and then staff cases with the trainees I’m working until about 1. Our teams cap at about 6 patients per team, so the workload is very reasonable and allows for plenty of time for teaching and to discuss cases in a fair amount of detail with the trainees. I very rarely cover on the weekends as the other faculty like working so the need is pretty low. Each of us does overnight call one weekday/week, but the residents are primary so we rarely get paged.

Depending on the day, I’ll either head home at that point and finish anything there or go back to my office to finish notes, call families, etc. How much additional work I have to do depends on the strength of the resident I’m working with. Right now, the resident I’m working with is outstanding, so he essentially runs the service and does a great job. For residents that aren’t as good, I’ll have to spend more time doing these auxiliary tasks.

I do a few other non-clinical academic things, but the inpatient schedule is extremely flexible so fitting this stuff in isn’t challenging. That really is one of the blessings of inpatient work - I love the flexibility. I always feel trapped when I’m in clinic.

I try to be done with all my clinical work by 2:30-3 - most of the time I’m successful. I’m in psychoanalysis, so I’ve got an hour of therapy, usually from 4-5, and am home after that. I hang out with my family and, onve my wife and baby go to bed (usually by 9), I either get in some gaming or do other academic tasks for an hour or so before I go to bed. Last night I spent that time reviewing an article for a journal and was in bed by 10:30, which is pretty typical. Rinse and repeat.

Our inpatient faculty also covers our neuromodulation service, so every few months I do that instead for 4 weeks. Mondays/Wednesdays/Fridays are ECT procedure days. Usually I get to the hospital by 8am and am done for the day by 1-2pm, maybe earlier depending on the census for the day. I have a half-day in clinic from 8-12 on Tuesdays and a full day of clinic from 8-5 on Thursdays which includes a mix of esketamine treatments, TMS mappings, and 2-hour evaluations. I’ll usually spend another hour or so on Thursdays finishing documentation once I get home.

I also work in the ED on Sundays from 7-7 for extra cash.

Are you undergoing psychoanalysis [at least partially] because you are training to be an analyst?
Or just for unbridled self actualization

 

[NickNaylor]

Are you undergoing psychoanalysis [at least partially] because you are training to be an analyst?
Or just for unbridled self actualization

Both. I’ve been seeing my therapist for about 5 years now and doing analysis for 3. Our local analytic institute has a “lay analyst” track that I’ll be doing starting next year, which basically includes everything except having training cases and doing supervision (this isn’t economically or logistically feasible for me to do in my current position). I’ve found it helpful personally but always had some interest in doing some form of analytic training which has been a partial motivation.

 

[deleted849476]

Both. I’ve been seeing my therapist for about 5 years now and doing analysis for 3. Our local analytic institute has a “lay analyst” track that I’ll be doing starting next year, which basically includes everything except having training cases and doing supervision (this isn’t economically or logistically feasible for me to do in my current position). I’ve found it helpful personally but always had some interest in doing some form of analytic training which has been a partial motivation.

When you say “lay” is that to say there are non-physicians there learning to be analysts, or just that it’s for psychiatrists without much previous exposure? I’m curious because, do I take this to mean that not all residencies prepare graduates equally well to do psychoanalysis in their practice? Or is it just that one can get that much better at it by being a patient and having additional exposure?

Along those lines, as long as I’m asking questions…if I’m interested in pursuing psych would I potentially benefit from seeing a psych (regardless of if doing psychoanalysis or not), both for exposure and for self actualization ? As in, my mental and emotional health is fine but who doesn’t want to be even better, especially if I want to help others in the same way by being a psych one day?