Internship year

[Just Joshin]

What's the internship year like? Is it as rigorous as some of the other specialties like surgery? Is it filled with rotations like IM and neuro. If so, how long are these rotations? Any info for an interested student is appreciated.

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[whopper]

This really can't be answered on this forum because it really depends quite a bit on your program.

My own program: Robert Wood Johnson-Atlantic City (Affiliated with RWJ Camden) has residents work a 5 day work week, on call Q5, work hours are about 8-5. Overall expect to work about 60 hrs a week.

However I knew of programs in NYC where you worked 6 days a week, 6am to 6pm & were on call Q3.

The variability of work is high in psychiatry. Most IM, surgery, Ob-Gyn programs for example all have residents working the maximum (actually usually more and the residents lie about their hours because they don't want their program shut down). In Psyche, several programs don't have the residents working anywhere near the max, but some do.

I've also noticed that in general the programs with the bad hours tend to be more in the urban hospitals, especially if the hospital is in an underprivildeged/low socioeconomic status/high crime rate area, and that residencies in rural areas tend to take it more easy.

As for neuro & IM, again, I've seen the length and responsibility vary. I've seen programs where the psyche residents are treated like medstudents in IM, only carrying a small handful of of the easier patients, I've seen others where they do EVERYTHING the IM residents do, including codes, admissions, calls etc.

 

[Just Joshin]

I'm just looking for a rough idea based on everyone's own experiences. So there are rotations then? Is it just IM and neuro or is it other services too? During those rotations, are psych interns still working psych hours or are they working the dreaded 24-36 hour shifts so many other interns complain about?

Also, does Q5 mean call every fifth night? Sorry, I'm just a pre-med hoping to get in to med school next Fall. I'm trying to learn the lingo.

 

[whopper]

Yeah sorry, Q means how often. Q 5 means every 5 days. Q D means once a day etc.

Overall psyche is among the easiest residencies in terms of work hours, though as I mentioned above, some programs are very difficult with work hours.

You're going to see a lot of variability with psyche residencies, where as in surgery, the majority of programs I've heard of pushes residents to over the maximum number of allowable hours.

 

[Hurricane]

There was a thread about this not too long ago, but I can't find it. Oh well... (editd to add: here is is)

The ACGME requires 6 off-service months: 2 neuro and 4 months of medicine (or peds or FM). One of the medicine months can be EM.

Programs vary widely in how they implement this. Some programs have their psych interns in the MICU, others do all outpatient. Most strike a balance in-between.

For example, at my program, we do 2 months of either medicine or peds wards (your choice), one month of adult or peds ER, and a med or peds specialty month, which is usually a lighter non-call month. (I'm doing palliative care, which is consults+clinic, 9-5 M-F) Then the 2 neuro months.

When you are rotating on these services, you are usually expected to function as an intern in these respective schedules. So you are on call along with the medicine interns, doing everything they do. The exception here is that we only take call for one of the two neuro months (which at first I felt guilty about, until I learned that the neuro residents gets to slack off when they have to rotate through psych consults.)

Medicine here is Q5, which means we are on call every 5th night. Like many programs are doing nowadays, we have a a night-float who takes admissions after a certain time though, so you're not taking admissions all night.

 

[sga430]

i have been to a few programs with no night calls the off service months. and some of them are urban.

 

[tr]

I'm interviewing now. Intern year at most of the programs I've looked at has either 4 or 6 months of medicine, 2 months of neuro, and the rest psych or other elective (e.g., peds or more neuro).

Usually 2-3 months are inpatient medicine with call q4 (sometimes q5). The other 2-3 months are clinic or ED months with no overnight call (although you may have overnight ED shifts). The neuro months may or may not have overnight call. The psych/elective months often seem not to have overnight call, and if they do it is like q10-q14. ("No overnight call" means your call is more like a late workday - stay till 10 - and then the night float takes over.)

So it seems like you might not have to do more than maybe 3-4 months of frequent overnight call in the whole intern year. I keep wondering if there is a catch to this. Presumably the programs are putting their best feet forward; but can they be actually misrepresenting total call time in writing??

 

[Solideliquid]

I'm interviewing now. Intern year at most of the programs I've looked at has either 4 or 6 months of medicine, 2 months of neuro, and the rest psych or other elective (e.g., peds or more neuro).

Usually 2-3 months are inpatient medicine with call q4 (sometimes q5). The other 2-3 months are clinic or ED months with no overnight call (although you may have overnight ED shifts). The neuro months may or may not have overnight call. The psych/elective months often seem not to have overnight call, and if they do it is like q10-q14. ("No overnight call" means your call is more like a late workday - stay till 10 - and then the night float takes over.)

So it seems like you might not have to do more than maybe 3-4 months of frequent overnight call in the whole intern year. I keep wondering if there is a catch to this. Presumably the programs are putting their best feet forward; but can they be actually misrepresenting total call time in writing??

Check out the PGY II call schedule. That is usually the catch, having you to at least Q6 call in PGY II or something.

At my program, we have one month of inpatient medicine (the other three months are IM outpatient clinic) where we take medicine call with the other IM interns. Although we have a night float and it means we are on overnight call 3-4 times a month, which is not so bad.

The other 10 months of the year we take 6 psych calls a month no matter which rotation you are doing. One month of the year we have no call at all.

So again, our call is so called "front loaded" and during PGY II we take call once or twice a month, PGY III and IV are solely back-up call from home via phone.