Burned Out!

[metired]

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So.....3 months into residency and I am already getting burned out. I haven't done anything psychiatry related yet and now I am on wards. That sucks in general, but now I am working with an attending that has no respect for anything psych related, including me. Can't do anything that makes her happy. Oh well just wanted to vent a little and see if anybody had any advice.

 

[angkshus]

So.....3 months into residency and I am already getting burned out. I haven't done anything psychiatry related yet and now I am on wards. That sucks in general, but now I am working with an attending that has no respect for anything psych related, including me. Can't do anything that makes her happy. Oh well just wanted to vent a little and see if anybody had any advice.

I'm 3 and 1/2 months into 3rd year of medical school and I'm already burnt out. I barely studied at all during my last rotation (but thankfully passed the shelf!) and haven't started studying for the next. I'd love you to trade places with you! I definitely need get re-motivated.

 

[sella turcica]

my experience on IM wards as an MS3 was similar. Since I'm an MS4 applying to psych residencies, I'm curious about your opinion. Care to elaborate? You can PM me if you want to.

 

[whopper]

Look at it this way. You're only going to do IM (or whatever non-psychiatric rotation) for a few more weeks tops (or months depending on the program) and then it's over. Try to soak it in as much as you can because this will be helpful when you take Step 3 and in your career as a physician.

You will regularly deal with several medical issues even in psychiatry.

If you do have an attending that is not respectful of psychiatry--now that's a bummer and something that should not be happening. Several doctors have preconceived and prejudiced notions of the other fields of medicine. Problem is that this person holds the power over you and will write your evaluation. In most cases, I think it'd be better just to try to tolerate it for now unless the person did something very out of line.

 

[Majesty]

Being burned out in residency is common.
Its was worse in about jan/feb for me. I hadn't had any time off and life generally sucked all the time. The hours were obscene and nobody wanted to hear about the 80 hour rule as some great savior. Because 80 hours still sucks balls.

You get over it though. The other interns were a lot of help. The only part of residency I miss is the other residents in my class.

I don't want to encourage alcoholism but try out liquid rounds with friends before a golden weekend. You will laugh, you will cry, you might throw up and go to sleep in the bar (i heard it happened to a friend of mine).

 

[beezley]

Being an intern blows, and it sounds like you have a crappy attending. It WILL get better. I think last year I hit a low about this time, things got a bit better over the holidays and then February really sucked. Once April comes it gets a little better. To quote Finding Nemo: 'Just keep swimming'. It WILL get better.

 

[heyjack70]

Look at it this way. You're only going to do IM (or whatever non-psychiatric rotation) for a few more weeks tops (or months depending on the program) and then it's over. Try to soak it in as much as you can because this will be helpful when you take Step 3 and in your career as a physician.

You will regularly deal with several medical issues even in psychiatry.

If you do have an attending that is not respectful of psychiatry--now that's a bummer and something that should not be happening. Several doctors have preconceived and prejudiced notions of the other fields of medicine. Problem is that this person holds the power over you and will write your evaluation. In most cases, I think it'd be better just to try to tolerate it for now unless the person did something very out of line.

I agree with Wopper's advice, as usual his reply is thoughtful and accurate.

I think the best advice I've heard about psychiatrists struggling on IM is this: You are not there to be an internist. You are there to do the work, write the notes, learn what you can, and survive the rotation. Keep you head down, write concise notes, keep your oral presentations as brief as possible (read from your admit note if needed) because the attending does not care what you have to say.

 

[whopper]

Several doctors have preconceived and prejudiced notions of the other fields of medicine. Problem is that this person holds the power over you and will write your evaluation. In most cases, I think it'd be better just to try to tolerate it for now unless the person did something very out of line.

I'm usually not one for biting the bullet and taking crap, especially if it deals with someone in the field doing something that's not right.

But in many cases in residency, an attending's power is like the gods, and the resident's power is that of the mortals. A good program will listen to resident complaints within reason, but many do not and as an intern, you will likely not know the politics of the situation.

I was in a very very dangerous position while as a chief resident where an attending was neglecting his duties, trying to make residents put to blame for his mistakes, and it was occurring without much correction by the department heads. I was put in a situation where I felt that to do that job I was supposed to do...as a doctor and as a leader for residents under me, I had to try to fix this because interns under my leadership were being put at the stake for the attending's laziness. I was insulated because the department head knew what was going on and told me she thought I was in the right--however she was in a position where she could not do much even though she was his boss. The dynamics of why it happened are not worth explaining, and thankfully by the time I left the program it was finally being corrected. The program by the way after all was said and done wanted me there as an attending, even told me money was not an object, and told the idiot he was going to be fired if things didn't improve but the process took several months. He was demoted but kept there.

Point being that almost every place I've seen, there's some type of political bull going on. Do not challenge an attending unless you know you are protected. ACGME rules can protect you up to a certain degree but it will be better to figure out what the situation is before you lead a frontal assault.

You could ask residents who have been there longer and are up the chain on advice on what to do with an attending that pulls this type of bull.

And by the way--remember this rule. You know what I'm writing about. I'm sure there are idiots in your class that just really tick you off and make you wonder what type of terrible doctor they will be. The reality is many of these people will end up graduating and being attendings. After all, in this stage of the game the failure rate is very small. A lot of these people do end up teaching in residency programs. In fact some doctors I know specifically went into teaching programs with the sole goal of having a resident do all the work for them while they could take it easy and try to schmooze their way out of doing real work.

The entire resident being the slave--attending being the god is IMHO only justified if the attending truly is a good one and wanting to teach. In those cases, the attendings usually won't want the residents treated so poorly. The reality is many of the attendings are actually types that if you actually care about what you are doing, you will likely surpass them within a few years while you soak up knowledge and they sit in the complacency of being a bad doctor.

So you might have to take a few lumps. The ACGME guidelines have offered protections and this has made things far better but there are still programs that are throwbacks and operating old-school. Make sure you know what you are doing if you push a complaint.

 

[Red Beard]

In the same shoes as the OP now, also burned out, but on my last long call for medicine for awhile tonight and looking forward to things chilling out for a while.


Haven't had attendings who were disrespectful toward psychiatry, but have had more than one "you are pretty good for a psych intern...." 🙄

 

[beezley]

'good for a psych intern'.... that always killed me last year. After medical school we are 'totipotent' as it were, all in the same boat in terms of knowledge whether you are psych, derm, surg or medicine-especially this early on in the year. I felt that I was often on par with my fellow interns which surprised them, but I don't really know why.

 

[whopper]

I got the above as well. By the time I ended my IM rotation, I was asked to leave psychiatry and go into IM because they liked my work.

I don't attribute that so much to me than I do starting out in IM only a few weeks into residency. When the IM residents start, they're blank slates. BY the time a psychiatry resident starts the IM rotation, most of the residents are much further in their education and see the psychiatry resident as behind them. I started IM earlier than most psychiatry residents because in my year we had an above average amount of new interns in the psychiatry residency.

Another thing is several psychiatry residents from the start see their IM rotation as something they simply should just endure. I didn't see it that way. I wanted to tried to learn everything I could while in it.

But I got to admit, by the last few weeks, I really was burned out. My last day in IM, when it ended, I felt like someone took some chains off my soul.

 

[OldPsychDoc]

...But I got to admit, by the last few weeks, I really was burned out. My last day in IM, when it ended, I felt like someone took some chains off my soul.

Diagnostic for "Destined for Psychiatry" 👍

 

[masterofmonkeys]

I am so burned out it's not even funny. And I have been for over a year now. I'm not sure I'll unburn as long as I'm in residency. The balance between services and education is a mythical thing in my neck of the woods; whispered about in quiet moments but never seen, never witnessed.

Medicine was the last two months of a particularly horrendous intern year--went over a month of calendar days without a day off on more than one occasion, logged an average of 90+ hrs while on a psych rotation, routinely did someone else's discharge summaries. Funny thing, I love internal medicine. And I spent the whole time trying not to go completely insane. There are dents in the walls in the wards...exactly at my forehead's height. I'll leave you to draw your own conclusions about that.

The guild structure of medicine is incredibly exploitive, and if I have my way as an attending, I'll help make it crumble. They have enormous power over us. We are 10-20 dollar an hour doctors who don't get paid overtime, and the temptation is to use us as such. As an intern, my hourly was the lowest of anyone on the floor, including the ward clerk. And making us do more work had no marginal cost to it whatsoever to a program. The ACGME is a joke. And the temptation will always be there to use the residents in such a manner so long as the system continues with this huge power differential in place.

My father (a professor in a non-medical field) has always lamented that while he loves research, he loves teaching even more, and has never once been promoted, never once been given a raise, never once gotten more than an honorarium or a plaque to signify his dedication to this. From what I've seen this is often true in the medical system. Which isn't to say that I haven't had some fantastic attendings who pushed me hard as both a psychiatrist and a physician, but funny thing, they don't really get paid any more for that, they don't get recognized for it, and the big machine doesn't give a damn that they do it.

The temptation will be to deal with it by saying that 'you've got to pay your dues'. I wonder if that's what my ancestors who were dragged into indentured servitude said? The truth is that injustice is still injustice. An even greater truth is that residency is and should be hard work. But it should be hard work with the purpose of making you a better physician, not to be a small and easily overburdened cog who's not allowed to squeak. Lying to yourself about it, making it a 'necessary evil', probably does make it easier. I have to say that one of the biggest stressors for me is the awareness of how little of the work I do is repaid in education.

Resist that. That tendency to rationalize the abuse is what makes the system continue to go round. That tendency to objectively and sterilely examine what is ultimately a social, political, and economic system that leaves it open to abuse is why it never gets changed. Because we as attendings will cognitively distort away the real horrors of residency.

I will say that, burned out or no, my GAF has risen from the 20s last year to the 50s due to the therapeutic effects of a couple of psychosocial interventions.

The institution of liquid rounds (as so eloquently put by Majesty--I'm stealing that btw) amongst my classmates. Some programs actually set aside an hour of didactics time for 'process group' so the residents can work through their frustrations and issues. Rock Band, alcohol, and stupidity seem to work pretty well for us though.

Taking your life back. I don't know about you, but I was a lot of things before med school and residency. Things that I let sit on the back burner while medicine slowly consumed more of my life. I am a doctor, but I am not defined by it. Yeah, I take my job very very seriously, to the point that work-life boundaries are a concept that I have heard of but don't quite understand, but I am more than that. I started training again, started writing, started to do the things I always did for myself and my own growth again. Not just leisure, not just pleasure. But things that matter to you.I feel more and more alive every day these days.

I have no idea where I was going with this. But good luck. And remember, more than 5 drinks in a night is a binge. Do not make me slap a diagnosis of EtOH abuse on you.

 

[NJWxMan]

I'm in CL now and I can see how others burn-out easily. CL is interesting, but it's probably the ugliest side of Psychiatry. Why? You get to see all of the "suicide attempts gone wrong" and the some of the poor judgment calls or pure unluckiness by your colleagues in the psychiatric ER. Completely open abdominal wounds from self inflicted gunshot fire, disfigured faces from self inflicted gunshot wounds, missing limbs due to "train accidents", infinite MICU admits and intubations due to benzo. OD's, borderlines not contracting, etc. I just feel like the med. and sx services use us to dump their impossible disposition patients.

 

[Doctor Bagel]

I'm on IM right now, and in some ways I'm actually liking being off service. I don't love IM. The didactics are pretty interesting, but our patients are pretty repetitive (I'm at the VA, so all old guys with bad hearts and lungs). But I like the feeling of being the off-service person because it makes it easy for me to set up distance between me and my work. I don't really care about the culture (which is fine, actually), and I'm not as worried about doing a great job. I'm doing my job, and writing my notes and all that stuff, but I'm not putting a whole lot extra out there and don't feel bad about it.

The other plus of being off service is that it's solidifying my choice of going into psychiatry. My other thought during third year was IM, but seriously, psych is so much more interesting. I can't get all that into options for diuresis or examining JVPs.

 

[st2205]

I am so burned out it's not even funny. And I have been for over a year now. I'm not sure I'll unburn as long as I'm in residency. The balance between services and education is a mythical thing in my neck of the woods; whispered about in quiet moments but never seen, never witnessed.

Medicine was the last two months of a particularly horrendous intern year--went over a month of calendar days without a day off on more than one occasion, logged an average of 90+ hrs while on a psych rotation, routinely did someone else's discharge summaries. Funny thing, I love internal medicine. And I spent the whole time trying not to go completely insane. There are dents in the walls in the wards...exactly at my forehead's height. I'll leave you to draw your own conclusions about that.

The guild structure of medicine is incredibly exploitive, and if I have my way as an attending, I'll help make it crumble. They have enormous power over us. We are 10-20 dollar an hour doctors who don't get paid overtime, and the temptation is to use us as such. As an intern, my hourly was the lowest of anyone on the floor, including the ward clerk. And making us do more work had no marginal cost to it whatsoever to a program. The ACGME is a joke. And the temptation will always be there to use the residents in such a manner so long as the system continues with this huge power differential in place.

My father (a professor in a non-medical field) has always lamented that while he loves research, he loves teaching even more, and has never once been promoted, never once been given a raise, never once gotten more than an honorarium or a plaque to signify his dedication to this. From what I've seen this is often true in the medical system. Which isn't to say that I haven't had some fantastic attendings who pushed me hard as both a psychiatrist and a physician, but funny thing, they don't really get paid any more for that, they don't get recognized for it, and the big machine doesn't give a damn that they do it.

The temptation will be to deal with it by saying that 'you've got to pay your dues'. I wonder if that's what my ancestors who were dragged into indentured servitude said? The truth is that injustice is still injustice. An even greater truth is that residency is and should be hard work. But it should be hard work with the purpose of making you a better physician, not to be a small and easily overburdened cog who's not allowed to squeak. Lying to yourself about it, making it a 'necessary evil', probably does make it easier. I have to say that one of the biggest stressors for me is the awareness of how little of the work I do is repaid in education.

Resist that. That tendency to rationalize the abuse is what makes the system continue to go round. That tendency to objectively and sterilely examine what is ultimately a social, political, and economic system that leaves it open to abuse is why it never gets changed. Because we as attendings will cognitively distort away the real horrors of residency.

I will say that, burned out or no, my GAF has risen from the 20s last year to the 50s due to the therapeutic effects of a couple of psychosocial interventions.

The institution of liquid rounds (as so eloquently put by Majesty--I'm stealing that btw) amongst my classmates. Some programs actually set aside an hour of didactics time for 'process group' so the residents can work through their frustrations and issues. Rock Band, alcohol, and stupidity seem to work pretty well for us though.

Taking your life back. I don't know about you, but I was a lot of things before med school and residency. Things that I let sit on the back burner while medicine slowly consumed more of my life. I am a doctor, but I am not defined by it. Yeah, I take my job very very seriously, to the point that work-life boundaries are a concept that I have heard of but don't quite understand, but I am more than that. I started training again, started writing, started to do the things I always did for myself and my own growth again. Not just leisure, not just pleasure. But things that matter to you.I feel more and more alive every day these days.

I have no idea where I was going with this. But good luck. And remember, more than 5 drinks in a night is a binge. Do not make me slap a diagnosis of EtOH abuse on you.

... and you're where? I'll be sure and strike that from my list.