Fellowship hours

[Horners]

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What’s the difference between residency and fellowship hours when it comes to psych fellowships?

From what I read and hear from my friends in residency is that hours are as low as 50 to as high as 80 intern year then it gradually decreases until pgy4... but what are the fellowship hours for CAP? Addictions? Forensics?

Did a forum review but couldn’t find it.


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[TexasPhysician]

My CAP was 40 hours/week.

 

[splik]

It will depend on the program. some CAP fellowships don't have call whereas others have lots of call (qhowever many fellows there). There should not be call in other fellowships. Forensic fellowships can vary from 40-80+ hours per week depending on the program and how much work you have going on with the better fellowships more labor intensive but even in those programs there will be chill weeks, it is not brutal the whole time despite what they might tell you.

 

[NickNaylor]

Our CAP fellowship seems to have fairly frequent overnight home call, largely covering the ER and staffing cases with the ER social worker. They otherwise seem to have pretty decent hours.

Our C/L fellows work usual business hours, don't work weekends as far as I know, and don't take any call.

Our other programs have been unfilled since I've been here, so I don't know what their schedules are like.

 

[OldPsychDoc]

Addiction Fellowship: oh, 40...yeah of course--40...


I mean in a busy week you could easily hit 40...especially if you count your lunch and travel times.

 

[Nasrudin]

I have no idea how 60 plus hour fellowships fill. You're basically a scab low-pay attending. And then they're going to use the salaried structure to be able to work a cush schedule while you hump the workload. And for micromanaging, knight and squire work relationships while they're there. Like, go see the patient, do all the work. And then go see the patient again with royal attending, present all the information, essentially doing double to work of just doing the job yourself.? For F's sake. Why are people doing that?

If I was to do a fellowship at all. It would for 35 or so hours with constant gratitude for my presence replete with superb academics and clinical mentorship. With independence. Good benefits. No call. And high pay moonlighting in house.

Maybe free meals. And massages. The good kind.

Then.... I'd consider it. And probably still say no.

I really don't get the allure. 4 years of undergrad. 4 years of medical school. And 4 years of residency. That's not enough of this **** for you people.

Jesus. I can't graduate soon enough.

Sorry for the useless rant. I just marvel at psych fellows.

 

[FlowRate]

Our CL fellowship is regular business hours, but those business hours are like 7AM-6PM... No thanks.

 

[TexasPhysician]

Our CL fellowship is regular business hours, but those business hours are like 7AM-6PM... No thanks.

Shocking. Where is that?

 

[FlowRate]

Shocking. Where is that?

I think most weekdays are nominally 8ish to 5, but it wasn't unusual to see them at 7:30 or 8 to prepare/get work done/sign out residents and they're often there until 6+ seeing late consults. Big NE academic center.

 

[clausewitz2]

I think most weekdays are nominally 8ish to 5, but it wasn't unusual to see them at 7:30 or 8 to prepare/get work done/sign out residents and they're often there until 6+ seeing late consults. Big NE academic center.

Our C/L fellows work like that, and also some weekends.

No.

 

[chajjohnson]

I've been on a few different C/L services at different hospitals. Some of them stop taking consults at 11AM. These ones had really nice hours, still 8-5 or so, but it completely removed those 4:59 "emergency" consults. And that honestly seems like a reasonable request that makes sure other teams are just slightly more organized than usual regarding calling consults. There really aren't consult emergencies, and the acutely decompensated patient can be handled by lots of different people, from the resident on call to a behavioral crisis team to an emergency psych provider. Heck, any inpatient doctor should be taught the very basics of delirium/agitation management and be able to handle it for an overnight, with the psych team consulted in the morning to refine management. Another C/L service stopped taking consults at 5pm. This one was the worst as we'd maybe get 2-3 consults in the morning, then a huge wave between 3-5pm as teams forgot they wanted a psych consult and put it in as they remembered at the end of the day. Resulted in us being there from 8-7 usually. The worst part was it was painfully obvious this wasn't improving patient care, it was just allowing for other teams to forget about a consult and cutting them some slack.

 

[clausewitz2]

I've been on a few different C/L services at different hospitals. Some of them stop taking consults at 11AM. These ones had really nice hours, still 8-5 or so, but it completely removed those 4:59 "emergency" consults. And that honestly seems like a reasonable request that makes sure other teams are just slightly more organized than usual regarding calling consults. There really aren't consult emergencies, and the acutely decompensated patient can be handled by lots of different people, from the resident on call to a behavioral crisis team to an emergency psych provider. Heck, any inpatient doctor should be taught the very basics of delirium/agitation management and be able to handle it for an overnight, with the psych team consulted in the morning to refine management. Another C/L service stopped taking consults at 5pm. This one was the worst as we'd maybe get 2-3 consults in the morning, then a huge wave between 3-5pm as teams forgot they wanted a psych consult and put it in as they remembered at the end of the day. Resulted in us being there from 8-7 usually. The worst part was it was painfully obvious this wasn't improving patient care, it was just allowing for other teams to forget about a consult and cutting them some slack.

I agree that actual consult emergencies are quite rare, but they do happen - one that comes to mind from our service was a pregnant lady at 32 weeks who had gone into premature labor and was adamantly refusing all medical or surgical interventions of any kind. Consult was for "capacity to consent to emergent c-section."

 

[chajjohnson]

I agree that actual consult emergencies are quite rare, but they do happen - one that comes to mind from our service was a pregnant lady at 32 weeks who had gone into premature labor and was adamantly refusing all medical or surgical interventions of any kind. Consult was for "capacity to consent to emergent c-section."

I understand that the team consulted because they were unsure of what to do, but any physician is qualified to perform a capacity exam. You don't need a C/L psychiatrist for that.

 

[clausewitz2]

I understand that the team consulted because they were unsure of what to do, but any physician is qualified to perform a capacity exam. You don't need a C/L psychiatrist for that.

Your practice environment must be very different from ours, because the vast majority of capacity exams that are even slightly complicated are handled by C&L psychiatry in this neck of the woods. I would guess that it is approximately 20% of the consults received by our service.

 

[chajjohnson]

Your practice environment must be very different from ours, because the vast majority of capacity exams that are even slightly complicated are handled by C&L psychiatry in this neck of the woods. I would guess that it is approximately 20% of the consults received by our service.

They've been a significant portion of consults I've seen as well. However, I'm saying they don't need to be handled by a C/L doctor. Most of the time the consult is simply because the patient made a decision the team didn't like. I even saw a few where the consulting team ran us through all the appropriate capacity questions they asked and the conclusion they came to, and they essentially did everything right but felt uncomfortable the patient was saying no. Seemed like more of a CYA thing in case the patient left and got more sick.

 

[clausewitz2]

They've been a significant portion of consults I've seen as well. However, I'm saying they don't need to be handled by a C/L doctor. Most of the time the consult is simply because the patient made a decision the team didn't like. I even saw a few where the consulting team ran us through all the appropriate capacity questions they asked and the conclusion they came to, and they essentially did everything right but felt uncomfortable the patient was saying no. Seemed like more of a CYA thing in case the patient left and got more sick.

Well, at the end of the day, most consult services exist from the hospital's perspective as a CYA thing, so why should the work of a consult psychiatrist be any different? I get what you're saying and totally agree with you in principle, but on some level if the reality is consistently different, then maybe it is actually part of the field.