Finding an offsite elective in PGY4 year

[phantasmagoric]

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I am currently PGY3 in a residency program in the Midwest. Next year, I was hoping for change of pace by doing an offsite elective. I am open to any field or setting of psychiatry because, to be completely honest, change of scenery is primarily what I am looking for. I would also just appreciate seeing how other systems are run. I feel that my exposure throughout residency was not optimal and not much opportunity here for moonlighting either..

For my program/track in particular, it would have to qualify as a “rural” site.

I wonder if it would be possible to rotate at a site in a different state. If so, I would prefer the following states in rough order of preference: California, Nevada, Utah/Arizona, Colorado, Wyoming/Idaho.

I would greatly appreciate any suggestions (or leads) on how to begin my search.

Is it as simple as cold-calling different psychiatric facilities in area of interest, arranging something, and getting approval from my program? I definitely feel a little bit lost right now…

Thank you

 

[Stagg737]

Is it as simple as cold-calling different psychiatric facilities in area of interest, arranging something, and getting approval from my program? I definitely feel a little bit lost right now…

For the first step, yes. I’d consider looking at other academic centers and PP docs. You would need to find a supervisor who is willing to agree to evaluating you per ACGME requirements, which is not particularly difficult. There are 2 main obstacles I see for this.

1) if you’re a resident, they will likely expect you to be able to function like one and prescribe meds. That means getting licensed in the state you’ll be rotating in and possibly a DEA for that state. Some states take forever with licensing, so if you’re really serious about this (like looking to practice in those states after residency) get started on this now. There are services that can help with this, but idk what their policy is for individuals who are still residents. This also means possibly needing to get your own malpractice insurance as your residency malpractice may not cover you working in other institutions.

2) Many hospitals may be unwilling to credential someone who is only going to be there for 1-2 months, so that could limit your options significantly. You’ll likely could certainly look into academic centers, but PPs that take in state residents for moonlighting or electives are more likely to be willing to take you on. Where I did residency there were several TMS clinics (before we got one) and sleep clinics where our residents did outside rotations. You just have to make sure that there is a psychiatrist who is willing to supervise and evaluate to the ACGME requirements, which are fairly straightforward.

So likely some pretty significant barriers to this. Others can chime in if I’m wrong, but my academic center does not take outside residents for electives as far as I know. I have only an “outside” resident here once, but it was for an FM resident in one of our affiliate programs in another city who wanted to transfer to our psych program, so state licensure, malpractice, and hospital credentialing were not an issue because we were technically the same system.

What may be a less ideal but more feasible alternative is to use 1-2 weeks of vacation and see if you can shadow in one of those states. You’ll likely wouldn’t be able to do everything you do as a resident, but you could see how their systems work and get more insights since you already know what to ask. You could even do that multiple times in different states as long as you can find places to do it.

 

[comp1]

I have NEVER heard of this. Is this something people actually do? I get that residents sometimes get less structured time, but I've never seen it used at a site not affiliated with the residency, much less in a different state. This sounds like a medical student externship, not something in residency. I mean your residency is paying you... I think I've vaguely heard of international stuff, but that's generally with residency affiliated attendings.

 

[Taddy Mason]

I have NEVER heard of this. Is this something people actually do? I get that residents sometimes get less structured time, but I've never seen it used at a site not affiliated with the residency, much less in a different state. This sounds like a medical student externship, not something in residency. I mean your residency is paying you... I think I've vaguely heard of international stuff, but that's generally with residency affiliated attendings.

I did it in residency for a forensic rotation but the site was in the state I was licensed in so I avoided any of those associated issues.