Finding PGY-2 Spots?

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hipster22

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Hello everyone,

I'm an intern at a fairly busy academic Psychiatry residency program. We have lost two people out of our program due to family issues (mid year). Our program has been completely unprepared for this and our call schedule has also reflected this. We have also lost a good amount of faculty and we no longer have set didactics. I feel like this program is no longer of any academic quality but rather just an excuse to move the meat for lazy ancillary staff.

I have done all my off-service rotations and I can definitely tell that the program is not organized compared to other departments. I really am getting sick of the way our lack of residents is being handled and the fact that the program administration is not doing anything to help manage the lack of manpower. A good number of our faculty has also left because of pay issues due to the institution/hospital suffering financially.

I'm feeling very scared that the program may not face probation soon for being so poorly managed. To top it off we have a very difficult and unreasonable program director who believes that we should just shut our mouth and not even think about complaining about anything on our chest. This is evident by this person not even making any conscious efforts to address the fact that we are down two residents. I am dreading finishing intern year and moving on to second year at this point because I know that the workload is going to be more concentrated on each resident. We are all lying about our duty hours so that we don't get hounded for violating hours and being inefficient.

In summary, I want to wrap up this intern year and find a second year spot somewhere else. I feel very scared about making mistakes with lack of supervision and the fact that I'm so overworked with the number of patients I have that I'm putting in wrong orders for patients.

I don't want to screw over my co-interns and I don't want to give my program director whiff of my intentions because I don't trust the guy, but I cannot see myself progressing in this program in a comfortable fashion without jeopardizing my sanity and patient care. I want advice on how you guys would recommend trying to look for a position while being discrete about it.
 
You aren't going to be able to jump ship without your PD finding out about it, without leaving your co-residents in a bad situation, and most target programs are going to want to talk to the PD about you before signing you on. So I don't see your plan as very realistic. If you took the position that psych wasn't for you and you were going to start over from scratch in something else, that might go over differently, but trying to jump ship just because you feel overworked as an intern and feel your program is mismanaged and at risk isn't going to go over well. First, intern year is the hardest year everywhere-- in lots of specialties people work long hours and feel abused and have very steep learning curves. It generally gets better as you get more senior. Second, you are in one of the shorter residencies, not a life sentence. It's often not a bad idea to keep your head down and ride it out if we are just talking about a couple of years. Third, probation is a slow and drawn out process-- in most cases you'll see it coming years out, and the place will wind down over years, so you'll probably finish. Or they will help residents find landing spots. And if it closes abruptly, that's a much better reason for you finding a new spot.
 
Mid-internship year is the worst. It generally gets better as you become more efficient and confident.

It is going to be difficult to move to a different program unless you have a very compelling reason to do so. Not liking the program is probably not going to be a good enough reason. What is your prospective gaining programs going to think? "Oh, I feel so sorry for him/her." Nope...they will definitely think more along the lines that you are a malcontent that are at risk of flaking out on their program.

Suck it up...continue to work hard and put the thought of leaving out of your head...it will only weigh you down.
 
This is unfortunately not that uncommon for psychiatry programs. Contrary to popular belief, surgery only has the second highest attrition rate of all residencies... and the highest is psych. Good psych programs have contingency plans in place, but some of those plans are more robust than others.

The good news is, finding a PGY2 psych spot somewhere else is easier than most other specialties. The bad news is, your PD can still tank your chance of moving elsewhere if they really wanted to. Be careful before you make any final decisions.
 
My PD is an unrealistic person unfortunately and doesn't realize that we are short staffed.

I don't feel like I'll have his full blessing for transferring but I don't think it's fair that he should be allowed to make me do something that I don't want to do.
 
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hipster22 said:
My PD is an unrealistic person unfortunately and doesn't realize that we are short staffed.

I don't feel like I'll have his full blessing for transferring but I don't think it's fair that he should be allowed to make me do something that I don't want to do.
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Hi! its call being an adult...
 
hipster22 said:
My PD is an unrealistic person unfortunately and doesn't realize that we are short staffed.

I don't feel like I'll have his full blessing for transferring but I don't think it's fair that he should be allowed to make me do something that I don't want to do.
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He's "allowed" to give you whatever recommendation he deems to be appropriate. That may or may not be positive. It may or may not be (unduly) influenced by the short-staffed situation. And that recommendation may or may not have enough influence on a new PD at a potential transfer program to stop any transfer. It all depends on the people involved and the way you handle it.
 
hipster22 said:
My PD is an unrealistic person unfortunately and doesn't realize that we are short staffed.

I don't feel like I'll have his full blessing for transferring but I don't think it's fair that he should be allowed to make me do something that I don't want to do.
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If you don't want to follow your PD's rules, then you could quit. But he/she is your boss and therefore, you have to do what he/she tells you to do to prevent from getting fired. This is NOT unlikely the real world. Nobody forced you to rank the program and match there. Now you have some options to consider. None may be the option you want...but at least you have options. Some people don't even match and are stuck hundreds of thousand in debt. Look at your options...and pick from the list.
 
j4pac said:
If you don't want to follow your PD's rules, then you could quit. But he/she is your boss and therefore, you have to do what he/she tells you to do to prevent from getting fired. This is NOT unlikely the real world. Nobody forced you to rank the program and match there. Now you have some options to consider. None may be the option you want...but at least you have options. Some people don't even match and are stuck hundreds of thousand in debt. Look at your options...and pick from the list.
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On a similar token, residents signed up or "ranked" a program on the fair assumption that the program has its **** together.
 
Doctor4Life1769 said:
On a similar token, residents signed up or "ranked" a program on the fair assumption that the program has its **** together.
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That said, there are two sides to every story....

Furthermore, @hipster22 I'm not sure what you're expecting your "malignant" PD to do about replacing the residents. We lost ONE intern at my program mid-year and cleaning up the call and rotation schedule was a complete nightmare for everyone involved.
 
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When I said he should not be making me do something I don't want to do, I'm implying that why would a program director want someone who is unhappy or uncontent in their program to continue?

Regarding the intern leaving, I feel that the program could make efforts to recruit someone who didn't match or is currently looking. I know it is possible to take someone off cycle (it's not convenient but it would at least help all the residents out).

It really sucks for me to see 3rd and 4th years taking call right now. We definitely need more resident slots and I'm definitely not alone in feeling that way. Our chief is even sympathetic to us, but the program director has very little involvement with the program.
 
hipster22 said:
When I said he should not be making me do something I don't want to do, I'm implying that why would a program director want someone who is unhappy or uncontent in their program to continue?

Regarding the intern leaving, I feel that the program could make efforts to recruit someone who didn't match or is currently looking. I know it is possible to take someone off cycle (it's not convenient but it would at least help all the residents out).

It really sucks for me to see 3rd and 4th years taking call right now. We definitely need more resident slots and I'm definitely not alone in feeling that way. Our chief is even sympathetic to us, but the program director has very little involvement with the program.
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Sorry, not to pile on, but your last sentence gives me a lot of skepticism about your view of how things are run. Until my own chief year I didn't really appreciate how much BS my PD would constantly deal with in the background to keep the place running. So much of the job is thankless

As for finding someone off cycle? I'm not sure where you'd be getting said people or if their quality makes keeping them around for 4 years is worth it. When we replaced our guy who quit/got fired early in his intern year, we exclusively looked at people in other psych programs, but that required us waiting until July.
 
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SouthernSurgeon said:
I don't think we would ever consider filling off-cycle if the situation arose. You're not just hiring a warm body for four months. You have to be confident the person you're bringing in will be successful in the program long term.

Plus, a mid-year replacement may be a warm body for the call pool, but who's to guarantee they will even do a good job with that? Might mean they need more oversight at night (i.e. still more work for everyone else involved) or that they make mistakes or are slow to pick up the system...
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yup. I do feel for the OP since as I said the interns in the program got completely dumped on when we lost ONE guy, but it was a temporary situation. We ended up having a small batch of good candidates available to come to us to replace him (and a larger batch of bad ones) for our open PGY-2 spot but none of them were sitting at home twiddling their thumbs. You can't just yank someone mid year from another program.

Plus, even if you bring someone on now, and it only takes a month or two for them to be call-ready, you still have six months of off-service rotations they'll still need to do, so you're still going to be down a resident for a half a year. Though my program had really front-loaded call with the interns doing most of it, (which isn't always the case in psych) so missing a PGY-2 theoretically hurts less than losing an intern.
 
WingedOx said:
yup. I do feel for the OP since as I said the interns in the program got completely dumped on when we lost ONE guy, but it was a temporary situation. We ended up having a small batch of good candidates available to come to us to replace him (and a larger batch of bad ones) for our open PGY-2 spot but none of them were sitting at home twiddling their thumbs. You can't just yank someone mid year from another program.

Plus, even if you bring someone on now, and it only takes a month or two for them to be call-ready, you still have six months of off-service rotations they'll still need to do, so you're still going to be down a resident for a half a year. Though my program had really front-loaded call with the interns doing most of it, (which isn't always the case in psych) so missing a PGY-2 theoretically hurts less than losing an intern.
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What I'm saying is that there are plenty of candidates who don't match or who could not complete residencies (but finished intern year), I know for a fact that they would jump at the opportunity. I know there are people looking to do observerships who are very deserving and would make wonderful candidates. I know that they would be easily teachable.

The off service rotations for these individuals would be a non-issue since the people I'm talking about have done IM or Surgery but had a change of heart and wanted psychiatry instead. this would entail getting someone who is waiting for a spot outside of the match.

I do understand your point about the PD doing a bunch of stuff behind the scenes, but I really think our chief has been doing a lot of the PD's responsibilities due to the PD's personal troubles.

Did you fill your PGY-2 Position mid-year? or was it at the beginning of a new year (i.e July)?
 
hipster22 said:
What I'm saying is that there are plenty of candidates who don't match or who could not complete residencies (but finished intern year), I know for a fact that they would jump at the opportunity. I know there are people looking to do observerships who are very deserving and would make wonderful candidates. I know that they would be easily teachable.

The off service rotations for these individuals would be a non-issue since the people I'm talking about have done IM or Surgery but had a change of heart and wanted psychiatry instead. this would entail getting someone who is waiting for a spot outside of the match.
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So where exactly are these people? Are they working residencies in other specialties? If so, snatching them mid-year will give your program a VERY bad reputation fast. Otherwise, the types of people who couldn't match or SOAP into anything are the people you want in your program for the next three years? C'mon now.

Did you fill your PGY-2 Position mid-year? or was it at the beginning of a new year (i.e July)?
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We lost the guy in the fall and filled it in July once his replacement completed the year at the program he was coming from. The benefits of taking the hit for a few months and getting candidates who aren't displaying red flags large enough to fly over the Kremlin far outweighs the advantage of filling immediately.
 
WingedOx said:
So where exactly are these people? Are they working residencies in other specialties? If so, snatching them mid-year will give your program a VERY bad reputation fast. Otherwise, the types of people who couldn't match or SOAP into anything are the people you want in your program for the next three years? C'mon now.



We lost the guy in the fall and filled it in July once his replacement completed the year at the program he was coming from. The benefits of taking the hit for a few months and getting candidates who aren't displaying red flags large enough to fly over the Kremlin far outweighs the advantage of filling immediately.
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I'm not saying to snatch them from another program mid-year. There are a lot of good candidates who cannot match into something or for whatever reason had to leave residency due to health reason's at one stage or the other. I've seen some general practitioners in particular who have gone through this as well.

But maybe I don't see the bigger picture as an intern. It just really sucks right now with having to take as much call as we are taking.
 
hipster22 said:
I'm not saying to snatch them from another program mid-year. There are a lot of good candidates who cannot match into something or for whatever reason had to leave residency due to health reason's at one stage or the other. I've seen some general practitioners in particular who have gone through this as well.

But maybe I don't see the bigger picture as an intern. It just really sucks right now with having to take as much call as we are taking.
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no there are not as many as you think...they didn't match for a reason...
 
jkdoctor said:
This is hateful nonsense imo. I have seen very good students not match into both derm and ortho.
The idea that there are not good candidates that did not match is total fiction. I know an attending dermatologist who did not match in derm until his third try. He packed in research after med school to fill two gap years.
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the thread is not about derm or ortho...its about psych...not uber competitive...its average competitive...you have good scores, good grades, good LoRs and apply appropriately, and not be weird during your interview, you will match...

and not matching there is always a reason...doesn't mean they are stupid or not capable, but they had a red flag or flags that kept them from matching...crappy step scores, poor grade or grades in clinicals, didn't apply to enough places or didn't rank enough places...but something...

and those same unmatched ortho and derm wannabes? you really think they are going to settle for a psych spot when their dream is derm or ortho? No of course not...otherwise your derm attending friend wouldn't have tried for three cycles to get derm...
 
jkdoctor said:
...
This is hateful nonsense imo. I have seen very good students not match into both derm and ortho.
The idea that there are not good candidates that did not match is total fiction. I know an attending dermatologist who did not match in derm until his third try. He packed in research after med school to fill two gap years.
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People who don't match into derm or ortho do one of three choices. They either spend a year making themselves more competitive for derm or ortho, they do a prelim year and try again, or they soap/scramble into something else (semi competitive, and for ortho usually something surgi). They aren't available to join a psych residency mid cycle.
 
Colleague, If people choose the second option, are they more likely to be successful the 2nd time around? On the surface, this seems like doing the same thing over and expecting a different result.

Law2Doc said:
People who don't match into derm or ortho do one of three choices. They either spend a year making themselves more competitive for derm or ortho, they do a prelim year and try again, or they soap/scramble into something else (semi competitive, and for ortho usually something surgi). They aren't available to join a psych residency mid cycle.
Click to expand...
 
Goro said:
Colleague, If people choose the second option, are they more likely to be successful the 2nd time around? On the surface, this seems like doing the same thing over and expecting a different result.
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I personally know people who landed an ortho spot after a year of prelim general surgery, so it does happen. I suspect it's not the most high yield approach though and so if you weren't close to the cutoff the first time this could be very risky.
 
Goro said:
Colleague, If people choose the second option, are they more likely to be successful the 2nd time around? On the surface, this seems like doing the same thing over and expecting a different result.
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I know of one ortho and one urology success story after street prelim general surgery year. I saw many more that never got that spot.
 
ThoracicGuy said:
I know of one ortho and one urology success story after street prelim general surgery year. I saw many more that never got that spot.
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Yeah, most decide "well GS is good enough for me".

the odds that they decide "oh, I've ALWAYS wanted to do Psych after all?" yeah. no.
 
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