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Started by NickNaylor
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Wow that's a lot more than I thought. Idk if my calculations are wrong but after you're done with residency and working as an attending that comes out to 150/hr*40hrs/wk*48wks/yr = $288,000. And I assume that if residents can pull in $150/hr then an attending would make even more which would put you over the 300k mark. Either I'm missing something or psychiatrists make as much as ophthalmologists?
Is there any moonlight opportunity at your program?
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I'm not sure it's "the worst" haha. I do love what I do but the hours are definitely long. You get used to it though, kinda. I do feel like I am getting a good education even though it's hard to remember that when you are exhausted.
Psychiatry can be very lucrative. I have also heard of residents making more than $100k with their combined moonlighting and residency salaries, but that requires a good amount of moonlighting and the willingness to sacrifice what would otherwise be your days off to work.
I'm still a lowly M4 (started med school in 2010 but took time off for graduate study/research in pharmacology and tropical medicine).
For EM, NYC is a place of extremes.
Some hospitals are crazy (mostly in bronx/brookyln) while others are relatively tame in comparison (mostly in manhattan).
Bellevue is probably the one exception but they still don't see any major trauma. The crazy ones are a goldmine for seeing large numbers of really sick patients and doing tons of procedures on a weekly basis (kings and jacobi for example).
I've got mixed feeling about med school. Honestly could write a whole other post about it. Overall I'm satisfied with the education but still disappointed about M3 and parts of M4 (disclaimer: my home school isn't in NYC but came here for the experience). Its a lot easier for many hospitals to make rotations a passive experience for med students (mostly shadowing, very few hands on procedures, and restricting EMR access). The other problem is that at many places there are just too many learners and not enough sick patients/procedures to go around. I think you learn best by doing (watch one, do one, teach one) and gradually gaining more autonomy as you gain more experience. Unfortunately this is more of a systemic problem in medical education and not school specific. Much of what you used to do in medical school as a M3/M4 is now being pushed back to residency.
Thanks for weighing in. I hope you make a similar thread when you're an intern.
Btw, are you aiming to match at a major county hospital?
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Nick, what's your take and outlook for someone who's interested in a combined Family Medicine & Psychiatry residency / career?
That's the plan.
We'll see, some of the community EM programs (high volume of sick patients w/ no other residencies like surgery, orthopedics, gas, etc) are great for getting hands on experience. They just aren't officially county hospitals or neccesarily in the inner city. I'm applying to them as well.
Sure, I'll try to make one sometime next year during an off service rotation (when we've got more free time).
I know very little about combined residencies, but I will repeat what one of my mentors told me, which is that he doesn't recommend combined programs unless you intend to practice in an area that truly lacks practitioners.
M4 here. From what I have heard from my friends most programs offer at least 3 months off in 4th year, w/ most people taking 1-2 of them in winter to interview. There is obviously a lot of variability if you factor in things like research rotations or independent studies.
The other thing to keep in mind is that expectations drop dramatically in the latter part of 4th year. Most rotations people do later in the year have ar fewer weekend and call days, and at least from what I have heard, many preceptors are pretty lenient about letting 4th years leave early in the sring semester (Note this really depends what you are doing, but most of my classmates and I purposefully built more relaxed schedules).
Regarding the training pushback/passive clinicals: what is the reason for this? Is it purely logistical? Is it educational (from the mes school on down) or legal (liability has forced med students to do less).
Ya I was actually doing those calculations for an attending. A resident could never pull close to 300k because they can only work like ~20 hours at the $150/hr rate. According to my calculations a pysch attending working 40hr/wk could pull 300k given NickNaylor's salary data. Am I wrong?
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Good question. I'm still trying to decipher the dangers that arise from asking med students questions in the OR...
Oh ok. I just assumed the demand for psychiatrists in EDs remained stable. Couldn't a psychiatrist make a career out of working this type of job?
Yes, and in fact some do. Many of the attendings that staff the ED at Big County Hospital only work the ED. One of my co-residents said that one of his attendings gets paid $135/hr part time - she directly told him this. At 2-3 12 hour shifts a week that's a pretty solid gross salary. If you're ambitious, it gives you time to do private work on the side (and one of the attendings does this - he has his own private practice and occasionally picks up 1-2 night shifts a week as extra income) or a pretty decent salary with plenty of leisure time.
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Would it be because of job competition and over-saturation?
Ohh so the ED work doesn't include benefits like health insurance, retirement, etc.? Im just trying to get an idea of how much a psychiatrist might make if they were to have a full benefits position working in the ED. The hourly would probably be lower than $135 cuz of the added benefits?
On a side note, is there a lot of down time for psychiatrists in the ED? I would guess that only like <25% of ED patients need a psychiatrist so even in a busy ER that might be a couple of patients an hour?
I have no idea what the particulars are with respect to compensation.
Our psych ED can house roughly 30 patients - there are two attendings that each staff half the patients and there's a third attending who sees consults in the ED. The psych ED is rarely below 50% capacity, and most of the time there are quite a few patients waiting to be transferred over to the main ED. However, the main ED is pretty massive - I'd say there's at least 100 beds if not more.
Is this a lasting treasure
Or just a moment's pleasure?
Can I believe the magic of your sighs?
Will you still love me tomorrow?
Or just a moment's pleasure?
Can I believe the magic of your sighs?
Will you still love me tomorrow?
I will never say neverrrr
Probably a combination of multiple factors.
- Legal issues. For those attendings that love to teach its not an issue but for others it can act as a big deterrent especially if they've been been apart of lawsuits before or deal with many high risk/complex patients. Its just safer on their end to let students watch from distance instead of getting their hands dirty and possibly making a mistake. Med students are covered by malpractice insurance but work under the attending's license so they take on all the liability.
- More complex/high risk patients (to piggyback off #1) - 20 years ago there were many more "straight forward" patients with just a few basic medical problems. Caring for these patients is a great way to gain experience initially as a med student. When most of the patients on your team have a laundry list of 5+ chronic medical conditions and are on 10 different medications it can be a huge hassle for even senior residents to manage them effectively.
- Customer service aspect of medicine - At many places patient satisfaction now takes precedence over learning. If the patient is not comfortable with students they won't have any on their treatment team. "I don't want to be your guinea pig" is a common thing you will hear if you rotate through hospitals in more affluent areas or at highly regarded universities.
- 80 hour work week limitations - Residents nowadays have less time to do even more work. That leaves less time for teaching and supervising med students during procedures. I can't tell you how many times I got the line "I'd love to show you how to do this but we're too busy or behind schedule today" during 3rd year. Gets incredibly frustrating after a while.
- Logistics of rotating at multiple hospitals. If you rotate through multiple hospitals with different EMRs if can be a huge pain to get security clearance, set up access, go through training, and get used to navigating the system. If rotations are only a month long some places would rather save themselves the time and money of doing this every month for new students.
As a result of the above 5 reasons (plus maybe a few more) there is now a huge amount of training pushback at many hospitals. Because of this, whenever there is a procedure available for med students, it usually goes to the senior fellow or resident who needs the experience because they never got the chance to do one in med school.
I've give you a good example for EM.
At my home hospital (very academic with every residency imaginable) when a level 1 trauma is called, everyone and their mother shows up. Surgery attending/resident/intern/med student, EM attending/resident/intern/med student, 2 nurses, 2 techs, plus a PA or nursing student occasionally. If the patient ends up needing a simple procedure (chest tube or central line) you almost never get to do it because there are literally 4-5 people senior to you who need the experience. Not to mention those procedures aren't that common with blunt trauma and you don't get to see much penetrating during your rotation. Here in NYC for traumas its just an EM resident, med student, and nurse (the attending stands back and watches). The residents have done so many that they're happy to give them away and on a typical night its not uncommon to see 4 or 5 major gunshots/stabbings.
At my home hospital (very academic with every residency imaginable) when a level 1 trauma is called, everyone and their mother shows up. Surgery attending/resident/intern/med student, EM attending/resident/intern/med student, 2 nurses, 2 techs, plus a PA or nursing student occasionally. If the patient ends up needing a simple procedure (chest tube or central line) you almost never get to do it because there are literally 4-5 people senior to you who need the experience. Not to mention those procedures aren't that common with blunt trauma and you don't get to see much penetrating during your rotation. Here in NYC for traumas its just an EM resident, med student, and nurse (the attending stands back and watches). The residents have done so many that they're happy to give them away and on a typical night its not uncommon to see 4 or 5 major gunshots/stabbings.
So essentially, you recommend that we get a good amount of county hospital rotations while in med school.
Oh and thanks for the awesome feedback!
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To be fair county hospitals come with there own sets of problems. They generally have fewer resources (especially staff) so in my experience you are more likely to end up doing scut work. There is always a balance to be had, and if you have the ability to choose among multiple sites for rotations you really need to do your research to see how each location operates.
I'm guessing this will vary by VA hospital, but would any of you guys say that you had more of an opportunity to get some hands-on experience versus "glorified shadowing" while working at a VA during clerkships and/or during internship compared to civilian hospitals?
I never worked at a VA prior to residency.
For the rotation I did at the VA, the service was effectively run by the residents. We did have an attending but he was busy doing other stuff and while he did see all of the patients, he saw them independently. He was relatively hands off.
I have no idea how common this is across other VAs or specialties.
Agree with Chir0nex.
It all depends on what you're looking for in medicne. There is no perfect hospital system (especially in the US).
Some people prefer nicer facilities, more educated patients, a slower pace, and doing mostly hands-off intellectual work.
For county type hospitals there are less resources to go around and we do end up performing more of the so called "scut work."
This usually involves things like starting our own IVs, drawing labs, starting nebulizers, and putting patients on CPAP/BiPAP.
(things that usually nurses or RTs would do at more academic places). However, once you've done it enough you get really good at it and it only takes an extra few min per patient. Plus its a good skill to have if the nurses are busy or if your patient is really sick and needs IV access/medications ASAP. I personally don't mind at all and actually really enjoy spending the extra time with patients and doing the "little things" for them.
As for VA hospitals they do usually provide more autonomy and hands-on experience but come with their own special set of problems.
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Why'd you ignore my questions, @NickNaylor? 🙁
Agreed. What matters most is who you have training you. I got to do a ton on my surgery rotation and it was almost entirely because of my residents. I had an opportunity to impress a couple of the senior residents on-call early in the clerkship, and by the end they were stepping up for me and pushing the attendings to let me do more in the OR (being first assist etc...). Part of it is luck in getting good residents who look out for their students. On the student end the most important thing is that whenever you are given a task, to do it well. That is the only way to get a good rep, and thus be given a chance to do more advanced things. Location is basically irrelevant IMO.
Just ban him, man 😉
The psychiatrists I know in PP charge $300-400/hr. They also tell me that the market can bare this. Is there a catch? The way they explain it to me, PP psych seems extremely lucrative, and not hard to fill. What incentives are there to take insurance for Psychiatrists?
And here I thought I was holding back 😉
While its certainly not an every day or even weekly event, if you know your stuff and are proactive you can perform multiple lines/tubes over the course of a month as an M4. I can’t comment on every county hospital as I haven’t spent time at them all. Talking to other M4s (myself included) many of us have had the chance to intubate, put in a central line, and do the occasional chest tube (all under close supervision).
And yes, I’m well aware that procedures aren’t everything in medicine. But, like everything in life, the more you practice the better you get at it.
Having rotated at 7 different hospitals (academic x2, county x2, community, private, and VA) I’d have to disagree. Of course working hard and getting good residents helps, but the culture of the hospital and their patient population also plays a big role in determining what students are able to do on rotations.
I also got to do more in the OR after working hard early during my M3 surgery rotation. Then again, I got to do far less overall compared to when I did a 2 week externship rotation at a busy community hospital during M2. It was just me, a senior resident, and the attending and I first assisted on twice as many cases...as an M2. Another example would be OB/Gyn. Half of our students do OB at the academic teaching hospital (more residents and less births) while the other half at our affiliated community hospital (less residents and more births). The 2nd group commonly gets 10-15 deliveries while the 1st is lucky to get 2-3 deliveries by the end of the rotation. It has nothing to do with working hard or having good residents. Rather, too many learners and not enough births = less hands on experience.
I think there is some truth to the county hospital/VA being more liberal with students. As a M3 I did 20-something intubations during my 1 week anesthesia month at the county hospital, whereas the med students I've talked to at the main hospital have all done <3 in their time. I also got to do a ton of A-lines and a few centrals at the county hospital as a M4, whereas at our main hospital I've done even less as an intern. I'm sure it varies based on attending/senior/location, but I dont think its necessarily an unfounded rumor.
I can field some questions on ENT and maybe surgical subspecialties in general, if any premeds are curious.
I can field some questions on ENT and maybe surgical subspecialties in general, if any premeds are curious.
As a new intern, do you ever see/hear of any DO discrimination from colleagues?
BTW congrats man, I didn't even realize you graduated, been following your profile since I started undergrad.
BTW congrats man, I didn't even realize you graduated, been following your profile since I started undergrad.
There will always be some degree of DO discrimination, whether to your face or behind your back. You knew that was the reality going in (or at least you should have), nothing to do about it now but move forward. I haven't seen it actually affect a resident yet, for what it's worth. No idea about long-term.
I haven't seen any personally but I agree with @Wordead's post.
It's already been touched on a little, but would you (or any of the residents/attendings) care to talk about the major differences you've experienced when rotating between main vs. county vs. VA hospitals? Are they different systems or is it just staffing/patient population that makes them different experiences?
In my experience they are all different systems and treat different patient populations. The VA has it's own self-contained system. In my program, most of the faculty are also professors at the university but primarily practice at the VA. The county hospital in my program is staffed entirely by faculty from the university. The patient population is predominantly the indigent. The university hospitals primarily see well-insured and wealthy folks. Because of the differences in population (vets vs. indigent vs. well-insured), there is little integration among the systems.
