Is your lifestyle better than your colleagues in other fields?

[SmallBird]

I think that most people recognize psychiatry as being a field that offers a better work life balance than others, but at the same time I am interested to hear the extent to which this is true for different people at different stages of their careers.

My sense as a PGY2 resident is that I have a much lighter workload during the week, and that I have at least twice as many free weekends as my friends doing medicine or neurology. I feel that in the discussions about salaries and mid-levels, this forum occasionally risks emphasizing the challenges of working in this field, and therefore wanted to bring up this really significant advantage - in my experience, any way.

An additional advantage that I feel is less spoken about is that there is less need for memorization and reading of 'core content' - I find myself just buying more and more psychotherapy books, because that's what interests me, and I don't feel I need to spend a lot of time reading outside this area, being able to pick up most of the core knowledge during didactics on from clinical experiences. By contrast, a close friend of mine who is a neurologist finds he has little time to read about his specific interests as he is snowed under by the amount of neuro anatomy, stroke protocols, etc. that he needs to know.

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[Rachell]

Psych has gotta be the most life-friendly field. Do you remember grade school? Many of my days I'm going home by 4pm. In our large hospital the other departments leave much later. Sleeping normal hours and having time to enjoy each day is priceless. I'm a happier person because of it, and my patients benefit. Life balance => happiness => energy => caring and thoughtful one-on-one sessions with patients. It's a win-win for all, and my patients ask to see me every week now.

 

[Dharma]

I am in no place to answer any of your questions but do you feel that knowledge, in-depth understanding, and subsequent mastery of neuroanatomy are paramount to the field of psychiatry (at least in the years to come, especially with ongoing brain research)? I find the interplay of various facets in one's life and the effects this interaction has on an individual's mental (and physical) health to be extremely interesting (and is what attracts me to the field), similar to what OPD said about this way back:

I came into psychiatry with a background in basic neuroscience research, so my perspective is that behavior is firmly grounded in the brain. Nevertheless, the brain is an extremely adaptive and plastic organ, and responds exquisitely to its environment. Therefore, everything is relevant--the patient's pre- and post-natal development, their early life experiences, their internal and external stresses and traumas, their relationships past & present, their thoughts, dreams, beliefs, loves, and hopes. Psychiatry brings together everything I love: science, medicine, psychology, philosophy, spirituality, compassion, understanding, and social justice. I hope that in answering your questions in this forum, I can pass some of this on to you.

OPD

I can't help but think that neuroanatomy plays a huge role here. I'm not criticizing your position (how could I as a measly M2) but wouldn't a psychiatrist strive to master neuroanatomy as it relates to the field (even if this is not necessary to success at the present time)?

Anyhow, just wanted to throw that out there...

 

[nitemagi]

I think that most people recognize psychiatry as being a field that offers a better work life balance than others, but at the same time I am interested to hear the extent to which this is true for different people at different stages of their careers.

My sense as a PGY2 resident is that I have a much lighter workload during the week, and that I have at least twice as many free weekends as my friends doing medicine or neurology. I feel that in the discussions about salaries and mid-levels, this forum occasionally risks emphasizing the challenges of working in this field, and therefore wanted to bring up this really significant advantage - in my experience, any way.

An additional advantage that I feel is less spoken about is that there is less need for memorization and reading of 'core content' - I find myself just buying more and more psychotherapy books, because that's what interests me, and I don't feel I need to spend a lot of time reading outside this area, being able to pick up most of the core knowledge during didactics on from clinical experiences. By contrast, a close friend of mine who is a neurologist finds he has little time to read about his specific interests as he is snowed under by the amount of neuro anatomy, stroke protocols, etc. that he needs to know.

I've found that I have plenty of time to arrange, but continue a trend from residency of filling it up. That isn't a bad thing. My other colleagues have a set 40-60hr week, depending on their field. Plus/minus call, sometimes.

I can arrange my time based on priority, which I believe is more possible in psychiatry than other specialties. Last year I worked 70hrs/week at multiple jobs because debt was a priority. Now I work 30hrs/week clinically, and spend the rest of my time doing writing and other projects. It's a nice feeling and a privilege to be able to choose how to spend your time, one which I have a lot of gratitude for at this time in life.

 

[Rachell]

Yes, we strive to master neuroanatomy. In our didactics we always refer to parts of the brain when discussing memory, emotion, disease states like schizophrenia, etc. On our Prite exams neuroanatomy is tested.

 

[nitemagi]

Yes, we strive to master neuroanatomy. In our didactics we always refer to parts of the brain when discussing memory, emotion, disease states like schizophrenia, etc. On our Prite exams neuroanatomy is tested.

While that's true we understand some aspects of neuroanatomy (mesolimbic, for example), trying to understand schizophrenia by simple anatomic abnormalities is a bit too simplistic. There are more pathway issues that are not visible grossly, so simply knowing the structure isn't enough.

I'd compare it to understanding genes as a reductionistic way of understanding the person. Twin studies, gene expression, all reveal there's a lot more to it.

A nice New Yorker article discusses some of this --

 

[digitlnoize]

I think that most people recognize psychiatry as being a field that offers a better work life balance than others, but at the same time I am interested to hear the extent to which this is true for different people at different stages of their careers.

My sense as a PGY2 resident is that I have a much lighter workload during the week, and that I have at least twice as many free weekends as my friends doing medicine or neurology. I feel that in the discussions about salaries and mid-levels, this forum occasionally risks emphasizing the challenges of working in this field, and therefore wanted to bring up this really significant advantage - in my experience, any way.

An additional advantage that I feel is less spoken about is that there is less need for memorization and reading of 'core content' - I find myself just buying more and more psychotherapy books, because that's what interests me, and I don't feel I need to spend a lot of time reading outside this area, being able to pick up most of the core knowledge during didactics on from clinical experiences. By contrast, a close friend of mine who is a neurologist finds he has little time to read about his specific interests as he is snowed under by the amount of neuro anatomy, stroke protocols, etc. that he needs to know.

Agreed x1000. I have soooo much more time off, even when I was an intern that it's not even funny. Now as a 2nd year, I'm loving it. I've been home well before 5 pm most days.

People always discuss yearly salary, but they really need to be looking at the hourly rate. When you put it that way, we rank very favorably. Still not #1, but much higher up the pack than our avg. yearly salary would have you believe.

All that being said, I think to call if a "lifestyle field" only applies if you enjoy the work. It's like derm. For me, I don't care how much derm pays. I couldn't do it. Ever. It sounds like hell. You couldn't pay me enough. If you felt that way about psych, the "awesome hours" wouldn't really be worth it.

I do sometimes wonder if we couldn't shorten residency by a year or two by upping the work hours though. Not that I'd want to. I like it the way it is...

 

[splik]

Yes, we strive to master neuroanatomy. In our didactics we always refer to parts of the brain when discussing memory, emotion, disease states like schizophrenia, etc. On our Prite exams neuroanatomy is tested.

when did schizophrenia become a disease state? i must have missed that...

 

[Rachell]

when did schizophrenia become a disease state? i must have missed that...

To be more accurate, it's a mental disorder that has a genetic basis. But I do subscribe to the theory of teratogens in utero possibly contributing to its phenotype seen later in life. Perhaps I used the term disease too loosely.

 

[splik]

ignore me, im just being an arse

 

[splik]

but do you subscribe to the theory that psychosis is related to alienation?

whether 'schizophrenia' has a genetic basis or not, it certainly has a strong social basis. why is it more common in african americans? that is not genetic. why is more common in migrants? why is it associated with urbanicity? why is it associated with parental separation and loss? distorted racial identity? perceived social disadvantage? the geographic region you live in? why is the incidence dwindling in some parts of the world (e.g. scandinavia), and doubling in others (e.g. London)? none of these things can be explained by genetics or neuroanatomy. which is not to say i dont think functional neuroanatomy is important for psychiatrists - one of the most useful teaching sessions i had was a brain cutting on the functional neuroanatomy of emotion and cognition.


sorry to derail the thread!

 

[masterofmonkeys]

Depends on the program. My work hours weren't particularly light in PGY1 and 2; my friends in medicine worked on avg fewer hours than I did and arguably the only 'harder' rotation they had than us was ICU--even that was fewer hours, just tougher call. My hours as a 3 (different program though) are great though. The trouble I'm running into is that I find it difficult to shorten my appointments enough to write notes in between patients. I'm a pretty fast note-writer; it's just that I don't like doing that. I usually find things to occupy the time even in a med-management appointment. Behavioral activation, MI, etc. I guess this is something that happens across specialties, but a 'full day' will be two hours longer once you get the notes done. 11hr days are not my idea of 'lifestyle'. I realize this is my issue and mine alone, so meh.

This is why I'm actually leaning toward private practice though. I am just tired of medicare's and insurance company's paperwork, I'm tired of bureaucracy, I'm tired of all those little games people play so they feel important which end up having nothing to do with good patient care.

TL;DR - 3rd year and later is pretty chill.

 

[PhinyGage]

I'm at a program where, in the past, both PGY1 and 2 carried a very cumbersome workload. Now, S/P work hour restrictions, PGY1 is more reasonable (60 hrs most weeks)and PGY2 is rather ridiculous (~70 hrs 10 months out of the year). Again, its all in the context of psychiatry. My complaints are limited when I compare to medicine and surgery (at my same program). But even they will admit that their is a different kind of stress when caring for patients with active psychiatric illness. Our consult service is highly regarded for that reason.

Our weeks may have slightly shorter hours but the extra stress of caring for psychiatric patients (at least at my program) balances out the "workload" differences.

Nobody (else) wants to go near our patients if they don't have to.

 

[michaelrack]

I can't help but think that neuroanatomy plays a huge role here. I'm not criticizing your position (how could I as a measly M2) but wouldn't a psychiatrist strive to master neuroanatomy as it relates to the field (even if this is not necessary to success at the present time)?
..

Yes, psychiatrists strive to master neuroanatomy, even though it is not necessary to success (a practicing psychiatrist doesn't need to be an expert at neuroanatomy). AS others have mentioned, a knowledge of neuroanatomy is necessary for board exams.

 

[SmallBird]

Yes, psychiatrists strive to master neuroanatomy, even though it is not necessary to success (a practicing psychiatrist doesn't need to be an expert at neuroanatomy). AS others have mentioned, a knowledge of neuroanatomy is necessary for board exams.

I guess I didn't think too much about the boards, but in terms of growing in competency as a clinician, I feel that I can pretty much read what I'm interested in 90% of the time, and still get good feedback from attendings. Based on the PRITE the neuroanatomy we need to know is far less than the neurologists need to know, and my sense is that the overall core content we need to know is also less, but I might be in for a rude awakening when board prep comes around!

 

[SmallBird]

I'm at a program where, in the past, both PGY1 and 2 carried a very cumbersome workload. Now, S/P work hour restrictions, PGY1 is more reasonable (60 hrs most weeks)and PGY2 is rather ridiculous (~70 hrs 10 months out of the year).

Wow, that is very intense - is that a general inpatient unit?

 

[michaelrack]

I guess I didn't think too much about the boards, but in terms of growing in competency as a clinician, I feel that I can pretty much read what I'm interested in 90% of the time, and still get good feedback from attendings. Based on the PRITE the neuroanatomy we need to know is far less than the neurologists need to know, and my sense is that the overall core content we need to know is also less, but I might be in for a rude awakening when board prep comes around!

The neuroanantomy a psychiatrist needs to know isn't that complex (compared to a neurologist), and I believe PRITE neuroanatomy is similar to boards.

 

[PistolPete]

Man, I wish I had as good of a lifestyle as I thought before going into residency. FIrst year was decent, but busy. About 55-60 hours per week. So far this year, averaging 70 hours per week, and call most weekend and plenty of nights. Blows. Can't wait till I never have to do call again!

 

[PhinyGage]

Wow, that is very intense - is that a general inpatient unit?

Not necessarily. About 5 months of it is. The other 5 months are electives and consult services that still require us to share call with others on the inpatient units. Its about q5.5 on average and we sometimes cater to a very entitled patient population (which means long hours to talk with families, give them the very best care, yadda yadda).

It is still doable but it gets old very quick.

 

[strangeglove]

Yes, psychiatrists strive to master neuroanatomy, even though it is not necessary to success (a practicing psychiatrist doesn't need to be an expert at neuroanatomy). AS others have mentioned, a knowledge of neuroanatomy is necessary for board exams.

I have a theory that you don't need to know neuroanatomy to be a good neurologist, since most lesions can now be localized with imaging and lesion location has little to do with management, except in certain very specific instances.

 

[DebDynamite]

Yes, the lifestyle is better. The hourly rate is better. A lot of it depends on what you want to do. I know a psychiatrist who makes just under 1million every year and has for about ten years or so. He works about 70 hour weeks. I know another one who makes 69 K a year and I don't think she works much at all, maybe 20 hours a week. There is a lot of variability in psychiatry.

I currently work in a VA. My salary is "average" for the region but when you look at how many hours I am putting in it's higher than most of the people I know working inpatient units around here in the other (non- VA) hospitals. I increase my income by about 15K a year with minimal moonlighting (phone call over the weekend for a child facility where I receive very few calls). I could be making even more if I wanted to, but I leave to go home at 430 every day, have every govt' holiday, etc etc. I was either going VA or private practice (no insurance) and I have no regrets about it. In a few years I will open up a private practice and cut back to part-time. My hours are excellent. I did all the math on the leave one could pull at a VA and there is so much leave available, you could just work four day weeks all year. It's not bad at all, but every VA is different and some are intolerable (from what I hear). Not so where I am.

 

[PistolPete]

DebDynamite, why did you choose the VA over no-insurance private practice?

 

[DebDynamite]

Many reasons, I have an unusual job at the VA. I get a lot of different exposure. I am moving to a different state next year and don't want to build my practice here. I take risks and the benefits package at a VA (pension plus 503b) is one that is hard to match. What I mean by that is that if I live a long time the benefits package from the US govt is going to supplant a lot of that p practice income. I am looking to retire out of the VA system. At the least,stay five years and get the health insurance for myself and family and then switch to either locums or p. practice. My VA has residents and meds students and there is "just enough" exposure here to academia for me, which is a plus. Not too much.

I enjoy working with the Vets, especially the OIF OEF vets, and there is a women's clinic here and I serve as the consulting psychiatrist for them. It's a population that the private practice model can't capture. It's a much, much more varied population than you would imagine. I get to work at 8, I leave at 430. The call is minimal. I'm starting a small business with my husband on the side that I expect to generate six figures a year by the time I am 50, and I barely put any work into it. I get to keep practicing psychiatry while I have a life. I don't deal with HMOs and bs like prior auths. While I philosophically prefer libertarianism, I'm a realist and since our system is totally broken , the VA is providing the best "free care" out there. They beat Obama Care hands down. I think insurance companies are pretty awful as a ROT, and I don't have to deal with them this way. Private practice, the population is different. Not bad, just different. And not one I am ready to service long-term.

The downside of the VA is the bureaucratic crap. For instance, I find myself making non-formulary "requests" to pharmacists at times. which is absolutely ridiculous. They really think they have a clue what the heck is going on and while some are very helpful,. essentially they are spouting off algorithms and they have zero clinical training the way we do. I hate it so much I have pretty much vowed to avoid that part of the job and stick to the formulary as much as possible. Even worse are some of the psychologists I interact with, who also have very little clinical training like ours but for some reason don't have insight into this. They make me want to pull my hair out with some of the ridiculous things they say,. and with such disturbing degrees of confidence I want to vomit. Anyway, for the most part I am really enjoying it. And as a ROT most of the pharmacists and psychologists are normal humans who don't act like cluster B nightmares. But the outliers that are at the VA, in my proximity, well that's the downside.

 

[PistolPete]

Interesting. What area of business are you going into on the side? I'd also like to start some non-medical venture when I get out into practice. Any tips?

 

[DebDynamite]

I can pm you but I already have the land required for it. That is a big expense and I inherited it. So I am not sure my situation applies to everyone. Also what part of the country do you live in?

 

[JamesPhilly]

OP, you mentioned as a PGY2 that your load isn't as great as our colleagues in other fields, and I'm sure that varies greatly from program to program, but I would second your observation

As a pgy1 my schedule is pretty sweet. We work hard during night float, inpt psych, and EM, but for the most part things are easier for me compared to pretty much any other specialty (again, this is only my experience). Haven't worked one weekend yet

I choose to keep my acls/atls, but that's not required. Which is great, i like the self directed learning. If you wanted to work more hours and take more responsibilities they would certainly let you. Myself, I'd rather spend time with the family