Leaving Psych Residency

[RadioFlierP]

Hi, I am a current PGY1, I know it is rather early but I am having difficulty in my psych residency. It is a brand new program. I expected some difficulty since it is a cultural shift for this small community based hospital. I am only 2 months in but the issues that have come up are more than what I anticipated.

When I was on the residency interview trail and looking at other residency programs websites, I would often see that there were decreasing numbers of residents in each class, often with PGY4 having the least amount. Is there a reason for this, outside of fast tracking into C&A? Is anyone familiar with transferring psych residency programs? How do you go about finding new openings? Is a letter of good standing from PD always required to transfer? When is the best time to look for new programs? Have others experienced difficulty in PGY1 year but that it got better in subsequent years? Sincere advice is appreciated.

---

Members don't see this ad.

 

[Psychotic]

You are an intern, right? What issues? Intern year is the worst no matter where you end up...

When you say "brand new" are you in the inaugural cohort? Why did you pick a place with no track record?

 

[Shikima]

You are an intern, right? What issues? Intern year is the worst no matter where you end up...

When you say "brand new" are you in the inaugural cohort? Why did you pick a place with no track record?

This day in age, any port in a storm for residency placement. Could be OP isn't blossoming in how they perceived - an element where expectations aren't being met.

 

[FlowersFromTheSun]

You are an intern, right? What issues? Intern year is the worst no matter where you end up...

When you say "brand new" are you in the inaugural cohort? Why did you pick a place with no track record?

Why are your posts so frequently completely devoid of empathy?

Not everyone gets to "pick" where they go and programs do intentionally mislead applicants.

 

[Psychotic]

Why are your posts so frequently completely devoid of empathy?

Not everyone gets to "pick" where they go and programs do intentionally mislead applicants.

So exactly what or where is your empathetic advice for the OP?

Applicants get to "pick" where they apply, and they get to rank programs on their match list. Applicants aren't completely helpless in all of this.

 

[RadioFlierP]

Hey, I am the OP. So by issues I mean essentially things are not going the way we were told, etc. I completely get it that intern year sucks UNIVERSALLY, but here are some specific issues with the program. Small facility, small program faculty, not a diverse group, for example only 1 female faculty member. The program mentioned that our off service months for PGY1 year would be at the main clinical site when we just got word about 3 weeks ago that it will actually be at an affiliated hospital that is about a 50 minute drive for myself as well as for the other 3 residents who all deliberately chose to live close to the main hospital site.

Additionally, apparently I didn't know that I am supposed to speak to everyone, a janitor complained to my program that I did not say hello to him or to other janitors and this got back to the PD who required that my advisor 'talk to me' and do some professionalism coaching.

Speaking of advisor, we are required to meet with an advisor for 1 hour a week, this on top of didactics, grand rounds etc. 1 hour a week is overkill honestly, there is only one advisor to chose from and we do do not like the person. Personally, I find the advisor to be rather condescending and that the advisor makes several faulty assumptions about residents backgrounds, feelings, etc. We asked for another advisor and were told no and that this is what is required by ACGME, a 1 hour weekly advisor meeting.

-Consultation and Liaison months are in year 3 and 4, I feel this may have been done in order to prevent residents from transferring out.

-5 total months of Child and Adolescent

Pros:
Short call one time per week, they are planning to increase this for next year but again who knows in what way because its a new program
Essentially no weekends
5 days CME $2000


I chose the program because I liked the idea of shaping a residency program and of shaping my education, I regret this decision daily. I was terribly wrong and I hate to feel this way honestly. I am trying to stick it out and hope that things get better, talking to mentors for a advice etc. I would like any true and helpful advice.
How likely is it to transfer out as a PGY2? When would one need to start looking and/or calling around? Are there any specific websites that post open positions?

 

[PikminOC]

That professionalism stuff is everywhere. Everyone gets butthurt

 

[Psychotic]

Sounds like the only thing that could be remotely interpreted as misrepresentation is the switch in the off service site location for first year, and those things happen everywhere. You could have or should have known about the diversity of the faculty, lack of females, etc., when you applied and interviewed. Not liking the advisor? Ehh, really? Be glad it is just an hour a week, make the best of it. Not knowing you were "supposed to" speak to everyone, janitorial staff included? Why wouldn't you greet them with a smile? I go out of my way to be friendly to everyone where I work - that is just common sense, not something you should be surprised about.

Having said the above, lots of people transfer PGY-2. There are active threads on the first page with this question. Spend some time going through the site, hard to miss this topic.

 

[splik]

It is an ACGME requirement for you to have 1hr of weekly supervision from someone other than your attending (who should also be providing 1hr of weekly supervision). It's not really supposed to be for advisement but for you to discuss cases, career options, learn psychopharm, have someone watch you interview patients and do your CSVs etc.

The Academy of Psychosomatic Medicine recommends residents complete their consultation-liaison rotation during their senior years as the most experienced psychiatrists should be the face of the department within the general hospital. Most programs now do get this requirement out the way in the early years (as most residents prefer to do outpatient later) but the top programs (for example MGH, BWH etc) do their c/l rotations as senior residents. It would not stop you from transferring out doing it later on, I'm not sure what made you suspicious about that.

5 months of C&A psychiatrist is more than most programs, and so probably not good if you don't like child, but every other major english speaking country requires general psychiatrists to do 6 months of C&A and the 2 month minimum is really inadequate. general psychiatrists would do well to get a more developmental perspective and get more familiarity with dealing with family systems, autistic spectrum disorders, intellectual impairment, and ADHD.

it sucks that your off service months will be ages away from where you live, and the janitor thing is a bit ridiculous! sounds like something from scrubs!!

Yes you would need a letter of recommendation from your PD. They would also need to complete the paperwork for you to get credit for completion of intern year. Hopefully your co-residents aren't lame, if you can organize together effectively you may be able to more positively shape your experience, while recognizing somethings (like douchey attendings) are unavoidable. When I had a supervisor who was a narcissicistic bully and the program would not change me, I just didn't attend supervision, but I would not advise that.

Although PGY-2 spots are much less competitive than PGY-1 spots they usually go to people switching specialty, or moving program for other reasons (for example spouse got a job in a different city etc). Presumably you were not the most competitive candidate to end up at a new program, so be aware that switching is risky and if at all possible, you would be advised to make the best of a bad situation (as you would have to resign your position before knowing whether you will get a different spot, most likely). I would imagine that being a new program if your co-residents aren't completely useless you would be able to show solidarity and work to improve the program as you have some leverage.

 

[Psychotic]

Splik buried the lede:

Presumably you were not the most competitive candidate to end up at a new program, so be aware that switching is risky and if at all possible, you would be advised to make the best of a bad situation (as you would have to resign your position before knowing whether you will get a different spot, most likely).

More succinctly, HTFU and make it work.

 

[675015]

I can tell you that I wish I could have had a true 1 hour per week of supervision as intern. We allegedly had supervision for an hour a week but I think I had about 3 hours of true supervision during intern year. I didn't care much at the time, but in retrospect I wish I had it.

 

[SeniorWrangler]

Probably a good idea to finish the year and look at switching for R-2 and beyond. Dropping out part way through is not good for you, and hoses your fellow trainees.

 

[Crayola227]

while it is true that intern year blows, resident enthusiasm for their programs tend to be highest during the early phase of residency (partly because idealization is a necessary step of one's professional development, and partly to reduce the cognitive dissonance by how much it sucks), so it is usually not a good sign if people hate their program this early on. it doesn't usually get better (though it can) and inevitably gets worse. the people who complain the most about residency or dislike where they end up in intern year, are usually the ones who are still planning their exist strategy or hating it even more as time goes on.

I don't know how it is in psych, I was gonna say that it seems like a lot of them hate intern year because it's a lot of medicine. And no one loves medicine except for the medicine folks, and even they don't love it either. It's a special beast that likes hospitalist work.

Also, things can get better intern year, a lot of interns will tell you the curve is steep and they hate it most at the start, and things get better after settling in.

 

[MacDonaldTriad]

I think a majority of interns think about bailing out at some point. Most of the OP’s complaints are things that trouble programs in general and they have nothing to do with psychiatry itself. Changing programs may or may not improve things. Only he or she can have the data to make that call, but the grass may not be that much greener elsewhere. Some people change programs for very legitimate reasons, but be aware that once you transfer, you are planted at the new program to the end. The board has rules about splitting training three ways and that would make you look like you take your problems with you.

 

[nancysinatra]

You could have or should have known about the diversity of the faculty, lack of females, etc., when you applied and interviewed. .

A lack of equal number of female faculty is never excusable. Sorry. But I'd love to hear your defense of why you think this is ok.

 

[hamstergang]

A lack of equal number of female faculty is never excusable. Sorry. But I'd love to hear your defense of why you think this is ok.

Sarcasm, or is this for real?

 

[Psychotic]

A lack of equal number of female faculty is never excusable. Sorry. But I'd love to hear your defense of why you think this is ok.

My comment was that if this was an important issue to the OP, he coulda/shoulda known from interview day. Read again the quote you pulled from my post and tell me what it says.

NOWHERE did I say anything about this "diversity" situation, good or bad.

 

[Amygdarya]

My comment was that if this was an important issue to the OP, he coulda/shoulda known from interview day.

More like she: I've never heard a man complaining about paucity of female faculty

 

[nancysinatra]

My comment was that if this was an important issue to the OP, he coulda/shoulda known from interview day. Read again the quote you pulled from my post and tell me what it says.

NOWHERE did I say anything about this "diversity" situation, good or bad.

How could it not be an important issue? If a whole psychiatry department at an academic institution is almost exclusively male, how is that not a problem?

Look, I attended residency at a program famous for its all-female program director line up, and year after year of all female classes. It was a disaster. I would never defend that situation either. But now I am in a different field of medicine, one that is almost all male. And it reminds me - medicine is still not evened out in terms of gender or race. So why is it up to this applicant to make it so? Why should the applicant have to "object" before he/she even matches at a place as to whether that place has a fair balance of gender and/or race on its faculty? Shouldn't that be the norm?

And if not, can you at least explain why you think it does not need to be the norm?

 

[nancysinatra]

Sarcasm, or is this for real?

What is sarcastic or wrong about my objecting to the idea that an applicant should "decide in advance" whether it's ok that a whole psychiatry department has only one female faculty member? Can you please explain? Why is the problem here with the applicant and not with the lopsided department? And, by the way, are you trying to ridicule me for simply asking the question? It sounds like you are. Well, then, hamstergang, shame on you. One simple question from me about equality in medicine and you pull the "sarcasm" card.

By the way I'd have the exact same response if the department was all female. (Assuming we're talking about psychiatry. If someone could produce an example of an all-female orthopedic surgery department I would not be so critical!) But in the case of an all female psych department, I'd suspect the reasons for the imbalance were different, but I would have no less objection. I've lived through it, and I have no illusions.

 

[hamstergang]

What is sarcastic or wrong about my objecting to the idea that an applicant should "decide in advance" whether it's ok that a whole psychiatry department has only one female faculty member? Can you please explain? Why is the problem here with the applicant and not with the lopsided department? And, by the way, are you trying to ridicule me for simply asking the question? It sounds like you are. Well, then, hamstergang, shame on you. One simple question from me about equality in medicine and you pull the "sarcasm" card.

I asked if that was sarcasm because I wasn't clear and didn't want to assume and then make a whole post based on assumptions that may not be true. Contrast that to your post here and maybe you'll see why that matters.

I wasn't commenting at all on the idea that an applicant should or shouldn't decide in advance about how they feel on the presence or lack of diversity in a program. I was more surprised by your comment that a "lack of equal number of female faculty is never excusable." This statement means that you think all faculties should have the same number of males and females or more females. Why not a faculty that is more male? It seems crazy to find that "inexcusable."

 

[so721]

The grass isn't always greener on the other side. Just because you think you may be miserable in your current program, does not mean you will find something better or more pleasant elsewhere. My advice is to suck it up, learn the system, excel in it and look forward to how amazing life will be post residency.

 

[psycheswape111]

The grass isn't always greener on the other side. Just because you think you may be miserable in your current program, does not mean you will find something better or more pleasant elsewhere. My advice is to suck it up, learn the system, excel in it and look forward to how amazing life will be post residency.

In med school, I thought life would be better after I got to residency and could focus on my true interests. I miss med school every day now. When does it end? I can't spend my whole life waiting for this magical time when everything is better to come. I'm more and more convinced that being in medicine will always suck.

 

[Merovinge]

In med school, I thought life would be better after I got to residency and could focus on my true interests. I miss med school every day now. When does it end? I can't spend my whole life waiting for this magical time when everything is better to come. I'm more and more convinced that being in medicine will always suck.

I'm really sorry to hear that you are feeling that way. I would try to find 1 mentor at your program that you can talk to about your concerns. Also if you are off-service as an intern, those months can be absolutely brutal as no one has any reason to care about you except as a meatbag of service. But seriously, find someone positive to talk to, even if it's back at your medical school.

 

[thoffen]

How many total faculty members are there?

Regardless, you are 2 months into residency. Probably not the best choice for you, but your concerns do not seem prohibitive in receiving an appropriate (though short of your expectations) residency education free from abuse. There seems to be some combination of lack of awareness on your part of what you were getting into and lack of consistency on their part about plans for your training structure meeting their expectations.

Giving up on residency does not seem appropriate in scale to your stated experience.

 

[ara96]

Eat ice cream and make the best of it!

 

[J ROD]

I feel the curve is steep at first. Several things I believed to be true about my program have changed as the class above me as not been as professional as they should have been. I have more call now and weekends. Have to work more hrs in general.

I am pushing 60hrs up to 80hrs per week depending on call on inpatient psych. I really do not like the area I live in. It is ok.

I dropped down my list to the middle. SO, I guess you could say it was my fault. I had some health issues really hurt my prep for CK but I had to take it and maintain my interview schedule, etc.

With all that said, the grass is going to be greener. Residency sucks and you just have to suck it up and play the hand you are dealt.
I really do like my fellow interns. That is the saving grace for me. And most of the fellow residents are cool as well.

Personally, I do not feel comfortable giving up my guaranteed spot and shooting for another program. The BS is there at almost every place. So, just be aware of that.

I wish I could be somewhere else but I will make the best out of it and get out. It will get better as you get used to the hospital, culture, EMR, etc. I think you got to have a really good reason to transfer besides I just do not like this place and then you have to have the PD support. Leaving them a spot down is not going to make them happy. SO, yeah......

But, in general, I hate academia and want private practice. It is a measuring contest everyday even if you are missing a certain body member. Everyone is the best, etc.......whatever.....can I just come in and work.

Mainly, all my post is to the OP......just be careful here. The bird in your hand may be better than the bird in the bush you do not have yet.

 

[J ROD]

In med school, I thought life would be better after I got to residency and could focus on my true interests. I miss med school every day now. When does it end? I can't spend my whole life waiting for this magical time when everything is better to come. I'm more and more convinced that being in medicine will always suck.

Once you are an attending you will be able to choose where and how you want to work. More crap usually means more money but in general you are able to better tailor things the way you want. You just have to keep playing the game. I feel like I am more a m-5 than anything. Same shit....just more I can do and I have some initials after my name. They still own your ass!

 

[futuredo32]

I was actually in your shoes. I matched into a brand new program and it was great for the first 18 months and then a lot we were promised changed. I contacted a biggger name program where I had interviewed and asked if they would consider letting me transfer as a pgy-3. BIG mistake. The bigger name program was SO malignant, I had zero autonomy over "my patients" no supervision, didactics were a joke, it was awful. I felt like more of a survivor than a graduate. Other than what I read on my own, all I learned about psychiatry I learned about psychiatry, I learned from the first brand new program, which continued to improve. It takes time for a new program to develop, I dont know how bad your program is, but in hind sight, I regret leaving my original program and currently share a suite with one of the attendings from my original program.