Life after residency

[toshiba25]

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Can any recent grads (1-3yrs out) comment on the transition since residency? Any things you wish you would've focused on more or less during residency? Any surprises or regrets along the way? Thanks.

 

[Doc Samson]

Can any recent grads (1-3yrs out) comment on the transition since residency? Any things you wish you would've focused on more or less during residency? Any surprises or regrets along the way? Thanks.

Don't think I have any regrets, but I can tell you what I feel helped me transition into attendinghood:

1) Lots of call = lots of experience. When my students ask about choosing a residency, I recommend places with more rigorous call. The experience of having to make decisions about patients independently while on call (with the happy safety-net of attending back-up) is probably the single most important factor in preparing for "the real thing." I guess I am surprised by how many more patients I'd seen in training compared to recently graduated colleagues from other programs (literally orders of magnitude).

2) Understanding the nitty-gritty of managed-care, malpractice, billing, etc. We covered a lot of this in a 4th year "transition to practice" seminar (2 hours a week for 6 months), but I also took advantage of some extra-mural programs offered by insurance companies that focused on teaching physicians about the world of HMOs. Much easier to get services approved for my patients now I know exactly what the evil folks on the other end of the phone are looking for.

3) Staying academic. Hard-core academia is obviously not for everyone, but I think maintaining some link with residents/med students helps you stay current.

Obviously, it's good to keep reading. Attending national meetings also helps keep you on the cutting edge.

 

[OldPsychDoc]

Moonlighting can also be a help. I landed a weekend inpatient job that let me function as an attending while I was a fellow. Having the opportunity to test my independent clinical skills helped a lot when I started my "real" job.

 

[Chrismander]

3) Staying academic. Hard-core academia is obviously not for everyone, but I think maintaining some link with residents/med students helps you stay current.

Is it possible to get back into academia after you've been out awhile? For instance, if you go do locums & private practice for a few years to pay off loans, how feasible is it to transition back to academia later on?

 

[Faebinder]

Maaaannnnnn... where are all those stories about this unique transformation...growing 1 foot taller, muscles rippling, eyes of an eagle, emitting phermones to attract the opposite sex, and eventually flying like superman?

 

[OldPsychDoc]

Maaaannnnnn... where are all those stories about this unique transformation...growing 1 foot taller, muscles rippling, eyes of an eagle, emitting phermones to attract the opposite sex, and eventually flying like superman?

You forgot the "swimming in piles of cash"... 😀

 

[Faebinder]

You forgot the "swimming in piles of cash"... 😀

dats right... mountains of cash!!!!!

 

[michaelrack]

Is it possible to get back into academia after you've been out awhile? For instance, if you go do locums & private practice for a few years to pay off loans, how feasible is it to transition back to academia later on?

It's easier in psychiatry than in some other specialties. If you have a skill valued by academia, especially the ability to teach/supervise residents doing psychotherapy, you should be able to get back in.

 

[ronin12]

I guess challenges faced after residency varies in different situations. personally clinical management of pt's was the easiest part, dealing with supporting staff, management,hospital administration seems to be the unexpected shocker. Being a resident your are under the wings of attending who gets the brunt of these issues. Other shocker was seeing psychologists, SW as chairing the psyciatry department. I always thought it as medical speciality. Now there is growing trend of selecting non physicians as head of psychiatry depts, especialy in non academic hospitals. I found it quite disappointing due to their lack of medical knowleged and resulting frustration caused by their idiotic behavior.
VA's, county hospitals, and stae hospitals are notorius for this.
If someone has visa issues, things can get pretty rough, certain people might try to take advange of visa needs.
Would apreciate other's input

 

[Faebinder]

I guess challenges faced after residency varies in different situations. personally clinical management of pt's was the easiest part, dealing with supporting staff, management,hospital administration seems to be the unexpected shocker. Being a resident your are under the wings of attending who gets the brunt of these issues. Other shocker was seeing psychologists, SW as chairing the psyciatry department. I always thought it as medical speciality. Now there is growing trend of selecting non physicians as head of psychiatry depts, especialy in non academic hospitals. I found it quite disappointing due to their lack of medical knowleged and resulting frustration caused by their idiotic behavior.VA's, county hospitals, and stae hospitals are notorius for this.
If someone has visa issues, things can get pretty rough, certain people might try to take advange of visa needs.
Would apreciate other's input

Boy do I have major issues with that. It's like making the president of the university a non-phd person.... how would they understand what professors go through if they never even got a phd? How would you really understand what an MD goes through if you never got one.

 

[OldPsychDoc]

Boy do I have major issues with that. It's like making the president of the university a non-phd person.... how would they understand what professors go through if they never even got a phd? How would you really understand what an MD goes through if you never got one.

As the chair of an academic department, you only need to know one thing--how to raise money through grants. PhDs have much better training at this, and several are running major departments. You just make sure you have a good Vice-chair for Clinical Affairs to cover the gaps in your experience.

 

[sunlioness]

IOther shocker was seeing psychologists, SW as chairing the psyciatry department. I always thought it as medical speciality. Now there is growing trend of selecting non physicians as head of psychiatry depts, especialy in non academic hospitals. I found it quite disappointing due to their lack of medical knowleged and resulting frustration caused by their idiotic behavior.

I'd like to think that idiocy is more related to the individual than the letters after his or her name. We were doing quite well with a PhD psychologist chair until the RRC threatened to yank our accreditation unless we ditched him.

I also don't understand what people go through to get a PhD since I've never gotten one and I would imagine our current MD chair, who is doing a fine job, doesn't either. Nevertheless he is the chair of a department composed in large part of psychologists.

 

[ronin12]

I'd like to think that idiocy is more related to the individual than the letters after his or her name. We were doing quite well with a PhD psychologist chair until the RRC threatened to yank our accreditation unless we ditched him.

I also don't understand what people go through to get a PhD since I've never gotten one and I would imagine our current MD chair, who is doing a fine job, doesn't either. Nevertheless he is the chair of a department composed in large part of psychologists.

There is nothing personal against any psychologist or social worker, I admire their work in their capacity. But i think this level of apathy among psychiatrists to guard their professional boundaries is resulting in psychologists demanding prescription previliges, among various states. As far as administration is concerned anyone can be an administrator, but without having medical credentials, i have hard time accepting the fact one would have vision and knowledge to understand the intricacies of day to day medical practice. I have personal experience of facing this frustration everyday., when the "administrator" is no more than a stenographer taking notes what the psychiatrists are saying and then simply put it together as memo on his behalf.
I wonder psychologists would be as gracious , when it comes to letting someone in their professional areas i.e (neuropsych testings etc).?
Also have anyone saw OT's chairing neurology or neurosurgery, etc or anyother speciality It is only psychiatry in which this phenomena is observed.

 

[Faebinder]

There is nothing personal against any psychologist or social worker, I admire their work in their capacity. But i think this level of apathy among psychiatrists to guard their professional boundaries is resulting in psychologists demanding prescription previliges, among various states. As far as administration is concerned anyone can be an administrator, but without having medical credentials, i have hard time accepting the fact one would have vision and knowledge to understand the intricacies of day to day medical practice. I have personal experience of facing this frustration everyday., when the "administrator" is no more than a stenographer taking notes what the psychiatrists are saying and then simply put it together as memo on his behalf.
I wonder psychologists would be as gracious , when it comes to letting someone in their professional areas i.e (neuropsych testings etc).?
Also have anyone saw OT's chairing neurology or neurosurgery, etc or anyother speciality It is only psychiatry in which this phenomena is observed.

This "phenomena" is also present in Family Medicine and usually in ancient departments where the chair has been the chair since the department was found. If you look at some of the professors out there in different medical colleges... some have dual professorship (like professor of surgery and professor of medicine). Those are the physicians who were around when both department lacked tenured professors and they would use one of the professors from different departments to help set them up.

This is all in the past. There is no excuse anymore. There is always a qualified MD out there to fill that spot (many have MBAs, some have multiple advanced degrees). I'm all about protecting turfs and the chair represents the department. Their vision pushes the department forward. How much will a phd understand how competitive it was for a resident to become an addiction vs child vs forensic fellow and how the competitive levels changed of recent? I am skeptical.

On a scary side note: With the phd argument, you might see a phd of nurse practioner (mental health) claim he/she is a better fit to be the chair of the department. Like some Family Medicine university departments who has PAs with PhDs as chairs.

 

[sunlioness]

I wonder psychologists would be as gracious , when it comes to letting someone in their professional areas i.e (neuropsych testings etc).?

Well, I don't know that many psychiatrists who want to be doing neuropsych testing, but that's irrelevant to your point. I do think it's interesting reading the psychology boards here on SDN. They snipe at us (not to mention masters level therapists) about as frequently as we snipe at them. So I guess it's all good. 🙂

Also have anyone saw OT's chairing neurology or neurosurgery, etc or anyother speciality It is only psychiatry in which this phenomena is observed.

I think psychiatry is fairly unique among the medical specialties as being more inherently interdisciplinary. Though having said that, only two residencies require the chair of the department to be a physician. Psychiatry and emergency medicine. Though I think even in those specialties where it isn't a requirement, they still almost always are.

Their vision pushes the department forward. How much will a phd understand how competitive it was for a reident to become an addiction vs child vs forensic fellow and how the competitive levels changed of recent? I am skeptical.

How much will an MD understand how competitive it was for a graduate student to secure an APA approved internship? And why does it matter in terms of performing effectively as chair?

 

[toby jones]

mmmmmmm health research funding.
😍

BTW... Sometimes we have people in academic administration positions (very high up ones such as dean of a school) not because they are PhD's but because they are very successful in obtaining funds and managing those funds. I lament this state of affairs in many respects... But there is a great deal of (I think legitimate) controversy because there are pros and cons to each side...

 

[erg923]

From a psychologist's perspective, I disagree with and do not understand having a non M.D./D.O as a chair of a psychiatry department. While I maybe more knowledgeable on statistics and grant writing than the "average" M.D., there are still plenty of research oriented M.D. out there. I have never seen anyone other than a Ph.D. in psychology chair a psychology department. It seems to me the chair is not only responsible for the research direction of a department, but also the maintenance of the department and future goals. Being a non-medical health professional, I could only speak towards the mental health aspect of psychiatry, and not the medical portion or the profession as a whole really.

Btw, I don't know many psychiatrist that want to do neuropsych assessment. Although I do have one very funny story. One physician insisted that I give the patients Trail Making every week to asses their "thinking skills." My attempts to educated him on the basic problem here (i.e., practice effects), and that neuropsych looks at patterns of results over many tests to draw conclusions (i.e., i would never make any conclusions by giving one test) fell on deaf ears. In this case, I think he gave the tests himself. I heard the patients' times really improved over the course of their hospital stay.....LOL