First off, we have so many faculty leaving. I see 13 patients in my care, and the attending comes in rounds for 30min-hour and tells me to increase this, decrease this etc. I just put in the orders do my MSE, and write my note for him to sign.
Attendings leaving the program in mass numbers over the course of a few years is a big sign something is wrong in the department.
I've said this several times on this forum. I've seen several programs keep terrible attendings that they know aren't competent either because the people running the program don't care/know or they can't replace the existing psychiatrist and would had there been more around.
The shortage of psychiatrists almost across the nation (it isn't happening in specific localities such as NYC and Washington, D.C.) has created the benefit of making us in demand, but created the problem of several departments tolerating bad psychiatrists.
My PGY-IV year, the program was split between two hospitals. One of the psychiatrists at the hospital where I was at was literally only coming in, signing off on the notes and spending 10 minutes (even less) with the resident and then walking out. It turned out he was double-dipping-that is working at one place, earning a salary, when he was supposed to be at the other place and not telling both places what was going on. The head of the department at this hospital was forced to become the 2nd in command of the entire hospital because the previous one left under bad circumstances, so she could barely manage the psych department. The double-dipping psychiatrist knew this and took advantage of this knowing she wouldn't be able to keep tabs on him.
The GME and head of the residency program was in the other hospital 1 hour away. I told her what was going on and her reaction was furious-not at him but at me for even bringing it up. Meanwhile very bad things were going on such as PGY-1s literally having only a few weeks experience not knowing what to do, the double-dipping attending wasn't there, and when he was beeped he wouldn't call back for about an hour. There were two attendings on that unit and the other one that was doing his job knew what was going on and addressed it but wouldn't (understandably) take the mantle and do the other doc's job in addition to his own.
So I talked to the head of the department in the hospital where the double-dipper was located (who was not the head of the academic dept. That head was in the other hospital and had a rep for just shoo-shooing things). She told me she completely agreed with me but she couldn't fix the problem because she was literally doing 2 high stress jobs at once-head of the psych dept and #2 doctor in the hospital-both jobs that are 80 hours a week and had to put her focus on the latter job. She didn't tell me this herself but her secretary told me she had almost no confidence in the new PD.
After seeing that the program director wasn't going to do anything about this, (in fact she started bad-mouthing me behind my back because I brought this up), I realized this was a situation I would not be able to fix. I was a resident, yes a chief resident, but if the PD isn't going to do anything and patients were experiencing bad outcomes because of this, I decided I had to either shut up and just stick my year out or go to the GME. I decided to go to the GME and tell what was going on because I would've been violating my Hippocratic Oath otherwise. I knew that I could experience severe fallout from my PD.
The GME looked into it and everything I told them they found out by their own investigation was true. They were able to prove that doc was double-dipping. My PD's reaction to the GME was all hugs and kisses acting as if she'll do everything they ask. The GME even told me they thought they could tell something was wrong with her because they knew everything I said including her bad-mouthing of me was true. They forced that double-dipping doc to stop. All of this played out over the course of about 6 very uncomfortable months for me.
If you look at my past posts I said a lot of good things about my residency program and they were all true-up until the beginning of my PGY-IV year. By then we got the new PD. BY then I changed my tone to we got problems we're working on but out of a sense of loyalty I didn't outright bash my program.
