I am interested in finding out more about pursuing a psychiatry residency. Specifically, what is the work product and expectations that exist during different years? Also what does a psych resident's daily schedule look like in different years? How do the calls work? Are the expectations reasonable for the amount of training you are given or expected to have? What are some things you wish you would have known or been able to do before entering your psych residency? How much writing do you do generally and what type? How much politics/bureaucracy do you deal with? What are some of the biggest stressors you encounter? Are your colleagues generally professional or are there lots of a-holes in the programs?
Appreciate any input!
That is a lot of questions! The answers to these are mostly program specific, and that's why you do interviews and talk to senior residents.
Most psychiatrists are kind people who care about others. Amazing, huh? So overall it is a benign specialty. There is always the odd jerk, but not as many compared to other fields in my experience.
Programs can vary a lot, but traditionally you do an intern year (PGY1) that largely consists of some basic rotations outside of Psychiatry: internal medicine, Neurology, emergency medicine. In some programs you basically belong to those services and do call like an IM intern during PGY1. Some programs have you do only call for inpatient psychiatry. Call every third night (Q3 call) is common, some programs require less. Then in PGY 2 is generally completely inpatient Psychiatry and Psychiatry call ( often still Q3), and often a rotation in consultation/liason Psychiatry. Then, in traditional programs you spend PGY3 and PGY4 practicing outpatient Psychiatry in academic and also community settings and learn how to do different evidence based psychotherapies like CBT. Programs can and do mix it up some. The ACGME website tells you what each program is required to teach at a minimum.
Generally, rotations outside of psychiatry are either the same or slightly easier than what the IM residents do. Inpatient psychiatry you probably see about 9 patients a day, they work you up to it usually as you gain experience. When you are on call in Psychiatry you may admit one to six patients over night. Again, it can vary by program. When doing outpatient psych you will see 6 to 12 patients a day. The more therapy you do, the lower number of patients because therapy appointments take a lot longer than medication management only.
Psychiatrists, especially those that do therapy, of course write linger notes than a surgeon, out of necessity.
If I could redo residency the only thing I would change would be to be a better friend to my colleagues, who are fine people. I would stress out less and realize today's problems will soon be only a memory. I would tell myself to calm down and that, yes, there is always some bureaucracy and a lot of hard work in residency, but it gets easier as you learn.
Probably the biggest stressor for me was being on call frequently by myself in a large psych hospital, Q3. I personally did Q3 call from MS3 through PGY3, and that is not kind to a body. I and my fellow residents learned how to be efficient, independent, and tough pretty quickly. Sometimes I had to stand up to staff or attendings regarding my clinical decisions with little support from a Psychiatry attending, and that was rough at times, but probably necessary learning. I missed a lot of family and friends activities. Usually I would work 24 to 30 hours straight with no sleep while on call, which I feel is unsafe. Not all programs are so rigorous.
