Making psychiatry residency 3 instead of 4 years

[psychic_hearts]

This was mentioned in the nurse practitioner crisis thread, but how can we go about reforming psychiatry residency to make it 3 years total instead of 4 years. Both internal and family medicine residency are 3 years. Thus fellowship taking the 4th year eg child fellowship would take 4 years instead of 5 when fast-tracked. All requirements are met after the third year and 4th year is often regarded as elective time better served by fellowship. Keep in mind, NPs are working independently in all settings eg in CAAP and Geriatric psychiatry without any fellowship whereas resident psychiatric physicians are spending unnecessarily long lengths of poorly paid and unnecessary training time 4th year better served with fellowship.

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[Monocles]

Full support for 3 year psych residencies.

Although I'm not sure about the fast tracking after pgy-2 part. I think having the pgy-3 outpatient year (working with grown ups) can be helpful in learning using the full range of medications, taking majority ownership of patient care, and figuring out if you really want to work with kids vs grown ups.

(And I am someone who avowed to never work with grown-ups again, ha!)

 

[psychic_hearts]

How do we take steps to reform this? It makes sense but who determines these things? APA? ACGME?

 

[J ROD]

You think residency programs are gonna support losing a year of an indentured servant. Especially one already trained and could be an independent already.........

 

[Sushirolls]

My understanding, Psych used to be 1 year of traditional internship, then was 2 years of residency back in the 60-70's. Intern year morphed into more psych and a 4th year was added. Understanding that history and decision might be necessary for any push to reverse it.

Concur that free labor won't be released.

Secondly, I disagree that it should be 3 years. If you are at a solid program with diversity of rotations, then 3.5 is more realistic.

 

[splik]

Making psychiatry a race to the bottom is not the answer. I disagree with shortening psychiatry residency as it will adversely impact psychotherapy skills/training and leadership development and consolidation of skills. I do support allowing fasttracking for addictions, geriatrics, and C-L psychiatry as is the case for child and adolescent. Opening up fasttracking to other specialties has been in discussion for years but has thus far stalled due to lack of consensus. geriatrics is most supportive of allowing for fasttracking. forensics is not going to be opened up to fasttracking.

What I would like to see is that residents should be able to bill for work (both in and out of training). This could increase pay for residents, get the government out of GME funding, and also increasing moonlighting opportunities for residents. There should also be more flexibility for residents who drop out of training for whatever reason to work.

Diluting training is not going to help you compete with NPs, and increasing the supply of psychiatrists by shortening residency will only lead to more competition from other psychiatrists while lowering quality. Shoterning residency training may also have the unintended consequence of reducing remuneration for psychiatrists due to perceived reduction of skills, reduced burden of education, increased supply etc

 

[Mass Effect]

This was mentioned in the nurse practitioner crisis thread, but how can we go about reforming psychiatry residency to make it 3 years total instead of 4 years. Both internal and family medicine residency are 3 years. Thus fellowship taking the 4th year eg child fellowship would take 4 years instead of 5 when fast-tracked. All requirements are met after the third year and 4th year is often regarded as elective time better served by fellowship. Keep in mind, NPs are working independently in all settings eg in CAAP and Geriatric psychiatry without any fellowship whereas resident psychiatric physicians are spending unnecessarily long lengths of poorly paid and unnecessary training time 4th year better served with fellowship.

If you wanted to be an NP, you should have gone to NP school. What they do is irrelevant.

Also, aren't you an intern? Maybe wait out the residency before jumping in to champion change in the number of years.

I also agree with @Sushirolls that at strong programs, you'll find at least part of 4th year valuable, if for nothing else than time to explore things the residency doesn't allow for due to time, such as neuropsychiatry, HIV psychiatry, another month of addiction, palliative care/end of life/geriatric psychiatry, women's mental health.

 

[psychic_hearts]

The question remains of who governs psychiatry residency duration length and how one can one go about reforming it. Requirements are met 3rd year. Programs "not wanting to give up their indentured servants" and fear of more competition dont really come into this (see the NP thread for ideas on challenging the threat they pose). This is a more objective assessment of a reasonable residency duration length. It should at least be given wider capacity for discussion. This post was asking how one can go about doing this. Of course everyone is entitled to their ideas etc. It is appreciated.

 

[tr]

A 3 year IM or FM residency is easily the equivalent of a 4 or even 5 year psych residency in hours worked. Most psych residents are working easy 40 h weeks in years 3 and 4, compared to the 80h weeks worked on most inpatient IM rotations.

I think psych could go to 3 years but it would be much less pleasant, and arguably worse for learning given the swap of spaced training and healthier sleep patterns (more effective for learning) for massed training and more sleep deprivation (less effective for learning).

I do agree with splik that psychotherapy is the most difficult part of psychiatry to learn to do well, and that removing the 4th year would further degrade this. However my impression is that there are many psychiatrists out there who are quite poorly trained in psychotherapy anyway, whether by preference or circumstance. Improving this would require specific interest and attention to evidence based psychotherapies on the part of program directors, more so than being a simple function of length of training. Really our residency programs should mostly have experienced clinical psychologists providing therapy supervision, instead of these dinosaur MDs who think that nodding sagely and saying 'I see' every once in a while somehow constitutes a 'therapeutic environment.'

 

[psychic_hearts]

Some psychiatry residents are on call q 3 days just as not all IM and FM programs are equivalent. These fellowships are a relatively new invention for psychiatry and since invented and encouraged, then it makes sense to reevalaute the curriculum duration for general psych residency and considering 4th year is elective time with requirements completed 3rd year, it makes sense to open it up to fellowship as suggested. The fact that NPs practice in all areas of psychiatry without fellowship is insult to injury. It should be challenged just as our curriculum and policies, the way we practice should be evaluated and restructured with change.

 

[Mass Effect]

The question remains of who governs psychiatry residency duration length and how one can one go about reforming it. Requirements are met 3rd year. Programs "not wanting to give up their indentured servants" and fear of more competition dont really come into this (see the NP thread for ideas on challenging the threat they pose). This is a more objective assessment of a reasonable residency duration length. It should at least be given wider capacity for discussion. This post was asking how one can go about doing this. Of course everyone is entitled to their ideas etc. It is appreciated.

It's not objective when you haven't even finished intern year of the residency. You are in no position to say it should be three years. How can you possibly be objective when you haven't even experienced it?

I also don't know why every resident is so freaked out by NP's. Once you're out in the real world, you'll realize how little they matter outside of getting you business. Half my patients are with me because their NP put them on 5 or so meds to keep them in bed all day.

 

[Mass Effect]

Some psychiatry residents are on call q 3 days

Where?

 

[psychic_hearts]

I never stated I was an intern. I dont feel that is relevant to the discussion and I dont feel that this should be getting personal/doxing etc. Arrowhead in California last i checked had q 3.

 

[MacDonaldTriad]

Do you really to become more like IM or FM?

 

[psychic_hearts]

Noone does and perhaps my question was poorly phrased as it has nothing to do with wanting to be an NP or IM. It merely has to do with reevaluating the 4th year which is elective time and as many new fellowships were created, consider allowing fellowship to take the 4th year.

 

[Attending1985]

Making psychiatry a race to the bottom is not the answer. I disagree with shortening psychiatry residency as it will adversely impact psychotherapy skills/training and leadership development and consolidation of skills. I do support allowing fasttracking for addictions, geriatrics, and C-L psychiatry as is the case for child and adolescent. Opening up fasttracking to other specialties has been in discussion for years but has thus far stalled due to lack of consensus. geriatrics is most supportive of allowing for fasttracking. forensics is not going to be opened up to fasttracking.

What I would like to see is that residents should be able to bill for work (both in and out of training). This could increase pay for residents, get the government out of GME funding, and also increasing moonlighting opportunities for residents. There should also be more flexibility for residents who drop out of training for whatever reason to work.

Diluting training is not going to help you compete with NPs, and increasing the supply of psychiatrists by shortening residency will only lead to more competition from other psychiatrists while lowering quality. Shoterning residency training may also have the unintended consequence of reducing remuneration for psychiatrists due to perceived reduction of skills, reduced burden of education, increased supply etc

I agree with you in theory. But why support a training model that is no supported beyond residency? Psychiatrists will be hard pressed to find a job that allows them to perform psychotherapy as a concession and will not find a job that values this. This isn’t a good thing but will it change? It seems most are t interested or don’t value psychotherapy in our profession.
What I support is shortening medical school. First Two years of school and you are awarded and MD then a rotating internship is required before moving onto a residency. Less debt, more real world exposure before choosing a specialty.

 

[OldPsychDoc]

How do we take steps to reform this? It makes sense but who determines these things? APA? ACGME?

ABPN and ACGME.

APA is an advocacy organization. It has no actual governance of the profession. Lots of people get that wrong.

 

[psychic_hearts]

ABPN and ACGME.

APA is an advocacy organization. It has no actual governance of the profession. Lots of people get that wrong.

Great, thanks!

 

[Mass Effect]

I never stated I was an intern. I dont feel that is relevant to the discussion and I dont feel that this should be getting personal/doxing etc.

It's not personal and it is relevant. It's like someone as an MS-1 wanting to change clerkship curriculum. You haven't been there so how could you possibly know?

And I'm going by your previous posts. You were in the med school class of 2019 according to your post history. So if you're not an intern, where are you in your training?

 

[Mass Effect]

I agree with you in theory. But why support a training model that is no supported beyond residency? Psychiatrists will be hard pressed to find a job that allows them to perform psychotherapy as a concession and will not find a job that values this. This isn’t a good thing but will it change? It seems most are t interested or don’t value psychotherapy in our profession.
What I support is shortening medical school. First Two years of school and you are awarded and MD then a rotating internship is required before moving onto a residency. Less debt, more real world exposure before choosing a specialty.

This is crazy. You're expecting people to become a medical doctor after two years of Anatomy, Microbiology, and Biochem, even if they've never set foot in a hospital or cared for patients?

 

[Attending1985]

This is crazy. You're expecting people to become a medical doctor after two years of Anatomy, Microbiology, and Biochem, even if they've never set foot in a hospital or cared for patients?

Do third and fourth years “take care of patients.” No IMO 3rd and fourth year are a waste of time jumping through hoops and playing the game not learning anything.

 

[VA Hopeful Dr]

Do third and fourth years “take care of patients.” No IMO 3rd and fourth year are a waste of time jumping through hoops and playing the game not learning anything.

If that was your experience than your school failed you.

Granted I'm FM but the students who rotate with me do H&Ps and come up with Assessments and Plans entirely on their own, then I go see the patient with them and either go with their plan or explain why I'm not.

 

[Mass Effect]

Do third and fourth years “take care of patients.” No IMO 3rd and fourth year are a waste of time jumping through hoops and playing the game not learning anything.

Uh, you didn't take care of patients during 3rd and 4th year?? Dude. If I was you, I'd sue the heck out of my school.

 

[psychic_hearts]

It's not personal and it is relevant. It's like someone as an MS-1 wanting to change clerkship curriculum. You haven't been there so how could you possibly know?

And I'm going by your previous posts. You were in the med school class of 2019 according to your post history. So if you're not an intern, where are you in your training?

I do not appreciate any form of doxing on the internet. I appreciate all that have engaged in discussion without bringing personal identifiable details into discussion.

 

[Attending1985]

Uh, you didn't take care of patients during 3rd and 4th year?? Dude. If I was you, I'd sue the heck out of my school.

My guess is you went to a for-proft school, most likely DO or Carib.

I went to a state school md.
The pseudo experience of 3rd and 4th year don’t compare to the real thing of residency and imo are not that useful.

 

[Mass Effect]

I do not appreciate any form of doxing on the internet. I appreciate all that have engaged in discussion without bringing personal identifiable details into discussion.

Good lord.

 

[VA Hopeful Dr]

I went to a state school md. I’ll call a lawyer.
The pseudo experience of 3rd and 4th year don’t compare to the real thing of residency and imo are not that useful.

Then either your experience was atypical or mine and @Mass Effect s was.

Given that I now precept and provide the same experience I received, I know which of those I think is likely.

Either that or a fairly new DO school and the lesser state MD school in SC are both just kicking ass at clinical rotations.

 

[clausewitz2]

I do not appreciate any form of doxing on the internet. I appreciate all that have engaged in discussion without bringing personal identifiable details into discussion.

It sounds like you should really give yourself a stern talking-to. It is incredibly rude to just go around doxxing people who you happen to see when you look in the mirror every day.

 

[psychic_hearts]

Many people are afraid of changing status quo. I dont think any of the recent responses were relevant to discussion so will lock further discussion.