New Psychiatry Attending Learning Curve

[DrBlorp]

For brief background information, I am currently an internal medicine physician. I enjoyed many aspects of internal medicine, however the field has changed quite a bit over the years, and I burnt out to the point of no longer being able to enjoy those aspects. I have had an interest in psychiatry since medical school, and am in touch with a few physicians I worked with as a medical student. I am currently applying to psychiatry residencies and have been graciously met with positive attitudes and encouragement in this endeavor.

I am hoping to gain insight on what the learning curve is like after residency as a new attending in psychiatry. The learning curve in as a new attending in internal medicine was very steep and very stressful, but I was young enough to handle the months to a year of constant anxiety, sleeplessness, and even weight loss. Had I had a family at the time, I'm sure I would not have been pleasant or mentally/emotionally present company for them. I am concerned about taking on another such stressful experience now at an older age with increased responsibilities in my personal life, and would love to hear what it was like for you all so that I can at least know what to expect in advance. thank you 🙏

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[Bartelby]

My first attending year really wasn't bad, but I worked in a system with good support (including a senior psychiatrist who served as an excellent boss/mentor). It was far less stressful than PGY1 or 2.

 

[Monocles]

For brief background information, I am currently an internal medicine physician. I enjoyed many aspects of internal medicine, however the field has changed quite a bit over the years, and I burnt out to the point of no longer being able to enjoy those aspects. I have had an interest in psychiatry since medical school, and am in touch with a few physicians I worked with as a medical student. I am currently applying to psychiatry residencies and have been graciously met with positive attitudes and encouragement in this endeavor.

I am hoping to gain insight on what the learning curve is like after residency as a new attending in psychiatry. The learning curve in as a new attending in internal medicine was very steep and very stressful, but I was young enough to handle the months to a year of constant anxiety, sleeplessness, and even weight loss. Had I had a family at the time, I'm sure I would not have been pleasant or mentally/emotionally present company for them. I am concerned about taking on another such stressful experience now at an older age with increased responsibilities in my personal life, and would love to hear what it was like for you all so that I can at least know what to expect in advance. thank you 🙏

I am a freshly minted "2021 edition™" attending. For me personally the transition has been near seamless, but only because I took an attending job on a unit that I am very familiar with. In fact the coworkers were the biggest draw of me taking that job. It was basically a continuation of residency, where I had already gotten the workflow streamlined many years prior. If were to make a comparison, perhaps fellowship was only half as challenging as residency, and being an attending is a third as challenging as fellowship, so on the grand scheme of things I have it pretty great.

In some ways psychiatry is like a reverse triangle in terms of difficulty. Intern year feels like a remnant of the "medical school firehose" and then it gets easier as you gain experience and narrow down your expertise. I would say the vast majority of people graduating from training will be providing more than competent care.

For the love of god please don't go through residency again. 2/10 would not recommend. If you feel burned out why not take some time off, or even consider non-clinical or non-medical jobs? The opportunity cost of going through training is way too high, IMO.

 

[FlowRate]

My residency did a pretty good job of allowing us to have a good bit of autonomy with our call experiences and PGY3/4 rotations. I did a bunch of extra outpatient work in my PGY4 year. I honestly don't think I really had any issue transitioning to being an attending. I run things by my coworkers sometimes but not as often as I thought I would (when I had regular weekly supervision I always made full use of the time.) I actually miss the weekly caseload supervision hour because I think you can always learn from how other people do things, not because I feel that I need someone checking my work.

I don't know how feasible this would be but you can pursue education in psychotherapy without having to go to psychiatry residency. Might be a slightly odd thing to do but I used to have a patient whose analyst was a cardiologist who (obviously) completed analytic training later in his life/career.

 

[Sushirolls]

I moonlighted ridiculous hours during residency. That was my learning curve.

After residency I only needed to grasp billing/coding and the physician pay system for the Big Box shop, and involuntary commitments for the state I was in. This was a quick learn.

The issues that have lead to burn out in IM will still persist even with Psychiatry Big Box jobs. As some above commented, I would not recommend doing an entire residency. Just not worth it. Focus on opening your own IM primary care cash clinic, then have wellbeing and 'psychiatry' be an emphasis of your practice. Talk with your patients, get to know them and help them optimize their functioning. Exercise, diet, self care, etc. You then have the benefits that when people are more severe you can refer them out. By being cash only you skip the issues of billing and coding that would come with a PCP who is doing the more timely work of Psychiatry. But your patients will have great loyalty because you'll know them, and you'll spend the time with them. In summary, you can have what you seek, to have it all, without the Scat of doing another residency. Think outside the box... being in the box has caused your burn out.

 

[MacDonaldTriad]

Undergraduate education is easier than undergraduate medical education. Undergraduate medical education is unfortunately easier than graduate medical education. The unfortunate truth is that GME education is also easier than being a grown up board certified physician all out on your own at your own risk. You are paid better, but they work isn't easier. Such is life.

 

[Sushirolls]

With this practice you can even sublease out a space to a Psychiatrist, with whom you selectively refer your more complex patients to. Plus you'll have the benefits of curbside consults from, or even doing a more formal arrangement to guide you on intermediate complex patients. Complete win win for folks.

Heck, I'd love this type arrangement with a cash IM.

 

[comp1]

I don't think the learning curve for being a psychiatry attending would be particularly big if you've already been an internist attending. However...my goodness...repeating residency. There must be a better way for you to find some meaning and purpose in your work! I'm also super surprised to see interest from residency programs. I thought there were significant Medicare funding limits on this sort of thing.

 

[Sushirolls]

I don't think the learning curve for being a psychiatry attending would be particularly big if you've already been an internist attending. However...my goodness...repeating residency. There must be a better way for you to find some meaning and purpose in your work! I'm also super surprised to see interest from residency programs. I thought there were significant Medicare funding limits on this sort of thing.

That's what I thought too. But elsewhere in SDN land this is labeled a rumor, and people can still do another residency with full funding. But I'm too lazy to research the truth in GME funding implications from CMS.

I am, though, opposed to GME funding for residency by CMS and believe it should end.

 

[deleted1100659]

The learning curve seems ok so far, not overwhelming, but I attended a high pt volume residency. I think the hardest part is the logistics sort of thing, figuring out the EMR at time, and figuring out whose role it is to do certain things (basically figuring out admin stuff). Also I have midlevels, which I did not have in residency, so that is definitely new for me. Also I think sometimes people feel strange about someone noticeably younger than them taking charge.

 

[90833]

The first year out of training was not a hard transition for me. It depends on what kind of job you signed up for.

I suggest reconsidering doing a second residency. It's a huge opportunity cost. You could go part time or go into concierge private practice to mitigate the burnout. Financially it could still be a better option than doing a second residency. Or consider a lower intensity "fellowship" to learn about primary care psychiatry. UC Irvine Train New Trainers Primary Care Psychiatry Fellowship | Department of Psychiatry & Human Behavior | University of California, Irvine

 

[NickNaylor]

I found the transition to being an attending pretty straightforward. That said, I did a LOT of moonlighting during PGY-3/4, so working independently and without supervision wasn't a new thing for me. Further, the clinical knowledge base of psychiatry is, I imagine, far more circumscribed than in internal medicine. While you won't be an expert on everything, I think it's a lot easier to have a bigger handle on essentially everything in psychiatry such that you can at least be fairly competent. A lot of what makes one an excellent psychiatrist is "soft" and are skills that you will continue to develop over the course of your career.

I imagine you'll find psychiatric training to be a cake walk compared to an internal medicine residency.

 

[hamstergang]

That's what I thought too. But elsewhere in SDN land this is labeled a rumor, and people can still do another residency with full funding. But I'm too lazy to research the truth in GME funding implications from CMS.

I am, though, opposed to GME funding for residency by CMS and believe it should end.

I believe that the case is that there are two parts to the funding. One of them is reduced by half when your funding has "run out." That leaves you with roughly 75% of the full funding which isn't always a big deal to every program. Also some places will have many residency programs and may be over the cap already. That means that they are getting only that 75% for some of their residents, and it doesn't matter to them which residents those are. At such a place, they wouldn't necessarily mind taking on the OP.

 

[Sushirolls]

So, DrBlorp, what are you planning to do at this juncture?