As promised, I'm back to talk about my favorite parts of the program (now that I have some more experience)...
1. Non-psychiatry rotations (hours vary): In first year, you have the option of doing a mix of medicine or pediatrics. Before, you only had the option of doing medicine floors or pediatrics floors. This year, an **ambulatory medicine** program was piloted where you do internal medicine in the clinic setting (~8:30a-5:30p, M-F). That includes evaluating patients in acute visits, new visits, comprehensive physical exams. Patients are diverse, most of them are English or Spanish speaking, and it's a great opportunity to practice your Spanish. There are also a number of patients with mental health issues, and it is helpful to see that intersection from a PCP perspective. Those who were part of the pilot really enjoyed it -- the preceptors are excellent teachers and some feel the material is more relevant than inpatient medicine. I think they are going to include that as an option going forward. I have done both medicine and pediatrics, and find the workload to be quite reasonable. For **medicine** (usually 7a-4p for 2 days, 7a-7p one one day where you cover your co-intern's patients, q4 call 7a-8p), psychiatry residents are capped at 4 patients (medicine interns typically have 8). I could take care of a full load of 8 patients, but I appreciate the opportunity to have more time to get to know my patients, counsel my patients, review material, and tap into the medical literature to find answers to questions the team has. I absolutely loved my medicine teams, and I learned so much. For **pediatrics** (6a-6p, M-F), psychiatry interns carry the same number of patients as pediatrics interns, about 4 patients. Sure, you have your typical RSV bronchiolitis but you also get some patients with interesting congenital and neurological conditions. There also is a unit where patients with eating disorders go, which is a great learning experience.
2. Psychiatry rotations (typically 8:30-4:30p): I enjoyed my **consultation-liaison** experience. There's a lot of bread and butter delirium, drug withdrawal, depression, anxiety, end-of-life issues but you'll also have less bread and butter cases -- I had some cases of unusual intoxication and peripartum psychiatry. There are several attendings on the team, and you will be able to work with them all. It was helpful to see their different approaches. In addition to teaching about psychopharmacology, some attendings are more psychodynamically focused and use each brief interaction as an opportunity for therapy (I observed one attending artfully confront a patient on their abandonment issues as it related to their chronic drug abuse. Another attending helped a patient gain more insight into their somatization in context of the Eriksonian stage of generativity vs. stagnation). You also rotate on two **inpatient** units during R1 year. 1N is known as the affective disorders unit, 1S is known as the college student/first break psychosis unit and there are a fair number of patients with borderline personality disorder, 2N is known as the psychosis unit but you will see a broad range of psychopathology on each unit. Each attending has their own approach, and there are so many lessons that you can learn from each, from precision in diagnosis, interview techniques, nuances in psychopharmacology, and much more. Didactics on diagnosis, the art of the interview, biopsychosocial formulation, and psychopharmacology are protected and I have never had to miss a session.
3. Electives and beyond R1: In the R2 year, you have 8-12 weeks of elective time which is uncommon for other programs. You can pick an elective (eg, partial hospital, pediatric C/L, women's mental health, child and adolescent emergency psych, adolescent eating disorders, etc.) or design your own (Northwell has no forensics fellowship, but there are plenty of forensically trained psychiatrists in the hospital and you could do an elective at another institution with a forensics program). You also spend a half day per week at continuity clinic and can focus on a variety of disorders (bipolar, OCD, college, early psychosis, perinatal, general adult). If you are an independent learner with a passion project, Pathways to Discovery is a great optional program. The goal is to design and implement an innovation project during a 4 week block of elective time and at least 1/2 day per week during R3/R4 years. Some people do medical education, perinatal psychiatry, literature and psychiatry, and much more as Pathways projects. If you are more research-minded, the Research Track is for you. You apply R1 year and then have 12 weeks of dedicated research time R2 year. For R3 year, you have dedicated 50% clinical - 50% research time. For R4, you can have up to 90% of your time for research. We have some prominent psychosis researchers such as Dr. Kane and Dr. Correll. There's also some really innovative stuff going on with neuroimaging and peripartum psychiatry.
4. Other perks: 4 weeks of vacation (For R1, separated into one 2 week block and two 1 week blocks. More flexibility in R2 for when your vacation is). The pay for R1 is $68,500 which is one of the highest salaries for residency programs, and gives you room to pay off debt, invest in your 403b for retirement, investing in stocks, etc. If you get healthcare insurance from Northwell, you could actually earn $14 per year if you get the most basic type of insurance which includes preventative care, obtain wellness credits by performing a few activities per year (your choice of dental cleaning, eye exam, annual checkup, etc.), and count the $500 annually from Northwell credited to your Health Savings Account. Annual gym stipend is $100 and there is an LA Fitness (discounted price with waived initiation fee and waived annual fee if you are a resident who purchases multi-year plan) as well as a Planet Fitness ($10/month) close by. Inexpensive rent with a spacious apartment close to the hospital if you get resident housing through the lottery. $600 annual education fund that you can use for educational expenses (paying for Step 3, etc.). Fall and spring retreats each year. Finally, my co-residents are an awesome bunch and I couldn't be happier to learn with them. They are really the best!
I'm sure there's more, but I can't think of the other perks right now...
5. I know that creating a rank list can be an agonizing process. And as the deadline to submit your list draws closer, please know that no matter where you end up, you can't go terribly wrong. You'll learn the basics of psychiatry through the program, but your own drive will determine how much you learn, how critically you think, and how good of a psychiatrist you will be. Find a place where you will feel happy and supported, and everything else will fall into place. Best of luck to you all!
