Hi, I'm a resident in psychiatry. The more time goes on the more I feel I can't stand this field. I am miserable whenever I am on psychiatry and was happier when I was off service as an intern. I'm not sure if this has to do with psychiatry itself or my program. In medical school, I did four month long psychiatry rotations and I enjoyed them very much. I found the patients and the material interesting. I got residency interviews at many good programs but unfortunately matched somewhat low on my list but not at the bottom of it. I was still okay with the program I got.
After arriving at my program, I found that many of the things that made me rank this program higher than others were lies or exaggerations. While the department here technically has a fellowship in the sub-specialty I want to go into, it is a joke. There's only one guy working in the sub-specialty and he makes up the entire program for it. The subspecialty is not even his main area of expertise and he makes no money with the subspecialty even though I know it's a very lucrative subspecialty in other places. There is literally one clinical site that is truly specific to the sub-specialty. I was told I could do an elective in the subspecialty as a second year but this elective does not actually exist.
The attendings here are sparsely involved in clinical care. They are not present most of the time and teaching and supervision are limited. We basically have to teach ourselves psychiatry on top of our well above average work load. We spend most of our time with the resident to attending ratio being 5:1 and the learning to scutwork ratio is worse than that. My friends at other programs have lots of 1:1 attending interaction. In third year (outpatient), there is no direct supervision for most of the patients though I was told there would be. There is limited structure on our psych services. It's unclear what each person's role is on a team. No one explains anything to the interns because everyone assumes someone else has told them and/or they already know even when logistics are not intuitive. I did not find out our psych unit had a padded isolation room until 9 months into intern year despite spending plenty of time on the unit before that. I still constantly hear about supposed departmental policies that I "should" have already known about. We were not given any sort of handbook or formal instruction on these policies. I spend all my time writing notes and doing social work and case management. The admin at our program is not receptive to feedback and any complaint a resident has is always dismissed with the excuse being that the complaint is due to something being wrong with said resident, even if all the residents feel that way. We are treated like delinquent children instead of adult professionals. We have no contingency plan for if someone is sick so everyone involved just gets screwed. Every other department here has a contingency plan. The other residents in my program don't seem to give a crap that our training is not ideal. They just want to get out of work as quickly as possible and then get wasted like college kids on the weekend. I have tried to work on improving things here but no one else will engage in it.
Furthermore, I hate spending so long talking to patients who aren't engaged in their care and don't respect me. I hate delving into the minute details of people's social history so I can better handle their dispo. I hate all the freaking talking about nonsense and listening to patients' endless rants about non-pertinent information. I hate typing notes that are 5 times longer than the other services. Why are the notes so freaking long? None of this crap was a part of the psych rotations I did in medical school.
Off service, team member roles are better defined. There's more teaching. There's less social work. I spend my time figuring out medical problems and treatment plans instead of dispo crap. I like being able to order labs, use evidence from physical exams to make decisions, and practice evidence based medicine instead of just arbitrarily prescribing whatever attending's pet drug for no apparent reason. Should I switch specialties? Am I a bad match for my program? Am I just burned out? Am I a whiny delinquent child? Sometimes I think I would like to quit medicine altogether but I feel that I can't with all this debt. And sometimes I am very happy about being a doctor (usually when I have been off service).
Things are complicated because I have no personal life here and no time to develop one. Long distance has destroyed the relationship I came into residency with. I'm single in a city full of young families and college kids. Dating for people my age seems to be non-existent and I don't have time for it anyway. I'm far away from my family and friends from my previous life. I tried to transfer programs this year but it didn't work out due to funding problems even though a program near my hometown really wanted to take me. I don't know what to do. My mood has been okay until this past week when I've noticed it's declining slightly as I'm back on my least favorite service. I don't have neuro-vegetative symptoms. I'm not anxious. I don't think I am mentally ill, but I am not happy with my life right now, as my life is this residency that I am dissatisfied with. I would be happy for any advice or constructive comments.
Thanks
After arriving at my program, I found that many of the things that made me rank this program higher than others were lies or exaggerations. While the department here technically has a fellowship in the sub-specialty I want to go into, it is a joke. There's only one guy working in the sub-specialty and he makes up the entire program for it. The subspecialty is not even his main area of expertise and he makes no money with the subspecialty even though I know it's a very lucrative subspecialty in other places. There is literally one clinical site that is truly specific to the sub-specialty. I was told I could do an elective in the subspecialty as a second year but this elective does not actually exist.
The attendings here are sparsely involved in clinical care. They are not present most of the time and teaching and supervision are limited. We basically have to teach ourselves psychiatry on top of our well above average work load. We spend most of our time with the resident to attending ratio being 5:1 and the learning to scutwork ratio is worse than that. My friends at other programs have lots of 1:1 attending interaction. In third year (outpatient), there is no direct supervision for most of the patients though I was told there would be. There is limited structure on our psych services. It's unclear what each person's role is on a team. No one explains anything to the interns because everyone assumes someone else has told them and/or they already know even when logistics are not intuitive. I did not find out our psych unit had a padded isolation room until 9 months into intern year despite spending plenty of time on the unit before that. I still constantly hear about supposed departmental policies that I "should" have already known about. We were not given any sort of handbook or formal instruction on these policies. I spend all my time writing notes and doing social work and case management. The admin at our program is not receptive to feedback and any complaint a resident has is always dismissed with the excuse being that the complaint is due to something being wrong with said resident, even if all the residents feel that way. We are treated like delinquent children instead of adult professionals. We have no contingency plan for if someone is sick so everyone involved just gets screwed. Every other department here has a contingency plan. The other residents in my program don't seem to give a crap that our training is not ideal. They just want to get out of work as quickly as possible and then get wasted like college kids on the weekend. I have tried to work on improving things here but no one else will engage in it.
Furthermore, I hate spending so long talking to patients who aren't engaged in their care and don't respect me. I hate delving into the minute details of people's social history so I can better handle their dispo. I hate all the freaking talking about nonsense and listening to patients' endless rants about non-pertinent information. I hate typing notes that are 5 times longer than the other services. Why are the notes so freaking long? None of this crap was a part of the psych rotations I did in medical school.
Off service, team member roles are better defined. There's more teaching. There's less social work. I spend my time figuring out medical problems and treatment plans instead of dispo crap. I like being able to order labs, use evidence from physical exams to make decisions, and practice evidence based medicine instead of just arbitrarily prescribing whatever attending's pet drug for no apparent reason. Should I switch specialties? Am I a bad match for my program? Am I just burned out? Am I a whiny delinquent child? Sometimes I think I would like to quit medicine altogether but I feel that I can't with all this debt. And sometimes I am very happy about being a doctor (usually when I have been off service).
Things are complicated because I have no personal life here and no time to develop one. Long distance has destroyed the relationship I came into residency with. I'm single in a city full of young families and college kids. Dating for people my age seems to be non-existent and I don't have time for it anyway. I'm far away from my family and friends from my previous life. I tried to transfer programs this year but it didn't work out due to funding problems even though a program near my hometown really wanted to take me. I don't know what to do. My mood has been okay until this past week when I've noticed it's declining slightly as I'm back on my least favorite service. I don't have neuro-vegetative symptoms. I'm not anxious. I don't think I am mentally ill, but I am not happy with my life right now, as my life is this residency that I am dissatisfied with. I would be happy for any advice or constructive comments.
Thanks