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Outpatient Psychiatry Elective

BobaBoba

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I am about to start my 4th year and plan to apply psych this application season. I am currently setting up my 4th year schedule. I have a couple more slots to fill. Although I am wanting to keep a balanced elective schedule with a couple psychiatry rotations and the rest being filled with other aspects of medicine, I was thinking of adding one more psychiatry elective that might be less traditional. My hope is to see firsthand some of the business aspects of running an outpatient psych practice.

I assume I will have to do some cold-calling to find someone that would allow me to work with them. I won't be surprised if I cannot find anybody willing to let me work with them.

My question is, if I could find an opportunity like this, would it be beneficial as an elective?

Thanks!
 

oldiebutgoodie1211

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I am about to start my 4th year and plan to apply psych this application season. I am currently setting up my 4th year schedule. I have a couple more slots to fill. Although I am wanting to keep a balanced elective schedule with a couple psychiatry rotations and the rest being filled with other aspects of medicine, I was thinking of adding one more psychiatry elective that might be less traditional. My hope is to see firsthand some of the business aspects of running an outpatient psych practice.

I assume I will have to do some cold-calling to find someone that would allow me to work with them. I won't be surprised if I cannot find anybody willing to let me work with them.

My question is, if I could find an opportunity like this, would it be beneficial as an elective?

Thanks!

it’s beneficial as a pgy4 less so as an m4 imo
 
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kopftonmd

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Not totally what you were talking about, but my school added outpatient as one of our options for MS3 clerkships (in combination with CPEP) and it was actually awesome. Not so much talk about running the business but I did get to hear attendings gripe about whatever their bugaboos were (lack of MAs, not enough therapy providers, no security, no drug screening on premises, etc.), which was a little window into that world.
 
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BobaBoba

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Not totally what you were talking about, but my school added outpatient as one of our options for MS3 clerkships (in combination with CPEP) and it was actually awesome. Not so much talk about running the business but I did get to hear attendings gripe about whatever their bugaboos were (lack of MAs, not enough therapy providers, no security, no drug screening on premises, etc.), which was a little window into that world.

That is probably how I should have asked the question. Should I try to do a month of outpatient psych? I have always enjoyed outpatient medicine over inpatient, and I think it could be beneficial to learn about some of the behind the scenes issues that these providers deal with.
 

kopftonmd

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I'm sure there are other (wiser) people than me who will say no, but I think you should definitely spend some time in outpatient. There's a lot to learn from outpatient, from nuts and bolts to broad ranges of pathology and (if you're at a big academic place) some refractory patients that have interesting psychopharm regimens. Plus there are so many psych docs who only work outpatient, so it's a taste of that.

I almost said that you should perhaps do 2 or 3 weeks rather than 4 if it's going to cut into time on other services but... if you're an M4 and you're decided, this is probably the time to coast. Plus you might be able to work on your interviewing and note writing skills, which are certainly never bad!
 

ERK123

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I did an outpatient psych elective as a 4th year and thought it was an extremely valuable experience. I learned nothing about business, but seeing psychopathology at differing levels of severity than what I had seen on in patient wards was quite eye opening. Before that rotation I had only seen patients in enough crisis to be on a locked ward, whereas the outpatient experience gave me a window into the life of a patient with schizophrenia or bipolar disorder who were trying to live their best life. I think it will be easier to empathize with certain decompensated patients in residency now that I have some sort of mental image for where proper care can take them. I also enjoyed observing a bunch of different interview styles from a variety of psychiatrists. The one downside was that the experience was almost entirely observing, but I still really enjoyed the experience.
 
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splik

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Since most psychiatrists work in the outpatient setting and it will be at least half of your residency training, it is certainly a good idea to get some outpatient exposure especially if you have already had sufficient exposure to acute settings (including at least one sub-i in inpatient, emergency or consultation-liaison psychiatry). Especially if the elective is done in an academic setting you are likely to learn little/nothing about the business of psychiatry (and most psychiatrists not-in private practice and a lot of those who are in pp don't know anything about business). bear in mind the clinical experience in outpatient is often more limited (maybe more observation than in inpatient settings) and due to COVID in large parts of the country you would be doing your elective from home and joining telemedicine visits.
 
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Doctorows

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I also did an outpatient psych elective in resident psychopharm clinic as a 4th year med student and found it very valuable. It also gave me some idea of what kinds of questions to ask about outpatient training on the interview trail that I never would've known to ask otherwise.
 

NickNaylor

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Personally I don't think there would be much value to doing an outpatient elective - I think there is less opportunity to actually learn all that much since an outpatient practice is typically busy and the scheduled appointments may setting aside extra time difficult. If you're rotating at a large, academic outpatient practice, you are likely going to learn nothing about the business of running an outpatient practice - that's something that you would likely see more at a private, solo practice.

From an educational perspective, I think you would likely learn more on an inpatient service (consider consults if you haven't had the chance to do a consult rotation). I do think it's important to see the outpatient side of psychiatry since that's what most people do, I just don't think doing a rotation as a medical student is the best way to get that exposure.
 

Stagg737

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Personally I don't think there would be much value to doing an outpatient elective - I think there is less opportunity to actually learn all that much since an outpatient practice is typically busy and the scheduled appointments may setting aside extra time difficult. If you're rotating at a large, academic outpatient practice, you are likely going to learn nothing about the business of running an outpatient practice - that's something that you would likely see more at a private, solo practice.

From an educational perspective, I think you would likely learn more on an inpatient service (consider consults if you haven't had the chance to do a consult rotation). I do think it's important to see the outpatient side of psychiatry since that's what most people do, I just don't think doing a rotation as a medical student is the best way to get that exposure.

I actually disagree with this. I realize I'm still a resident, but I had 2 rotations that had an outpatient component in med school. One was split with inpatient at a place that was very busy. The other was a cash-only outpatient practice where the doc did a lot of psychotherapy. It had a completely different feel from inpatient and the prescribing practices almost felt like it was another field altogether at times. For med students who really want to practice outpatient or don't think they want to do inpatient/consults, I do think it's a valuable experience as they may be better pursuing a different field if they really end up hating the outpatient side.

I do agree that they'll likely learn much more on the inpatient unit and that an elective at a private practice that doesn't overbook would be better than academic. However, I did think my outpatient experiences were important and they have lined up with my expectations in residency (preference for inpatient/consults).
 
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