PGY1 Psychiatry--don't feel like continuing in the same program

[hipster22]

---

Members do not see this ad.

It's about time we are getting ready for the next year and I find myself very unhappy about the prospect of staying in my program another year. I feel a big part of it is that PGY-2's carry most of the workload in the program and we are already short on residents which makes it even harder as all of us will most likely be doing an extra month of night float.

Faculty is very limited in my program and I'm very scared about the fact that we may be losing a lot of electives. It's no question that my program took a dive in terms of funding this year which contributes to a lot of these changes.

I feel like I don't know enough to be a PGY2 and supervise the 1's as I'm constantly working on notes/finishing later than others. I also feel that I have not been reading as much which contributes to my worries about next year.

My question is, if I decide not to move forward with renewing my contract next year, is there anything I would have gained by finishing my intern year in Psychiatry? Could I work for a research firm or teach something? I know that for those who have done only a year of medicine, they are always able to do a GP position or something. I'm an AMG for whatever its worth.

 

[QofQuimica]

I think everyone has some trepidation when transitioning from intern to junior resident, because it is a big jump in responsibility as you've mentioned. However, what seems more concerning is that your response to feeling unprepared isn't, "gee, I better kick my butt in gear and start reading more/working harder to be more efficient so I can be ready." Are you looking to change programs, or are you looking to get out of psychiatry/medicine altogether? If it's the latter, then sure, drop out. Though I think at this point, it's probably worth finishing your intern year, in part because by dropping out now you're going to make your co-residents suffer an even greater coverage shortage, and in part because I'm guessing you don't have another job already lined up, and you presumably want to continue to be able to pay your bills for the next few months while you figure out your next move. You will also need to complete an intern year if you want to apply for a license, although I have no idea what kinds of jobs, if any, are open to someone with just a psych intern year.

 

[Shikima]

It's about time we are getting ready for the next year and I find myself very unhappy about the prospect of staying in my program another year. I feel a big part of it is that PGY-2's carry most of the workload in the program and we are already short on residents which makes it even harder as all of us will most likely be doing an extra month of night float.

Faculty is very limited in my program and I'm very scared about the fact that we may be losing a lot of electives. It's no question that my program took a dive in terms of funding this year which contributes to a lot of these changes.

I feel like I don't know enough to be a PGY2 and supervise the 1's as I'm constantly working on notes/finishing later than others. I also feel that I have not been reading as much which contributes to my worries about next year.

My question is, if I decide not to move forward with renewing my contract next year, is there anything I would have gained by finishing my intern year in Psychiatry? Could I work for a research firm or teach something? I know that for those who have done only a year of medicine, they are always able to do a GP position or something. I'm an AMG for whatever its worth.

If you're concerned about the program you are in, look for alternative programs which would have a PGY-2 spot for you. The time would be now in asking around the country and looking at listings for open positions. Even considering specialty changes is reasonable if you aren't wanting to move and could see yourself doing something different.

I wouldn't throw the towel in at all, you've worked too hard to get to where you are now. But there are always options.

 

[michaelrack]

My question is, if I decide not to move forward with renewing my contract next year, is there anything I would have gained by finishing my intern year in Psychiatry? .

you may be able to get a job working at a state psychiatric hospital- some of them in rural areas are desparate

 

[gutonc]

You haven't answered the most important question. Do you still want to be a doctor?

Answer that for us and we'll be able to give you some useful advice.

Regardless of how you answer that question though, yes, finish this year. You have <3 months to go.

 

[hipster22]

I definitely want to finish intern year and I still want to be a doctor.

I just cannot be happy at this place anymore. The weather is atrocious, the conservative nature of the people is a complete opposite of my liberal upbringing, and most importantly, the program faculty is limited and very unstable. This is a very resident dependent program and any learning that I've done has been on my own.

I carry about 13 patients everyday that I write notes on. I do Physical exams on all my patients as we have no NP's or PA's. I have missed several didactics and lied about duty hours on several occasions as it is very possible to violate hour rules (not total hours) for an intern.

I don't see anything getting better in second year. I'm so overwhelmed and sleep deprived just doing the scutwork that I can either choose between sleep or reading. I go to a very intensive program (not your typical psych program) and I am deeply concerned about how miserable I will be if I force myself to be unhappy for 3 more years.

Simply put, and I know this is going to sound awful, I cannot meet the quality of patient care and ridiculous quantity of patients seen that this program requires.

 

[gutonc]

I definitely want to finish intern year and I still want to be a doctor.

I just cannot be happy at this place anymore. The weather is atrocious, the conservative nature of the people is a complete opposite of my liberal upbringing, and most importantly, the program faculty is limited and very unstable. This is a very resident dependent program and any learning that I've done has been on my own.

Alright...stop there. You matched at a program in a location that you hate, and a program you (putting on my turban and picking up my crystal ball, will say) ranked very low. And, unsurprisingly, you hate it.

So help us out more. Where, in a quartile nature, was this program on your rank list?

First or 2nd quartiles? Well, you chose poorly and can easily grab a better spot either as a PGY2 or by going back in the match next year (meaning you'll take a year off).

3rd Quartile? Hopefully you're a DO and can score an unfilled AOA spot. Otherwise throw into next year's match and choose more carefully.

4th quartile? Suck it up and stick it out.

 

[hipster22]

Alright...stop there. You matched at a program in a location that you hate, and a program you (putting on my turban and picking up my crystal ball, will say) ranked very low. And, unsurprisingly, you hate it.

So help us out more. Where, in a quartile nature, was this program on your rank list?

First or 2nd quartiles? Well, you chose poorly and can easily grab a better spot either as a PGY2 or by going back in the match next year (meaning you'll take a year off).

3rd Quartile? Hopefully you're a DO and can score an unfilled AOA spot. Otherwise throw into next year's match and choose more carefully.

4th quartile? Suck it up and stick it out.

It was 4th quartile ( I applied to only a few programs). I went to a US MD school, had some health issues that required me to take time off. I was hoping to do what you suggested for first and second quartiles.

I didn't think this place was as terrible as I do now as recently there have been a lot of big changes.

 

[cookymonster]

I'm sure others in the program are feeling overworked too, but are they struggling with it as much as you are? Presumably at least some of your classmates are going to didactics (if you're skipping these, I don't think you have a lot of ground to complain that no one is teaching you anything). Is everyone else routinely violating duty hours? Are others considering quitting?

If not, there are a few questions you should ask yourself:

How efficient are you (especially at note writing)?
How comfortable and competent are you with managing patients for your level of training? How have your Evals and PRITE scores been?
How well do you manage stress?

If you have issues in these areas, moving to another program or quitting residency isn't going to take care of them.

Second, I don't know your program, but it isn't going to be like this for three years. PGY-4 is a joke in most psychiatry programs. Even if it's more rigorous for you, it's nothing like intern year. You may like outpatient psych more than Inpt. And the resident shortage you have this year ought to improve. Have you done night float yet? I actually enjoyed it.

If you still want to be a psychiatrist with decent employment prospects, I don't think you have many options other than to stick it out at least through next year, as your PD has no time to replace you now. If next year goes poorly and the resident shortage gets fixed, you may discuss with him whether a transfer would be mutually beneficial so you can leave on good terms. You can also short-track into C/A elsewhere after PGY-3.

 

[hipster22]

I'm sure others in the program are feeling overworked too, but are they struggling with it as much as you are? Presumably at least some of your classmates are going to didactics (if you're skipping these, I don't think you have a lot of ground to complain that no one is teaching you anything). Is everyone else routinely violating duty hours? Are others considering quitting?

If not, there are a few questions you should ask yourself:

How efficient are you (especially at note writing)?
How comfortable and competent are you with managing patients for your level of training? How have your Evals and PRITE scores been?
How well do you manage stress?

If you have issues in these areas, moving to another program or quitting residency isn't going to take care of them.

Second, I don't know your program, but it isn't going to be like this for three years. PGY-4 is a joke in most psychiatry programs. Even if it's more rigorous for you, it's nothing like intern year. You may like outpatient psych more than Inpt. And the resident shortage you have this year ought to improve. Have you done night float yet? I actually enjoyed it.

If you still want to be a psychiatrist with decent employment prospects, I don't think you have many options other than to stick it out at least through next year, as your PD has no time to replace you now. If next year goes poorly and the resident shortage gets fixed, you may discuss with him whether a transfer would be mutually beneficial so you can leave on good terms. You can also short-track into C/A elsewhere after PGY-3.

There are other classmates who cannot make it. It's a busy program and we all agree that the didactics are pretty worthless. You have to read on your own.

I'm slow and I did not do wonderful on PRITE as I'm not a great test taker.

It's doubtful resident shortage will resolve as this is a state run institution and there is more budget cuts planned.

I looked into the option of fast tracking into a C/A fellowship but I don't see any after PGY2, I honestly don't even feel like finishing second year here as I feel like I'm always walking on egg shells around the PD. I've also asked a few of my upperclassmen and they've said that outpatient years get better but they urged me to find ways to escape the program if I can as they had a miserable time here.

 

[ThoracicGuy]

There are other classmates who cannot make it. It's a busy program and we all agree that the didactics are pretty worthless. You have to read on your own.

I'm slow and I did not do wonderful on PRITE as I'm not a great test taker.

It's doubtful resident shortage will resolve as this is a state run institution and there is more budget cuts planned.

I looked into the option of fast tracking into a C/A fellowship but I don't see any after PGY2, I honestly don't even feel like finishing second year here as I feel like I'm always walking on egg shells around the PD. I've also asked a few of my upperclassmen and they've said that outpatient years get better but they urged me to find ways to escape the program if I can as they had a miserable time here.

These two statements here would make me concerned that you will have a hard time finding a new position in a better place. Couple that with this being low on your match list, and I suspect that if you want to be a doctor you need to stick it out in your program.

You are an intern and there's always alot of scut as an intern, but the job does get better (usually) as you advance. The work may not lessen in volume, but the type of work you do as you advance usually is better.

 

[Arcan57]

Your seniors may not have an appropriate appreciation of the difficulties you would face in securing transfer to a better program. You're an intern that matched into the bottom of your rank list in a relatively uncompetitive specialty and are struggling in your current program. While
I'm sure your program has issues, it doesn't seem like what you have been doing has led you to what you had hoped for in terms of your career. It's possible a change of scenery will help your mood but a more liberal city with better weather isn't going to fix the fact that you're behind your peers (in fact switching to a new system will exacerbate this).

 

[hipster22]

These two statements here would make me concerned that you will have a hard time finding a new position in a better place. Couple that with this being low on your match list, and I suspect that if you want to be a doctor you need to stick it out in your program.

You are an intern and there's always alot of scut as an intern, but the job does get better (usually) as you advance. The work may not lessen in volume, but the type of work you do as you advance usually is better.

It's not even scut work that bothers me. I think it's just the sheer distance from family and lack of organization in the program.

I know that I was not a very desirable candidate to begin with. Primarily due to my low test scores (no failures) just low scores due to being a poor test taker.

I feel that my patient care and day to day knowledge is on par (as has been reflected by evaluations) with my level of training. I feel that the volume of work is going to eat me alive no matter how hard I try. I am not alone in feeling this way.

Also, I don't think the program has much resources in terms of didactics to offer so I don't think I'm missing out on much by not being able to attend (this goes for a good bunch of us who are covering the services).

 

[BobBarker]

You need to stay and finish if you want to be a doctor.

 

[hipster22]

I just don't understand why people say you should always finish intern year if you are truly miserable? Is this so you can practice? I mean this system seems so opposed to people transferring.

 

[QofQuimica]

I just don't understand why people say you should always finish intern year if you are truly miserable? Is this so you can practice? I mean this system seems so opposed to people transferring.

Primarily because your MD/DO is useless without a residency. And dropping out in the middle of your intern year is just about guaranteed to ensure that your career in medicine is over. So you need to make a decision: do you want to be a practicing psychiatrist or other physician some day, or are you so miserable/burned out/disillusioned with it that you don't even want to continue with a career in medicine any more?

If it's the former case, then sure, you can try to transfer programs. It may or may not be possible given your weakness as a candidate and as a resident, and your PD will have to be on board because at minimum you'll need a LOR from him. But if he won't support you for a transfer, and if being a psychiatrist is your dream, then you should probably suck it up if you can. Because dropping out of residency with your PD unwilling to support you will make it impossible for you to become a practicing psychiatrist, or even to get a medical license. Like it or hate it, that's how the medical training system works in this country: no intern certificate, no getting a license and practicing as a physician in any capacity. Ever.

If it's the latter case, then really nothing is keeping you there except financial and perhaps personal considerations. If you don't have another job lined up already, how do you intend to support yourself if you drop out right now? And likewise, do you dislike your current situation enough that you're willing to throw all of your co-interns under the bus by forcing them to pick up your slack for the next 2.5 months? Maybe you hate all of them too, and you'd like to give them the proverbial middle finger along with your program and the entire medical field. And maybe you don't need your residency salary to live on. If that's the case, then again, nothing is stopping you from leaving right now. Do what you gotta do. Just make sure you are ok with the consequence that there ain't no going back.

 

[hipster22]

Primarily because your MD/DO is useless without a residency. And dropping out in the middle of your intern year is just about guaranteed to ensure that your career in medicine is over. So you need to make a decision: do you want to be a practicing psychiatrist or other physician some day, or are you so miserable/burned out/disillusioned with it that you don't even want to continue with a career in medicine any more?

If it's the former case, then sure, you can try to transfer programs. It may or may not be possible given your weakness as a candidate and as a resident, and your PD will have to be on board because at minimum you'll need a LOR from him. But if he won't support you for a transfer, and if being a psychiatrist is your dream, then you should probably suck it up if you can. Because dropping out of residency with your PD unwilling to support you will make it impossible for you to become a practicing psychiatrist, or even to get a medical license. Like it or hate it, that's how the medical training system works in this country: no intern certificate, no getting a license and practicing as a physician in any capacity. Ever.

If it's the latter case, then really nothing is keeping you there except financial and perhaps personal considerations. If you don't have another job lined up already, how do you intend to support yourself if you drop out right now? And likewise, do you dislike your current situation enough that you're willing to throw all of your co-interns under the bus by forcing them to pick up your slack for the next 2.5 months? Maybe you hate all of them too, and you'd like to give them the proverbial middle finger along with your program and the entire medical field. And maybe you don't need your residency salary to live on. If that's the case, then again, nothing is stopping you from leaving right now. Do what you gotta do. Just make sure you are ok with the consequence that there ain't no going back.

I have every intention of staying the last 2.5 months. I don't hate anyone. I just really don't understand why everyone always emphasizes the importance of finishing intern year and saying that transferring is not that hard. I feel incredibly burned out and I don't feel like even thinking about if I will be able to survive next year.

 

[ThoracicGuy]

I have every intention of staying the last 2.5 months. I don't hate anyone. I just really don't understand why everyone always emphasizes the importance of finishing intern year and saying that transferring is not that hard. I feel incredibly burned out and I don't feel like even thinking about if I will be able to survive next year.

Transferring to a new program, in general, is hard. You have to find a program that has a spot AND open to taking you. Just because they have the spot open doesn't mean they necessarily will want you to fill it. They will want to talk to your PD before it would happen. Typically programs will not want another program's problem and that is often how transferring residents are perceived.

So the importance of finishing intern year? One, it allows you to get a permanent license assuming your a US grad. Two, leaving in the middle of the year to move to another program looks bad. It says you don't honor your commitments. Who's to say you won't want to leave the next program halfway through because you don't like it there.

And finally, just because your program may be bad, there's no guarantee the program you transfer to won't be worse.

 

[hipster22]

Transferring to a new program, in general, is hard. You have to find a program that has a spot AND open to taking you. Just because they have the spot open doesn't mean they necessarily will want you to fill it. They will want to talk to your PD before it would happen. Typically programs will not want another program's problem and that is often how transferring residents are perceived.

So the importance of finishing intern year? One, it allows you to get a permanent license assuming your a US grad. Two, leaving in the middle of the year to move to another program looks bad. It says you don't honor your commitments. Who's to say you won't want to leave the next program halfway through because you don't like it there.

And finally, just because your program may be bad, there's no guarantee the program you transfer to won't be worse.

Thank you. I definitely have no intention of leaving during the middle of the year. I just can't bring myself to sign my contract for PGY-2 because I don't want to be miserable another year longer.

 

[QofQuimica]

Thank you. I definitely have no intention of leaving during the middle of the year. I just can't bring myself to sign my contract for PGY-2 because I don't want to be miserable another year longer.

Ok. So what DO you want to do? If you're the typical intern, you've currently got six figure debt and no other marketable skills to leverage to pay it all back. So if you're going to bail out of residency, you need a plan.

 

[j4pac]

I have every intention of staying the last 2.5 months. I don't hate anyone. I just really don't understand why everyone always emphasizes the importance of finishing intern year and saying that transferring is not that hard. I feel incredibly burned out and I don't feel like even thinking about if I will be able to survive next year.

Is a leave of absence after your 1st year an option? You sound like you are burnt out and need a break. I'm not sure that a change of scenery is a recipe for success. Though you may be in a better area...you will have to learn new hospital processes, EMR, and you will have an underdeveloped rapport with staff and residents. The grass isn't always greener, and it looks like you are looking for the easy way out .There is no easy way out. Perhaps you can take a leave of abs cense and come back rejuvenated...?

 

[hipster22]

Ok. So what DO you want to do? If you're the typical intern, you've currently got six figure debt and no other marketable skills to leverage to pay it all back. So if you're going to bail out of residency, you need a plan.

Ideally I would love to go to a PGY-2 position in an area closer to home where I would have family support. I would love to say adios on July 1st to my current program and not look back but I do realize that it would be tough to make a living or get any job with just one year of Psych intern year done.

I just wonder that why do people keep on emphasizing the need to finish intern year then, if there is not real value of a licensed physician who is not BE or BC?

Also, I do take points that my PD could also pursue action against state licensing boards regarding me as well.

I just feel stuck and helpless here. Also, there is no possibility of taking a year off. The service is too busy to accommodate for even sick days.

 

[cookymonster]

We get it, the program sucks. You can either plot your exit strategy or sign the contract. If you decide to get out, you have to either talk to your PD about a transfer or seriously look into your job prospects after your intern year. That would mean finding a job that will hire you and a few attendings who can provide good references. If you don't want to take those risks, sign the contract, commit to a 2-3 year ordeal (depending on if you want to short-track into CAP), and make the best of it.

If you don't want to feel "stuck and helpless," knock it off with the woe-is-me attitude and play the cards you've been dealt.

 

[mercaptovizadeh]

Please, just grin and bear it and tough it out. We've all been there. Anything you do like dropping out, LOA, transferring, is bound to complicate your life even more than it already is. Medicine is a wretched career for many of us at first but we sometimes find a niche that works. To get there, you have to complete residency. If you are competent and not facing remediation, just keep your head down and finish up residency at the current place, then organize your life how you wish once you are an attending and have the power to do so.

 

[QofQuimica]

Ideally I would love to go to a PGY-2 position in an area closer to home where I would have family support. I would love to say adios on July 1st to my current program and not look back but I do realize that it would be tough to make a living or get any job with just one year of Psych intern year done.

I just wonder that why do people keep on emphasizing the need to finish intern year then, if there is not real value of a licensed physician who is not BE or BC?

Also, I do take points that my PD could also pursue action against state licensing boards regarding me as well.

I just feel stuck and helpless here. Also, there is no possibility of taking a year off. The service is too busy to accommodate for even sick days.

Because a partial intern year is completely worthless. At least if you finish your intern year, you can apply for a full license in some states (assuming you're an American grad). Having an intern certificate also makes for a much smoother transition point if you do decide to change careers within medicine. There are many specialties that require a general intern year followed by advanced residency training; it is obviously quite common in those specialties for people to come into them after having done an intern year elsewhere. Completing a year of internship is a natural transfer point for people who do switch programs or specialties. Of course, if you're in a specialty like psych that has its own integrated intern year, that is not going to be as helpful. But if you are going to change programs, it will still probably be easier to do that as a new PGY2 than in the middle of the intern year.

Have you looked into finding a position at another program? All of this discussion is moot unless there is a potential open position for you that you'd consider taking.

 

[Crayola227]

they go on and on about getting that intern certificate because you can't even push paper with just your MD

ever hear how people say just go work for a big medical insurance company as a reviewer? you know the people who rubberstamp/deny prior authorizations? almost all of those jobs require you to have a license, and you can't get a license ANYWHERE without at least a year of residency

even being a forensic examiner for the state, they want you to have a license

check out the dropout club website, seriously go look at jobs for MDs and see how many *don't* require a license

the fact that job prospects are still crappy with a license and no residency does not then mean that there's no point to finishing intern year and getting your license for crying out loud

an MD and no license? you can pretty much go work for Kaplan or the USMLE test prep people... only problem usually with a $40K job is paying off your loans... sure you can go IBR but you'll be paying on them for the next 20 years for sure, you can't even keep up with their interest on resident salary levels/middle class wages, so you'll be saddled with debt and it will just grow until discharge forever.... I dont' know what that sort of debt and salary equate to for your credit long term

 

[Angry Birds]

Leaving your residency like that would be an absolutely atrocious idea.

 

[hipster22]

Because a partial intern year is completely worthless. At least if you finish your intern year, you can apply for a full license in some states (assuming you're an American grad). Having an intern certificate also makes for a much smoother transition point if you do decide to change careers within medicine. There are many specialties that require a general intern year followed by advanced residency training; it is obviously quite common in those specialties for people to come into them after having done an intern year elsewhere. Completing a year of internship is a natural transfer point for people who do switch programs or specialties. Of course, if you're in a specialty like psych that has its own integrated intern year, that is not going to be as helpful. But if you are going to change programs, it will still probably be easier to do that as a new PGY2 than in the middle of the intern year.

Have you looked into finding a position at another program? All of this discussion is moot unless there is a potential open position for you that you'd consider taking.

There are two possible openings at places where I could make a convincing argument of wanting to go to (location is near my family) but the problem is that the contract is due this week per my PC. The positions are due to people leaving due to family reasons and they are not for sure available yet, but it will be certain by May (after my signed contract is due). I read my contract for next year and it says that either party can terminate it at any time without any set notice. I have been putting of returning my contract for next year for a while and my PC knows it's due soon. Should I just tell my PD that I have the potential for two spots next year and tell h I won't know for sure till Mid-May?

 

[blue0rchid]

Get some SSRI. Go see a therapist. Get a dog. Find a good friend to vent. Do whatever you can. Just don't lose your job. The moment you tell your PD you have potential for two spots next year, you will have a higher potential for losing this job next year.

 

[hipster22]

Get some SSRI. Go see a therapist. Get a dog. Find a good friend to vent. Do whatever you can. Just don't lose your job. The moment you tell your PD you have potential for two spots next year, you will have a higher potential for losing this job next year.

I wish there was time to do that. You can't even get sick in my program and calling back up is forbidden.

 

[hipster22]

Why is it such a crime to transfer programs if a position is available (that's an hour away from your sick parents for instance)?

 

[gutonc]

Why is it such a crime to transfer programs if a position is available (that's an hour away from your sick parents for instance)?

Nobody said it was a crime.

But you don't (but kind of do...although mostly don't) seem to understand that there's no such thing as a "transfer" in residency. There's only "quitting your current position and hoping to score another one".

If you can drop your current spot (after completing this year of course) and obtain that magical spot you speak of, well then, no harm (other than probably having to do another 6-12 months of residency), no foul. But if you can't...while certainly not a crime...it's clearly a terrible idea.

 

[dozitgetchahi]

Why is it such a crime to transfer programs if a position is available (that's an hour away from your sick parents for instance)?

Dude, these other programs aren't offering you anything set in stone. Hanging your hat on their promises could be really dangerous - people renege on things all the time when you have nothing in writing. Maybe their residents don't end up leaving, maybe they decide not to fill the positions, etc etc. It sounds like these other PDs haven't spoken to your PD yet either, and this discussion may bring an assortment of other problems along with it.

Sounds like you're so miserable at the moment that you'd accept practically anything other than continuing on, including being jobless. This may sound appealing now, but note that you could find yourself looking in the mirror in a few months going 'oh **** - what have I done'.

Your training may suck hard at the moment, but...this too shall pass. Four years of getting your ass kicked sounds a lot better than a lifetime of job issues and problems stemming from bailing out of residency with no backup options.