Psych residency hours?

Discussion in 'Psychiatry' started by Merely, Aug 26, 2017.

  1. Merely

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    How difficult is psych residency? I always see mention of how derm residency is like 40-50 hours a week and super cush compared to like most other residencies like IM and surg who consistently put in 70+ hours weekly. What is psych like? Is it stressful? Do you deal with very sick patients? Are you putting in 70+ hours a week or is it more like derm where you're doing 40-50hrs per week during residency?
     
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  3. coyotelime

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    - In general less hrs than medicine and much less than surgery
    - Hrs vary by program I'd imagine, but PGY1-2 are heavier (which I think is typical of most psych residencies - front loaded) - could get up to 65-70/wk when you factor in call, but again that varies depending on institution. I interviewed at places that hit 60 maybe a month out of the whole 4 years. Some programs advertise no call period. I know some programs let you do outpatient for your medicine months too, so that should be super chill
    - PGY3-4 usually outpt so a lot more chill, maybe 50 hrs/wk?
    - Off service rotations will be institution dependent, I've been 65-85 depending on team/workload on medicine past 2 mos. Neuro is variable too, but in general 60-80 depending on how busy consults/inpatient can be
    - Difficulty is subjective. You couldn't pay me to do OB/GYN, but obviously those that go into it love the field and they are much needed, just like everyone in medicine.
    - Stress is also subjective. I personally do better talking to people about their behavior/mood/delusions/etc than trying to explain to someone with metastatic disease why they won't be walking again. Prob emotionally draining as everyone says, so depends on your forte
    - People on inpatient psych are generally medically stable, but they can be stably sick (i.e. have chronic disease).
    - When consulting you will see pts everywhere in the hospital from the floridly psychotic teenager trying to throw his poo at RNs to some postop hypoactive delirious old dude, they can be "sicker", but you are there to address their psych issues, though often med titration can involve consideration of their underlying medical illnesses (i.e. kidney/liver disease, other stuff being treated like infections with antibiotics etc)
    - Would love to see others' input on these questions! Glad you have an interest so early (and if you're in med school/college, time to upgrade your flair :))
     
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  4. DisorderedDoc417

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    45-60hrs a week typically. Depending on call, you may or may not have more hours on a regular basis. On paper (to a med student) the job may look pretty easy, but I would exercise caution when comparing to derm. 60 hours of inpatient psych becomes mentally taxing. I find the degree of fatigue proportional to the number of personality-disorder/100th suicide attempt on neurontin/chronic re-hospitalization type admits. In that sense, you work with one of the sickest or most debilatated populations. As a student I thought it was the first-episode manic that was really sick but it turns out he's the easiest guy to treat on the floor!

    We also don't break up our time as interns between interviewing, doing procedures, operating, etc. It is interview --> H/Ps, daily follow-ups, and more H/Ps. You will rapidly become a skilled psych-intake machine based on raw repetition. To that end, I think it is stressful and can become mundane work. Do we have folks regularly coding or seizing suddenly and severely d/t to hyponatremia? Nope.

    I would say expect to work fairly hard in residency. If you do not -- you will suffer later in your career. That said, we have plenty of time to spend with family, exercise, read up, and "live life". I think the fun of psychiatry lies in treating the newer symptomatology and psychosis, but that is because I don't have the nuanced skillset yet to handle patients with 30 years of venturing through hell and back through every diagnosis, drug, and demon under the son. Someday!

    Hope this helps.
     
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  5. Seroquel

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    Yes, psych residency is like derm generally speaking. Of course first year of derm doing IM is definitely way more hours/work than intern year for psych. I would say the first two years vary between 40-60 hrs when factoring call unless you're at one of the few work heavy residencies. It's not the norm to be working over 60 hrs. Later years it's probably more like 40-50. Off service is definitely more. I've found even my busiest call shift on inpatient psych (where I'm just an intern) to be much less stressful than an EM or IM shift. I just find medical emergencies more nerve wracking than psychiatric ones. I'd also say interviewing patients where you can sit for longer periods is significantly easier on the body than running around answering pages, writing notes, putting in stat orders, etc on medicine. Sure you're doing some of that on psych but I find the intensity to be lower. Long story short, psych residency has great hours in comparison to every other field and is similar in that way to derm and path residencies.
     
  6. Armadillos

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    Psych is similar to derm or path with the exception in derm and path your expected to go home and read every night for a couple hours. In psych you realistically could pass boards never having ever picked up a psych textbook.
     
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  7. FlowRate

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    Our program averages about 50-60 hours a week for psych rotations, including overnight call, night float, and weekend coverage. (Night float weeks are 70 hours.)
     
  8. justclouds9000

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    What is H/P?
     
  9. justclouds9000

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  10. clausewitz2

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    I think our program comes in at about this many hours. What kills me so far second year is that we have Friday overnights that just tack on to our regular day duties, so a couple times a month I pull 28 hours at a stretch.
     
    #9 clausewitz2, Aug 26, 2017
    Last edited: Aug 26, 2017
  11. FlowRate

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    Yeah we do Saturday 24's and Fridays overnight. I hate those shifts.
     
  12. clausewitz2

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    We only have Saturday and Sunday 12s second year, , but they are sometimes overnight and are always in our exceptionally busy psych ED so not a chance of sleep. Worse is that sometimes we have Friday overnights after a full day and then are expected to do a Saturday overnight as well. Still better than weekend 24s, though.
     
  13. st2205

    st2205 Attending

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    Saturday 24s were the worst possible thing in our program, especially as your "post-call day" was another weekend day.
     
  14. 3lefts

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    Yuck!


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  15. Merely

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    how does one determine as an m4 if a program works their residents like crazy or if it's a more laid back 50hr per week type situation?
     
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  17. DisorderedDoc417

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    History and physical
     
  18. st2205

    st2205 Attending

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    Ask about call. Find out the frequency. Find out what call is (i.e. home call or is it just a shift where you're working non-stop but it's called call). Ask residents how much they work. Get a feel for how their body matches what they're saying. Stuff like that.
     
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  19. TexasPhysician

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    I averaged 40 hrs/week.


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  20. Blitz2006

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    While Psych Hours are obviously no where near OBGYN, GSurg, etc., I think people underestimate the amount of reading involved in psychiatry, to be a GOOD psychiatrist. Yes, you can scrape by residency/boards with bare minimal, but trust me, it will catch up to you as an attending....My advice is, the harder you work in residency, the easier your life will be as an attending...

    But if you want to be a GOOD/Competent psychiatrist, there is a lot of reading in psych, as well as Neuro (40% of boards is Neuro).

    And psychiatry patients can be very draining, 1 hour in-take with a psych patient can feel like 3 hours of patients in another speciality. So keep that in mind.

    But to answer your question, I think the average is 50-55 hours/week in psych residency. Be aware, there are some residences, while the minority, that do work you hard (70 hours/week), and vice versa, a few residencies that underwork ya (35-40 hrs/week).
     
  21. FlowRate

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    Yeah and those 24's are in an exceptionally busy ED... It's pretty brutal. Friday + Saturday night sounds rough, too.
    I was very attentive to call and I still don't think I got a good feel for even my own home program. Most residents at places don't know the call schedule beyond their own nose. If you ask for too much detail, you start to get weird looks. Most residency websites and handouts aren't super detailed, either. At least, that was my experience on the trail.
     
  22. J ROD

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    My program ranges out between 50-60 hrs/wk over second yr. Close to 70 hrs/wk intern yr. More like 45 hrs/wk for 3rd and 4th year. Definitely front loaded first 2 years.
     
  23. NickNaylor

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    We, too, have a front-loaded program. The only time I worked 70+ hours were on off-service rotations as an intern. Even on my busiest psych rotations during PGY-2, I would typically work 60-65 hours/week. The benefit is we have zero call as PGY-3s/4s.

    PGY-3 is a total joke. I do maybe 20 hours of actual clinical work a week for my residency duties - and that's being generous. More time for moonlighting and other academic stuff that I was having to shoehorn in on evenings and weekends that I can actually get done during the day.
     
  24. HockeyPsyGuy

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    Man our hours first year were regularly 70-90hrs when you factor in call on or off psych service. 2nd year is between 60-70 and here I was thinking I had it easier this year. One more thing on the list of a few that makes me feel like I picked the wrong program :/
     
  25. clausewitz2

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    I mean, if that call was in house, it sounds like you were regularly violating duty hours, so...probably not the greatest program?
     
  26. HockeyPsyGuy

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    Apparently the 80h week rule is averaged over a month. So 2 70h weeks and 2 90h weeks in a month don't break the duty hours.

    Yea I guess not. We get good training, we are a moderately well respected program in a good hospital in a mid/large city. We lie to applicants about the hours though, as well as the somewhat toxic environment with regards to some of our instructors. And life is pretty miserable 1st year. "It gets better" is the motto. But I didn't even realize other places regularly had 40-60h work weeks even in the first two years!
     
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  27. Merely

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    You lie to applicants about hours? Wow that's pretty ****ty...what program are you at...
     
  28. MedMan80

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    Our program was pretty much like this, "gets better" attitude, and heavy hours PGY1-3..We did not have the opportunity to take applicants out to dinner and so always interviewed with faculty/PD nearby, so one couldn't be honest to the applicants..
     
  29. Merely

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    Wow, I guess the only way to find the truth out is to do an away rotation there for a couple of weeks, that's super ****ty to be expecting to go to a lifestyle friendly program for 4 years then to get completely ****ed when you have to work 70 hours a week for years...
     
  30. 3lefts

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    I don't mind working hard but the prospect of making a big decision based on untruths/ unknowables is making me nervous! Anything we could ask that is more likely to elicit a realistic portrayal of a residency?


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  31. HockeyPsyGuy

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    I think most of the impression/information you get from a program on interviews is representative of how it really is. We have an interest in getting good residents to our program since we will be working with them, and overall I think I'm getting great training here and other people would too. Unfortunately that means bending the truth on some of the less desirable parts of the program. I would just be mindful of people saying things like, "The call schedule can be a bit rough first year but blah blah silver lining" because that probably means the call schedule is awful.

    On the other hand, I think it's possible with intuition and research to spot a 'malignant' program, which would be a much worse situation to be in than having to work tough hours with some bullying personalities along the way. In the former, from what I imagine, residency sucks, your life sucks, and you gain nothing for it. In our situation we at least become empowered knowing that we can handle demands we thought we couldn't. We share some rotation sites with residents from other programs in the city and it is clear (from our perspectives) that our clinical judgement and acuity have been honed much more sharply than some of our peers. Idk maybe I am justifying my own situation to myself, but I do feel like I am better in the end, as a clinician at least, for the rigorous schedule and tough love approach from some of my superiors.

    Plus, it gets better, right?
     
  32. st2205

    st2205 Attending

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    Any time you hear the phrase "you learn a lot," it's a euphemism for something fairly educationally worthless and rather unenjoyable. Same goes for "it will make you a better psychiatrist."
     
  33. clausewitz2

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    "You get a lot of autonomy" = the attending is at home and doesn't always answer the phone and you're flying solo, ready or not.
     
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  34. MedMan80

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    "Once you work here you can work anywhere" = will be flying solo, little supervision, you will see the worst of the worst
     
  35. ExcaliburPrime1

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    PGY-1: Can be horrible (worst is black/gold weekends on inpatient psych, so would work 12 days in a row including weekend, then have weekend off, then rinse and repeat). Medicine was also brutal. Best hours were actually neuro (neuro consults!) I'd say 60-80 hours per week on average.

    PGY-2: Average of one-24 hour call per week (including dreaded Saturday 24s) but even the ones during the week can be draining. With that factored in, again about 60-80 hrs per week, although there are a couple of easier rotations thrown in.

    PGY-3 and 4: Haven't done yet. PGY-3 we only do about 10-11 24-hour calls all year, so that's nice, and none as PGY-4. Outpatient life is apparently stressful in a different way but hours are better.
     
  36. clozareal

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    PGY-1: The inpatient medicine months are the most brutal, breaking 80 hours per week is the norm. It's a tough medicine residency. However, that's just for 2 months. The other two medicine months are 40-50 hours per week (outpatient) with weekends mostly off (or psych call). We get weekends off in both months of neurology. Otherwise, it's pretty much 40-60 hours per week throughout residency. Our inpatient psych is 8am-5pm with 1-3 weekend days a month and 0-1 evening shifts per week. That ends up being 50-60 hours per week with maybe the most being 65 hours. We have a few months of outpatient psychiatry in PGY-1, where it's about 40-50 hours per week that time. No 24 hour call shifts until PGY2 year unless switch a day/night shift with another resident to do that. We also have 2-3 weeks of night float all 4 years.

    PGY 2: We have about half a dozen 24 hour shifts and a weekend day shift every 4 weeks, so I believe it's around 50-60 hours per week.

    PGY-3 and 4: Not quite sure, but much less than PGY1 and 2. Still have night float, and PGY3's have to work some holidays and weekend shifts, but not as much as PGY-2s.
     
  37. fpsychdoc

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    It's only your intuition and observations that count during residency interviews, not what you are told. Pretty much like every employer in the real world, you're unlikely to get an accurate portrayal in interviews. Residents, including PDs, paint a rosy picture and hide most of the unpleasant things during interviews and then call it PR later. Your best bet for accurate information is if you're close with anyone with a connection at the program who can give you a candid portrayal.

    If anything sounds suspicious or even mildly abusive/malignant, run away and don't look back. They likely treat their residents much worse than their applicants.

    ---

    Regarding thread topic, I am at a community hospital in one the busiest metro areas, and I really can't complain.

    PGY-1: you average 50 hours a week in the psych part. Only the two medicine inpatient months are crazy (80 hours average).
    PGY2: average 50 hours a week including call for the whole year
    PGY3: average 40-50 hours a week.
    PGY4: no call. 40 hours a week.
     
  38. HockeyPsyGuy

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    Do we go to the same program?
     
  39. WingedOx

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    Though those still are probably true statements, to be honest.

    In general I've found that students/residents don't have a great idea of what is or isn't actually "educational" for later in their careers until they cross those thresholds... myself included.
     
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