Psych residency hours

[SpringDO]

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How many hours a week does psych resident work?

 

[UnderdogMD]

It varies but certainly it closer to the lower end for residency programs. Search programs in Freida and you will see the hours a psych resident works the first year. Keep in mind these are self reported and not always accurate.

 

[mass1]

As a first year, I work 45-50 hours a week on psych rotations and 65 hrs a week when I was on IM

 

[Soggun]

n of 1 and all that but, in my experience (note that these include calls):

first year: psych rotations - 45-50hrs; neurology - 65-70hrs; medicine - 80-85hrs on average (with a one or two weeks that were approaching 90-95hrs)
second year: highly variable depending on the rotation... as little as 40-45hrs (partial program) and as much as 70hrs (nightfloat)
can't speak for 3rd and 4th year yet.

 

[digitlnoize]

Similar to above. ~50-55 hours a week on inpatient psych. ~45-50 hours a week on consult psych. Neuro wards pushes 80. Neuro consults ~50. Medicine wards 65-75 depending on the week.

 

[twright]

How many hours a week does psych resident work?

Really varies. In our program during PGY2 inpatient psych, people routinely left work around 7 or 8pm, and we had maybe 2-3 weekend calls (Friday night, Saturday day, Saturday night, or Sunday day) per month. That put us in the neighborhood of 70 hour weeks.

Consults were about the same, sometimes worse.

 

[vistaril]

n of 1 and all that but, in my experience (note that these include calls):

first year: psych rotations - 45-50hrs; neurology - 65-70hrs; medicine - 80-85hrs on average (with a one or two weeks that were approaching 90-95hrs)
second year: highly variable depending on the rotation... as little as 40-45hrs (partial program) and as much as 70hrs (nightfloat)
can't speak for 3rd and 4th year yet.

I don't think some of you guys are adding up medicine hours right.....iirc, there is now a rule that says interns cant work more than 16 hours in any day....so 16 x 6(1 day off on average per week) gets you to a MAX of 96......there is no way someone is working 85% of the max hours that they could possibly work each shift as an intern on medicine.

I averaged 45-50 on psych as an intern....50 or so on medicine...45 or so on neuro.

 

[VMSmith]

I don't think some of you guys are adding up medicine hours right.....iirc, there is now a rule that says interns cant work more than 16 hours in any day....so 16 x 6(1 day off on average per week) gets you to a MAX of 96......there is no way someone is working 85% of the max hours that they could possibly work each shift as an intern on medicine.

I averaged 45-50 on psych as an intern....50 or so on medicine...45 or so on neuro.

You're assuming that interns actually adhere to duty hour limits while on medicine.

 

[vistaril]

You're assuming that interns actually adhere to duty hour limits while on medicine.

a fair assumption in most cases.....programs are generally very careful about this to not get in trouble. And I have no idea why a medicine intern at most places would need to stay more than 16 hrs on any given call day anyways....usually you and your cointern are going to break up the call day into different shifts for each of you, so you aren't even going to be admitting for all of those 16 hours on your call days.

I just dont buy these 85 hr medicine week stories....I was pre intern rules and we never did anywhere close to that in a week on medicine. And certainly not an average of that.

 

[notdeadyet]

I don't think some of you guys are adding up medicine hours right.....iirc, there is now a rule that says interns cant work more than 16 hours in any day....so 16 x 6(1 day off on average per week) gets you to a MAX of 96......there is no way someone is working 85% of the max hours that they could possibly work each shift as an intern on medicine.

I averaged 45-50 on psych as an intern....50 or so on medicine...45 or so on neuro.

That said, you've acknowledged before that on the medicine rotations on your program then psych interns are not treated the same as medicine interns, carrying less challenging patients and responsibilities. 50 hours/week may be what your institution's psych program or medicine program accommodates, but it ain't like that everywhere.

I probably averaged about 70 hours on medicine. This is not a malignant program, but it's one whose medicine interns work very hard and psych interns are expected to do the same. I could probably have cut a few hours off of that by cutting corners, but...

On the others, inpatient psych about 50 hours/week, 50 hours for inpatient neurology, 40 hours for outpatient neurology. About 40-50 hours/week for EM.

 

[Doctor Bagel]

Prior to the new duty hours, I worked about 70 to 80 hours/week on medicine, 40 hours a week (if that) on neurology and 60 to 70 hours a week on inpatient psych months.

 

[xlithiumx]

Guys! No one can be right but Vistaril. It's part of who he is. He's just right. His experience in fact trumps your experience. If he says you didn't work those hours, then YOU DIDN'T WORK THEM.

Also, :troll:

 

[annie501]

I don't think some of you guys are adding up medicine hours right.....iirc, there is now a rule that says interns cant work more than 16 hours in any day....so 16 x 6(1 day off on average per week) gets you to a MAX of 96......there is no way someone is working 85% of the max hours that they could possibly work each shift as an intern on medicine.

I averaged 45-50 on psych as an intern....50 or so on medicine...45 or so on neuro.

when I was an intern, we did two 30 hour call days and two 8-10 hour days in a week on internal medicine.
I can imagine 4 days there from 6am-4pm, and 2 "call" days (at Q4 call) where they are there 16 hours (until 10pm or so, maybe picking up new patients until 8pm before night float gets in). That's 72 hours.

 

[vistaril]

when I was an intern, we did two 30 hour call days and two 8-10 hour days in a week on internal medicine.
I can imagine 4 days there from 6am-4pm, and 2 "call" days (at Q4 call) where they are there 16 hours (until 10pm or so, maybe picking up new patients until 8pm before night float gets in). That's 72 hours.

if there is a night float system(and most programs have that now) it would be extremely unlikely to have *both* interns there for 16hrs during the day on call days....that would be completely illogical and repetitive.

 

[MiddleRoad]

Medicine 70-80/week. EM 60/week. Neuro 45-72/week. Psych 50-65/wk.

 

[splik]

Medicine 60-70 hours; EM 50 hrs; Med consults 35-40 hrs; I/P Psych 35-50 hrs; Nightfloat 60hrs; Neuro 40-45 hrs.

 

[Soggun]

a fair assumption in most cases.....programs are generally very careful about this to not get in trouble. And I have no idea why a medicine intern at most places would need to stay more than 16 hrs on any given call day anyways....usually you and your cointern are going to break up the call day into different shifts for each of you, so you aren't even going to be admitting for all of those 16 hours on your call days.

I just dont buy these 85 hr medicine week stories....I was pre intern rules and we never did anywhere close to that in a week on medicine. And certainly not an average of that.

To elaborate:

My 80-85hr estimate on medicine was with a NF system in place (starting at 6PM). We worked 6 days a week. Officially rounds were 7, but I would have to get there at 6-6:15 to round appropriately. It was Q2 in terms of accepting patients (til 6), though there were no days without admissions between 5 and 6 and on days accepting patients, staying until 9-10PM to finish discharges/admissions/notes was a regular thing. The other days were 6 (including rounding time) until 4 officially, but 5 was more likely to finish work.

So, total, that's an average of 15-16hrs 3 days a week and 10-11 the other 3 days (frequently towards the later end of that spectrum)... That puts it right around the 80 hr mark. On the odd weeks where things come up and run long, 85-90hrs definitely happened.

I will put the caveat on this that my intern year was the first year my program had a medicine affiliation with the hospital I'm referring to. There were some duty hour violations which were reported and taken very seriously by my program. Significant efforts were made during the year and subsequently to improve the system and get interns out earlier - and I understand that has paid some dividends this year (hours-wise) for the current interns out there. While those hours were pretty brutal to get through, I also want to say that I 100% don't regret it. I think I learned more those 4 months than at any other time in my medical training to date. Incredible teaching and tons of exposure.

 

[TexasPhysician]

40 hours/week here including PGY-1

 

[Merovinge]

Just curious what the schedule looks like for people working 40ish hours/week? How/when do you take call?

 

[TexasPhysician]

Just curious what the schedule looks like for people working 40ish hours/week? How/when do you take call?

Home call by phone.

 

[vistaril]

40 hours/week here including PGY-1

nice..I've been running 35ish pgy-3 and pgy-4 year, but was over that(because of occasional call duties) pgy-1,2 year. I think the concept of in person call, at least it's usefulness in psych residencies, really needs to be looked at and questioned.

 

[hamstergang]

I think the concept of in person call, at least it's usefulness in psych residencies, really needs to be looked at and questioned.

What do you mean by this, more specifically? I have several guesses but don't want to assume anything.

 

[Bartelby]

if there is a night float system(and most programs have that now) it would be extremely unlikely to have *both* interns there for 16hrs during the day on call days....that would be completely illogical and repetitive.

It's not that hard to believe. At my program each team has one admitting intern and one non-admitting; they alternate so you admit every other day. A rough schedule is as follows:

-Day intern gets to hospital to preround at 6a, morning report 7:45, start rounds 8:20
-Finish rounding ~11:30, six patients on your list (two overnight, four olds)
-11:30 - 12: Enter orders / call consults
-12 to 12:30: finish daily notes
-12:30 to 6:30: deal with family discussions, finish all work for old patients on your list, discharge patients who are going home (let's say two discharges today), see two to three new admissions doing the interview, exam, staffing, and entering all orders
-6:30 to 7p: sign out to nightfloat (who will start admitting soon too)
-7 p to anywhere from 8 t 10p: finish all of your admission notes (must be done that day), all of your discharge summaries (must be done in 24h), finish any last minute things on your list, enter daily labs for the next day.

The cap under this system is no more than eight patients by the end of the day, no more than five admits each day.

That puts your day at anywhere from 14 - 16 hours, usually 15. On wards I admit every other day. 15 x 3 = 45 plus my nonadmitting days 12 x 3 = 36 for a total of approximately 81. I try to squeeze out of work a few hours earlier when I can bringing my total to around the upper 70s and have never stayed later than 10p (avoid violating by coming back at 6). So it's very possible.


My hours on psych are significantly better, in the 40 - 50 hour/week range.

 

[da8s0859q]

40 hours/week here including PGY-1

So I matched into EM (got lost on my way to that forum, excuse me) and still feel like even the residency lifestyle on EM months beats that of several specialties, especially since we'll be doing 8s, but damn. You guys have it nice. 👍

 

[F0nzie]

Hours will vary by institution. However, even within my own institution, hours vary widely on a service depending on who the attending is. Some attendings will want you to sit around and do nothing even after the work is done, in which case you're toast. While others will want to lecture you or engage you in other clinical work.

If you work at a glacial pace and take forever to finish your notes (which seems like a lot of residents) you will not get out early even if you have the chance. This is probably why I spent 10-15 hours a week less on IM than my colleagues while they spent an extra 2-3 hours at the end of the day writing notes. WRITE YOUR NOTES IF YOU WANT TO GET OUT EARLY.

 

[F0nzie]

There have been times I have seen residents spending an extra 2-3 hours WRITING NOTES after their 24 hour shift on the psych consult service.

WHY ARE YOU WRITING NOTES ON PATIENTS YOU SAW 12 HOURS AGO. YOU ONLY HAD 3 PATIENTS TO SEE IN A 24 HOUR PERIOD.OH.... AND WHAT'S THIS? YOU'RE HANDING OFF A PATIENT THAT WE WERE CONSULTED ON THE PREVIOUS DAY THAT YOU DID NOT HAVE TIME TO SEE?

A few aspects of residency I will not miss.

 

[vistaril]

What do you mean by this, more specifically? I have several guesses but don't want to assume anything.

in most of the real world in psychiatry nobody is there to admit patients or see pts in the ER in the evening and overnight. You have 24 hrs to do H/P.

 

[nancysinatra]

Hours will vary by institution. However, even within my own institution, hours vary widely on a service depending on who the attending is. Some attendings will want you to sit around and do nothing even after the work is done, in which case you're toast. While others will want to lecture you or engage you in other clinical work.

If you work at a glacial pace and take forever to finish your notes (which seems like a lot of residents) you will not get out early even if you have the chance. This is probably why I spent 10-15 hours a week less on IM than my colleagues while they spent an extra 2-3 hours at the end of the day writing notes. WRITE YOUR NOTES IF YOU WANT TO GET OUT EARLY.

If you were a resident at my program then you'd know that one reason notes can take forever is because of the insane templates attendings want us to use. Lately it has become popular to make us use templates that document every aspect of the patient's entire psychiatry experience. For example, even if they've never touched alcohol you still have to comment on the withdrawal protocol you are using.

Never mind we went to med school and managed to make it through 3.75 years of residency. No, we're so dumb that we can't be trusted to write a simple competent note. We have to use their special templates which are unwieldy, klunky, time consuming (and don't fit into the Epic screen in a very user-friendly way) and contain irrelevant information such as what we are doing for occupational therapy for our patient. Couldn't OT just write their own notes? If I call an IM consult they will write their own note, and my attending doesn't have a place in the template for "IM interventions." But OT???

I could give my patient 300mg of zyprexa by mistake and no one would care, or I could use Nardil 100% of the time as my go-to first line treatment for everything and high dose Mellaril as my only 2nd line agent, and absolutely no one would care, but if I forget to mention that my patient could benefit from having a vocational assessment, that would get me in big trouble.

 

[MacDonaldTriad]

Wouldn't it be ironic if not having an EMR would be seen as a positive by the next generation? Templates communicate much less information than a blank page and a pen in my humble opinion. Just speaking as an old technophobe.

 

[nancysinatra]

Wouldn't it be ironic if not having an EMR would be seen as a positive by the next generation? Templates communicate much less information than a blank page and a pen in my humble opinion. Just speaking as an old technophobe.

I moonlight at a place with all paper charts. I'm not sure but I think I provide better care there. I can focus on the patient, and think about them, and document my thoughts and plans, which I can't do in Epic with all its mandated stupid questions that are invariably motivated by some legal fear.

Occasionally I'll want more history and wish I had an EMR so I could look up old notes. But if we had a "chart room" then I could walk over there and look in the chart. It would probably take 1/2 the time it takes me to navigate Epic/Eclypsis/CPRS/etc.

 

[Excitotox]

Wouldn't it be ironic if not having an EMR would be seen as a positive by the next generation? .

Yup, it would ironic. But at my dinosaur of an institution, we still have mostly paper charts... and I can only read about 50% of of what is written in said charts. The situation is all kinds of dangerous, and it frankly amazes me that we don't have more mistakes than we do (... and we do have mistakes).

I have also rotated at a nearby hospital with Epic. Sure, Epic can be clunky... but I can read every word written. To me, legibility is more than worth the price of clunkiness.

 

[hamstergang]

Wouldn't it be ironic if not having an EMR would be seen as a positive by the next generation? Templates communicate much less information than a blank page and a pen in my humble opinion. Just speaking as an old technophobe.

But there's no reason there can't be an EMR where there aren't templates, but instead notes that are fully free text, just like paper would be. Except that it would be legible and searchable, and therefore far superior.