Psych Residency with max 40hrs /week

Discussion in 'General Residency Issues' started by GinnieM, Aug 2, 2015.

  1. GinnieM

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    hi,
    i am an IMG, and we will come to the US because of my husbands job. i want to do a psych residency (and hopefully child psy fellowship). i have a 4 yr old son and i cannot work more than about 40 hrs a weeke. (he has special needs and i want&need to be there for him).
    is there any possibility to find a residency like that?i still have to take 2 usmle steps and i dont know if it worth it , if i cannot find a residency that works out for us.
    thank you so much for your help.
     
  2. rokshana

    rokshana Member
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    no...that won't happen
     
  3. GinnieM

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    what do you think are the least possible hours?
     
  4. Menacer

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    Less than 80.
     
  5. smq123

    smq123 John William Waterhouse
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    I agree with the others....working 40 hours per week, maximum, is not going to happen.

    Realistically, you are probably going to work about 60-80 hours a week. Some rotations may be even more than that.
     
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  6. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    This is potentially possible in later years of training but not so likely in internship/2nd year. You've got to do things like medicine wards, and I think a 40 hour work week for that would be impossible. Also, psych residents are generally responsible for covering nights/weekends. 80 hour work weeks are rare in psychiatry, but 60 hour work weeks are probably pretty common for interns/lower level residents. At my program, a 40 hour work week was definitely possible in your last year and potentially in PGY3 year. You still need some flexibility to stay late periodically, though, which could be a supportive/available spouse/family member/nanny (likely the best solution, although expensive). I've heard of people splitting residencies, but I don't know how common that is.

    Another thing to note is that as an IMG, you might have fewer options, which means you could get stuck with a more work heavy program. The reportedly super cush psych residencies (San Mateo comes to mind) are historically pretty competitive.
     
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  7. rokshana

    rokshana Member
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    in the beginning, 60-80 hours, as a senior, 50 ish? maybe some weeks will be 40-45, but won't be the max.
     
  8. Law2Doc

    Law2Doc 5K+ Member
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    This. I'd say 60+ is the best OP can expect to see. OP should also be cognizant about the fact that the US is a big place and as an IMG you don't always get a residency in the exact region you want, so if the husbands job brings him to a location that's more competitive, OP may potentially have to be prepared for a long commute on top of the long hours, if not a LDR.
     
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  9. TexasPhysician

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    The problems here is that most cushy residencies (low hours) are more competitive. The few I know of haven't interviewed IMG's recently.
     
  10. atomi

    atomi Member
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    Actually, it is very much possible if you are willing to do what a psych intern did to me my intern year and call in sick multiple days in a row so that some internal med intern gets pulled off an elective rotation to cover for them.
     
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  11. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**
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    Lol, nice.
     
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  12. serimeri

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    what? Seriously that actually happened. Was the person genuinely sick?

    Our PD has shared the crap out of us about calling in sick. you have to be on your death bed essentially....or like an appendicitis or something
     
  13. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    Well, that's pretty not cool unless the person was actually sick, and you didn't know what was going on. In many programs, I imagine this would actually come back to haunt you at some point.
     
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  14. Winged Scapula

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    For those in the field, are there many shared or part time positions in Psych residencies? That's the only way I could see this working.
     
  15. Crayola227

    Crayola227 The Oncoming Storm
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    OP - I'm sorry but in this country we have a hard time really doing what's best for society in terms of how we treat mothers, children, children with special needs, disabilities, or illness, or patients, or dcotors, or immigrants, the poor, mentally ill, or humanity really. True, life isn't fair, and the US is the rule that proves the rule. (Although having been to 2nd world countries I'll say we have pretty good infrastructure with our water, sewage, building codes and the like.)

    Last on this list is resident well-being. IMG well-being - I'm not sure I've ever seen the phrase in print, it's boggling my eyes.

    Sadly as well, is how some people are perfectly competent full fledged attending physicians from other lands, and the only way they can practice clinically is if they are "lucky" enough on hands and knees to enter into the intern sweatshop.

    Psychiatry is less competitive although I don't know how that plays out for IMGs.

    They have some of the lightest hours for residency - but that's only saying so much given the cap is 80 hrs. There is a thread by Koikisi called "help I feel like a hypocrite but I feel ready to quit intern year" that I probably shouldn't refer you to because it's scary. But her situation sounds like a worst case scenario in psych. Try looking at the Psych specialty forum here on SDN they may have ideas on where to apply and what that looks like.

    I wish you luck. Children and residency isn't easy, but it's doable with sacrifice of time with your child and salary for chilcare. Some residencies but I don't think most have childcare facilities on site. Also, some programs will let you work on notes from home, a program like that I would say would a must for you.
     
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  16. GinnieM

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    thank you for your answers!
    i do not think i am going to do this...
    maybe some points which may help me: i am from the EU (i heart, it is easier to get in than from India or the Caribbeans). I had one good score (99, i have not taken the other steps yet) and i have 3 good LORs from 2 ivy universities and a PHd. and we could afford a nanny(because of my husbands job).
    other than that, i have nothing to weigh in.
    i cannot see a way making this doable for our family. :( :( .
    50 hrs might be doable, 60 not.
    do you know about fellowship? are these hours more like 40ish? is there any way to do the residency or internship without salary, just in order to be able to work as an MD later?
     
  17. Raryn

    Raryn Infernal Internist / Enigmatic Endocrinologist
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    There's a lot of questions in your posts with indefinite answers.

    As an EU graduate, you are definitely in a better place compared to someone who went to med school in the third world, especially if your grasp of the English language is good. The PhD will not hurt you either, though it might not change your odds that much for community programs (simply increasing your odds of a university program). Your overall chance of matching into a psychiatry residency with those credentials (assuming you do fine on Step 2, pass CS, and apply to a reasonable amount of programs) would be excellent.

    With regards to the primary question of hours, there's 200+ psychiatry programs in this country with 200+ answers to it. Certainly, your ~6 months of medicine/neurology will be working 50++ hours a week, with close to 80 hours as an intern on medicine not being all that unreasonable. But that's 6 months... with the other 3.5 years of residency, many psychiatry programs have relatively low hour expectations. Programs have varying amounts of inpatient and consultation/liaison exposure, and it is entirely possible that 2.5 years out of that 3.5 are primarily outpatient exposure with 40-50 hour workweeks on average... and it's entirely possible that the split is the other way. Many (most? all?) psych programs also require call, and that will involve coming in nights/weekends/holidays to cover the inpatient services and for emergency consultations. Call may be infrequent... or may be done on a weekly basis. There's too many possibilities.

    Basically, psychiatry is one of the lowest hours/week residencies possible. The hours aren't as contractually limited as an EM residency, but for the majority of your experience you will not be slaving away 60+ hours a week... but certain months each year you probably will be. As a side note, even matching a more "chill" program is no guarentee that your hours will be chill. I have a friend at a program that has lost 5-6 residents over the last few years due to various forms of attrition (termination, voluntary resignation to switch specialties or b/c of illness, a number of residents fast-tracking into child psych) and the remaining residents have to do drastically increased call to compensate.

    I don't know any details regarding fellowships.

    There's no way to do any ACGME-accredited residency without drawing your full salary, it would break accreditation requirements. Theoretically, programs could allow part-time or shared residencies, but these are quite unusual, and I don't actually know anyone either in real life or on SDN who has completed one.
     
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  18. gutonc

    gutonc No Meat, No Treat
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    FWIW, the shared positions I've seen are shared on a per-rotation basis rather than working PT all the time. So while this would average out to 40h a week over the course of the residency, during any particular rotation, it would still be the regular work hours (50-80).
     
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  19. Winged Scapula

    Winged Scapula Cougariffic!
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    OK. I seem to remember a shared OB/GYN position when I was in residency in which one resident would work Tuesday Thursday and the other Monday Wednesday Friday and they would switch off every other week. I wasn't sure how they kept that schedule organized and maybe it was only for certain rotations.
     
  20. Law2Doc

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    Creating a part time track is a pretty significant administrative headache for a program so they have to want to keep someone badly -- I can't see it as something frequently offered up for a new hire, as there are tons of people that look just as good on paper happy to work full time. I don't see this as a real option.
     
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  21. Winged Scapula

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    Oh I know its probably unrealistic, just wondering if it was at all seen in Psychiatry.
     
  22. Kevin Baker

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    I go to one of these programs with less hours than most and while 40 hrs a week on psych rotations intern year , is feasible if you're efficient, that doesn't include the extra hours from a short call or two a week which would bump it up to 45 or more hrs. In addition, some weeks may have two calls, some zero, so a flat 45 isn't even guaranteed. And off service months have anywhere from 50 hrs plus short call hours to 70 with built in call. On the interview trail I recall hearing of a place with medicine months closer to 50 hr weeks. Not sure where but I think it was a midwest program. What you want may be feasible if you can commit to 50 hrs a week but it'll be a rare program . If you can commit to a few months of longer hours, that opens up a lot more possibilities.
     
  23. Crayola227

    Crayola227 The Oncoming Storm
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    I get the impression these shared positions may have been more common in the days of programs not filling so well, before applicant outnumbered slots not to say if psych did or didn't, in which case as it was appointed previously maybe 2 halftime residents were better than none. Or if the need for halftime arises later, like for pregnancy or other condition let's say halfway through 2nd year, rather than you resigning maybe they take one of the desperate but somewhat rare PGY2s or even 3 out there on part time because that's more appealing than just having a total hole from resignation of a resident they have more interest in keeping.

    Also, like the hypothetical program above I imagine some specialties more than others need continuity of care more than others. On L&D for example every other day probably works fine. In psych, I'm not sure.

    Just my thoughts, I can't claim to know.
     
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  24. thehundredthone

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    Talk about over-sharing eh.
     
  25. Doctor Bagel

    Doctor Bagel so cheap and juicy
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    I haven't seen it. SDN is the only place where I've even heard that it might potentially be an option. I have seen fellows work part-time, but that doesn't help the op for the first few years.

    However, now the op has revealed that she's coming from an EU program and that she's willing to work 50 hours a week, it's possible she could find a spot, especially if she has some geographic flexibility.
     
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  26. GinnieM

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    the problem other than the hours are sick days..in the us sick days for children are non existent,right?
    i could never work if my kid needs me, i would probably just go home the moment i get the call. that would possibly mean the end of the residency, right? (would happen about every 2 mths for about 1 day)
     
  27. Crayola227

    Crayola227 The Oncoming Storm
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    Ahh geez, you could match and then everyone is forced to take this as it comes, if it's 1 day q 2mos they may just be stuck trying to deal with it
    it may be tolerated OK on an infrequent basis, but if it's even one day per rotation I'm guessing that's pushing it I don't know in psych
    it will vary rotation by rotation as well
    being AMG vs FMG also plays into this too, it's easier to get rid of FMGs that are inconvenient for a reason like this vs US, I don't know what your guys' FMLA etc rights are
    part of what plays into this is how lean the program is in terms of coverage and number of bodies, that plays into your expendability
    it's tempting to bring this up at an interview so they know what they're signing up for, making it less likely they will cut you if they take you and this comes up
    however if you put your worst foot forward you may not get any position

    don't just try to match and see what happens and they fire you unless you are prepared for that to be the end of your career here
    you will likely get 1 chance as FMG here

    will there be an age or stage where you would not be needed at the drop of a hat for the child? in that case biding your time until you can make a more total commitment would be best so you don't risk this being an issue costing you your one residency chance

    is there any way to have those calls covered by anyone other than yourself, cutting down on the frequency of such "gotta drop residency at a phone call" moments?

    I don't want to press you for info, but I am curious why you would need to do this, and it's not because I'm judging you, I'm just wondering because if we knew maybe there would be some better suggestions for your situationn
     
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  28. WingedOx

    WingedOx Unofficial Froopyland Forum Mod.
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    Also, let's face it, they don't always churn out the most prepared psychiatrists.
     
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  29. Crayola227

    Crayola227 The Oncoming Storm
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    I could make a joke, but I won't, because I really love and respect psych as a field.

    C'mon, surely practicing self-care, sleep hygeine, and relating to friends and family is part of the training of a good psychiatrist,
    and what makes them more adjusted than the rest of medicine (all jokes of how crazy psychs are aside?)?
    Because I think the rest of medicine forgot how to play nicely with others

    Why is it that the "crazy" doctors are actually living the most rational lives of the bunch?
    are the rest of us missing something? like sleep or sanity?
     
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  30. Wordead

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    Be a stay at home mom instead of being a garbage POS resident and a terrible parent simultaneously
     
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  31. Raryn

    Raryn Infernal Internist / Enigmatic Endocrinologist
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    I'm in internal medicine (generally more intense than psychiatry) and we have 12 sick days a year we can use. If you use one on an inpatient service, you'll have to make it up by giving up one of your days off later in the year, but if people are legitimately ill or have a real family emergency, we don't exactly kick them out of residency.
     
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  32. thepoopologist

    thepoopologist Ph.D in Clinical Meconium
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    FMLA. Get it after you match. Leave whenever your kid acts up
     
  33. Crayola227

    Crayola227 The Oncoming Storm
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    I've heard can be an issue for IMG's non-citizens but not sure would look into.

    Also, you are NOT eligible for FMLA for either 6 mos or 1 yr into a job, not sure, but I know for a fact it's not right away by any means.

    Also, there are other things that play into FMLA like how long you need leave for and days off you already have coming to you.

    Things to keep in mind.
     
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  34. doc05

    doc05 2K Member
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    it will be 1-2 years before you actually start residency. by then your kid should be in school, no? any reasonable chance things will stabilize, or will you need to be a full-time mom forever?
     
  35. GinnieM

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    thank you.
    what is FMLA? school will unfortunately not change a lot.
     
  36. mvenus929

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    Family Medical Leave Act. It's a law that allows you a certain amount of time (I can't remember how much) off from your job for family or medical purposes without being fired. Many women invoke it to get additional maternity leave beyond what their job allows, but it is also for those who need to take a leave of absence to take care of a sick child or parent, or to make preparations for a family member's funeral, estate, etc. It is not necessarily paid time, but you can't be fired when you apply for leave under the law.
     
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  37. Crayola227

    Crayola227 The Oncoming Storm
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    But again, pay attention to the fine print with FMLA as it is not as helpful as it sounds many times.
     
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  38. Smurfette

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    You can't be fired for taking FMLA (which I believe starts eligibility after you've been employed a year), but if you take more than your specialty board allows in a given year, or cumulatively over all years of residency, you may not be board eligible or will need to extend your training in order to sit for the boards. Obviously, this can affect the ability to start a fellowship on time as well. There's not always extra time built in that you can take, as any sick days, vacation days, and any leaves all count against you.
     
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  39. Mass Effect

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    At my program, it is possible to work 40-50 hours most weeks after intern year. Intern year is mainly medicine, so you WILL work 80 or so hours a week during that year. But once you're on all your psych rotation, it is definitely much lighter. I work about 40-50 hours a week, with the exception of once every 6 weeks or so when I work a weekend in addition to the regular week. We also do a month of nightfloat, which is 5 12 hour shifts for a total of 60 hours those weeks. Aside from that though, it's pretty standard 40-50 hours. Also, one day of the week is devoted to didactics only so you really only work 4 days and attend lectures that 5th day (unless you're on that weekend).

    These programs exist. They're just hard to find.
     
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  40. DoctorMedic

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    Also remember the less hours you do the more other residents would have to cover. There will be regular rotations and psych calls, usually more for lower years and less for higher years but like others have said, not gonna happen.
     

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