Psychiatry Intern Year Question

[sunshine1160]

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I was wondering for those of you doing your required non-Psychiatry months, do you get treated the same way that the other for instance medicine interns do? Or is it even worse in terms of the patient load you get? Is it still capped at 10, or is this variable if you aren't in IM?

I am asking because I'm a little on the older side compared to most graduates, and I am looking into programs that are not going to be that physically taxing for the first year. I tend to get burned out by quantity sometimes and overwhelmed, which is one of the reasons I chose Psychiatry because its not physically burdensome the same way some other specialties are.

Some of the programs that I have been recommended have 400+ patient beds, but I wonder if that matters much, but rather its the intern to patient load that determines how much you do?

Thanks for any leads!

 

[675015]

I would strongly advise against choosing a psychiatry program based on the internal medicine months that make up only 8% of your training.

 

[OldPsychDoc]

"Off-service" months will vary tremendously between programs, so it's a good question to be asking on interviews. A lot of it will depend on the training culture of the respective medicine & pediatrics programs at those institutions as well.

 

[Monocles]

Hi sunshine, I'm interested in knowing the same question.

I'd like to bandwagon on and ask a similar one: do programmes vary in the number of "medicine" months and do you get to pick which off-services? Ex: I'm interested in child psych, so I think it benefits me more to have 6 months of peds vs 6 months of medicine or OBGYN, etc.

 

[jjmack]

There are two required neurology months required for a psych intern year. These can vary by program and if you're interested in child psych a program that lets you do peds neuro for at least one of the month can be helpful. The medicine off service months vary tremendously between programs. Also so let you do some peds instead of IM. I wouldn't suggest all peds since while on call you'll have minor IM questions to handle.

Hi sunshine, I'm interested in knowing the same question.

I'd like to bandwagon on and ask a similar one: do programmes vary in the number of "medicine" months and do you get to pick which off-services? Ex: I'm interested in child psych, so I think it benefits me more to have 6 months of peds vs 6 months of medicine or OBGYN, etc.

 

[profstudent]

I was wondering for those of you doing your required non-Psychiatry months, do you get treated the same way that the other for instance medicine interns do? Or is it even worse in terms of the patient load you get? Is it still capped at 10, or is this variable if you aren't in IM?

I am asking because I'm a little on the older side compared to most graduates, and I am looking into programs that are not going to be that physically taxing for the first year. I tend to get burned out by quantity sometimes and overwhelmed, which is one of the reasons I chose Psychiatry because its not physically burdensome the same way some other specialties are.

Some of the programs that I have been recommended have 400+ patient beds, but I wonder if that matters much, but rather its the intern to patient load that determines how much you do?

Thanks for any leads!

I agree to not pick a program based only on how their off-service rotations are. With that said, look for places where internal medicine is completed as part of a consultation service rather than inpatient. If memory seeves, Ohio State does this.

 

[Nasrudin]

Avoid the NYC programs if you don't want ball-busting medicine months. I tried to transpose my medicine experience to universal themes about medicine in general and got a lot of conflicting responses such that I realized what I experienced was not, in fact universal. Medicine programs apparently have a huge variety of workloads.

What I can say for sure is that all the medicine programs in NYC will work you hard. And you'll be treated exactly like a medicine intern.

I've heard people describe their medicine program training in other forums and was shocked at how much easier the workload sounded. 4 patients vs 10, capped all the time vs not, admissions all in the morning, whereas doing H&P's at 9pm on your running census--you discharged somebody at 6 pm and now you've got an opening on your 10 capped roster--enjoy your evening working late on a non-call shift type deal.

These details matter. It's hard to get a grasp on them from interviewing.

But really it's only 6 months so....it goes fast...I would only consider it if you really can't hack working really hard for 6 months. Most of us can.

 

[Shikima]

It'll only make you a better physician and put you in line for Step 3. Take the heat, it's limited in time and exposure. Internship is meant to be difficult, but it's not really 'that' bad.

 

[Bartelby]

It varies from program to program. At my program we do inpatient and nightfloat for three months plus one month ER, carry the same patient load as the IM interns and are not treated any differently in terms of formal responsibilities, though I think competence is expected from us while excellence is expected from the IM residents.

At some programs you get a reduced patient load, or you get to take easy ambulatory / elective / consult months to fill your requirements. I would strongly recommend not seeking out the easy way. Four months of hard work is well worth it for a lifetime of greater familiarity with IM.

 

[Armadillos]

I personally would think its really important to get some ambulatory or "urgent care" type exposure during residency, to learn more about the common stuff your patients and family expect you to know about as a doctor. For example as a medstudent on peds, literally the most common rash I saw was the kawasaki's rash b/c thats the nature of being a referral center, but I dont think I saw a single kid with poison ivy. Throughout medschool I saw a bunch of folks with chronic osteomyelitis, but probably never worked up an ankle injury. Maybe my medschool just didnt have great ambulatory training, but I'm certainly more comfortable taking care of a sick patient on an IM floor than I would be sorting through a days worth of garden variety complaints in an outpatient clinic.

 

[Member 1337]

It'll only make you a better physician and put you in line for Step 3. Take the heat, it's limited in time and exposure. Internship is meant to be difficult, but it's not really 'that' bad.

To echo what Shikima said, I would be a bit concerned about an attitude of "not wanting to work as much as" medicine interns, or that you would want to be treated differently than a medicine intern (a real doctor?).

Medicine rotations (Internal Medicine or Family Medicine inpatient services) are your opportunity to sink your teeth into complicated clinical cases in a way that will solidify your training as a physician and set you up for success as a PGY-2 through PGY-4, where you'll be expected to provide supervision and support to other interns.

Your colleagues will quickly notice an attitude of not wanting to carry your fair share of the workload; they'll also notice that you may think yourself of being less capable than interns training for other specialties.

Just a word of caution... you know what Charles Swindoll says about attitude... might want to do a quick check up before intern year starts...

 

[Nasrudin]

Oh c'mon. It's not that serious. A 60 hour per week medicine program with good teaching attendings is better than a grinding experience.

I mean, to extent I agree, but on the upper end of age and lower end of energy its worth some consideration.

We'll all learn the same level of basic medicine more or less, take the step 3, and then steadily forget stuff or that which we did know will become out of date.

 

[Mass Effect]

OP, this is entirely dependent on the program. The ACGME requires 4 months of IM and 2 months of neurology. There are some programs where your medicine months are only outpatient, some where it's inpatient and outpatient, and some where it's all inpatient. Same with neurology. These questions are important to ask other residents during interview. Just frame the question as wanting to learn more about the program rather than telling them what you're looking for.

BUT be careful with how you plan to use the information you get. The program I ended up at has a horrible reputation among the psych residents on inpatient medicine. We're treated like medicine interns and carry 10 patients, capped all the time. The second we discharge, we get another one. I routinely broke duty hours. However, now I'm back on psych and I love it. I work about 40-50 hours a week and call is totally manageable. I'm glad I'm here instead of other programs, even if the medicine months might have been easier other places. It's only a few months versus 4 years in psych.

But really it's only 6 months so....it goes fast...I would only consider it if you really can't hack working really hard for 6 months. Most of us can.

Did you guys have to do all your medicine months inpatient? At my program, we got two electives and two inpatient months.

To echo what Shikima said, I would be a bit concerned about an attitude of "not wanting to work as much as" medicine interns, or that you would want to be treated differently than a medicine intern (a real doctor?).

Your colleagues will quickly notice an attitude of not wanting to carry your fair share of the workload; they'll also notice that you may think yourself of being less capable than interns training for other specialties.

Melodramatic much? Please. There is nothing wrong with the OP's concern/question.

 

[Nasrudin]

OP, this is entirely dependent on the program. The ACGME requires 4 months of IM and 2 months of neurology. There are some programs where your medicine months are only outpatient, some where it's inpatient and outpatient, and some where it's all inpatient. Same with neurology. These questions are important to ask other residents during interview. Just frame the question as wanting to learn more about the program rather than telling them what you're looking for.

BUT be careful with how you plan to use the information you get. The program I ended up at has a horrible reputation among the psych residents on inpatient medicine. We're treated like medicine interns and carry 10 patients, capped all the time. The second we discharge, we get another one. I routinely broke duty hours. However, now I'm back on psych and I love it. I work about 40-50 hours a week and call is totally manageable. I'm glad I'm here instead of other programs, even if the medicine months might have been easier other places. It's only a few months versus 4 years in psych.



Did you guys have to do all your medicine months inpatient? At my program, we got two electives and two inpatient months.



Melodramatic much? Please. There is nothing wrong with the OP's concern/question.

I feel the same way. I'm happy about my psych training and am glad I came to this program...now...that I'm done with medicine...which for me was just medicine floors. Not ICU. Not overnight with less SW. Not clinic. Just straight up old boring general medical floors.

Before I came back to psych. I was doing way more general medicine floors than the medicine and prelims in my cohort. And was better at this microspecialization than they were. By which I mean I had the cell phones of the social workers. New all the regular consult and department numbers by heart. I knew how to negotiate patient care through the medical bureaucracy like a lobbyist knows congress.

Such that I don't think of it as the perfect solution to being prepared to handle or consult properly for the medical issues of my psych patients, although it did prepare me for that, so much as being the thing I survived and moved on from. It's not something that I think I would change my rank list over if I could do it over. Although were I not the spry old man that I am I could see the case for doing just that.

 

[Member 1337]

Melodramatic much? Please. There is nothing wrong with the OP's concern/question.

Ok, my post was a bit overdramatic, and I do appreciate the empathy that others offered the OP in responding to their concerns of "patient load" and being "physically taxed" and "overwhelmed" and "burned out by quantity"and "that's why [they] chose Psychiatry."

Partially that's my own overreaction against Psychiatrists that come accross as not being able to hang with the "real doctors." A bit defensive, I suppose. We should be nice to the Psychiatrists who don't want to work as hard as other specialties (in all seriousness) - it's a lifestyle choice.

 

[Member 1337]

Ok, my post was a bit overdramatic, and I do appreciate the empathy that others offered the OP in responding to their concerns of "patient load" and being "physically taxed" and "overwhelmed" and "burned out by quantity"and "that's why [they] chose Psychiatry."

Partially that's my own overreaction against Psychiatrists that come accross as not being able to hang with the "real doctors." A bit defensive, I suppose. We should be nice to the Psychiatrists who don't want to work as hard as other specialties (in all seriousness) - it's a lifestyle choice.

"Member 1337, you still sound like a prick."

I agree, I'm going to shut up now.

 

[Nasrudin]

"Member 1337, you still sound like a prick."

I agree, I'm going to shut up now.

Haha.

Tell member 1337, that s/he is not a prick, just resistent to the lazy psychiatrist motif, which I can understand. I think this impulse that member 1337 has is a healthy one. I'm just not sure that medicine hours clocked is that intelligent of a screen.

I know a senior resident who's breath is choked and strangled under the immense weight of his own corpus who likes to congratulate interns for being slow enough to have to stay late "for their patients" while bragging that he used to stay till midnight on non call medicine shifts.

What he really needs to do is pick up the pace, get the F out of the hospital and go work out. And eat a vegetable or 2.

I think you're a better clinician when you're fresh, energetic, in shape, and have good attitude. Not because you work long dumb hours.

At the same time you don't get good at something laying around in a hammock sipping piña coladas. Except chilling....which is ...

Aw f@ck I keep going back and forth.

Somewhere in the middle sweet spot then.

 

[Mass Effect]

"Member 1337, you still sound like a prick."

I agree, I'm going to shut up now.

LOL I don't think you're a prick. You make a good point. I cringe every time I hear about a psychiatrist calling medicine to ask how to manage HTN or CAD. I agree with you on that. I just don't think there's anything wrong with considering intern year hours when ranking/interviewing.

 

[675015]

To

LOL I don't think you're a prick. You make a good point. I cringe every time I hear about a psychiatrist calling medicine to ask how to manage HTN or CAD. I agree with you on that. I just don't think there's anything wrong with considering intern year hours when ranking/interviewing.

To be fair, do you really want psychiatrists managing CAD?

 

[Psychobabbling]

It really varies. Even in the same program. At my program - some residents did overnight calls their medicine months, some worked 6 days a week....others (me) worked 5 days a week with 1-2 6 hour saturday shifts, max of 8-1o hrs any given day. Medicine team loved me and offered to add me to their residency program by creating a spot for me if I agreed to leave psych. The same team hated the psyc resident before me (meeting and working with that resident when I got to psych - really confused why that was the case).

If you pay attention - you'll see splitting going on all around you. It's almost encouraged in some places....

 

[Mass Effect]

To
To be fair, do you really want psychiatrists managing CAD?

I should have been more clear. No, they don't need to manage CAD and for a new diagnosis, get medicine involved. But when someone is on the inpatient unit and they have a diagnosis of CAD coming in, do you really need a medicine consult to make sure they're on all the right meds that they came in on? Do you really need medicine to confirm they need a baby aspirin?

 

[Shikima]

I should have been more clear. No, they don't need to manage CAD and for a new diagnosis, get medicine involved. But when someone is on the inpatient unit and they have a diagnosis of CAD coming in, do you really need a medicine consult to make sure they're on all the right meds that they came in on? Do you really need medicine to confirm they need a baby aspirin?

Same goes in the other direction, Medicine InPt service consults for the appearance of depression - can't start Zoloft 50mg and refer to OutPt for follow-up?

 

[675015]

Same goes in the other direction, Medicine InPt service consults for the appearance of depression - can't start Zoloft 50mg and refer to OutPt for follow-up?

Our medicine service likes to start all their depression patients on Effexor or cymbalta (even seen pristiq!) because SNRIs are newer and work on two neurotransmitters instead of one.

Of course we also had a psych intern who would ask medicine "how many insulins should I give the patient?" Knowing full well that would trigger medicine to just take over all non psychiatric care.

And to think US News thinks very highly of this medical center...

 

[Shikima]

🤐 The pluralization of insulin.....

 

[serimeri]

Our medicine service likes to start all their depression patients on Effexor or cymbalta (even seen pristiq!) because SNRIs are newer and work on two neurotransmitters instead of one.

Of course we also had a psych intern who would ask medicine "how many insulins should I give the patient?" Knowing full well that would trigger medicine to just take over all non psychiatric care.

And to think US News thinks very highly of this medical center...

Hmm..isn't that what intern year is for? As medical students, you don't umm...deal with dosing too much, especially insulin dosing cuz its so variable.

Just as another point, I love medicine, and don't mind doing the intern year reqs..

but even the busiest, hardest Psych program is always going to be more lax than FM/IM at 99.9% of the places, just being honest.

 

[sunshine1160]

Unfortunately, I am at a certain age and my body is at a capacity where its tough for me to do something very demanding. I will need to look at smaller community programs. When you get past a certain age, putting in central lines at 4 AM in the morning is not easy.

Plus, I need to be in a program that allows me to not be a completely absentee mother to my kids.

I think I'm going to apply to smaller community programs.

 

[splik]

smaller community hospitals do not necessarily have lighter demands, in fact the opposite may be true. smaller programs may have more call as there are fewer residents to cover the call pool. but it's very unlikely you will be "putting in central lines at 4am" at any program. smaller programs will also be less forgiving if you have issues because your kid is sick etc. There are some small programs which have a lighter load but in general they can be busier. they may also have less ancillary staff meaning you have more clerical/sw/nursing tasks to do. it all depends on the hospital.

oh and to answer your initial question no hospital is going to give you a higher patient load than IM interns, what possible good can come of that? you will have the same, or fewer depending on the program. at many places, especially if the psych interns aren't very good, they medicine program limits what psych residents can do. in terms of procedures, the medicine residents are usually clamoring to do procedures as they need to get signed off so most of the time someone will happily oblige if your pt has a procedure that needs doing

 

[Psychotic]

When you get past a certain age, putting in central lines at 4 AM in the morning is not easy.

In psychiatry?

Except for some overnight shifts in the ER, I haven't had to be anywhere at 4 AM, and definitely haven't put in any central lines at any hour of the day of my soon to be completed intern year.

Ask questions, learn more about schedules. I haven't heard of anything like this.

And don't assume that a small community program will be any easier on you schedule-wise.

 

[sunshine1160]

realized i forgot to follow up on this thread. But do newer programs tend to be easier on their demands/requirements of residents since they were functioning without them for quite sometime?

Also, as you guys are practicing in the inpatient unit in the real world, how much do u feel ur medicine rotations in residency prepared you or were necessary for medically managing some of your sick patients?

I know I'm being demanding with my requirements, but it's difficult when you have to split your time with kids.