Psychiatry Programs With Low Hours? Concerns re: autoimmune fatigue.

[LynnHolmes95]

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[darknecrosforte]

These are probably the most relaxed residencies you can match at without feeling like you're skating too hard. Most are 1-3 hours away from "fun" places and have a high proportion of residents who had kids during training. I'm basing this info on reviews of previous interview seasons on Reddit and SDN, matcharesident(.)com, and other publicly available tools.

Southern Illinois University
U of Illinois COM - Peoria
Loyola
Pine Rest - Grand Rapids, MI
Wright State U - Dayton, OH
LSU Baton Rouge
Community Health Network - Indiana
Harvard South Shore - Brockton
Most programs in Arizona
Kaweah Delta - UCI

 

[kaysisiel]

I would also look into UC Riverside. They advertised no calls several years ago.

 

[MedMan80]

These are probably the most relaxed residencies you can match at without feeling like you're skating too hard. Most are 1-3 hours away from "fun" places and have a high proportion of residents who had kids during training. I'm basing this info on reviews of previous interview seasons on Reddit and SDN, matcharesident(.)com, and other publicly available tools.

Southern Illinois University
U of Illinois COM - Peoria
Loyola
Pine Rest - Grand Rapids, MI
Wright State U - Dayton, OH
LSU Baton Rouge
Community Health Network - Indiana
Harvard South Shore - Brockton
Most programs in Arizona
Kaweah Delta - UCI

i thought SIU was not a cush residency by any means..?

 

[darknecrosforte]

i thought SIU was not a cush residency by any means..?

What does cush mean? Low % IMG? High pay to work hours ratio? You may be mis-translating what I'm saying. I'm responding to the "less hours" part of OP's question and am relating the % of parents to "easier" residency. It doesn't bother me if my list is 10% wrong, but I'm just saying I would not describe any of these programs as cush (except Kaweah Delta), hence my confusion.

 

[TexasPhysician]

Call schedules and hours can change on a year to year basis. Anything from last year could be outdated, so you’ll need to check at interview time.

Historically, I’d look into:
Palmetto SC
San Mateo, Cali
UTMB TX
U Arkansas
Rochester

 

[MacDonaldTriad]

There are ways to decelerate training to accommodate for situations like this. We had a couple share a position each half time for 8 years about 30 years ago.

 

[Mass Effect]

What does cush mean? Low % IMG? High pay to work hours ratio? You may be mis-translating what I'm saying. I'm responding to the "less hours" part of OP's question and am relating the % of parents to "easier" residency. It doesn't bother me if my list is 10% wrong, but I'm just saying I would not describe any of these programs as cush (except Kaweah Delta), hence my confusion.

Wait, what? Cush means easy and low hours. It has nothing to do with IMGs.

I'm confused because you said you would not describe any of these programs as cush, but you just listed them as the most "relaxed" programs.

OP, as @TexasPhysician said, this is something that changes so you need to ask during interview. Check out the interview review threads from past years. The list mentioned by @TexasPhysician is a place to start. Wish you well, in career and in your illness!

 

[Crayola227]

Traditionally, but I can't speak specifically for psych, high IMG rate programs are considered notorious for being sweatshops.

 

[Mass Effect]

Traditionally, but I can't speak specifically for psych, high IMG rate programs are considered notorious for being sweatshops.

Not so much in psych. Cush has a pretty straight-forward meaning in psych.

 

[LynnHolmes95]

5

 

[MedMan80]

Many IMG places are sweatshops, but not all by any means. When i was interviewing back in the day for SIU, I totally got the vibe that it was a sweatshop/IMG run and so stayed away..

 

[MrChance2]

I’d venture to guess than more than 50 hours per week on psych rotations years 1-2 and more than 40-45 hour Shift/week years 3-4 is uncommon and unless a program has a reputation for working you hard (which you should be able to find out on interviews) you should be under the numbers said in like 50%+ of programs. That’s what my interviews were like anyway. Anyone disagree?

 

[BiscoDisco]

Thanks for all the suggestions!

Is it true that rural programs have more lenient work schedules over ones in the city due to lower population? I have a friend that specifically chose Dartmouth (a DO) which is rural New Hampshire for psychiatry over Columbia in NYC b/c she felt that the city would be way more hectic, even though NYC is 'more fun.'



I'm actually in Texas too! I'm in my 4th year at TCOM. Do you have any insights about Texas psych residency programs? I didn't see much information on SDN about Dell's psychiatry program in Austin.

Also, I am a DO student – so I think some of the programs like San Mateo might not accept DO students. I know UC Irvine doesn't despite having a DO residency director for psychiatry, has all MDs .

What do you guys think of MUSC?

And are there any ACGME/MD programs in California besides San Mateo that I should consider or are they too competitive/MD only exclusively?

Thanks in advance!

Wouldn't call musc cush. Middle.of the road....a great program though. Loved that place.

 

[LynnHolmes95]

Wouldn't call musc cush. Middle.of the road....a great program though. Loved that place.

h

 

[BiscoDisco]

Did you go to MUSC for psych? What was it like in PGY1 vs PGY2-4? I attended undergrad there, so I have 'roots' there.

Interviewed. Ultimately felt Charleston was too small town.

 

[Lexanoob]

And are there any ACGME/MD programs in California besides San Mateo that I should consider or are they too competitive/MD only exclusively?

I would look into UC Davis as well. They are DO friendly and they seemed more laid-back in culture and with hours as well.

 

[st2205]

There are ways to decelerate training to accommodate for situations like this. We had a couple share a position each half time for 8 years about 30 years ago.

That sounds awful.

 

[EarlyCareerAcademicPsych]

The OP presents a request for information which is totally reasonable, IMO. I'm so glad to hear that such a thoughtful person is joining the field!

And - of course - if begs the question: do you get the same training if you do less work? The answer is "no". Sorry to piss in the pool but that's the ugly truth.

This idea of going a bit longer with a reduced schedule seems to most responsible thing to do. This is a way to attend to your health and the limitations of this chronic illness without missing out on the important training experiences involved.

Take for example fast tracking: residents at the end of their PGY4 year are better trained than residents at the end of their PGY3 year. Because they have trained for an additional year!!! I repeatedly talk to CAP fast trackers who get frustrated that they can't do in one year what their classmates do in two years. Um - you can't.

Like MacDonaldTriad, we had a resident who did her "PGY4 year" over a period of two years so that she could be home with her new baby as a new mom. I think that it worked out well for her. She has come on to the teaching faculty. She's an asset to our teaching community and great therapist.

Good luck with this, LynnHubbard! I hope that you find a place which suits you.

 

[NickNaylor]

I agree with the previous recommendations with respect to selecting a program. While I think it's important to keep in mind your limitations and how to accommodate them, I would also strongly advise against trying to go to the most "chill" program you possibly can as I can't see how it wouldn't adversely affect your training. The fact of the matter is that you improve your skills as a clinician with practice and by seeing patients. That will necessarily require seeing a lot of patients over a long period of time in as many settings as you can.

Approaching residency simply as a barrier to "get through" is, IMO, the wrong approach. Instead, think of it as the last opportunity to prepare you to treat patients completely independently. While lifelong learning is a thing, you won't have the supervision and direct teaching that you will get in residency. If you think of residency in that way, would you still want to go to the most "chill" program that you can?

Instead, I would suggest trying to find programs that you think will train you well and pursue medical accommodations from there for what is a perfectly legitimate diagnosis. My program, for example, would have zero problem accommodating you if you were otherwise a great applicant. One of my co-residents has MS and was quite open about this during his interviews as it's obviously a big deal. He would sometimes have to be out for work, but he nevertheless graduated on time. Some programs may not be as accommodating and may screen you out if you're forward with your concerns, but then again that may not be the kind of place you want to go to anyway.

 

[clausewitz2]

@NickNaylor is spot on about the appropriate mindset for choosing a residency. I am not sure you can appreciate the way your perspective will change during training a priori, so I present a short play:

Me, start of PGY-2: "why does this **** take 4 years again? What kind of ***** can't remember 30-odd drugs? Nobody can't tell me nothin'!"

Me, start of PGY-4: "oh, f*ck, f*ck, f*ck, I am almost done, please teach me everything you know RIGHT NOW!"

 

[FatherPsychiatry]

@NickNaylor is spot on about the appropriate mindset for choosing a residency. I am not sure you can appreciate the way your perspective will change during training a priori, so I present a short play:

Me, start of PGY-2: "why does this **** take 4 years again? What kind of ***** can't remember 30-odd drugs? Nobody can't tell me nothin'!"

Me, start of PGY-4: "oh, f*ck, f*ck, f*ck, I am almost done, please teach me everything you know RIGHT NOW!"

Haha I'm the exact same way. PGY-4 which is supposed to be our "chill" year (no call, all elective and some outpatient) so I thought I'd just skate through after 3 years of hard work. Yet I feel like I'm reading much more and pursuing more supervision now than my first 3 years.

 

[EarlyCareerAcademicPsych]

I appreciate the multiple ways the same point got made here.

And - again - good luck with this @lynnhubbard! I hope that your attempt to address this issue directly is met with the respect it deserves.

 

[krj]

Hey @lynnhubbard , everyone above made really good points about not cutting down the psych portion. One thing that could probably be cut down compared to some residencies is how IM months are handled. TIGMER in San Antonio started this year and the IM months are broken up between 2 inpatient months and 2 outpatient months. The hours off service are lighter than the psych months, which i think is not that common and there is no call on IM. If you want to know more, just send me a message. We also have 3 people from TCOM: Psychiatry Residency Program.

 

[PsychApp777]

HSS is NOT a cush program by any means. Per my friends who go there the call is straight up malignant.

If you're looking in the Boston area, Tufts is a completely different story. Schindelheim (Tufts PD) is a gem of a human being and psychiatrist, and very much family and work/life balance oriented. Their calls can be a bit busy but I've heard of Tufts rotations where you are literally done by lunch!

Tufts has 30 hour shifts. Not exactly cush if you ask me.

 

[Taddy Mason]

Tufts has 30 hour shifts. Not exactly cush if you ask me.

Source?

 

[PsychApp777]

Source?

Check their Freida profile.

 

[Taddy Mason]

Check their Freida profile.

FREIDA is grossly inaccurate across the board for all specialties. Also, 30hr shifts is an ACGME violation...

 

[PsychApp777]

FREIDA is grossly inaccurate across the board for all specialties. Also, 30hr shifts is an ACGME violation...

Freida wasn’t inaccurate for the majority of programs I interviewed at (according to the info they gave during orientation), nor was it inaccurate for the program I’m currently at. But if you’re drawing from personal experience that contradicts Tufts’ self-created profile, I’m sure people would appreciate your sharing it. (I admittedly have no personal experience with Tufts.)

 

[Taddy Mason]

Freida wasn’t inaccurate for the majority of programs I interviewed at (according to the info they gave during orientation), nor was it inaccurate for the program I’m currently at. But if you’re drawing from personal experience that contradicts Tufts’ self-created profile, I’m sure people would appreciate your sharing it. (I admittedly have no personal experience with Tufts.)

I applied to 2 different specialties and can count on one hand the number of programs that had accurate FRIEDA profiles. Also, why would a program intentionally advertise an ACGME violation on their FRIEDA profile?

 

[splik]

FREIDA is grossly inaccurate across the board for all specialties. Also, 30hr shifts is an ACGME violation...

not an ACGME violation - you are allowed 24 hours continuous work + 6 additional hours for continuity of care (i.e. 30hrs) which is fairly standard in some specialties. I have no idea about Tufts, but it was considered a fairly chill program in my day.

 

[Taddy Mason]

not an ACGME violation - you are allowed 24 hours continuous work + 6 additional hours for continuity of care (i.e. 30hrs) which is fairly standard in some specialties. I have no idea about Tufts, but it was considered a fairly chill program in my day.

Ah, my understanding was that it was 4hrs for transition of care/education. That said, I stand by FRIEDA being a source that should be taken with a large grain of salt.

 

[PsychApp777]

I applied to 2 different specialties and can count on one hand the number of programs that had accurate FRIEDA profiles. Also, why would a program intentionally advertise an ACGME violation on their FRIEDA profile?

I went on 20 psychiatry interviews. How many psych interviews (i.e. first hand experiences with different programs) did you have? Not bragging here, just saying that as far as anac-data are concerned, I highly doubt yours are better than mine. But all this aside — Freida profiles are the most accurate data we have regarding individual programs as they are submitted by the programs themselves. It seems to me the burden of proof is on you to discredit Tufts’ SELF-reporting re: their program.

Also, even if Tufts did change their max shift length recently to meet ACGME requirements (and didn’t update Freida), it’s a bad sign that they EVER had 30 hour shifts. A humane program would never have such shifts, regardless of ACGME regulations.

 

[downwithDTB]

I don't think my program cares about Frieda. I imagine that programs that aren't trying really, really hard could care less about that database and might very rarely update it. I imagine that most programs have 24 hour "on" shifts and many honest programs would rightfully allow for the maximum allowable "transfer-of-care" time when reporting shift lengths for transparency. This certainly doesn't imply that you have to stay for the maximum transition time, but that after your shift ends you stay for sign out *gasp* and may need to wrap up an active emergency issue with a patient for no longer than (6 hours in the past) 4 hours.

 

[Coupd'Cat]

If you're looking on the East coast, I would add Montefiore to your list. Several of their residents chose the program specifically because it was more laid back. Full day didactics are nice, too. Best of luck.

 

[MedMan80]

If you're looking on the East coast, I would add Montefiore to your list. Several of their residents chose the program specifically because it was more laid back. Full day didactics are nice, too. Best of luck.

I can attest to this as well, but it is a competitive program

 

[Mass Effect]

I went on 20 psychiatry interviews. How many psych interviews (i.e. first hand experiences with different programs) did you have? Not bragging here, just saying that as far as anac-data are concerned, I highly doubt yours are better than mine. But all this aside — Freida profiles are the most accurate data we have regarding individual programs as they are submitted by the programs themselves. It seems to me the burden of proof is on you to discredit Tufts’ SELF-reporting re: their program.

Also, even if Tufts did change their max shift length recently to meet ACGME requirements (and didn’t update Freida), it’s a bad sign that they EVER had 30 hour shifts. A humane program would never have such shifts, regardless of ACGME regulations.

What? Many programs have 24-hour shifts. When you work a 24, you will likely stay longer to wrap things up, give sign out, dictate, whatever. That isn't the sign of a bad or non-cush program. The non-cush part depends on how many 24s you work (q 3 days versus q 4 months, for instance), not that they exist as they exist in many programs.

 

[MacDonaldTriad]

it’s a bad sign that they EVER had 30 hour shifts. A humane program would never have such shifts, regardless of ACGME regulations.

I'm just imagining surgeons looking at this and validating our lazy reputations. When PGY-Is could only do 16 hours, everyone in my program were unhappy as this made for very strange shifts and more handovers. They were very please when it went away and now they do 24 hour shifts less often again.

 

[tellme_areyoufree]

HSS is NOT a cush program by any means. Per my friends who go there the call is straight up malignant.

If you're looking in the Boston area, Tufts is a completely different story. Schindelheim (Tufts PD) is a gem of a human being and psychiatrist, and very much family and work/life balance oriented. Their calls can be a bit busy but I've heard of Tufts rotations where you are literally done by lunch!

I'm sort of annoyed to have to respond to this, but I'm an HSS resident and guffawed outloud at "straight up malignant."

Excepting call days, staying after 8a-4:30p was "late." That was true at the VA as well as my 25% non-VA time in pgy1-2. I had multiple attendings early on (when I was slower) say "what can I do to make sure you go home on time" well before the end of the day, each day. In fact I've found the faculty, and also especially my co-residents, to be supportive beyond anything I imagined.

Re Call - I don't know how it stacks up against other programs but I averaged ~8-9 hrs call/wk, and we all have the same amount of call. Given that I often left early and work less than 8-4, I average 40hrs/wk or less of actual hours worked.

My experience of our rotations is that I've had plenty of time to read and no work burdens I would consider abnormal or unacceptable (again, the day ends at 4-freakin-30). Even our medicine months are 5days/wk, and roughly 8-4:30.

If you'd like to talk about this program, feel free to ask me questions about it. I'm a current resident, and this person Monocles is not a current resident. I'm happy to share my actual experience.

 

[Monocles]

I'm just imagining surgeons looking at this and validating our lazy reputations. When PGY-Is could only do 16 hours, everyone in my program were unhappy as this made for very strange shifts and more handovers. They were very please when it went away and now they do 24 hour shifts less often again.

Oof. I wonder why the medical culture encourages physicians to be this way.

Blah blah if truck drivers, pilots 12 hour limits why surgeons etc etc

 

[MacDonaldTriad]

It is true that Medicine ER doctors generally work 12 hour shifts. Many other branches of medicine are organized around daytime clinics, inpatient work, and then pull and scratch to cover 24 hour consults and ER evaluations.

 

[PsychApp777]

What? Many programs have 24-hour shifts. When you work a 24, you will likely stay longer to wrap things up, give sign out, dictate, whatever. That isn't the sign of a bad or non-cush program. The non-cush part depends on how many 24s you work (q 3 days versus q 4 months, for instance), not that they exist as they exist in many programs.

Everyone on this thread seems to be assuming that 30 = 24. I think the program probably would have put 24 (as the vast majority of other programs do) if that’s what they meant (everyone knows you have to give sign out...no one considers that part of the shift). I can’t imagine a scenario in which a psychiatrist would have to stay more than 3 hours (which is a lot) to tie up loose ends. This isn’t surgery where you can’t leave an operation until it’s done.

 

[MacDonaldTriad]

Fortunately it has been a very long time. Overnights are the first thing you get to stop doing when you finish training. My point is that we have the same number of patients flowing in being seen by the same number of Indians so chopping the task into smaller bits that hit more frequently just made it harder because it made for strange shift times.

 

[BiscoDisco]

I go to university program, no 24s, no overnights, home call from pgy2+, and on service months during intern year we're often done and out by 1-2pm...sometimes as early as noon.

 

[Mass Effect]

Everyone on this thread seems to be assuming that 30 = 24. I think the program probably would have put 24 (as the vast majority of other programs do) if that’s what they meant (everyone knows you have to give sign out...no one considers that part of the shift). I can’t imagine a scenario in which a psychiatrist would have to stay more than 3 hours (which is a lot) to tie up loose ends. This isn’t surgery where you can’t leave an operation until it’s done.

As was said earlier in the thread, no program is doing 30-hour shifts and if they are, they're not broadcasting it. I don't know how many hours Tufts residents work, but I do one as an acquaintance and she raves not only about the program, but also about the lifestyle, so I have 0 doubt the 30-hour blurb you saw was inaccurate.

I go to university program, no 24s, no overnights, home call from pgy2+, and on service months during intern year we're often done and out by 1-2pm...sometimes as early as noon.

From one extreme to another. I'd argue there's a certain point where learning is affected. For example, never doing overnights? That's not good either.

 

[Monocles]

I go to university program, no 24s, no overnights, home call from pgy2+, and on service months during intern year we're often done and out by 1-2pm...sometimes as early as noon.

Omg where is this paradise?

 

[NickNaylor]

I go to university program, no 24s, no overnights, home call from pgy2+, and on service months during intern year we're often done and out by 1-2pm...sometimes as early as noon.

This is not totally dissimilar from my training experience, though getting out by 1-2pm wasn't typical. Our weekend rounding and call is loaded in PGY-2, so there is essentially no inpatient call as a PGY-3 or PGY-4 apart from two consult months during PGY-4. PGY-2s do four 24-hour, in-house calls over the course of the year, but otherwise that's it.

 

[EarlyCareerAcademicPsych]

Again - the quality of the work is crucial. I am available to work a lot more if the work is meaningful and impactful.

I think that this is getting lost in the conversation about hours which was started by the OP who is thoughtfully considering her options.

We aren't doing the kind of labor that gets easily measured by the amount of time put into it. It is taxing, emotionally challenging work. If there are supports, evidence of efficacy and learning to help with it, then it is much better.

But then again, I'm a sucker - I deeply believe that psychiatry can help people get well. I have seen in happen again and again.

 

[rhondabear]

Omg where is this paradise?

Yes where is this

I’ve also heard that the Delta place in Cali is very nice.

Others that I’ve heard of but not yet mentioned:
-med student friend at University of South Dakota said the program is VERY family friendly and has very little call.

- was told the OU Tulsa program is a very chill community program.

Can anyone chime in regarding Tulsa & South Dakota??

 

[Espadaleader]

Yale is a cush in a way. 1 month dedicated research first year, 3 months second year, 3rd year 25% protected, and 4th year no clinical requirements, you can do as you please as long as you do a few clinical months in whatever you like. You can make $50,000 a year moonlighting in PGY3 and PGY4 too. Biweekly ED weekday call and MOD weekend call in PGY1 2 and 3 but