Psychiatry Residency Hours

[clausewitz2]

I don't fully buy this as it seems nearly universal that Psychiatry does capacity evals. This isn't about individual departments, it's the expectation throughout medicine. I don't know how/why this came to be.

I know some of my co-residents came from med schools where psych essentially never did capacity evals.

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[Dharma]

why Are we doing capacity evals? Cant they be done by any physician?

I say teach one with their whole team watching then tell em to go do it themselves next go round.

 

[Dharma]

Go on....?

Are you strictly speaking from a salary point of view?



Surgery would have been really high on my list as well if certain life things didn't make it untenable.

Anything- money (which ain't THAT great) or hours (which btw good F'ing luck pulling heavy hours in psych). Do this for the wrong reasons (in other words "lifestyle" being the primary motivator) and strap in for misery and lots of questioning about why you went to medical school...

That's all I have to say about that. Choose wisely kids.

 

[Old&InTheWay]

We have an attending here that refuses them. He tells the person consulting that capacity evals are not psych specific and that he would be willing to come down and teach how to do them but that we won’t continue to do them as a consult

This is basically what I’ve been taught as an MS4, that when someone calls for a capacity evaluation, the first question to ask is, “have you already spoken with your patient?” That the role of psychiatry in capacity evaluation is to help another physician determine to what degree a persons mental illness, or dementia, or delirium may impeding their capacity.

 

[NITRAS]

Refusing consults you don’t want to do is a sign of maturity.....right.

LOL

 

[Mass Effect]

Dude they aren’t getting 15-20 new consults a day. Probably a few new consults and mostly follow ups. Our psych program didn’t get that many new consults a day in a 1000 bed hospital.

I won't speak to that specific person, but my CL service most certainly does get 15 - 20 consults a day. That said, we also have a huge service and can handle that. When you're at a program with 1 -2 residents on CL, there's no way there's that much volume unless it's a bad program.

Also, we had different attendings with different viewpoints on capacity consults. I require the primary team to be with me when I do a capacity evaluation AND I do some teaching to the primary team on how to do their own afterwards. Don't forget the "L" in CL.

 

[Marasmus1]

I would run so fast from a program like this. If you're seeing 15 new people/consults a night during call (which presumably also includes being paged about existing patients), I don't see how it's possible to provide good care. Same for the poor resident who is seeing 15-20 consults a day. You don't learn anything on consults if you're seeing that many new consults.

The trick to education is having volume that isn't overwhelming so you can actually read up on your patients and research things you don't know and have time to thoughtfully come up with recommendations/plan. Programs in which you're seeing that many patients give you no time to do either.

I agree with you. I do not think I am able to provide good enough care for my patients because of the time constraint. 15 overnight new patients + pages from floors limit my limited time for each new patient I see to max. 15 minutes. So in 15 minutes I have to evaluate the patient, obtain collateral if I can and decide the disposition/plan.

Educational wise I am not sure if I agree. I have plenty of time to read during my free time(when I am not in the hospital). I see so many psychopathology that I feel very comfortable managing cases. I have followed up so many patients that I feel very comfortable with psychoparmacology. Therapy part is lacking for sure but I am planning to compensate it during my light outpatient years with CBT and DBT courses/certifications.

 

[Marasmus1]

Dude they aren’t getting 15-20 new consults a day. Probably a few new consults and mostly follow ups. Our psych program didn’t get that many new consults a day in a 1000 bed hospital.

How many new floor consults (outside the ED) can you possibly get during overnight call? Maybe a 24hr weekend day will pick you up new consults but outside of an emergency capacity consult or agitation consult, there are pretty much no floor consults outside the ED that HAVE to be done overnight in psych. Again, our 1000+ bed tertiary care hospital doesn’t yield even 1 emergency consult a night on average.

Let’s do the math;

On average day from 8 am. To 5 pm.

5-6 legit psychopathology consult such as medication stewardship for chronic schizophrenia, bipolar, MDD, GAD patients who are admitted for medical reasons or suicide attempt.

5-6 follow ups.

3-4 capacity evaluations.

5-6 substance abuse counseling consults( for some stupid reason as a hospital policy, whoever comes with above 100 alcohol level, positive opiate or cocaine in the urine has to be cleared by psychiatry before discharge)

So I do around 15 H/P new consult note + 5 progress notes a day in C/L service. Minimum I had was 12 and the max I saw was 28 ( that day I left the hospital at 11 pm. )

Overnight call
5 new patients at adult Psych ED
3 new child patients at Child psych ED
5 medical ED consults mostly attempted suicide, malingering, psychosis r/o schizophrenia etc.
2 Capacity consults from medical floors.

So during overnight call I do on average 15 H/P. Minimum
I had was 8, maximum was 26 when I continuously worked 32 hours to finish my work.

 

[calvnandhobbs68]

Let’s do the math;

On average day from 8 am. To 5 pm.

5-6 legit psychopathology consult such as medication stewardship for chronic schizophrenia, bipolar, MDD, GAD patients who are admitted for medical reasons or suicide attempt.

5-6 follow ups.

3-4 capacity evaluations.

5-6 substance abuse counseling consults( for some stupid reason as a hospital policy, whoever comes with above 100 alcohol level, positive opiate or cocaine in the urine has to be cleared by psychiatry before discharge)

So I do around 15 H/P new consult note + 5 progress notes a day in C/L service. Minimum I had was 12 and the max I saw was 28 ( that day I left the hospital at 11 pm. )

Overnight call
5 new patients at adult Psych ED
3 new child patients at Child psych ED
5 medical ED consults mostly attempted suicide, malingering, psychosis r/o schizophrenia etc.
2 Capacity consults from medical floors.

So during overnight call I do on average 15 H/P. Minimum
I had was 8, maximum was 26 when I continuously worked 32 hours to finish my work.

So number 1 your hospital has the stupidest policy in the world. Yes, I guess if everyone who came in drunk or high had to have a mandatory psych consult, we would have probably been hitting easy 20+ consults a day too.

Why are so many people needing capacity evaluations at your hospital? And are you really seeing 2 capacity evals a night ON AVERAGE? That’s total BS if its true. I would say kick those to the day person but since you seem to only have one resident on consults during the day....

Is it just like default everyone consults psych when there’s an inkling of concern? You guys seriously need to start teaching services how to do capacity evals themselves (we even put a tool in the EMR for it) if you’re getting multiple consults a day for it.

I wouldn’t doubt that you’d see that many people overnight in a large ED (although again the fact that they have one resident covering the psych ED and normal ED is a bit much). It was the number of floor consults that you’re getting overnight (which is really still too much if you’re averaging 2 floor consults a night that you’re actually doing). You guys need to do some serious education on capacity evaluations there.

 

[clausewitz2]

So number 1 your hospital has the stupidest policy in the world. Yes, I guess if everyone who came in drunk or high had to have a mandatory psych consult, we would have probably been hitting easy 20+ consults a day too.

Why are so many people needing capacity evaluations at your hospital? And are you really seeing 2 capacity evals a night ON AVERAGE? That’s total BS if its true. I would say kick those to the day person but since you seem to only have one resident on consults during the day....

Is it just like default everyone consults psych when there’s an inkling of concern? You guys seriously need to start teaching services how to do capacity evals themselves (we even put a tool in the EMR for it) if you’re getting multiple consults a day for it.

I wouldn’t doubt that you’d see that many people overnight in a large ED (although again the fact that they have one resident covering the psych ED and normal ED is a bit much). It was the number of floor consults that you’re getting overnight (which is really still too much if you’re averaging 2 floor consults a night that you’re actually doing). You guys need to do some serious education on capacity evaluations there.

Our service is not as bad as what @Marasmus1 is describing but we were explicitly forbidden to say anything to consulting services about their ability to do capacity evaluations and were strongly discouraged from even providing education about the elements unless we were asked first.

In our case I think this may have had something to do with the OCPD traits of the director of the service and not trusting others to do a "good enough" job.

 

[splik]

In our case I think this may have had something to do with the OCPD traits of the director of the service and not trusting others to do a "good enough" job.

maybe, but it could also be (a) other services complain if the residents are perceived to be "blocking" consults and (b) as a resident you are incentivized to see as few consults as possible, but when you are running a service are incentivized to see as many as possible for financial reasons. It's hard to run a financially solvent c/l service

 

[clausewitz2]

maybe, but it could also be (a) other services complain if the residents are perceived to be "blocking" consults and (b) as a resident you are incentivized to see as few consults as possible, but when you are running a service are incentivized to see as many as possible for financial reasons. It's hard to run a financially solvent c/l service

Yeah I thought that, especially b) for a long time but I talked to someone with knowledge of their finances and they assured me that the service is solidly in the black. I mean I'm sure it is still one of the motivations regardless, people respond to incentives, but they aren't struggling. I have also seen the person in question have very strong opinions about the arrangement of chairs at a talk they were giving and being visibly upset that one row had an extra chair.

 

[Stagg737]

I've posted on this forum before about deciding between psych and gen surg. Anyways, just curious what the lifestyle is like in psych residency? How many hours a week typically? You get weekends off ever? How much vacation time? I know this is very dependent on the institution but just trying to get a general idea of what it would be like.

Looking at our system, I'm averaging about 53 hours a week as an intern. That includes my IM rotations and an incredibly easy outpatient neuro rotation, so probably averaging about 50 hours per week. 15 vacation days, 10 sick days, X CME days. I get a lot of weekends off. If I'm on an inpatient rotation I work 2-3 weekend call days. If I'm not on an inpatient rotation, it's 1-2 call days per month. This month I got lucky and have no weekend or night call.

Our consult service simply doesn't see new consults overnight.

Ain't nobody seeing new consults overnight, though, outside of really rare emergent capacity evals for surgeries that need to happen RIGHT NOW.

We only have to see consults overnight if they're stat, otherwise they go to the day team. Fortunately, the teams at our hospital are typically good at not placing stat consults and we rarely get them.

Funny you should mention the bolded though as the only stat consult I've gotten was for a patient with "SI" who was going to get an urgent appendectomy in the morning and had a stat consult placed to me by the surgery NP around midnight. Patient didn't have SI and had never had it but the NP got scared because he said that the day before his pain got so bad he "almost wished I could die". That note was the most passive aggressive note I've ever written. I also enjoyed calling the on-call surgeon at 2 am and informing him that his patient did indeed have capacity to have his urgent appendectomy in the morning.

why Are we doing capacity evals? Cant they be done by any physician?

Yes and they generally should be done by their primary doc. There are occasional cases I've encountered where I do think they were complicated enough to warrant a psych consult for capacity, but the vast majority are just because the internists didn't want to take that liability to deal with it themselves. Ideally, if it's truly complicated enough to warrant a psych consult then someone with forensic training would be available, but I don't know of anywhere that this actually happens unless the legal system is involved.

We have an attending here that refuses them. He tells the person consulting that capacity evals are not psych specific and that he would be willing to come down and teach how to do them but that we won’t continue to do them as a consult

Someone should get that man a medal.

I say teach one with their whole team watching then tell em to go do it themselves next go round.

Another funny story is the time I tried to teach the night team of internists how to do a capacity eval and the patient ended up throwing his dinner against the wall because the senior resident told him he wouldn't be able to discharge him. The guy definitely had capacity and after I went in with them and talked to him he calmed down and left, but I was surprised by how bad some of the residents on that team were in terms of determining capacity and how little they actually knew. I do try and teach the basics because they're not that hard to understand, but some people just don't get it and it somewhat baffles me.

 

[clausewitz2]

Another funny story is the time I tried to teach the night team of internists how to do a capacity eval and the patient ended up throwing his dinner against the wall because the senior resident told him he wouldn't be able to discharge him. The guy definitely had capacity and after I went in with them and talked to him he calmed down and left, but I was surprised by how bad some of the residents on that team were in terms of determining capacity and how little they actually knew. I do try and teach the basics because they're not that hard to understand, but some people just don't get it and it somewhat baffles me.

Overheard coming out of the mouth of an actual senior OB resident:

"So like we're pretty sure she has capacity, unless she decides she doesn't want to do what we're suggesting and then we think she doesn't."

 

[Stagg737]

Overheard coming out of the mouth of an actual senior OB resident:

"So like we're pretty sure she has capacity, unless she decides she doesn't want to do what we're suggesting and then we think she doesn't."

Lol, it's sad how often this is the underlying reason for the consult. My favorite is when one specific IM attending at the VA waits until the day of d/c to tell a patient they're going to a SNF and when the patient refuses we get the capacity consult. Every. Single. Time.

 

[Marasmus1]

Long story short, I do not think hours matter. What matters is how much of the actual time, when you are in the hospital, you spend for patient-care related activities.

I have friends almost hitting 80 h. a week.Large portion of it is spent watching netflix overnight, having 2 h. lunch break each day, 1 and half day didactic.

On the other end of the spectrum i have friends who average 40 h a week and they consider it a light day if they can take a couple of minutes break for restroom.

 

[clausewitz2]

ha of course youre solidly in the black, because of the high volume of consults!! I bet they have also negotiated extortionate rates with the insurance companies too! and the probably still pay crap

Our health system actually has a large captive insurer and also owns the Medicaid mental health carve-out for the county so the incentive structure is sometimes unusual and there is actually a reason for paying for some things that reduce overall costs to the system. We actually take in more money from insurance premiums than from billing for care. The C&L people were recently able to run some numbers about how much money was getting shelled out due to issues around substance use in medical hospitalizations, and so now we have a substance use consult team separate from the main C&L service. Similarly, a "behavioral health ICU" after it became clear that a huge driver of prolonged psychiatric hospitalizations was driven by a small number of individuals who our nursing staff felt they could only handle at our current staffing ratios by more or less moving them permanently to seclusion rooms. I imagine it's a different experience working in this system than in most American centers where payors and providers are not playing for the same team. I always wondered if Kaiser ends up working more like that but I am on the wrong side of the country to find out.

 

[Mass Effect]

I agree with you. I do not think I am able to provide good enough care for my patients because of the time constraint. 15 overnight new patients + pages from floors limit my limited time for each new patient I see to max. 15 minutes. So in 15 minutes I have to evaluate the patient, obtain collateral if I can and decide the disposition/plan.

Educational wise I am not sure if I agree. I have plenty of time to read during my free time(when I am not in the hospital). I see so many psychopathology that I feel very comfortable managing cases. I have followed up so many patients that I feel very comfortable with psychoparmacology. Therapy part is lacking for sure but I am planning to compensate it during my light outpatient years with CBT and DBT courses/certifications.

Ever hear the saying quality over quantity? Your hospital may get all the psychopathology in the world. If you're truly seeing 15-20 new patients in a day, you have 0 time to actually learn from them.

Also, I'm going to echo the other posters. There is no reason you should have 2 capacity evals on average at night nor have 5 capacity evals during the day. Capacity to do what? What are you assessing?

 

[Marasmus1]

Ever hear the saying quality over quantity? Your hospital may get all the psychopathology in the world. If you're truly seeing 15-20 new patients in a day, you have 0 time to actually learn from them.

Also, I'm going to echo the other posters. There is no reason you should have 2 capacity evals on average at night nor have 5 capacity evals during the day. Capacity to do what? What are you assessing?

Some may have 0 time to learn from 15-20 patients.

I do have a lot of time to learn from them. out of 15-20, there are 3-5 educational cases each day. What I generally do is when I get back home I read about them from different sources.

Capacity consults are mostly capacity to sign out against medical advice. Capacity for STAT surgery. Capacity to refuse medication etc..

 

[FlowRate]

Let’s do the math;

On average day from 8 am. To 5 pm.

5-6 legit psychopathology consult such as medication stewardship for chronic schizophrenia, bipolar, MDD, GAD patients who are admitted for medical reasons or suicide attempt.

5-6 follow ups.

3-4 capacity evaluations.

5-6 substance abuse counseling consults( for some stupid reason as a hospital policy, whoever comes with above 100 alcohol level, positive opiate or cocaine in the urine has to be cleared by psychiatry before discharge)

So I do around 15 H/P new consult note + 5 progress notes a day in C/L service. Minimum I had was 12 and the max I saw was 28 ( that day I left the hospital at 11 pm. )

Overnight call
5 new patients at adult Psych ED
3 new child patients at Child psych ED
5 medical ED consults mostly attempted suicide, malingering, psychosis r/o schizophrenia etc.
2 Capacity consults from medical floors.

So during overnight call I do on average 15 H/P. Minimum
I had was 8, maximum was 26 when I continuously worked 32 hours to finish my work.

For comparison, I just finished a week of night float at an 800 bed, 65,000 ED visits/year quaternary care hospital. I did about 18 consults all week, all in the ED except for one (not actually very urgent) floor follow-up, no new floor consults, no capacity evals. And that was a pretty typical night float week. There are large hospitals where teams are comfortable managing a wide range of issues. Unfortunately, there's a new policy where psych has to see any "safety concern" to remove sitters, which will increase the number of marginal consults (cases where the primary team would have felt comfortable managing on their own if it wasn't for the new policy.)

I've also done night float at a 650 bed hospital with a 60k visit ED. For various reasons that hospital tends to get more of the emergency psych stuff so it was typically 6-12 ED psych consults per night but still very rare floor consults.

Granted, we do our share of capacity evals during the day, but it's pretty rare (floor consults in general, actually) overnight.

 

[Stagg737]

Unfortunately, there's a new policy where psych has to see any "safety concern" to remove sitters, which will increase the number of marginal consults (cases where the primary team would have felt comfortable managing on their own if it wasn't for the new policy.)

Is this at a VA? If you don't want to share I understand, but the VA we rotate at implemented a similar policy with the roll-out of the suicide screening and it more than doubled the number of consults we got because so many people were being placed on 1:1.

 

[NickNaylor]

Is this at a VA? If you don't want to share I understand, but the VA we rotate at implemented a similar policy with the roll-out of the suicide screening and it more than doubled the number of consults we got because so many people were being placed on 1:1.

We have a nearly identical policy at one of our non-VA hospitals.

 

[Stagg737]

We have a nearly identical policy at one of our non-VA hospitals.

I don't think the policy itself is unreasonable, especially if a patient has made explicit statements of SI or HI. The VA's policy (at our VA) is so frustrating because of the ridiculously low threshold for "safety concerns" that trigger a 1:1 (a positive PHQ-2 triggers a 1:1).

 

[FlowRate]

Is this at a VA? If you don't want to share I understand, but the VA we rotate at implemented a similar policy with the roll-out of the suicide screening and it more than doubled the number of consults we got because so many people were being placed on 1:1.

Nope, academic hospital.

And w/r/t your most recent comment and what I already wrote, nursing staff has chosen to interpret the new rules as including things like saying "I'm in so much pain that I almost want to kill myself" which is clarified by the patient as not representing any actual suicidal intent.

 

[Stagg737]

Nope, academic hospital.

And w/r/t your most recent comment and what I already wrote, nursing staff has chosen to interpret the new rules as including things like saying "I'm in so much pain that I almost want to kill myself" which is clarified by the patient as not representing any actual suicidal intent.

I feel you. Had to do a tertiary screen on a 65 year old guy having neck surgery because he had made a suicide attempt when he was drinking as a teenager and never had any psychiatric problems afterwards (and hadn't used alcohol in 30+ years). The levels of CYA never cease to amaze me...

 

[Mass Effect]

Nope, academic hospital.

And w/r/t your most recent comment and what I already wrote, nursing staff has chosen to interpret the new rules as including things like saying "I'm in so much pain that I almost want to kill myself" which is clarified by the patient as not representing any actual suicidal intent.

And people talk about healthcare costs. It's because of nonsense like this.

@Marasmus1 we can agree to disagree, but I just can't buy that you see 15-20 consults a day, 3-5 of which are educational, that you see them all by yourself, that you provide good care, and that you have time to actually go home and read/learn from the 3-5 that are educational. All of those things just aren't congruent during a regular work day. But I'll agree to disagree.

 

[clausewitz2]

Fun consults triggered by *****ic automatic screening policies:

1) a borderline woman who had completed full-model DBT years ago who honestly answered "yes" when asked if she had contemplated suicide in the last 30 days. She was gainfully employed and in a stable relationship. "I've thought about suicide every day for the last 10 years, I'd never do it."

2) someone dying of liver cancer who expressed a wish to kill the person who murdered their sibling

3) the most Appalachian man I have ever met, an illiterate carney who had never previously in his life been more than 50 miles from his birthplace, who, frustrated with a perceived lack of respect implied by the fact that his CT surgeon sent a resident to check on him after surgery instead of coming himself, expressed a wish to go outside and "smoke till my head explodes"

4) STAT consult at 3 AM from women's hospital. Someone presents in labor and at admission scored an 8 on the PHQ-7. Order put in by nursing, "that's what the orderset says to do." I helped clarify the distinction between a regular ol' consult order (we see them within 24 hours) and a STAT consult (we see them in less than an hour). This happens again the next month.

 

[clausewitz2]

And people talk about healthcare costs. It's because of nonsense like this.

@Marasmus1 we can agree to disagree, but I just can't buy that you see 15-20 consults a day, 3-5 of which are educational, that you see them all by yourself, that you provide good care, and that you have time to actually go home and read/learn from the 3-5 that are educational. All of those things just aren't congruent during a regular work day. But I'll agree to disagree.

Man if I was being worked to the bone like that I'd want the illusion that I was actually benefiting in some way too.

 

[Monocles]

Fun consults triggered by *****ic automatic screening policies:

1) a borderline woman who had completed full-model DBT years ago who honestly answered "yes" when asked if she had contemplated suicide in the last 30 days. She was gainfully employed and in a stable relationship. "I've thought about suicide every day for the last 10 years, I'd never do it."

2) someone dying of liver cancer who expressed a wish to kill the person who murdered their sibling

3) the most Appalachian man I have ever met, an illiterate carney who had never previously in his life been more than 50 miles from his birthplace, who, frustrated with a perceived lack of respect implied by the fact that his CT surgeon sent a resident to check on him after surgery instead of coming himself, expressed a wish to go outside and "smoke till my head explodes"

4) STAT consult at 3 AM from women's hospital. Someone presents in labor and at admission scored an 8 on the PHQ-7. Order put in by nursing, "that's what the orderset says to do." I helped clarify the distinction between a regular ol' consult order (we see them within 24 hours) and a STAT consult (we see them in less than an hour). This happens again the next month.

Hahahaha that is frustrating.

Our medicine teams treat us as if we were magicians or miracle workers. We would get random STAT (rapid response) pages for people who have psych consults put in! When we ask medicine if they were given their PRN/recommended meds, they would go "well we wanted you to talk to them first and see if that would calm them down..."

-.-

 

[splik]

Unfortunately, there's a new policy where psych has to see any "safety concern" to remove sitters, which will increase the number of marginal consults (cases where the primary team would have felt comfortable managing on their own if it wasn't for the new policy.)

I think this is from some misinterpretation of joint commission guidelines as something like this happened at my hospital too. No one bothered to tell me (or my overlords) about this policy. I have instructed my residents to ignore all such requests and informed the respective service medical directors that we will not be doing this (turns out they started "screening" for SI using something that isn't even a screen and the nurses then put all the malingerers on 1:1s). Maybe this will make them think twice before coming up with stupid policies without deigning to tell me about them beforehand.

 

[Armadillos]

We have an attending here that refuses them. He tells the person consulting that capacity evals are not psych specific and that he would be willing to come down and teach how to do them but that we won’t continue to do them as a consult

Your attending must not get paid based on productivity. I don’t either, but my understanding is out in the real world softball consults are like gold.

 

[TexasPhysician]

Your attending must not get paid based on productivity. I don’t either, but my understanding is out in the real world softball consults are like gold.

Depends on pay rate. C&L work has a huge range of $. I had a CEO contact me about C&L and offered $110 per new consult. Wouldn’t budge, so 2 years later and they still have no psych C&L.

A friend of mine across town with a different hospital is getting $450 per new consult.

 

[FlowRate]

Depends on pay rate. C&L work has a huge range of $. I had a CEO contact me about C&L and offered $110 per new consult. Wouldn’t budge, so 2 years later and they still have no psych C&L.

A friend of mine across town with a different hospital is getting $450 per new consult.

I was just thinking today about whether I'd be willing to do PRN consult work when I get out into practice. It takes me usually 1-2 hours to see most consults--I guess 3+ hours if you have a really complicated case with lots of chart, collateral, and liaison work but hopefully that's relatively rare outside of academic centers. I don't particularly enjoy doing it, so I'd need a pretty strong hourly rate, which is how I settled on $350 per consult. Good to know that wasn't as completely crazy/unlikely as I thought it would be.

 

[Mad Jack]

Our C&L service easily gets 20 consults a day at our main campus due to our steadfast unwillingness to ever refuse any consult for any reason and some quirks of PA law and nursing home placements (i.e. everyone who had ever looked at a psych medication needs a full psych eval before they got to a SNF).

Ain't nobody seeing new consults overnight, though, outside of really rare emergent capacity evals for surgeries that need to happen RIGHT NOW.

During the day we also have multiple residents and a nurse clinician with multiple attendings splitting up that workload.

We usually get about 6-10 consults a day largely because of state laws and nursing home policies affecting placement for anyone with a history of mental illness or that are on certain medications. History of drug use (ever)? Currently on haldol? ANY active mental illness? Welcome to the world of target admissions where the rules are made up and common sense doesn't matter. Our ER is the busiest by far in the region though, so we easily have between 15-30 psych patients a day come through.

I average 56 hours a week overall on the inpatient psychiatric service due to evening and weekend call but honestly it isn't that bad. Medicine was 55 hours outpatient (due to still having psych call responsibilities) and inpatient medicine was just north of 70 hours a week. Outpatient psych in third year is going to likely be a pretty rough 50-60 hours per week, plus Q7 overnight phone call for admission orders and such.

 

[DoctorStrange0101]

I worked 40 hours/week regardless of rotation.

What program was that?

 

[Tangerine123]

So far, my PGY1 was like this:

Depression Ward:
6 Month rotation
3.5 Residents
30 Patients
8am-6pm

Addictions Ward
4 Month rotation
3 Residents
40 Patients
8am-2pm(ish)

Call is dealt with a point system.
Nights - 1 Point
Weekends - 2 points
Holidays - 3 points
So I just assign myself 1 weekend or holiday shift (9am-8pm) per month. And it usually is enough points for the month.

 

[justalittlestar]

So far, my PGY1 was like this:

Depression Ward:
6 Month rotation
3.5 Residents
30 Patients
8am-6pm

Addictions Ward
4 Month rotation
3 Residents
40 Patients
8am-2pm(ish)

Call is dealt with a point system.
Nights - 1 Point
Weekends - 2 points
Holidays - 3 points
So I just assign myself 1 weekend or holiday shift (9am-8pm) per month. And it usually is enough points for the month.

How many points do you need by the end of the month?

 

[Tangerine123]

How many points do you need by the end of the month?

You don't really need to have a certain amount of points. It's a priority list.

The 3 at the bottom of the list can be randomly selected for a nightshift with little to no notice if somebody gets sick or can't make it. If none of those three are available, we go up the list.

Striving for 3 points per month is usually enough.

As a side note. A few hours before they randomly assign those "emergency" shifts, they ask if anybody wants to volunteer. You get twice as many points

Somebody volunteered for new years, she got 6 points. That means she doesn't have to do shifts for 2-3 months.

The algorithm takes into consideration the amount of time you've been working at the clinic, and if you have a full or part-time contract