Quality of Life in residency

[km446]

Hello,

I was just accepted into medical school, and I have always wanted to go to medical school with the goal of becoming a psychiatrist. Lately I have been re-thinking this decision, as quality of life concerns are more pertinent to me now that I have been out of school for awhile than they were as an undergrad churning away in a pre-med curriculum. I know the medical school years will be demanding time-wise, but I am not sure what to expect in residency. So, my question is, what is your life like as a psychiatry resident? How many hours a week do you work? And for females, what are your experiences with maternity leave and starting a family while in residency? I am 25 now, so by the time I am a resident I will certainly be wanting to start a family.

Also thoughts on the quality of life of a PhD or PsyD would be helpful, as these would obviously fit my interests in mental health...

Thank you for your time! I appreciate it very much.

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[whopper]

A lot of this will vary per residency. While the current regulations allow programs to make residents work a maximum of 80 hours a week, some programs force residents to work over that using various tricks.

Fortunately, from anectdotal experience, psychiatry residencies tend to do this less vs other fields of medicine. However, it still does happen.

Most programs from what I've seen will work residents about 20-60 hrs a week, depending on what rotation they're doing and what year of the program they are in. Where I did residency, I did on average about 60 my first year. My last year, minus my chief resident responsibilities, I was doing often less than 40 hours a week.

As for starting a family by the time you graduate, some programs are less likely to pick up candidate who are pregnant or who have children. It's a glass ceiling effect and this is true of any profession.

 

[masterofmonkeys]

my program just tells you its all your fault when you violate, until you learn to stop reporting your hours accurately. Seems to work pretty well. Only a few of us tolerate the blame well enough to actually report it.

Be careful with programs and hrs. Some programs will keep you at 80 damn near all year as interns, and you'll come close to violating the 10hr rule on a regular basis as a 2nd year.

It will also be interesting to see what happens to 3rd year with the requirement for inhouse seniors now. I suspect that 3rd year will no longer be the cakewalk it used to be at most programs.

 

[Doctor Bagel]

Based on the response above, I guess it really varies where you go, but in general, psych residents have a better quality of life than most other residents. I'm an intern and just finished 4 months of inpatient work (psych and IM), and I averaged about 60 to 70 hours/week. I had one week on IM wards where I worked 84 hours, but my average for the rotation was way below that. Now I'm on a rotation where I'm expecting to work no more than 40 hours/week.

So, no, hours violations aren't happening everywhere. Still, residency is hard, and call just plain sucks, imo. So if lifestyle's a huge concern, maybe rethinking medicine makes sense.

 

[km446]

A lot of this will vary per residency. While the current regulations allow programs to make residents work a maximum of 80 hours a week, some programs force residents to work over that using various tricks.

Fortunately, from anectdotal experience, psychiatry residencies tend to do this less vs other fields of medicine. However, it still does happen.

Most programs from what I've seen will work residents about 20-60 hrs a week, depending on what rotation they're doing and what year of the program they are in. Where I did residency, I did on average about 60 my first year. My last year, minus my chief resident responsibilities, I was doing often less than 40 hours a week.

As for starting a family by the time you graduate, some programs are less likely to pick up candidate who are pregnant or who have children. It's a glass ceiling effect and this is true of any profession.

Thanks for the good info. I am also wondering if rural residency placements are a little "easier" on hours worked? And, what were the years in between your first and last year of residency like?

Thanks again!

 

[DD214_DOC]

Rules for interns are changing. Beginning next year, I think interns are not allowed to be in-house for more than 16 consecutive hours. Post-call interns/residents are no longer allowed to see ANY patients, whereas now you can see established patients but not take on any new patients. I have only heard of the approved changes second-hand, so look them up to be sure. The new intern rules are really changing how call is handled in programs who do not utilize a night float system.

With regards to my intern year in psych, it isn't really that bad. Being military my day is 0730 - 400PM regardless of what I have to do. Inpatient psychiatry rotations I'm usually pretty busy up until signout at 4:00PM. Usually rounds are done around 11AM and the remaining day is spent writing notes, handling ward issues, or new admissions.

Things get pretty busy when you are, "off service", or rotating through another department. Here we do two months of internal medicine wards and one month of family medicine wards. I'm on family medicine right now. I get up about 4:15AM, get to work around 5:00AM to lookup labs and stuff, and get signout from the night float person at 6:00AM. I pre-round then attend the morning pimp fest at 7:30AM, then go for attending rounds from 8:00 until whenever. Turnover is at 5:00PM, but usually I'm here until 6:00PM taking care of loose ends. This is 5 days / week and we are required to work 3 weekends during the month to round.

Psych call is q8 days including one weekend day. Off-service call is service dependent.

So, my point is that intern year is going to be pretty busy no matter what you do.

 

[whopper]

Be careful with programs and hrs. Some programs will keep you at 80 damn near all year as interns, and you'll come close to violating the 10hr rule on a regular basis as a 2nd year.

If a program makes you work the full 80 hrs, expect to do more. IT's called reality. No matter how much a place makes you work, sometimes you just got to stay there a few more hours because of this or that.

So if a program says they'll work you 80 hrs a week, expect it to be more than that at least on occasion.

I am also wondering if rural residency placements are a little "easier" on hours worked? And, what were the years in between your first and last year of residency like?

That in general has been my experience, but there is no absolute exception. I've noticed the places that tend to violate ACGME follow these general trends:
1) not a university setting
2) in a poor urban area
3) a number old school teachers that believe that inflicting pain on residents make them better doctor (or perhaps more accurately, they are narcissistic and a bit masochistic and have found a perfect outlet where they can inflict their pain on others, get enjoyment, and the victims are stuck dealing with it).

Where I did residency, they had the 3rd and 4th year residents do outpatient work. That was far easier. It was the hospital work where they really made you work hard because in effect the resident was cheap labor. In outpatient you don't have to deal with an ER full of people (sometimes more than 12), several of them are actively psychotic, and each person waiting longer dings the hospital so you're put under pressure to see as many as possible quickly. In outpatient, you see patients one at a time in a controlled pace.

You should consider that hard work is not a bad thing. It'll likely allow you to learn more. You just don't want to be in a situation where you're working hard because some attending is exploiting you and not teaching. I've had that happen a few times, and the attendings got away with it easily because they were hard to replace. You got to be careful not to enter a program that is malignant.

 

[TexasPhysician]

Thanks for the good info. I am also wondering if rural residency placements are a little "easier" on hours worked? And, what were the years in between your first and last year of residency like?

Thanks again!

My university program has me working 50-some hours/week as an intern. Not bad at all. Very good at teaching as well.

 

[masterofmonkeys]

This is something that applies across specialties, but one of the unintended consequences of the work hour changes is that interns will likely have fewer days off in total. Since most psych hospitals have weekend call coverage rather than having primary teams round, weekend call freq. will almost double, but be 12h instead of 24h shifts.

Same number of call hours, but distributed across more days. How anyone thinks it's a good idea to have fewer days off, I don't know. Then again, I've heard there was a lot of very strange politicking going on with the work hours. Including some crap from actual resident organizations in the east coast threatening to unionize if call shifts weren't shortened (I'd like to do some anti-union gangbusting on those idiots if this is true), and ACGME polling lay people but not residents about what they'd like to see in work hr restrictions.

 

[Red Beard]

I just looked at my medhub (where we log our hours.)

I've worked an average of 58 hours per week since starting my program last June. Rotations were 2 months of ward medicine, 2 months of neurology, and almost 1 month of psychiatry.

I've been at or above 80 hours only 2 weeks.

I've had a 'violation' for 'no day off in last 7' three times, all corresponding to a rotation switch.

I've had one violation for <10 hours between shifts because I was on q3 home call and had to come in for an acute issue at night.

The hardest weeks have been medicine weeks. By far. Psych is a relative cake walk, even on the inpatient service. 5-6 calls in 3 months, plus 2 weeks (5x12hours) of nightfloat. Regular call shifts are just 12 hours on a Friday night, or weekend day or night.

 

[sunlioness]

Rules for interns are changing. Beginning next year, I think interns are not allowed to be in-house for more than 16 consecutive hours.

They're also not allowed to be in the hospital unsupervised, either by an upper resident or attending who is actually physically present there with them. My program had to make some changes because of this. When I was there, interns did take in-house call overnight by themselves with an upper level resident and attending on phone back-up. Starting this week, they did away with overnight call entirely and now have an R2 night float resident who works 6 days per week, 4 - midnight in house and then takes phone call from home until 7am. Not too sure how it's going to work out just yet.

 

[whopper]

Several of these changes are interesting. I remember some of the rules designed to protect residents actually upsetting some of them. E.g. several of the residents wanted to get their weekend calls out of the way so they wanted to do 2 weekend call days in a row. The ACGME didn't like that.

I also thought the patient log was a pain in the butt. Yes, I understand why it's a requirement, but I was in a program where I had a good patient diversity. The log wasn't protecting me and it was a pain maintaining it, especially during a very busy day when you're juggling 12 patients at once.

I also remember one of my buddies being in a malignant program and they forced him to do things that could only be done during the day. E.g. he had to meet with someone from GME and hand in some files. Fine, but he was on night-float and by 8AM, by ACGME rules he had to be out of the hospital. The GME didn't open till 9AM and they required him to see them. So he shows up to GME at 9AM and his PD finds out and reamed him. Yeah, doesn't make sense, the GME should've allowed him to just slip the files under the door--yada yada yada, that's why the program was malignant.

 

[Doctor Bagel]

They're also not allowed to be in the hospital unsupervised, either by an upper resident or attending who is actually physically present there with them. My program had to make some changes because of this. When I was there, interns did take in-house call overnight by themselves with an upper level resident and attending on phone back-up. Starting this week, they did away with overnight call entirely and now have an R2 night float resident who works 6 days per week, 4 - midnight in house and then takes phone call from home until 7am. Not too sure how it's going to work out just yet.

This is my program's big challenge in adjusting to the changes. As it is, it looks like we're not going to have interns do overnight call or weekend call at all because of this supervision issue. Currently, interns are in house alone on call with attending and upper level backup available by phone. We actually have to call the attendings about essentially every pt who comes in, so the supervision is there, it's just not physically in house.

 

[km446]

My university program has me working 50-some hours/week as an intern. Not bad at all. Very good at teaching as well.

Is that becoming more normal, or is your program an out-lier? Do you think there are many similar programs?

I am really having a hard time making this decision! I know that I would love my job as a psychiatrist, but I love a lot of things in life, and want to have time for all of them! I really dislike working more than 40 hours/week, too, so it might just be the sad reality that medicine isn't the best fit for me after all.

 

[Red Beard]

Is that becoming more normal, or is your program an out-lier? Do you think there are many similar programs?

I am really having a hard time making this decision! I know that I would love my job as a psychiatrist, but I love a lot of things in life, and want to have time for all of them! I really dislike working more than 40 hours/week, too, so it might just be the sad reality that medicine isn't the best fit for me after all.

I was just talking with my wife the other day about work hours. I remember thinking (before medical school) that 40 hours a week was a huge burden. Nowadays 40 hours feels like part time! 8 hours feels like the blink of an eye.

 

[whopper]

While I was single and in residency, 60 hours is where I started feeling that if I worked more than that, I felt like my soul was being eaten away. Yeah, I was able to do that, but my enjoyment of the job dropped.

I think for most people 40 hours is that limit, but most people have more things going on in their lives than doctors. Most residents I know don't party on weekends, run some type of social club, and raise kids. Working as a resident and medstudent ups one's tolerance.

 

[MDchouette]

I really dislike working more than 40 hours/week, too, so it might just be the sad reality that medicine isn't the best fit for me after all.

Do not go to medical school unless there is nothing else you can envision doing with your life. There are plenty of other ways to make a living (and a better one, at that) and to make a difference in the world. And, there is an immense amount of personal sacrifice involved in medical training. It's not just the hours; it's the weight of human suffering that you will see as a doctor.

There is no question that psychiatry is one of the easier residencies, at least in terms of time commitment. As for starting a family, people seem to say that getting pregnant sometime in the second or third year of residency is feasible. The idea is to try to time your pregnancy to when you'll be doing outpatient, when your schedule will be most predictable.

If you don't want to work more than 40 hours a week, there are certainly ways to do that in the medical profession. But, before you can get there, there's a lot of toiling (and working way more than 40 hours), and I'd think long and hard about whether medicine is right for you.

That said, I'm a psych intern and I love my job. I couldn't see myself doing anything else. I worked about 70-80 hours a week on my medicine months and took overnight call every fourth night. On my psych months, I'm working about 60 hours a week and finding it absolutely lovely. It isn't an easy life, by any means, but I'm sure I'm in the right profession.

 

[digitlnoize]

Is that becoming more normal, or is your program an out-lier? Do you think there are many similar programs?

I am really having a hard time making this decision! I know that I would love my job as a psychiatrist, but I love a lot of things in life, and want to have time for all of them! I really dislike working more than 40 hours/week, too, so it might just be the sad reality that medicine isn't the best fit for me after all.

I had a career prior to going to medical school. I was a musician (part time), ran a music store (40-50 hrs/wk) and taught guitar lessons (~15-20h/wk).

Now as a 3rd year medical student, I work 8-10h/day plus studying (reading for a couple of hours each weeknight and 6-8h all weekend, while hanging out with my family, watching TV etc.

The 60+ hours/week I put in as a medical student is soooo much better than the 60 hours I put in slaving away at my other jobs, despite the fact that I love music, and if I could get paid a great salary and have job security, I would.

I guess my point is that the pain involved in long hours depends greatly on how much you enjoy the work, how much you're getting paid to do said work, how busy you are while doing the work, and a host of other factors.

All of that being said, my goal in life is to have job security, a decent salary, and work 40h/wk or less, even if that means a slight pay cut. I'm simply not willing to trade my personal time for money. I love my wife and kids and love spending time with them and it's not worth it to me to lose that time to make more $$$.

Unfortunately, it's a long road to having the freedom and financial ability to do that. After working your butt off in undergrad (40h/wk), med school (60h/wk), and Residency (60-80h/wk), then you have to pay off $200k in student loans before you'll really be able to kick back and be comfortable. If you're willing to do all that work, then by all means, go for it. If not, then look elsewhere.

 

[Sweegs]

Hmmm... I'm glad this thread is here. Let's keep it going.

I'm currently training to be a psychiatrist, in Australia (in the RANZCP program). Due to various reasons (family etc) I'm considering migrating to the US to practice in the near future. Therefore I'm finding out as much information as I can about this process. The APA has basically ignored my queries, and ECFMG is yet to reply, but the worst case scenario as I currently see it is:
- nothing I have done after med school counts
- I'll have to go through residency (again)
- that's after finishing Steps 1 and 2

With the above in mind, I'm very interested in finding out what life as a psych resident is like. From the replies so far, the hours are generally better as expected.

Is there a 'standardised' curriculum with exams and mandatory terms, or it all dependent on where the residency is?
Psych residency is typically four years in total, or is this variable as well?

Constructive input welcome!

 

[whopper]

I'm not familiar with the Australian training process but from what I've heard it's similar to England. I do have some knowledge of how it goes there. The two educational systems (UK and the US) are not completely compatible. Medstudents from the UK who graduated (in general) are not as well trained as US students.

That is not a criticism. In fact, in several ways I find the UK system better in their training. In short, they do not adhere as much to the sadomasochism model that we in the states use. The students there are pushed as hard. So why is this system possibly better? The doctors are kept in a student type of status longer. While we are considered attendings after residency, doctors there are called "registrars" (if I remember correctly) that are the equivalent of a chief resident. This status lasts for years. The registars are still considered to be in a state of semi-training.
The above was written for those of you who were about to jump out of your seat and accuse me of being UN-PC.

But the point is, jumping from there to here may not be a completely compatible transfer. There may be things you already know or don't know in comparison with US trained doctors.

Don't expect ECFMG to be of much help. They weren't much help to me and everytime I called them, they put me on hold (at long distance rates) for times longer than 30 minutes. Vonage or another internet based phone service may help. Even when they talked to me, they didn't seem to care about what they were doing.

 

[Doc Samson]

Hmmm... I'm glad this thread is here. Let's keep it going.

I'm currently training to be a psychiatrist, in Australia (in the RANZCP program). Due to various reasons (family etc) I'm considering migrating to the US to practice in the near future. Therefore I'm finding out as much information as I can about this process. The APA has basically ignored my queries, and ECFMG is yet to reply, but the worst case scenario as I currently see it is:
- nothing I have done after med school counts
- I'll have to go through residency (again)
- that's after finishing Steps 1 and 2

With the above in mind, I'm very interested in finding out what life as a psych resident is like. From the replies so far, the hours are generally better as expected.

Is there a 'standardised' curriculum with exams and mandatory terms, or it all dependent on where the residency is?
Psych residency is typically four years in total, or is this variable as well?

Constructive input welcome!

I think the best way forward would be to find someone who has made the Australia-to-US psychiatry move previously. Off the top of my head I can only think of John Coverdale at Baylor (who'd from New Zealand) - but I bet he could point you in the direction of someone that'd be helpful.

http://www.bcm.edu/psychiatry/index.cfm?pmid=5510

 

[VMSmith]

I'm at a large academic center in an urban location.

In my PGY-1 year, I averaged ~70 hrs/wk on my medicine months, and went over 80 hours only once (and my average that month was 78). My non-medicine months were much lower than 70, more like 55-60. I violated the 10 hour rule 2 or 3 times during a month on q3 short call, but technically, I could have left earlier if I wanted to (I had signed out my pager and was finishing notes).

During my PGY-2 year I haven't come close to violating any of the regulations. On my busiest rotation so far, I was somewhere between 55-60 hours. This month I'm around 48 or so. I don't even pay attention to my work hours anymore because I'm so far from ever violating them. My weekends are generally totally free - I make plans with friends, I go out of town for short trips, etc. Sometimes I go out during the week. I spend a lot of my free time playing video games. My girlfriend works more than me.

Other than having to work the occasional weekend, I really don't have much to complain about.

 

[carlosc1dbz]

I'm at a large academic center in an urban location.

In my PGY-1 year, I averaged ~70 hrs/wk on my medicine months, and went over 80 hours only once (and my average that month was 78). My non-medicine months were much lower than 70, more like 55-60. I violated the 10 hour rule 2 or 3 times during a month on q3 short call, but technically, I could have left earlier if I wanted to (I had signed out my pager and was finishing notes).

During my PGY-2 year I haven't come close to violating any of the regulations. On my busiest rotation so far, I was somewhere between 55-60 hours. This month I'm around 48 or so. I don't even pay attention to my work hours anymore because I'm so far from ever violating them. My weekends are generally totally free - I make plans with friends, I go out of town for short trips, etc. Sometimes I go out during the week. I spend a lot of my free time playing video games. My girlfriend works more than me.

Other than having to work the occasional weekend, I really don't have much to complain about.

Thank you so much for sharing your experience. Its great to know that people can have some sort of a life during Residency. Maybe not so much internship, but after that. Spending time with my family and friends at least one day a week is such a positive thing for me.

It would be nice to hear other peoples PGY 1-4 experience with schedule

 

[whopper]

I graduated > 2 years ago.

For me it was like this...
PGY I: 55-80 hours a week. (IM however was about 60-85/week during those few months). Mind you the 80 hour week the residents wanted to get their weekend call days out of the way and voluntarily wanted to do it all in one weekend so they could keep the other 3 weekends free.
PGY II: 50-65 hrs a week.
PGY III: 35-55 week
PGY IV: 20-40 week

Some additional data: we didn't have to do call in the institution overnight. We were allowed to go home at 10 pm, but if things happened at the unit we'd get beeped and we had to do admissions over the phone. In general that followed a rule of thirds: 1/3 you got beeped to the point where you got less than 5 hours of sleep, 1/3 you got beeped to the point where you got about 5 hours a sleep (enough for me to feel fine the next day), and 1/3 you barely got beeped at all.

But per ACGME rules at that time, even if you got beeped to death, you still had to work the next day just as many hours as if you were not on call. As bad as that may sound, I've done the other type of call (overnight in the hospital). The way I did it was far better on my soul (at least IMHO).

 

[wolfvgang22]

Urban county hospital residency program. Almost exculsively see court-ordered psychotic patients. I do lots of evaluations for court affadavits as part of my education each week. All call is overnight inpatient psych call, responsible for about 150 patients while on call, attendings available for supervision by phone. Usually work 30 hours on call days (8am one day to 2pm next day).

Hours:
PGY I: 70 - 85 hours per week. Inpatient call Q5, often got 1-2 hours of dozing near a phone, praying no cardiac arrests or PE's occur. They do anyway from time to time.

Mom had unexpected heart bypasses; program let me use 4 vacation days to go take care of her in another state. So my call was stacked at the end of the month when I got back. I then got sick and used my sick days, so I guess it worked out. Got sick again later on in the year, but went to inpatient call anyway and answered pages with cell phone while lying on the restroom floor, because I was out of vacation and sick days. Fortunately only 6 admits, all either too sedated prior to admission to interview or examine (huzzah for thorazine) or just having passive suicidal ideation because they ran out of meth/oxycontin/beer/xanax.
Medicine rotations were the easiest, less hours. Loved ER - hurrah for shift work! Neurology rotations interesting, regular 7am-5pm hours, very nice.

PGY II: Average 60 hours per week. Inpatient call Q14. One holiday call a year! Huge improvement, cake walk by comparison to PGY I. Slowly starting to catch up on sleep lost PGY I, maybe lose weight gained PGY I. Marriage a little rocky at times over past year, think things are improving with being home more. A little more time to talk to kids and read a forum online once in a while. Discovered I have a TV. They made Iron Man 2? Cool. Buddy gets beaten by a patient after asking "so how are you today?" to a paranoid schiz patient. Program gives us body alarms, talks buddy out of reporting assault to police. I don't grind my teeth as much as I did last year.

PGY III: ??? probably a repeat of PGY II because of the rule changes - program has a committee trying to figure this out...

I don't think my program is a malignant or bad one, that's just how it is.

 

[carlosc1dbz]

Urban county hospital residency program. Almost exculsively see court-ordered psychotic patients. I do lots of evaluations for court affadavits as part of my education each week. All call is overnight inpatient psych call, responsible for about 150 patients while on call, attendings available for supervision by phone. Usually work 30 hours on call days (8am one day to 2pm next day).

Hours:
PGY I: 70 - 85 hours per week. Inpatient call Q5, often got 1-2 hours of dozing near a phone, praying no cardiac arrests or PE's occur. They do anyway from time to time.

Mom had unexpected heart bypasses; program let me use 4 vacation days to go take care of her in another state. So my call was stacked at the end of the month when I got back. I then got sick and used my sick days, so I guess it worked out. Got sick again later on in the year, but went to inpatient call anyway and answered pages with cell phone while lying on the restroom floor, because I was out of vacation and sick days. Fortunately only 6 admits, all either too sedated prior to admission to interview or examine (huzzah for thorazine) or just having passive suicidal ideation because they ran out of meth/oxycontin/beer/xanax.
Medicine rotations were the easiest, less hours. Loved ER - hurrah for shift work! Neurology rotations interesting, regular 7am-5pm hours, very nice.

PGY II: Average 60 hours per week. Inpatient call Q14. One holiday call a year! Huge improvement, cake walk by comparison to PGY I. Slowly starting to catch up on sleep lost PGY I, maybe lose weight gained PGY I. Marriage a little rocky at times over past year, think things are improving with being home more. A little more time to talk to kids and read a forum online once in a while. Discovered I have a TV. They made Iron Man 2? Cool. Buddy gets beaten by a patient after asking "so how are you today?" to a paranoid schiz patient. Program gives us body alarms, talks buddy out of reporting assault to police. I don't grind my teeth as much as I did last year.

PGY III: ??? probably a repeat of PGY II because of the rule changes - program has a committee trying to figure this out...

I don't think my program is a malignant or bad one, that's just how it is.

Thanks Wolfvganag and everyone else for posting their schedules. Its a great way for students applying to understand what the norm is.