Surprisingly, I don't regret a lot. Maybe being anxious about a whole lot of stuff that doesn't matter.
As a related tangent -- in hindsight, is there anything else you all wish you had considered when picking out residency programs that you felt like you didn't realize until later?
This isn't really based on a regret or wish to redo the past. I think I actually chose reasonably well in this regard. But something I hear a lot of people say is that they want all the diversity in psychopathology, culture, and socioeconomic status, but what many don't realize is that you need diversity in complexity too. You don't want the majority of your practice to be straightforward MDD/GAD, and you don't want the majority to be complex on every front. And you need a residency that helps you climb that learning curve.
In my residency, the longitudinal clinic has an effective way of triaging patients by level of complexity, with PGY2's getting the more stable patients with fewer comorbidities, while the PGY3+'s get people who are more of a diagnostic dilemma, who may have multiple health problems and many trials of meds they have already been on. On call during my first year, you just saw patients and were told what to do by your senior. The next year, you learned to "run" call and hold the pager. After that you expanded to the more complex service that is C/L. But those sorts of learning curves are not something I thought of much when I was interviewing for residency, and when I am involved in recruitment activities now, I don't see people asking those questions much either. Everyone is interested in all the opportunities that might be available, but fewer people are brave enough to ask about how the system is built to help them absorb the impact of all there is to learn. Because that would be acknowledging that you can't drink from the fountain.
However. You have to learn to talk to the motivated, relatively well-resourced and psychologically minded "worried well" person before you learn to talk to the person who is none of those things. Unless you know yourself well and you're the unicorn who actually thrives in that environment, you do NOT want to be thrown into the deep end an entire acute IP unit where the typical patient has severe mental illness, is underserved, has a personality disorder, has AODA issues, AND is part of a culture different from yours. This goes for practice, too. It's draining to have all your patients be complex, and it's boring for all your patients to be "easy." You need a balance. Sort of like interval training in sports.
