Regrets

[psychapp121]

What regrets do you guys have about things you wish you would have done differently during residency? I want to make sure these few years count and learn as much as possible so would like to see if people regret doing or not doing certain things that could benefit them as an attending/in future, thx

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[OldPsychDoc]

Failing to prioritize my oldest son's emotional well being.

I.e.--Care for yourself and your loved ones first.

 

[wolfvgang22]

Based on the other thread, state law about administering ECT for a patient who lacks capacity!

 

[SourceOfDenial]

Shoulda started my own individual therapy sooner.

 

[romanticscience]

What regrets do you guys have about things you wish you would have done differently during residency? I want to make sure these few years count and learn as much as possible so would like to see if people regret doing or not doing certain things that could benefit them as an attending/in future, thx

Feeling like hard ethical or medico-legal decisions were all up to me. I would have felt less shame in having my attendings decide and/or getting the hospital administration involved. My most stressful residency experiences involved decisions constrained by institutional pressures, which weren't' always clinical. The endured risk was above my pay-grade.

 

[FatherPsychiatry]

Failing to prioritize my oldest son's emotional well being.

I.e.--Care for yourself and your loved ones first.

Ouch. This one hit home for me.

Feeling like hard ethical or medico-legal decisions were all up to me. I would have felt less shame in having my attendings decide and/or getting the hospital administration involved. My most stressful residency experiences involved decisions constrained by institutional pressures, which weren't' always clinical. The endured risk was above my pay-grade.

Definitely true. I'm at a place with a lot of "autonomy" but didn't realize how much stuff was well beyond my control or pay-grade. I internalized a lot of failures of the system and goofy protocol/institutional type stuff, causing a lot of pointless stress on my part. Getting through this was actually... therapeutic for me even outside of work, ie, residency was in a sense some kind of exposure therapy and the benefits have externalized to much of my outside life for the better.

 

[Merovinge]

You'll get lots of clinical answers but I think this is a key time to take advantage of socially. We aren't neurosurgeons doing 88+ hours a week, seize the opportunity to spent time with your co-residents and residents in other specialties or your specialty at other programs in town. You will make lifelong friends, people who you can reference for their clinical skills via a text message. For single individuals, this is easily the best time to find a life partner due to the automatic camaraderie/friend network you will have with other residents (who will have other friends...). Young attendings or senior residents can be a great help with your career, helping you compare offers and figure out what you are looking for in your first job. Needless to say, senior attendings can be a wealth of knowledge beyond clinical pearls and are often well connected when you are at conferences or just making introductions.

 

[splik]

I would like to have taken some time off to travel during residency. This was approved by my PD but unfortunately my immigration situation precluded this. You fritter away the best years of your life in training.

While you should certainly try to get the most out of your training by reading widely, getting good therapy supervision, getting diverse training experiences etc, remember residency is only the beginning of your training. Great physicians continue learning as a lifelong endeavor. I learned a ton in my first year as an attending, and continue to learn things at a slower pace today.

 

[hallowmann]

I will preface with I'm still in training, but maybe further along and with some moonlighting experience.

If you haven't done this already, learn how to eat healthfully, exercise regularly, and in general try to determine the type of person you want to be on this Earth. You create a lot of habits in residency, and you're probably working longer hours than you will in the future. If you can solidify good habits and qualities, it'll really help you maintain them. Its currently what I'm working on.

 

[AD04]

I wish I didn't buy so many clothes and shoes. I should have put all that money into TQQQ instead.

 

[Stagg737]

I would have started having children later, probably during 3rd or 4th year. I love my kids, but starting during intern year affected my ability to be a good resident and certain rotations definitely affected my ability to be there for my family as much as I wanted.

 

[psychapp121]

thank you all for being willing to share your insights

 

[whopper]

I might've picked a different residency program. Something I only picked up on much later on. The program I attended provided me several non-academic benefits like really good free food (it was in Atlantic City and the hotel had casino quality food, and it was free for residents), it was close enough to my parents so I could go to their place and see them when I wanted, but far enough away so they wouldn't bug me, but I felt opportunities for research were almost non-existent, ER docs, and the ER psych nursing staff tried to bully attendings and residents, the ER psych attendings were weak (had they not been weak the ER docs and ER psych nurses wouldn't try to bully them).

When I worked at U of Cincinnati, first as a fellow, later as an attending, I was working with and next to top people in the field, and seeing top quality work from the best, while in residency while some psychiatrists were good they weren't major league good, and some were just terrible.

 

[Ailuene]

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?

 

[J ROD]

Regret nothing..........

 

[wolfvgang22]

In retrospect I wish I had paid more attention to the call schedule, which was pretty heavy q3, and so I feel like I basically worked non-stop for 3 years, but on the other hand that gave me a lot of confidence in being autonomous as a physician and I have some great colleagues and friends from residency. So give some, get some. The best thing I did was go with my gut and pick a group of people and location I liked on interview day. I felt like I could fit in with an open mind.

With my child fellowship, it was a bit different. I felt I learned a great deal that helps me daily in practice, even though I don't see kids in my job now, and that has immense value. However, I definitely lost two years of attending income. The fellowship I attended away from my home residency program treated first year fellows like PGY1 residents, which was jarring after being known as a very competent senior resident on a short list to being an attending in my prior program. I understood why - the new program didn't know me at first and also there existed certain egos. I never got the opportunity to pursue research because it was an insular and cut-throat environment for projects. I know it is that way a lot of places, and I let location and prestige cloud my vision a bit. Sometimes I wonder if doing the fellowship was necessary. But, life is a journey that we learn from and help us grow into who we are in the present. I don't know if that helps any. Trust your instincts.

 

[NickNaylor]

On the whole I enjoyed my residency experience, so I don't really have too much in the way of things that I would change. I do wish I had chosen electives that gave me more exposure to specialized areas (e.g., eating disorders), but beyond that I wouldn't change much. If you're just looking for advice, I would say to take advantage of the clinical opportunities that you have to the fullest. You really don't have that much time to learn, and soon enough you will be out on your own without the "attending back-up" that often provides a sense of security. Take time for yourself, of course - and you can only do so much - but the opportunity to learn is something that you won't get back.

 

[Armadillos]

This may be a hot take that will get blasted by the forum (maybe rightly), but based on my current practice I sort of wish I hadn’t spent much time on therapy training, especially CBT for depression/anxiety given there are millions of therapists out there to refer to and I could just pick up a manual if ever needed.

With that time I would have probably picked up more useful experiences working in specialized clinics like eating disorders/paraphilia/movement disorders/parasomnias/forensic/etc because now out in the real world a PCP+Therapist should be enough to manage 90% of MDD/GAD so kind of seems like a waste to spend a lot of time training on CBT for that in residency.

But maybe now I’m just taking that basic knowledge for granted and it makes a foundation for the more complex stuff I now deal with in the real world?

 

[Nudexta]

Doing more child and learning CPT codes

 

[finalpsychyear]

the luxury of maximally building your knowledge base was taken for granted. In retrospect I wish I entered each rotation like i had to be ready for a "shelf" exam at the end of it. I believe had I done this for forensic, addiction, CL, eating disorders, geriatric, ECT, and even child I would have loved my accumulated knowledge. Not sure how much of this is practical as you will be focused on getting a job and passing boards in your 4th year but in hindsight i wish i still had that drive and desire at the end of it.

In essence I had 20 hour total weeks as a 4th year with no call or wknds ever so i don't exactly regret that either just wish maybe a balance might have been better.

 

[Sushirolls]

Wished I didn't put the recreation on hold for hunting. Should have picked up the shotgun or rifle and done something, somewhere. State where I did residency, home state, or extended family locations... something, somewhere, extend effort to get meat. So therapeutic and refreshing for the soul. Med school and residency, felt like a small part of me died neglecting the rituals and traditions of hunting for that many years.

Wished I had also taken more residency, and other specialty residents to the gun range for education and basic understanding of guns. The few I did all had good experiences even if it didn't change their opinion politically on guns, but they felt more educated and informed.

 

[SourceOfDenial]

Wished I didn't put the recreation on hold for hunting. Should have picked up the shotgun or rifle and done something, somewhere. State where I did residency, home state, or extended family locations... something, somewhere, extend effort to get meat. So therapeutic and refreshing for the soul. Med school and residency, felt like a small part of me died neglecting the rituals and traditions of hunting for that many years.

Wished I had also taken more residency, and other specialty residents to the gun range for education and basic understanding of guns. The few I did all had good experiences even if it didn't change their opinion politically on guns, but they felt more educated and informed.

Strange—residency did the inverse for me. Getting enjoyment out of going to the range on a Saturday and then rounding on people whose lives were devastated by guns on a Sunday changed my relation to them. Wished resident retreats to the range weren’t a thing.

 

[the_blackest_night]

I wish I had actually bothered to do the readings assigned for didactics. Would have gotten a lot more out of all those psychotherapy didactics we had.

 

[Sushirolls]

Strange—residency did the inverse for me. Getting enjoyment out of going to the range on a Saturday and then rounding on people whose lives were devastated by guns on a Sunday changed my relation to them. Wished resident retreats to the range weren’t a thing.

Their lives weren't devastated by guns. They were devastated by depression, substance use, personality disorders, or even the criminal who wielded it. My relation to guns didn't change, but instead enhanced my professional growth to focus on the real issues needing addressing.

Do you also wish residents wouldn't use salt or water after seeing CHF or DI? Do you wish people wouldn't drive, after rounding on some one dealing with the fallout from a motor vehicle accident? Have you removed all knives from your home after rounding on a patient who cut their wrists and required ortho/hand to repair their tendons? Do you stop taking tylenol after seeing some one on C/L who needs a liver transplant after a tylenol OD? This list goes on and on.

Thanks for minimizing my personal share on what I considered to be a multiyear regret. Your response really wasn't necessary.

 

[wolfvgang22]

Their lives weren't devastated by guns. They were devastated by depression, substance use, personality disorders, or even the criminal who wielded it. My relation to guns didn't change, but instead enhanced my professional growth to focus on the real issues needing addressing.

Do you also wish residents wouldn't use salt or water after seeing CHF or DI? Do you wish people wouldn't drive, after rounding on some one dealing with the fallout from a motor vehicle accident? Have you removed all knives from your home after rounding on a patient who cut their wrists and required ortho/hand to repair their tendons? Do you stop taking tylenol after seeing some one on C/L who needs a liver transplant after a tylenol OD? This list goes on and on.

Thanks for minimizing my personal share on what I considered to be a multiyear regret. Your response really wasn't necessary.

I'm surprised you're surprised you got a response given the controversial nature of firearms. I will not be surprised to see this whole thing continue to escalate and now derail the entire thread, that's usually what happens when this topic comes up.

Edit: I want to add that I have a nuanced view on the topic, myself. I am not against hunting or firearms in the correct limited circumstances.

 

[mistafab]

Just wanted to say that this thread is a gold mine. Please keep the regrets coming.

 

[SourceOfDenial]

Thanks for minimizing my personal share on what I considered to be a multiyear regret. Your response really wasn't necessary.

You shared about your regrets not taking more residents to the range, and I shared how my own personal relation to guns changed in residency. My sharing doesn’t belittle your viewpoint, but instead offers a narrative that differs from your own.

The rest of your post is absurd —comparing guns to water and salt? Come on. But, residency did impact other aspects of my life. For instance, I no longer use a chainsaw, and don’t ride a motorcycle.

 

[mojetter]

Getting married to the cute ICU nurse prior to graduation from residency....Should have been single for a bit longer

 

[meow1985]

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.

 

[meow1985]

More on stuff that doesn't matter.

To quote one of my most nonchalant residency friends, "no one thing you do in residency really matters all that much."

That means don't beat yourself up and recognize that mistakes are part of the process. There will be lots of times when you are not at 100% percent because you've been awake for 24 hours or whatever, or because the rotation you're on just isn't your strong suit. Also, don't compare yourself to other learners too much. Everyone is on their own learning curve. Or on a series of learning curves, actually, since development is lopsided. Examine your countertransference, but recognize, also, that if patients are upset with you, it's usually their own stuff, not that you did something wrong. The vast majority of residents will never be in danger of probation, remediation, failure, or firing. Relax and revel in the fact that for a limited time, the buck doesn't stop with you.

 

[mbgr2014]

Reading this as an intern is incredibly helpful for getting ideas of how to optimize my learning but also my well-being. thanks for being honest, everyone

 

[gucci2020]

Wish I hadn't ranked Staten Island University Hospital in my top 10 for the Match. I want out. The PD and his small band of suck ups make coming to work such a drag.