The Road to Psychiatry

[JackedDiezel]

I've been looking on this forum for a while, but have never posted, But I really need a basic outline of the Road to becoming a Psychiatrist. I've seen topics about soon to be Residents and everyone of them mentions how Pysc gives you more free time than most of them.
First you get a college Degree in Bio and all those other required courses,
Then you spend the first 2 years of med school with everyone else regardless of intended medical profession. Then you specialize in Pysc for 2 years, My question is, Why is Pysc residency less time consuming? Can someone help me out here.

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[erg923]

Thats not correct. All 4 years of general med school, just like everyone else. Psych "specialization" (i.e., residencey) only comes after that. Residencey is psychiatry is 4 years long as well.

PS: Your undergrad degree does not have to be in biology or any science for that matter. What matters is that you take the premed requirements for med school. And of course, those are mostly hard sciences. But major in what intertest you. If its psychiatry then I would highly recommend neuroscience or psychology, of course.

 

[JackedDiezel]

Thats not correct. All 4 years of general med school, just like everyone else. Psych "specialization" (i.e., residencey) only comes after that. Residencey is psychiatry is 4 years long as well.

PS: Your undergrad degree does not have to be in biology or any science for that matter. What matters is that you take the premed requirements for med school. And of course, those are mostly hard sciences. But major in what intertest you. If its psychiatry then I would highly recommend neuroscience or psychology, of course.

Thanks for the Answer, But Can you help me get this straight, So....4 year undergrad, 4 year general med school, then....4 years of residency or 4 years general residency and then 4 years pysc residency, and by less time consuming I meant I've read all over these boards that pysc residency will allow for more free time then that of surgery and those intense specializations, is this strictly because there are less "Calls" on pysc.....I can't think of the word right now.

 

[HMSPSYCH]

This is the typical route to become a psychiatric MD.

Pre-medical school-
4 years -Any science major (biology,chemistry, genetics, physiology, etc) or premed requirement (1 year of organic chemistric, inorganic chemistry, physics, biology) will do. Key is to get as many As as possible in these classes!
MCAT- Highly challenging test.
Countless hours volunteering/groups/research/extracurricular activities

Medical School-
4 years of classroom lectures. Lots of scutwork, overnight calls, stressful exams.
USMLE 1- 8 grueling hours of testing in all fields of basic science medicine.
USMLE 2 CK- same as above but more clinical medicine.
USMLE 2CS- 7-8 annoying hours of doing H&P on live patients.
Interview for residency

Residency-
4 years of classroom lectures and long work hours/stress.
Intern year-mostly on medical floors, intense work schedule, lots of over night calls.
Year 2-4: less calls (depends on the each program but usually avg q5-7 at many) in general but can work 65-75 hours per week. Training in ECT/psychotherapy/proper medication use/monitoring. A little TMS(me). Inpatient/outpatient/consult work.
USMLE 3- 2 consecutive days of testing covering all fields of medicine.

Post-residency-

Written Board Exam covering psychiatry and neurology.
Oral Board Exam
Fellowship (optional)

Basically, psychiatry residency training may seem ‘easier’ than some of the other medical specialties but it is highly challenging/stressful, nevertheless, and more grueling/competitive in comparison to most other careers (PhD, MBA, engineering, law, etc.)

 

[erg923]

This is the typical route to become a psychiatric MD.

Pre-medical school-
4 years -Any science major (biology,chemistry, genetics, physiology, etc) or premed requirement (1 year of organic chemistric, inorganic chemistry, physics, biology) will do. Key is to get as many As as possible in these classes!
MCAT- Highly challenging test.
Countless hours volunteering/groups/research/extracurricular activities

Medical School-
4 years of classroom lectures. Lots of scutwork, overnight calls, stressful exams.
USMLE 1- 8 grueling hours of testing in all fields of basic science medicine.
USMLE 2 CK- same as above but more clinical medicine.
USMLE 2CS- 7-8 annoying hours of doing H&P on live patients.
Interview for residency

Residency-
4 years of classroom lectures and long work hours/stress.
Intern year-mostly on medical floors, intense work schedule, lots of over night calls.
Year 2-4: less calls (depends on the each program but usually avg q5-7 at many) in general but can work 65-75 hours per week. Training in ECT/psychotherapy/proper medication use/monitoring. A little TMS(me). Inpatient/outpatient/consult work.
USMLE 3- 2 consecutive days of testing covering all fields of medicine.

Post-residency-

Written Board Exam covering psychiatry and neurology.
Oral Board Exam
Fellowship (optional)

Basically, psychiatry residency training may seem ‘easier’ than some of the other medical specialties but it is highly challenging/stressful, nevertheless, and more grueling/competitive in comparison to most other careers (PhD, MBA, engineering, law, etc.)

What he/she said......

 

[masterofmonkeys]

intern year is 6 months psych 2 months neuro 4 months med/peds at many places.

 

[Esquire]

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[cleareyedguy]

The psych I know from daycare drops his kids off at 8 am and picks them up well before the closing time of 6:00 pm. His days of overnight calls are over.

I and my lawyer colleagues, on the other hand, work however long the partners/judges/clients make us. I go in to work and don't know if I will go home that night. There is no call schedule since we are expected to be available at all times at the drop of a hat. There is no "residency" and therefore no light at the end of the tunnel.

If you're in private practice as a lawyer or doctor or most anything, you make your own hours.

Prior to that, the professional school route is fairly straightforward. If I were talking to someone who apparently knows very little of this (is the original poster in high school?), I'd emphasize majoring in whatever most interests him (I'm assuming a him, since my gender bias is in favor of a girl having done some reading before asking such a naive question) and mentioning that med school can be very expensive but that you start making a living wage as a resident. I'd also mention that some psychiatrists work far more than some surgeons, that psychiatry does emphasize lifestyle more than some other specialties but can be more stressful, and that few doctors work the hours of the hardest working big firm lawyers (though few of us can make the 7 figure incomes that are standard at the top of the Big Firm pyramid--which by the way can typically include an entering class of 50 hot shot recent law school graduates and which may wind up with 1-3 people making partner; fewer in this economy. And once you make partner, your hours typically only go up til you become obsolete at 60. In contrast, I know hardly any psychiatrists who ever retire--mainly because they enjoy it).

By the way, residency hours were capped at 80 largely because of the actions of a grieving father in the '80's and '90's. I mention this only because Sidney Zion died last week...

 

[nancysinatra]

By the way, residency hours were capped at 80 largely because of the actions of a grieving father in the '80's and '90's. I mention this only because Sidney Zion died last week...

Will the cap now be removed by any chance? I thought the hours were capped in NY State because of Sidney Zion, but the rest of the nation lagged behind in that for many years. So was it really the Zion case that caused the 80 hour rule nationwide, or something else? And didn't the Zion case primarily raise the issues of attending backup and residents having a manageable caseload?

I wouldn't say that having my hours capped at any certain total number effects my quality of life that substantially. (Though if I were working 120 hours per week I might feel differently). Residency is only 4 years, and not all of that is on services where you could even theoretically exceed 80 hours. Patient care might be effected in some fields by the cap, if the number of residents hasn't been increased since the rule was put into place.

 

[chameleonknight]

I think Neurosurgery is exempt from the 80 hr rule, and I bet you can count on one hand the number of general surgery programs that comply with it.

 

[whopper]

I don't think the cap would be removed. Its worked its way into national ACGME requirements. There have been educational materials to support this move citing increased medical errors & such. To drop the 80 hr cap after so much has been established to support it would too much of an about face to the public, and would fly in the face of the data from several sources, including the ACGME that have acknowledged that a cap gives higher quality of care, and reduces dangerous mistakes.

There have also been a number of additional rules & regulations in several states that throw a heck of a lot of liability at employers that make their employee work tremendous hours--such as liability for any car accidents made by employees not allowed to have enough sleep. So, if the 80 hour cap were ever to be removed-residency programs could face other non-ACGME problems such as having to explain why their resident who slept for a total of 4 hours over the course of 3 days crashed his car.

Several program directors may not know about the driving laws I mentioned, and they may not be in all states, though I do know for a fact that they are in at least a few.

 

[nancysinatra]

But the 80 hour rule is meaningless, since it's averaged out over 4 weeks. I could work 168 hours one week, 0 hours the next, 152 hours the next week, and 0 hours the following week. That would average to 80 hours per week, but it wouldn't be great for patient safety, if you believe that sleep in between shifts is necessary to prevent medical errors. Whoever designed this system knew this could happen and did not care to avoid it. Sure there are some other smaller rules like 10 hours in between shifts but they seem to be routinely violated. I know lots of interns in various specialties currently working 150 hour weeks right now.

The 30 hour rule seems more important to me than the 80 hour rule. I can put in 80 hours in one week and still have energy left, but after 24 hours with no sleep I'm in danger of making serious mistakes. However I've never heard of any specialty that across the board takes that rule terribly seriously. To the extent that it is taken seriously, all the same amount of work is expected to get done by residents as on any other day, just faster. If you don't get it done in that shorter period of time when you're operating on less sleep, you're considered "inefficient." It all seems very arbitrary to me.

 

[billypilgrim37]

But the 80 hour rule is meaningless, since it's averaged out over 4 weeks. I could work 168 hours one week, 0 hours the next, 152 hours the next week, and 0 hours the following week. That would average to 80 hours per week, but it wouldn't be great for patient safety, if you believe that sleep in between shifts is necessary to prevent medical errors. Whoever designed this system knew this could happen and did not care to avoid it. Sure there are some other smaller rules like 10 hours in between shifts but they seem to be routinely violated. I know lots of interns in various specialties currently working 150 hour weeks right now.

The 30 hour rule seems more important to me than the 80 hour rule. I can put in 80 hours in one week and still have energy left, but after 24 hours with no sleep I'm in danger of making serious mistakes. However I've never heard of any specialty that across the board takes that rule terribly seriously. To the extent that it is taken seriously, all the same amount of work is expected to get done by residents as on any other day, just faster. If you don't get it done in that shorter period of time when you're operating on less sleep, you're considered "inefficient." It all seems very arbitrary to me.

This sounds like a function of the programs you've been associated with. Both the residency programs at my school and at my current program were/are remarkably compliant with the rules. My program director nearly had a stroke when I told him I'd violated the 10-hour rule a few times during medicine, and he was visibly agitated I hadn't come right to him as soon as it happened. To be fair, he's worried about consequences of rules violations, but that's humane and reasonable.

In many institutions, the work hour rules have demanded a change in culture. At some programs who are willing to gamble with their accreditation, it hasn't. My buddy who's a surgery resident at Hopkins says they're now watched like hawks, and he's personally annoyed that he's missed some cases because he was sent home. That's a huge change. And a good one, at an institution where the rules were famously flaunted.

 

[nancysinatra]

This sounds like a function of the programs you've been associated with. Both the residency programs at my school and at my current program were/are remarkably compliant with the rules. My program director nearly had a stroke when I told him I'd violated the 10-hour rule a few times during medicine, and he was visibly agitated I hadn't come right to him as soon as it happened. To be fair, he's worried about consequences of rules violations, but that's humane and reasonable.

In many institutions, the work hour rules have demanded a change in culture. At some programs who are willing to gamble with their accreditation, it hasn't. My buddy who's a surgery resident at Hopkins says they're now watched like hawks, and he's personally annoyed that he's missed some cases because he was sent home. That's a huge change. And a good one, at an institution where the rules were famously flaunted.

Yeah, I see what you're saying. To give my program credit, they would be concerned, I'm sure, if violations happened and got reported. I doubt people are often going over 80 hours on psych. (I won't speak for medicine.) However my personal feeling is--and this is entirely personal--this is my education and the care of patients, and if I'm not tired out at 80 hours, why should some arbitrary cap force me to go home then and there? We can probably finish our basic inpatient psych work in that time most of the time, but for some psych inpatients we seem to practically be their primary care providers and that's why leaving at a set time galls me at times.

I rarely hear residents mention Libby Zion or medical errors when the 80 hour rule is discussed. I can see the relevance of the 30 hour rule to Zion and others harmed by medical errors. But the 80 hour rule sounds like it relates more to resident quality of life than to medical errors, because 80 hours, while taxing, is not enough to make me be so tired I can't put in an order or think straight. Anyway I don't know many residents or med students who know who Zion was, or who could say why 80 hours is particularly important which is why I'm a bit dubious.

On the other hand, though, if someone just wants me as slave labor that's galling in a different way...

 

[billypilgrim37]

However my personal feeling is--and this is entirely personal--this is my education and the care of patients, and if I'm not tired out at 80 hours, why should some arbitrary cap force me to go home then and there?

Well, that might all be true of you. Do you believe that's true for your colleagues? Do you believe there would be reliable ways to separate the NancySinatras from the BillyPilgrims? Do you believe you can monitor yourself that well? Most of us can't.

 

[nancysinatra]

Well, that might all be true of you. Do you believe that's true for your colleagues? Do you believe there would be reliable ways to separate the NancySinatras from the BillyPilgrims? Do you believe you can monitor yourself that well? Most of us can't.

Of course I think there should be regulations, and they should not just reflect my personal wishes, but I also wish that everything didn't have to be so arbitrary, and seem to have so little relation to the actual needs of patients. I'm an intern and I think I'm reasonably efficient for my level of experience, and if I get to spend 10 minutes each day with my patients on my current rotation that's a lot.

I would also say I spend a LOT of my day doing paperwork, and most of it's not even meaningful documentation or order writing, either. Obviously this is a widespread complaint in the medical world, but that's what those hours are spent doing. No one has sat down and explained how the NUMBER of hours I'd work was chosen or what makes it rational. I assume it's as irrational as the WAY I spend my time. Some of the time I spend is meaningful. But for every order I put in, and for every patient interview I conduct or note I write, I repeat the process 4 or 5 times in the form of documentation that merely serves legal or jhaco purposes. So I doubt that the number 80 was chosen for any more medically-related reason than nancysinatra woke up one day and picked it out of a hat.

I guess I'd be ok with 80 hours if someone just explained and backed it up for me in a sound, rational way that made sense and accounted for patient care. I have a feeling the number 80 has nothing to do with patient care, just like the bazillion repeat forms and notes I fill out each day probably don't either.

 

[michaelrack]

. I know lots of interns in various specialties currently working 150 hour weeks right now.
.

So they are only spending 18 hours/wk off of work???

 

[notdeadyet]

So they are only spending 18 hours/wk off of work???

Good catch. If someone can look at you and utter the phrase, "I work 150 hours/week" without symptoms of mania or substance abuse, they're probably exaggerating. It's a math thing.

 

[nancysinatra]

You all have a good point. But that's what I was told. Perhaps I'm being misled! Or they might have said 120 hours. Which is still a lot. Or people could be including hours they were allowed to sleep but were still on call. I kind of think that's what's going on.

Also, if you get 3 hours of sleep per night, that's 21 hours per week, not far off of 18. I can imagine people expecting interns to endure that. And interns might have a different attending or upper level each day they work. Attendings and upper levels don't care if the intern sleeps during THEIR shift, or their night on call. (This is what actually convinces me of the need for the 80 hour work week.)

And let me clarify that by "lots" I'm referring to about 3 or 4 people. I imagine I could round up 4 or 5 more if I needed to, to bolster my case here.

 

[nancysinatra]

Here's a recent SDN thread where someone reports working 120 hours/week:

http://forums.studentdoctor.net/showthread.php?t=647205

That's probably closer to the top end, in reality, I am guessing.