Work Life Balance in Psychiatry?

[StayOnTop]

So, I'm obviously interested in Psychiatry, and admittedly, one of the appealing aspects of it is that it seems like one of the specialties that allows for work life balance. On one of my psych rotations, though, it's been killer. I know residency is tough, so I guess I shouldn't be shocked to see a resident work 6:30 am-7 or 8 PM damn near every day, but the attending on the service is working 7 am to about 8 PM, and she states that this is the norm for her, except when she is on outpatient when she works about 9 am-7 or 8 PM, (the last hour finishing notes).

Is this accurate for attending life? I've done a few psych rotations, but this is the first time I've worked this close with an attending. Is this accurate? Based on your anecdotal and real life experience, what kind of hours should I expect as an attending? Thanks for any help.

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[SmallBird]

So, I'm obviously interested in Psychiatry, and admittedly, one of the appealing aspects of it is that it seems like one of the specialties that allows for work life balance. On one of my psych rotations, though, it's been killer. I know residency is tough, so I guess I shouldn't be shocked to see a resident work 6:30 am-7 or 8 PM damn near every day, but the attending on the service is working 7 am to about 8 PM, and she states that this is the norm for her, except when she is on outpatient when she works about 9 am-7 or 8 PM, (the last hour finishing notes).

Is this accurate for attending life? I've done a few psych rotations, but this is the first time I've worked this close with an attending. Is this accurate? Based on your anecdotal and real life experience, what kind of hours should I expect as an attending? Thanks for any help.

That is not the norm in any of the contexts I've worked. My experiences over the last few years:

- VA: Residents 8.30 am to between 4 and 6pm on inpatient, 8.30 to 5pm outpatient. Attending 9 to 3.30/4pm.
- Community mental health center: Residents and attending were generally 9 to 5pm
- Academic inpatient settings: Residents generally 8.30 till 4 or 5pm. Attending would be variable between 9am to 1pm and 8.30am to 5pm. Beyond 5pm was typically when there was excess cross-coverage.
- Student health service: Residents 8.30am till 5pm; attending 8.30am till 5pm with an hour lunch every day!
- ED: Residents 8am till 6pm; attending 8am to 8pm three times a week.

 

[northernpsy]

You shouldn't have any problem finding a job with easier hours than that. You can even just work part time if you want.

You might not make as much money as someone who is cranking out RVUs at a steady pace and willing to take a lot of call, but if you care more about having free time and flexibility than you do about making as much money as possible, there is nothing to worry about.

 

[bedevilled ben]

So, I'm obviously interested in Psychiatry, and admittedly, one of the appealing aspects of it is that it seems like one of the specialties that allows for work life balance. On one of my psych rotations, though, it's been killer. I know residency is tough, so I guess I shouldn't be shocked to see a resident work 6:30 am-7 or 8 PM damn near every day, but the attending on the service is working 7 am to about 8 PM, and she states that this is the norm for her, except when she is on outpatient when she works about 9 am-7 or 8 PM, (the last hour finishing notes).

Is this accurate for attending life? I've done a few psych rotations, but this is the first time I've worked this close with an attending. Is this accurate? Based on your anecdotal and real life experience, what kind of hours should I expect as an attending? Thanks for any help.

Psych has some of the best hours in the biz. As a fresh psych 'tern, I'm only averaging 60 hours a week on my inpatient unit, which is incredible. The attendings are basically 9-4, though most of them dip into private practice after hours during the week or on weekends. If work-life balance is important to you, I can't really think of a better specialty than psych.

 

[masterofmonkeys]

Pretty atypical. Especially the attending hours, which don't make any sense at all. There's no reason for an attending to be there that late at all. Only thing I can think of, if it's July and your residents are fresh meat, they may just be inefficient due to the newness. I was moonlighting at 5p on Friday and the interns (1st month) were finishing up around 7p. A month ago, the last class of interns (12th month) were usually done by 3

 

[splik]

Psych has some of the best hours in the biz. As a fresh psych 'tern, I'm only averaging 60 hours a week on my inpatient unit, which is incredible. The attendings are basically 9-4, though most of them dip into private practice after hours during the week or on weekends. If work-life balance is important to you, I can't really think of a better specialty than psych.

and this is probably on the higher end of hours - i worked about 35 hours on average on inpt psych as an intern but new interns tend to be slower

 

[bedevilled ben]

and this is probably on the higher end of hours - i worked about 35 hours on average on inpt psych as an intern but new interns tend to be slower

Unreal. I already feel like I won the gorram lottery with my residency. My peers in IM and FM are complaining about their in-house hours and I'm just sitting here unable to imagine doing anything else.

 

[Sardinia]

Unreal. I already feel like I won the gorram lottery with my residency. My peers in IM and FM are complaining about their in-house hours and I'm just sitting here unable to imagine doing anything else.

I tried looking up "gorram lottery" and nothing came up on Google. Educate me please.

 

[allyphoe]

I tried looking up "gorram lottery" and nothing came up on Google. Educate me please.

Try googling "gorram" by itself.

 

[bedevilled ben]

I tried looking up "gorram lottery" and nothing came up on Google. Educate me please.

Gorram reavers! It's a reference to an unfortunately somewhat obscure TV show, Firefly.

 

[Doctor Bagel]

So, I'm obviously interested in Psychiatry, and admittedly, one of the appealing aspects of it is that it seems like one of the specialties that allows for work life balance. On one of my psych rotations, though, it's been killer. I know residency is tough, so I guess I shouldn't be shocked to see a resident work 6:30 am-7 or 8 PM damn near every day, but the attending on the service is working 7 am to about 8 PM, and she states that this is the norm for her, except when she is on outpatient when she works about 9 am-7 or 8 PM, (the last hour finishing notes).

Is this accurate for attending life? I've done a few psych rotations, but this is the first time I've worked this close with an attending. Is this accurate? Based on your anecdotal and real life experience, what kind of hours should I expect as an attending? Thanks for any help.

If you struggle with notes as an outpatient psychiatrist, I could see working 9 am to 8 pm. By that I mean you don't concurrently chart, and you write really long notes. BTW, I hate concurrent charting, but it's necessary if you've got a med management type of outpatient clinic and want to get out on time. I can't really see working 7 am to 8 pm as an inpatient service as an attending especially when residents are there to do a lot of the work. How many patients is she responsible for? Most likely she's working that much because she's got some ocpd traits and creates more work for herself, which means she'd be working a lot in any field.

I trained at a more work intensive program, and I worked maybe 50 hours a week on the inpatient service. 6:30 am to 7 or 8 at night is really weird for a psychiatry resident. Is this a sweatshop type of program?

 

[splik]

My peers in IM and FM are complaining about their in-house hours and I'm just sitting here unable to imagine doing anything else.

Actually psychiatry residents probably complain the most about the hours they work. The fewer hours you work, the more people complain about it. I never hear the residents in surgical subspecialties complaining about their hours, and where I did residency, the IM residents basically voted to take more overnight call because they thought it was better for their education. Cognitive dissonance theory explains the need to justify our decisions. This also explains why psych residents in more prestigious programs who work harsher hours tend not to complain too much about it and justify them as being necessary for their training, compared to residents at less well regarded programs with harsher hours. Is it really more "educational" taking more call etc. at a top program than at a crappier program? Possibly, but I doubt it, and certainly not enough to explain the difference in the attitude of residents. Instead what explains the pride vs grumbling about hours/work intensity is that the people at the top programs chose to be there and have to justify it by reducing the dissonance produced by the harsh hours. Whereas if you end up at program you didn't really want to end up at, you will be more liable to complain about the hours worked. Similarly if you're a US grad you are more likely to complain than if you're a foreign grad. studies show that FMGs have less substantially less burnout than their american counterparts even taking into account financial indebtedness (which is associated with burnout).

 

[clausewitz2]

Actually psychiatry residents probably complain the most about the hours they work. The fewer hours you work, the more people complain about it. I never hear the residents in surgical subspecialties complaining about their hours, and where I did residency, the IM residents basically voted to take more overnight call because they thought it was better for their education. Cognitive dissonance theory explains the need to justify our decisions. This also explains why psych residents in more prestigious programs who work harsher hours tend not to complain too much about it and justify them as being necessary for their training, compared to residents at less well regarded programs with harsher hours. Is it really more "educational" taking more call etc. at a top program than at a crappier program? Possibly, but I doubt it, and certainly not enough to explain the difference in the attitude of residents. Instead what explains the pride vs grumbling about hours/work intensity is that the people at the top programs chose to be there and have to justify it by reducing the dissonance produced by the harsh hours. Whereas if you end up at program you didn't really want to end up at, you will be more liable to complain about the hours worked. Similarly if you're a US grad you are more likely to complain than if you're a foreign grad. studies show that FMGs have less substantially less burnout than their american counterparts even taking into account financial indebtedness (which is associated with burnout).

Don't you think there is at least a significant influence of the quality of clinical instruction one gets from attendings when on-service with them? I can imagine a sort of halo-of-educationality effect driven by actually getting useful and top-notch guidance during the days that carries over into call, so one associates "being at work" with "learning stuff." Note that this is not necessarily inconsistent with the cognitive dissonance theory, but might explain any differences in perceived educational benefits during rotations that does not map strictly on to when the call falls in the calendar year (one would expect the cognitive dissonance from the initial decision to attend a program with tough hours to have some temporal relationship with the decision).

For what it is worth for the OP, I am a fresh intern in a psych ER at a consensus-reputable place, and I am just about breaking 50 hours per week. My two colleagues on my rotation are logging similar hours. No weekends, although we do rotating weeks of nights where the hours are slightly longer and reportedly do not involve a great deal of sleep. I am informed by all in a position to know that we have tougher hours on our major first year inpatient rotation, and contra @splik in this instance it is not necessarily possible to be done sooner via efficiency, as one of the attendings on that unit likes to schedule interns in multiple lengthy MI sessions a day and provides extensive and legendarily tear-inducing feedback, meaning one has enforced chunks of times during which one cannot work on notes. We are still talking maybe 8-6, though.

 

[surfguy84]

You shouldn't have any problem finding a job with easier hours than that. You can even just work part time if you want.

You might not make as much money as someone who is cranking out RVUs at a steady pace and willing to take a lot of call, but if you care more about having free time and flexibility than you do about making as much money as possible, there is nothing to worry about.

Would it be possible to work every weekend and have your weeks off? I saw someone on this forum talking about getting paid 8-10k for a full weekend. 4-500k a year with 5 days off a week seems almost too good to be true..

 

[st2205]

Would it be possible to work every weekend and have your weeks off? I saw someone on this forum talking about getting paid 8-10k for a full weekend. 4-500k a year with 5 days off a week seems almost too good to be true..

You certainly could (but wouldn't be making 8-10k/wkend as splik mentioned), but I'd imagine you'd fine weekend only work highly unrewarding. You'll be dealing with much higher volumes and the goal is really to keep things afloat and execute the plan of the weekday team (if they have one). Certainly, you could go above and beyond and not just check the box, but the limited time of two days will really handcuff you, plus you won't have much other support like a social worker. If you're cool with just going to work and approaching it like a job and getting paid, it could work in your favor. If you're looking for more of a balance of professional satisfaction it may not provide that and you may want to look for a psych ER setting and take the weekend shifts (this limits you geographically to a significant degree).

 

[surfguy84]

Yes very few people want to work weekends so medical directors would be very keen to hire you. it will keep the other psychiatrists on staff happy too if they dont have to work weekends. bear in mind though that if you take a salaried job working weekends you would not be making 8-10k per weekend, that would be an independent contractor rate that is on the high end and very rare indeed (most will pay a lot less - about half as much would be typical) and if you are essentially agreeing to work every weekend, the institution may prefer to hire you rather than have a locums position etc that pays more. on the plus side if you are salaried you will get benefits (health insurance, sick leave, vacation, 401k potentially pension in public sector etc) and won't have to pay as much tax. you almost certainly wouldn't be able to find a single gig that would pay you 8-10k to work every weekend, you would have to find a few, but again very atypical and possibly mean living in a very grim part of the country.

Thanks to you and @st2205 for those detailed answers. Along the lines of what st2005 mentioned, I'm kind of viewing this as simply work; I just want to go in do my job and leave. Of course I want to provide the best care I can, but I'm not looking for anything else outside of a paycheck (as large as possible). Medicine is a second career for me, so I know what I want out of work/life.

My thought was to take weekend work in some god awful area of the country (which hopefully pays more), and then fly back home for the rest of the week. Whether its locums or whatever, finding work on the weekend seems like it'd provide a pretty good life balance.

 

[northernpsy]

I know the docs in my group would LOVE anyone who was willing to work weekends for us, because we actually are stretched a little thin on weekend coverage right now. 🙂
Unfortunately though, I have never heard of an inpatient unit that was willing to pay $8000 a weekend for weekend coverage, even in non-desirable locations. I would agree with the above posters that earning something like $3500-4000/weekend would be more realistic. If that is enough for you, then there is no reason you can't just work weekends and enjoy having your weekdays off to travel or do whatever it is you want.

Another option you might want to consider would be negotiating with hospitals to work as a hospitalist in a schedule like "7-on, 7-off" or maybe even "14-on, 14 off" (I actually have seen the 14 day on/off schedule for a job that was somewhere like rural Alabama - I think because they were expecting that people wouldn't want to actually live there and would be traveling for the job from the place they wanted to live). Even if the place doesn't currently have their inpatient unit scheduled that way, some places WILL consider doing a 7on/7off schedule if you ask for it. The more desperate a place is for a psychiatrist, the more open they will be to negotiation.

Yet another option would be to do a little bit of tele psychiatry work during the week to earn some extra money. I have done tele psychiatry myself and while it can be a little frustrating sometimes if there are technical difficulties, it isn't that bad.

 

[surfguy84]

I know the docs in my group would LOVE anyone who was willing to work weekends for us, because we actually are stretched a little thin on weekend coverage right now. 🙂
Unfortunately though, I have never heard of an inpatient unit that was willing to pay $8000 a weekend for weekend coverage, even in non-desirable locations. I would agree with the above posters that earning something like $3500-4000/weekend would be more realistic. If that is enough for you, then there is no reason you can't just work weekends and enjoy having your weekdays off to travel or do whatever it is you want.

Another option you might want to consider would be negotiating with hospitals to work as a hospitalist in a schedule like "7-on, 7-off" or maybe even "14-on, 14 off" (I actually have seen the 14 day on/off schedule for a job that was somewhere like rural Alabama - I think because they were expecting that people wouldn't want to actually live there and would be traveling for the job from the place they wanted to live). Even if the place doesn't currently have their inpatient unit scheduled that way, some places WILL consider doing a 7on/7off schedule if you ask for it. The more desperate a place is for a psychiatrist, the more open they will be to negotiation.

Yet another option would be to do a little bit of tele psychiatry work during the week to earn some extra money. I have done tele psychiatry myself and while it can be a little frustrating sometimes if there are technical difficulties, it isn't that bad.

Thanks for the detailed message. Those are also interesting work options. I had read a little about telepsych, but have really been interested by what I've read. Though I've never been able to find a good range for what those companies pay - can you shed any light on this?

 

[st2205]

Thanks for the detailed message. Those are also interesting work options. I had read a little about telepsych, but have really been interested by what I've read. Though I've never been able to find a good range for what those companies pay - can you shed any light on this?

You'll find a huge range in these and they will also vary in what type of setting it is (doing ER evaluations, seeing CMHC patients, etc.). I would presume (with nothing to back it up) that the largest proportion of telepsych covers CMHCs. The one I spoke with at a dinner was offering $125/HR. Others may offer more.

Have you considered just part time employment? Maybe three days per week? I'd imagine there are a lot of locations you could get 150k or more for three days. That'd be a lot less grueling than flying some place (a significant amount more of total hours away from home) and you wouldn't be missing weekends. If you're assuming a standard 3,500-4k/weekend then you're looking at ~160-190k/yr assuming 48 weekends per year. The salary difference between that and a part time gig is negligible. The lifestyle difference is drastic.

 

[surfguy84]

You'll find a huge range in these and they will also vary in what type of setting it is (doing ER evaluations, seeing CMHC patients, etc.). I would presume (with nothing to back it up) that the largest proportion of telepsych covers CMHCs. The one I spoke with at a dinner was offering $125/HR. Others may offer more.

Have you considered just part time employment? Maybe three days per week? I'd imagine there are a lot of locations you could get 150k or more for three days. That'd be a lot less grueling than flying some place (a significant amount more of total hours away from home) and you wouldn't be missing weekends. If you're assuming a standard 3,500-4k/weekend then you're looking at ~160-190k/yr assuming 48 weekends per year. The salary difference between that and a part time gig is negligible. The lifestyle difference is drastic.

Those are some good things to think about - thanks for your advice. If there was enough telepsych work to go around, even 40 hours a week doing that would be pretty attractive. I never thought it'd be possible to do telepsych full-time, hence my desire to do a full block of weekend work. But even at $125 hr, that'd be more than enough to live comfortably.

I'll look more into this as residency draws a bit closer.

 

[splik]

Those are some good things to think about - thanks for your advice. If there was enough telepsych work to go around, even 40 hours a week doing that would be pretty attractive. I never thought it'd be possible to do telepsych full-time, hence my desire to do a full block of weekend work. But even at $125 hr, that'd be more than enough to live comfortably.

I'll look more into this as residency draws a bit closer.

well remember for non-salaried positions you have to pay more taxes and have no paid vacation, sick days, health insurance, retirement plan etc so $125/hr becomes alot less even controlling for writing of tax deductions. There are salaried telepsych positions too. It can absolutely be full time there are many full time telepsych gigs. My friend had an offer for a salaried telepsych gig for $270k (may have been more) + benefits, but it sounded awful. It was inpatient and ER telepsych, set up in a hospitalist 12hrs 7on/7off model. Inpatient and ER telepsych pays more than outpatient stuff for obvious reasons, but personally I would not want to be doing telepsych (it's often pretty poor quality) assessments of acutely suicidal/psychotic/homicidal individuals and decided their disposition as well a relying on the support staff at the other end who i've never met before...

 

[justclouds9000]

and this is probably on the higher end of hours - i worked about 35 hours on average on inpt psych as an intern but new interns tend to be slower

Would you mind sharing where you did your intern year? (residency)

 

[justclouds9000]

Are ce

If you struggle with notes as an outpatient psychiatrist, I could see working 9 am to 8 pm. By that I mean you don't concurrently chart, and you write really long notes. BTW, I hate concurrent charting, but it's necessary if you've got a med management type of outpatient clinic and want to get out on time. I can't really see working 7 am to 8 pm as an inpatient service as an attending especially when residents are there to do a lot of the work. How many patients is she responsible for? Most likely she's working that much because she's got some ocpd traits and creates more work for herself, which means she'd be working a lot in any field.

I trained at a more work intensive program, and I worked maybe 50 hours a week on the inpatient service. 6:30 am to 7 or 8 at night is really weird for a psychiatry resident. Is this a sweatshop type of program?

Are certain residencies known as sweat shop types? How does one find out about which program may be like that?

 

[timbernight]

Are ce


Are certain residencies known as sweat shop types? How does one find out about which program may be like that?

I realize this thread is older, but I think this is a great question. How can a student get an idea of whether a program is a "learn-a-lot and work as hard as necessary for that learning" type vs a "use its residents as indentured servants" type?

 

[TR08]

^bump

 

[Sushirolls]

Ask as many of the residents you can when you interview.
Especially the ones who aren't on the front lines of tours, or advertising to the program.
You see a resident in the corner pounding out a note on the unit disinterested in the student tour, they give a polite smile and wave, as the tour guide notes they are one of the residents. You step out of the herd, walk up to them and say, can I get your cell phone number to ask about the program later this week? They'll say yes.

Programs will try to hide their less ideal residents, or those they know who won't advertise the program in most positive light.

A surrogate observation, is to ask about a moonlighting. A program that permits and encourages their residents to moonlight, is likely better. A positive moonlighting culture is hard to find in programs, but if you see the residents eyes light up with a particular glow, and excitement in their voice, you know the work life balance is good enough. Even if you don't want to moonlight.