Yale...

[DrIng]

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Just thought I would pass along some interesting info I heard today. Apparently there was a US IMG who went to my school in Australia who she was accepted into Yale psychiatry, and left after three months and is now pursuing psychiatry training in Australia instead. The rumour has it because the program was so hard core and such long hours and gruelling schedule etc... Just thought people might be interested, and bear in mind this is just a reliable rumour.

 

[ORBITAL BEBOP]

I wonder if it was the program that was difficult or the fact that residency in australia does not entail working like a slave and staying up for 30 plus hours in a row.

 

[DrIng]

I think there's an element of both. Once you've done an internship, which everyone has to do and during which the most your likely to work is 60+ hours and it's often closer to 45/week, training is very benign, around 40- 45 hours a week with calm patches during that during which you can relax. An average registrar on my ward at present would be managing 5-6 inpatients...And yes, there is none of this 24 hour shift business let alone 30 hours plus.
But from what I have heard Yale does seem particularly hard core.
The other plus is Australia is tha the public health care system means that you admit and keep in patients as long as you want not as long as their insurance covers... (which is what you sometimes here about patients in the US). Any thoughts welcome.

 

[ORBITAL BEBOP]

How do you all cover patients overnight if you dont stay for 24 hours?

 

[DrIng]

I'll try and explain the way it works, and this is for a 300+ bed psych hospital (the main one in a city of approx 1 million people). Each registrar or intern will have a variable number of patients never more than about 6 or 7, the day staff work from 8:30ish to 5ish, then from 5pm till 10om there's a night cover which rotates among the staff of the hospital and you do that maybe once every two weeks, at 10pm the night doctor starts and they cover the whole hospital, overnight admissions etc. The person who is the night doctor is allocated to do that for a set period of time like 3 months and they will work one week on, one week off. On the weekend there will be one shift that starts at 9am and goes till around 4pm and another that goes from 4pm till 10pm. So on nights and weekends there's one registrar to cover the hospital with sometimes an intern to help on the weekends.
So in short you only do about 45 hours a week. The night job is great because after about 3am there are rarely any admissions so you get to sleep for hours before going home, and then you've got the day to do whatever you want. Very civilised.
The hospital is a different campus from the mainstream hosptial and doesn't do direct admissions, they all have to come through the emergency department of another hospital to be assessed.

 

[Poety]

I'll try and explain the way it works, and this is for a 300+ bed psych hospital (the main one in a city of approx 1 million people). Each registrar or intern will have a variable number of patients never more than about 6 or 7, the day staff work from 8:30ish to 5ish, then from 5pm till 10om there's a night cover which rotates among the staff of the hospital and you do that maybe once every two weeks, at 10pm the night doctor starts and they cover the whole hospital, overnight admissions etc. The person who is the night doctor is allocated to do that for a set period of time like 3 months and they will work one week on, one week off. On the weekend there will be one shift that starts at 9am and goes till around 4pm and another that goes from 4pm till 10pm. So on nights and weekends there's one registrar to cover the hospital with sometimes an intern to help on the weekends.
So in short you only do about 45 hours a week. The night job is great because after about 3am there are rarely any admissions so you get to sleep for hours before going home, and then you've got the day to do whatever you want. Very civilised.
The hospital is a different campus from the mainstream hosptial and doesn't do direct admissions, they all have to come through the emergency department of another hospital to be assessed.

I'd like to konw why US residency's aren't this humane. I mean honestly. Why do the US residency's breed miserable residents instead of nurturing them and helping them to learn more by promoting well being?

I've never understood this.

 

[DrIng]

Neither have I... And I would say to people who are in training who like the idea of the above system to talk to program directors etc about implementing it, it really does work. Of course I don't know how many patients your expected to carry as a resident in the US. Oh, and registrars generally have one afternoon a week 'off' to go to training and one afternoon a week to go to a community outpatient clinic, on those days you see your patients a bit faster... Hope this gives people hope. I'd be interested to hear details about how the US system typically runs at various hospitals.

 

[ORBITAL BEBOP]

Forgive my ignorance, but is Australia socialized health care? Maybe it is the healthcare model and the number of patients that is different and allows for one person overnight to admit patients. At most programs I see in america for IM, 2 residents see patients.

Also, DRING, when you say you get one afternoon off, do you in 7 days or in 5 days (weekdays)? How are weekends covered?

 

[DrIng]

Yes Australia is socialised medicine, in that health care is a right. We do have a public system and a private system though, so it's kind of a mix between the US and Canadian systems....
The number of admissions overnight varies but between 10pm-9am it's only ever up to about 5 patients, there are more people being assessed in ED overnight but they wait till morning to be assessed by a psychiatrist. The weekends are covered by one registrar at a time(resident) and an intern but there are two day shifts each weekend day, so 4 people will do part of a weekend shift but that's out of about 20-30 registrars on the campus.

 

[HippoMania]

I'm a general adult resident at Yale, and I just wanted to respond to the email about Yale being hard core. I think overall, the number of work hours and clinical responsibilities ARE probably greater than most psychiatry programs, and the medicine months are TOUGH, (although it has become easier over the past two years). But that said, I feel that there is A LOT of support here, really good morale, the amount of supervision you get is excellent, and the residency directors are very friendly and responsive. And if you're into research, the opportunities are really outstanding. I mean, it's nice to pick up any journal and see that at least some of the authors are people who you know. Most importantly, I think because the residency has the reputation of being clinically challenging as well as part of a dept that is so strong in research, people really seem to highly regard the residents once they leave or apply for fellowship. I'm not trying to sound like a recruitment brochure! It's just really how I feel.

 

[DrIng]

Any other thoughts?

 

[nortomaso]

I'm a general adult resident at Yale, and I just wanted to respond to the email about Yale being hard core. I think overall, the number of work hours and clinical responsibilities ARE probably greater than most psychiatry programs, and the medicine months are TOUGH, (although it has become easier over the past two years). But that said, I feel that there is A LOT of support here, really good morale, the amount of supervision you get is excellent, and the residency directors are very friendly and responsive. And if you're into research, the opportunities are really outstanding. I mean, it's nice to pick up any journal and see that at least some of the authors are people who you know. Most importantly, I think because the residency has the reputation of being clinically challenging as well as part of a dept that is so strong in research, people really seem to highly regard the residents once they leave or apply for fellowship. I'm not trying to sound like a recruitment brochure! It's just really how I feel.

Hippomania, thanks for sharing your thoughts about your program. In the past, posters have mentioned that they were a little concerned during their interview at Yale due to the small number of residents coming out to represent the program at interview day. I hope that wpn't be the case this year.

 

[mosche]

I'm a general adult resident at Yale, and I just wanted to respond to the email about Yale being hard core. I think overall, the number of work hours and clinical responsibilities ARE probably greater than most psychiatry programs, and the medicine months are TOUGH, (although it has become easier over the past two years). But that said, I feel that there is A LOT of support here, really good morale, the amount of supervision you get is excellent, and the residency directors are very friendly and responsive. And if you're into research, the opportunities are really outstanding. I mean, it's nice to pick up any journal and see that at least some of the authors are people who you know. Most importantly, I think because the residency has the reputation of being clinically challenging as well as part of a dept that is so strong in research, people really seem to highly regard the residents once they leave or apply for fellowship. I'm not trying to sound like a recruitment brochure! It's just really how I feel.

HippoMania, thanks for the insight/clarification. To everyone else who has concerns re;Yale, please take this in the manner that it is given. Doesn't anyone who goes to Yale, MGH, Wash. U., UCSF, Duke, Hopkins, Mayo, Pitt., or other such uber-elite programs expect them to be "hard core"? Even if I was planning to attend a program outside of the U.S. such as Oxford or Cambridge (I don't know if they even have med. schools), I would expect the program to be "hard core". You don't get that name recognition without being "hard core". I may be naive; however, I assumed that that was why people who come out of such programs are, generally, viewed as the standard bearers.

BTW, I'm NOT at any of the schools mentioned!

 

[ptolemy]

I'll try and explain the way it works, and this is for a 300+ bed psych hospital (the main one in a city of approx 1 million people). Each registrar or intern will have a variable number of patients never more than about 6 or 7, the day staff work from 8:30ish to 5ish, then from 5pm till 10om there's a night cover which rotates among the staff of the hospital and you do that maybe once every two weeks, at 10pm the night doctor starts and they cover the whole hospital, overnight admissions etc. The person who is the night doctor is allocated to do that for a set period of time like 3 months and they will work one week on, one week off.

I'd like to konw why US residency's aren't this humane. I mean honestly. Why do the US residency's breed miserable residents instead of nurturing them and helping them to learn more by promoting well being?

I've never understood this.

This I think is simple monetary reasons, if you can only carry 6 pts, and there is a 300+ bed hospital, you would need over 50 residents to staff one hospital. Then figure in night float, who's manning the clinic, who's doing elective/other hospitals, and you have a ton of residents for one program. The school/hospital paying the residents don't have the resources to pay this, the gov't/ACGME doesn't want to pay/have so many residents trained, etc. this would be my impression. anyone else?