Medical Education US

Hello.Can anyone tell me what the first year of psych residency is like? Firstly, what do you do in orientation? How is the call schedule set up? Do you have weekend calls? How many days do you work consecutively before you have a day off, and is it only 1 day or do you get more off? How much vacation time is alloted in year one? How demanding is the general med/internal med part? How demanding is year 1 of psych in general. Any and all help is greatly appreciated. I have been to several forums and none which have helped so far.

It would be helpful to know what your background knowledge is of residencies - are you currently a medical student, and if so, what year are you?

To try to answer your questions:

Orientation week - As I did a med-psych residency, my orientation was a little different - I did medicine orientation at the start of my year, and I don't even remember that. I'll try to guess what it would be though:

You'd need to get your white coats, oriented to the hospital - ID's, benefits information, ACLS training (at least for medicine - probably not for psychiatry), and probably a description of different rotations and expectations. You'd probably get your schedule for the year, explaining what rotations you'll be doing when.

The psychiatry call schedule at Univ of Iowa was done by the chief resident (a 4th year resident who is doing chief resident responsibilities as part of their elective time) - we did it on a month to month basis. We'd get to select any particular days we wanted call and days we didn't want call, and then the chief would make a call schedule that tried to accomodate everyone's wishes. For medicine, the call schedule was actually done on a yearly basis by the chief residents. All of these processes are subject to change a lot, and are going to vary a lot from program to program. I know that when I left Iowa in 2001, they had a night float system in place - which means that those rotating through call only had to cover from 5pm-10pm and cover 24hrs on the weekends. The night float covered the hospital from 10pm-8am on Sun-Thurs - and that position rotated either every 2 weeks or once a month - I don't recall how it was ultimately done.

You should expect to get weekend calls at most programs.

I would think that your first year or two, you'd probably get 1 day off each week. I think it is an ACGME requirement now that you do not work more than 80 hours per week (average) and you get at least 4 days off per month - I haven't reviewed that information in a few years though so it could have changed. At Iowa, though, the psychiatry weekend coverage was usually pretty light and we'd be done around noon or shortly after.

From what I remember, we'd get 3 weeks of vacation each year - and usually there are going to be certain rotations where you can NOT take your vacation. Probably less so in psychiatry, but definitely in medicine, you'd be prevented from taking time off during rotations where your service was needed - like in the ICU or on cardiology.

As far as how demanding int medicine will be - that all depends on the program you go to, and what rotations they have you participate in.

Overall, for general psychiatry, I would say the first year will be the most demanding - the medicine rotations (especially call) will probably be more stressful than psychiatry call (although not necessarily as busy - depending on the program). Also, you'll probably have more psychiatry call your first two years compared to later years - at least that's how Iowa was set up.

All of these questions are going to be very different from one program to another, so I'm not sure how much my answers help - but at least you've now gotten an answer

Thank you for your help Admin!! Your response is very helpful. I have one more question, if you don't mind -I know the stipend is nominal at many places, but do you get paid weekly or monthly? Is there any time at all for another job? Thanks again!

I was paid on a monthly basis. There is not going to be much time for anything other than eating and sleeping your first year, and possibly the same your second year. Some programs will let you moonlight, but I think at most places you have to wait until your 3rd or 4th year, and you'd need your program's approval to do so.

Thank you again Admin! I truly appreciate all your help. I know I have more questions...I hope it's not too much of a bother if I post more questions later.

Definitely not a problem.

Hello again Admin. With regards to call schedules -if you're in a program where you provide the chief resident with preferences which he/she tries to accomodate, do you still generally end up being on call every third day? I guess a second job will be out of the question...but on days when you're not on call, do you usually get done around 5pm? Do you think by the end of the day a person could mentally have the energy to study for Part 3 of the USMLE? Thank you again.

Sorry...more questions....

What is the general policy/maximum sick days alloted per year? What is the policy on maternity leave? Do you just have to repeat that year if you have to go on maternity leave?

Most programs are not going to have call every third night, especially not for psychiatry. Even on your medicine months, you'd probably be on call every 4th night. For psychiatry, I typically had 4-5 calls per month. Some programs may have more, some less.

Also, if you are on call every 3rd night, you are definitely not going to be in any shape to do anything. Every 5th night is also pretty exhausting - but once a week is not so bad.

It depends on which program you are at regarding what time your day ends. At Iowa, on the inpatient unit, we basically accepted admissions until around 4pm. If you got an admission just before 4pm, plus had a busy day, you could potentially be there until 7-8pm. It also depends on how "efficient" you are - I was usually there later than most people, but I think I was a relatively slow worker. I know where I'm working now, we usually make sure the residents are done by 4:30, but I think we may be unusually nice to the residents.

As for studying for Step 3, you will probably have enough energy to do so, as some months will be busier than others, and there is not a whole lot of studying you can do for Step 3 anyways. I'm sure you've heard the saying - 2 months for step 1, 2 weeks for step 2, and number 2 pencils for step 3.

I'm trying to remember what the rule was with sick days - I don't think there was any hard and fast rule, except for maternity /paternity leave. At Iowa, I'm pretty sure the women got 6 weeks for maternity leave (it may have been that they got 3 weeks of sick time plus 3 weeks of vacation that they'd have to use all at once), and the guys got 3 days paternity on medicine or 5 days paternity on psychiatry (you had to time your kids as a med-psych resident). I don't believe the women had to make up any extra time - it usually just came out of their elective time. Again, this would probably vary from program to program. Unfortunately, this is not always an easy question to ask when interviewing as some people may look down on wanting to take someone who plans on having a lot of kids and taking the time off during residency. In psychiatry it is usually less of an issue than in very time-intensive residencies like surgery.

Is it rare that someone gets fired or quits the program?

What is the average stipend amount received each month? Is there any way to make additional money doing extra calls or any other work in the hospital?

It is rare for someone to get kicked out of a program, but it does happen. It's basically been situations where someone has consistently been unable to perform the required duties. Anyone can make one mistake, and most people can't avoid making a few mistakes. When there are repeated patterns of mistakes, in spite of efforts to education and correct the problems, that is when people are asked to leave a program.

People do occasionally leave one program and go to another. It is probably more common in med-psych (and other combined) residencies. This is because many people who do a combined residency will find that they definitely like one field over the other and realize it is not necessary to complete the residency in both. I've also seen several people transfer in to a med-psych residency program, because they realized they were more interested in the medicine experience, combined with psychiatry.

I've also known people who start in surgery and wind up in radiology - it happens, and I've known quite a few people who have made the switch and seem very happy to have done so.

As for average stipends - I believe they are currently starting in the upper $30k, close to $40k per year. As I mentioned, usually after your 2nd year you'll be able to moonlighting at some programs - moonlighting can take the form of taking calls at other hospitals, or working for clinics that need someone to see patients. You should not expect to be doing this during your first or second year, and this is obviously a question you'd have to ask about when interviewing. Most programs that allow moonlighting will let you know, as it is definitely an attractive option to man people.

Are the benefits packages usually pretty good?

This varies from program to program. I'm guessing they are all fairly decent though - covering insurance issues. Univ of Iowa had an excellent benefits package - free health insurance and medications for you and your family. You'd get one dental cleaning per year paid for. It would cover eye exams, but I think you still had to pay for glasses, etc. You got all of your health care at the university hospital. Ob/gyn care even covered fertility. I don't believe it covered elective cosmetic procedures, but I wouldn't be surprised if it did either. I'm guessing that their benefits were better than most (can't really get any better), but again, this is something to ask when you interview.

I think there was pretty basic (minimal) disability insurance and maybe even life insurance.

I doubt any programs provide pensions or things like that, but I believe at Iowa some of the residents did put money into a 403B retirement account as tax deferred income.

With regards to the internal med/family med part of year 1, are all the calls overnight calls which require staying in the hospital? How about with neuro? With psych calls, are you required to stay in the hospital overnight as well? Do calls begin within the first month of year 1?

Calls and how they are done depend on the program. I would think most programs would have call where you have to stay in the hospital, especially for medicine. Possibly FP might be home call - I'm not that familiar with how FP calls are usually managed. Neurology call will also depend on what rotation you are doing for your neurology - if you are doing an outpatient month, you may not have to take call. If you are doing inpatient, you most likely will have to stay in the hospital during call.

Calls do typically start with the first month of year 1 - but it may depend on what rotation you are doing. My first month was emergency medicine, so I just had shifts in the ER with no real call.

In year 1, are you allowed to switch your days off with someone else? Also, do you think it would be feasible to do PhD while in residency -or would that just be too much?

Usually you work out your days off based on when they need coverage on the units. You typically would work it out with the other people on rotation with you, and you'd pick which days you each want.

As for doing a PhD - you could possibly get some of the coursework done, especially during elective time. I'm not sure what your goal would be with getting a PhD though. Depending on what you wanted to do with it, you could probably do a fellowship after residency and get the necessary experience.

I've been researching a number of programs and after your mention of Univ of Iowa, I checked out their website and the med-psych program information and curriculum. How did you like it? What were the positives/negatives?

I relate to the notion expressed in the beginning of this thread to the effect of "It's been a while and I hardly even remember" which sums up the important notion that you get through it and move on to a more comfortable and manageable way of life. At times you are exhausted and stressed, but you learn alot, and it ends. I am surprised at times, when my mind turns to the lowest times that first year, to remember how low that was. But it sure helped to know the time was finite, passing each day, and there was always at least a glimmer of light at the end of the tunnel.

I am happy that I chose to do my residency at University of Iowa - so that should say a lot in itself.

Regarding medicine department:
1. Very strong department with excellent faculty in general medicine and most, if not all, specialties.
2. You will be well prepared to practice general medicine, or apply for a fellowship.
3. I HATED my general medicine clinic there - in fact, I think I developed a reputation as being a "difficult" resident - because I complained a lot about the experience. I was usually blamed for being too slow, as I never learned how to really focus clinical visits with the patient population that I had in my clinic. I think those who did their rotation at the VA hospital did not suffer as much, but it's hard to say. I'd have to say that was really the only clear negative I have to say about my medicine experience. If it weren't for that experience, I would probably have more seriously considered a primary care career. It is unfortunate, as I really think that experience is completely different from most real world general medicine experiences. I would not be surprised if they have revamped / improved the rotation though. I think other residents didn't find it as painful as I did - so don't take my experience as the rule.
4. I really liked the more traditional educational model they follow, as it was very similar to what I was used to in medical school at University of Chicago. You have medical students, interns, residents, sometimes fellows, and attendings on the treatment team. The residents had a lot of autonomy to dictate treatment, and as a result, had a lot of responsibility to provide care.
5. I guess aside from the medicine clinic, work load could get to be a lot - but in reality, I believe it was not as bad as most academic medicine residency programs. A lot of the medical students seemed to have this perception that the residency program was "malignant" there, but I honestly don't think they appreciate how much worse it could be (and is) at other places.

On to psychiatry:
1. The program is VERY biologically based - for better and worse. This was one concern that I had when I was deciding on programs, but in the end, while frustrating that good psychotherapy training was a challenge, I believe that the overall training experience there was far better than most other places. The attendings are truly outstanding regarding diagnosis and evidence based treatment approaches. With a little effort, you can get decent psychotherapy training. From what I've heard, they are now making more psychotherapy time available for the residents. They have a few people who are good supervisors for therapy, but I don't think there is anyone there who would be considered an analyst, or even have significant analytic training.

2. They have an excellent eating disorders program

3. They have an excellent schizophrenia research program

4. I was actually a little disappointed that the research experience was not more readily accessible to the residents. I was used to University of Chicago where if you just had a though in your head "research", someone would pull you into their lab and put you to work. At Iowa, I had to really push and prod a little until I found someone who was a good mentor for pursuing some research studies. It could also be that I wasn't overly interested in schizophrenia research, which is where most of the action is there.

5. Call there was VERY busy, and you had a lot of responsibility. Psychiatry call was much busier than medicine call (in general), but I found it less stressful - as psychiatric emergencies aren't nearly as critical as medical emergencies (at least my impression). They did change the call system part way through my residency to a night float model, which probably made a HUGE improvement.

Just some general comments about University of Iowa: The medical hospital is an incredible facility. You do rotations at both the university and the VA hospital. It is a decent VA hospital and added a good experience. Iowa provided excellent benefits, especially the complete medical coverage for you and your family - all appointments and medications are free. Whether it is because the care is free, or because Iowa City is a small town with not much to do, the residents seemed to have lots of kids - in most departments there. Iowa City is considered a family friendly town, and I'd agree with that. Overall, though, if you aren't familiar with small towns, things can get very boring there, very quickly.

Your insight is so helpful! It really makes a difference to hear first hand experience and details. It's truly invaluable. I hope to get such in-depth information about each program I'm looking into. I'm very interested in the schizophrenia research you mentioned, so I consider that a big plus. At Iowa, how many psychotherapy cases did you have on your own? -& How long did you follow through with them. Also, was inpatient adult psych challenging? Were there any particularly difficult cases that stand out? I ask because many programs begin with that, and I was wondering if it's relatively easy to handle in the beginning, or if it's challenging right off the bat.

I'm more than happy to share my experiences. I'm not sure how many psychotherapy cases I had - probably somewhere between 5 and 10 cases total where I did absolutely no medication management. I followed those patients anywhere from a few weeks to 1.5 years.

I enjoyed inpatient adult psychiatry. It did get busy at times, but I never felt it was "challenging" aside from the work load. There are a variety of situations that make for difficult "cases" - usually these involve decisions of having to do things that the patient doesn't want, issues that have to do with legal issues, and issues that have to do with dangerousness to self and others.

The toughest part is really time management - both doing inpatient as well as when you are on call. I think that if you go to a decent program, you'll feel comfortable that you have enough supervision / support available - yet also feel that you have enough room to learn and make decisions for yourself.

Are there any specific psych texts you would recommend going over before year 1?

During medical school, I had a copy of Kaplan and Sadock's Synopsis of Psychiatry along with the Kaplan & Sadock's Study Guide and Self-Examination Review in Psychiatry. I didn't really read the Synopsis, but I did go through most of the Study Guide. The study guide is a very nice set of organized questions and answers, with fairly detailed explanations. Now that I think about it, I didn't really read too much of the synopsis, but it makes for a great reference book. While in residency, I also got a copy of the Kaplan & Sadock's Comprehensive Textbook of Psychiatry which is my main reference text at this point.

During residency, I also carried around Kaplan & Sadock's Pocket Handbook of Clinical Psychiatry. It seems like it'd be more useful to the resident / intern than to a med student, as the information seemed to be more of what you had to know when writing orders / evaluating patients, than general theory information (from what I recall).

I'm certainly curious to see what other people found useful.

[ Edited by Admin on 2005/1/30 9:17 ]

I know residents usually get 2-3 weeks of vacation a year, but I was wondering if it's a paid vacation or not? Does the govt. take out social security & medicare from residents paychecks? Just wondering how much you actually get to keep from your stipend.

Vacation is paid. I believe most if not all programs also provide benefits (health insurance). Govt does take out usual taxes at most places - I'm not sure if VA hospitals are an exception. I know some residents had different retirement fund options if they were paid through a VA, but I don't remember any of the specifics. For some reason I'm thinking the VA paid residents could not contribute to a 403b retirement fund, but I didn't make enough to consider that anyway.

That's interesting...I didn't even realize you could contribute to a retirement fund as a resident. I wasn't sure if the stipend is considered to be "regular" income like any other job. Therefore, I thought maybe the stipend would be taxed differently.

Does the stipend vary between smaller hospitals & larger ones?

Not much difference between salaries at various programs. The main difference appears to be cost-of-living in the area - areas like New York pay more, but it's not that much of a difference.

Is $30,000 usually the bare minimum salary received in year one? How much of an increase is there in the following years?

FREIDA Residency Database has all of the information you can ever want about residency programs. Just a quick search shows that a few of the programs I checked start at $40k per year. They show an increase in salary of around $1k-$1500, but you also have to figure most programs will include a cost of living raise each year as well. In other words, the entire scale usually goes up each year, so you not only move from a first year salary to a second year salary, but whole scale will be around $1000 higher, for a net raise of around $2000 per year.

FREIDA has been so helpful! Thank you so much!!

I assume benefits vary from program to program, but is health insurance available for free at every program? If so, then is it correct to assume that nothing is deducted from your paycheck at all for healthcare?

I would guess that some programs do charge for health insurance, similar to any other job - with different costs for different plans. But, that's just a guess, as I was spoiled at University of Iowa with full coverage for virtually everything, at no cost.

I think you mentioned that at University of Iowa, they covered one dental cleaning a year. Was that the extent of what was included in the dental coverage they offered? Does health/dental extend to spouses and/or children?

As a resident, are you an employee of the hospital or the affiliated University?

Are there any tuition-type fees for the didactic? If so, what do they encompass and how much do they run? What is the general fee for books for PGY1?

From what I recall, dental did cover family as well, but that was just for the cleaning once a year. I had to pay for a second cleaning each year, and the residents also had to pay for any work that had to be done. I'm pretty sure that dental coverage is going to vary significantly between residency programs.

I believe I was an employee of the hospital at University of Iowa. I think some of the residents were employees of the VA hospital. I don't know how much difference it makes. I know that one of my co-workers did his residency at Loyola University, and as a result, his family was able to get free tuition for college at Loyola - as his daughter was college age, it was a great perk for him. I doubt that there are many programs that offer that perk though.

Regarding the next post about costs during residency for the didactics - there is no charge for the coursework you do during residency. Books can vary in price, but for psychiatry, you really don't need to spend more than $200 for every book you would really need, and probably less than that. I used most of the same books that I had as a medical student.