POSTING RULES:

Dear community, I (resident in psychiatry in a European country), have encountered a bit of a frustrating situation at work. I am working a position that was newly created when I started working at the hospital. Basically, my position is to see patients who walk in for some sort of psychiatric “emergency”. 90% of them aren’t an emergency, but are rather looking for a consultation with a spontaneous therapist, and do not fit the criteria to be treated as an outpatient in our clinic (you gotta be severely mentally ill for that) and I can’t really do anything for them. That’s obviously very draining - I don’t build relationships with patients, I just let them pour out their hearts and the tell them good luck in finding a therapist. I also don’t really learn anything because I don’t see what happens next, if my Dx was right etc. I have brought up that I don’t think this is a good way of structuring the position and have made suggestions in things that could be changed to make it less frustrating. Both was met with understanding by my supervisor, but it didn’t really have any consequence. One of my suggestions was that if they didn’t want to change the position (for example by pre-selecting the patients and sending those who clearly aren’t an emergency away), then at least the rotation should be shorter, because I didn’t think anyone after me will want to do this for a whole year.

Eventually, I made it clear that I wanted to rotate to one of the wards or else I would quit. They granted me that wish and I’m switching soon.

Now to the AITAH question: the new guy for the position, who is a friend of mine, had a talk with my supervisor and made it very clear that he wasn’t willing to do it for longer than 3 months, or else he would quit. I was then called to my supervisor’s office and she basically called me out for talking badly about my position in front of my colleagues and thereby making it so hard for them to find someone willing to rotate to it. She didn’t really understand my frustration either. She basically argued that our job is always frustrating and that is nothing special about my position. It was a pretty strange and uncomfortable position and I didn’t really know what to say.

So 2 questions:

Am I wrong for assuming that psychiatry is not automatically frustrating most of the time?

Am I the asshole for talking shit about my position in front of my colleagues?

Not in a case where they are being prescribed other controlled medications, or other major safety concerns. Imagine working with the patient for several months, and it happens to come up seemingly out of the blue during a visit.

...

Hello,

I have an interest in forensic psychiatry but haven’t had luck getting into programs that I have been aiming for. I have an interest in programs with child and adolescent exposure since I am CAP trained. Last year I didn’t apply to many programs and this year I applied to some more but still hasn’t worked out. I know there are programs still open but I think I want to go back to the drawing board to make myself a stronger candidate. I feel like the interviews go well, unless I’m just delusional but I do feel I need to stregnthen my CV. Might apply again in 2 years. Any advice on how to strengthen an application, especially as an attending at this time other than attending AAPL ?

Thank you !

I’m starting to think I ask my patients too many questions on their symptoms. Usually end up with a paragraph or two. I used to pride myself on my thoroughness but I notice it annoy the occasional patient. What is the bare minimum amount of info I need for billing? All my attendings always fed me the ideal answer which doesn’t work in reality when you’re seeing double to triple the patients you saw in residency clinic.

But I always see in transfer records that most psychiatrist maybe write a few sentences? Way less work than I put in.

So what is the bare minimum needed? Obviously keeping the safety questions and directed questions. But I want my patients who don’t like a lot of questions to feel more control in the interview.

I'm a current 4th year USMD student and I'm getting quite concerned about my match chances this year. Currently 4 academic and 1 community program interview, 2 of them at signals.

I was wondering if any psychiatrists or residents might weigh in on the importance of letters of interest. Is it beneficial for applicants to send these out, especially at places we signaled? Should we wait until later on into the application cycle?

Thank you for all the advice in advance! It's absolutely appreciated.

This might be a generally inappropriate line of thinking, but I work CL and we have a few frequent flyer anorexia nervosa patients I feel like I have a decent relationship with I have seen over the course of a few years. I have new students and residents every month, and I've noticed when these patients are admitted the female students and residents seem to have significant counter-transference after seeing these patients. One of the best residents I've worked with (who happened to be female) left a first visit pretty angry and exhibited therapeutic nihilism after what I thought was an OK visit. Not a reaction I'd ever seen from her. Other female learners seem to spend 2-3x as long interviewing these patients compared to other patients, going over their chart, asking questions, etc. Male learners do not seem to have this kind of reaction.

Is it even useful bringing this up? Is it just a curiosity in my mind? Am I being sexist? In most cases I don't think it's getting in the way of patient care (except in the angry resident above who wanted to stop seeing the patient entirely). In my mind I just imagine that body image concerns are way more prevalent for women and that every woman one way or another has struggled with body image, and these patients bring those struggles to the forefront. If any women (or anyone else) has input on this I'd love to hear it, and if anyone else has noticed/brought this up as a means of self-reflection/whatever.

Hi long story short, im terrified. Only 4 interview invites from signals (2 academic 2 community). US MD, no red flags, and sending out LOIs but I have no idea what to do to get more interviews? are they coming or am i screwed? any support is appreciated plz

Step 1: Pass first try

Step 2: 250

EC: fine nothing amazing or terrible, mild research 1 psych pub

LOR: 2 psych, 1 IM one writer submitted super last minute but he offered to write the letter because he thought well of me... but not sure how strong it is because it was uploaded last minute after a lot of prompting...

Rotations: Mainly honors (including psych), some high pass

I've moved to a new community service that has a very different culture to my previous settings.

The prescribers in this setting advocate for low dose librium detox's for individuals without physiological symptoms of alcohol dependence.

This doesn't sit comfortably with me, I've seen over reliance on Benzodiazepines as a crude pharmaceutical tool for managing complex psycho-social problems during my time in psychiatric settings. In my opinion it fosters a reliance on anxiolytic medication as a means of coping when psychological/behavioural interventions would be more efficacious and empowering for the individual.

I'm struggling to find any clinical studies or articles discussing using a medicated detox for psychological dependence, any personal insight or signposting to relevant sources would be greatly appreciated

As noted in the DSM.

Hi all. I moved to the US for love after completing a psych residency in my home country (Europe). Some have suggested that I apply directly to a fellowship in this transitional phase. I have some research in my cv (including 2y working in the States), clinical experience (beyond my residency I worked in an addition psych unit and as a PCP), and formal training from a psychodynamic psychotherapy institute. I'm already ECFMG certified, with step 2 score 24x.

I would appreciate suggestions! Do you think it's possible to get accepted? I know many seats go vacant each year, so it kinda seems within reach. Are there specific fellowships you would recomment I prioritize as easier to get into? Ideally I would like to stay in Michigan.

Thanks!

Hey all - there are a few different threads here on salaries, but it's all over the place and does not have the full context of comp - e.g., including shifts, schedule, PTO, benefits, location, etc. to make it useful. We all know that medicine needs more transparency and this is information we all need to make sure we are fairly paid. All the salary reports out there are just not useful - they are either too broad and not specific to our situation or cost $$$.

A few months ago, my anesthesiologist friend tested a spreadsheet format in the Anesthesiology sub-reddit and has crowdsourced >500 anonymous salaries for the community. It has become an extremely helpful resource for them to ensure they are being paid fairly. I have worked with him to extend the sheet and the questionnaire to other specialties as well. Looks like there are 8 psychiatrists salaries added already.

So, let's do it together as a Community. This is fully anonymous, so it really decreases the taboo of discussing our comp.

Here is the salary questionnaire - https://marit.fillout.com/t/vfyw8PEHj2us

Let me know if you have any feedback on questions in there. And you see the data collected so far here. Add your comp info if you are willing, and it will unlock the full spreadsheet. The more data we get in there, the more useful it will be for all of us!

PS: This is for physicians and APPs in the US only

Hello, I'm a west coast R3 at a large university program. Have been looking into the job market and data recently after talking to some R4s. Currently looking into doing locums work due to being single and no children. Does anyone have experience starting locums right after residency? Thanks!

I get a lot of consults for “capacity to leave AMA”, but by the time I meet with the pt they have either agreed to stay or I can talk them into staying. Once I talk them into staying, I’m not sure what I’m even assessing anymore. Afterwards I get a lot of insistence from the medical doc or social worker, to say they either do or do not have capacity to leave, even though they have agreed to stay.

Curious what do other people do in this situation?

Hello amazing people! final med student here. So, I'm a non US IMG interested in doing psych residency in the US. I failed step1 like 6 months ago and I'm studying for the retake now. My thoughts are doing research one year or two in computational psychiatry to cover the red flag and enhance my cv before applying for the match. I have a decent experience in ML and coding but no cs degree, it's all self learning.. Is this even realistic? I'm thinking out loud cuz I feel like a dululu 🫠 TIA!

I have read few articles that discuss the differences in method of classifying and such. I'm looking for something more detailed but searching for publications lead me nowhere. Has anyone come across a decent article?

Hello all,

I am finishing medical school and will be entering into my psychiatry residency this summer.

I am thrilled about Psychiatry, I become more excited by the day as I approach graduation.

My question for you here, is to probe for suggestions from those with greater experience in the field regarding where you see the field heading.

More specifically, if you were to choose either a skill set or additional degree, expertise, etc. in another field completely outside of medicine, what would you choose? A PhD in physics? Chemical engineering? In your experience what have you seen that you would suspect could be a very interesting addition to medical training? Anything from aviation mechanics to gardening (though I’m particularly interested in STEM).

Recently I saw a job advertisement from Neuralink interested in recruiting Neurosurgery residents and I was wondering if anyone has come across interesting pioneering opportunities on any such frontier.

This is a thought experiment and I am not interested in the typical constraints, or to hear, “you won’t have time in residency,” etc. What in your experience would be an interesting STEM field that could at one point potentially overlap with psychiatry? My interests are linguistics, engineering, mechanics, chemistry, etc.

If you could wake up tomorrow morning and have a PhD in any STEM(or other) field, what would it be and why?

I look forward to your responses! I’m in love with psych, not looking for an out, just ideas to explore.

Thanks!

Help me compile a list of the best (ie gold standard or expert consensus) screening forms for children, both self-report and parent / caregiver administered for the following conditions:

1. Mood disorders
2. Anxiety disorders
3. Psychotic disorders
4. Substance use
5. OCD
6. ADHD
7. Eating disorders
8. Behavior disorders
9. Autism spectrum disorder

Thanks!!

I'm in a spot where I can't work full time, or even really reliably part time, but I'd love to do a couple night shifts here and there, or a consulting role or two. Trouble is, initial job search only turns up more long-term positions.

Anyone know how to find essentially "substitute psychiatrist" positions?

Hey all,

Just wondering if anyone knows of any data regarding lifetime hospitalizations for patients with certain psychiatric disorders. For example, this paper (https://www.sciencedirect.com/science/article/pii/S0165032718324728#:~:text=At%20some%20point%20during%20their,40%25%20resulting%20in%20hospital%20admission.) suggests 12% of patients with MDD have some form of hospitalization in their life.

I'm guessing the rates are much higher for things like schizophrenia and bipolar, but couldn't find anything concrete after a moderate google session.

This thread is for all questions about medical school, psychiatric training, and careers in psychiatry For further info on applying to psychiatric residency programs, click to view our wiki.

I’m young in this field and in the settings that I’ve been exposed to (medical psych, locked inpatient, IOP, private practice, therapist’s office) never have I seen any of these more excentric techniques used. Is anyone anywhere in the world still using them in a clinical setting?

Hey everybody,

I'm a 4th year resident looking at different jobs. I understand that asking about RVU productivity bonuses can be important when that is part of how you get paid. I am wondering what the average RVU for an inpatient adult psychiatrist would be? The job I'm looking at guarantees a salary up for 2 years up to 4100 RVU then pays ~70/RVU after that. This is for a 7 on 7 off job seeing between 12-15 patients per day.

Would it be pretty easy to hit that 4100 RVU limit just working this 7 on 7 off schedule with that volume? I've tried asking my attending at my residency but they are not RVU based and have no idea about any of this.

Thank you!

So, I am working presently as a supervising provider at a major regional adult inpatient psychiatric hospital. I’ve recently been frustrated with my decision making regarding our patients with Schizoaffective or Schizophrenia and their response to treatment.

Often, these patients come in after coming off their medications, or when their medications have stopped working. I’ll put them back on their old regimen, or trial a new one. I do my best to optimize their regimen, identifying a therapeutic dose with serum level monitoring. Some patients improve drastically, others just somewhat. Some are good candidates for Clozapine, others not so much (will refuse the blood draws or unlikely to tolerate the side effects). I start that whenever I can.

What I have wanted to ask here is how do others in this role decide when a response is “enough”? So many patients have residual symptoms that are quite burdensome, and yet I know with each medication change, our odds of an improved response are increasingly diminished, and I have to weigh whether it is worth the time and utilization of resources to trial a new medication (or combination) despite knowing the odds are against us. Of course, this is to some degree the nature of the illness. But I never want to be leaving anything on the table. Some patients are clearly so unwell, involuntary Clozapine or even ECT is needed, and I have no qualms pursuing those things. But it’s when patients are not quite that ill, but their functioning remains significantly compromised, that I question myself on when to say enough is enough.

Frustrating things further is I find these patients family members, their outpatient clinicians, are all so disengaged. I find it very difficult to get reliable collateral regarding their “baseline”, and whether we are back to that. So many have essentially just become wards of the state, and it feels isolating to feel like I am solely responsible for saying “You’re stable” or “you have reached maximum benefit.“ when their cognitive impairment remains so substanti they are condemned to living in essentially an assisted living level of care.

To be clear, I’ve had many excellent outcomes. So many patients respond to treatment. But it’s how I handle these more treatment resistant cases that I am trying to reflect on. Perhaps this is just me taking too much ownership of what is a very challenging, treatment resistant illness, that has limited treatment options available to us as prescribers. I think part of it is that. Nonetheless, wanted to see how others feel about this topic, or what strategies they have to determining when patients are truly at “maximum benefit”.

As someone who aspires to be a doctor and as a current social worker and therapist, I'm curious about how much therapy psychiatrists do? And if so then how much of your time is devoted to that compared to other tasks?

Wondering what you all make of this association? There’s certainly an increased risk of developing depression, anxiety and suicidality with these agents. Really curious how these medications impact the psyche, or are there any confounders the study didn’t account for? Curious to hear your thoughts.

https://www.nature.com/articles/s41598-024-75965-2

I got inspired to ask this by a recent thread on r/medicine. I’m still in residency, so I want to hear from people who’ve been working in this field for years/decades. How fulfilling is psychiatry for you? Have you regretted pursuing this specialty or met someone that has? Why?

For CAP fast-trackers registering for the NRMP match, what date are we supposed to enter under “expected completion date of residency”?

Should it be the date of completion of PGY3 year (expected date of transfer to fellowship program) or PGY4 year (expected date for completion of 4 year adult residency) ?

Thanks in advance :)

Hi everyone PGY2 here working inpatient currently in the Southeastern United States. I have a question regarding the relative risk of higher than normal starting doses for second generation antipsychotics, specially for behavioral management or issues non-psychotic related issues. I've seen aripiprazole and risperidone used in the outpatient setting for severe agitation and behavior related management across several types of populations (i.e. ID, Autism) and I'm just curious about the overall risk of starting something at a moderate-high a dose initially.

Ive look in both Kaplan and Maudsley and they both say go low and slow. I know with inpatient we can observe them and monitor for issues but I'm concerned about the relative risk outpatient as I will be moving to that soon. Our clinic serves a large population with sometimes relatively long wait times. Sometimes people come in moderately disorganized or combative, and they won't be seen again for another 6-8 weeks. I wouldn't started a SGA at the highest range end dose, obviously, but my concern is more toward the mid-range doses (ie 2mg risperidone BID, Abilify 10mg QD) and risk for potential serious side effects. Im familiar with NMS and I know that it's mainly from going too fast too quick in blocking d2, but I'm assuming the relative risk is lower for SGA's specifically with lower D2 affinity like olanzapine or partial affinity like aripiprazole.

Is there something else I'm missing or should be on the look out for? I know inpatient we stabilize patients using higher doses in an observed setting and can manage them if side effects emerge, but I'm concerned about the relative risk outpatient as I will be moving to that soon. I want to be sure I'm not underdosing patients with untreated behaviors that could spiral into something worse, but at the same time I want to be safe and not cause unnecessary harm. Any tips on how to approach these matters? Any medications you would recommend as well are appreciated! Thanks in advance!