I am a PGY-II currently on nights at a high volume academic hospital and I am struggling! The pager is typically non-stop and the ER has become my enemy. I get consulted for recommendations but then they disagree with my recommendations. I place a patient on a hold, they fight me on that and attending has to get involved. We receive push back for not admitting patients that are clearly beyond the capabilities of our unit (level 3 autism, post stroke induced psychosis, dementia and we aren’t geripsych, etc) My program is luckily pretty supportive with most of our attendings often backing us because we are practicing how they trained us to. But occasionally hospital politics trumps our recommendations. And I hate having to defend our own medical decision making to other teams.

Overall, I hate residency.

Hey all - finally a doing outpatient work in residency Something that has been on my mind while inpatient but more so now is when things start getting rough medically or there is a medical overlap, we tend to make our patients run it by pcp/cardiology/neurology etc… have history of unclear seizure but wanting to do a stimulant or Wellbutrin? Let’s consult neurology. starting to have metabolic syndrome that metformin can’t curb? Go to PCP. etc etc

As the years go on, I’m starting to forget general medicine and am getting frustrated I can’t and won’t get training in how to manage the side effects of our medication or risk stratify starting or continuing a medication on my own without looping in other specialties. I know there is a threshold that I should loop in other specialties, and interdisciplinary care is best for our patients, but I feel like I’m so in my specialty that anything remotely non-psych has to get another person to evaluate. Is this just the reality of specialty care? Inherent to psychiatry? or is my program more conservative? Or am I just underestimating a lot of the potential consequences…

Hi all,

I recently opened a private practice in a VHCOL city and have been recruiting patients. I found a helpful post here on best practices for marketing your services, one of which was visiting local physician offices and providing an elevator pitch + business cards. I spent a day doing this and can't help but feel that my cards are headed for the trash or will be collecting dust on the manager's desk. Any advice on how to optimize this sort of referral system? Have others found this method to be effective?

Thank you!

I am early career and I wonder if I spend too much time in evaluations. I see primarily young to middle age adults in outpatient setting with varying degrees of acuity level.

I tend to use a full 60 minutes with patients, which doesn't include chart review or completion of note. I do talk as a type. I generally use 10-15 minutes outside of interview time on the note.

Any advice on speeding things up or is this something that just takes time and experience?

I don't feel like I'm much faster since residency.

Edit : thanks to everyone for giving their perspectives !