A Day in the Life for Psychiatry Residents

Fourth year of residency is great! This is the year you get to choose what you want to do, outside of two months of time doing rotations in a junior attending role. The junior attending role basically requires a fourth-year resident to be in an active teaching and supervisory position with lower-level psychiatry residents, namely first years. I started off my fourth year by completing my junior attending rotations, both of which I did at the inpatient psychiatry unit at IU Health Methodist Hospital with Dr. Aimee Patel and Dr. Jonathan Withers. July and August are great months to act as a junior attending as you can be very helpful, as this is when the first-year residents start residency. I wanted to come back to the Methodist inpatient unit since this is one of my favorite places to rotate at; it is where interns rotate for two months of their first year.

After I finished inpatient psychiatry at Methodist, I went to a one-month block of outpatient sleep medicine in September. Sleep disorders and sleep issues are very prevalent in psychiatric patients, so I wanted to get a better handle on sleep disorders and their treatment. Prior residents have rotated with sleep medicine during their fourth year, so I reached out to the faculty they have contacted in the past to set up this rotation. Other rotations people have done in the past outside of the department of psychiatry include toxicology (through the emergency medicine department) and global health rotations; while I was an intern on neurology, one of the then fourth years spent one day a week in one of the neurology outpatient clinics. It’s flexible, so if you have an interest in something and want to spend more time getting clinical exposure to it, ask and see if you can do it, you’ll likely be able to.

Starting in October and continuing through the end of the academic year, I will focus primarily on outpatient psychiatry (with some exceptions), with the same schedule each Monday through Friday. I should mention, despite having been on inpatient and off-service rotations for the first three months of fourth year, you can still take up to one day off per week working in other areas. For me, I continued my third year, Monday afternoon, general adult outpatient psychiatry clinic at IU Health Goodman Hall with Dr. Susan Conroy; on Wednesday afternoons, I continued following with my psychodynamic psychotherapy patient from third year along with working on projects related to the education track (see more below). Below I highlight my schedule from October through the end of the academic year:

Monday: In the mornings I will work with Dr. Anup Deshpande in the Goodman Hall psychiatry clinic, working primarily with geriatric psychiatry patients. Then, in the afternoon, I will stay at Goodman Hall and continue in my third-year residency clinic with Dr. Conroy. This is one of my favorite clinics I have worked in, and the way it is set up allows for a significant amount of autonomy and independence to allow for you to become more comfortable making decisions with treating outpatients. I also have a significant amount of continuity with patients, especially since I have been in this clinic now for over one year.

Tuesday: On Tuesdays, I veer away from outpatient to an inpatient setting, as I am going to work at the Logansport State Hospital to see patients. One of the things I really want to have before graduating is having some experience in a state hospital environment. We do not have much exposure to state hospital in our regular residency curriculum, besides a couple days in the second year of residency on a forensics rotation.

Wednesday: In the morning I will be working with Dr. Conroy again, but this time doing outpatient electroconvulsive therapy treatments. Then, in the afternoon, I continue working with my psychodynamic psychotherapy patient from third year. I want to continue getting more experience in therapy, so I am continuing to work with my therapy patient this year.

Thursday: In the mornings I will be working with Dr. Matthew Miles at the VA SUDRP clinic (SUDRP is the VA’s dual diagnosis psychiatry-substance use disorder clinic). I worked with Dr. Miles as a second year resident at the VA in SUDRP, and want more experience with treating substance use disorders prior to graduating. In the afternoons, I continue at the VA, but will work with Dr. Corey Trobaugh in the same VA general adult outpatient psychiatry clinic I worked in as a third year resident. Similar to my Monday afternoon resident clinic with Dr. Conroy, this clinic has a great deal of autonomy and patient continuity.

Friday: In the mornings I take my education half day, during which time I am free from clinical duties to work on various projects related to the education track our residency offers. I have been a part of the education track since being a second-year resident. I help the team that runs the first-year medical student psychiatry course. It’s something I’ve enjoyed being a part of, helping edit and fine-tune presentations for lectures for the course, and running small group sessions when the course is in session in May of each academic year. We have also worked on a research project related to how our course affects bias and outlook towards the field of psychiatry and psychiatric patients. In mid-2023, we had a paper published in Academic Psychiatry regarding this research. For the second half of Friday, I go to didactics, grand rounds, and resident business meeting. This is a great time to visit with and catch up with fellow residents!

Hopefully all the above drives home that fourth year is flexible, and it is really up to you to decide what you want to do during it. Besides being flexible, there is no call in fourth year, which is a really nice change! And I feel like I have plenty of free time in the evenings and on weekends to spend it with my wife, visit with family, and work on hobbies of interest. I’m looking forward to the next stage in my career!

For PGY-3 year, our residency has 12 months of outpatient clinics. A highlight of our program is that we can choose clinics based on our interests and have a wide variety patient populations and hospital settings to choose from. These include but are not limited to: general psychiatry, addiction psychiatry, gender health, child and adolescent psychiatry,  woman's mental health, and geriatric psychiatry.  In these clinics, you will follow the same patients for an entire year and will learn from the different experiences, approaches, and styles of different attendings and clinic settings. 

Here is a peek at my weekly schedule:

Monday: I am on the education track and have protected time on Monday mornings to work on lectures that will be used to teach our medical students. In the afternoons, I have a general adult psychiatry clinic at Goodman Hall. 

Tuesday: In the morning, I see my psychoanalytical psychotherapy patient and I staff this with an attending after the session. In the afternoons, I have a general adult psychiatry clinic at Eskenazi Health Center on West 38th street. I really enjoy this clinic as I am able to serve a very diverse patient population and feel like I make a difference.  

Wednesday: In the morning, I work at the VA Medical Center in an adult psychiatry clinic. In the afternoon, I work in a Goodman Hall clinic that has a mix of general psychiatry and addiction psychiatry. I am interested in addiction psychiatry and look forward to this clinic every week. 

Thursday: In the mornings, I have clinic at Goodman Hall where I see patients with a large assortment of complex psychiatric and medical comorbidities. In the afternoons, I have clinic at Riley Children's Hospital on the maternal fetal medicine side in a clinic that specializes in woman's mental health before, during, and after pregnancy. This is also one of my favorite sites as I find serving this patient population very rewarding. 

Friday: At this point in my week I can take a breath because Fridays are always devoted to didactics, and we have protected time the entire day. In the mornings, we have our PGY-3 psychotherapy didactics. At noon, lunch is provided and we have our weekly resident business meeting. In this meeting, we give updates on committees, groups, and different projects going on within our residency. I am currently the Goodman Hall site chief so I will make announcements related to that if I have any. This meeting usually ends early, and we have time to catch up with our co residents. In the afternoon we have didactics with all residency classes and rotate through a variety of topics throughout the year. 

Saturday and Sunday: You can find me exploring downtown Indianapolis where I currently live. I love being able to walk to most places nearby within 20 minutes. For me, Indianapolis is large enough to always have something new and exciting going on but not so large that it feels overwhelming. 

The second year of residency is the year where the real fun begins. All rotations are under the psychiatry umbrella, the profession that we have chosen as ours. Overall, we continue with our Monday to Friday rotations, understanding that Fridays are the days we have our precious Didactics: from 11:00 to 16:00, time to gather with residents and fellows, have lunch together, talk about how life is going, have journal clubs, paper discussions, lectures, Ground Rounds, and more! It is really a fantastic learning time.

In second year, we have several rotations, and we typically share those rotations with one or two classmates. For example, I started with the substance use disorders clinic in the VA Hospital, while other classmates are doing Geriatrics Psychiatry in Crawfordsville, and others a mix of Research, Forensics, and Palliative care in the different tertiary hospitals we have available in Indianapolis: Methodist Hospital, University Hospital, and the modern county hospital, Eskenazi Hospital. This year, we are more exposed to psychiatrists who have led specific tracks within psychiatry, such as addictions, psychotherapy (CBT), consult liaison, and emergency psychiatry, among others. If you have a particular interest in Child and Adolescent Psychiatry, you can start rotations at the leading pediatric hospital of the state, Riley Hospital.

As PGY2s, we also begin to have leadership positions in different subgroups within our program, for example, a representative for the Indiana Psychiatric Society, the Multicultural Physicians Alliance, and multiple committees like Diversity, Safety, and Wellness.

Second year is synonymous with shifts, or as people say here, “being on call.” Now, being on call is the first time you’ll find yourself dealing with clinical situations, just as if you were alone dealing with real-life medical decisions. The truth is that we always have attending psychiatrists and multiple group support chats to ask and to back up our clinical decisions, making it a sine-qua-non opportunity to learn and test ourselves.

Finally, the second year is when you settle more into the beautiful city of Indianapolis, a “right-size city” with all the amenities of big cities like an international airport, professional sports, museums, tons of parks, bicycle paths, and cosmopolitan cuisine available, and at the same time, all the warm midwestern hospitality and commute friendly distances. In just one line, IUSM and the entire experience here in Indianapolis have vastly exceeded my expectations.

PGY-1 is a great mix of solidifying knowledge and skills about general medicine, as well as learning more about the practice of psychiatry. Because of the variety of services in which we practice as interns (emergency medicine, internal medicine, neurology, inpatient psychiatry and emergency psychiatry call), I have been able to follow patients in several settings. It is fun to see how my skills grow, as I broaden my interviewing skills, differentials and treatment options for patients.

My daily schedule is rotation dependent, but generally, my day goes as follows:

6:45 am: First alarm goes off. I strategically am renting a house immediately across the White River, so for the majority of my rotations, I have a 3-minute drive to the Eskenazi hospital parking lot (which is ideal to park for both rotations at Eskenazi Hospital and the VA Hospital). 

7:45 am:  Arrive at the hospital and begin chart-reviewing on patients. At first, getting used to the different EMRs and figuring out which information was important to review took a while for me (and I would try to arrive at the hospital earlier). After some time, I've gotten faster, and usually review the patient's vitals, new labs/imaging, which medications (scheduled versus as needed medications) they received, and nursing notes. 

After chart reviewing, I go see my patients alone before rounding with staff and the team. This is one of the favorite parts of my day. As I get to know a patient over time, I've been able to learn how treatments really improve the patient's well-being. It's also fun just chatting with people.

9:30 am: Rounds begin! Most of my rotations have had table rounds, where we discuss how patients are doing and treatment plans for each patient with the attendings, pharmacists, social workers and therapists to coordinate our care. The medical students usually present first, and then I'll add pertinent information or plan updates if necessary. The social workers and pharmacists will chime in about any concerns they have. Finally, depending on the attending, we will have pertinent group discussions about how to best care for the patients. This part was terrifying at first because I felt more responsible for the assessment and plans for each patient than I ever did in medical school, but it has gotten easier over time. All of my attendings have been very supportive with my plans for patients—and will reign me in when I get too ambitious too fast for a patient!

10:45 am: I put in orders for patients, get patient's discharge orders in and begin working on notes, if I haven't already. I also file necessary paperwork (e.g., commitment paperwork or report filing after emergency detentions at the VA.)  On Fridays, we have didactics until 4 pm, so I head over to Goodman Hall as soon as I have wrapped up orders and notes on my patients.

12:00 noon: I grab lunch. I tried to tell myself that I would only order salads from hospital cafeterias during residency, and I lasted about a month. I discovered the sushi at the VA (mildly pricey, but surprisingly alright), quesadillas at Eskenazi hospital and Au Bon Pain everything at Methodist Hospital. I usually head back to my workstation and keep working on my notes.

1:00 pm: Sometimes, we see new patients together as a team. My attending, the medical students, and I will group interview a select few patients. Usually, the medical student will begin the line of questioning, followed by me, followed by the attending. It's still uncomfortable discussing a plan with a patient in front of everyone and answering the patient's questions in front of everyone. Again, as I've gotten more comfortable with the different medications and treatment options we offer patients, I've gotten better at answering their questions. 

If things are wrapping up, I will spend some time working through various psychiatry topics with medical students. I love this time because I always feel I learn information better when I am asked to teach it and I inevitably learn more from the really good questions the medical students ask.

2:30 pm: I try to have the majority of my work done by this point. I call patient families to update them or for more collateral information, if needed. I will sometimes do some more chart digging for certain patients, as well. 

3:30-4:30 pm: My days usually ends. When I get home, I plop on my couch for about half an hour, scroll through emails, and read up a little about a patient question I had during the day (e.g., how lithium toxicity can present). Dr. Davis recommended a great website, simpleandpractical.com, that sends out a daily newsletter about a daily psychiatry topic (for a subscription fee that can be reimbursed with our education fund). 

5:00 pm and beyond: About once a week on my psychiatry rotations, I will work at the Crisis Intervention Unit (CIU) at Eskenazi Hospital for emergency psychiatry call through the evening. There, the licensed clinical social workers are so great at talking through patients before I go see him. After my assessment, I staff with the attending, write admission orders and write H&Ps on patients. I average about three patients per evening call shift. There are some very acutely psychotic patients that come through the CIU, so I always make sure I stay safe and I often learn a lot from them.

Most other evenings, I do some light housework before my husband comes home from work. We either cook together or walk to a place downtown for dinner. There are a ton of different food options within a mile or two of the downtown area. I'm forever discovering new places. Our walk is always down the White River State Park area, which is beautiful. I try to go to a Zumba classed at the local YMCA or squeeze in a home workout a several times a week. As I wrap my evening up, I'll watch Netflix with my husband while knitting a bit, postcard with friends on Postcrossing, work on my bedtime routine and then try to limit my phone browsing before bed. I'm asleep by 11 pm!