My 3rd year of residency with IU Psychiatry started in July 2020. The residency dedicates the PGY3 experience to outpatient clinical settings and, fortunately, the PGY3s can tailor their weekly schedules to their areas of interest. I am stationed in a different clinic each half-day during the week, meaning I spend the morning working under one attending physician and then switch to a different clinic/attending for the afternoon. COVID changed everything about how we conduct patient appointments and, until things clear up, we are completing many encounters through video chats or telephone calls. Most clinics run in a similar fashion, so what follows is the general breakdown of the daily workflow in an outpatient mental health clinic.
I arrive at the clinic (or log into the electronic medical record from home) and interview new and returning patients throughout the day, ordering labs, imaging, and other diagnostic tests as needed. I also prescribe and alter the patients’ medication regimen if indicated. I then plan a follow up appointment with each patient. Some of my supervising attendings like to speak briefly with each patient after I complete the interview, while others opt for a dedicated staffing time after I have seen all my patients that half-day. In either case, I recount the pertinent points from the patient interview and propose a treatment plan to my attending and we discuss teaching points and nuances in the patient’s background and treatment plan. Often I complete the notes for each patient encounter as I go, but sometimes I am left to complete a note or two at the end of the clinic day. I enter the appropriate diagnoses and billing codes for each patient encounter then preview my clinic schedule for the next day to be more prepared. By 5:00pm, I am typically finished with my work for the day.
Every 8-10 weeks, I take overnight call from home seven consecutive nights from 4:30pm until 8:00am for Riley Children’s Hospital. While on call, I evaluate any patients who require psychiatric assessment after being seen in the emergency room as well as any medically admitted patients who need psychiatric consultation. Most of the time, few calls come in because we have a fantastic on-site team of clinicians who triage and handle most problems.
In the evenings, I take my dog on a walk (Torbjorn, a wheaten terrier!), cook dinner, and spend time with my wife. We like to do jigsaw puzzles and play video games. Some weekends, we like to visit with family and friends.
Overall, PGY3 is shaping up to be challenging but very educational. I am being given much more autonomy with my patients, and I am becoming more competent in the administrative and extra-clinical requirements that come with being a doctor. It should be a great year!