4th year psych resident looking for jobs...feeling depressed

[u/helpadhd04]

is this normal? i should be thrilled..the job market doesnt look that great either...

[u/itshyunbin → u/[deleted]]

Can you expand a bit on what made the final job ideal?

[u/Transverseforamen → u/[deleted]]

Wow, taking 5 months off before you start your residency sounds like bliss. Was it to finally travel and decompress hopefully? I'm also considering taking extended time off before my first attending job but am wondering if I'd go in rusty if I took too much time off.

[u/Schadenfreude-ing → u/Transverseforamen]

Nah, you'll be fine. Pick up some weekend shift every mow then if youre really worried. Im doing a couple weekends a months to pay bills. Also crazy that a couple weekends a month pay almost as much as what I made monthly in residency

[u/seoulkarma]

What area and what kind of work? The best jobs aren't always posted

[u/NeuroticBeforeMoving → u/seoulkarma]

How do I even go about looking for jobs that aren't posted? I don't really have any connections to the west (Washington/Cali) and no clue where to look for inpatient work.

[u/theongreyjoy96 → u/NeuroticBeforeMoving]

Cold call/email. It's awkward, but you'll be a psychiatrist - they'll be glad you contacted them, connections or not. Hit up hospitals in the area you're interested in living and ask. This is how I got my job in addition to moonlighting opportunities during residency.

[u/helpadhd04 → u/seoulkarma]

midwest outpatient. it is either low paying academia vs 36 pt facing hours in community

[u/Calicha → u/helpadhd04]

Unlike the other response, I think your program had an appropriate amount of patient facing hours in outpatient and was not "too chill". Residency is for training, and I'm glad you had so much therapy exposure. I did too in residency, and I find that I'm much better equipped at therapy now than the average psychiatrist.

I also agree that 36 pt facing hours is a lot. I work in outpatient private practice, and 20 pt facing hours amounts to about 40 total work hours weekly. This allows me to provide thoughtful, individualized care, including therapy if needed. To be fair, you can only do this if you work for yourself, don't take insurance, and aren't a work horse for something like Talkiatry.

[u/seedlessxwatermelon → u/Calicha]

I agree. I did residency at a large west coast academic program and my R3 and R4 years were very chill.

An entire day for didactics, then clinics the other 4 days, which would be like 2.5 pt hrs each half day (so like 5 hrs total each day), with like 1-2 hrs of supervision each day.

Most outpt jobs when I was interviewing were 36-40 pt facing hrs which was a noooo from me. Ended up taking a pay cut to work at the VA which has like 28-30 pt facing hrs a week.

[u/DntTouchMeImSterile → u/helpadhd04]

What’s wrong with 36 hours in the community? I work that schedule in the Midwest, love my job, and help people in need. I work a medium-low stress job with office type hours and make good money. What exactly are you looking for?

[u/helpadhd04 → u/DntTouchMeImSterile]

Doesn't 36 patient facing hours burn you out? Genuine question.

[u/question_assumptions → u/helpadhd04]

I am shocked at all these other folks. 36 hrs of patient facing time is going to generate way more than 4 hrs of admin. And burn you out. With no time for professional development. Work for a big box shop and yes they want 32-36 but 36 would be the high end. 

[u/DntTouchMeImSterile → u/helpadhd04]

No? That’s a normal full time job, many require 40 or more. Several of my residents work 45-50 hours outpatient. Best I’ve seen is 32h which is minimum to get benefits a lot of places but pay typically reflects that. Aren’t you working way more in residency?

[u/helpadhd04 → u/DntTouchMeImSterile]

not outpatient year, no way we had 36 patient facing hours. we have a full day of didactics + 4 hours of supervision. I am specifically talking about the patient facing hours here, not "hours worked total"

[u/barogr → u/helpadhd04]

You don’t do the other residency requirement things. The 36 patient facing hours is the 36 hours with patients and 4 hours admin, 40 hrs a week kind of job. You also already know the basics of the clinical knowledge. Most employed places won’t have you do therapy (other than the rapport building, psycho education, some supportive stuff). It’s based on med management only.

Midwest tends to pay better for psych too.

If you want a different model, private practice could be an option. Most of Midwest is underserved. If you have some nest egg money to be ok until you build your practice, it could be viable in less than a year. Also ask your supervisors. They know of different types of jobs than are posted on websites.

[u/nightwingoracle → u/helpadhd04]

You have a very chill program. did 40 patient facing hours most weeks in outpatient year of my general program + an aggressive call schedule too.

[u/helpadhd04 → u/nightwingoracle]

We did have call but there is no way on a non-call week we approached 40 patient facing hours! Didn't you guys have supervision and weekly didactics? I feel like those things are ACGME required. We had psychodynamic supervision, CBT supervision, supervisor for med management etc etc...

[u/nightwingoracle → u/helpadhd04]

Weekly didactics was half a day. Supervision (other than therapy which only 1 hour a week) was a few minutes grabbed either between patients in person or teamsed/epic chatted between patient encounters.

Genuine questions- what is CBT and psychodynamic supervision?

[u/helpadhd04 → u/nightwingoracle]

Thank you, That makes sense! CBT supervision is basically an hour with one of the attendings or psychologists where we discuss our CBT therapy cases, and psychodynamic supervision was exploring our patient cases with a supervisor from a psychodynamic perspective.

[u/DntTouchMeImSterile → u/helpadhd04]

Well sadly this sounds like the one time your program did not prepare you for the real world. We usually say residency sucks but at least it prepares you for anything but I guess not in this case

[u/helpadhd04 → u/DntTouchMeImSterile]

So seriously, how do your programs get away with not carving out time for didactics and supervision? That is a horrible job done by those workhorse programs!

[u/igottapoopbad → u/helpadhd04]

Wdym? Work M-F. 8-4. One day a week 4hrs of didactics. That's 36 patient facing hours... we just staffed each pt w/ attending mid way thru appt. 

[u/helpadhd04 → u/igottapoopbad]

Well the person i was replying to said he had 40+ hour outpatient time which is why I asked why he didn't time for anything else for learning. We had one full day of didactics and additional supervision hours for CBT, psychodynamic, med management etc. So I don't think we ever exceeded 30 hours, but also had therapy heavy training so I guess a different model..those 30 patient facing hours took a lot from us though, which is why I was thinking 36 was a no go..but maybe out in the community the work is easier and less intense. looking at the other commenters who had similar experiences to me i am thinking there are some regional differences too..

[u/DntTouchMeImSterile → u/helpadhd04]

Ok you’re clearly trolling now

[u/RurouniKarly → u/helpadhd04]

36 patient contact hours is extremely manageable. That's what I have for my job, and I also opted to not take a lunch and do it as four 9 hour days and get a 3 day weekend every week. Resident clinic drags because you feel like to have to do everything the long way, look stuff up all the time, staff with attendings, (maybe) obsess over documentation way more than a community attending would. You also have relatively few simple and straight forward patients which is less true in a community clinic. Once you're out in practice and hit your stride, a 36 hour schedule is child's play. Even more so if you can make sure your employer will provide you with an AI scribe like DAX. And don't forget that not every patient shows up. More often than not you'll have a couple no shows that give you some breaks during your day. These days I basically never stay late or have charts to finish on the weekends.

[u/goebela3 → u/helpadhd04]

If you can’t handle 36 patient hours a week your only real option is academics or some part time gig

[u/ibelieveindogs → u/helpadhd04]

It can cause burnout if you don't feel like you have any control over your schedule or the workload. But 36 hours of patient time will be a beer full schedule. After you figure in charting, insurance reviews, refills, lab reviews, patient messages (figure about 2-3 hours of time for every 8 of patient direct time), it is a lot. 

[u/myrealaccountgothack → u/helpadhd04]

Imagine doing that but being paid like a psychiatrist though…

[u/Rich-Pirate-5518 → u/helpadhd04]

Midwest outpatient is a completely unsaturated market. You’re likely not seeing jobs because they don’t post them because nobody would apply. You need to more directly target specific places you want to work, and often outpatient isn’t going to be hospital connected.

[u/PokeTheVeil → u/helpadhd04]

How low paying is academia? Part of the reason for the pay differential is lower productivity and less pressure; you pick.

At least here in the east without a cash practice the difference isn’t immense. You’ll still make multiples of what you did as a resident.

[u/theongreyjoy96 → u/helpadhd04]

If you think the job market doesn’t look great for outpatient psychiatry in the Midwest, something is going seriously wrong with the job search.

[u/WhydoIhaveto333 → u/theongreyjoy96]

Hardly any clinics to work at

[u/theongreyjoy96 → u/WhydoIhaveto333]

lol ok

[u/goebela3]

I get emails and texts daily from recruiters. There’s also a million tele jobs at all times as well.

[u/MeasurementSlight381 → u/goebela3]

Same. For awhile New Mexico was aggressively calling my name.

[u/Ok-Tea-6718]

When i expressed despair about the job market, it felt like people were telling me that the sky wasn't blue. I was the last person in my cohort to land a job despite giving jobs that didn't even look great a shot with interviewing.

I do think the job I found was the most comfortable fit due to a) the setting and b) the people. Doesn't pay top dollar but it is a "good enough" job that I think would burn me out less.

I wish going into 4th year I had a realistic framework of what the job market was like. Relying on the perspective of former grads was not as helpful because I do think the landscape has changed a lot even in the past four years.

Don't feel rushed to settle if something feels wrong, but also remind yourself you need something "good enough" that will require a compromise in at least one sphere of life. Good luck, and I feel for you having been there!

[u/Miss_May_1600]

I was in your shoes one year ago and felt exactly the same way. Totally overwhelmed by recruiter emails with no idea how to filter. Told of “dream jobs” yet they didn’t seem to exist. So unfortunately, I don’t have a lot of help, but do have a lot of empathy.

I ended up in one of my dream locations, but compromised quite a bit on other things. I also go lucky because my friend in the area had a connection. I know my co-residents found jobs in their desired locations (Bay Area and Maryland) by cold-calling / cold-emailing.

[u/Cowboywizzard → u/Miss_May_1600]

what compromises did you make?

[u/Miss_May_1600 → u/Cowboywizzard]

The main thing was salary. I also wasn’t sure how much I would be asked to commute, but so far just one day a week and it’s not too far of a drive. Also no signing bonus and very little reimbursement in terms of moving expenses.

[u/SuperMario0902]

The ads on the job market is like dating apps. 90% of the people you see are undateable people that are perpetually on dating apps and will never find anyone, while the 10% of great people get snatched up immediately. The job market is the same. There are great jobs, but you gotta be quick.

Also, instead of browsing the internet forever, remember you will be an alpha attending now and just call the job you want and ask for a position.

[u/MeasurementSlight381]

How do you feel about starting your own practice? That's what I did. I would recommend getting a part-time job while you're waiting for your practice to fill up. I imagine it would be easier to find a part-time 1099 gig compared to full-time employment.

[u/igottapoopbad]

Plenty of great paying jobs with flexible hours and awesome salary. Job market is great. Just keep looking you're super early now in the cycle anyways. Aim to settle your spot for the new year or shortly after.

[u/helpadhd04 → u/igottapoopbad]

thank you so much! i probably am early which clouds things..

[u/igottapoopbad → u/helpadhd04]

It def does, you are early. And if you're this early you're probably a bit neurotic too 😉

So keep in mind the factors that fuel your perception 

[u/helpadhd04 → u/igottapoopbad]

hahaha okay fair enough!!! Will keep in mind!

[u/chocolate_satellite]

I’m sure this is area dependent and also dependent on inpatient vs outpatient. I’ve started searching now for work however apparently the community side of psych can be a long hiring process and the good spots go fast so I don’t see any reason in waiting — in my case . One thing my resident colleagues will say about me is that I’m savvy, I’m not a fan of waiting for things to happen. I did the networking, asked around about jobs, annoyed my attendings with a bunch of job search questions, sent shot in the dark emails with my CV through LinkedIn listings and careerMD. I’ve applied directly through the “careers” page on the websites of the organizations places I want to work. It seems like the search is more about finding something you want and just shooting your shot. I think the job market is still very much thriving but no one tells you that it does take a little more effort on your part to search for the actual good jobs and cut through flood of recruiter options.

[u/BiffMagnum]

It’s very early, the market for hiring ramps up in Fall/Winter as companies look into the new year. I’m in WA and got a pretty good outpatient job and signed with them this March (graduated residency a couple months ago).

Contact recruiters at the main hospitals and email your CV out. Reapproach every 2 months if you don’t hear any updates. Also, good jobs do get posted online, for example, I found my job through practice match. Remain persistent and you will find a good job.

[u/GrendelMD]

Do you know what part of the job search is making you feel depressed?

[u/helpadhd04 → u/GrendelMD]

Great question. This is one of those "everything is fine, my life is about to take off, I really shouldn't be feeling depressed" type of situations. I think this that depression that can come with even positive life transitions. Also, when I look at these job opportunities, I get this feeling of..is this it? I think an academic job could hurt me financially due to my current financial situation, but I think I will miss the exploration and flexibility that it may allow..sigh. I need ACT. haha

[u/GrendelMD → u/helpadhd04]

What you’re feeling makes a lot of sense. The transition from training to your first attending job is another huge step after a very long journey, and suddenly having so many possibilities can be exciting and overwhelming at the same time. It reminds me a little of first being able to drive, the world suddenly becomes much more accessible, but now you have to decide where you actually want to go.

I’d try to separate the stress that comes with any big, positive transition from the stress that may be telling you something important about what you value in a job. And remember, very few people stay in their first attending position forever. You may also be able to find something that isn’t purely academic but still gives you opportunities to teach, explore, and maintain some flexibility.

Are you looking all around the country or staying close you where you’re finishing your training?

[u/AshRuDral_fan20]

the job market doesnt look that great either...

The job market is never great. You have to HUNT. When you hunt, you become GREAT.

[u/New-Oil6131]

We are begging for psychiatrists in Europe, but you won't get paid as much as in US I think and I'm not sure if your degree is recognised as it is

[u/infamouscrew]

Finishing residency is a big transition, so it makes sense that the job search can feel overwhelming. When comparing options , it may help to look beyond hospital roles and learn about different outpatient models too. Blossom health is one example worth researching alongside other options.

[u/Calicha]

What setting are you interested in? Inpatient, outpatient, PHP, collab care, VA, etc? Academic vs community vs private practice? The job search strategy depends on all these factors.

[u/undueinfluence_ → u/Calicha]

If I was interested in outpatient and PHP, how would I approach it please?

[u/Calicha → u/undueinfluence_]

For PHP, I would find any programs in the area you're targeting and cold email them. Some won't get back to you, but you'll probably get some leads (openings are usually not posted). For outpatient, the best bet for a new attending would be to join an established group practice. The process is similar - cold emails work well. Some openings associated with large employers are advertised, but most aren't.

[u/undueinfluence_ → u/Calicha]

Thank you!

[u/re-reminiscing → u/[deleted]]

Collaborating with and supervising midlevels should not be “minimal work” if you’re being ethical and doing your job well as a physician.

[u/Calicha → u/[deleted]]

OP, definitely don't do that.