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A Day in the Life of a Psychiatrist - 2002-05-22

In the United States, medical doctors who have passed their examinations and internship, usually spend three years (psychiatrists, four) as residents in a teaching hospital or clinic. During that time, they apply their knowledge to real-life cases under the supervision of experienced physicians. Often they have to spend long, grueling hours at work and be "on call" for emergencies. Many residents say they work at least 100 hours per week, at no extra pay for overtime.

Earlier this month (May 8), a lawsuit was filed on behalf of residents throughout the country against medical institutions, saying the centralized program for assigning residents to hospitals keeps them from negotiating better wages and working conditions. And the Board that overseas doctors' training has threatened to strip its seal of approval from the residency program for general surgery at the prestigious Yale University Hospital, unless it improves its residents' working conditions.

This landmark decision serves as a warning signal to other hospitals with residency programs. But some residents find their experience rewarding, despite the hard work and relatively low pay.

The psychiatric emergency service, located in the main emergency room of Johns Hopkins University Hospital, is relatively quiet on a late May afternoon. Dr. Peter Chodynicki, a resident physician in the Department of Psychiatry and Behavioral Sciences, is dictating one last report before he heads home.

"I come to work approximately at eight [a.m.]. I check lab results on my patients. We start rounds approximately at 8:30 [a.m.] with the attending [physician], nurses, social worker, occupational therapist," he said. Dr. Chodynicki works closely with therapist Mark Reeves. They often discuss patients.

Doctor: "Why hasn't he [the patient] been compliant?
Therapist: "It's a good question. I think a lot of times he feels he doesn't need the medicine. He starts feeling good and he stays away from the hospital."

Psychiatrist Peter Chodynicki and therapist Mark Reeves take care of about eighty patients. "I try to monitor the patients' symptoms and ensure they are doing OK in the community and if things are not going so well, then I ask Dr. Chodynicki to assist me in any medication management and problems there may be that could include hospitalization, day hospital whatever is necessary," he said.

Johns Hopkins University takes about eight resident psychiatrists a year. Under the supervision of attending board-certified psychiatrists, who are members of the Johns Hopkins faculty, they care for the hospitalized patients, who stay overnight, day patients who spend most of the day at the hospital, but go home in the afternoon, and out patients - those who come from time to time. Dr. Chodynicki said, officially, his duty ends at five in the afternoon, but often he stays longer. Once or twice a month he is assigned to a 12-hour duty shift, usually in the emergency room.

"You see a great variety of patients there: patients who are very depressed and are at high risk for suicide; patients who have anorexia or eating disorder and are very severely malnourished; patients who have Alzheimer's disease and they have hallucinations or delusions; patients who have bi-polar illness and have a syndrome of mania. [These] patients are restless, sleepless and often engaged in some activities which put them in a severe risk of hurting themselves. Those are very ill patients who require immediate care and hospitalization," he said.

Zlatica Hoke: "Have you ever been attacked by a patient?"
Dr. Chodynicki: "Once, yes."

Peter Chodynicki's residency ends this summer. He said his final year has been the most enjoyable, a far cry from his first year at Graduate Hospital in Philadelphia.

"At the beginning I did the toughest rotation which was medical intensive care units," he said. Dr. Chodynicki said he would start the day at seven in the morning to check on his patients and get ready for the round of patients with supervising physicians and other medical staff. He would spend the afternoon with more patients, and evenings with his paperwork and studies. Three times a week he was on call. Dr. Chodynicki said he may have worked twelve hours a day.

"I never counted them [the hours]. I spent most of the time in the hospital during my first year and I would just go home essentially to sleep at night and then in the morning, I would be back in the hospital," Dr. Chodynicki said.

He said today, he makes only about $8,000 more than he did four years ago. That's about half of what board-certified physicians make, but he has no complaints.

"As residents, we work under supervision. We make a lot of decisions on our own and that's great, but the ultimate responsibility for what we do is carried by the attendings [supervising physicians]," he said.

Many resident doctors complain that they are assigned too many duties that are usually not performed by physicians, and therefore not a useful experience for them. The Johns Hopkins resident psychiatrist said, for him, they were all part of the hospital experience.

"Often times we had to arrange for things that did not require medical expertise, for example, arrange for patients' transportation home, a lot of paperwork, things like drawing blood from patients, which can be done by the nursing staff. I think that our time could have been used more efficiently," he said.

But overall, Doctor Peter Chodynicki said he values his experience as a medical resident tremendously and considers it the most productive time of his life.