June 16, 2013

All Graduating Psychiatry Residents

USA Psychiatry Residency Programs

Participating cities, USA

Dear Graduating residents:

First of all, I want to congratulate you for your hard work and perseverance in finishing your training to become Board Eligible Psychiatrists since first matriculating into medical school some 8 or more years ago.  This is a wonderful accomplishment, I hope I am not the first nor near the last in acknowledging this to you all at this time.

That said, I also want to perhaps be the first to tell you, from a psychiatrist who has been practicing now 20 years, you need to be prepared that whatever you have learned these past 2 or so years since working in outpatient and specialty electives to get you prepared for what you hope to be doing for the next few years at least, your postgraduate experiences will not be as likely what you anticipate.

First off, if you have any interest in independence and autonomy to practice in a manner that serves both your patients and yourself in as productive and efficacious as possible, forget it!  You will be micromanaged, second guessed, harassed, ignored, belittled, and just plain dictated to in order to achieve others’ goals that may have clinical care somewhat concerned, but it is serendipitous at best until proven otherwise.  No, if your mentors, supervisors, program directors, and other directorial inputs have been at all honest and direct with you since starting residency, and you care about providing the best patient care possible, you would have left the program by now if those truths and revelations were made clear.  Simply because you are now agreeing to basically just prescribe medication and give limited, selective diagnoses that serve insurer and/or bureaucratic agendas first and foremost.

Furthermore, if you have any interest in providing patients a level of care that maximizes outcomes in restoring healthy and functioning abilities, be ready that is dumbed down to figuring out what is the best management of biochemical imbalances that define the patient’s disorder.  Note it is not even called an illness or disease anymore.  No, your interest will be narrowly directed to prescribing more likely multiple medications from moment one of meeting the patient, and patients will be more likely to be expecting you to provide the best medicines to make the symptoms be removed within a week at best.  And, therapy is not an option, probably something that you have been told already, much less not provided the best training to master a few psychotherapeutic interventions as eclectic care is no longer a concern, because it has been drummed into your processes that there is no reasonable reimbursement opportunity to provide appropriate psychotherapy from a psychiatrist’s perspective.

Finally, and this one is solely my opinion but one realized by the history of what politicians and bureaucracy’s history in this country of regulating care has resulted to now, because of the Patient Protection and Affordability Care Act (i.e. PPACA or more well known as Obamacare), you most likely will be working in one of the following few treatment positions by 2016:  State or federal or privately run community mental health clinic outpatient work; inpatient acute care via conglomerate hospital organizations or chronic state run facilities; addiction program psychiatric consultant work; VA programs; correctional facility mental health management programs; or, micromanaged “private practice” run most likely by non psychiatrists that have to answer to insurer panels that will only authorize services you agree to by contract that have no real negotiation in rates of reimbursement or practice interventions.

I am sorry to forward this correspondence at a time you are preparing to begin your paths to allegedly less supervised and more independent opportunities to provide care and access collegial interactions to allow you to be the best psychiatric provider possible and grow as a physician.  But, I think to not note these above impressions and experiences by a predecessor, who was as eager and invested to “blaze a trail of good care and autonomy” as you all hopefully are now, but from what I see these 20 years later what the system really allows and expects of graduates, to not do so would be negligent and disrespectful of your position now.

I hope to finish on a positive and motivating note though, and that is simply this:  if you compromise and minimize what you know are the standards of care, if you allow people who are not peer equivalents and have no accountability for the potential less favorable outcomes to care interventions should you follow those persons’ leads, and if you are not completely committed to what you spoke at your Medical School graduations in reciting the Hippocratic Oath, then you will either fail in your goals or sell your professionalism out for less admirable needs, SO DON’T!

Do what is right, what is the standard of care, what is in the patient’s best interest first, what your respected colleagues and mentors would expect and duplicate in their practice styles, and what allows you to lay your heads down each and every night and rest as peacefully and soundly as possible.

You are an important part of what psychiatry needs to be redoing right and responsibly to the communities we serve, and really protect in these days of uninvestment in care by non clinical entities trying to control and dictate health care, more often solely for the sake of profit.  And I think many of you can make a difference for the right reasons.  I just hope you had the influences in your trainings these past 4 years to remind you what you need to do.

As I write at this site often, be safe, be well, and for you as graduating residents, be right and firm!


Joel Hassman, MD

Board Certified Psychiatrist

Class of 1993, University of Maryland Residency of Psychiatry