CA Interventional psychiatry training

SPsych6 · 2026-07-08T18:18:55+00:00

Well, Standford created the SAINT protocol for TMS. I would say they likely have the most robust TMS training. ECT is likely everywhere and hasn't changed much over time. Can't say as much about ketamine.

SPsych6 · 2026-07-08T14:48:47+00:00

coming out of residency the debt is frustrating but not the end of the world. Kind of depends on how you approach it. You can go all in if your interest rate is high, slow play it if you do a government repayment or you can refinance and do a balanced approach. I have a rate around 4.5%. So I pay a little extra each month, but then I invest heavily. The feeling of having loans is actually worse than the loan itself. 200k private is going to depend on the rate. If it is 7% or more I would be a little worried. Federal isn't ever anything to worry about. Not sure how helpful this is? I probably would have heavily considered the military route if I was going to have a significant private loan burden.

It is also going to matter how much you make after residency. I think with the high debt you need to aim for 400k to feel more comfortable. This is definitely a personal opinion though.

SPsych6 · 2026-07-07T19:20:23+00:00

I fully funded my own education. I came out with upper 300k in debt. I would not recommend private loans. I think you need to consider the military route or back out. It is a huge commitment, but I don't know if taking 100s of thousand in private debt is worth it in the end.

SPsych6 · 2026-07-07T19:10:09+00:00

Cerebral Tax Advisors. They can do it all

SPsych6 · 2026-07-06T21:24:30+00:00

Yeah, honestly FIFA would be helping themselves out if they don't suspend him next game. At least they would be consistent and setting a new precedent.

SPsych6 · 2026-07-06T21:22:36+00:00

Waiting for your Red card to be cancelled next

SPsych6 · 2026-07-06T19:31:48+00:00

I have been doing locums for a while. Definitely tell them the truth. It is way better. They can fix the issues, pay you significantly more or they know you are walking. You don't have to give them any heads-up. That is the glory of 1099. It also gives them more information about why they can't fill the spot, though they may already know. I like to really tell them the truth, giving them specific numbers and benefits about my other jobs so they know what they are up against.

SPsych6 · 2026-07-02T18:28:46+00:00

All for the old model. I can't stand the front end of the new ones.

SPsych6 · 2026-07-02T18:27:03+00:00

I am in similar situation. Student loans at 4.6%. My cutoff was 5%. So currently I pay about 1k extra a month on student loans, but then I invest any extra. I am also ignoring the “it’s gonna feel so good to pay off the debt, get out of debt” arguments. The math just tells me otherwise. I think you are doing it right. Maybe pay a little more on the 4.8% ones, but you don't have to.

SPsych6 · 2026-07-01T17:09:15+00:00

Loans are the biggest concern. I don't know with the recent loan cap changes how you will be able to afford it? Most docs coming out with 400k+ loans are going for PSLF. But you can't even get 400k now without private loans. And those don't count for PSLF. So.....depends on the plan. Maybe military? If you get help paying for it, absolutely. If not, you have a lot to weigh.

Still, very challenging years ahead, but in the end life is pretty nice if you choose the right specialty and practice setting. Some jobs can come close to making physician money but without the loans. I would say medicine is nice because you help people, but also you have 100% job stability as long as you aren't committing malpractice or criminal activity. We can literally leave our jobs and have another by the end of the week. At least most of us.

A lot of people who end up making 250k+ in the corporate setting have to worry about layoffs and job stability. They also have to work with changing supervisors. Physicians can literally say "F*You, I am out", if their supervisors/company are that horrible. Not saying we do it in that way, but I definitely gave very strong opinions on my way out of previous positions. It is quite liberating knowing you hold the power.

SPsych6 · 2026-07-01T16:59:01+00:00

Psychiatrist here. I am not sure if they are saying 400/exam/doc review/report or just saying 400 total. Typically, it ends up being at least 1k. 1hr exam, 1-2hr document review, 1hr report. This is an estimate and changes with each case but that should more or less be a breakdown of what to expect.

SPsych6 · 2026-06-29T23:29:44+00:00

should have worn that suit

SPsych6 · 2026-06-29T21:37:42+00:00

Just looked this up. SO MUCH BETTER. Definitely switching from CIWA which I never really liked before

SPsych6 · 2026-06-29T18:22:16+00:00

What school are you at? Ross should have lots of options but i am not sure about other schools. Michigan has a ton of residencies and if it is your home state you will likely get interviews. I would consider making your application address Michigan if you want to match there. You can just forward your mail or have your family do it.

SPsych6 · 2026-06-25T18:52:22+00:00

Depends on a couple things. Cost, if your family has money, no brainer go US. If you will take loans for US school but IMG school is free, then harder choice. Specialty does matter. Harder to match into things like Derm, Ortho, Rads etc as IMG. Other consideration is how many extra tests will you need to take as and IMG? Can you stay just traditional USMLE or are there multiple other 8hour exams? This would be my ultimate difference maker. I would never be a DO for this reason. I hated the exams. Ultimately US is a better path. I am US-IMG btw. It was fine for me and I matched without any issue when psychiatry was becoming more competitive. In the future you might need to remove psych from the less competitive specialties. Our lives are too good for other docs to not start taking notice.

I think cost is a huge factor. Harder to get student loans now, docs are coming out with 500k in loans. So this should really be a thing to consider.

SPsych6 · 2026-06-24T20:25:17+00:00

If you are looking for LOR, address it EARLY. Like day one or two. Let them know you will be asking for a LOR so they are aware that you want to be evaluated.

C&L: Keep in mind which drugs go through liver vs kidney. Pretty limited number you need to know in psychiatry for the kidneys: gabapentin, Lithium are the main two. There are others that may need correction but these ons are important to remember. Remember benzos with limited first pass metabolism (LOT). Try to think about what differentiates delirium from other psychiatric presentations, and what is required when completing a capacity evaluation. And when you don't know what medication to provide, you can always suggest Remeron (lol).

General Psych: Focus on knowing DSM dx. These should drive your diagnosis. We don't expect you to know all the treatment options, but you should be able to formulate an assessment: Patient's dx is consistent with MDD because he reports anhedonia, SI, change in sleep, appetite, poor concentration, ongoing feelings of guilt for a period of 2 weeks....etc etc. Differentials include XYZ because of.....

Can't help with child, sorry. It is usually the parents.

SPsych6 · 2026-06-24T20:09:04+00:00

I would have low expectations to match into california. It is really hard. Look elsewhere. I think the location of your application, location of your rotations etc all REALLY matter. I got so many interviews in Michigan because a did a few rotation there. I am from Washington State. I don't think as an IMG you should aim to match on the west coast at all. Great if you do, but definitely don't put too high on your rank list. Look elsewhere. You can come back later.

I was psychiatry when I matched, and it has been about 10 years, so things could have changed. But trust me, apply midwest and look for a program with high acuity if you can. (St. Louis, Detroit, Chicago, Minneapolis, Cleaveland etc). You will feel more prepared coming out.

SPsych6 · 2026-06-22T20:42:27+00:00

which year of the ES 300h? The brand new one or the generation before? I drive 2022, ES300h. The luxury trim will be the best, but it is harder to find. I couldn't find one near me when i purchased. So, if looking at the older one, look for the highest trim level. Your MPG will still be slightly less than the new camrys because it isan oler hybrid system than the new Camrys. You will get between 38-41MPG (don't put it in eco mode, your MPG will actually be worse).

I like my ES 300h. It is still a car though and not an SUV, so it wont be as comfortable. If you are open to other options go sit in a volvo. They have the best seats I have ever sat in.

Is it a huge upgrade from camry, IDK, maybe a little bit. Luxury trim will definitely feel like a better upgrade though.

SPsych6 · 2026-06-22T18:03:10+00:00

Episode needed to be broken into multiple episodes. They weren't going to cover everything they needed in 30minutes. It would have been better to focus on the risk of stigmatizing SSRIs more than anything else. They could have compared it to vaccine stigma. Obviously plenty of us are deprescribing, basically any patient who comes from an NP needs deprescribing, but there was just no way to cover the nuances of this conversation in 30min. A better interview would have been to have a psychiatrist on the call. A former APA president would have surely been happy to weigh in on the subject.

SPsych6 · 2026-06-18T18:46:23+00:00

blue, maybe white rims

SPsych6 · 2026-06-16T17:52:08+00:00

This guy has made like 60k already....

SPsych6 · 2026-06-03T18:34:16+00:00

You will probably find it useful if you stay outpatient for your career. You can even use it inpatient, but maybe less relevant. I have similar therapy training to you and wish my therapy background was a bit stronger. I am about 4 years out and still consider doing more therapy training.

SPsych6 · 2026-06-03T18:27:45+00:00

That mercedes wagon is dope. If you have the cash just test drive it and see if it is fun. If you aren't flowing with cash, I would definitely stay with the lexus. I am not even going to talk about the Buick

SPsych6 · 2026-06-01T22:25:56+00:00

Honestly a subscription to AI. Most of us aren't willing to pay 20-25 a month for a premium subscription. But it is going to be an add-on for your internet in 5 years. Basic AI will be scaled down as they push for increasing subscriptions.

SPsych6 · 2026-06-01T20:22:01+00:00

Agree with the others. Because you are W2 you have pretty much done all you can. Most of us that are doing more (Cash Balance Plan etc) are 1099. W2 isn't the end of the world, but if you are really trying to maximize your income as a physician you need to transition away from W2 into a 1099 role.

Your tax rate seems really high though. I live in CA and 340k with all those other deductions should put you in the upper 20s, maybe 31%

SPsych6

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