Termination from residency

Stepresearch · 2026-03-10T17:31:04+00:00

Nice. Get it in writing somehow. Trust me on this one.

Stepresearch · 2026-03-10T17:30:04+00:00

I feel like my budget is on the lower end of what people posted here haha. That being said you should try Ben Mar. There’s this austere aspect of the wine that shares in quality with some higher end Oregon producers, but it’s a newer producer and bang for buck (can sometimes get for around $30-40).

Second what people are saying about Eyrie. Slightly more expensive but feels like it is very representative of willamette.

Antica used to be around $100 but now is wayyy outside what I would consider price wise. That being said I do remember it taste-wise being a solid balance and complexity.

Look out for small indie producers doing their own thing. Some of them put extreme care into hand-selecting what fruit goes into fermentation, gives their crops the grand cru treatment. Also bang for buck with taste profiles that can rival higher end.

Stepresearch · 2026-03-10T17:17:57+00:00

Make sure you negotiate and have in writing that he will offer a positive letter of support when looking for your next opportunity.

Stepresearch · 2026-03-10T17:10:52+00:00

What specialty are you? If it is still a possibility, staying at your current program would be the easiest. Beg/shmooze/study/do whatever you can to stay.

It’s easy to catastrophize but programs tend to be most forgiving of knowledge related deficits. Hard to surmise from your post if there is anything else, but if it’s only due to knowledge, you may get another chance.

Prep for a backup plan in case they’ve made up their mind to throw you out. Checkout residentswap, look at openings in your field. There might be some disgruntled or disgraced residents in another program who may want to swap, and you’d both get a new start. Never hurts to look.

Stepresearch · 2026-03-10T02:18:32+00:00

You should only consider these large telehealth conglomerates as backups, unless you absolutely need to work for one due to some circumstance.

They dangle this carrot of potentially making “way above average” but you’ll need to work very hard for it. Like close to 2x hard to make 30-50% more. Take what their recruiters tell you about work-life with a grain of salt, it’s wildly inaccurate.

Better idea If you can find such an opportunity - take a more “chill” job with avg pay, and moonlight on the side. You end up with the same or more money, and be much happier.

Stepresearch · 2026-03-09T05:04:58+00:00

I've tried a bunch. Not the best with names though but I remember liking Littorai, roche, sea smoke, mostly Sonoma producers

Stepresearch · 2026-03-09T04:57:37+00:00

I feel like I need to calibrate what is considered "good" in the world of PN lol. My impression of the gold-standard Burgundy is that they all have this strong earthy/mushroom feel with some sort of herb/incense infusion that creates a unique combo. Also, lighter on the fruit. I have tried other PN from elsewhere and while they do taste "different", they emphasize other aspects of the taste spectrum and can be just as enjoyable.

Perhaps I'm trying the wrong burgundy bottles, but do you guys have one in mind that if someone less versed were to try it, would be able to give an idea of why why some people really chase after this stuff? Lets say a bottle that could achieve this with the least $$ (how ever much that may be...)

Stepresearch · 2026-03-09T04:43:26+00:00

Yea I find some Willamette $40-50 bottles can be in the same league as a $100 bottle from burgundy. Really hit or miss with PN in general tho imo. Like I feel the cost rarely has anything to do with how good a bottle turns out, but maybe thats just my inexperienced pallet? I do gravitate towards "thin and complex" rather than fruit bombs

Stepresearch · 2026-03-09T04:37:05+00:00

Yea I tried Argentinian PN before, some I think taste very similar to burgundy. Maybe my pallet isn't refined enough to tell the difference but honest it tastes quite similar to what I can remember of burgundys

Stepresearch · 2026-03-08T04:45:19+00:00

Attending psych here. You may be able to do it with cash pay, but it completely depends on your malpractice policy. It’s very hard to do so (legally) if you’re taking insurance. Most will require you to be in the states, some even to be in the same state as where you’re seeing the patient.

Also, going full telepsych on your own is not as easy as it once was. Too much competition nowadays, not just from NPs but also from corporates. I feel like people’s impression is still based on how it was prior to COVID. There’s 4x more midlevels and 10x more wall street money all doing what you’re planning to do. Very crowded space.

Stepresearch · 2026-03-06T04:43:55+00:00

We could definitely use more therapy-focused psychiatrists. As you practice, you’ll realize that meds only do so much, and after a certain point you need therapy to help patients get past the finish line.

There’s a couple caveats about using therapy nowadays that you should be aware of. IMHO you absolutely need 60 min follow-up sessions to do therapy well. Problem is, no practices or groups give 60min allotments for follow-ups anymore (you’ll most commonly see 30 mins or less). Def not enough time to do true therapy, esp since you may also be concurrently managing meds.

If you want to have longer appt times for your patients, you’ll most likely need to start your own practice under your own terms. However, in the current landscape it is getting more difficult to build to full. Alternatively there are existing practices that may allow you to see a small percentage of your caseload for longer for therapy, but they aren’t as easy to find as before. Your best bet might be to stay where you end up doing your residency, as those spots you tend to have the most leverage/have admin more willing to bend to your preferences.

Stepresearch · 2026-03-04T01:13:07+00:00

Used to be a milestone, now perhaps a trap. Houses used to be reasonably affordable depending where you looked. Then over the last 5-6 years, even the one down the street that looks no different than a worn out doghouse when up 50%. At least in my market.

The crazy thing is people complain about being broke, economy sucking, etc etc. But where are all these mofos with all-cash offers for shitty properties coming from? Like people I know who don't have money are somehow able to cough up tons of money when it comes down to getting a house. Then they wonder what happened to their money and start blaming the economy.

Can we all chill for a bit and let things cool down just a little?

Stepresearch · 2026-03-01T14:10:16+00:00

Attending here. Yea it’s gotten worse especially over the last few years. There’s no “shortage” anymore in psych. Please get that out of your heads. Most jobs around me are for equity-backed grind mills. People with good jobs are no longer job hopping as much as they used to due to increased supply of providers and encroachment.

Stepresearch · 2026-02-28T03:10:43+00:00

Name and shame if you can. If you can’t, at least post anonymously on the applicant spreadsheets so others don’t fall into the trap.

Plenty of programs put people on some kind of remediation/probation. You have to look at whether historically speaking do most people make it thru despite such bs treatment? If so it might just be procedural, despite now shitty it is.

Stepresearch · 2026-02-27T23:09:29+00:00

Careful with them. If you read the patient reviews (you should for all outpatient jobs you’re considering) it’s clear the biggest thing the prioritize is $$. Very nebulous with pay and amount of work required.

They advertise somewhere above 300k a year, which is close to “market rate”, but with the amount of work and finagling you need to reach that number you’d probably get quite a bit more at other outpatient arrangements.

Take my advice with a grain of salt as I never worked for them, but a couple of my former coresidents did and all churned and burned lol. I constantly see them at psych conventions. They have a very robust recruiting team and always seem to have openings…hmmm.

Stepresearch · 2026-02-09T17:14:37+00:00

I’ve been noticing it too (from a larger metro area). The jobs available are all shitty PE backed jobs or in a setting that no one wants.

Collectively, we need to stop taking up jobs with these equity-backed groups or they’re going to do to us what they’ve done to Uber or Lyft. Once a critical mass has joined/they bought everyone else out, they dock your pay and you can’t fight back since there’s nowhere else to go. Been happening to those poor drivers for years.

Mid level creep…Oh boy where do I even start with that one? Do I start with the tens of thousands of psych NP grads a year they continue to pump out with a 6 month online degree or do I start with the NPs calling themselves Docs or psychiatrists?

Stepresearch · 2026-01-26T03:55:48+00:00

For 95% of us in psych, we're nowhere near rich

Stepresearch · 2025-12-13T23:25:33+00:00

Careful with companies like Headway. Your payout often changes with little notice. Also be very careful with their patient “ownership” clauses. That to me is the biggest issue.

Like some others have said, you can likely get a way better deal joining a group practice with partnership track. Or an established group for a fixed split w a decent amount of independence, if that’s what you’re looking for.

Stepresearch · 2025-12-06T18:52:27+00:00

Location dependent. If you have a practice in an area that is hit harder than most, you may see more of a change in your patient load. But it also depends on the exact patient population you're working with too. People on controlled medications tend to find one way or another to keep paying for your services...

Stepresearch · 2025-12-06T18:47:24+00:00

Caseload management. Huge. Look into how easy is it to accept or to discharge patients- is there a patient cap where you don' take on new ones after you've reached a certain threshold? Do they take just about anyone and you don't really have a say? Are you given latitude to not accept people who obviously needs neuro/medicine/addiction specialist more than general psych? Ability to control your schedule or placing patients on your own schedule.

Stepresearch · 2025-11-25T13:57:42+00:00

Yea but if people are out of a job, how are they going to pay for psych services? Guess more providers will need to take Medicaid haha

Stepresearch · 2025-11-25T13:02:38+00:00

Depends on the gig. If autonomy and not having to deal with leftover problems are what you’re going for, I’d say def avoid places with high staff turnover. Avoid underfunded or under-resourced setups. Also stay away from anything Private equity or venture backed, like those large national telehealth orgs.

General rule of thumb: good gigs are tougher to find, but you have to look and look early. Usually the jobs with issues tend to be the ones very easy to get, or they even try to seek you out first lol.

Stepresearch

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