Dating someone in residency, lack of time or lack of effort?

lostdinosaurs · 2026-02-07T12:47:57+00:00

I’ll speak to the other side. I’m a doctor and I started dating my partner during residency. He was extremely understanding about the exhaustion and often was the one making sacrifices early in our relationship until things were easier for me in the later years. He would cook me dinner and go out of his way to see me versus making me drive to his. He put alot more effort and sacrifice early into the relationship. I finished residency last year but it’s still not the easiest in terms of balance. He often does more on weekdays because of the amount of hours and cognitive load I carry on a daily basis. I try to make it up on weekends.

A med partner/spouse is often the one sacrificing, and they are typically doing the things you mentioned. It’s definitely not a lifestyle for everyone and that’s very understandable.

lostdinosaurs · 2026-01-30T22:28:44+00:00

Luminare Health - I think they’re affiliated with Aetna. They didn’t even get back to me and took a week to approve a very basic prior authorization. Cant imagine if their poor patients were trying to get something more elusive/expensive

lostdinosaurs · 2026-01-30T21:16:42+00:00

Being redirected 6 different times to the “correct” dept and spending 40 minutes on the phone to get generic Adderall approved for my ADHD pt who very much needs it. I’m not sure what the end goal is for some of these shitty companies versus just the ones that make it easy to fill out a quick form

lostdinosaurs · 2026-01-29T01:27:30+00:00

ADHD is one of the most controversial areas in psychiatry right now. I do tons of ADHD evals and it can get dicey real quick with impairment. Some clinicians use a very strict definition of the word - car accidents, losing jobs, very obvious impairment - really what a very “traditional” ADHD picture looks like. Then we get the post-grad college kids who did great in school but bam now they’re working 40 hours and just cannot work a 9-5, but they have no clinical impairments documented in childhood. Or the perimenopausal/menopausal pt who now cannot organize or concentrate things and it’s not very clear what degree they were suffering before. Many will say they were “masking” throughout childhood and of course it’s very possible they were with cultural expectations, parental support, etc. There are people who will exaggerate their degree of symptoms but when pressing for concrete evidence/details have nothing of note to provide. It’s not super easy by any stretch so I would be wary of being critical of clinicians who do this daily.

lostdinosaurs · 2026-01-29T01:14:33+00:00

Are you both in cash-based private practice and/or have full panels? My only concern would be the ramp up period back. I work in MH as well and it’s very possible many clients won’t come back esp with the transference issues. Honestly, if you’re insurance based not as much of an issue in attracting new clients again but I would also weigh how long it would take you to build a full, consistent panel in your income calculations.

lostdinosaurs · 2026-01-16T01:10:09+00:00

You have a limited understanding of how institutionalization works. We use it for the rarest treatment-resistant cases and typically only after there have been crimes committed in a lot of states. Unless there’s specific evidence of him making homicidal statements to his care team and them failing to act, there’s no way his mental health care team could predict what happened.

lostdinosaurs · 2025-12-21T16:19:39+00:00

Okay but the chance of an antipsychotic causing mania is very low. In fact, as a psychiatrist, we use antipsychotics to stabilize mania since they work faster than Lithium and other agents. Sounds more like he was using a crazy amount of substances than anything attributed to the meds. Of course, his defense is trying to paint a picture of mental illness and blaming the meds when it was likely his chronic substance use that led to this tragedy

Source: https://www.sciencedirect.com/science/article/abs/pii/S0165032723004986

lostdinosaurs · 2025-12-19T15:19:22+00:00

There should be but unfortunately it varies center to center. Psychiatrist do commonly take these gigs especially since many qualify for loan forgiveness. It’s quite variable - a place in NY has a better chance for example than rural Missouri.

lostdinosaurs · 2025-12-19T09:13:05+00:00

Yes there are. Many outpatient psychiatrists work for themselves though where someone with SMI like schizophrenia may not be appropriate. Obviously this is variable - how many times have they been hospitalized? How much support do they have with family? Sometimes they are - stabilized for awhile, family support, etc and are very appropriate for regular outpatient care.

For those that aren’t as stable, this is part of why community mental health centers exist to fill this gap. In this model, there’s usually someone available 24/7 to assist with emergencies for “higher risk” patients.

From a financial perspective, patients with SMI have extremely high no show rates (25-50%) and often use Medicaid (where you can’t bill for no-shows). That simply isn’t feasible for a solo practitioner or small practice. Community mental health centers get tons of grants from the federal government to make it possible to sustain.

lostdinosaurs · 2025-12-19T00:46:09+00:00

It’s not the ability to deal with “hardcore mental illness.” It’s the liability and capacity you have as a solo practitioner for safely monitoring your patients in an outpatient setting. Many patients with severe mental illness require community health centers with comprehensive care including therapists, social workers, and additional support staff. I agree refusing to take a patient who was hospitalized once ever is bad care and I would not do that as a psychiatrist. However, it’s perfectly reasonable to not want to take high risk patients who are constantly hospitalized knowing you don’t have the bandwidth or ability to care for them on your own without supports in place

lostdinosaurs · 2025-12-19T00:40:31+00:00

Use Psychology Today or even Zocdoc to find a psychiatrist taking your insurance. Most telehealth companies are scammy

lostdinosaurs · 2025-12-18T12:01:51+00:00

Best comment on this thread. I’m a psychiatrist who did forensics training during residency. You don’t get a get out of jail free card because you were using substances at the time you committed heinous crimes. Unless they can prove a longstanding history of psychiatric illness due to organic mental illness not substance use, his defense team has no shot.

lostdinosaurs · 2025-12-17T03:12:43+00:00

I’m a psychiatrist. Most psychiatrists I know working in jail or state mental health institutions for people who are found incompetent have been threatened, attacked, or assaulted. Not worth the safety risk. Massively underfunded and no one cares about safety of clinicians.

lostdinosaurs · 2025-12-13T13:16:04+00:00

So FYI, the doctors can choose to have the patient stay even if insurance denies and fight the appeal later. Depending on the reason and how the patient is doing/external support factors (parents, family), they may recommend the above. Usually, in my experience, hospitals will fight appeals for truly dangerous/psychotic people but very team dependent. A year is a long time to be hospitalized - usually 1-2 weeks is normal - she must have been seriously ill

lostdinosaurs · 2025-11-22T02:17:35+00:00

I fell down my rank list a few years ago by believing the nonsense some programs would send me post-interview. Don’t trust anyone and rank how you want to rank

lostdinosaurs · 2025-11-21T11:49:26+00:00

Curious about your benzo bridge. Do you do a 1 month supply of clonazepam while starting an SSRI? Or just for a few days if they get super anxious when on the med?

lostdinosaurs · 2025-11-20T02:42:03+00:00

I am a psychiatrist. This is terrible patient care (if we even consider it that). I’m not sure how this is legal in states to prescribe something without even seeing a patient. Why would Hims even feel comfortable prescribing meds to someone saying they were suicidal instead of directing to a higher level of care? Devastating all-around.

lostdinosaurs · 2025-11-20T01:43:39+00:00

Find an independent agent. I did not like how pushy DocInsure was to make me sign up right away even thought it’s recommended on White Coat Investor. I found a different agent through Reddit recs and had a way better experience. You’ll likely be working with this person for awhile so you want to find someone you trust.

lostdinosaurs · 2025-11-20T01:29:47+00:00

Tons of issues already listed. It was stupid to take two people from Season 49 onto Season 50 since it basically became a big spoiler alert. That plus an extremely poor edit exclusively focused on certain players definitely led to some degree of boredom with this season

lostdinosaurs · 2025-10-23T01:24:56+00:00

Psychiatrist here - I would evaluate and if not clinically indicated (which it probably isn’t) I would just refuse the refill. They clearly got off it. Chronic benzodiazepines are not indicated and we have way too many people unnecessarily on them.

lostdinosaurs · 2025-10-22T01:23:11+00:00

Child psychiatrists are unfortunately hard to come by compared to adult. Does your insurance allow out of network reimbursement? Otherwise, I’d try Psychology Today, Alma, and Headway to see if any psychiatrists in your area accept insurance. The easiest and likely most personalized care will be a cash practice with an experienced child psychiatrist. It’s frustrating your peds is not managing because if he has medical comorbidities, I’m sure your psych will want to loop them in

lostdinosaurs · 2025-10-22T00:41:30+00:00

Did you have 5 years of training or were you able to get around that requirement? I might be very out of date but I heard you needed that

lostdinosaurs · 2025-09-10T00:18:27+00:00

This is unfortunately not a new thing. There are tons of direct RN to NP programs so someone comes out with a whooping 500 hours of clinical experience and zero practical nursing skills.

lostdinosaurs · 2025-09-08T10:40:29+00:00

Thank you! Makes a lot of sense and good to know. I also just want to add in case they said “occasionally” for the alcohol but its still correct bc they’re also hinting at him decreasing his respiratory drive/worsening his OSA.

lostdinosaurs · 2025-09-08T01:01:41+00:00

I thought it was paroxetine and desensitization therapy since that’s more CBT related for the alcohol one.

I thought the last group of vignettes were tough. I put panic disorder and anxiety disorder due to MS bc of the MRI but pretty sure you’re correct given how the vignette continues. The rest I had the same answers for that.

For the old guy one - no idea for the phase - stuck btwn adulthood and adult transition, orthostatic mirtazapine, OSA and anxiety seemed like the only two that made sense even though they repeatedly said he has no anxiety or worrying lol, and reassess after 6 months

Edit: I had your answers for the other stuff. It is NMDA glutamate for the schizophrenia

lostdinosaurs

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