A Day in the Life for Psychiatry Residents

The transition from medical school to intern year has been daunting at times, but the faculty and staff at IU have made it so much easier through their support and expertise! I'm currently on a two-month inpatient rotation at Eskenazi Hospital. Let’s explore what a typical day looks like:

Inpatient Psychiatry at Eskenazi Hospital
First-years spend about half the year on inpatient services: two months each at Methodist Hospital, Eskenazi Hospital and the VA Medical Center. Eskenazi Hospital is Indianapolis's flagship community hospital and serves over one million patients per year. I often say it's like psychiatry boot camp. Interns on the psychiatry service can expect to carry 6-10 patients suffering from everything from mood to schizophrenia-spectrum to trauma to substance-use and personality disorders, among many other psychiatric problems, in addition to conditions like catatonia. No two days are the same, which is a good thing!

Before Work | 5 to 7 a.m.
I like to have a long on-ramp, so to speak, for my mornings. My day goes a lot better when I give myself the time to wake up, have coffee, watch the news and get ready, as opposed to sleeping in and having to rush out the door. Inpatient psychiatry can be personally and emotionally challenging, so finding time for equanimity and intention-setting keeps you from bringing your stress into work.

Commute | 7 to 7:30 a.m.
IU residents live all over Indianapolis, so one’s commute could be as little as five minutes or perhaps up to an hour. I’m coming from the suburbs, so my commute takes 30 to 45 minutes depending on traffic. I take this time to listen to psychiatry podcasts or audiobooks. You’d be surprised what clinical pearls you can pick up in the morning and get to apply the same day!

Morning Work | 7:40 to 10 a.m.
I start by reading about my patients: what happened overnight, any behavioral events, their vitals and labs, etc. Then I try to touch base with nursing before seeing patients. One of the trickier things for me to learn has been balancing patient-centered care with efficiency: spending more time with your earlier patients can mean rushing the later ones. This rotation teaches you to be both efficient and thorough, so that every patient gets the face time they deserve.

Treatment Team Meeting | 10 to 10:45 a.m.
This is where the real magic happens. Treatment at Eskenazi Hospital doesn't simply consist of "whatever the doctor decides to do." Social workers, care coordinators, pharmacists, nursing, the attending and the resident all meet to coordinate care: residents give their assessment of the patient and suggest changes to the plan, nursing relays their concerns, social work handles outpatient follow-up and legal matters, etc. This is a great opportunity to learn all the ins and outs of integrated healthcare and the medico-legal system!

Afternoon Tasks | 10:45 a.m. to 4 p.m.
Afterward, I put in orders, call consults, call family and outpatient providers, and take any questions I might have to the pharmacist and attending. If a patient has an emergent concern, you act as the primary physician: redirecting acute distress, defusing an issue between patients or with staff, and so on. These scenarios can require some creative improvisation, but you always have a supportive, knowledgeable attending to help you through or debrief afterward. Then I write my notes and check in once more with my patients before heading out for the day.

Commitment Hearings
One of the features that drew me to IU was that residents serve as expert witnesses in commitment hearings for patients whose illness may present a risk of self-harm, harm to others or grave disability. We're excused from clinical duties for these hearings, which may last 30 minutes or a couple of hours, and we give an account of our daily interactions with the patient, our diagnosis and our proposed treatment plan. It's a chance not only to help patients get care they can't seek for themselves but also to practice speaking to non-psychiatrists about the field.

Crisis Intervention Unit | 4:30 to 10 p.m.
Once or twice a month, first-years take an evening shift in Eskenazi Hospital's Crisis Intervention Unit (CIU). Patients come down to the CIU after being medically cleared, and the resident (often with a medical student on their psychiatry rotation) assesses them, then staffs with the attending. It's a great chance to learn the interviewing skills unique to emergency psychiatry and to develop a framework for determining which patients are safe to go home with follow-up and which require admission.

Friday Schedule
All psychiatry residents have Friday afternoon off for didactics, no matter what rotation they're on. So on Fridays at Eskenazi Hospital, I do morning rounds, staff with the attending instead of the treatment team, then finish orders and notes by around 10:30 a.m. Didactics run 11 a.m. to 4 p.m., with free lunch at noon from a local restaurant. It's great to end the week catching up with your co-residents or making weekend plans. And speaking of which, first-years have no weekend duties on psychiatry rotations, yet another feature that drew me to IU!

Second year has been off to a great start! We’ve officially wrapped up our off-service rotations, which means we're now spending the majority of our time exploring different specialty areas within psychiatry. The block I’m currently on looks a little different each day, so I’ll walk through what a typical week looks like.

Before Work | 5:30 to 6 a.m.
No matter what rotation I’m on, the day starts nice and early when my 11-month-old wakes up at the crack of dawn. The morning usually consists of getting both of us ready, packing the diaper bag and heading out the door. I typically enjoy my morning coffee in the car while dropping the baby off at childcare and making my way to work. I commute to work, which can take anywhere from 25-45 minutes depending on traffic.

Monday | Geriatric Psychiatry
Mondays are spent at the VA Medical Center rotating with a geriatric psychiatrist in her outpatient practice. It’s great exposure to the older adult population, and I enjoy getting to see the intersection between psychiatric illness, cognitive changes and medical comorbidities.

Tuesday | Forensic Psychiatry
On Tuesdays, we head to the local jails to observe forensic evaluations performed by a forensic psychiatrist. These days are always interesting because we discuss competency and insanity evaluations and then see how they are actually applied in real-world cases. It’s one of those experiences that reminds you just how many different directions you can take a career in psychiatry.

Wednesday and Thursday | Palliative Care
Wednesdays and Thursdays bring us back to the VA Medical Center, where we are in the palliative care clinic providing supportive psychotherapy. This has been a great opportunity to slow down, connect with patients and practice fundamental psychotherapy and CBT skills. After we see our patients in the morning, the afternoon consists of staffing cases with our supervising psychologist.

Friday | CBT and Didactics
Friday mornings are spent in CBT lecture instructed by an amazing psychologist we get to work with! Afterward, we head to our residency didactics for the remainder of the afternoon. Didactics cover a wide range of topics and are a great opportunity to learn about current issues in psychiatry, build on what we’re seeing clinically and, of course, catch up with co-residents after everyone has been scattered across different rotations all week.

Overnight Call | 4:30 p.m. to 8 a.m.
Second year is also when we begin taking overnight call, where our main responsibility is covering the VA Medical Center, Goodman Hall and University Hospital. On weekends, call is 24 hours, and our responsibilities extend to cover Riley Hospital for Children. Call has been a great opportunity to put everything we learned during our first-year medicine and psychiatry rotations into practice. Although overnight call can certainly keep us on our toes, it has been one of the best opportunities to build confidence and practice making independent clinical decisions. If any questions arise, our staff is always available via phone. Once 8 a.m. rolls around, it’s time to hand off, head home and get some sleep!

The third year is centered on outpatient training. You will build your own schedule from a wide range of settings and specialties, including addiction, functional neurologic disorders, early psychosis, ECT/TMS, general adult psychiatry, and more across Indianapolis. With increasing autonomy and continuity, you begin to connect your clinical decisions to real outcomes as you follow many of the same patients for one to two years. You are also surrounded by attendings and mentors eager to discuss your questions and help you grow into a more confident and independent psychiatrist. Here is what a typical Wednesday looks like for me.

5:30 a.m.
My mornings begin with an alarm at 5:30, at which point my girlfriend and I play chicken to see who will snooze longest before one of us gets up to tend to the barking dogs. The other starts breakfast, lately eggs, oatmeal and turkey bacon. Pigs are too smart and cute; sorry, turkeys. After breakfast, I head out for my 15–20 minute commute, usually listening to a psychiatry podcast related to something I expect to encounter that day.

7 a.m.
I arrive early enough to settle in, finish chart review and prepare for clinic. For new patients, I build a concise picture of their psychiatric and social history, prior medication trials, current treatment and major life circumstances. For returning patients, I review recent visits, labs, prescriptions and messages from their care team. I also use this time for clinical questions, refills, messages and paperwork.

8 a.m.
Wednesday mornings are spent at Goodman Hall in a dual-diagnosis clinic focused on substance use disorders and co-occurring psychiatric illness.

This clinic has taught me how important it is to preserve trust and collaboration even when illness affects insight, judgment or motivation. Some of the hardest problems are not simply choosing the right medication, but helping patients navigate insurance changes, employment problems, housing instability or interruptions in treatment. It has been meaningful to see how medications, therapy, recovery supports and a strong treatment relationship can interrupt a downward spiral and help someone begin rebuilding.

About every other week, I start with a new intake. These visits are generally 90 minutes, giving me time to gather history, develop a tentative plan, staff with my attending and return together to discuss next steps. 45 minutes are allotted for follow-up visits, and I am generally seeing between 2-4 patients each morning and afternoon.

12 p.m.
Around noon, I grab lunch downstairs at Sonny’s Pizza and Deli, one of several options covered by our residency meal allowance, while finishing notes, messages, refills or paperwork.

1 p.m.
Wednesday afternoons are reserved for psychodynamic psychotherapy.

I am still learning what it means to practice psychodynamically, but I have come to appreciate how open the work can be. At its core, it involves becoming more aware of recurring, often unconscious patterns in how we understand ourselves, relate to others, respond emotionally and navigate conflict. I think of it as helping patients develop greater freedom and intention in how they live.

At 1 p.m., I meet with my psychotherapy supervisor to review the previous week’s session. After each session, I write process notes about what stood out, what I noticed in the patient, my own reactions and how I responded. With appropriate consent, sessions may also be recorded so we can revisit specific moments in supervision. This has become one of the most valuable parts of my training, helping me become more aware of myself in relation to my patients and more deliberate as a therapist.

2 p.m.
By the time my patient arrives, the previous session is fresh in my mind. I may have themes I want to revisit, but the session remains flexible depending on what the patient brings that day. We might explore longstanding interpersonal patterns, existential concerns, values or continue CBT techniques that have been useful.

3 p.m.
Afterward, I write my process notes for the following week, finish documentation, respond to any new messages and wrap up for the day.

The rest of the week, the structure of my daily routine is mostly the same:

Monday 
I spend the morning in the functional neurologic disorder clinic at Goodman Hall, combining medication management, CBT and psychoeducation. I am learning how to discuss the relationship between physical symptoms and mental health in a way that feels validating rather than dismissive. In the afternoon, I work at the VA Medical Center caring for veterans with a broad range of psychiatric concerns.

Tuesday 
My morning is spent at Eskenazi Hospital’s outpatient mental health clinic with an emphasis on early psychosis, where many patients are also navigating major socioeconomic stressors. In the afternoon, I work at Eagle Highlands working with patients towards the opposite end of the socioeconomic spectrum, gaining exposure to another side of outpatient psychiatry.

Thursday
I spend the full day in general adult outpatient psychiatry at Goodman Hall.

Friday
Friday is protected for education. We begin with psychodynamic group, discussing patients, challenging moments in therapy and weekly readings. This is followed by our resident meeting with lunch and afternoon didactics.

Weekends
Third-year weekends are generally free aside from a small number of call weekends at Riley Hospital. I spend my free time powerlifting, participating in community discussion and book groups, reading and gaming. The residency also organizes social and wellness events throughout the year, including yoga, pickleball, movie nights, hiking, boating and retreats. It is an incredible group and place to train, and I'm grateful to be a part of it!

Fourth year is a time to explore our career interests, integrate all the knowledge acquired as residents and apply our skills in various settings of your choosing. This year is tailored to all elective time, so basically you pursue what you are most passionate about when building your schedule! Let me take you on a walk with me during my clinic day:

8:30 to 10 a.m.
I see my first patient of the day for intake in general adult clinic at Goodman Hall. This is a thorough hour to hour-and-a-half-long interview of the patient to form a diagnostic impression and treatment plan.

10 to 10:30 a.m.
I discuss treatment plans with my attending. Attendings allow us the autonomy to formulate a treatment plan and provide teaching points during staffing. We then see the patient together and include the patient in our treatment decisions.

10:30 to 11:15 a.m.
I see my next patient for a half-hour follow-up where I check in on how they are doing from a biopsychosocial as well as a safety perspective and make any necessary adjustments to their treatment plan.

11:15 to noon 
I take my next follow-up.

Noon to 1 p.m.
A great, solid hour of lunchtime where I grab some delicious sushi from the Methodist Hospital cafeteria — yes, you guessed it… Sushi Boss! I then grab myself a cup of Tinker coffee, also conveniently at Methodist Hospital. If I have a sweet tooth, I will also stop by Au Bon Pain for a baked treat! I like to sit outside and enjoy my lunch and some sunshine while finishing up orders and notes for my morning clinic patients.

1 to 1:45 p.m.
I see my first follow-up patient for my afternoon clinic, which is a somatic disorders clinic. Most of my patients here struggle with functional neurologic disorders. These are very unique, interesting and challenging cases.

1:45 to 2:30 p.m.
I see my next follow-up patient.

2:30 to 3:30 p.m.
This is my favorite part of the day and a very meaningful and rewarding one too! During this time, I see a patient consistently on a weekly basis for 6 to 8 weeks for cognitive behavioral therapy, a mainstay for functional neurologic disorders. I get to have longitudinal, close follow-up with the same patient on a weekly basis and get to really know and help them make the connection between their thoughts, emotions and behaviors and how this has an impact on their neurological symptoms. I really enjoy this part of clinic because it is a unique opportunity to perform therapy and learn the role of nonpharmacologic interventions in treatment of more challenging patients.

4 to 4:30 p.m.
I usually head home around this time after placing medication and lab orders for my patients.

5:30 to 8:30 p.m.
I finish up any notes I may have. I then prepare and enjoy dinner with my family. After dinner, we usually go for a walk or stop by the gym.

8:30 p.m.
It’s time to get ready for bed, but first I must see the next episode of The Pitt!

What I like about our program
Our attendings support resident autonomy and create a fostering learning environment. As an academic institution, we also have dedicated education track time to work on projects related to curriculum development, medical student teaching or posters to be presented at national conferences. Our program also offers protected time off for the research track to complete research-related projects. The mentorship offered within our department makes our experience as residents more enriching and meaningful. Not only are our attendings there for supervision, but they are also great mentors to support our professional development.