Thomas Wolz, DO

A day in the life of a PGY-3 Resident

My name is Thomas Wolz, DO, and I am one of the PGY-3 psychiatry residents here at Lehigh Valley Health Network (LVHN). Our third year is predominantly spent in the outpatient clinical setting and split between a few different locations. All six PGY-3 residents spend some time at LVHN Mental Health Clinic–17th Street. The cohort also has clinic hours at LVPG Adult and Pediatric Psychiatry–1259 Cedar Crest while the other half of the cohort has clinic time at LVPG Adult and Pediatric Psychiatry–Muhlenberg. These programs are each unique in their settings, patient populations and wonderful support staff. The 17th Street clinic is in the heart of Allentown while the LVPG practices are in suburban Allentown and Bethlehem. We primarily see patients for medication management and also carry a caseload of a minimum of five patients we perform therapy with. The therapeutic models we incorporate and learn are supportive psychotherapy, cognitive behavioral therapy and psychodynamic psychotherapy. The general caseload for patients initially starts with one-hour visits for all follow-up patients and longer for new intakes. As we grow more used to the workflow of outpatients over the first few months, our follow-up times are reduced to 30-minute slots while maintaining one-hour appointments for therapy patients.

I spend Mondays and Tuesdays at the 17th Street clinic. The first patient appointment is at 8:30 a.m. and I usually show up half-an-hour beforehand to review my patients for the morning, should I not have had the chance to review the day before. I see the patient, come up with a plan and leave the room briefly to discuss the case with my attending before returning to the patient with a finalized plan. Once the patient leaves, there is often time to wrap up the rest of the note before the next patient arrives. On Monday afternoons following clinic, we have cognitive behavioral therapy supervision with Drs. Carosella and Salas from 4-5 p.m. Tuesdays following clinic, we typically have supervision with Dr. Martin, one of our outpatient attendings and the program director, where we discuss particularly challenging patients and scenarios.

Wednesdays from 8-10 a.m. are spent in psychodynamic psychotherapy supervision with Drs. Lewis and Marraccini. Each of us must carry at least one case that we perform weekly psychodynamic therapy. On these mornings we discuss our conversations from that week and explore the cases more thoroughly in a laid-back, conversational setting with our attendings. We typically split into two groups between the two attendings, allowing ample time for in-depth discussion. After supervision, we have didactics beginning at noon and ending at 4:30. A typical didactic schedule will be two back-to-back hour lectures to begin, composed of a combination of journal clubs, case presentations from other residents and fellows, grand rounds and talks from attendings within psychiatry and adjacent fields. The third hour is group supervision and the final hour is board review. Group supervision is usually spent with Dr. Martin, our program director, and we discuss anything important for the good of the residency and any interesting cases. One group supervision of the month is spent with Dr. Norris, our departmental chair.

The latter half of the week is where our cohort splits, with half of us going to the Cedar Crest LVPG clinic, like myself, and the other half going to the Muhlenberg LVPG clinic. The days are like those at the 17th Street clinic with slight exceptions. We begin our days at 8 a.m. and on Thursdays see patients until 5 p.m. On Fridays we see patients until 4 p.m. and spend the final hour of the day in supervision with one of our attendings.

The last part of our work schedule during third year is the call schedule. We have in-person call every fourth weekend on average. Half of the weekends are spent working on the inpatient psychiatric unit while the other half of the weekends are spent working on the psychiatry consult-liaison team on the medical floors. We nearly always will be working with a resident from the PGY-1 or PGY-2 classes during these weekends. In addition to the in-person call weekends, we also have a form of overnight home call. Approximately once a week we are responsible for any urgent after-hours calls to the outpatient psychiatry clinics and any urgent issues for the consult psychiatry patients in the hospital. We receive a page, return the call of whoever had a concern, and address the issue remotely, all while not having to leave home. Often home call is simple, usually receiving one page or fewer a night, and when we are paged it is mostly in the early evening hours.

Most days throughout third year I am done with work by 5 p.m. and my time is free in the evenings. This work-life balance allows me to spend more time with friends, doing hobbies and exploring the Lehigh Valley.