Psychiatry Residency

PHEW! You made it through intern year, passed all three board exams, and somehow made it to PGY-2. Now it’s time to focus on what you actually came here to do: Psychiatry!

As a PGY-2, life feels a little different. The days may be a little longer, the expectations are a little higher, and you’re expected to know a little more. But the good news is that you also have the opportunity to really stretch your wings and flex those psychiatry muscles.

7:00 AM: Rise and Shine

Most days begin with getting to work around 8:00 AM. Depending on your rotation, you may be working in an inpatient or outpatient setting, although the majority of PGY-2 is focused on inpatient psychiatry.

During the Day: Psychiatry, Psychiatry, and More Psychiatry

PGY-2 provides the opportunity to experience psychiatry in different settings, including:

Consult-Liaison Psychiatry

Inpatient Psychiatry

Child and Adolescent Psychiatry

Emergency Psychiatry, and others!

This is the year when things really start to come together. You’ll build confidence and learn to navigate increasingly complex psychiatric presentations, all while continuing to work closely with the incredible attendings at VTC.

We also start night float rotations during this year. While working overnight comes with its own unique challenges (and a strong appreciation for LOTS of caffeine!), it’s a great opportunity to develop some independence, sharpen your clinical skills, and become more comfortable managing patients and making decisions on your own.  The safety net is there, but it is just a little bit farther away.

Of course, the expectations are greater. You’re expected to know more, do more, and occasionally look like you know exactly what you’re doing! The good news? By this point, you might actually be getting pretty good at it.

4:00-6:00 PM: The Workday Winding Down

During PGY-2, short-call requirements are reduced, but you’ll spend more time on rotations that may include six-day workweeks and the occasional 24-hour weekend shift.

On a typical day, work will wrap up somewhere between 4:00 and 6:00 PM. Once you’re finished, it’s time to enjoy the evening and recharge for the next day.

Evenings: Finding the Balance

Fortunately, Roanoke offers plenty to do outside of the hospital, particularly if you enjoy the outdoors. Whether it’s hiking, exploring the area, spending time with you coresidents, or simply being lazy and relaxing at home, there are plenty of ways to make the most of your time outside of work.

And, of course, there is always the alternative:

Going home to study…

We’re sure our attendings would recommend that option!

At the end of the day, PGY-2 is about finding the right balance between working hard, learning, growing, and maintaining a life outside of residency. It’s a busy year, but it’s also an exciting one. This is the year where you start feeling less like a resident who is learning psychiatry and more like a psychiatrist in training. And that’s pretty great!

Third year of psychiatry residency is when you spend the year developing longitudinal relationships with patients by regularly seeing them in your various outpatient clinics.  Here at Carilion, we are able to choose from clinics that serve children and adolescents, adults, and geriatric patients.  There are also opportunities to focus on addiction psychiatry, college students, veterans, and underserved populations.  My clinic responsibilities are largely from 8 AM to 5 PM Monday trough Friday, working in outpatient clinics at the Salem VA and Carilion's Tanglewood location that is close to Roanoke Memorial Hospital. On Wednesdays, I travel to clinical site 45 minutes away where I get to meet with patients from more rural areas.  Since Carilion is one of the largest healthcare systems in this region, I get to work with a variety of patients from different backgrounds representing a wide breadth of psychopathologies, and continue learning about the nuances of psychopharmacology and developing therapy skills. Didactics continue each Thursday morning where we supplement our knowledge in these areas.  During third year, you finish the last of your 24 hour calls, allowing time for moonlighting which you are cleared to start doing during this year.  As a senior resident, you help to mentor interns on their short calls as they learn how to admit and manage patients; this experience is particularly rewarding and shows you how much you have learned so far in residency.  Of course, your own learning continues, and is supported by faculty and our awesome administrative staff via mentoring and education. Since you are on more of a routine this year, it is important to take advantage of that! This is a time where you can explore career and fellowship opportunities and pursue your goals in medicine and research. Besides work, Carilion offers free gym membership to residents, something I utilize - especially their indoor and outdoor pool.  Living in this region provides unique chances to experience the natural beauty of Appalachia with copious hiking trails and campgrounds. There are many active groups in town that cater to interests in music, the arts, and the outdoors. Everything you need to live comfortably is easy to get to in Roanoke thanks to its size. If you ever need to get out of town, Roanoke is served by Amtrak and our local airport. Each time you return home, you will be greeted by the huge neon star on Mill Mountain, an important cultural and natural landmark - it even has a zoo! 

My name is Tom, and I am one of the chief residents for the 2026-2027 academic year. 4th year at VTC is pretty much all electives other than required sub-attending blocks on inpatient psychiatry and consult liaison. My schedule also includes rotations in VA inpatient psychiatry, palliative care, TBI clinic, interventional psychiatry, GME administration, geriatric psychiatry, VA ambulatory clinic, as well as a 3-month block of trauma-focused psychotherapy through the VA. I'm considering a career as a VA psychiatrist, so I designed my schedule with a heavy VA emphasis this year. All PGY-4 residents also keep a half-day of VA clinic per week (with our same patients from PGY-3 year) for long-term continuity.  My typical schedule varies a bit based on which rotation I am on, but I usually work ~ 8 AM - 4:30 PM. Along with other senior residents, I also supervise the interns 1-2x a month on their evening short-call shift at the hospital. After work, I usually try to go to the gym or go for a hike on one of the many hiking trails in the area.