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PGY-3 Spotlight

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PGY-3 Clinical Rotations:

  • MD leader of an Assertive Community Treatment (ACT)-like program for severely mentally ill patients at a federally qualified health center in Hillcrest
  • Two psychotherapy cases at the UC San Diego Outpatient Psychiatric Service (OPS)
  • Bereavement elective learning therapeutic techniques for working with patients suffering from grief, loss, and complicated grief, 1-2 psychotherapy cases/yr
  • Survivors of Torture International clinic providing psychiatric care to refugees
  • Intakes at Vista Balboa Crisis House that provides a respite for patients in crises who do not require inpatient admission
  • South Bay Guidance Center county clinic for severely mentally ill patients in the community, 1-2 psychotherapy cases/yr

Average weekly hours:

Least (35 hours), Most (82 hours, during night float), Average (45 hours)
# weekend call shifts per month ~ 1
# night floats - 4, in one-week chunks spaced ~ 2-4 months
# holidays working - 4

Get to know Al

Background & Education:

I grew up in the Chicago suburbs. I went to college at Washington University in St. Louis where I majored in psychology/minored in Spanish and ran division III track and field. I returned home to Chicago for medical school at Rush University (still very much a pizza snob). Driven by a lifelong desire to live in California, I was ecstatic to make the move to San Diego and since then my family has also relocated to SoCal! 

Career Goals/Interest within Psychiatry:

  • Child and adolescent psychiatry - During PGY-2 year we rotate for one-month on an inpatient child psychiatric unit and at a youth eating disorders program. We have the opportunity to join the San Diego Academy of Child and Adolescent Psychiatry (SDACAP) chapter and attend meetings for local networking. I used my UCSD education funds to participate in the national American Academy of Child and Adolescent Psychiatry (AACAP) annual meeting in Chicago last year, and will be presenting a case with one of my peers for the virtual conference this year.
  • Global psychiatry - I am currently working on developing volunteer opportunities working with medical providers and refugee patients at the border in Tijuana, Mexico.
  • Community psychiatry - This specific track of our residency fulfills my interest in learning about health systems, population health, and advocacy.
  • Psychotherapy - The San Diego Psychoanalytic Center offers lectures, a free fellowship for residents and experienced local analysts who may serve as supervisors during PGY-3 or 4 years.
  • Humanities - There is a quarterly "Literature of Madness" lecture series during didactics. 

    Typical Week

    SUNDAY 
    AM:
     I get to sleep in! Then meet my friend for a trail run at Iron Mountain to catch up and enjoy the great outdoors. This is one of my favorite routes for running or hiking that is only a 35 min drive Northeast of the city; it's intermediate difficulty, about 5 miles round trip with a rewarding view. You can see the Channel Islands on a clear day! On our way home to we stop at Pannikin coffee and get a latte and one of their famous muffins.
    PM: I have a chill evening grabbing groceries at Sprout's or a local farmer's market if I have more time. I love how there are so many weekly farmer's markets here - most of the major neighborhoods have them. Later, I will prep lunches for the week and watch some stand-up comedy before bed for a couple laughs.

    MONDAY

    AM: I typically wake up at 6:30 on weekdays and have some bulletproof coffee (black coffee and butter!) and a smoothie while I check my emails. Then I head to Family Health Centers in Hillcrest. Commuting from North County isn't bad because it's against traffic and it is close to the VA in La Jolla, but it is farther from downtown. All morning and afternoon I am calling patients with severe mental illness in the community for check-ins. Given their high-risk status, I try to connect with each patient q 2-4 weeks. We have weekly team rounds with each therapist to discuss how each patient is doing, coordinate care, and decide whether they have improved enough to downgrade to a lower level of care.
    Noon: I'm eating veggies with Bitchin' sauce (amazing local hummus-like concoction) at my desk and look up information on a new psychotropic one of my patients mentioned. Later I discuss cases with my supervisor and he gives me tips on developing as a physician leader on this team. I continue to virtually "meet" patients until 4 when I head home.
    PM: This year I have a fair amount of time to read and alternate between fiction and nonfiction. Currently I'm doing a book club with a friend reading Catch-22 so I call her to 'catch' up. Then I'll grill some tuna and veggies with leftovers to eat for the week. It's easy to be a pescatarian/vegetarian in San Diego, lots of good fish! Lights out for me at 10:30.

    TUESDAY
    AM: From 8 to 10 we have PGY-3 journal club. Then from 10-12 I have two psychotherapy cases.
    Noon: I'll walk over to the UCSD cafeteria to have lunch with classmates, my favorite time of day (of note: the cafeteria has amazing breakfast burritos that taste really good after a night float shift).  My bereavement elective is currently virtual and we use fictional works to supplement our discussions on grief and loss. Today I watched a heartwarming movie, "A Man Called Ove," and my peer and I discussed this dark comedy with our supervisor and how much it made us cry.
    PM: I'm home at 4 today, in time for supervision with an esteemed local psychoanalyst to dissect the transference I experienced with my morning therapy patients. Then I'm dying to get in the ocean and might throw on my rashguard and flippers and go bodyboarding at the beach for an hour. (The stingray shuffle is second-nature for me now). I have a lot of patient notes to prep so I pick up some tacos from City Tacos for a quick dinner; the portabella mushroom taco is the best.

    WEDNESDAY
    AM: Starting the day setting up my home office for the Survivor's of Torture International clinic, which is currently all virtual. I am learning how to provide trauma-informed, culturally competent care. This morning I meet with patients who speak Arabic, English, Spanish, and Haitian-Creole.
    Noon: Driving downtown for my afternoon clinic; I listen to Spanish Podcasts like NPR's Radio Ambulante to keep my language skills fresh. If I have time, I will eat my salad in the grass in beautiful Balboa Park (home to the San Diego Zoo and much more). Then I head in to the crisis house, where I meet with 1-2 patients who recently arrived. When we are on call in the hospital we often send patients here from the ED.
    PM: Pre-COVID I used to go to run club in North Park at Milestone Running Shop. Sometimes there would be up to 60 people, all ages and abilities there on Weds nights! Now I still try to reconnect with a friend from the club and do a run in that area before heading home. I eat leftovers for dinner and do readings to prepare for didactics.

    THURSDAY
    AM: Didactics! Pre-COVID, I enjoyed the free coffee, fresh fruit, and breakfast burritos and chatting with my friends before the speaker started. Now, I roll right out of bed into a Zoom lecture from my couch with my own coffee and see everyone's pets on screen. Lectures range from a Jeopardy-style "Mind Games" competition between the residents and faculty to psychopharmacology talks by Dr. Steven Stahl. After the first lecture, the residents separate by class; last week the PGY-3's learned the ins and outs of prescribing medications for opioid use disorders.
    Afternoon: I have personal psychotherapy during the lunch hour, since PGY-1. The program leadership helped me find a therapist and appointment time that would fit in my schedule. We receive one year of free psychotherapy provided by the program, if you choose to participate. Since I am in the community track, we have a full day of didactics. This week we talked about the infrastructure of the San Diego County behavioral health system. We end with group supervision with a psychologist, sharing interesting cases and gaining insight from peers.
    PM: After a lot of computer time, I bring an avocado sandwich to the beach  and walk to the beach to do some creative writing and watch the sunset. I prepare for tomorrow's patients and get to bed early.  

    FRIDAY
    AM: My co-resident and I carpool to Chula Vista with some Indie jams going, getting there at 8:30. We work with severely mentally ill patients at the South Bay Guidance Center and have one therapy case there. I like this clinic because I have many TAYs (Transitional Age Youth) and Spanish-speaking patients.
    Noon: I eat lunch at my desk and finish seeing patients at 4. From 4-5 I complete notes and write labs.
    PM: Movie night with my classmates! Pre-COVID we would do this at someone's apartment and pick a different psychiatry-related movie. Last time we watched One Flew Over the Cuckoo's Nest. The commentary from classmates is often more entertaining than the film.

    SATURDAY
    AM: Have some coffee, grab my wetsuit and Foamie to meet my classmates for a surf sesh (I'm happy if I stand up on one or two waves). When we finish we pick up some acai bowls for breakfast and a few of the guys head to play frisbee golf in Balboa Park.
    Noon: Do some laundry and reading.
    PM: Likely join my friends at a craft brewery; Modern Times is one of our faves. Rinse and repeat!


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