A Week in the Life (PGY4)

A Typical Week for Shelby Powers, MD, MS


  • Shelby Powers with her baby
    Morning: Weekday mornings, I wake up around 6:30am. I get ready and put together my toddler’s lunch and “school” bag. I aim to leave the house by 7:30am, but nearly every morning it is closer to 7:40am. Those toddler snuggles are worth the delay! From 8 to 11am, I see patients both in person and by telehealth for hour-long psychotherapy appointments. I have been seeing half of my patients since the beginning of my PGY3 year and truly enjoy working with them. At 11am, I switch gears and attend virtual supervision and didactics with the perinatal clinic. Beginning January 2024, I will see peripartum patients on Monday mornings and my psychotherapy clinic will move to Wednesday afternoons. 
  • Afternoon: At noon I often attend the virtual med-psych conference unless I have meetings for research, national subspecialty groups or program leadership roles. Monday afternoons are reserved for my work as the Duke Behavioral Health Outpatient (BHOP) Chief Resident. This typically involves checking in with residents or meeting with various outpatient staff, like our outpatient director or other clinic administrators. It’s a great opportunity to start to learn the system more intricately and advocate for residents in the clinic.
  • Evening: One Monday per month, I have dinner with one of my mentors, an attending at the state psychiatric hospital. Otherwise, I might pick up my son from “school.” We often head to the Duke Gardens or to the park down the street from our house. Then its dinner, toddler bath time, and bed before 11pm.


  • Morning: As part of my interest in psychosis, I work at the VA Mental Health Intensive Case Management (MHICM) clinic. This clinic sees veterans with serious and persistent mental illness (SMI; e.g., bipolar disorder, schizophrenia, clozapine management, long-acting injectables). I mostly see patients in the office but sometimes accompany case managers on home visits.
  • Afternoon: Tuesday afternoons are the dedicated Academic Half-Day (AHD) for the entire residency. This is three hours of protected lecture time. As a member of the Duke Psychotherapy Track, I often have an additional hour of a therapy-related lecture. AHD is in person once per month and lunch is provided! Otherwise, I Zoom in from home, probably while eating a microwaved burrito. AHD ends at 5pm.
  • Evening: My Tuesday evenings are jam-packed! I participate in an extra psychodynamic therapy elective from 5 to 6pm. We watch and discuss “classic” recordings from psychotherapy with one of our psychotherapy instructors. For those of us interested in psychotherapy, it is an incredible opportunity. Afterwards, I have a free hour and usually take my son to the park near our house while my husband makes dinner. Just after 7pm I start another psychodynamic course, Psychological Development Across the Life Cycle, through the local psychoanalytic center. The Psychoanalytic Center of the Carolinas offers a fellowship to trainees and early attendings in the area. It provides $5,000 for additional treatment, coursework, conferences, etc. This has been an amazing opportunity.


  • Morning: Another therapy morning for me! Beginning at 8am, I see two patients as part of an Acceptance and Commitment Therapy (ACT) practicum. This is a year-long elective with didactics and supervision provided by respected experts in ACT. Lectures/supervision are from 10am until noon.
  • Afternoon: Unless I have meetings, I sign into Chair’s Conference while eating lunch. Chair’s Conference is an eclectic mix of engaging extras—residents may present on their work, attendings lead a series modeling vulnerability by sharing their struggles, residents may present on personal identities, etc. After this, I have protected research time to work on presentations, abstracts, manuscripts, data gathering and analysis, etc. I have also been using this time to interview for addiction psychiatry fellowship! The program offers protected time for interviews.
  • Evening: Once a month, my Wednesday evenings include yet another psychotherapy course from the psychoanalytic center, Personality in Psychotherapy and Supervision, taught by Nancy McWilliams! Once Wednesday per month I Zoom with my best friend in Kansas City. If nothing is planned, you may find me hanging in the backyard with my son.


  • Morning: This is a slower morning for me. I spend my time at BHOP, the Duke outpatient clinic located at Duke Regional. This is the busiest morning in the clinic as it brings together all of the PGY3s for a morning of patient care and shared didactics. I am present to help answer resident questions or to troubleshoot clinic issues. At 11:00, residents and attendings gather for group supervision and didactics. Didactics may include presenters from community programs or industry.
  • Afternoon: I often grab lunch from the Duke Regional cafeteria (I recommend the Philly cheese steak!). Recharged, I spend the afternoon seeing my own outpatient panel. This is usually six patients followed by an hour of supervision. I try to complete my notes before leaving for the day, but I am admittedly still working on efficiency.
  • Evening: This is the first night of the week where I don’t have any regularly planned social or professional activities. I usually make dinner for the family and play with my toddler.


  • Morning: I drive 20 minutes to the state psychiatric hospital in Butner, NC. As part of my interest in SMI, I spend my morning on the Community Transitions Unit. This unit serves patients with extended stays at the hospital due to severe, chronic or treatment resistant illness. A large portion of my morning is spent in one-on-one psychopharmacology didactics with the attending.
  • Afternoon: I often head back to Durham and grab lunch at a coffee shop. This afternoon is my administrative half-day, a time meant for managing patient messages, calling back patients or coordinating with other care providers; however, I also have an hour blocked for psychodynamic supervision. I meet my supervisor at her community office in the community to discuss patient cases. I credit the quality of my supervision with nurturing my interest in psychotherapy and I really value this time with her. Afterwards, I return to Duke Regional Hospital to wrap up any lingering clinical work from the week.
  • Evening: We tend to order in on Fridays, often from our favorite local pizza place, Sofia’s. The evening is for relaxing. 


  • Morning and afternoon: We usually start the day with homemade sourdough waffles. Then my son is in toddler swim “lessons,” so we head to the local pool, where he and I have some fun! Afterwards, we often go to the American Tobacco Trail. This is a 23-mile paved trail through several counties in the area. I get some exercise pushing him for a few miles in the stroller and we stop at a playground or two along the way. Nearly every weekend seems to have a toddler birthday party, but we also find time to run errands and complete chores. 
  • Shelby and her toddler son at the lake
    Evening: Depending on the season and the weather, we might attend an NC State University football game, catch a Durham Bulls game, or meet up with friends for a backyard dinner.  


In 2016, my parents retired to North Carolina and bought a house on a lake about 90 minutes from Durham. Many weekends from March to November you can find us at their place, bobbing in the water, taking boat rides, and roasting marshmallows. My parents are also happy to keep an eye on the tot while I work on research projects. After a little sun and fun, we are ready to restart the week! 

I chose Duke because …

… I had a phenomenal interview experience. Back when interviews were in-person, the resident dinner was an opportunity to experience and better understand a program’s intangibles. My Duke dinner felt like a meal with good friends. My impression was that residents were engaged, happy and well-supported. Interactions with Dr. Vestal the following day cemented my interest. I had been advised to prioritize a program’s interpersonal fit when interviewing, and the fit with Duke felt effortless. I am so glad that I let this sense lead my decision. Duke has the world class training I was seeking, and I have also felt at home.

My favorite thing about Durham is ...

… it is both big enough to have everything I want and small enough to be convenient. We were able to buy a house with a big backyard where my son loves to play. My house is close to all of the program sites and so time spent commuting is minimal. There is rarely significant traffic. Parking for events and restaurants is convenient. I am 15 minutes from an international airport. I love music and live performances and I desired that in a residency location. The Durham Performing Arts Center hosts touring Broadway shows and other national acts. Great musical groups come through the area. Durham offers both entertainment and comfort. 

My favorite thing about Duke is ...

Shelby and co-residents at the PGY4 retreat to Wilmington, NC
Shelby and a few of her co-residents at the PGY4 retreat to Wilmington, NC

… the tangible support that comes in many forms, both personal and professional. I experienced this during a high-risk pregnancy and later a cardiac surgery. The program did not dictate what would happen, but instead asked what I needed and how they could help. I was never pressured to make decisions based on the program’s needs. They worked to get me what I needed without compromising or extending my training. Life happens. The program knows this and my colleagues have had similar positive experience of the program’s caring and flexibility. I know that resident wellness has meaning at Duke Psychiatry.

My advice to prospective residents is ...

... no matter where you are interviewing, don’t be afraid to reach out to current residents. Residency is a significant chunk of time, and both applicants and programs are looking for a good fit. It is important to have your questions answered, plus these informal conversations may provide a sense of the program’s culture. In my opinion, Duke is a good fit for those seeking excellent training surrounded by great people.

Read other Week in the Life narratives: