So everyone i have spoken to LOVES their psych rotation

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yet it on the bottom of the totem pole

is it really just the negative stigma? bc lifestyle is great too, right?

It's a great specialty, but for the same reasons that surgery, optho, or other procedure heavy fields are popular for their immediate impact on the patient, psych is unpopular for the much longer course of recovery (if any at all).

However, is it possible your school's department is really good and skews impressions?

Psych was my favorite 3rd year rotation, I thought it was really fun.

Originally Posted by CatFactorial

It's a great specialty, but for the same reasons that surgery, optho, or other procedure heavy fields are popular for their immediate impact on the patient, psych is unpopular for the much longer course of recovery (if any at all).

However, is it possible your school's department is really good and skews impressions?

I don't think it's just one department making it great, I've heard lots of people say psych is really cool who aren't planning on going into it. Part of it is probably the lack of immediate impact, part of it may be the stigma of being a psychiatrist and all that entails, and I think a lot of people just have it crossed off their list from day 1 because they don't want to deal with that patient population, which is understandable.

Originally Posted by Dr Gerrard

yet it on the bottom of the totem pole

is it really just the negative stigma? bc lifestyle is great too, right?

Psych is like Art/Music in public education

Its fun and enjoyable. The people who work in it are generally a little crazy themselves, but they like what they do.

When it comes to budgets, psych is the first to go. You don't get any respect from the smart teachers, and, in reality, any medicine doctor can fix what can be fixed... we leave the incurable psychotic diseases to the psychiatrsits. Plus its depressing, everyone being depressed all the time. And irritating, because, honestly, can't everyone tell the difference between dementia and delirium... do we really need a psych consult? Yes. Because who wants to deal with that?

Originally Posted by OveractiveBrain

Psych is like Art/Music in public education

Its fun and enjoyable. The people who work in it are generally a little crazy themselves, but they like what they do.

When it comes to budgets, psych is the first to go. You don't get any respect from the smart teachers, and, in reality, any medicine doctor can fix what can be fixed... we leave the incurable psychotic diseases to the psychiatrsits. Plus its depressing, everyone being depressed all the time. And irritating, because, honestly, can't everyone tell the difference between dementia and delirium... do we really need a psych consult? Yes. Because who wants to deal with that?

Whenever I hear physicians in other specialties talk about psych and FM, it's like they could at any time pat the family docs and psychiatrists on the head and tell them to let the grown-up doctors take care of the real problems. I've heard very nice people sound fairly condescending toward those two specialties in particular.

Figure 1:

Originally Posted by SteinUmStein

Whenever I hear physicians in other specialties talk about psych and FM, it's like they could at any time pat the family docs and psychiatrists on the head and tell them to let the grown-up doctors take care of the real problems. I've heard very nice people sound fairly condescending toward those two specialties in particular.

Because they're tools.

But it's not hard to see why many people don't wanna do psych. The patient population is difficult, almost NOBODY respects psychiatrists (as indicated above), and you hear about psych residents and doctors being killed or assaulted by patients(which I guess factors into the 'difficult population'). Not surprising, although you will find many on these boards who will vehemently argue that psych is one of the few "hidden gems" in medicine.

Originally Posted by Slack3r

Because they're tools.

But it's not hard to see why many people don't wanna do psych. The patient population is difficult, almost NOBODY respects psychiatrists (as indicated above), and you hear about psych residents and doctors being killed or assaulted by patients(which I guess factors into the 'difficult population'). Not surprising, although you will find many on these boards who will vehemently argue that psych is one of the few "hidden gems" in medicine.

I didn't mean to badmouth psych, I think it's a really neat field that I would consider going into if I enjoyed my rotation. There are a few things about it that make me hesitate though, like the notorious 'difficult population.' If every patient wanted help from their psychiatrist I really think the field would be much, much more popular.

I hated my psych rotation. To much pseudo intellectual masturbation.

I am kind of interested in psych but the danger aspect kind of scares me. I find it interesting, but I definitely wouldn't be able to physically hold my own against a crazed patient!

How do psychiatrists protect themselves from stuff like this?

Originally Posted by neusu

I hated my psych rotation. To much pseudo intellectual masturbation.

I think this might bother me too, I don't have a very high threshold for BS. Hopefully the department at my school is more evidence-based and biological than hyper-analytical.

Originally Posted by Dr Gerrard

I am kind of interested in psych but the danger aspect kind of scares me. I find it interesting, but I definitely wouldn't be able to physically hold my own against a crazed patient!

How do psychiatrists protect themselves from stuff like this?

Assault rates are probably higher in the ED, frankly. I think the risk is present but way overblown. Any hospital worth existing should have appropriate staff to deal with any situations that come up

Originally Posted by neusu

I hated my psych rotation. To much pseudo intellectual masturbation.

As opposed to neurology, which is intellectual masturbation. :-)

Too much of the actual practice of psych seemed to be mainly social work for me.

I'm sure you can have a lucrative practice listening to rich people complain and paying in cash, but it seems like a waste of an MD.

Also, the DSM is garbage and probably will still be garbage after the revision.

Originally Posted by johnnydrama

As opposed to neurology, which is intellectual masturbation. :-)

Too much of the actual practice of psych seemed to be mainly social work for me.

I'm sure you can have a lucrative practice listening to rich people complain and paying in cash, but it seems like a waste of an MD.

Also, the DSM is garbage and probably will still be garbage after the revision.

The social work part is problematic... I didn't go to school for this long to be a glorified social worker. I wish there was something in between outpatient in the suburbs listening to rich people complain and intense inpatient care of people who are never going to get better or who will keep coming back with the same problems exacerbated by poverty, drug abuse, etc.

Yeah, the depressingness of many of the patient's life situations can definitely be tough to deal with, particularly in C&A... It's like half the patient pop is the same as forensic peds

Originally Posted by Dr Gerrard

yet it on the bottom of the totem pole

is it really just the negative stigma? bc lifestyle is great too, right?

people like psych rotations because unless you do it at a rotten place, you generally start late and end wildly early.

it's a nice rotation to visit but I wouldn't want to live there.

Recently there was that paper that described Alzheimer's (and potentially Parkinson's) as behaving in a prion-disease kind of fashion.

I feel like more advances in that regard are on the way, so psychiatry seems like a really exciting field to be entering now.

Originally Posted by CatFactorial

Recently there was that paper that described Alzheimer's (and potentially Parkinson's) as behaving in a prion-disease kind of fashion.

I feel like more advances in that regard are on the way, so psychiatry seems like a really exciting field to be entering now.

If there's a clear biological basis to something in the brain, it belongs to neurology.

It's an interesting rotation. The attending and I tend to trust people differently, so it's tough.

Hours aren't awful, though.

I give the field more respect than I had originally given it.

Originally Posted by johnnydrama

If there's a clear biological basis to something in the brain, it belongs to neurology.

What an asinine sentiment.

Is depression abiological?

Originally Posted by CatFactorial

What an asinine sentiment.

Is depression abiological?

I was joking. :-)

I actually enjoyed most of my psych rotation, except for when I had to answer psychiatry consults all over the hospital... which was just sad as it showed me how little physicians try to apply some basic knowledge of psychiatry in their own practice of medicine (and was a teaching point for me). I developed a lot of respect for the psychiatrists and I thought dealing with the truly psychotic patients was awesome. The antisocial people creeped me out.

I like doing some procedures so that was the main reason I didn't entertain psych as a career possibility, but I haven't much to add to what else was said here... there's a strong perception of it as "low on the totem pole", and psychiatrists get far less respect than they should. They also taught me how to deal with very difficult patients and also refine my interviewing skills. I hope everyone who rotates through it has the same experience as I did.

Originally Posted by OveractiveBrain

Psych is like Art/Music in public education

Its fun and enjoyable. The people who work in it are generally a little crazy themselves, but they like what they do.

When it comes to budgets, psych is the first to go. You don't get any respect from the smart teachers, and, in reality, any medicine doctor can fix what can be fixed... we leave the incurable psychotic diseases to the psychiatrsits. Plus its depressing, everyone being depressed all the time. And irritating, because, honestly, can't everyone tell the difference between dementia and delirium... do we really need a psych consult? Yes. Because who wants to deal with that?

Wow, that's a lot of condescension.

Originally Posted by ArcGurren

Wow, that's a lot of condescension.

Par for the course for that particular poster.

I do agree that there are two perceptions of psych, either dealing with rich housewives or psychotic potentially homicidal homeless people. Too bad.

Originally Posted by Dr Gerrard

I am kind of interested in psych but the danger aspect kind of scares me. I find it interesting, but I definitely wouldn't be able to physically hold my own against a crazed patient!

How do psychiatrists protect themselves from stuff like this?

As mentioned before, the ER doctors probably have more to worry about in this department than psychiatrists do. Ask the residents and attending psychiatrists you meet. You will probably get an occasional "crazy drunk guy in the ER took a swing at me" or some story like that but you will be surprised how rare serious violence is. In general be careful around intoxicated people (no matter which specialty you practice), be careful around psychotic people who may not really understand what is going on, and be careful around deeply antisocial and angry people. With some common sense though I think the risk is minimal.

A couple of things kept me on the fence about psychiatry for a while. One is the amount of respect from the public and colleagues-- psychiatrists probably get the least respect of any field. The other is the lack of confirmatory labs/imaging and the lack of procedures.

Ultimately though I realized that psychiatry is what I have the most interest in and enjoy doing the most. I don't care if people will be less impressed with my being a psychiatrist than they would if I were say, a surgeon. My own interest and enjoyment of what I do will be a much better motivator to get up and do a great job than anyone else's admiration ever could. And for the absence of labs and the "hanging up the stethoscope," you still get to use your medical knowledge in the interface between psych and medicine, and you will ultimately use different skill sets (the mental status exam especially) that can be just as nuanced and interesting to learn and employ.

Psych isn't for everyone (thankfully, because we need people excited about every specialty out there!), but if it appeals to you I say really consider what is holding you back and make your decision based on what you see yourself enjoying most day to day, not based on what will make your parents/friends/family/random strangers most impressed.

I'm having a lot of fun on my psych rotation, but I don't want to do it for the rest of my life. The residents work normal hours, not the 9-4 with 90 minute lunches that we get as medical students.

I can deal with the depressingness for 6 weeks... but not for the rest of my life. 90% of the kids that we are seeing have been abused. And the rest have miserable home life that just doesn't reach the level of abuse. And the assumption is that most of them are going to come back to the hospital several times. Most of the kids spend an extra week or two in the hospital after being stabilized until they have somewhere to go. Overall it is an interesting thing to do for a little bit but not something I could do for the rest of my life.

i think if you've been training for over 9 years+ in undergrad, then med school, and soon residency---and you're still thinking about climbing that totem pole, and not about finding a specialty that best fits your personality and skills while supporting your recreational life--then I don't know what to say. Screw the totem pole, and do something you enjoy.

Originally Posted by adaptation1

i think if you've been training for over 9 years+ in undergrad, then med school, and soon residency---and you're still thinking about climbing that totem pole, and not about finding a specialty that best fits your personality and skills while supporting your recreational life--then I don't know what to say. Screw the totem pole, and do something you enjoy.

Screw the totem pole eh?

You might need the product in this ad:

that's the product i will recommend the psych patient who sticks a pencil up his penis.

Originally Posted by johnnydrama

Screw the totem pole eh?

You might need the product in this ad:

Just matched in psych. Why?

1. I enjoyed my psych rotation, so I did another. Liked that one too.

2. Massive shortage. > 55% of practicing psychiatrists are over 55yo. Shortage only going to get worse.

3. Ability to practice free from insurance system. Getting easier as shortage gets worse. Less headaches and...

4. Low office overhead. Rent, utilities, me. Easy.

5. Research is insane right now. New schizophrenia drugs with less side effects, new imaging/labs/diagnostics on the horizon, more efficacious treatments for various disorders (ECT advances, TMS, deep brain stimulation, etc).

6. Lifestyle is awesome. Great hours, little call. Good pay, especially if considered per hour. I know the salary averages say $180k, but I haven't met anyone making less then 200k for a 40h work week. Grads going to shortage areas have been getting 250-300k.

7. Detective work. Many docs get "psych patients" and don't even try. The amount of undiagnosed or misdiagnosed medical problems is astounding. Thyroid, hemochromatosis, cancer, the list goes on and on.

Regarding safety: it's something I was mildly concerned about, but after looking into it am not. Research has shown that ED docs and IM (esp Geri) are more likely to be victims of violence. Most psych wards have very good security. Take precautions with no ties, easy escape routes, etc. not usually an issue.

I enjoy usually having time to talk to my patients. Where else is medicine can you make this kind of salary with 1h pt visits? Some can be difficult, bu you learn ways to handle them.

I love it. Future PROAD specialty IMO.

Originally Posted by digitlnoize

Just matched in psych. Why?

1. I enjoyed my psych rotation, so I did another. Liked that one too.

2. Massive shortage. > 55% of practicing psychiatrists are over 55yo. Shortage only going to get worse.

3. Ability to practice free from insurance system. Getting easier as shortage gets worse. Less headaches and...

4. Low office overhead. Rent, utilities, me. Easy.

5. Research is insane right now. New schizophrenia drugs with less side effects, new imaging/labs/diagnostics on the horizon, more efficacious treatments for various disorders (ECT advances, TMS, deep brain stimulation, etc).

6. Lifestyle is awesome. Great hours, little call. Good pay, especially if considered per hour. I know the salary averages say $180k, but I haven't met anyone making less then 200k for a 40h work week. Grads going to shortage areas have been getting 250-300k.

7. Detective work. Many docs get "psych patients" and don't even try. The amount of undiagnosed or misdiagnosed medical problems is astounding. Thyroid, hemochromatosis, cancer, the list goes on and on.

Regarding safety: it's something I was mildly concerned about, but after looking into it am not. Research has shown that ED docs and IM (esp Geri) are more likely to be victims of violence. Most psych wards have very good security. Take precautions with no ties, easy escape routes, etc. not usually an issue.

I enjoy usually having time to talk to my patients. Where else is medicine can you make this kind of salary with 1h pt visits? Some can be difficult, bu you learn ways to handle them.

I love it. Future PROAD specialty IMO.

Thanks for your input, really good to know. Quick question if you have time - how do you see yourself dealing with depressed/disturbed/generally unhappy patients day in and day out? Do you see it wearing on you, or is there a particular way that psychiatrists tend to cope with it? Thanks again.

Originally Posted by adaptation1

that's the product i will recommend the psych patient who sticks a pencil up his penis.

Or in the case of the Fusilli Jerry!

Although I guess the Ass Man saved the day then.

Originally Posted by SteinUmStein

Thanks for your input, really good to know. Quick question if you have time - how do you see yourself dealing with depressed/disturbed/generally unhappy patients day in and day out? Do you see it wearing on you, or is there a particular way that psychiatrists tend to cope with it? Thanks again.

It's sort of like dealing with the Diabetics who won't follow their diet or watch their sugars. You just do the best you can and move on. That's all you can do.

I've also been dealing with it much of my life. I spent a good amount of time in the music biz in the late 90's, where everyone was gloomy and depressed, lol. No, seriously. There was tons of mental health problems around me, particularly depression, substance use, etc, and I learned how to deal with it...or adjusted to it.

I think it helps to really look at each patient as an individual. Wellbutrin might work wonders for the anhedonic depressed housewife, but not for others. One person might respond well to an exercise plan, another might prefer prescribed volunteerism. You just have to try and find the right combination of a) what makes them tick, and b) what they're willing to do/try, and c) meds.

Oh, I forgot to mention the awesomeness of tele psychiatry. And, that many psych jobs (both tele psych and live) are state/gov't jobs, which qualify for PSLF loan forgiveness and pay pretty well. I know a guy making $215k working 32 hours/week for a state hospital, plus seeing patients on the side in his private office 1-2 days a week.

Another nice thing is that psych isn't just depressed patients. There is a TON of variety. If you don't like the depression, you can see more schizophrenics. There addiction, forensics, Consult-Liason (hospital medical psych), etc, etc. You can do more ECT, or more med management. Love talking? Do therapy. hate talking? Do med management. It's very, very manageable and easily tailored to your own interests and personality.

I am planning on doing Child & Adolescent psych. Possibly Child Consult-Liason. ...but maybe not.

Easily my fave rotation this year, talking to interesting and dare I say entertaining patients, weekends off/no call, talking about videogames to kids on my ped psych portion, and studying/being fascinated by the inner workings of the human-mind


With that being said, I have no interest in becoming a psychiatrist

Originally Posted by digitlnoize

Just matched in psych. Why?

A great list! Lots of stuff to be excited about in psych.

Originally Posted by SteinUmStein

Thanks for your input, really good to know. Quick question if you have time - how do you see yourself dealing with depressed/disturbed/generally unhappy patients day in and day out? Do you see it wearing on you, or is there a particular way that psychiatrists tend to cope with it? Thanks again.

Frankly, you will meet depressed, anxious, neurotic patients in every field. I am actually a trained obgyn who is now going into a psychiatry residency. Frankly, my job as an obgyn requires me to a therapist 50% of the time.

Originally Posted by belle54321

Frankly, you will meet depressed, anxious, neurotic patients in every field. I am actually a trained obgyn who is now going into a psychiatry residency. Frankly, my job as an obgyn requires me to a therapist 50% of the time.

That's fair, I've also heard from family practitioners and general internists that half their day consists of essentially psych patients who don't want the stigma of seeing an actual psychiatrist.

Originally Posted by belle54321

Frankly, you will meet depressed, anxious, neurotic patients in every field. I am actually a trained obgyn who is now going into a psychiatry residency. Frankly, my job as an obgyn requires me to a therapist 50% of the time.

Funny you mention this. One of my former mentors was a mid-career OB/Gyn who said if he could do it all over again, he'd go into psychiatry.

Originally Posted by adaptation1

i think if you've been training for over 9 years+ in undergrad, then med school, and soon residency---and you're still thinking about climbing that totem pole, and not about finding a specialty that best fits your personality and skills while supporting your recreational life--then I don't know what to say. Screw the totem pole, and do something you enjoy.

This.

OP- you do make a good point, I don't know why people always mindlessly say they like something, but really have no interest in it. It's like how everyone says they like art, but really have never tried it or learned about it. What's the purpose?

I personally loved it, but knew I wouldn't be good at it. So I chose a different field.

I've worked with inpatient kids and I agree, 90% have been abused, some raped. The work is extremely rewarding or depressing, depending on how you look at it. Treatment can make all the difference in the world and turn despair into sorrow or hope for a good amount of the patients. Stabilizing somebody suicidal is extremely valuable, which in my opinion compares to an emed saving someone's life.

There is a certain percentage of sociopaths but you encounter those anywhere in life, especially in prison. Frankly, it really depends on the place you work at how bad the pathology is - you could work in an outpatient setting. Also, while you may not get as much respect outside, inside a psych ward or mental health facility you are the boss. It's not for everyone - if you get stressed out by all the craziness, do something else, some find it funny or are able to be the strong tower that the patients need.

Stabilizing somebody suicidal is extremely valuable, which in my opinion compares to an emed saving someone's life.

+1 on this being a very rewarding thing to observe (and one of the few things observable on a very short time frame)

Originally Posted by digitlnoize

Just matched in psych. Why?

1. I enjoyed my psych rotation, so I did another. Liked that one too.

2. Massive shortage. > 55% of practicing psychiatrists are over 55yo. Shortage only going to get worse.

3. Ability to practice free from insurance system. Getting easier as shortage gets worse. Less headaches and...

4. Low office overhead. Rent, utilities, me. Easy.

5. Research is insane right now. New schizophrenia drugs with less side effects, new imaging/labs/diagnostics on the horizon, more efficacious treatments for various disorders (ECT advances, TMS, deep brain stimulation, etc).

6. Lifestyle is awesome. Great hours, little call. Good pay, especially if considered per hour. I know the salary averages say $180k, but I haven't met anyone making less then 200k for a 40h work week. Grads going to shortage areas have been getting 250-300k.

7. Detective work. Many docs get "psych patients" and don't even try. The amount of undiagnosed or misdiagnosed medical problems is astounding. Thyroid, hemochromatosis, cancer, the list goes on and on.

Regarding safety: it's something I was mildly concerned about, but after looking into it am not. Research has shown that ED docs and IM (esp Geri) are more likely to be victims of violence. Most psych wards have very good security. Take precautions with no ties, easy escape routes, etc. not usually an issue.

I enjoy usually having time to talk to my patients. Where else is medicine can you make this kind of salary with 1h pt visits? Some can be difficult, bu you learn ways to handle them.

I love it. Future PROAD specialty IMO.

I liked psych because I came in at 9 AM and left at 1 PM and the psych facility had a really good sandwich shop. That doesn't mean I want to make a career of it.

Originally Posted by digitlnoize

It's sort of like dealing with the Diabetics who won't follow their diet or watch their sugars. You just do the best you can and move on. That's all you can do.

I've also been dealing with it much of my life. I spent a good amount of time in the music biz in the late 90's, where everyone was gloomy and depressed, lol. No, seriously. There was tons of mental health problems around me, particularly depression, substance use, etc, and I learned how to deal with it...or adjusted to it.

I think it helps to really look at each patient as an individual. Wellbutrin might work wonders for the anhedonic depressed housewife, but not for others. One person might respond well to an exercise plan, another might prefer prescribed volunteerism. You just have to try and find the right combination of a) what makes them tick, and b) what they're willing to do/try, and c) meds.

Oh, I forgot to mention the awesomeness of tele psychiatry. And, that many psych jobs (both tele psych and live) are state/gov't jobs, which qualify for PSLF loan forgiveness and pay pretty well. I know a guy making $215k working 32 hours/week for a state hospital, plus seeing patients on the side in his private office 1-2 days a week.

Another nice thing is that psych isn't just depressed patients. There is a TON of variety. If you don't like the depression, you can see more schizophrenics. There addiction, forensics, Consult-Liason (hospital medical psych), etc, etc. You can do more ECT, or more med management. Love talking? Do therapy. hate talking? Do med management. It's very, very manageable and easily tailored to your own interests and personality.

I am planning on doing Child & Adolescent psych. Possibly Child Consult-Liason. ...but maybe not.

Thanks for this post.

I'm interested in psych, but I'm not sure if I'll be any good at it...waiting to third year to find out.

Originally Posted by Schizotypy

Thanks for this post.

No prob. Glad to help!

Since it's come up a couple times, I will also throw in a vote for "Do what you're good at." Yet another reason that I like psych is that I feel like I can be a better psychiatrist than I could a surgeon.

While people can certainly break the stereotypes, typically speaking, an adrenaline junky would probably get really bored in psych and might be better suited to ER, Trauma Surgery, or the like. OTOH, some people may not have the manual dexterity for procedures, or the patience, or the attention to detail.

Know thyself and ye will know thine specialty. Or something.

I actually really hate this process. Why is it that PA's, NP's, nurses and other providers aren't forced to pick a specialty and are free to switch at any time? Why can a PA practice at a much higher salary after only 3 years, but a medical student with 4 years of training isn't fit for anything but an apprenticeship? While we're reforming our healthcare system, we should start with the training process for physicians. This 100 year old Oslerian system is an antique in dire need of an update. Sigh. Soapbox off.

I really enjoy psychiatry but since one my main drive to enter medical school was to open up an free / low cost outreach clinic for bread and butter family practice problems, I'm not sure I will be able to justify it to myself. I know that just as many poor people have psychiatry issues, but honestly letting go of "real" medicine after all this medical school seems like such a waste.

Looking for combined psychiatry / real medicine programs..But I don't think they exist outside of peds and neuro. Then again, there's my IMG stigma. My step was great, but I'm not sure I'm competitive enough for a dual program. Still have a year to decide...

I agree our medical system makes so little sense in some areas. I understand the reasons. You wouldn't want anybody with an MD opening up a surgery clinic...

Originally Posted by hrandani

Looking for combined psychiatry / real medicine programs..But I don't think they exist outside of peds and neuro.

You do give up a wide chunk of medicine to become a psychiatrist, true. But you do the same when you become a radiologist as well. Or a pathologist. Or a dermatologist. Or really anything outside of the generalist IM / Family medicine / pediatrics fields. I wouldn't say any of those fields are a waste of a medical education just because they hone in further on one area instead of further developing a broader base.

You can do a combined residency if that's your thing. Internal medicine / psychiatry exists, as do psych/neuro and family medicine/psych. You can also become triple boarded in psychiatry, peds, and child psychiatry. The statistics suggest that most people who do combined residencies end up primarily practicing just one, though, so I think it is questionable whether the extra training is worth it.

It's a very noble goal you have of bringing quality care to poor individuals. Poor people have every type of problem and can benefit from access to every type of specialist, so don't think that you have to go into internal medicine if you want to be of any use to low-income people (although that is a great route).

Also as a side note I know what you are talking about but I would avoid saying any field of medicine isn't "real" medicine and does not require a medical education. It comes across the wrong way.

Originally Posted by hrandani

I really enjoy psychiatry but since one my main drive to enter medical school was to open up an free / low cost outreach clinic for bread and butter family practice problems, I'm not sure I will be able to justify it to myself. I know that just as many poor people have psychiatry issues, but honestly letting go of "real" medicine after all this medical school seems like such a waste.

Looking for combined psychiatry / real medicine programs..But I don't think they exist outside of peds and neuro. Then again, there's my IMG stigma. My step was great, but I'm not sure I'm competitive enough for a dual program. Still have a year to decide...

I agree our medical system makes so little sense in some areas. I understand the reasons. You wouldn't want anybody with an MD opening up a surgery clinic...

No, but if "any" MD decides they want to learn how to do a Lap Chole, they should be able to get checked off on the procedure without the need for a 5 year residency. That's asinine, IMO.

I agree that if you want to open a FM office, psych probably isn't the way to go. The good news is that you'd do PLENTY of psych in FM too.

I'm not usually a fan of the double board thing, but if you have a specific interest it can be good for some people. I wouldn't write it off just because you don't think you're competitive. You can always apply to the combined programs, and apply to non-combined ones (in whatever field) as a backup.

Finally, you DO NOT have to let go of real medicine. You will use it every day in psych. In particular, you should seriously look into Consultation-Liason psych. Although it's less of a problem in outpatient psych, pretty much every inpatient psychiatrist has to be able to handle almost anything, since the psychiatrist is often the only doctor who these patients see, so guess who is controlling their HTN, DM, and everything else while they're admitted. Some facilities have a specific "medical" doctor on staff who handles these things, but most don't have the budget for that and it falls to the psychiatrists to be able to at least manage the basics of these things. These are often VERY uncontrolled, but relatively stable (not crashing on you, hopefully) chronic medical conditions.

So you still use your medical knowledge. A lot. In fact, it's one of the things I like best about the field...