Anesthesia vs Psych

[BigBear123]

I have just a couple months to decide and I am conflicted, PLEASE HELP!! Any input is greatly appreciated.

Psych and anesthesia may seem very different, but I like different things about each. I LOVE pharmacology and it is the main thing that is attracting me to both. Lifestyle is also important to me, as is living in a big city.

In psych, I love psychopharmacology, I think mental illness is interesting, the lifestyle is very nice, and psychiatrists are very nice people to work with. However, I don't think I could do outpatient psych (I don't love clinic in general) which makes up the majority of the field of psychiatry. I also am a pretty impatient person and I get frustrated during extended interactions with patients - I highly value efficiency and in psychiatry I feel like a lot of things take much longer than they should. I really could not care less about psychotherapy and wish that it was not an aspect of psychiatry. I wish psychiatry was more like medicine in terms of being able to monitor/diagnose with lab tests and the like. I do like consult liaison psychiatry (did a rotation in it) but I am hesitant to enter a field just to do one specific subspecialty.

In anesthesia, I love procedures and getting to keep my hands and mind busy constantly - it is a good fit for my restless nature. I love the pharmacology as well. However, the lifestyle is not as nice, especially during residency, though I hear you can get a M-F 7-3 ASC type job... I don't really care about making lots of $$$ so maybe this would be a good option for me. I hear that it can be rough for anesthesiologists in terms of interacting with surgeons. I am also a little concerned because I am female and I know anesthesia is still very much a male-dominated field and I wonder if I would get along with my colleagues as well as I do in psych.

In terms of my application, I would say I am pretty average. My grades are mostly high pass. My step 1 is in the low/mid 230s. I am at a top 20 school.

---

Members don't see this ad.

 

[skypilot]

I have just a couple months to decide and I am conflicted, PLEASE HELP!! Any input is greatly appreciated.

Psych and anesthesia may seem very different, but I like different things about each. I LOVE pharmacology and it is the main thing that is attracting me to both. Lifestyle is also important to me, as is living in a big city.

In psych, I love psychopharmacology, I think mental illness is interesting, the lifestyle is very nice, and psychiatrists are very nice people to work with. However, I don't think I could do outpatient psych (I don't love clinic in general) which makes up the majority of the field of psychiatry. I also am a pretty impatient person and I get frustrated during extended interactions with patients - I highly value efficiency and in psychiatry I feel like a lot of things take much longer than they should. I really could not care less about psychotherapy and wish that it was not an aspect of psychiatry. I wish psychiatry was more like medicine in terms of being able to monitor/diagnose with lab tests and the like. I do like consult liaison psychiatry (did a rotation in it) but I am hesitant to enter a field just to do one specific subspecialty.

In anesthesia, I love procedures and getting to keep my hands and mind busy constantly - it is a good fit for my restless nature. I love the pharmacology as well. However, the lifestyle is not as nice, especially during residency, though I hear you can get a M-F 7-3 ASC type job... I don't really care about making lots of $$$ so maybe this would be a good option for me. I hear that it can be rough for anesthesiologists in terms of interacting with surgeons. I am also a little concerned because I am female and I know anesthesia is still very much a male-dominated field and I wonder if I would get along with my colleagues as well as I do in psych.

In terms of my application, I would say I am pretty average. My grades are mostly high pass. My step 1 is in the low/mid 230s. I am at a top 20 school.

The interactions with surgeons and concerns with being a female will be nothing in Anesthesia compared to the difficulties of interacting with violent Schizophrenics in inpatient Psychiatry. If you are looking for a lifestyle job though, you will be a long way from one in Anesthesia. Residency will be arduous and then you probably will be pressured to do a fellowship. Once you finish residency your first job will not be in an ASC, the main choices for new grads are to work in Tertiary or Community hospitals with a significant on call burden. So by the time you get to that cushy 9-5 surgicenter job you will be 10 years post graduation from Medical school. Psych has a much better lifestyle. And you can choose to work much less in Psychiatry or choose to work more if you want to make lots of money. As a U.S. female grad in Psychiatry, you will be in high demand and can pretty much live wherever you want.

 

[Urzuz]

The interactions with surgeons and concerns with being a female will be nothing in Anesthesia compared to the difficulties of interacting with violent Schizophrenics in inpatient Psychiatry.

Actually I would say that interacting with surgeons and schizophrenics can be quite comparable!

 

[GravelRider]

Actually I would say that interacting with surgeons and schizophrenics can be quite comparable!

You can give haldol to schizophrenics...

 

[BigBear123]

It sounds like it would be difficult to find a job with "nice" hours even for lower pay as a new grad?

 

[deleted162650]

It sounds like it would be difficult to find a job with "nice" hours even for lower pay as a new grad?

Not really. Plenty of "Mommy Track" options out there theses days. Many groups are starting to turn towards these types of arrangements instead of hiring new partners as it's financially better for the group to pocket some money off the mommy tracker every day instead of splitting the pie with yet another new partner.

 

[GravelRider]

Part time "mommy track" jobs are still 40-50 hours a week in a lot of places (mon-fri 7-5) and there will still be a group of super partners siphoning money off your labor and working a lot less than you. Anesthesia is not a lifestyle field.

 

[chocomorsel]

As someone who was in your exact same shoes 9 years ago and chose Anesthesia, I would say go for Psych. 100%. All the way. I am trying to look for a way out of the OR right now or even going part time. I can't stand many surgeons. They can be serious douche bags, and as a female it will be more difficult, in the way the surgeons talk to you is different than they do their male counterpart anesthesiologists. Trust me, I live it daily.

And then there are the CRNAs. Let's not even get started on that one, especially as a female doc.

I feel like I made a wrong decision based on pride, and being made fun of for wanting to be a shrink. I go to work, do my thing, try to stay quiet but get into some disagreements with surgeons occasionally although I try to avoid it. It sucks being talked to like you are the help sometimes or being yelled at when a patient moves, being rushed to get to the next patient like they are a bunch of cattle and not humans.

I dream of a job where I am my own boss and make my own hours and have to answer to no one. One day it will come. One day I will transition to an outpatient doctor of some sort. Be it botox, medspa, marijuana, whatever.

And by the way, call in Anesthesia sucks too. You never know what disasters you will be called to try and save.

 

[deleted162650]

As someone who was in your exact same shoes 9 years ago and chose Anesthesia, I would say go for Psych. 100%. All the way. I am trying to look for a way out of the OR right now or even going part time. I can't stand many surgeons. They can be serious douche bags, and as a female it will be more difficult, in the way the surgeons talk to you is different than they do their male counterpart anesthesiologists. Trust me, I live it daily.

And then there are the CRNAs. Let's not even get started on that one, especially as a female doc.

I feel like I made a wrong decision based on pride, and being made fun of for wanting to be a shrink. I go to work, do my thing, try to stay quiet but get into some disagreements with surgeons occasionally although I try to avoid it. It sucks being talked to like you are the help sometimes or being yelled at when a patient moves, being rushed to get to the next patient like they are a bunch of cattle and not humans.

I dream of a job where I am my own boss and make my own hours and have to answer to no one. One day it will come. One day I will transition to an outpatient doctor of some sort. Be it botox, medspa, marijuana, whatever.

And by the way, call in Anesthesia sucks too. You never know what disasters you will be called to try and save.

Go back and do Pain. That's basically psych + needles.

 

[chocomorsel]

I can't handle drug seekers.

 

[neutro]

do pain medicine after anesthesia. basically its a lot of psych if you practice pain medicine...
set up your own independent pain practice - dont take crap from anyone.
douchy surgeon - dont take his patients. non compliant, drug seeking patients - discharge from practice.
you can further specialize within pain medicine as to what you want to do or see. like youre the cancer pain doc in town, or injectionistm or you do pain mgt for patients with multiple comorbid conditions...or a bit of all...
basically it takes some time to build a reputable, respected pain practice. while you are building your pain practice, do OR anesthesia.

psych is good and its in huge demand, meaning you can do conceirge's medicine if you wish. but after a while, just talking talking talking gets old.

 

[neutro]

I can't handle drug seekers.

make a policy in your clinic if you practice pain - "no narcotics first visit. First consultation is evaluation only". Ofcourse you will break this rule for your cancer patients or that patient who has had 4 back surgeries, stim trial and ITP...but that will eliminate 90% of drug seekers. get utox on all patients first visit if seeking opiates. if they still make it in to your practice, give them a "transition of care" form which puts the onus on them to get you their previous physicians notes stating why they are on opiates, why are they being discharged, and what is the last UTOX. Obviously no meds if urine is dirty.
That will get rid of 99% of druggies. If that 1% still makes it in, titrate opiates off 20%/ week...

done.


thats my protocol for drug seekers. i still see them so i am compensated for my time (the hospital i should say). the FP doesnt get to bitch that i refused the patient, like some PP guys. and i do the right thing in not feeding the opiod epidemic.

 

[deleted307836]

I can't handle drug seekers.

To be fair, though, isn't this a big part of psych as well (except benzos and stimulants instead of opioids)?

 

[BigBear123]

Thank you for all your replies! I am interested in pain management, I really enjoyed it during my anesthesia rotation and think it would be a great fit for me considering all of my interests. I have heard that pain is very competitive, and am wondering if I would have a good shot of landing a fellowship... I am wondering if it would be unwise of me to go into anesthesia if I were to have the goal of a pain management fellowship in mind.

 

[deleted162650]

Thank you for all your replies! I am interested in pain management, I really enjoyed it during my anesthesia rotation and think it would be a great fit for me considering all of my interests. I have heard that pain is very competitive, and am wondering if I would have a good shot of landing a fellowship... I am wondering if it would be unwise of me to go into anesthesia if I were to have the goal of a pain management fellowship in mind.

No that would not be unwise. I know a few people who did anesthesia just to get to pain.

 

[Temeraire]

No that would not be unwise. I know a few people who did anesthesia just to get to pain.

I'm basically doing that. Just matched to a fantastic anesthesia program affiliated with an equally fantastic pain fellowship, and I can't wait to start!

I knew coming into med school that I like pain research and treating pain patients, but I needed to pick a residency first. During M3, I enjoyed my psych rotation and told myself that if I didn't like my anesthesia rotation (which was scheduled later in the year), I would do a psych residency without complaint. However, after my first month of anesthesia (and still 2 more months at different programs), I found myself enjoying the day-to-day work of anesthesia way more than psych. Coupled with the fact that there are far more pain-related research and networking opportunities for anesthesia residents than for psych residents, my decision was a no-brainer.

 

[chocomorsel]

make a policy in your clinic if you practice pain - "no narcotics first visit. First consultation is evaluation only". Ofcourse you will break this rule for your cancer patients or that patient who has had 4 back surgeries, stim trial and ITP...but that will eliminate 90% of drug seekers. get utox on all patients first visit if seeking opiates. if they still make it in to your practice, give them a "transition of care" form which puts the onus on them to get you their previous physicians notes stating why they are on opiates, why are they being discharged, and what is the last UTOX. Obviously no meds if urine is dirty.
That will get rid of 99% of druggies. If that 1% still makes it in, titrate opiates off 20%/ week...

done.


thats my protocol for drug seekers. i still see them so i am compensated for my time (the hospital i should say). the FP doesnt get to bitch that i refused the patient, like some PP guys. and i do the right thing in not feeding the opiod epidemic.

Thanks so much for this advice. I have thought of doing pain in the past. I just always imagined it to be full of a bunch of druggies and those patients drive me crazy. Maybe I will look further into this. Although I do hear it's quite competitive.

 

[neutro]

Thanks so much for this advice. I have thought of doing pain in the past. I just always imagined it to be full of a bunch of druggies and those patients drive me crazy. Maybe I will look further into this. Although I do hear it's quite competitive.

everyone has to deal with druggies/
FP, surgeons, ortho, psych, neurology...

we just deal with more of it. doesnt mean it cannot be done well..

put protocols in place. train your staff. and be ready to have discussions with the patient that they are addicted within 5 minutes if you suspect aberrant behavior.

i am concerned however if you are doing anesthesia for pain...if you go with that attitude, you will likely struggle in residency since anesthesiology residency is not just a residency - it is considered apprenticeship by the ABA. you cant learn it from a book. you need to be actively and genuinely involved in every single case and discussion...so if you are genuinely interested in anesthesia, then thats fine...but if pain medicine is more of an interest, try PMR, Neurology and maybe psych...they can also lead to a pain fellowship but it will be challenging since most pain fellowships are anesthesia based.

 

[chocomorsel]

everyone has to deal with druggies/
FP, surgeons, ortho, psych, neurology...

we just deal with more of it. doesnt mean it cannot be done well..

put protocols in place. train your staff. and be ready to have discussions with the patient that they are addicted within 5 minutes if you suspect aberrant behavior.

i am concerned however if you are doing anesthesia for pain...if you go with that attitude, you will likely struggle in residency since anesthesiology residency is not just a residency - it is considered apprenticeship by the ABA. you cant learn it from a book. you need to be actively and genuinely involved in every single case and discussion...so if you are genuinely interested in anesthesia, then thats fine...but if pain medicine is more of an interest, try PMR, Neurology and maybe psych...they can also lead to a pain fellowship but it will be challenging since most pain fellowships are anesthesia based.

Me? I am done with anesthesia residency. Thank God. Although I was interested in it, the politics and drama that came with training were horrible.

 

[deleted307836]

I'm basically doing that. Just matched to a fantastic anesthesia program affiliated with an equally fantastic pain fellowship, and I can't wait to start!

I knew coming into med school that I like pain research and treating pain patients, but I needed to pick a residency first. During M3, I enjoyed my psych rotation and told myself that if I didn't like my anesthesia rotation (which was scheduled later in the year), I would do a psych residency without complaint. However, after my first month of anesthesia (and still 2 more months at different programs), I found myself enjoying the day-to-day work of anesthesia way more than psych. Coupled with the fact that there are far more pain-related research and networking opportunities for anesthesia residents than for psych residents, my decision was a no-brainer.

I'm curious, why was psych your backup instead of PM&R?

 

[neutro]

Me? I am done with anesthesia residency. Thank God. Although I was interested in it, the politics and drama that came with training were horrible.

i apologize.
i misquoted.

 

[Temeraire]

I'm curious, why was psych your backup instead of PM&R?

I just didn't like PM&R all that much. I liked the chronic pain patients and the interventional stuff but I couldn't get very interested in the other aspects of rehabilitation science. Also, I'm not a huge fan of rounding on inpatients with noncritical issues (I loved my ICU sub-i, in contrast), so if I could minimize that in my residency that would be lovely.

 

[BigBear123]

I am leaning towards doing anesthesia over psych now and am pretty sure that is what I will ultimately end up doing. After talking to my anesthesia advisors, it seems like I will have a good shot at getting into pain (residency director at my home program, where I hopefully will stay at if they take me, said they've only had 1 resident who was unable to get into pain). HOWEVER, I am still nervous in case for the possibility that that might not happen. I want to have a family one day and do not want to be working more than 40-50 hours per week after residency. I really don't care much about $$$. BUT the attendings at my home institution seem to work 60+ hours per week. Would it be possible for me to accommodate my lifestyle needs in anesthesia? Or would my only other option be to apply to a non-OR based fellowship (i.e. palliative care)?

 

[nimbus]

I am leaning towards doing anesthesia over psych now and am pretty sure that is what I will ultimately end up doing. After talking to my anesthesia advisors, it seems like I will have a good shot at getting into pain (residency director at my home program, where I hopefully will stay at if they take me, said they've only had 1 resident who was unable to get into pain). HOWEVER, I am still nervous in case for the possibility that that might not happen. I want to have a family one day and do not want to be working more than 40-50 hours per week after residency. I really don't care much about $$$. BUT the attendings at my home institution seem to work 60+ hours per week. Would it be possible for me to accommodate my lifestyle needs in anesthesia? Or would my only other option be to apply to a non-OR based fellowship (i.e. palliative care)?

Average is 55hrs per week. Tens of thousands of anesthesiologists work 40-50hrs/wk.

 

[bashwell]

Although if you really don't care much about money, and you want to only work 40-50 hours per week, there are probably easier ways to do that than anesthesia. (Not knocking anesthesia, just saying in your case).

 

[deleted547631]

I have just a couple months to decide and I am conflicted, PLEASE HELP!! Any input is greatly appreciated.

Psych and anesthesia may seem very different, but I like different things about each. I LOVE pharmacology and it is the main thing that is attracting me to both. Lifestyle is also important to me, as is living in a big city.

In psych, I love psychopharmacology, I think mental illness is interesting, the lifestyle is very nice, and psychiatrists are very nice people to work with. However, I don't think I could do outpatient psych (I don't love clinic in general) which makes up the majority of the field of psychiatry. I also am a pretty impatient person and I get frustrated during extended interactions with patients - I highly value efficiency and in psychiatry I feel like a lot of things take much longer than they should. I really could not care less about psychotherapy and wish that it was not an aspect of psychiatry. I wish psychiatry was more like medicine in terms of being able to monitor/diagnose with lab tests and the like. I do like consult liaison psychiatry (did a rotation in it) but I am hesitant to enter a field just to do one specific subspecialty.

In anesthesia, I love procedures and getting to keep my hands and mind busy constantly - it is a good fit for my restless nature. I love the pharmacology as well. However, the lifestyle is not as nice, especially during residency, though I hear you can get a M-F 7-3 ASC type job... I don't really care about making lots of $$$ so maybe this would be a good option for me. I hear that it can be rough for anesthesiologists in terms of interacting with surgeons. I am also a little concerned because I am female and I know anesthesia is still very much a male-dominated field and I wonder if I would get along with my colleagues as well as I do in psych.

In terms of my application, I would say I am pretty average. My grades are mostly high pass. My step 1 is in the low/mid 230s. I am at a top 20 school.

Want to open a lean private practice, work 32 hours per week, never wake up before 0800, and clear $250K? Go Psych.

 

[aimedicine]

Want to open a lean private practice, work 32 hours per week, never wake up before 0800, and clear $250K? Go Psych.

And not be a real doctor....at least that's the perception anyway.

 

[deleted547631]

And not be a real doctor....at least that's the perception anyway.

I suppose that depends on how much weight an individual places upon the importance of what others think of them and their chosen profession. Psych has a bright future in medicine.

 

[WholeLottaGame7]

I suppose that depends on how much weight an individual places upon the importance of what others think of them and their chosen profession. Psych has a bright future in medicine.

Really? I obviously haven't done psych since med school, but it seems ripe for midlevel encroachment/takeover. And it's not just PAs and NPs, you can get encroachment from psychologists and even social workers. It's mostly talking to patients, and we all know that is an area where midlevels brag about their advantages over MDs. Plus, it seems like outcomes are nebulous enough that it would be easy to publish studies proving "no difference" between MDs and PA/NPs.

It is a difficult patient population and I'm sure reimbursement can't be great unless you run a boutique practice, so those might be barriers to encroachment, but I wouldn't count on it. I'm sure there are some psych people floating around that can comment.

(Disclaimer: I'm not saying that MDs don't have advantages over other fields in psych, I'm just trying to play devil's advocate)

 

[Psai]

Really? I obviously haven't done psych since med school, but it seems ripe for midlevel encroachment/takeover. And it's not just PAs and NPs, you can get encroachment from psychologists and even social workers. It's mostly talking to patients, and we all know that is an area where midlevels brag about their advantages over MDs. Plus, it seems like outcomes are nebulous enough that it would be easy to publish studies proving "no difference" between MDs and PA/NPs.

It is a difficult patient population and I'm sure reimbursement can't be great unless you run a boutique practice, so those might be barriers to encroachment, but I wouldn't count on it. I'm sure there are some psych people floating around that can comment.

(Disclaimer: I'm not saying that MDs don't have advantages over other fields in psych, I'm just trying to play devil's advocate)

There are a ton of psych nps out there and they are terribly mismanaging patients. I don't know how bad it will get but a lot of people that we were admitted to psych inpatient were there because some np switched their meds for no reason. Yeah this guy was on lithium for 10 years no problem for mania so let's put him on an atypical because a drug rep told the np that they're great.

 

[deleted547631]

Really? I obviously haven't done psych since med school, but it seems ripe for midlevel encroachment/takeover. And it's not just PAs and NPs, you can get encroachment from psychologists and even social workers. It's mostly talking to patients, and we all know that is an area where midlevels brag about their advantages over MDs. Plus, it seems like outcomes are nebulous enough that it would be easy to publish studies proving "no difference" between MDs and PA/NPs.

It is a difficult patient population and I'm sure reimbursement can't be great unless you run a boutique practice, so those might be barriers to encroachment, but I wouldn't count on it. I'm sure there are some psych people floating around that can comment.

(Disclaimer: I'm not saying that MDs don't have advantages over other fields in psych, I'm just trying to play devil's advocate)

Mid-levels are already well entrenched in mental health yet demand is through the roof for psychiatrists and will continue to be so for the foreseeable future.

 

[Ligament]

Do psych residency. If you then decide to, then apply for a Pain Medicine fellowship, which allows psych applicants (though tougher to get in, still possible). I personally think psych residents make excellent pain medicine fellows.

If you want to do psych for a career, you will be in high demand. You can establish a cash only practice. You can have excellent hours and lifestyle.

If you do Anesthesia for a career, you will deal with douchebag surgeons constantly, and will eventually be replaced by a nurse anyway (CRNAs). You will be 100% locked in to your groups call scheduled for your entire career with minimal flexibility in your life. The CRNAs were created and fostered by greedy ass anesthesiologists and their greed will destroy the entire profession in the next 20 years. The CRNAs should be banned and outlawed but it is too late.

I'd highly recommend doing the psych residency then possible pain medicine fellowship after. You get TONS of psych in Pain Medicine, and you get TONS of procedures (more than you'd do in general anesthesia). You also get a (for now) good lifestyle. Only negative is it is much easier to establish a cash-only psych practice than a cash-only pain practice. Either way, it behooves you to start with a psych residency.

I'd argue you'll see as much psych pathology in a chronic pain practice as you would in an outpatient psych practice. Might not be as varied, but the total amount of psych cases will be nearly as large.

 

[deleted50478]

I have just a couple months to decide and I am conflicted, PLEASE HELP!! Any input is greatly appreciated.

Psych and anesthesia may seem very different, but I like different things about each. I LOVE pharmacology and it is the main thing that is attracting me to both. Lifestyle is also important to me, as is living in a big city.

In psych, I love psychopharmacology, I think mental illness is interesting, the lifestyle is very nice, and psychiatrists are very nice people to work with. However, I don't think I could do outpatient psych (I don't love clinic in general) which makes up the majority of the field of psychiatry. I also am a pretty impatient person and I get frustrated during extended interactions with patients - I highly value efficiency and in psychiatry I feel like a lot of things take much longer than they should. I really could not care less about psychotherapy and wish that it was not an aspect of psychiatry. I wish psychiatry was more like medicine in terms of being able to monitor/diagnose with lab tests and the like. I do like consult liaison psychiatry (did a rotation in it) but I am hesitant to enter a field just to do one specific subspecialty.

In anesthesia, I love procedures and getting to keep my hands and mind busy constantly - it is a good fit for my restless nature. I love the pharmacology as well. However, the lifestyle is not as nice, especially during residency, though I hear you can get a M-F 7-3 ASC type job... I don't really care about making lots of $$$ so maybe this would be a good option for me. I hear that it can be rough for anesthesiologists in terms of interacting with surgeons. I am also a little concerned because I am female and I know anesthesia is still very much a male-dominated field and I wonder if I would get along with my colleagues as well as I do in psych.

In terms of my application, I would say I am pretty average. My grades are mostly high pass. My step 1 is in the low/mid 230s. I am at a top 20 school.

Sounds like you should keep looking at other specialties.

 

[WholeLottaGame7]

There are a ton of CRNAs out there and they are terribly mismanaging patients.

FTFY. Hasn't prevented encroachment in our field (or other fields).

Psych was interesting for a month, but couldn't imagine doing it for the rest of my life.

I think there's a little "grass is greener" + "best case scenario" going on here, as if it's a piece of cake to open a cash-only psych practice and make a ton of money. If the average psychiatrist worked 40hrs a week and pulled in $300K, don't you think med students would be flocking to it?

That's like saying, "go into anesthesia, you can join an MD-only PP group where you make partner in 2 years and pullin $650K covering an ASC for 40hr a week." Sure, there may be people out there doing that, but good luck getting that job.

You're probably just as or more likely to end up making $150K seeing Medicare schizophrenic patients in the local health department.

 

[hebel]

Really? I obviously haven't done psych since med school, but it seems ripe for midlevel encroachment/takeover. And it's not just PAs and NPs, you can get encroachment from psychologists and even social workers. It's mostly talking to patients, and we all know that is an area where midlevels brag about their advantages over MDs. Plus, it seems like outcomes are nebulous enough that it would be easy to publish studies proving "no difference" between MDs and PA/NPs.

It is a difficult patient population and I'm sure reimbursement can't be great unless you run a boutique practice, so those might be barriers to encroachment, but I wouldn't count on it. I'm sure there are some psych people floating around that can comment.

(Disclaimer: I'm not saying that MDs don't have advantages over other fields in psych, I'm just trying to play devil's advocate)

I'm about to start psychiatry residency, and do somewhat agree with you. However, I think the big difference between the midlevel threat in anesthesia vs psych is that anesthesia is more of a service specialty. Patients will seek out particular surgeons based on reputation or some other reason, whereas a large majority of patients have no idea who or what (crna v MD) their anesthesia provider is, going into an operation. In my opinion, this causes a huge decrease in an anesthesia docs potential leverage with administrators or hospital systems (essentially, they do not have any patients of their own).

Similar to surgeons, I DO think patients actively seek out outstanding psychiatrists. Word of mouth is strong, and can lead to a loyal patient base...especially in a very personal field like mental health. So I agree that I might be concerned if I were an average or subpar psychiatrist, but I think If a psychiatrist can distinguish themselves (which honestly isn't that difficult) midlevels are not much of a threat.

 

[aimedicine]

If there is any specialty primed for complete annihilation by midlevel, it is psych. Lets be real 95% of psych is bulllshyt mixed with SSRI....its so easy to start a mental health clinic, that im planning on owning one in nxt few yrs and partner with NP (or even psychologist to run it)...the idea came from a midlevel friend of mine who is on verge of opening up her 2nd clinic...that should tell you everything u need to know about the future of psych...once supply catches up to demand, that field will be paying less than peds. And its laughable that some of you think psychiatrist will make a better (or even as good) pain physician than anesthesiologist.

 

[Ligament]

If there is any specialty primed for complete annihilation by midlevel, it is psych. Lets be real 95% of psych is bulllshyt mixed with SSRI....its so easy to start a mental health clinic, that im planning on owning one in nxt few yrs and partner with NP (or even psychologist to run it)...the idea came from a midlevel friend of mine who is on verge of opening up her 2nd clinic...that should tell you everything u need to know about the future of psych...once supply catches up to demand, that field will be paying less than peds. And its laughable that some of you think psychiatrist will make a better (or even as good) pain physician than anesthesiologist.

I am a fellowship trained Pain Medicine attending ten years into private practice. Thought I do a ton of them, Pain Medicine is way more than procedures. There is a LOT of psych involved. A psychiatrist will likely not be a procedurally competent as an anesthesiologist at start of fellowship, or maybe at the end. But there is so much psychopathology involved in outpatient chronic pain having a pscyh background will be a huge benefit to the patient.

 

[aimedicine]

I am a fellowship trained Pain Medicine attending ten years into private practice. Thought I do a ton of them, Pain Medicine is way more than procedures. There is a LOT of psych involved. A psychiatrist will likely not be a procedurally competent as an anesthesiologist at start of fellowship, or maybe at the end. But there is so much psychopathology involved in outpatient chronic pain having a pscyh background will be a huge benefit to the patient.

I was really talking about interventional pain mgmt.