Assorted Psychiatry Residency Questions

[277768]

Hi!

I have a few questions about psychiatry:

1) Why does residency placement seem so un-competitive? Average USMLE scores for placement in many psychiatry spots is very low, and many very good programs have FMGs or DOs as residents. I've noticed a trend of allopathic students away from the field.

2) How difficult is the competition with nurses, PhDs in psych, etc.? In general? Metropolitan Cities like NYC, SF, Boston, etc?

3) Do your patients get to you after a while? Does the neurosis rub off? How do you keep them from getting to you?

4) I've heard the field is very pro-gay. I am a gay man myself and am eager to learn more about it. Some of my most supportive doctors are shrinks. Is it a gay supportive field?

None of these questions are meant to be mean-spirited, but are honest inquiries I have about the field. Please no sarcasm or overly cynical, unproductive remarks.

All opinions appreciated.

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[cleareyedguy]

1) I don't think there is a trend away from the field. In fact, there continue to be very strong applicants to psych, including some of the most competitive overall students and MD/PhD's. Top programs are highly competitive from top to bottom, but there are relatively few "top" programs in psych, and some prestigious places do have a hard time getting strong candidates to fill a class (while some less known programs do quite well). One reason is that our programs are large, while the really competitive specialties like ortho, derm, radiology, and neurosurgery are small. If every psych program only took 4 residents, we'd be seen as a killer specialty that turned down most of its applicants. And then we'd be even less able to treat the millions of people who need our help.

2. competition with nurses. I'm not sure I understand. For private psychotherapy patients? I don't know the answer to that. In NY, lots of people prefer to see psychiatrists for therapy, and I don't think we see non-psychiatrists as much of a threat.


3) Much of training is learning to deal effectively with countertransference, burnout, etc.

4) I'm not sure psychiatry is pro gay, but there are certainly a disproportionate number of gay men in the field. Historically, psychoanalysis was outspokenly against a bias against gay men (see for example Freud's letter to the mother of a homosexual man). His early enlightenment was followed by a few decades of pathologizing, but the field no longer demonizes (analytic institutues have been accepting gay men and women for about 15 years now). Why do gay men apply in high numbers? Dunno. I don't think the same is true for gay women; they're around, but they aren't nearly as ubiquitous.

 

[BabyPsychDoc]

Re gays. I think psychiatrists are more accepting of differences, which is probably why you find your shrinks friends supportive. I don't know whether there more gays in psychiatry overall, but it certainly seems that it is easier to be open about your sexual preferences when working in psych. In my programme, there is at least one gay resident (woman) and a number of gay nurses (of both genders). Everyone on the unit seems just to accept the fact that these people prefer those of their own gender - there is no even moderate amount of gossip .

In contrast, in my past life of a GP, I had several patients working as nurses on general medical wards. They were very much concerned about their "secret" becoming known among their colleagues. Coming out? Forget about it!

 

[whopper]

1) Why does residency placement seem so un-competitive? Average USMLE scores for placement in many psychiatry spots is very low, and many very good programs have FMGs or DOs as residents. I've noticed a trend of allopathic students away from the field.

All residencies tend to go in cycles. As of the last MATCH, surgery had plenty of open spots, psychiatry filled up completely.
Despite this, I do think several who go to medical school are not geared on the tracks to psychiatry. This is only my speculation. I am of the opinion that most of pre-med courses & curriculum today encourage personality types that do not want to work in the mental health profession. E.g. biochem, biology, & engineering majors. People that would have chose a mental health profession tend to be psychology, sociology, & counseling majors. There's some very different personality types that go to each field.

Medical school is also highly physical-medicine-centric. The guy teaching Pathology, ID, Anatomy etc have no interest in psychiatry & will not bring it up much during lectures. For that reason, culturally in most medcshools, it does not become a trendy residency to choose, kinda like how in high school the popular crowd trends to football, cheerleading etc, while the geeks go into the computer or chess club. I thought this type of thought process was silly. To pick a profession because of peer pressure--of which sometimes the professors & attendings do contribute I think is crazy.

2) How difficult is the competition with nurses, PhDs in psych, etc.? In general? Metropolitan Cities like NYC, SF, Boston, etc?

I've noticed no real competition among other mental health providers. One thing going for us psychiatrists now is there's a shortage of us in most places. I will say though that this shortage creates several other problems even for psychiatrists such as having to tolerate another psychiatrist's lame work, and know that this guy will still have a strong market to support his poor practice standards.

3) Do your patients get to you after a while? Does the neurosis rub off? How do you keep them from getting to you?

Yes.
However anything in any field after a certain amount of time will start to bug you. If you have a love for the field, your tolerance for these things is much higher. You will also develop coping mechanisms to deal with this. Compare that to surgery where you are on call Q2, and pulling an all nighter several times a week, or having to stick your finger up someone's rectum on a daily basis in medicine, then sticking your finger out, and inspecting the stool on your finger. Every field has its ups & downs.

4) I've heard the field is very pro-gay. I am a gay man myself and am eager to learn more about it. Some of my most supportive doctors are shrinks. Is it a gay supportive field?

I believe so. This is a field where we are forced to examine social issues, what is considered normal vs abnormal etc. I've even had a drug counselor who is very right wing, and is against the gay lifestyle, but as a mental health professional, he does not let that side of him affect his professional conduct or judgments, and he was very open that he had to make sure he did not allow his beliefs to come in the way, even asking the team to tell him if they thought he was out of line. I am pro-gay myself and his treatment approach & mine never were at odds, and I was considered his treatment team leader. We both know the professional standards, agree with them & follow them.

None of these questions are meant to be mean-spirited, but are honest inquiries I have about the field. Please no sarcasm or overly cynical, unproductive remarks.

No problem. That's how I interpreted your post.

 

[235750]

I'm just in medical school, but I feel the need to respond to a few of this things you said:

1) Why does residency placement seem so un-competitive? Average USMLE scores for placement in many psychiatry spots is very low, and many very good programs have FMGs or DOs as residents. I've noticed a trend of allopathic students away from the field.

You're joking right?? Psych completely filled up this year and the average step 1 score went up. while the current step 1 average for psych isn't competitive for a surgery residency, the trend is that more people (US MDs and DOs) are applying. I expect this trend to continue.

If you enjoy your psych rotation(s), why would you care if the field is ultra competitive or not? Psych is emotionally draining and has no procedures (except ECT) which is why I imagine most people don't consider it

2) How difficult is the competition with nurses, PhDs in psych, etc.? In general? Metropolitan Cities like NYC, SF, Boston, etc?

I also don't get this. Do you mean NP psych therapists? And/or maybe the PhD/PsyDs with the MS so they give prescribe some meds? I would be interested to hear responses to this, but I don't read about psychiatrists losing their jobs. I hear big cities are competitive in regards to other physicians, and this is with all of medicine

4) I've heard the field is very pro-gay. I am a gay man myself and am eager to learn more about it. Some of my most supportive doctors are shrinks. Is it a gay supportive field?

Well homosexuality is no longer defined as a disorder in the DSM so the field is making progress right?

Seriously though, I was a nurse at an inpatient psych unit and worked a lot with psychiatrists, and I think they're fantastic people. They can be a little strange, but in general they are a caring and understanding group which explains their choice in career.

I don't know if pro-gay is the appropriate term I would give to them...what do you mean by this? Not discriminating against you because of your sexual preference should be a given in psychiatry, so if that's your question then yes, I would say they are pro-gay. If you mean, will they sign your petition to repeal proposition 8, then I'd probably say, most likely, but it's not guaranteed.

Good luck!

 

[whopper]

If you enjoy your psych rotation(s), why would you care if the field is ultra competitive or not?

I wanted to go into psychiatry because I love the field. So when I was in medical school & heard not many people were applying into it, that just made me happier.

If something is not competitive (and psychiatry appears to be more competitive these days), if you want to go into the field, the competition factor if anything should only be a negative thing if the field is too competitive, or if you're a type of person that wants to justify to others (or to yourself) that you did something very competitive.

Just my opinion-getting into something because its competitive is not the way to live life. There are more meaningful things. The amount of money you make (which everyone knocks as a superficial way to gauge yourself) is more important than being able to say you did something competitive.

I think most medical students are still in the one-upmanship thought process because several of them were the brightest guy in school, and that mindset is to some degree beneficial in the very competitive process of medical school. However during and after residency-the most important things become successful & proper practice, patient satisfaction, & your own personal satisfaction with life. Whether or not I went through something ultra-competitive or not doesn't matter, and even on that matter, out of everyone I hang out with, I still went through something harder & more competitive than most of the people I know-but that doesn't matter to me.

Everytime in residency I saw a surgery resident suffering from lack of sleep, feeling demoralized, and pimped out, in no way did I feel that I should've been in a more competitive & difficult field. However several of them felt they needed to be in something difficult. Different strokes I guess. I'm not knocking people who do have this ultra-competitive nature. Just saying that's not what I want out of life.

I don't know if pro-gay is the appropriate term I would give to them...what do you mean by this?

True. I consider myself pro-gay in the respect that I think homosexuals are entitlted to equal rights & respect as human beings. If someone in a health professional role were to use a person's homosexuality against that person, I'd object to that. Is that truly "pro-gay"? I guess one could cut my statement apart & say no because anyone should be doing this.

 

[235750]

I wanted to go into psychiatry because I love the field. So when I was in medical school & heard not many people were applying into it, that just made me happier.

Well said! This is what I felt last week, it was a great feeling.

 

[Faebinder]

Hi!

I have a few questions about psychiatry:

1) Why does residency placement seem so un-competitive? Average USMLE scores for placement in many psychiatry spots is very low, and many very good programs have FMGs or DOs as residents. I've noticed a trend of allopathic students away from the field.

2) How difficult is the competition with nurses, PhDs in psych, etc.? In general? Metropolitan Cities like NYC, SF, Boston, etc?

3) Do your patients get to you after a while? Does the neurosis rub off? How do you keep them from getting to you?

4) I've heard the field is very pro-gay. I am a gay man myself and am eager to learn more about it. Some of my most supportive doctors are shrinks. Is it a gay supportive field?

None of these questions are meant to be mean-spirited, but are honest inquiries I have about the field. Please no sarcasm or overly cynical, unproductive remarks.

All opinions appreciated.

1) It may look uncompetitive because of low USMLE, however, the competition is more in personality and ability with English and adaption to the US culture. An FMG who barely speaks English and has 99 on USMLE, used his "neurology" rotations to satisfy the "psychiatry" requirement of ECFMG and has no clue what "I was jonesing" means is less useful to a residency than the US born IMG 79 USMLE scorer who has great command of English, did an Sub-I in psych in the US and understands when a patient is being sarcastic about his suicidal thoughts vs serious.

2) Don't worry about PsyD or Nursing competition, when push comes to shove, no one wants responsibility for the truly psychotics and manics. When polypharmacy is involved, everyone runs away and wants the MD to fix their mess in the hospital. Rural wise, you have even more freedom. Just don't expect to make $500k a year while working 40 hours a week.

3) Unfortunately it seems to be a symptom in psychiatry. When you are in the business of telling people how they are wrong in their way of thinking, it feeds your ego and you can become narcissistic or worse you can start justifying abnormal behavior to yourself. Have a good reality check from family is one way to ward this off.

4) The field is not pro-gay, it's just not judgmental nor reactive towards judgment. It's part of the advantage of understanding patients and advocating for them... you can disagree with them but you dont act on it nor do you instigate problems from it (well most of the time that is). I.E. you wont usually get people badly reacting or treating you even if they disagree with your way of living.

 

[notdeadyet]

Nice post, Faebinder...

 

[peppy]

has no clue what "I was jonesing" means

Ah, so that's where I went wrong. In my interviews, I should have been careful to use more terminology from http://www.urbandictionary.com to impress the interviewers with my knowledge of the language of the common person.

(I'm being silly here but of course I actually agree very much with your point that good psychiatrists should be able to tune into the cultural clues that patients give them.)

 

[psychotrope]

All residencies tend to go in cycles. As of the last MATCH, surgery had plenty of open spots,.

the nrmp lists surgery as having 5 unfilled positions. (and who knows if those were actually real). I don't know if I would call that plenty.

You may be going by the prelim surgery slots, which there is usually a ton of.

 

[BabyPsychDoc]

Faebinder, while I agree with the spirit of your post, may I point out that if you do not understand some slang, you could always ask for clarification, and patients are generally happy to provide such. Let's be honest - even the US-born native English speaker may not be familiar with all regional dialects (not a very good example, but the first thing that comes to mind is "soda" on the East Coast, "pop" in the Midwest, "soft drink" in England, etc); and the US psychiatrists have plenty of non-English speaking patients to treat, so the language problem will always be there, in one form or the other, you just have acknowledge it and deal with it. On the other hand, if you do not know your medicine (as reflected by a borderline USMLE score), your options are somewhat more limited.

I am also wondering what you mean when talking about substituting neurology for psychiatry requirement of ECFMG. As someone who recently went through the ECFMG certification process, I cannot recall any specific psychiatry requirements there.

 

[Faebinder]

Faebinder, while I agree with the spirit of your post, may I point out that if you do not understand some slang, you could always ask for clarification, and patients are generally happy to provide such. Let's be honest - even the US-born native English speaker may not be familiar with all regional dialects (not a very good example, but the first thing that comes to mind is "soda" on the East Coast, "pop" in the Midwest, "soft drink" in England, etc); and the US psychiatrists have plenty of non-English speaking patients to treat, so the language problem will always be there, in one form or the other, you just have acknowledge it and deal with it. On the other hand, if you do not know your medicine (as reflected by a borderline USMLE score), your options are somewhat more limited.

USMLE hardly touches your knowledge of Psychiatry. We all know that. It will show you are a good test taker which is great for psychiatry but you'd have to try and see it from the PD's side where the culture difference is huge. It will be a struggle explaining cultural detail after detail to an FMG resident who has never been in the US. You underestimate the struggle. Worse if the resident has a bad bad accent (and if you think Psych patients wont hold it against you, you are way wrong).

I am also wondering what you mean when talking about substituting neurology for psychiatry requirement of ECFMG. As someone who recently went through the ECFMG certification process, I cannot recall any specific psychiatry requirements there.

At first I didn't think it was possible but I confirmed it with several FMGs. Many FMGs do 2 weeks in psychiatry in this home country, which apparently is deemed acceptable in ECFMG eyes but some states have psychiatry weeks requirement. They get around that by making their neurology count as psychiatry.

 

[BabyPsychDoc]

USMLEs do test the factual knowledge of psychiatry and behavioural medicine, and to a certain extent English language skills (I think everyone would agree that the Step 2 CS is a joke, the only purpose of which is to eliminate FMGs with poor language skills/interpersonal skills).

I may be underestimating the struggle, though, since I am not looking at things from a perspective of someone "fresh off the boat".

I am amazed that it is allowed to substitute neurology for psychiatry.

 

[drmona2011]

Hello to all!

I am currently a 4th year med student (IMG) completing 4th year clinical rotations in the U.S. I've been interested in Psych since day 1, and now that it's getting closer to applying, etc., I'm wondering what Psych residency lifestyle is like? I've been trying to get an idea from reading various Program descriptions on the web, but I thought this would be a better resource. What can I expect/look forward to?

And do all programs start with a preliminary year/Internal Med?

Thanks so much!

 

[whopper]

It's going to highly vary per residency. In general psychiatry is somewhat easier vs the other fields but there is variability among the programs. I know of several psychiatry programs that are tougher than some IM programs in terms of hours, workload, etc.

You will likely not have to do rectal exams, procedures, draw blood, injections, among a few other things several medical doctors usually do in practice.

 

[masterofmonkeys]

It's going to highly vary per residency. In general psychiatry is somewhat easier vs the other fields but there is variability among the programs. I know of several psychiatry programs that are tougher than some IM programs in terms of hours, workload, etc.

You will likely not have to do rectal exams, procedures, draw blood, injections, among a few other things several medical doctors usually do in practice.

I would quote your earlier post too, but I have no idea how to multi-quote. But I am always astonished at the fact that only a handful of people started med school knowing they were going into psych, and yet so many are willing to hang up their stethoscopes, sometimes absurdly early in their medical careers.

It makes me question the motivation for going into psych. If you went to med school wanting to be 'a doctor' and are willing to just turn aside from all that medical knowledge, is the real reason you're going into psych because you've decided you don't like medicine that much? Personal observations being fundamentally limited, I have noticed this trend in psych, rads, anesthesiology, and derm, and it distresses the crap out of me.

I think it's an important question--leaving aside the issue of whether its ok for any physician to lose general medical competence--because it raises issues of motivation and what someone hopes to 'get out of' being a psychiatrist.

Does it lead to people who are poor diagnosticians, lazy with meds, and bad therapists? One could argue it does.

I'm not sure why I went off on that tangent, but there you have it.

 

[kugel]

I am always astonished at the fact that only a handful of people started med school knowing they were going into psych, and yet so many are willing to hang up their stethoscopes, sometimes absurdly early in their medical careers.

And it's equally astounding how many intend to become a PCP, but instead become a specialist. My own take on it is that most people entering Med School don't really know what daily life in medicine is like, don't understand what they'll be doing, don't understand the residency process, etc. My own observation is that those who've spent time working in medicine before med school tend to know about what they want, what they'll be good at, what they don't like, etc.
But I have no data. None, nada. Not a single datum.
MMWhaaa, Haaa, haaa, haaa
(evil laugh ending with my pinky at the corner of my mouth)

It makes me question the motivation for going into psych. If you went to med school wanting to be 'a doctor' and are willing to just turn aside from all that medical knowledge, is the real reason you're going into psych because you've decided you don't like medicine that much?

Hmmm... Psychiatrists spend the majority of their time directly in front of patients, Talking to them. I'd argue a sort of the reverse:
Those going into specialities with little patient-contact decided they like procedures and/or data, but not patients. In all my time in the hospital a few yrs back, I met every one of my physicians - except for a single radiologist. Personally, I have trouble calling any career in which you rarely/ever see the patient "Medicine."

Does it lead to people who are poor diagnosticians, lazy with meds, and bad therapists? One could argue it does.

You'd have to show that this is less commonly the result in other specialties. I've seen it in nearly every field. I'm more aware of it when it happens in my own field, because most of the physicians I know are in that field.

I'm not sure why I went off on that tangent, but there you have it.

This forum is filled with people ready to tell you why. Sure you want that?

 

[gynogrl]

Just to contribute some data, I have an n=1 type of experience: my fiance is applying for psychiatry along with a much higher than normal number of his classmates. He got most of his interview offers well before transcripts and Deans letters went out, and was told by PDs that his personal statement and letters of recommendation won them over. So competitiveness-wise, I would surmise that psychiatry programs care far less about your test-taking ability and much more about your interactions with patients and team members. And that they're probably quite competitive when it comes to those attributes.

As far as hanging up stethoscopes - most of the future psychiatrists in my class hated medicine. They hated using the same diagnostic protocols and treatment plans for every single patient, and they hated seeing patients' needs and deeper problems pushed by the wayside. Enter psychiatry. Yes it's different than a lot of medical fields, but intrinsically it seems to be a lot closer to why most of us went into medicine in the first place - because we actually want to help people.

And as you might be able to tell from my handle, I'm going into a very different type of specialty, in part because I don't have the patience to sit and talk with someone for an hour to try to figure out what's really going on, and all the while not knowing if anything they tell me is the truth. But I admire people who do, and don't think they're lazy or inept. Though I do admire their hours.

 

[HiScarlett]

@masterofmonkeys, you clearly have zero experience working in psych, or you would know how much medicine we actually use... Your ignorance is so mindblowing, that I cannot even take the time to explain any further.

 

[Doc Samson]

@masterofmonkeys, you clearly have zero experience working in psych, or you would know how much medicine we actually use... Your ignorance is so mindblowing, that I cannot even take the time to explain any further.

Here's some advice from your friendly neighborhood moderator - before you go flaming a long-time respected poster, you might want to be absolutely sure that you've fully understood the post that you're objecting to. To my read, MoM was not saying that there is no medicine involved in psychiatry, rather he was bemoaning the notion that some of colleagues believe that a career in psychiatry is a good excuse to surrender you general medical knowledge and aptitude.

 

[dl2dp2]

I would quote your earlier post too, but I have no idea how to multi-quote. But I am always astonished at the fact that only a handful of people started med school knowing they were going into psych, and yet so many are willing to hang up their stethoscopes, sometimes absurdly early in their medical careers.

It makes me question the motivation for going into psych. If you went to med school wanting to be 'a doctor' and are willing to just turn aside from all that medical knowledge, is the real reason you're going into psych because you've decided you don't like medicine that much? Personal observations being fundamentally limited, I have noticed this trend in psych, rads, anesthesiology, and derm, and it distresses the crap out of me.

I think it's an important question--leaving aside the issue of whether its ok for any physician to lose general medical competence--because it raises issues of motivation and what someone hopes to 'get out of' being a psychiatrist.

Does it lead to people who are poor diagnosticians, lazy with meds, and bad therapists? One could argue it does.

I'm not sure why I went off on that tangent, but there you have it.

I think you make a good point, but I think the way medicine is so specialized now this appears to be the inevitable direction that medicine is going more and more. Nobody goes to medical school willing to be a radiologist--at least they never say that at interviews. Nevertheless, they fly to it in droves, and that field is certainly NOT having a deep introspective crisis. Statistically, probably more than half of the doctors these days don't use the stethoscope on a routine basis. So I think rather than criticizing medical students in failing to conform to a specific stereotype of that good old country doctor, or House, M.D., perhaps it's the stereotype that needs to be re-examined.

Though I suspect more and more people are going to go into psychiatry for the "lifestyle", I don't think this necessarily is relevant in terms of competency. Is a good lifestyle an advantage that people should consider when entering this field? I think absolutely. I don't think we should be too limited by our puritanical guilt in automatically assigning virtue to self-torture.

Also, people who go into psych tend NOT to actually be the type who hates medicine in general. Psych people tend to debate between psych, medicine and neurology. There is a fair amount of general medicine involved in everyday psych practice. I would argue people who truly despise medicine end up going into non patient care specialties, or arcane procedural specialties.

 

[Trevelyan]

I know of several psychiatry programs that are tougher than some IM programs in terms of hours, workload, etc.

Which psych programs are those?

 

[slope]

1) Why does residency placement seem so un-competitive? Average USMLE scores for placement in many psychiatry spots is very low, and many very good programs have FMGs or DOs as residents. I've noticed a trend of allopathic students away from the field.

I agree with the posters above in the sense that the trend of recent years shows that the field is everything but "un-competitive". Somehow I sense that having FMGs or DOs as residents is not a very good sign for you or a sign of a possible bias that those programs might have...I don't know whether that's true or not, but you can find a lot of programs that have almost no FMGs whatsoever (if that works better for you).

2) How difficult is the competition with nurses, PhDs in psych, etc.? In general? Metropolitan Cities like NYC, SF, Boston, etc?

We don't need to compete with nurses or PhDs...we all have our own niche...but if there is more to this question, please elaborate!

3) Do your patients get to you after a while? Does the neurosis rub off? How do you keep them from getting to you?

I guess that depends very much on one's personality and defense mechanisms.

4) I've heard the field is very pro-gay. I am a gay man myself and am eager to learn more about it. Some of my most supportive doctors are shrinks. Is it a gay supportive field?

Your question, as the other posts pointed out, begs clarifications as to what "gay supportive" means. You will be able at times to hear or read homophobic remarks made by psychiatrists...it is not a common occurrence, though...there is a very active group, AGLP, of gay & lesbian psychiatrists and you might want to look it up online for more information and as a source of networking. In the end, it comes down to a few things:
- what do you make of a possibly negative experience you have rather than the experience in itself;
- what part does your being gay play in your life, and in what way and to what extent would it reflect in your interactions with the pts (as a gay psychiatrist/therapist, you would be dealing with a lot of pts, gay-friendly or not)

 

[nitemagi]

1. The top psych programs are still very competitive.

I think what's being alluded to is an innate stigma even in medical schools, and the fact that all those in psychiatric/medical education haven't figured out how to sell our specialty to medical students. They don't see what's so inspiring about it, and don't get introduced to it early enough. Then students too often get biased from early on by criticism from the uninformed, many of whom are faculty passing on misinformation from their own medical training.

I try and pass onto students (probably still unsuccessfully) the beauties of psychiatry -- That after 10 years in medicine the biggest issues are boredom and burnout. Psych can be emotionally taxing, but it's never boring, is a secret lifestyle specialty, and often works less hours for more money than our algorithm following colleagues.

It has more flexibility than most other specialties, as well. Many go into IM when they can't decide because they're sold on what I consider the myth that it's the most flexible. But if you go into cards, nephrology, or whatever, your day is still mostly the same -- Do some caths (procedures - insert dialysis, etc. here), round on your inpatients, then do clinic the rest of the day. That's it for your career. In psych you can do forensics for two days, inpatient consults for two days, and a day of psychotherapy clinic. And change your focus whenever you want, do half days in one area and so on. Mix and match to whatever you like.

And the material is just cool! Other specialties are interesting until you master it, but then you're done. There's no new frontiers. Psych is the oldest professional medical specialty, deals with the most complex organ, and needs the most help to continue to move the field forward. We need smart people. So join us.

2. I don't feel we're competing, for the most part. Though there is turf wars everywhere. That's a much longer thread about how psychologists, mid-level providers, politics, and economics have led to our current situation. Regardless, psychiatrists are still highly sought after.

3. I remember a friend finishing attending an AA meeting in our psych rotation in med school and said "God I need a beer." I think there's many ways we cope with this, and some people are better than others. If you have the introspection and humility to recognize when it's getting to you, you'll be fine.

4. Overall, yes.

 

[carlosc1dbz]

1. The top psych programs are still very competitive.

I think what's being alluded to is an innate stigma even in medical schools, and the fact that all those in psychiatric/medical education haven't figured out how to sell our specialty to medical students. They don't see what's so inspiring about it, and don't get introduced to it early enough. Then students too often get biased from early on by criticism from the uninformed, many of whom are faculty passing on misinformation from their own medical training.

I try and pass onto students (probably still unsuccessfully) the beauties of psychiatry -- That after 10 years in medicine the biggest issues are boredom and burnout. Psych can be emotionally taxing, but it's never boring, is a secret lifestyle specialty, and often works less hours for more money than our algorithm following colleagues.

It has more flexibility than most other specialties, as well. Many go into IM when they can't decide because they're sold on what I consider the myth that it's the most flexible. But if you go into cards, nephrology, or whatever, your day is still mostly the same -- Do some caths (procedures - insert dialysis, etc. here), round on your inpatients, then do clinic the rest of the day. That's it for your career. In psych you can do forensics for two days, inpatient consults for two days, and a day of psychotherapy clinic. And change your focus whenever you want, do half days in one area and so on. Mix and match to whatever you like.

And the material is just cool! Other specialties are interesting until you master it, but then you're done. There's no new frontiers. Psych is the oldest professional medical specialty, deals with the most complex organ, and needs the most help to continue to move the field forward. We need smart people. So join us.

2. I don't feel we're competing, for the most part. Though there is turf wars everywhere. That's a much longer thread about how psychologists, mid-level providers, politics, and economics have led to our current situation. Regardless, psychiatrists are still highly sought after.

3. I remember a friend finishing attending an AA meeting in our psych rotation in med school and said "God I need a beer." I think there's many ways we cope with this, and some people are better than others. If you have the introspection and humility to recognize when it's getting to you, you'll be fine.

4. Overall, yes.

Great post, and great answers. I hope I can still get into psych when I finish med school. I would like to mention, that every top program regardless of what specialty it is, have high average STEP scores.