Ah yes, I remember back in 3rd year being very torn between Psych vs. IM (with a subspecialty in heme/onc or endo). I also seriously considered Emergency Medicine.
Now that I'm a resident in Psych, I definitely think that I made the right choice.
Reasons I decided against the IM/heme/onc route:
-I like "bread and butter" psych a lot more than I like "bread and butter" IM, and I've always believed it's best to make sure you'd be happy in the main specialty just in case some circumstance prevents you from going on to fellowship
-At my med school, the IM residents seemed pretty miserable and some of the IM attendings were kind of mean. I think that malignancy is more prevalent in IM than it is in psych.
I've seen lots of people switching from IM/FM to psych, but not nearly as much of the other way around. I suspect that this may in some cases be because it's easier to switch from IM to Psych than vice versa (to switch from IM to psych, you can get credit for doing a PGY-1 in IM and still graduate from a Psych program on time, but you have to start over as an intern if you switch from psych to IM) but it does seem like overall psych people are more satisfied with their jobs than IM people are.
-I felt like I could potentially make more of a positive impact in psych. Psych needs more good med students who have a genuine interest in the specialty and genuinely have compassion for mental illness. There are already plenty of good med students interested in IM.
-In IM, you WILL see a lot of mental illness in your chronic pain patients and such, but you're in a far worse position to actually address their true underlying issue than when you see these patient in a psych context.
Reasons I decided against EM:
-PRESS-GANEY scores! Go ask the folks on the EM forum what they think of press-ganey scores and I bet you'll get an earful. The current trend at many hospitals is to make the
EM departments very focused on "customer satisfaction" even though giving the patient what they want is frequently in conflict with practicing good medicine.
I was at a hospital that did track customer satisfaction for the psych department too
but at least in psych, people tend to understand intuitively that the patients are not necessarily always in the best position to recognize what help they need.
-The specialty can be tough on the body. Even though I am not THAT old, things like
leaning over somebody to suture and the constant "jumping up and down" aspect of EM aggravated my chronic back pain. The frequent sleep schedule changes are also tough.
-Even though having a lot of days off is great, you may not get to spend as much time with your family if you work nights/weekends/holidays
-Sometimes I think med students don't get a full taste of what the pace in EM is really like (since they usually only carry a few patients at a time and obviously always have backup). It is far different as a resident or an attending, especially if you end up in a solo coverage situation.
-I didn't like the idea of being tied to a hospital. It's nice that in psych you have the option of opening your own office if you want, and it's a realistic option even in the current business climate. Obviously not an option in EM.
Misgivings about psych? I did worry about if I would forget about medicine. We do enough medicine in psych that I don't think that will happen though. Good psychiatrists need to be able to recognize when a general medical condition is masquerading as a psych problem or exacerbating it (Two things you learn fast: Even psych patients get sick with other problems sometimes, and you should never take the ED's word that the patient is "medically cleared").
I love Psych. The patients are really interesting and you have a lot of flexibility in how your practice. It's a good field.
