EM vs psychiatry?

[brandtson]

Hello,
First time poster...looking for some advice. I'm currently a PGY2 in a 4 year EM program and im considering a career change. I'm just not sure about the longevity of the field. Feel like i'm always just "moving the meat"/trying not to get sued and that i'm just getting through my shift to get to my days off. I'm also tired of the nights/weekend/holidays and would like to be home on weekends with my kids...they don't care if I had tues and weds off when there at school all day. I wanted to do psych when i was a student but, of course, was discouraged and ended up going with the only other speciality i could stand. My dilemma is that i've been offered a psych spot outside the match and several interviews but i would have to start as a pgy1 july 2007, granted i would get credit for my primary care. So, 2 more years of residency, 2 more years of interest on my 180k of loans, 2 less years of +200k ER salary. Sounds like a no brainer to most but then i have to do this job for the next 35 years. Anybody else decide between EM and psychiatry? What made the decision for you?Advice? Thanks

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[Analyzethis]

Very interesting I was just thinking about this today and talking to someone. During my M3 year the only thing I liked was EM and psych-i hated everything else! Then I got to wondering how opposite of fields these really are. I mean EM you barely get to know the patient, have no follow up care, rely almost completely on objective tests even more so than almost any other field- v. knowing your patients extremely well and having very good follow up with lots of talking, no objective tests, rather its mostly a subjective field.

The only thing they have in common as they both have pretty good lifestyles with no call (and not talking about academic psych with call)-

To me although EM has no call-i think working weekends, nights, holidays is worse than working a 9-5 weekday schedule which 90 percent of private pract psych guys do. So to me psych wins lifestyle hands down. The only thing you really are left to decide is what you LIKE better-they are completely different fields as far as subjective material and that is what it will come down to for most.

Pay is virtually the same give or take a few thousand and you can earn mor ein either field by working a bit more etc.

Personally I chose psych and actually have come NOT to like the ED but its still a good choice for many!

 

[nitemagi]

Funny. I have this conversation all the time. I thought about it myself. And my best friend here at school is still debating it. For me I realized if I did EM I'd become an alcoholic. Too much stress all the time. It would only encourage a short attention span, and I need to encourage the opposite.

There's some EM attendings here that understand the dual appeal to people. One of them has an article that breaks up all the medical specialties, as in an algorithm.

The first division is "Crazy" or "Not Crazy" (meaning patients).

Crazy-->EM or Psych
Not Crazy-->Everything else

 

[raspberry swirl]

i know to someone who is nearly done with residency, another 2 years seems like an eternity. but 2 years really isnt that much in the long haul, especially if it means finally finding the niche were you can really be happy. the sole fact that you are posting this here, means you really are unhappy with ER. not to mention, its not as though your ER training was a waste- everything you gained during your ER residency will help you in psych or wherever you end up.

the way i see psych, is that there are so many different things you can do- different types of practices, inpatient vs outpatient, etc., etc. when you're an ER doc, thats it. you work in an ER. not a lot of variability there. but psych is more tailor-able (is that a word?) to your life. if you like the fast paced unpredictable-ness of the ER, you should be able to find something in psych that fits that (but with regular hours). or if you think you want something calmer and laid back, you can hook up with a group and do private practice. not to mention, even as a resident, the schedule for psych is pretty good - i believe at most places, 3rd year of residency is pretty much all outpatient, 9-5 type stuff. so you'd have your weekends for your kids sooner than you think

shift work sounds nice in theory, but frankly, working holidays and weekends SUCKS. my mom worked in retail and she always had to work christmas eve and the day after christmas, the day after thanksgiving, etc. we could never go anywhere for holidays, and it was never a relaxing time for her. granted, i hate the ER, so im quite biased. but i think choosing psych is the right choice, especially if someone is offering you a spot outside the match- no hassles to deal with! i wish someone would do that for me

 

[Neurotica]

Funny. I have this conversation all the time. I thought about it myself. And my best friend here at school is still debating it. For me I realized if I did EM I'd become an alcoholic. Too much stress all the time. It would only encourage a short attention span, and I need to encourage the opposite.

There's some EM attendings here that understand the dual appeal to people. One of them has an article that breaks up all the medical specialties, as in an algorithm.

The first division is "Crazy" or "Not Crazy" (meaning patients).

Crazy-->EM or Psych
Not Crazy-->Everything else

I also heard about this algorithm. The next part, once you got within "crazy," was attention span: short--ER, long--psych.

 

[nitemagi]

I also heard about this algorithm. The next part, once you got within "crazy," was attention span: short--ER, long--psych.

EXACTLY!

 

[Dartos Vader]

2 years lost is nothing compared to the thirty five years of working at a job you will hate. I thought about ER but then realized I spent half my shift watching the clock, waiting for work to end. In psych I feel like the day just flies by and I feel totally refreshed and relaxed at the end of the day. It feels awesome to do what you love every day, worth every second of training.

 

[Analyzethis]

TOTALLY agree-I found with EVERY rotation I did in medschool, all I could think about was when the day was over and I just dreaded wakikng up and going to work in the morning, I hated what I was doing all day and was just painful. But psych, I literally am excited to go to work each day, I love the people I worked with in psych, I love the work I do-the patient interaction etc. The day DOES Literally fly by-not to say I dont still like to see the day end-but nice to know that your day is filled with hours of enjoyment rather than complete misery!

 

[worriedwell]

A question regarding what you mean by saying that you will get credit for your primary care?

Does that imply that you will not have to do any medicine? How about neuro?

Because if so, and you are starting as a PGY1, you actually will have 4-6 months of nothing to do. I would see if that means you have to do extra psych or what. Because it might be nice to have 4-6 months of elective...or better yet...if you finish two years in the ED you probably can MOONLIGHT in the ED during your residency once you get your unrestricted license. And I don't know what hospitals require regarding psychiatry moonlighting, but you may be able to start psychiatry moonlighting after your pgy1 year. This would mean that you can usually dramatically increase your salary during your residency. (and you can do it two or three years before others in the psychiatry residency which they will be jealous of.

There are many residents who moonlight during their third and fourth year and nearly double their salary! That means you'd be approaching $100,000 per year which might make it a little less financially scary to switch careers.

By the way, this would entail not that much extra work, especially if you are used to overnight shifts (and when you psych moonlight, usually it isn't as crazy as regular ER moonlighting).

I would strongly advise a switch if you are already feeling the burnout from EM. Money should not be the driving force.

I would also strongly advise negotiating or finding out why you start as a pgy 1 when you already have half of your intern requirements completed. If true, it might mean you can finish in 3.5 years, and if you moonlight for most of those years, it really makes the financial burden not so bad.

Remember, often in psychiatry, especially during certain rotations, you will have the energy to do an extra shift for money.

And by the way, the absolute worst case scenario, if you don't find yourself loving the long term outpatient world of psychiatry, is to do the residency, then to go back and finish one more year at some EM program somewhere and then you can be "double specialized". Don't underestimate the flexibility this might allow you and the additional earning power, especially in a community hospital where resources are slim.

Things change, people change, life changes...go with the flow, you're never set in stone. A physician's earning power and job security no matter what specialty allows the "debt" thing to be something that won't cripple you. Its just a matter of getting over the psychological aspect of having debt hanging over your head. But the average american lives their whole life in debt, so you are not alone.

Delayed gratification is tough, especially since we've been through so much, but 1-2 years is NOTHING in the grand scheme. If you are thinking about living the blinged out lifestyle...you still can do it, but just 2 years later. The added interest on the debt is a drop in the bucket.

Good luck,
worriedwell

 

[brandtson]

Thanks for all the great responses! I'm not really sure what they will do with the primary care months...graduate early vs elective vs moonlighting. We have not discussed the details...this was all kind of thrown in my lap and I was told "get back to us" So I need to make a decision soon. Speaking of living a blinged out lifestyle, I'm thinking about a pair of these when my practice gets rocking.
http://www.icedoutgear.com/cb29.php

 

[brandtson]

And no psychiatrist is complete without a pimp cup

http://www.icedoutgear.com/pimp-cups.php

 

[worriedwell]

I ordered 3 pimp cups.

 

[Anasazi23]

Here's the best part for the "dracula style golden playa grillz combo:"

-Care Instructions-
1.Maintain normal hygiene, you should rinse the grillz in cold soapy water after each use.
2.Store Grillz in the box supplied.
3.Do not use solvents to clean.
4.Do not place in boiling water or leave on parcel shelf of car.
5.Your grillz is made for you.do not let others use it.

Imagine this green face thingy with a set of those.

 

[brandtson]

Again, thanks for the advice...I have gotten mostly positive comments about the field of psychiatry from the 5 or 6 psychiatrists I've spoken with and have been encouraged. However, one of them was not so encouraging and basically said that all "real world" (ie not residency) psychiatry is 10 minute med checks and that if I hated the factory-like atmosphere of EM it is no different in psychiatry. Also, you only get to practice "real psychiatry" in residency where money and time are not a concern to you but when you get out its all a business. Finally, he believed that psychologists and other mid level providers were going to decrease the number and pay of jobs(although in reality probably no different than a NP in a fp office or PA in an ED). Now this guy had to close an unsuccessful private practice and now works for a community health center so maybe he's just bitter but is there any truth to his outlook on psychiatry? I know that you could talk to 5 different attendings in any field and get 5 different views of the speciality so maybe thats it. Any thoughts

 

[deleted6669]

Again, thanks for the advice...I have gotten mostly positive comments about the field of psychiatry from the 5 or 6 psychiatrists I've spoken with and have been encouraged. However, one of them was not so encouraging and basically said that all "real world" (ie not residency) psychiatry is 10 minute med checks and that if I hated the factory-like atmosphere of EM it is no different in psychiatry. Also, you only get to practice "real psychiatry" in residency where money and time are not a concern to you but when you get out its all a business. Finally, he believed that psychologists and other mid level providers were going to decrease the number and pay of jobs(although in reality probably no different than a NP in a fp office or PA in an ED). Now this guy had to close an unsuccessful private practice and now works for a community health center so maybe he's just bitter but is there any truth to his outlook on psychiatry? I know that you could talk to 5 different attendings in any field and get 5 different views of the speciality so maybe thats it. Any thoughts

I did my psych rotation at a lock down inner city psych facility. my preceptor was the chief of psychiatry and loved his job. a few new admissions/day with whom he spent at least 30-45 min each then rounds on all the regulars and a few acute flare ups/day to deal with. he worked regular hrs, no weekends/nights/holidays but he did share call with the rest of the group, most of which was phone call from home. he had a great approach and really put folks at ease. one of the things he would do with every new pt after introducing himself was to start this way:' I know things don't seem like they are going really well for you right now but let's talk about the last time you felt really good..."and folks really opened up to that and it helped him to obtain a great hx and involve pts in the decision making process. if you have the temperment for it( I don't-SOME of my pts need to be sane, so I work em) it seems like a great career.

 

[chocomorsel]

Thanks for all the great responses! I'm not really sure what they will do with the primary care months...graduate early vs elective vs moonlighting. We have not discussed the details...this was all kind of thrown in my lap and I was told "get back to us" So I need to make a decision soon. Speaking of living a blinged out lifestyle, I'm thinking about a pair of these when my practice gets rocking.
http://www.icedoutgear.com/cb29.php

Thanks for making me laugh this early morning with the grilz and pimp cups. Too funny. I am a third year and my choices now are ER, psych and Family medicine. I start psych in 2 weeks and can't wait. I don't find out about ER till next july or august, but I have to admit, even thout it was on top of my list first and second year, it's slowly slipping now that I hear about the high turnover rate of ED physicians and rotating between days and nights every few months. I don't want to be doing that in my 40's and 50's. Sounds less appealing, but then again, I haven't rotated thru it yet. Good luck with your decision but I have to say, you gotta look at the long term, like 10-20 years from now, where do you think you'll be happier. Making a little less in a field you love, and more time with family, or making a little more in a field you feel so-so about, but you can't get off when you want, have to work nights, and some holidays.
Again, good luck, but it sounds to me that your mind is almost made up already.

 

[hsperson]

Sorry to intrude on a residents thread, but I'm an undergrad, and I was having some of the same dilemmas. If someone were to ask if I'm passionate about medicine, I could easily and honestly say that I'm passionate about psychiatry (or related careers). Although I've gotten over the stigma engulfing psychiatry, I feel a sort of pressure to do something more intense like surgery or EM. I guess there's this whole "I've got to cut people open' complex. What do you guys think about that. Invasive procedures seem like they could be interesting, but would it get old after a while? Would you all be okay not performing invasive physical procedures? Thanks.

 

[i61164]

At one private hospital where I live, EM docs work one week on, one week off. Obviously it sucks to have to work some weekends and holidays, but getting two weeks of vacation per month for the rest of your life can't be sooooo bad.

 

[brandtson]

There is that flexibility with EM which is part of the reason I'm having a difficult time choosing. Some of the job offers my friends have gotten...amazing. A senior who just left does 15/8 hour shifts at 125/h +benefits...so thats 180k base + health paid+malpractice paid+10k sign on+partner 1 year with potential for 50K in bonus...working 36 hours a week. This isn't a rare case either. Look in the latest EM news mag in career corner...avg 130-170/hour in midwest. I'm not saying EM isn't probably one of the best fields right now but its not for everyone. The work is taxing and unpredictable and you can expect to get sued about every 2 years BUT I did get to intubate/place a central line and resucitate a TCA overdose the other night which was cool.

 

[i61164]

Yeah, I've actually found myself wishing that EM appealed to me (because the hourly pay is so good and the hrs/week is pretty nice too). Unfortunately it's just not a good fit for my personality and I refuse to choose a specialty based on "lifestyle." For people that like it (and have ADHD perhaps) it seems like the best bang for your buck and a lot of vacation time to boot. Not to mention that it's one of the few 3 year residencies and you can make almost as much as a general surgeon that did a 5 year residency. Obviously the 3 year thing doesn't apply to you if your program is 4 years. I heard those are dying out and the vast majority are 3 years.

 

[kumar28]

anyone else have trouble choosing between these two fields?

 

[peppy]

This was a big dilemma for me too. Each field appealed to a different aspect of my personality/desires.
Then, due to jumping up and down all the time during an EM rotation, I suffered a muscle strain in my back that made it hard to stand up straight (much less stoop down to suture things!) on a few shifts until it healed. That made me think about how the physical stress of EM might really take a toll on me as I get older and my body isn't so forgiving. I like the idea of being able to practice psych for as long as I want to and not having to retire young just because my body can't take the stress anymore like I suspect would happen in EM.
Oh, and with all the frequent fliers, drug seekers, homeless people, and other odd characters that come to the emergency dept, I finally decided...if I'm going to be seeing these people as patients, I'd rather be seeing them as a psychiatrist who is in a position to try to help them with their real issues rather than an ER doc who just gets annoyed at having my time wasted by them.
Not to mention the drug overdoses and suicide attempts, where you can patch them up temporarily but will never really know if they manage to get back on their feet.

 

[Still Kickin]

There's some EM attendings here that understand the dual appeal to people. One of them has an article that breaks up all the medical specialties, as in an algorithm.

The first division is "Crazy" or "Not Crazy" (meaning patients).

Crazy-->EM or Psych
Not Crazy-->Everything else

Actually, I don't think the algorithm is referring to patients...
But it's funny. Here it is:

http://ucsfsynapsemed1.blogspot.com/2007/01/from-ben-choosing-medical-specialty.html

 

[whopper]

Whether or you pick EM or Psychiatry--I think you should do so based on your passion for the field.

I love psychiatry. I went to medschool just to be a psychiatrist. I have never regretted that decision. The only time I ever doubted it was right before my first rotation in psychiatry, I feared it would not live up to the hype I made it in my mind. It lived up to my own hype. I'm currently living the dream (except for the fact that I don't have a mansion filled with a harem of hot babes like Hugh Hefner does).

You need to see if the fields fit your personality. I can tell you that if psychiatry or EM does not match your personality, you will probably not like either field. EM can be stressful & thankless especially in an urban setting. You're also in a position where if the patient need inpatient treatment--you'll have to alert the doctor on the correpsonding unit who will not be happy to hear from you & suspect anything you give them is a dump job.

As for psychiatry--there is a lot of manupilation & exploitation our own patients try to do on us & the system. Several of our own patients are very uncomfortable to deal with in the community, and most people in medschool are of a mindset that if you can't attach a numerical value onto it, it can't be treated.

 

[JMC_MarineCorps]

I started medical school hell bent on EM...even thought about ortho, but every time I was asked what kind of medicine I would practice, the answer was always EM. EM this, EM that...shift work is awesome, no pager, jack of all, master of none -- blah, blah, blah.

Did my psych rotation and started posting on SDN because all of a sudden I had to sort out this weird gut instinct that my search for a balanced life was over.

Such an awesome specialty, such an awesome opportunity to enjoy your life and your career.

Still the best kept secret in medicine as far as I'm concerned.

I'm sorry to hear that you discovered a bit late that you're unhappy...I've already vowed never to repeat my PGY-1 experience, and am only 3 months into it to date (my backup is cooking school), but I've met many a folk who have repeated PGY-1 in their pursuit of happiness.

Me personally, I would rather stay miserable and make 200K/yr x35 yrs than to repeat 2 years of residency by starting all over, but that's me...in an effort to avoid this painful mistake, however, I thought long and hard about the things that mattered most in my life - and the rest is history.

 

[Doc Samson]

I've had a couple of colleagues go the other direction (psych -> ED). I think the common draw (for some of us at least) is the emergent quality - I freely admit I enjoy the rapid assessment/diagnosis/stabilization part of my work more than any aspect of long-term care. There's just something about bringin order to a chaotic situation that's immensely satisfying, more so when others seem too anxious to want to step in.

 

[strangeglove]

If shift work appeals to you, there's always emergency psychiatry. This is pretty much all rapid assessment and stabilization, except for the homeless folks who come looking for a place to bed down for the night. I don't think it pays as well per hour as emergency medicine, but there's nothing to stop you from having a private practice on your days off.