Is Psych going to become much more competitive in the next few years?

[Indodo]

No

---

Members don't see this ad.

 

[HarryMTieboutMD]

Purely speculation and anecdotal... but highly unlikely. Most of my classmates in medical school (US MD) really enjoyed the psych rotation, but we had four actually go into psychiatry, and I think most schools have somewhere around 5-10. I think the reason is primarily that psychiatry is not seen as a medical specialty, and people want to feel like they are going to become "real" doctors (up to interpretation). Certain people will always be drawn to the OR. Even with interventional psychiatry, people who want to be (non surgical) proceduralists with favorable work hours have a lot of other options that pay much better- anesthesia, IR (especially now that it is becoming its own residency), EM...

For the people who blow Step 1 out of the water and go into money/lifestyle specialties because they can, I don't see psychiatry achieving the status of 1990s derm, optho, rads, rad onc, etc anytime soon. Though of course there are the exceptions... NYC analysts on 5th Ave/Park Ave and forensic psychiatrists who have ridiculous setups with the corporate world, but these are the exceptions rather than the rule. I don't pretend to understand how reimbursements under the ACA will actually happen (does anyone?), but I highly doubt that psychiatry as a whole will be reimbursed like the other specialties are/were.

Kind of obliquely related, but the good news is, and this has to do with my first point, that it seems (again, anecdotal because I don't feel like looking up actual numbers) is that more and more MDPhD/MDs interested in basic science research are choosing psychiatry. For psychiatry to truly evolve as a medical specialty, we need more people like Danny Weinberger and Karl Diesseroth, who push the boundaries of what we know about neuroscience and are not afraid to delve into the mechanisms of these pathologies. Psychiatrists almost glibly talk about a revolution where pathology is understood on the level of the neurocircuitry, but this sophistication in understanding of psychiatric disease is absolutely necessary for the field to be universally (ie, not just those of us wise enough to choose it!) respected as a truly medical specialty.

 

[OldPsychDoc]

Kind of obliquely related, but the good news is, and this has to do with my first point, that it seems (again, anecdotal because I don't feel like looking up actual numbers) is that more and more MDPhD/MDs interested in basic science research are choosing psychiatry. For psychiatry to truly evolve as a medical specialty, we need more people like Danny Weinberger and Karl Diesseroth, who push the boundaries of what we know about neuroscience and are not afraid to delve into the mechanisms of these pathologies. Psychiatrists almost glibly talk about a revolution where pathology is understood on the level of the neurocircuitry, but this sophistication in understanding of psychiatric disease is absolutely necessary for the field to be universally (ie, not just those of us wise enough to choose it!) respected as a truly medical specialty.

Speaking as someone who invested a good chunk of his youth in basic neuroscience, I both agree with this and yet am uneasy about it. I think that there is a fundamental disconnection between the aspects of our discipline that seek this detailed sophisticated knowledge and those that pursue it for the sheer fascination of connecting deeply with the human experience. Put more simply, the low functioning chronic mentally ill guy I admitted last night doesn't give a whit about his synapses and "connectome"--he just wants someone to understand the depths of his distress and suffering and who wants to try to make it better. The psychiatrist who is really gifted at the latter probably isn't the one "pushing the boundaries of neuroscience".

 

[budda10000]

As long as your define the corners of California as mostly places very few psychiatrist wants to live. With the exception of San Quentin and a couple others (which tend to be highly competitive) the vast majority of sites are in areas of the state they have trouble attracting people. California tends to build prisons in areas that few people want to live, for obvious reasons.

http://cphcs.hodesiq.com/joblist.asp?ClassCode=9758&user_id=

about 1/3 the listings are in crap spots, the rest are within commuting distance of some really nice places.(san diego, orange county, san luise obisbo, folsom, sacramento). Really the only butthole's in CA is the inland desert and the southern central valley. Rural some of the other places may be but they are really nice and the real estate prices reflect that.

 

[digitlnoize]

Speaking as someone who invested a good chunk of his youth in basic neuroscience, I both agree with this and yet am uneasy about it. I think that there is a fundamental disconnection between the aspects of our discipline that seek this detailed sophisticated knowledge and those that pursue it for the sheer fascination of connecting deeply with the human experience. Put more simply, the low functioning chronic mentally ill guy I admitted last night doesn't give a whit about his synapses and "connectome"--he just wants someone to understand the depths of his distress and suffering and who wants to try to make it better. The psychiatrist who is really gifted at the latter probably isn't the one "pushing the boundaries of neuroscience".

The good news, to me, is that we need both. I'm more like the guy "trying to understand the pt", but we need the connective people to figure out how to fix this stuff. It's way beyond me...

 

[HarryMTieboutMD]

Speaking as someone who invested a good chunk of his youth in basic neuroscience, I both agree with this and yet am uneasy about it. I think that there is a fundamental disconnection between the aspects of our discipline that seek this detailed sophisticated knowledge and those that pursue it for the sheer fascination of connecting deeply with the human experience. Put more simply, the low functioning chronic mentally ill guy I admitted last night doesn't give a whit about his synapses and "connectome"--he just wants someone to understand the depths of his distress and suffering and who wants to try to make it better. The psychiatrist who is really gifted at the latter probably isn't the one "pushing the boundaries of neuroscience".

This is true, but one of psychiatry's problems is that there remains a parsing between the two. They are not at all mutually exclusive; in fact, I think that they are inextricably linked. Obviously, the basic scientist psychiatrists represent small fraction of the field, but the work they do has an enormous clinical impact. The more we understand about the brain, the more we can truly empathize and offer hope to patients. I think Danny Weinberger serves as a perfect example- he saw many, chronic, refractory to treatment schizophrenic patients and knew that psychiatrists should be able to offer much more, and thus dedicated his professional life to exploring the genetics of schizophrenia because genes transcend phenomenology, represent mechanisms of disease, and reveal targets for more sophisticated, therapeutic intervention. In fact, Lieber has an entire division dedicated to pharmacotherapeutics.

Also consider the example Silkworth and AA. In the 1930s, he described alcoholism in a very elegant way by focusing on its mechanism rather than purely its phenomenology, what he then called the "allergy". Of course, we now know that the pathophysiology of addiction is not a Type 1 Hypersensitivity reaction, but the clinical description of an allergy is an exaggerated, pathologic response to an exogenous stimulus, which accurately describes the use patterns of the alcoholic/addict. The true mechanism, of course, is now well characterized. Dr. Silkworth did not have the luxury advances in neurobiology and immunopathology to understand the mechanism, but his description, which he derived through examining and questioning the mechanism, is correct. And regarding the original members of AA themselves, his mechanism oriented description was vital to AA in its early days and still serves as a crucial foundation to the 12 Step Program, which, as far as I can tell, is the only entity that offers a solution for why the person drinks/uses in the first place. Now, of course, we can educate our patients on the "allergy," but we can frame the mechanism in terms of brain disease.

 

[jettavr6]

http://cphcs.hodesiq.com/joblist.asp?ClassCode=9758&user_id=

about 1/3 the listings are in crap spots, the rest are within commuting distance of some really nice places.(san diego, orange county, san luise obisbo, folsom, sacramento). Really the only butthole's in CA is the inland desert and the southern central valley. Rural some of the other places may be but they are really nice and the real estate prices reflect that.

Negotiate. The offer is just that - an offer. They would love for you to jump at the bit. If you feel you are worth more than that, make a counteroffer.

 

[budda10000]

Negotiate. The offer is just that - an offer. They would love for you to jump at the bit. If you feel you are worth more than that, make a counteroffer.

Agree with this totally, another way to the nice spots is to take a position in a not so nice place for a year. They give priority to lateral transfers(people already employed by CDC).

 

[Silent Cool]

Let me try to make this as simple as possible.

10 hours = 50k
20 hours = 100k
30 hours = 150k
40 hours = 200k
50 hours = 250k
60 hours = 300k

The numbers will shift slightly depending on your geographic location.

But how many weeks of vacation does this include? Touche!!

 

[Silent Cool]

Prestige is the temptation of the weak, and the ambush of lifestyle.

@Leo Aquarius ,

Did you pen that or did someone else?

I like that.

 

[Leo Aquarius]

I penned that myself actually.

 

[Silent Cool]

I penned that myself actually.

Nice.

I added that to my quote list a few days ago.