Opinions.
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Opnions.
Not to confirm or refute any claims above, I don't see how having more qualified candidates on paper would be a bad thing. Obviously it would not be a good thing for the average applicant.
Short-term, a good thing, as more patients can access services.
Long term, a bad thing, as the demand for psychiatry training will create increasing numbers of positions to meet this demand, eventually saturating the market and precipitating decreasing compensation and employment issues. Look to pathology and radiology for examples.
And, child psych is currently in a tailspin.
And, child psych is currently in a tailspin.
It's true you don't hear much about NPs taking over derm. I wonder if it's just a matter of time though.How is it that Derm has been able to protect their profession so much better than other specialties such as Path and Rads? There would be plenty of justification for increasing derm residency slots with the number of people wanting to go into derm - but you don't see that happening, and you also don't hear much about NPs taking over Derm. Man, the dermatologists really are smarter than the rest of us are.
What do you mean?
Could you please expound upon this?
It's true you don't hear much about NPs taking over derm. I wonder if it's just a matter of time though.
http://archderm.jamanetwork.com/article.aspx?articleid=1895673
"Nurse practitioners and physician assistants billed independently for more than 4 million procedures at our cutoff of 5000 paid claims per procedure. Most (54.8%) of these procedures were performed in the specialty area of dermatology."
Psychiatry is becoming more competitive, but so is everything, psych still has one of the lowest average step 1 scores on the charting outcomes. The average for psych may have went up from 218-222, but the average for FM did the same thing, and the average for EM went from 23o-235.
Here's my question though. Do you guys legitimately think that it's due to people having more of an interest in psychiatry or whether it's the same people who want a lifestyle specialty that is driving PM&R to be more competitive?
Do you think that in the end more competitive applicants simply drowns out the people who legitimately want to be psychiatrists with people who are half hearted about it but want to work a 8 to 5 job?
Definitely lifestyle. Why do you think Derm/Ophtho are top dogs? LIFESTYLE. Only difference is, not everyone can get 250s. So next bet is PMR/Psych. I mean, I obviously have no data to back this up, and this is my opinion only, but do you really think if Derm had Primary Care Pay and were expected to work 50-60 hour weeks/weekends, it would be super competitive? I doubt it.
So yes, unfortunately, competitiveness may have a downside in that it may drown out people of sincere interest in psych. But then again, you can say that about any speciality right? I'm sure there are lots of people with 210s who sincerely love Derm or ENT or Plastics...but c'est la vie.
Why not just assume that Family Medicine is going to be at a 230 by 2020 as well with that logic. Hell, why not assume that Rads onc will be 270 by then too.
You missed my point. Everything is indeed going up. I was trying to show that competitiveness can be measured by the rate of change.
Look at 2009:
http://www.nrmp.org/wp-content/uploads/2013/08/chartingoutcomes2009v3.pdf
The big guns, Derm/ENT were around 240ish (241/242). Now they are around 250ish. So roughly 8-9 point jump in 8 years. Now Radiology, which was once part of the "holy grail", was 238 in 2009, and now only 240 8 years later. So even Rads went "up", but the rate is obviously much slower and clearly it is no longer a "ROAD" specialty.
Interesting enough, psych went down from 2 points from 2009 to 2011 (216 to 214). So +4 gain these past 2 years isn't anything to sneeze at.
Rads & Gas are suffering paranoia in short term market. Once it chills out it'll balance out.
Well that's the thing, Psych is only a lifestlye specialty on the surface. It has an extremely high rate of people quiting every year.
I'll humor the notion that FM is also a quazi-life style specialty too tbh. Sure it's not a strict 40 hour job, but ppl can easily find a pretty good balance and lifestyle for sure.
Can somebody tell me why people say psych is fun to read about but its horrible to practice? I haven't had my psych rotation yet, but academically I find it really interesting, it was my favorite block during the first 2 years favorite subject to study for step 1, I don't mind talking to patients, but if I don't want to do therapy, I can just do med checks right?
Is this actually true? I normally think of the high-burnout specialities as those that are either high pressure (EM) or high workload (some surgical fields).
Here's my question though. Do you guys legitimately think that it's due to people having more of an interest in psychiatry or whether it's the same people who want a lifestyle specialty that is driving PM&R to be more competitive?
Do you think that in the end more competitive applicants simply drowns out the people who legitimately want to be psychiatrists with people who are half hearted about it but want to work a 8 to 5 job?
Here's my question though. Do you guys legitimately think that it's due to people having more of an interest in psychiatry or whether it's the same people who want a lifestyle specialty that is driving PM&R to be more competitive?
Do you think that in the end more competitive applicants simply drowns out the people who legitimately want to be psychiatrists with people who are half hearted about it but want to work a 8 to 5 job?
Lifestyle. Eventually, most of us grow up and realize that our personal lives are actually pretty important, and that the quality of our own lives is more important than some notion of self-sacrificial altruism, a notion that most med students are lying about anyways. It would be nice if, as a profession, we can get over this anathema towards self-interest. It's all a façade anyways.
The high levels of stress, low job satisfaction, and burnout are partially self-imposed. We do have the power to stop such nonsense. The first step is putting the responsibility of health back where it belongs -- the patient.
So where do you think the averages will be for psych in 2020?
Averages of what? Step I? I have no idea. I don't imagine it will change much in 4 years. Probably still under 230? As others have mentioned, psych is somewhat protected from an abundance of applicants due to the nature of the work and field itself, and the general sense that it's the least, "mediciney" of all the specialties. Even then, child is probably the more lucrative area of psych, and even most psychiatrists don't want to do child psych. I get offers all the time for $280k-$320k. The demand is absurd, and the supply is incredibly low. Sometimes, however, there is a reason why supply is low...
Averages of what? Step I? I have no idea. I don't imagine it will change much in 4 years. Probably still under 230? As others have mentioned, psych is somewhat protected from an abundance of applicants due to the nature of the work and field itself, and the general sense that it's the least, "mediciney" of all the specialties. Even then, child is probably the more lucrative area of psych, and even most psychiatrists don't want to do child psych. I get offers all the time for $280k-$320k. The demand is absurd, and the supply is incredibly low. Sometimes, however, there is a reason why supply is low...
I disagree somewhat with your first part. You are right, psych is obviously less "mediciney". But I noticed on this forum (not just your post), people tend to portray psych as some vague, hippy specialty that is far removed from the 'medical world'. I understand that psych is unique, but I dunno, I feel like a 'good' psychiatrist integrates medical knowledge into their practice. For instance few months, in clinic I got a patient that was on effexor 375 mg, and he told me that he recently was also started on HTN meds. His MDD wasn't treated adequately which is why PMD referred to Psych (yes, I was shocked that PMD on his own accord titrated effexor up to 375 before consulting psych). After tailoring patient off effexor and switching to remeron, MDD has been treated, and patient's BP actually went down so much that PMD took patient off norvasc. So most likely effexor was causing HTN? But anyways, my point is, I feel like psychiatrists if they want to, can make their field 'mediciney' even when treating MDD/Bipolar/GAD, etc. (ie, checking vitals, monitoring labs). Even for management, while we are not regimented like internists treating HTN or Endocrinologists treating DM, we still do have some guidelines/symptom scales for treating MDD, GAD, Schizophrenia, its just a bit more flexible.
And yes, we don't physically examine patients, but we still take histories from patients, prescribe medications, review some neuroimaging, review routine labs, which is more than what a lot of other 'doctors' do (ie. pathologists, radiologists, etc). So while we don't fit the textbook definition of a doctor (steth around neck, white coat, etc), we are not the only speciality that doesn't either. So I dunno, I'm not sure we can keep using that we are not "real doctors" as a cop out excuse of why psych isn't as competitive as it can be.
I personally think it all comes down to reimbursing/lifestyle with regards to competitiveness. I'm certain if psych had starting salaries of 400k like certain surgical specialties, we wouldn't be having this conversation.
Just my 2 cents.
I think it is more the nature of the work. Medicine as a field attracts a lot of folks who get uncomfortable interacting with a given patients for more than 5-10 minutes. The surgical friends I have dread clinic as though apocalypse is coming each time they go. At 400k starting, sure a lot more people would be interested, but there would still be folks who just want no part of really getting to know a patient. I think many folks in FP and peds would love to jump over to psych if it paid 2x what they make however.
There are people in my class that fall into this description too.
While Derm and Psych are compared commonly, I think another major reason that Derm is so competitive is due to the fact that it is also far more lucrative in general. I think the average psych makes 200k, the average derm is closer to 300.
I personally think it all comes down to reimbursing/lifestyle with regards to competitiveness. I'm certain if psych had starting salaries of 400k like certain surgical specialties, we wouldn't be having this conversation.
Just my 2 cents.
Whats the difference between 280k and 400k? A lot of people don't want to do psych because of the stigma associated with mental illness, and the lack of diagnostic test and objectivity makes students and attendings in other specialties say psuchiatrist aren't " real" doctors.
Whats the difference between 280k and 400k?
Derm's salary is nearly 100% of the reason it is so competitive . Independently, we need a $$ emoji!
I don't understand why reimbursements are so high in Derm tho. Not to mention I don't understand why Derm does so much of what it does. I think adding a 1 year derm fellowship for FM doctors would reduce a lot of wait time for random crap like cyst expression.
The difference between 280 and 400k is nearly 100k extra in disposable and/or investable income a year. It cuts the time to get to "#$^&# you money" in half.
Video reference.
At the pay rate I'm about to accept (academic), I have basically no chance of getting there while I'm young enough to enjoy it. Still going to make the same choice, still glad I did, but yeah, it matters.
I'm fairly certain most non-medical people are not aware that Derm is the pinnacle of medicine (like we do inside the medical world). They usually think things like plastics and neurosurgery are the cream of the crop.
We're short enough psychiatrists that I doubt any of us will be out of a job in our working lifetimes. Another big difference with psych is that if you're good, there's a market for cash therapy, something that I doubt will change in the future, because a good psychiatrist is tough to find.Short-term, a good thing, as more patients can access services.
Long term, a bad thing, as the demand for psychiatry training will create increasing numbers of positions to meet this demand, eventually saturating the market and precipitating decreasing compensation and employment issues. Look to pathology and radiology for examples.
Child psych is just a rough field- I love psych, but C&A is brutal and not for me. I have a feeling a lot of others feel the same way.Hmm, I may be chicken-littling here. After reviewing match data, it appears static. We're getting about 290 a year, and US Allo percentage has been static (not a perfect metric I know). However, perception amongst the child psychiatrists I know is that it's getting harder to recruit the really talented ones into child. Three programs I'm familiar with that traditionally filled with their choice of candidates, have had to scramble over the last two years. The two programs I've most recently been affiliated with have struggled to get their best and brightest to go into child, whereas historically there was no such issue.
*Shrug* Maybe we all need CBT.
Child psych is just a rough field- I love psych, but C&A is brutal and not for me. I have a feeling a lot of others feel the same way.
At the pay rate I'm about to accept (academic), I have basically no chance of getting there while I'm young enough to enjoy it. Still going to make the same choice, still glad I did, but yeah, it matters.
SO I guess you've done your psych rotation, how is child brutal? My guess would be the parents helicoptering and what not. The only rotations I have done are OB/gyn ( ptsd from that one) and a couple of electives.Child psych is just a rough field- I love psych, but C&A is brutal and not for me. I have a feeling a lot of others feel the same way.
Yeah I agree with this. 120k/year is a big difference.
Like I said earlier, I think this whole "stigma" thing is blown out of proportion. If Psych was crushing an easy 400k, I don't think that many people will care about "stigma". Outside of the medical world, I'm pretty sure society regards derm and psych on similar levels of "prestige". I'm fairly certain most non-medical people are not aware that Derm is the pinnacle of medicine (like we do inside the medical world). They usually think things like plastics and neurosurgery are the cream of the crop. Yet Plastics and Neurosx aren't part of the elite "ROAD" specialties. Because we know that Derm makes 500k crunching 9-5 hours, while Neuosurg hits maybe 700k-800k, but with crazy hours and ridiculous malpractice, things people don't consider.
The bright side is psych is going up on reimbursements (while most others are coming down), and hopefully simple economics of supply and demand continue to drive our stock up.