Psych to pediatrics

[arrell87]

I discovered that I liked psychiatry relatively late last year which came as a surprise because I had been devoted to doing pediatrics all through med school. I decided to apply to psychiatry and have interviewed at some great programs. However, after doing more electives this year, I've realized that I should have applied to pedi. I still enjoy psych but pedi is a better fit and I think it will make me happier in the long run. So my dilemma is what to do about match. I feel somewhat bad that if I rank I am taking a spot from someone who would stay in the program. I approached my pedi advisor about SOAPing and they have strongly discouraged me from doing this. Can anyone offer any advice on whether I would be better off SOAPing or matching and then transferring out pgy-1. Is it hard to transfer out of psychiatry and are most PDs supportive about this? Thanks

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[Psychiatrized]

Going into psych knowing that you don't want to be there will be miserable for you and certainly impose a hardship to the program you end up at. Please don't match a program with the plan to jump ship.

 

[Bartelby]

Going into psych knowing that you don't want to be there will be miserable for you and certainly impose a hardship to the program you end up at. Please don't match a program with the plan to jump ship.

Agreed. If you are that sure about peds maybe you could withdraw from the match and try to do a year of research (or something else productive) while you reapply.

Also if I understand SOAP correctly there would be no harm in entering and only talking to / attempting to match at programs that meet your standards so you could also hope to get lucky in the SOAP with a plan to fall back on something else next year.

 

[LucidDreaming]

Dude or Lady. Just go into child psych. Done and done.

 

[LucidDreaming]

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[nancysinatra]

Going into psych knowing that you don't want to be there will be miserable for you and certainly impose a hardship to the program you end up at. Please don't match a program with the plan to jump ship.

I would not make your decisions based on concern about how the psych program may be affected. So what if it's an inconvenience to some program--the whole Match system is one big inconvenience to students and residents, as illustrated by your current predicament. Now if there's a chance that you might need the psych program's blessing and a letter of recommendation next year, then in that case I'd rank programs that seem flexible and supportive.

Is SOAP like the scramble? Why did your peds advisor recommend you not do that?

It shouldn't be hard to switch to peds after intern year, but you'll probably have to start as a PGYI.

 

[Bartelby]

It shouldn't be hard to switch to peds after intern year, but you'll probably have to start as a PGYI.

For me that would be more of the issue. The psych intern year will not do much for you in pediatrics, meaning it is generally wasted experience. If you can do research in the year off (or a second degree like MBA or MPH or something worthwhile) I think many programs do not look down too much on that and it would be much more pleasant than having to do intern year twice. Of course I could be wrong about competitiveness, I don't know if places would prefer to see you jump ship from your current program after one year versus have one year of time out of clinical medicine doing something relevant.

Then again arrell, maybe you will end up liking psychiatry and stick with it. I think many of us could be happy in more than one field.

 

[arrell87]

I would not make your decisions based on concern about how the psych program may be affected. So what if it's an inconvenience to some program--the whole Match system is one big inconvenience to students and residents, as illustrated by your current predicament. Now if there's a chance that you might need the psych program's blessing and a letter of recommendation next year, then in that case I'd rank programs that seem flexible and supportive.

Is SOAP like the scramble? Why did your peds advisor recommend you not do that?

It shouldn't be hard to switch to peds after intern year, but you'll probably have to start as a PGYI.

I'm not 100% sure how the SOAP works but my peds advisor insinuated that the pickings would be slim and that I could end up at a mediocre peds program, or worse, a prelim year in IM or surgery or something. Of course, I could get lucky, but she didn't recommend taking the gamble. I'm a strong applicant and she thinks I'd be better off matching to the best fit psych program and then transferring if needed.

Picking a program I think will be flexible and supportive should I decide to leave is the hard part. In retrospect, they all seem pretty flexible and supportive--of course they wouldn't show any tendency to be otherwise on interview day.

 

[arrell87]

Then again arrell, maybe you will end up liking psychiatry and stick with it. I think many of us could be happy in more than one field.

That is definitely a possibility!

 

[vistaril]

I discovered that I liked psychiatry relatively late last year which came as a surprise because I had been devoted to doing pediatrics all through med school. I decided to apply to psychiatry and have interviewed at some great programs. However, after doing more electives this year, I've realized that I should have applied to pedi. I still enjoy psych but pedi is a better fit and I think it will make me happier in the long run. So my dilemma is what to do about match. I feel somewhat bad that if I rank I am taking a spot from someone who would stay in the program. I approached my pedi advisor about SOAPing and they have strongly discouraged me from doing this. Can anyone offer any advice on whether I would be better off SOAPing or matching and then transferring out pgy-1. Is it hard to transfer out of psychiatry and are most PDs supportive about this? Thanks

lots of questionable advice being thrown around....

If you are sure you want to do peds and not psych(and not in a 52/48 sort of a way), then DONT rank a bunch of psych programs. You are going to be a better candidate applying into peds next year in the match if you were just watching tv at home all year and not attached to a psych program than if you were interviewing as a pgy-1 in psych.

That said, if you are really a strong candidate, you may match in the SOAP. It may not be at a good program, but then it comes down to whether you want to do peds at a crappy program or lose a year and go to a better program. Keep in mind that peds is only 3 years and you can probably still get many peds fellowships from a crappy program. But again, losing a year(if going to a good peds program is super important to you...it wouldnt be to me to give up a year) isn't the end of the world.

But if you *know* you are going to be switching into peds next year anyways, it would be very stupid and costly to go through this match in psych. It's certainly not going to help you any, and it's probably going to hurt you some.

It's sort of like when baseball players switch positions....you always move down the defensive spectrum. Center fielders, as they get older, become corner outfielders. Third baseman move to first base. You never see a left fielder start playing shortstop, and you rarely ever see a psych resident switch to anesthesiology.

 

[arrell87]

But again, losing a year(if going to a good peds program is super important to you...it wouldnt be to me to give up a year) isn't the end of the world.

I'm more concerned about ending up in middle-of-nowhere, USA.

But if you *know* you are going to be switching into peds next year anyways, it would be very stupid and costly to go through this match in psych. It's certainly not going to help you any, and it's probably going to hurt you some.

It's sort of like when baseball players switch positions....you always move down the defensive spectrum. Center fielders, as they get older, become corner outfielders. Third baseman move to first base. You never see a left fielder start playing shortstop, and you rarely ever see a psych resident switch to anesthesiology.

Why is this the case? Forgive me if I'm wrong, but transferring specialities doesn't seem to be much of an issue in other fields, other than logistical issues... I hear about people going between psych, IM, surgery, ob/gyn, pathology, etc. all of the time. If someone is considered a strong applicant for any field, and ends up in psych and trying to leave, what's the difference between that and any other specialty?

 

[Armadillos]

lots of questionable advice being thrown around....

If you are sure you want to do peds and not psych(and not in a 52/48 sort of a way), then DONT rank a bunch of psych programs. You are going to be a better candidate applying into peds next year in the match if you were just watching tv at home all year and not attached to a psych program than if you were interviewing as a pgy-1 in psych.

That said, if you are really a strong candidate, you may match in the SOAP. It may not be at a good program, but then it comes down to whether you want to do peds at a crappy program or lose a year and go to a better program. Keep in mind that peds is only 3 years and you can probably still get many peds fellowships from a crappy program. But again, losing a year(if going to a good peds program is super important to you...it wouldnt be to me to give up a year) isn't the end of the world.

But if you *know* you are going to be switching into peds next year anyways, it would be very stupid and costly to go through this match in psych. It's certainly not going to help you any, and it's probably going to hurt you some.

It's sort of like when baseball players switch positions....you always move down the defensive spectrum. Center fielders, as they get older, become corner outfielders. Third baseman move to first base. You never see a left fielder start playing shortstop, and you rarely ever see a psych resident switch to anesthesiology.

What does this have to do with the situation the person is posting? Psych and Peds have similar stepI average like 215 vs 220 or something like that.

Also was just flipping through first Aid and noticed this past year that the Psych lower quartile stepI score is actually higher than or equal to the lower quartile score of Peds, Obgyn, EM and IM. (They obviously had higher overall average and upper quartile than psych though)

To the person starting this thread, sounds like this would be a good thing to talk to whoever does career advising for students at your school, I think they would be a much better resource than an internet message board.

 

[vistaril]

I'm more concerned about ending up in middle-of-nowhere, USA.



Why is this the case? Forgive me if I'm wrong, but transferring specialities doesn't seem to be much of an issue in other fields, other than logistical issues... I hear about people going between psych, IM, surgery, ob/gyn, pathology, etc. all of the time. If someone is considered a strong applicant for any field, and ends up in psych and trying to leave, what's the difference between that and any other specialty?

because psych is different. The nature of it is different, how it is viewed is different. That's your answer. Also, I suspect transferring specialties from pathology to something else(other than psych) would fall into the same category of increased difficulty as well.

 

[vistaril]

What does this have to do with the situation the person is posting? Psych and Peds have similar stepI average like 215 vs 220 or something like that.
.

it's not just about initial competitiveness of entry......that's part of it sure, but not the whole story. Continuing with the baseball analogy, if someone was a shortstop in high school, is drafted and then made into an outfielder in the minor leagues, they never move back to a middle infield position....even if they were a very good middle infielder in high school.

 

[Bartelby]

it's not just about initial competitiveness of entry......that's part of it sure, but not the whole story. Continuing with the baseball analogy, if someone was a shortstop in high school, is drafted and then made into an outfielder in the minor leagues, they never move back to a middle infield position....even if they were a very good middle infielder in high school.

Even if you consider psychiatry rotations totally worthless with respect to preparing for other specialties (which I disagree with), all programs will do 4-6 mo of medicine and 2 mo neurology in intern year meaning 6-8 mo of non-psychiatry rotations in PGY-I. I have no doubt that a PGY-I year in psych would better prepare you to start out as a medicine or pediatrics intern than would sitting at home watching TV, or for that matter doing a second degree or research.

Still, it's quite a bit of work to go through intern year twice and the three years of pediatrics residency will be plenty to become a good pediatrician, so if arrell is just stalling for time before starting peds I think other options could be more fun.

 

[BobA]

Matching into psych and then switching to peds will be a negative because it will make you look like someone who doesn't know what they want. A PD will ask themselves - if this person left another program what's to prevent them from leaving mine?

It's not a massive red flag, but it would make your application less competitive.

Slightly better would be to find some other way to spend the year - research, even IM pre-lim.

Other the other hand - once you get into psych you might find out you like it more than you imagine you will now.

 

[vistaril]

Matching into psych and then switching to peds will be a negative because it will make you look like someone who doesn't know what they want. A PD will ask themselves - if this person left another program what's to prevent them from leaving mine?
.

yep.

Also, it's such a big difference.

 

[vistaril]

Even if you consider psychiatry rotations totally worthless with respect to preparing for other specialties (which I disagree with), all programs will do 4-6 mo of medicine and 2 mo neurology in intern year meaning 6-8 mo of non-psychiatry rotations in PGY-I. I have no doubt that a PGY-I year in psych would better prepare you to start out as a medicine or pediatrics intern than would sitting at home watching TV, or for that matter doing a second degree or research.

Still, it's quite a bit of work to go through intern year twice and the three years of pediatrics residency will be plenty to become a good pediatrician, so if arrell is just stalling for time before starting peds I think other options could be more fun.

well it's 6, not really 6-8(the number of programs that do this is like 3 out of 100+)......furthermore, as I've pointed out numerous times, the 6 months off service arent the same as the 6 months on service. You don't have procedural requirements that the prelims have(or the cats). You don't have to constantly meet benchmarks in terms of progress the categoricals have, and not even the prelims in this case. You are often excused for psych lectures during these off service months. On neurology months, you don't have to do meet numbers of cases like the neuro interns need to start getting checked off on.

Yes, you are part of the the service and may(if done right) function in much the same way as the categorical or prelim, but it's not the same...especially in terms of ensuring minimum standards.

And many programs(most?) dont require 4 months of inpatient medicine. It's not uncommon for it to be a combination of something like 2 months inpatient medicine(or peds), 1 month outpatient peds or med(sometimes two), and then another month that counts towards that requirement(an adolescent clinic, urgent care, etc).

As for the 2 months of neurology, the basic setup for all neuro programs across the country is to have the 'real' neuro training occur during the pgy-2 year for neurology residents. When psych interns are thus doing their neuro, if they are on this service they are not functioning in any way as a neuro resident(obviously, since the neuro residents are pgy-2)....if they aren't on the high volume inpatient neuro service(acute stroke for example where the neuro residents are), they are generally on consults(helping out) or at a VA service somewhere(much slower paced and again helping out)......

A psych intern year is much much different from a prelim year. Or a categorical medicine year.

But the larger reason the person shouldnt take an intern year in psych is because thats going to limit their interviews for what they want to do in peds...in addition to it being a red flag for peds pds.

 

[Bartelby]

well it's 6, not really 6-8(the number of programs that do this is like 3 out of 100+)......furthermore, as I've pointed out numerous times, the 6 months off service arent the same as the 6 months on service. You don't have procedural requirements that the prelims have(or the cats). You don't have to constantly meet benchmarks in terms of progress the categoricals have, and not even the prelims in this case. You are often excused for psych lectures during these off service months. On neurology months, you don't have to do meet numbers of cases like the neuro interns need to start getting checked off on.

Yes, you are part of the the service and may(if done right) function in much the same way as the categorical or prelim, but it's not the same...especially in terms of ensuring minimum standards.

...

But the larger reason the person shouldnt take an intern year in psych is because thats going to limit their interviews for what they want to do in peds...in addition to it being a red flag for peds pds.

That's odd, at my program psych interns are evaluated in the same way as the medicine interns at the end of the rotation, we definitely do not get to leave for psych lectures, our caseload is exactly the same as the medicine intern (as dictated by the admitting schedule, there is no 'deciding' to do), and while we don't have to do procedures we are offered them and I tended to accept. I guess things vary from place to place. On neuro I agree, we can't function in the same capacity as a neuro PGY-2 but on consults I still saw patients on my own, presented directly to the attending, and then saw the patient with the attending directly so there was a lot of learning and not too excessive handholding.

Still, I agree with your overall point that taking the psych intern year probably will not help the OP's case.

 

[vistaril]

That's odd, at my program psych interns are evaluated in the same way as the medicine interns at the end of the rotation, we definitely do not get to leave for psych lectures, our caseload is exactly the same as the medicine intern (as dictated by the admitting schedule, there is no 'deciding' to do), and while we don't have to do procedures we are offered them and I tended to accept. .

the difference though is that medicine interns are not *just* evaluated on a month to month basis......they are being evaluated over the whole year in terms of their fitness of duty to progress.

For example, a medicine intern in December can come on service with a team that, for whatever reason, he just doesn't click with. And for whatever reason maybe he's also off his game a little that month for some reason. Whatever the attending and/or upper level resident writes about him that month for his eval goes in his record, but the larger issue is how is he progressing over the YEAR. Because that is really how he is evaluated. When psych interns are on service, they like the medicine intern are evaluated for that month, and that's it.....the larger and more important question of how their overall progress is going is irrelevant, since they are just doing one of a couple of medicine inpatient off service months and are not going to be an internist.

Think about it this way: when medicine interns are 'held back', it's almost never because of one month(unless it was something egregious). It's always the overall pattern/theme of not meeting standards over the whole period leading to annual or biannual review....

Also, and this is a less important point, when attendings and upper level residents 'grade' you for your medicine months, they aren't really holding you to the exact same standards. They probably won't tell you that(why would they? what is the point?) but they aren't....it's the same way when family medicine residents rotate through a month of general surgery. Hell it's the same way when family medicine consults occasionally rotate through a month(non required of course) of C-L psychiatry.....

I'm *not* saying that if for some reason a psych intern wanted the complete medicine experience for that month they are on they couldn't get. In most cases they can if they work at it and make it clear they want it.

 

[splik]

the move from psychiatry to another specialty is MUCH more difficult than the move into psychiatry from another specialty. First, with the exception of pathology you start as a PGY-2 if you transfer into psychiatry. If you leave psych you will start as PGY-1 and NONE of your intern training will count (even if you spent 6 months doing peds). Psychiatry tends to welcome and embrace people leaving from other specialties and there are a number of programs that have dedicated spots for these people (e.g. Hopkins, UW, Yale etc). conversely, psychiatry is sadly still viewed negatively by other fields and you will be 'tainted' and untouchable (I exaggerate) but people will think there is something wrong with you for having wanted to go into psych in the first place.

That said I would still recommend doing the intern year. You don't seem to know what you want to do. And d'you know what? That's okay. This country has a crazy system where you have to pretty much know what you want to go into as a 3rd year. It's a year where you get paid, will be in clinical practice and will be better prepared for your peds residency if you decide you want to go that route. Of course if you really hate psych (hopefully not else why did you apply) obviously don't do it.

I think what everyone should agree on is you definitely should NOT go into to the SOAP. have a look at last year's list, only the sh*tty programs were left (i suppose you could do a peds prelim but why). You have no idea how many programs, how many spots there will even be, it's just a bad idea. If you don't want to do 2 intern years then figure out something interesting and useful to do next year that will justify having missed that year. remember you will be less competitive next year.

When you sign your contract for residency, it only for one year. You owe your future program nothing but that year, just as they don't have to renew you afterwards.

 

[vistaril]

the move from psychiatry to another specialty is MUCH more difficult than the move into psychiatry from another specialty. First, with the exception of pathology you start as a PGY-2 if you transfer into psychiatry. QUOTE]

Agree with much of what is here, but just pointing out that a lot of people do rematch as a pgy-1 rather than transfer in as a pgy2.....

 

[nancysinatra]

I don't think a peds PD is going to look back at a current psych intern's medicine months and care much about how they were graded. They're going to look at Step scores, LORs and the usual stuff. Plus this isn't a hand surgery fellowship. The competition can't be that tough.

I see why watching TV for the year could be better--you'll get paid almost as much, and you won't be stigmatized in the same way. Sadly there are some people in the medical profession who really look down on psychiatry and those of us involved in it. At my institution, some of those people are found in pediatrics. But if you truly have an interest in both peds and psych, then maybe those aren't the people you want to work with.

As far as the neuro/IM months--that varies. I took neuro call as a PGY1 and had to do everything the neuro PGYIIs did. It was the same on the rotation itself. I found that by doing all the same work as the neuro residents, and really showing an interest, that I was treated well by the team and the attendings. But I have classmates who blew that rotation off, and they came away complaining of "mistreatment." There probably is some discrimination, but some of it, I gotta say, was deserved. At my program the psych residents are known for not knowing much IM or neuro, and having little interest.

 

[vistaril]

I took neuro call as a PGY1 and had to do everything the neuro PGYIIs did. It was the same on the rotation itself..

where I was at the neuro pgy-2 residents are the only person in house overnight for neuro and are making TPA calls on acute stroke patients during call after er eval.....I certainly wasn't going to be doing that as a psych intern during my two months off service on neuro! And Im pretty sure if I did the er docs wouldnt have listened...

 

[nancysinatra]

where I was at the neuro pgy-2 residents are the only person in house overnight for neuro and are making TPA calls on acute stroke patients during call after er eval.....I certainly wasn't going to be doing that as a psych intern during my two months off service on neuro! And Im pretty sure if I did the er docs wouldnt have listened...

At our program, there was a separate stroke pager held by the PGYIII and the attending. That pager as well as the on-call intern/resident's would go off if the ER doc suspected a stroke. I remember one case of a guy who came in, with posterior circulation type symptoms, and I went and saw him and basically just awaited the arrival of the upper level. I ordered lots of tests on stroke patients but I think the ER doc always ordered the initial head CT. My job mainly seemed to be to call radiology and wake them up so they'd (angrily) read the imaging for us. For status epilepticus or anything else, we were on our own. The thing is, there aren't really that many neuro emergencies. The vast majority of the time it was dementia "exacerbations" or Parkinsons related stuff. And plus the ER doc is right there probably laughing at all the inept residents that trail through.

My program no longer uses this system, but for me it was a good learning experience.

 

[m1345]

Hmm OP, I'm sorry you're in this situation--it must be stressful. However, clearly no one is suggesting that you cannot achieve your dreams, whatever they may turn out to be, as you are a great student and haven't done anything *wrong*--the timing of this horrific match system is just working against you. My advice (take with a grain of salt...I'm a MS4):

1. Figure out exactly how sure you are you want to be a pediatrician vs psychiatrist. I understand that pediatrics may be in your blood, but something made you apply to psych. What is the chance that you may actually want to stay in psych (or child psych?) vs peds? 0%? 5%? 40% If its in the >40% range, I'd go through with the match, as it sounds like you have some very reputable programs on your list and you may like psych or child psych more than you thought. If you do go in this direction, I'd strongly consider programs that allow you to do pediatrics instead of medicine during your intern year in order to help you better understand exactly what you're interested in.

2. If you're sure you want to go into peds (and I'm curious how you've bounced between these two so dramatically/?suddenly), my first general, not-OP specific question is, can you participate in the soap in the sense of, "I want to SOAP for peds but only if I like the programs that have open spots? If I don't like these programs, I'd rather not match and take a year off." If you can do this (just check out what the soap offers without having to agree to match somewhere/anywhere), you should do this if you can find a decent peds program in a location that you can get excited about. If you don't find anywhere exciting/decent (which it sounds like you deserve based on your record), take a year off!

3. Take a year off! Research, get an MPH/MBA, build that resume, do something that convinces programs that you are committed to peds, and HAVE FUN (seriously...thats so important). I think that this will look great while reapplying. Who doesn't love an applicant who has decided to pursue more academic opportunities, even if it means delaying graduation?

Good luck!!

 

[vistaril]

3. Take a year off! Research, get an MPH/MBA, build that resume, do something that convinces programs that you are committed to peds, and HAVE FUN (seriously...thats so important). I think that this will look great while reapplying. Who doesn't love an applicant who has decided to pursue more academic opportunities, even if it means delaying graduation?

Good luck!!

just a quick point- if this person does decide to go through the match not this year but next year, make sure you arent still paying your med school at least.....

 

[arrell87]

Thanks for the advice, everyone.

I guess what I'm hearing from multiple sources is to go ahead and match. I'd really prefer not to take a year off due to having to take out more loans, etc. Plus I'd rather be doing something clinical during that time. My heart just wouldn't be in an MPH, etc.

I'm not 99.9% or maybe even 80% set on pediatrics. As Bartelby said, it *may* be possible to be happy in a variety of specialities, and I could possibly come to love psychiatry as much as I love peds.

It's really disheartening to hear how many specialties still view psych so negatively. At least with primary care specialities, I would think they'd see the value in psych. Most of the internists and all of the pediatricians at my institution were very appreciative of psychiatrists and encouraged me to apply. I guess I can always re-apply to my home program. I think I'd be willing to do another pgy-1 year if it really meant that much to me.

And yeah, this match system sucks.

 

[vistaril]

Thanks for the advice, everyone.

I guess what I'm hearing from multiple sources is to go ahead and match. I'd really prefer not to take a year off due to having to take out more loans, etc. Plus I'd rather be doing something clinical during that time. My heart just wouldn't be in an MPH, etc.

I'm not 99.9% or maybe even 80% set on pediatrics. As Bartelby said, it *may* be possible to be happy in a variety of specialities, and I could possibly come to love psychiatry as much as I love peds.

It's really disheartening to hear how many specialties still view psych so negatively. At least with primary care specialities, I would think they'd see the value in psych. Most of the internists and all of the pediatricians at my institution were very appreciative of psychiatrists and encouraged me to apply. I guess I can always re-apply to my home program. I think I'd be willing to do another pgy-1 year if it really meant that much to me.

And yeah, this match system sucks.

well for starters, im not sure that was the concencus here(to just go ahead and match)....that said, it seems to be what you want to do.

As for specialties(or really subspecialties) viewing psych negatively relative to general medicine/peds/family/ob/em, I find that those primary care specialties listed(I consider ob and em to be primary care...if they arent you really dont have much to make up primary care) tend to view psychiatry more negatively than say.....dermatology or radiation oncology. That's probably because dermatology and radiation oncology doesn't have to work with us....they probably don't view us as colleagues, but from their perspective we 'do our thing' and they do their thing and nobody has any relationship.

Just in my experience, I've been far more likely to run into a general hospitalist for example who feels psych 'doesn't do anything' than an opthalmologist. Optho probably doesnt care what we do, but I don't know that they would make the assumption that it's not of any value(?)...

 

[arrell87]

Just in my experience, I've been far more likely to run into a general hospitalist for example who feels psych 'doesn't do anything' than an opthalmologist.

Probably because they've been consulting you.

 

[kindasorta]

Probably because they've been consulting you.

It's also because mental illness is NOT solved by a pill. And it's also not solved in short timespans. Mental illness is leagues more complex than [HIGH BP --> GIVE MED --> NORMAL BP]. It's part of the reason I despise the people in IM, they have a pubescently limited understanding of nuance and genuine complexity. Of course your moribidly obese DM2 with poor hygiene and 1.5 lower extremities saying they want to die isn't going to be resolved with a psych consult. But that's all these ***** IM docs use psych for. I really believe that psych shouldn't be utilized as a consult service at all in medicine save for genuine acute psychiatric illness. But of course this is chicken and egg, and those IM docs don't know psych illness from their squeekily clenched b-hole, so it's the same old consult argument that never ends.

 

[vistaril]

It's also because mental illness is NOT solved by a pill. And it's also not solved in short timespans. Mental illness is leagues more complex than [HIGH BP --> GIVE MED --> NORMAL BP]. It's part of the reason I despise the people in IM, they have a pubescently limited understanding of nuance and genuine complexity. Of course your moribidly obese DM2 with poor hygiene and 1.5 lower extremities saying they want to die isn't going to be resolved with a psych consult. But that's all these ***** IM docs use psych for. I really believe that psych shouldn't be utilized as a consult service at all in medicine save for genuine acute psychiatric illness. But of course this is chicken and egg, and those IM docs don't know psych illness from their squeekily clenched b-hole, so it's the same old consult argument that never ends.

in a lot of those cases IM is just dumping on psych. they know we dont have a lot to offer that pt. they are just hoping we may be able to help with dispo.

 

[kindasorta]

in a lot of those cases IM is just dumping on psych. they know we dont have a lot to offer that pt. they are just hoping we may be able to help with dispo.

agreed. but they shouldn't walk away all butt-hurt when we can't do anything. either they're playing dumb, or they actually are dumb and can't wrap their head around what mental illness actually entails and how complex resolution or stability actually is.

 

[nancysinatra]

agreed. but they shouldn't walk away all butt-hurt when we can't do anything. either they're playing dumb, or they actually are dumb and can't wrap their head around what mental illness actually entails and how complex resolution or stability actually is.

But all fields seem to look down on each other. Anesthesiology and surgery hate each other. And we dump on medicine, neuro, EM and OB. What goes around comes around. Plus why SHOULD IM docs understand mental illness? That's like saying they should know orthopedics. Maybe you could argue that family docs should know some psychiatry, and they probably are better at it than IM.

If anyone should know psychiatry, it ought to be psychiatrists. And we should be glad that no one else knows our field, because it assures us all a job. As it is, the minute an imaging test for schizophrenia is invented, we're going to lose that illness to neurology. Our field has nothing to gain and everything to lose by others usurping our knowledge!

 

[PistolPete]

"As it is, the minute an imaging test for schizophrenia is invented, we're going to lose that illness to neurology. Our field has nothing to gain and everything to lose by others usurping our knowledge!"

That sounds terrible. Not sure I agree. I am a proponent of psychiatry developing more objective measures for the illnesses we treat, such as a blood/imaging test for MDD/schiz, and if we do develop them, we ought to keep ownership of it.

 

[OldPsychDoc]

"As it is, the minute an imaging test for schizophrenia is invented, we're going to lose that illness to neurology. Our field has nothing to gain and everything to lose by others usurping our knowledge!"

That sounds terrible. Not sure I agree. I am a proponent of psychiatry developing more objective measures for the illnesses we treat, such as a blood/imaging test for MDD/schiz, and if we do develop them, we ought to keep ownership of it.

Don't worry--I've never met a neurologist who wanted anything to do with mental illness beyond ordering a psych consult.

 

[vistaril]

But all fields seem to look down on each other. Anesthesiology and surgery hate each other.!

it's a different kind of hate though....it's like the red sox and yankees hating each other. I don't think surgery hates us in that way....more that we are playing a different sport in a different league.

 

[nancysinatra]

it's a different kind of hate though....it's like the red sox and yankees hating each other. I don't think surgery hates us in that way....more that we are playing a different sport in a different league.

Agreed.

 

[BS81]

it's a different kind of hate though....it's like the red sox and yankees hating each other. I don't think surgery hates us in that way....more that we are playing a different sport in a different league.

It's more like the yankees and the royals... one side tends to **** more on the other. Psych is like Barcelona playing the beautiful game on the other side of the ocean. Absolutely awesome but unappreciated by the mainstream.

 

[nancysinatra]

Don't worry--I've never met a neurologist who wanted anything to do with mental illness beyond ordering a psych consult.

But what about neurosyphillis? Or MS? Wasn't MS thought to be "functional" at one point in history?

Here is an intriguing article:

http://www.ncbi.nlm.nih.gov/pubmed/20136530

One thing it says is this:

"Syphilis did not manifest as a psychiatric illness until the French Revolution. At the time, the Pinel School was focussing on the environment and moral therapy. Bayle, who made the first discovery of the cause of a psychiatric disease - chronic arachnoiditis - paid the price for his discovery by being driven from psychiatry."

It's also telling that normal pressure hydrocephalus is treated only by neurologists, whereas most other dementias (i.e. ones where you wouldn't do an LP) are often managed by psychiatrists. Now if we were willing to do LPs maybe we could treat NPH too, and expand our territory beyond just the DSM. (And if we could read MRIs we could probably overlap even more with neuro when it comes to dementia).

And why did we let Huntington's go? My point is that the minute a "test" comes around for an illness, psychiatry seems to want to wash its hands of it! Personally I think it is because we get no training in LPs or MRIs, and our program directors would have no clue how to add this training into our residencies, since they can't do these things themselves. This is a recipe for obsolescence!

 

[BS81]

But what about neurosyphillis? Or MS? Wasn't MS thought to be "functional" at one point in history?

Here is an intriguing article:

http://www.ncbi.nlm.nih.gov/pubmed/20136530

One thing it says is this:

"Syphilis did not manifest as a psychiatric illness until the French Revolution. At the time, the Pinel School was focussing on the environment and moral therapy. Bayle, who made the first discovery of the cause of a psychiatric disease - chronic arachnoiditis - paid the price for his discovery by being driven from psychiatry."

It's also telling that normal pressure hydrocephalus is treated only by neurologists, whereas most other dementias (i.e. ones where you wouldn't do an LP) are often managed by psychiatrists. Now if we were willing to do LPs maybe we could treat NPH too, and expand our territory beyond just the DSM. (And if we could read MRIs we could probably overlap even more with neuro when it comes to dementia).

And why did we let Huntington's go? My point is that the minute a "test" comes around for an illness, psychiatry seems to want to wash its hands of it! Personally I think it is because we get no training in LPs or MRIs, and our program directors would have no clue how to add this training into our residencies, since they can't do these things themselves. This is a recipe for obsolescence!

Would love this. Especially as neuroimaging advances and more biomarkers get elucidated these should become part of our training. Would probably need some fellowships at first like interventional radiology or cards to learn to do these procedures before they get incorporated in to the general residency training.

 

[vistaril]

But what about neurosyphillis? Or MS? Wasn't MS thought to be "functional" at one point in history?

Here is an intriguing article:

http://www.ncbi.nlm.nih.gov/pubmed/20136530

One thing it says is this:

"Syphilis did not manifest as a psychiatric illness until the French Revolution. At the time, the Pinel School was focussing on the environment and moral therapy. Bayle, who made the first discovery of the cause of a psychiatric disease - chronic arachnoiditis - paid the price for his discovery by being driven from psychiatry."

It's also telling that normal pressure hydrocephalus is treated only by neurologists, whereas most other dementias (i.e. ones where you wouldn't do an LP) are often managed by psychiatrists. Now if we were willing to do LPs maybe we could treat NPH too, and expand our territory beyond just the DSM. (And if we could read MRIs we could probably overlap even more with neuro when it comes to dementia).

And why did we let Huntington's go? My point is that the minute a "test" comes around for an illness, psychiatry seems to want to wash its hands of it! Personally I think it is because we get no training in LPs or MRIs, and our program directors would have no clue how to add this training into our residencies, since they can't do these things themselves. This is a recipe for obsolescence!

the big thing is though that a lot of people go into psychiatry because they don't want to do things like LPs and read MRIs. People who are interested in those sorts of things go off and do neurology and other stuff where you do that sort of stuff.

 

[vistaril]

Would love this. Especially as neuroimaging advances and more biomarkers get elucidated these should become part of our training. Would probably need some fellowships at first like interventional radiology or cards to learn to do these procedures before they get incorporated in to the general residency training.

you wouldnt need a separate fellowship to do LPs. IR is a field comprising a *bunch* of different advanced procedures, many of which are very technical. There is no comparison between that and an LP.

I don't see psychiatrists going around doing LPs in my career.

 

[BS81]

you wouldnt need a separate fellowship to do LPs. IR is a field comprising a *bunch* of different advanced procedures, many of which are very technical. There is no comparison between that and an LP.

I don't see psychiatrists going around doing LPs in my career.

True. But if you incorporated ECT, DBS, TMS, vagal nerve, infusions or whatever else comes down the pike that actually works you could pull off a one year fellowship. Eventually maybe.

 

[nancysinatra]

True. But if you incorporated ECT, DBS, TMS, vagal nerve, infusions or whatever else comes down the pike that actually works you could pull off a one year fellowship. Eventually maybe.

It should be called "fourth year."

 

[BS81]

you wouldnt need a separate fellowship to do LPs. IR is a field comprising a *bunch* of different advanced procedures, many of which are very technical. There is no comparison between that and an LP.

I don't see psychiatrists going around doing LPs in my career.

Too true. At UIC they have one of the few dedicated neuropsych units where they treat things like Huntington's, Tuberous Sclerosis, behavioral changes due to seizures etc. and they still consult out for their LP's.

 

[michaelrack]

It's also telling that normal pressure hydrocephalus is treated only by neurologists, whereas most other dementias (i.e. ones where you wouldn't do an LP) are often managed by psychiatrists. !

The difference between NPH and many other dementias is that NPH is potentially curable, and even when not 100% curable, appropriate tx can modify the course of the disease. I guess the same can be said for vascular dementia (for which neurologists will manage anti-platelet tx). Psychiatrists manage the behavioral manifestations of dementias- but they don't prescribe tx's that modify the underlying course of the dementia (although one can possibly make a weak arguement for Alzheimer drugs altering the dementia's course).

 

[michaelrack]

I don't see psychiatrists going around doing LPs in my career.

It's not just a matter of doing the LP (in private practice LP's can easily be turfed to RADS, although neurologists usually do their own)- one also has to be able to interpret the results.

 

[nancysinatra]

The difference between NPH and many other dementias is that NPH is potentially curable, and even when not 100% curable, appropriate tx can modify the course of the disease. I guess the same can be said for vascular dementia (for which neurologists will manage anti-platelet tx). Psychiatrists manage the behavioral manifestations of dementias- but they don't prescribe tx's that modify the underlying course of the dementia (although one can possibly make a weak arguement for Alzheimer drugs altering the dementia's course).

True enough--if really good treatments were available for most dementias then the difference between neuro and psych in this area would be more obvious. But it's a chicken and egg scenario--do we not "treat" the underlying course of dementia because we focus on the "behavioral" side of things, or do we focus on the behavioral aspects because we don't "treat" underlying courses of things?

 

[vistaril]

It's not just a matter of doing the LP (in private practice LP's can easily be turfed to RADS, although neurologists usually do their own)- one also has to be able to interpret the results.

yep....the procedures an internist does in the private community hospitals are totally different than what they do as a resident. Lines included.