Psychiatrists once again rank 2nd in overall satisfaction.. why??

[l0st1]

http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=17

Psychiatry ranks 7th from bottom for compensation, and only 50% would choose the same field again, yet it ranks second only to DERM for overall career satisfaction. That is very surprising to me. How is this possible and are these results to be trusted?

Psychiatrists seem to deal with lesser social & professional standing, uncertain treatment outcomes, scrutiny from the media, a very dependent patient population, lack of procedures, competition from mid-levels, emotional drainage and lack of scientific evidence for many diagnosis/treatments just to name a few issues that come to mind.

So how is it that they are so satisfied? I'm aware that there are a couple of other threads in regards to this but none answer the above questions.

What I do know that psychiatrists have going for them is that they are in high demand, they have flexible work schedules that are relatively light compared to other fields of medicine, they can work in a diverse number of settings..

What am I missing? Are lighter work schedules the main answer to work-life satisfaction?

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[hamstergang]

I don't know, but something else to consider is that specialties are to some degree self-selecting groups. Maybe easily satisfied people are drawn to psychiatry. And unsatisfiable people to surgery or whatever.

 

[Jorje286]

I would take all of these numbers with a grain of salt. The average reported is not a good indicator of happiness or career satisfaction. Satisfied with income has probably a lot more to do with expectations than anything else. I mean Ophthalmology scored lowest... If there's anything to take from this is that doctors in general do not seem like a satisfied or a happy bunch. "Choose Specialty" is probably the most valuable indicator, and dermatology is the only one with a respectable score.

 

[J ROD]

Those that usually end up Psychiatry are usually self-selected. Psy is very different from other fields so I think most of those in it are in it because they want to be. Not because of other reasons. Hence, why I think most are satisfied even with the low compensation comparatively. Also, many Psy docs do not work as many hrs as other docs so when you compare their $/hr they are not that bad off. I know several folks that make more than the average by simply working more. The work is there if you want the extra pay. Also, it is not a physically demanding field with regular hrs.

 

[Bartelby]

Here are a few reasons off the top of my head:

1 - lighter schedule with more flexibility, which is a HUGE factor (this goes double for residency)
2 - high demand pretty much anywhere in the country, strong options for autonomous practice
3 - extremely interesting subject matter with the ability to gain a high level of "mastery" of a narrower field instead of having to take all comers like an internist
4 - you spend all day cultivating relationships with other humans, and more meaningful relationships leads to more happiness
5 - good salary, especially when factoring in hours worked
6 - huge range of options when choosing practice settings (inpatient, CL, partial programs, outpatient group, outpatient solo, outpatient collaborative, addiction center, forensics, child, on and on)
7 - malpractice is less of an omnipresent concern than some fields (like OB)
8 - contrary to some stereotypes we do see people improve, often as much or more on average as many other specialties
9 - you come to understand yourself and your world better through your work
10 - every medical specialty has to deal with difficult patients, we just have the time and tools to make it more fulfilling
11 - hard to quantify exactly why, but the minute-to-minute stress of psychiatry is just so much lower than, say, IM or surgery

That is just a starter, and I'm sure you could find some burned out people to bitterly dispute each point. For me, though, I can totally see why psychiatrists would be more fulfilled than many specialities. In many cases it's hard to see how we couldn't be.

 

[manly_man246]

I would take all of these numbers with a grain of salt. The average reported is not a good indicator of happiness or career satisfaction. Satisfied with income has probably a lot more to do with expectations than anything else. I mean Ophthalmology scored lowest... If there's anything to take from this is that doctors in general do not seem like a satisfied or a happy bunch. "Choose Specialty" is probably the most valuable indicator, and dermatology is the only one with a respectable score.

Ophtho scored the lowest because compensation has been getting nuked outside of retina and other fellowships. They still have additional revenue streams which are not open to Psych though.

 

[OldPsychDoc]

Maybe "satisfaction" and "revenue streams" are not that tightly correlated.

 

[Frazier]

http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=17

Psychiatry ranks 7th from bottom for compensation, and only 50% would choose the same field again, yet it ranks second only to DERM for overall career satisfaction. That is very surprising to me. How is this possible and are these results to be trusted?

Psychiatrists seem to deal with lesser social & professional standing, uncertain treatment outcomes, scrutiny from the media, a very dependent patient population, lack of procedures, competition from mid-levels, emotional drainage and lack of scientific evidence for many diagnosis/treatments just to name a few issues that come to mind.

So how is it that they are so satisfied? I'm aware that there are a couple of other threads in regards to this but none answer the above questions.

What I do know that psychiatrists have going for them is that they are in high demand, they have flexible work schedules that are relatively light compared to other fields of medicine, they can work in a diverse number of settings..

What am I missing? Are lighter work schedules the main answer to work-life satisfaction?

Short version:
Because the field is awesome.

Longer version:

Essentially everyone that wants to match psych can match psych. There are very few people that were deadset on the specialty but were forced into a different field in medicine (unlike, say, derm).

Most people that enter the field choose so intentionally and not as a backup for something more competitive (say what happens often with IM and GenSurg).

People in psych go into it already knowing that it pays relatively little compared to other specialties -- they can be pleasantly surprised when they learn they can easily make more by working more than the 40 hour standard (say in opposition to the 300k surgeon that can't as easily ramp up their hours from a 60hr standard baseline).

Psych has a relatively benign schedule to it compared to majority of other specialties (not waking up at 3AM on the regular, working midnight shift, or missing your kid's birthday/holidays can do wonders for QoL).

Psych has the least likelihood of successful lawsuit among all medical fields...less stressful.

Psych has the least barriers to entry for PP. After being burnt out from bureaucracy, much easier for the 45 year old hospital psych to leave his gig and go solo than say the 45 year old hospital ophtho.

Psych has most ease of abandoning insurance models in all of medicine.

Psych folk typically have a good grasp on emotion and managing mental health. Perhaps they are more in tune with recognizing a stressor in their life and successfully addressing it compared to other specialties that aren't as trained in that area.

That survey is not a flash in the pan fluke...look at my sig, the trends have been consistent for years.

Regarding your counterpoints: "lack of procedures" is largely moot (physicians than require procedures don't choose psych). "Threat of midlevels" is largely moot (majority of specialties have this pending threat...from FM to IM to Ophtho to Derm). "Lesser professional standing" means very little (trend is for no specialty to respect any other specialty). "High media scrutiny" is questionable (what media is this? YouTube comments? Scientologist documentaries? I don't see many 60 minute stories scrutinizing the field).

 

[MacDonaldTriad]

When I read the OP, I was about to start typing up a storm, but by the time I read the other comments, most of the arguments were well articulated already. I will just add a couple because I like hearing myself talk:

Psychiatrists seem to deal with lesser social & professional standing,
As compared to what? Other more ego centric physicians who feel gratified by looking down on psychiatrists? It is true, some of our colleges don’t respect psychiatry, but most of the public does and they aren’t interested in our junior high school playground regressions in medicine. If a psychiatrist helps them they are pleased and grateful.

uncertain treatment outcomes,
Thank god for this. I don’t know about you, but when treatment outcomes become more certain, they become more like memorizing antibiotic spectrums and mundane protocols that can go below the med-levels.

lack of procedures,
Most of us don’t miss procedures, if we did, more than 8% of us would do ECT.

competition from mid-levels,
Just like water seeks the lowest point, med-level competition pressure is in direct proportion to how sweet the deal is. If mid-levels found psychiatry not attractive or not financially rewarding, there wouldn’t be any.

and lack of scientific evidence for many diagnosis/treatments
Oncologists know some risk factors, but they don’t know why some people get CA and some don’t. They know the odds of recovery from cut, slash and burn treatments, but they cannot predict who responds. Neurologists don’t know why some people get MS and other’s don’t, and steroid treatments are not operating on the disease level, mostly on the syndrome level.
Very very few diseases in medicine have been worked out to the final etiology, and when they are, they seldom suggest useful treatments (e.g. Huntington’s disease, glycogen storage diseases, mitochondrial failure). Psychiatry probably isn’t all that different from other branches in medicine.
Psychiatry isn't for everyone, but it is a good deal for a lot of us.

 

[nitemagi]

I sometimes have described therapy as like a procedure - skill based intervention that's operator dependent.

 

[Mad Jack]

http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=17

Psychiatry ranks 7th from bottom for compensation, and only 50% would choose the same field again, yet it ranks second only to DERM for overall career satisfaction. That is very surprising to me. How is this possible and are these results to be trusted?

Psychiatrists seem to deal with lesser social & professional standing, uncertain treatment outcomes, scrutiny from the media, a very dependent patient population, lack of procedures, competition from mid-levels, emotional drainage and lack of scientific evidence for many diagnosis/treatments just to name a few issues that come to mind.

So how is it that they are so satisfied? I'm aware that there are a couple of other threads in regards to this but none answer the above questions.

What I do know that psychiatrists have going for them is that they are in high demand, they have flexible work schedules that are relatively light compared to other fields of medicine, they can work in a diverse number of settings..

What am I missing? Are lighter work schedules the main answer to work-life satisfaction?

Some people don't care about prestige, and think 200k is plenty of money. While only 50% would choose psychiatry again, most specialties surveyed fall into the same ballpark (derm is the only big exception, somewhere around 68% if I remember correctly). Also, not everyone likes procedures- personally, I always found having to do procedures and tests as a clinician to be tedious, an annoyance that had to be taken care of. As to the evidence, not everyone needs to have things spelled out for them in black and white to be happy.

Pluses- your patients sometimes actually get better. Much better. Often, in other fields, results are temporary, prolonging the inevitable, or a way of mitigating an underlying lifestyle issue that will never be fixed or changed. Your patient with heart disease is never going to get better, nor will your COPDer, nor will your obese, chain-smoking patient cut back on the cigarettes and start eating healthy 99 times out of 100. Get a patient on the right meds, and they can go from being completely unable to function to living a fairly normal life- a big change, and often a fast one. Unlike most fields that just prolong life, psychiatry gives you a chance to substantially improve quality of life. Or so my psychiatrist mentor tells me.

Other big bonuses to the field are some of the most reasonable hours in all of medicine, ease of relocation and finding a job, the ability to completely avoid taking insurance (over half of psychiatrists operate on a cash-only basis, allowing them to set the terms of their services), complicated patients that require a lot of hard work to figure out, generally working either solo or as part of a small partnership rather than as an employee, and the lack of tedious procedures.

Midlevel encroachment isn't as bad as it seems, but who knows what the future holds. At the end of the day, there'll always be somebody willing to pay (in cash) for the expert with experience rather than the person running off of algorithms.

 

[DJspreadsheet]

Control over my own life. I can work as little or as much as I want. I can retire early or work until I'm wearing a diaper. I can move to any city of the country I so desire. I can work for an ivory tower institution or be my own boss (your local ED doc will ALWAYS be an employee - a pawn of hospital administrators). I can take insurance or remove myself from the grid and accept only cash-paying patients (your local heart surgeon or gastroenterologist or radiologist will ALWAYS be a slave to the whims of insurance companies).

Sparse competition. It's easy to stand out in this field because there's a lot of **** psychiatrists. That makes it easy to be highly successful.

Intellectually stimulating. The greyness you allude to is what allows me to use my brain and approach problems in a novel manner (and once again, set myself apart from the herd). Anyone can memorize CHADS criteria and proceed down the algorithm. (the lab-driven specialties are especially vulnerable to mid-level encroachment for this very reason).

With respect to mid-levels. People with financial means will always pony up the cash to see a psychiatrist rather than a mid-level. Mid-levels in psychiatry will always be relegated to those without means or those in areas where psychiatrists don't want to live. The same can't be said for fields where the customer has no real choice in the matter (I'm looking at you ED and anesthesiology).

 

[Shikima]

Control over my own life. I can work as little or as much as I want. I can retire early or work until I'm wearing a diaper. I can move to any city of the country I so desire. I can work for an ivory tower institution or be my own boss (your local ED doc will ALWAYS be an employee - a pawn of hospital administrators). I can take insurance or remove myself from the grid and accept only cash-paying patients (your local heart surgeon or gastroenterologist or radiologist will ALWAYS be a slave to the whims of insurance companies).

Sparse competition. It's easy to stand out in this field because there's a lot of **** psychiatrists. That makes it easy to be highly successful.

Intellectually stimulating. The greyness you allude to is what allows me to use my brain and approach problems in a novel manner (and once again, set myself apart from the herd). Anyone can memorize CHADS criteria and proceed down the algorithm. (the lab-driven specialties are especially vulnerable to mid-level encroachment for this very reason).

With respect to mid-levels. People with financial means will always pony up the cash to see a psychiatrist rather than a mid-level. Mid-levels in psychiatry will always be relegated to those without means or those in areas where psychiatrists don't want to live. The same can't be said for fields where the customer has no real choice in the matter (I'm looking at you ED and anesthesiology).

In all fairness, with respect to Anes, their Pt's don't talk back.

 

[DJspreadsheet]

In all fairness, with respect to Anes, their Pt's don't talk back.

But the surgeon does.

 

[digitlnoize]

http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=17

Psychiatry ranks 7th from bottom for compensation, and only 50% would choose the same field again, yet it ranks second only to DERM for overall career satisfaction. That is very surprising to me. How is this possible and are these results to be trusted?

?

These salary rankings are bunk. They fail to take into account the number of hours worked. We get paid very good hourly wages, particularly in child, but adult salaries aren't far behind.

The combination of good pay, good hours, wide open job market, and ability to own your own practice and have freedom, means high job satisfaction.

 

[Leo Aquarius]

http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=17

Psychiatry ranks 7th from bottom for compensation, and only 50% would choose the same field again, yet it ranks second only to DERM for overall career satisfaction. That is very surprising to me. How is this possible and are these results to be trusted?

Psychiatrists seem to deal with lesser social & professional standing, uncertain treatment outcomes, scrutiny from the media, a very dependent patient population, lack of procedures, competition from mid-levels, emotional drainage and lack of scientific evidence for many diagnosis/treatments just to name a few issues that come to mind.

So how is it that they are so satisfied? I'm aware that there are a couple of other threads in regards to this but none answer the above questions.

What I do know that psychiatrists have going for them is that they are in high demand, they have flexible work schedules that are relatively light compared to other fields of medicine, they can work in a diverse number of settings..

What am I missing? Are lighter work schedules the main answer to work-life satisfaction?

Did you know that about 80% of psychiatrists work LESS than 45 hours a week. 80% !!

Can you now see why total annual salary is not meaningful without knowing average weekly hours worked? A $210,000 salary from 35 hours of work translates to $300,000 at 50 hours a week all things being equal.

In my neck of the woods, psychiatrists in solo practice charge $300 to $400 per hour. Show me another non-surgical specialty that makes those kinds of big bucks.

Consider this. If psychiatrists were forced to work 50 hours a week like many surgical specialties do and high-end specialties like oncology, then our reported salaries would hit the $300,000 range. Can you imagine how competitive we'd get having a reported salary up there with General Surgery, Oncology, and Ophthalmology?

 

[Leo Aquarius]

Ignore the "only 50% would chose psychiatry again." Look at the study. EM is ranked 4th in career satisfaction and "Only 42% would chose it again." Hogwash. Peds is ranked 5th in career satisfaction and "Only 51% would chose it again." Bloody doubtful.

 

[Shikima]

But the surgeon does.

Ego's always need to be stroked.