Psychiatry FAQs

[Anasazi23]

1. Q. What does it take to become a psychiatrist? What should I major in during undergrad?

A. The road to psychiatry is a relatively long one. It starts in undergraduate school (college) where you must complete all traditional requirements for entrance to medical school. In addition to the requirements for your degree, you must complete (with some minor variations) 2 semesters each of physics, biology, chemistry, and organic chemistry, all with lab. In addition, many medical schools require calculus or at least college-level algebra. It is helpful in medical school to have taken physiology, anatomy, biochemistry and statistics, but these courses are rarely required by medical schools themselves. Check individual medical schools for their entrance requirements.

For a list of all US and Canadian medical schools who grant the MD degree, follow the link to the American Association of Medical Colleges.
For a list of all US medical schools granting the DO degree (doctor of osteopathic medicine) follow the link to American Association of Colleges of Osteopathic Medicine.
These links provide details on the locations of medical schools, and offer guidelines on how to obtain admission.

Both MDs and DOs can become psychiatrists.

You must take the MCAT (Medical College Admissions Test) in order to be accepted to medical school. Some overseas medical schools do not require this. Your score on the MCAT, combined with your grades in undergraduate, research and/or volunteer experience determine your competitveness for entrance to medical school. It doesn't matter what your major is in undergraduate, as long as you fulfill the above requirements. Many entering medical students have majored in history, English, philosophy, in addition to biology, chemistry, and psychology. The key is to major in whatever you enjoy. That will ensure interest in your studies, and help build a good GPA.

Your acceptance to med school, however, is only the beginning. You now must endure 4 years of medical school, which generally consists of 2 years of basic science courses, followed by two years of clinical rotations, endless tests and clinical exams. Toward the end of your fourth year of medical school, you apply for your desired residency...either psychiatry, internal medicine, surgery, dermatology, neurology, emergency medicine, etc., etc. It is possible to apply to more than one residency, but this makes things more difficult.

After graduating medical school, you are finally a doctor, you start your residency and finally start making some money (although much less than you will comprared to when you finish residency and become an attending physician). A psychiatry residency is four years. This varies slightly, but generally consists of 4 months of internal medicine, 2 months of neurology, and the remaining months and years of psychiatry.

If you happen to attend a psychiatry residency with a child psychiatry fellowship, your time in residency increases from 4 to 5 years. Though, this is shorter overall than the required two years of child psychiatry fellowship if done at a hospital or institution outside that of your psychiatry residency location.

Psychiatry residencies vary greatly, and reviews of the various programs can be found on this site. In addition, you can see basic profiles of the various psychiatry residency programs on the AMA FREIDA website.

This link to the American Psychiatric Association's Career Corner has a section for prospective medical students with useful links.

Good luck!

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[Anasazi23]

2. Q. Ok, enough already. I graduated psychiatry residency. Now, I'm afraid to go out into the 'real world.' I'm not ready yet! What fellowships can I go to that will help me delay the inevitable?

A. [Link to the Psychiatry Fellowships sticky]

Psychiatry fellowships are available to anyone graduating a psychiatry residency and wishes to pursue further training. As outlined in the above link, these can either be Board Certified Psychiatry subspecialties, or academic-type fellowships that allow for further training and expertise, but do not lead to board certification.

 

[Anasazi23]

3. Q. What is the difference between a psychiatrist and a psychologist?

A. A psychiatrist is a physician who specializes in the diagnosis, assessment, and treatment of psychiatric disorders. It grew as a profession out of the rigors of medicine. As such, you must be an MD or a DO to become a psychiatrist. In this way, psychiatry is a branch of medicine not unlike pediatrics, or surgery. Psychiatrists complete four years of medical school and at least four years of psychiatry residency after graduation from medical school. They typically use medications and other forms of therapy, such as psychotherapy, ECT, and others, in order to treat patients. They often are involved in research, and work in hospitals, university settings, and private practices where they see patients and/or conduct psychiatric research.

A psychologist, who typically earns a PhD (Doctor of Philosophy) or PsyD (Doctor of Psychology), was borne out of the academic study of human behavior. There are many branches of psychology, including industrial/organizational, experimental, developmental, and others. Clinical psychologists tend to specialize in behavioral interventions and psychotherapy, and are specialists in psychological testing. Further, they are often involved in research, typically studying the effects of human behavior, brain-behavior relationships, and more abstract psychological theories.

 

[Anasazi23]

4. From a soon-to-be medical student:

I'm going to be a first year medical student this coming fall and I am extremely interested in pursuing psychiatry. I'd love for a stiicky on this field to be started: I know that I want to know more about

- what kind of board scores are necessary to get the residency of your choice

Board scores vary widely depending on which program you are applying to. As important as board scores, however, is any former research or clinical experience. While psychiatry applications have been on the rise, the field is still relatively non-competitive for average programs. This changes drastically when it comes to more prestigious university programs, or programs in more desirable areas. In this sense, the board scores will range from being accepted with board failure to 90%tile for the more competitive programs.

- when doing electives, do you want to do psych electives, or do you choose different fields to gain diversity in clinical experience?

Psych electives are a good idea in general if you're sure you're going to pursue a psychiatry residency. However, don't let this stop you from seeking out a broader knowledge base at the expense of training you'll receive anyway while in residency. Other good electives for psychiatry residents include neurology, rheumatology, pain management, and internal medicine. Another advantage to doing psych electives is that it allows you to "showcase" yourself at potential residency spots, as well as getting a feel for how various psych institutions operate. Of course, some good letters of recommendation are to be had at psych elective rotation slots, since most med school require only one psychiatry rotation as a medical student.

- during your first years, should you ask professors/mentors for letters of recommendation, or are these completely worthless?

In general, only letters of recommendation from clinical professors (i.e. teaching attendings) carry weight. In the first two years of med school, the learning is largely case-based and heavy with basic science. The final two years of med school consist primarily of clinical rotations and continued tests. It is from these rotations that the majority of med students get their letters of recommendation. This makes sense, since residency programs want to know if you can do the work, and play well with others.

- Since psychiatrists don't make all that much compared to other specialities, if you're in massive debt after medical school, is it still possible to pay off these loans in a reasonable amount of time?

Psychiatrists salaries are on the lower range of physician salaries. They seem to average between $117,000 and $134,000, but the ranges are much, much higher. I personally know a few psychiatrists making $250,000 - $750,000. This will depend largely on the area in which you practice, whether or not you accept Medicare/Medicaid, whether you work in a private practice, a clinic, as a university or academic psychiatrist, are fee-for-service, or a combination of these. Also, the amount of patients you see per day varies greatly amongst psychiatrists, as does the clientele base. While some medical schools are more expensive than others, I have yet to meet a homeless psychiatrist or one who could not at least live a reasonably comfortable life while making loan repayments.

There are incentives to work in underserved areas, which provide loan forgiveness. However psychiatrists, as most physicians, tend not to flock to these areas.

Here is an online popular physician-recruiting website that has statistics on its ongoing medical specialty salary survey:
http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

- Are the staff in psych hospitals really as crazy as I think they are?
- do you guys really get to help people or is it just "treat em and street 'em?"

How do you tell the difference between a psychiatrist and a psych patient?

The psychiatrist is the one with the keys!

Joking aside, it may seem to some that psychiatry attendings tend to be on the odd side. While I know of no objective data for this, it is my experience that there are just as many wacky internal medicine docs and surgeons around when I was a med student, and continues while I'm a resident. Perhaps it's "craziness by association?"

Psychiatry is probably the least "treat 'em and street 'em" medical specialty out there. Unlike IM or ER, long-term relationships are often created with patients...sometimes too long. While there certainly is a "revolving door" effect in psychiatry, the same can be said of most branches of medicine.

 

[Anasazi23]

Q. I need more details, even if they're outdated and old. Can you tell me more about how much psychiatrists make? That BMW isn't gonna pay for itself!

A. Here is some older data on psychiatrist salaries:
From Psychiatric Times: Compensation Levels Hold Steady, but Future Uncertain May 2003 Vol. XX Issue 5

"The American Medical Group Association, whose members generally belong to larger group practices than those who join the MGMA, listed the following median salaries for 2001:

Psychiatrists $158,275

Child psychiatrists $172,017

Psychologists $80,406

According to a 2000 survey conducted by the publication Psychotherapy Finances, psychiatrists in private practice on average received income from the following sources: Self-pay (46.2%), managed care (23.1%), indemnity insurance (15.3%) and other third parties (9.2%). Other sources accounted for 6.2% of income.

The Psychotherapy Finances survey also found that between 1997 and 2000, psychiatrists reported an income increase of 13.7%. Psychologists, on the other hand, reported a 0.7% decrease over the same period. Social workers saw their income rise 6.2%."

Psychiatrist Salaries 2001

It's important to note that these salaries chage quite a bit due to recent medicaid reimbursement changes. This, however, may be offset by psychiatrists cutting down on their acceptance of Medicaid patients, thus potentially increasing their incomes once again.

According to the American Board of Child and Adolescent Psychiatry (1998), Board Certified CA psychiatrists command from $165,000 - $200,000.

I'll post more as I can...

 

[Anasazi23]

[copied from the fellowships sticky]

I can tell you that in general, subspecialists tend to make more than generalists (even though psychiatry is a specialty within medicine). Child psychiatrists have large earning potential, of course depending on the type of practice setup. Their average starting salaries tend to be higher than adult general psychiatrists. From my practical experience, they range from $140,000 to >$500,000.

Forensic psychiatry can also be quite lucrative - again depending on your work practices. Salaried prison psychiatrists make around $110,000-120,000. Those involved in adult psychiatry doing forensic expert witnessing and consultation make much more, often easily $200,000+. I know a forensic psychiatrist pushing the $700,000 mark on Long Island.

Non board-certified fellowships that you mention, such as psychopharmacology, generally net you nothing extra, from what I've seen. You may be able to negotiate an increase in your salaried position either in a hospital or academic medical center, but wouldn't count on all that much extra.

There is a joke in psychiatry that geriatrics is the only subspecialty in medicine that decreases your salary. The theory behind this is that all the patients are Medicare/Medicaid only, making reimbursement difficult. However, it is not uncommon for geriatric specialists to command a somewhat higher salary than generalists in the hospital setting. Also, private psychiatrists working for nursing home networks can make quite a lot of money, easily over $200,000.

Addiction psych has been discussed elsewhere. Basically, you can either make base salary typical for the region, or have a clinic practice or methadone mill and make lots.

Perusing the back of Psychiatric News shows that C/L psychiatrists can also make either typical salaried position salary $20,000-$30,000 more, again depending on the area and other clinical duties.

Keep in mind that many of the psychiatry salaried positions are 'faculty practice' positions. Meaning, you are paid a base salary by the hospital and have time dedicated to seeing private patients using the hospital facilities (office, reception, etc). In some cases, this DOUBLES a psychiatrist's practice income, depending on the caseload. Faculty practice positions typically require the doctor give a percentage of the earnings to the department in return.

 

[sga430]

how about the salaries of those psychiatrists that go into pain med? community psychs? sexual psychs? btw i heard there r fellowships in sexual psychs. is this tru?

 

[prominence]

how about the salaries of those psychiatrists that go into pain med? community psychs? sexual psychs? btw i heard there r fellowships in sexual psychs. is this tru?

bump

 

[Solideliquid]

bump

They make a gazillion dollars a month.

 

[Anasazi23]

They make a gazillion dollars a month.

Correction: a quadrazillion per month. More if you take call.

 

[Anasazi23]

how about the salaries of those psychiatrists that go into pain med? community psychs? sexual psychs? btw i heard there r fellowships in sexual psychs. is this tru?

I'm not sure how much pain psychs make. I'm sure it would entirely depend on the amount of procedures they do.

Community psychs, according to those I know and the advertisements in the Psychiatric news, make what appear to be going rates in academic positions for their areas.

I'm not aware of sexual fellowships. If they exist, they are non board-certified specialties within psychiatry. Though there are lots of subareas of sexual disorders and units to rotate through as part of forensic fellowships. Of course, this involves more the sex offense category of psychiatry and forensics, rather than partner sexual disorders.

Interestingly, there is also SA (Sexaholics anonymous) and SAA (Sex addicts anonymous) and even S-Anon for the partners.

 

[Anasazi23]

Questions from a poster regarding practice setup:

Do you know an good resources on how to actually start a psychiatry practice?

I've been having some butterflies about whether or not its easy to do well in psychiatry while still practicing the way I would like to practice.

I know there are books about this, and are special links on the apa website www.psych.org. Also, your residency will have classes on practice startup, and there are entire seminars at the APA conferences yearly devoted to this topic.
APA Career Corner. Links to job databases, employer resources, and other information useful to the practicing psychiatrist.


Practice Management for Early Career Psychiatrists [.pdf file]

For example. like some of the styles you mentioned to me earlier.

in a private practice, boutique setup. how does one start that up? how to get patients? let's say I graduate from my residency/felloship and am ready to start.

do I take out a loan, get an office, employee, paperwork and then start trying to get patients? get privaleges at nearby hospitals? work partime as consultliason at nearby hospitals? i've thought a little about doing some anxiety, depression, addiction, stress reduction seminars at local public libraries (someone mentioned that awesome idea earlier somewhere) where I can 2xweek help people free of charge and get my name out (pass out my buissness card along with other helpful materials for attendees)?

If its boutique style...how do you go about getting clients that can pay? do you only give your card to rich patients, when you are part-timing in a consult service? how does one make money in the beginning?

I think that in the beginning, you have sort of take what you can get, as most new businesses struggle in the beginning. However, as your practice grows, you become selective in the patient you choose to treat. You charge, say, $300 for an initial eval for 45 mins, and you tell them it must be in cash. Your ideas about local talks and whatnot are fantastic ideas, and something that many smart clinicians do at the outset.

Child/adolescent practice - Is this field practiced in less of a boutique style b/c insurances reimburse more for child/adolescent services? why do they make more? more people willing to pay out of pocket?
I would imagine that it may be easier to get patients like this if you are doing parttime somewhere?

Don't know too much about child...People will pay anything to "fix" their kids. Again, however, this won't happen if you're in an inner city clinic. You have to cater to the right population. They reimburse more for this insurance-wise because there is more training involved (fellowship).

here's a good question. how do you go about getting patients of a specific population type? patients who can afford it? do young practitioners start with medicaid/care and then transition to better insurance/out of pocket? how does it work?

I reall imagine myself being able to see a wide variety of patients (one in the hospital/crisis center-loved that week of my clerkship) and another type in my own practice, along with doing group/seminar activities in a more public setting.

I have seen many setups like this...i.e. docs that have their inpatient medicaid population, then their high-paying privates at night or in the evening. This seems to be a good setup, since you keep hospital privilages, and get insurances covered often. As your private practice grows and you find yourself turning away patients due to your hospital duties, it's time to start considering dropping your inpatient hours and going full time outpatient. The reason people still do hospital psych is because it's basically worry-proof. The insurance is there, the office is there, the money is guaranteed, the hours are guaranteed, the patients are guaranteed...you just work and pick up a paycheck. No insurance hassles, no fighting with HMOs, no preauthorizations, etc. Some people aren't willing to deal with these hassles. That's why you'll pay someone to do it for you.

Addiction clinics- how do these work? is it all referral based? do these patients do well and maintain sobriety in any significant way?

are there any web resources, or magazines that outline steps to take as a novice psychiatrist in building up a patient base, a referral base, and starting a practice ?

Addiction clinics, except for big-money places (Betty Ford, ect) are referral based. They are also salaried, unless you run it yourself. Methadone mills are popular, and make money for a reason.

Check out the APA site to get you started. Also check Amazon and the APA press for psychiatric practice books. They're in existence.

Here's a couple to get you started:
Career Planning for Psychiatrists

Entering Private Practice

Practical Psychiatric Practice

Good luck!

 

[Anasazi23]

Q: Any semi-updated information on psychiatrists' salaries?

A: According to U.S. Department of Labor, General Psychiatrists make $173,992 less than two years in practice, and $180,000 over one year in practice. Of course, the general trend is that you continue to increase your salary as your experience increases.

Other general information about psychiatry can be found on the same webpage. Though, you're likely to find much more detailed information about psychiatry on this website.

 

[Socky]

Hi All!
I just finished my 9 month internship in Psychiatry and then 6 months in Gyne/Obs. I am so undecided as what to do next in Postgraduation. No clear websites around. Was kinda interested in DPM or Mrc psych etc. I already have FCPS knowledge.
Will really appreciate any info you guys can provide...
thanx,
Zoe

 

[Anasazi23]

What country are you from?

 

[icebreakers]

Q: Any semi-updated information on psychiatrists' salaries?

A: According to U.S. Department of Labor, General Psychiatrists make $173,992 less than two years in practice, and $180,000 over one year in practice. Of course, the general trend is that you continue to increase your salary as your experience increases.

Other general information about psychiatry can be found on the same webpage. Though, you're likely to find much more detailed information about psychiatry on this website.

the u.s department of labor has data on these physicians-
Do we have any data/info on Self-employed physicians—those who own or are part owners of their medical practice—generally have higher median incomes than salaried physicians.
and what about data on psychiatrists practicing over 5years, 10years?

 

[BrianUM]

Hi everyone.

I was accepted into medical school recently, and I have always been interested in psychiatry. I heard of a combined neurology/psychiatry program. Can anyone tell me more about this program? How is their earning potential?

 

[Anasazi23]

Hi everyone.

I was accepted into medical school recently, and I have always been interested in psychiatry. I heard of a combined neurology/psychiatry program. Can anyone tell me more about this program? How is their earning potential?

There is some information on this in the fellowships sticky. Earning potential is theoretically comparable to either psychiatry or neurology, since the practices are similar. Of course, thos neuropsychiatrists that find themselves a niche or have larger, non-academic caseloads will be paid substantially more.

Check the freida website for residencies in neuropsychiatry. Search under "combined residencies: psychiatry/neurology."

 

[Anasazi23]

Q. How long is a child/adolescent (C/A) fellowship?

A. This question is asked frequently, and the answer is, twofold:

--A child psychiatry fellowship is technically two years after completion of your general psychiatry residency.

--However, if you attend a residency program that has an affiliated child/adolescent fellowship available at the institution, and are accepted into that child fellowship, you can forego (essentially skip) your fourth year of psychiatry residency and begin the child fellowship. This would reduce the total training time by a year, thus putting you in line to graduate, with fellowship, after 5 years total instead of 6. As stated, however, you must either attend a program that has a child fellowship 'attached' or go to a program that allows you to leave a year early (rare) in order to qualify for eliminating the senior (4th) year of general psychiatry residency.

In short, the fellowship is 2 years after residency. If your institution has a child fellowship available, you can skip 4th year and begin the child fellowship. That brings the total residency/fellowship training time to 5 years.

All other Board-certified fellowships are one year post-residency.

 

[Nameless7]

Thanks for all the info!

How much do psychiatrists make in academia? I was reading about professors at Stanford. From what I gather, they work in the Medical Center Line and just recently were able to get the same pay as everyone else, but tenure is not available to them. What I don't understand is why they weren't getting paid well, even though they're considered full-time professors.

Do you know how much the typical psychiatry professor makes? And do you know if they typically make more income by seeing patients? If so, how? Sorry, I'm just really interested in psychiatrists who work in academia. Any info at all, especially firsthand, would be greatly appreciated. Thanks!

 

[sga430]

I heard those in academica make less unfortunately.

 

[OldPsychDoc]

The Psychiatry Mentoring Thread is now open!

I am an inpatient attending and medical student education director in the Midwest. I also have a part-time general adult outpatient practice, and a special interest in addiction medicine.

Psychiatry is a diverse field: there are many different individual workstyles, different preferred patient populations, different treatment settings. In addition, the culture and practice style might vary considerably from region to region within the US, so my mentorship is going to be considerably colored by my own experience. If you don't like the advice I give, you can probably find someone else to tell you something different! (And if I can, I'll try to direct you to that person or resource, even if it's not my thing...)

I came into psychiatry with a background in basic neuroscience research, so my perspective is that behavior is firmly grounded in the brain. Nevertheless, the brain is an extremely adaptive and plastic organ, and responds exquisitely to its environment. Therefore, everything is relevant--the patient's pre- and post-natal development, their early life experiences, their internal and external stresses and traumas, their relationships past & present, their thoughts, dreams, beliefs, loves, and hopes. Psychiatry brings together everything I love: science, medicine, psychology, philosophy, spirituality, compassion, understanding, and social justice. I hope that in answering your questions in this forum, I can pass some of this on to you.

OPD

 

[OldPsychDoc]

Vizious asks:
"What is the most difficult part of your practice/career?"

It depends on the day.

With patients, it's usually about getting someone to do something they really don't want to do. That can be taking their meds, stopping using drugs, staying in the hospital, getting out of the hospital...you get the idea.
You have to develop a sense for what motivates the patient and then build on that in any way you can.

Another tough thing is when you feel you're out of options, that the patient has "tried everything", and they're still depressed, or whatever. I always try to come up with "one more thing we could try".

A big thing for me lately is frustration with institutions--trying to get an insurer to pay for needed services, or a county to cough up funds for a treatment program, or my own hospital's administrative demands. It's part of every job, I guess, but you'd better have well-developed coping skills yourself in this business!

 

[OldPsychDoc]

A PM asked:
"How much overlap is there between neurology and psychiatry.
What are some similarities between the two?"

A lot actually. First, as you might be aware, both fields are certified by the American Board of Psychiatry and Neurology. Psychiatry board exams are at least one-third neurology, and we rotate for at least 2 months on neurology services as part of our residency. It might be useful to remember that Sigmund Freud was trained as a neurologist, too.

In practice, we overlap pretty frequently regarding issues of dementia, sleep disorders, and chronic pain conditions. Many neurological disorders have psychiatric presentations, as well--Huntington's, temporal lobe epilepsy, Tourette's, for example. We have to know our brain structures and neurotransmitters pretty well!

So why would someone choose one field over the other? I think it's that psychiatrists are really interested in behavior which affects the person, whereas neurologists are more interested in diseases that affect the organ of the brain. I see patients with stroke, traumatic brain injury, chronic headache, etc. all the time--but I'm not primarily dealing with those conditions, but rather the emotional and behavioral sequela. Could I be a neurologist? There's no legal reason why not, nor any legal reason why a neurologist couldn't evaluate and treat a psychiatric condition. However, we usually stay on our own sides of the fence, because that's what we're more comfortable dealing with. (There are a few fence-straddling neuropsychiatrists who have taken extra training in this area in order to be more comfortable in both worlds. It's not yet a board-certified specialty, although I hear it may soon become one. You can also go to one of a few combined residency programs and get double-boarded if you (glutton for punishment) so desire.)

So why did I choose psychiatry? For me, the real frontiers of neuroscience are about how the brain produces behavior. My apologies if I offend any neurologists out there, but most of the practice of neurology is about "plumbing and packaging"--e.g. strokes, trauma, tumors. Broadly, the stuff of psychiatry is more about subtle changes in neural activity and regulation producing dysfunctions in basic drives. These dysfunctions then interact with all sorts of complex factors in our patients' psychosocial environment to cause unique and personal sets of problems, large and small. These are the conditions that we have the privilege of evaluating and treating--and if you like people and have a lot of patience, it can be kind of fun.

 

[OldPsychDoc]

Medstudent416 asked: Hi! Thank you for the information you have provided in this forum. I am just starting my fourth year of medical school and will be applying to Psychiatry residencies this Fall. My question is - how much of your time do you spend doing therapy with patients, as opposed to referring it to other professionals such as psychologists?

In my practice, which is but one style among many, I have no "therapy patients". My job in this large multi-specialty group is to do diagnostic evaluations, medication evaluations, and medication management. This keeps me pretty busy, even being scheduled at one hour for an intake and 20 minutes for follow-up--other practices may shorten these times to get more patients seen, as you've probably heard. I'm not "forbidden" to do therapy--I just choose not to, and would find it quite hard to schedule, as I'm often booked up weeks in advance. (I personally am only a part-time outpatient clinician as well, which reduces my availability.) You will certainly find other psychiatrists who practice according to a totally different model.

That said, almost all of my interactions with patients involve some sort of psychotherapeutic interaction--whether it's psychoeducation, supportive problem-solving, "CBT-lite" or "DBT-lite", even a little psychodynamic insight here and there. Nevertheless, if I see that one of my patients needs a good hour-at-a-time for a few weeks to sort some issues out--they get referred to one of my excellent in-house or community colleagues (usually a LCSW or psychologist) who has chosen to arrange their career to specialize in this.

(P.S. Sorry for the delay in responding to your question.)

 

[OldPsychDoc]

squishee asks: "As a psychiatrist, what do you think of hypnotherapy? Would you say that it's a method that holds a lot of therapeutic promise, or just another mildly useful tool?"

I'll put it in the "mildly useful" category. You can get training in it (I haven't), and it has utility in some selected situations. However, a minority of patients will fall into the "easily inducible" category, and the evidence for more general efficacy is limited.

And also states: "I'm really interested in going into psychiatry, but I've heard that successful treatment of patients is often long and difficult and I'm worried about becoming frustrated with the profession. Any thoughts?"

We have easy patients, difficult patients, chronic patients and acute patients, just like everyone else. How quickly do you think internists "successfuly treat" diabetes and hypertension? Psychiatry is a great field if you like interesting and unique patients and continuity of care. There is a lot of satisfaction in helping someone turn things around, or even in helping a chronically mentally ill person to maintain function in the community. Of course there are frustrating moments--but they are offset by the satisfying ones.

 

[OldPsychDoc]

solumanculver asks: "I'm currently applying to MD/PhD programs with the intention of doing the PhD in neuroscience and going on to do a residency in psychiatry. I'm really not interested, though, in a lot of the kinds of things that psychiatrists seem to do, like dealing with depressed upper-class housewives and personality disorders. Is it feasible to have a career in academic psychiatry where you're only dealing with schizophrenia and OCD and other, more serious, disorders?"
"Choosing your disease" is much easier in academic centers than in most kinds of private practice, since large academic programs are more like to have a specialized "Schizophrenia Program" or "Treatment-resistant Depression Clinic" in which you can become an attending. Getting a PhD in neuroscience is very compatible with psychiatry and with doing psychiatrically-oriented research. It covers a lot of ground--whether you're planning to do molecular genetics, neuronal cell biology, pharmacology, or imaging. (You will eventually have to decide, you know...) And the nature of psychiatric disease is such that there is still a LOT of discovery to be done.

"Also, as an academic psychiatrist, how do you balance clinical duties with research, teaching, and administration. Would you be free to alter your schedule one year to be mostly clinical work and another year to be all research? I feel like I might want to do that in my career..."
It's all going to come down to money. I suggest that you have a talk SOON with a researcher who does the work you envision doing. Some researchers, even with MDs, can't wait to get enough grants to cover 100% of their time for research only, so that they never see another patient. A typical path for an MD/PhD type like you describe is to finish residency and get attached to a (well-funded) senior researcher in a "lecturer" or "clinical instructor" position--basically a post-doc. This gives you a year or two where you're splitting your time, attending in a specialized clinic as you envision, doing some research, writing some papers, and applying for what's called a "K" award--a five year career development grant. If you can get this, and turn your work into a coveted "R01" grant--you're on your way to a tenure-track position in a university department. You probably won't be doing the alternate years thing you descibe though--research needs to keep moving forward and you really can't just start and stop. Good luck! It's not for everyone, but very rewarding for those who so choose.

PS--I will also refer you to the excellent thread maintained by Tildy under the title "Academic Medicine" in this forum. Almost all of it is equally applicable to academic psychiatry.

 

[OldPsychDoc]

I've been asked for some opinions about residency personal statements, so I thought I'd post some general advice here.

I think that you want your personal statement to do three things:
1) provide a "hook" that lets the reader know that you're an interesting, thoughtful person (and which will encourage your interviewers to talk about the things which make you an interesting person, thus allowing you to shine in the interview!)
2) answer briefly and directly the question "why psychiatry?". This is probably the most important content that you need to portray. If it looks like you could submit this essay to an application in any speciality, then we are likely to doubt your commitment to treating the mentally ill.
3) provide some indication that you have a realistic expectation about psychiatry, preferably based on your clinical experience.

If you can do this concisely in three or four paragraphs, you'll be fine. Remember that it is only part of the package. It's rare that the personal statement has much to do with the decision to interview or not interview an applicant, except in the most exceptional circumstances.

Remember that this is also carries the basic expectation that the statement is written in fluent and concise English. Do hand it to some trusted readers for honest feedback before you send it out. It really will be taken by the readers at evaluation time as the only example we have of your writing skills--we will want to have an idea of how your documentation might look. Make it something that others will want to read.

 

[OldPsychDoc]

As a third year student, I find that I'm being trained to be a physician that remains within a large hospital or academic setting, when my true interest lies in helping those in a small group outpatient setting. I have been thinking about psychiatry, and my special interest is in mood disorders and how they relate to obesity, diabetes, addiction, sexual dysfunction, chronic pain etc. - so basically I'd like to be part of a wellness center. I have NO idea how to get involved with that or what type of institution to apply to, to facilitate such a career. What is your opinion on this?

You're right about one thing--training in academic centers tends to warp one's thinking until you eventually start believing that academia is all there is! Do not lose heart, though, because your perspective of wanting to do outpatient-centered Behavioral Health services is definitely a valid one once you get launched on your career. Start asking around, look for people who seem to be doing what you want to do, and ask them where they recommend training. It might be a community hospital-based program, or it might be a mid-range academic program that has the perspective you want. There's no easy way to find out from FRIEDA or the other databases, but a little legwork and you'll come up with something. You might check at those places which offer combined Psych-FP programs--even if you're not interested in doing a double program, it may indicate they share your philosophy.

I am a 2nd year osteopathic (DO) medical student interested in pursuing child psychiatry. Just like at my initial interview, I have been challenged "why psychiatry and why osteopathic medicine?" I however find them both complementary as they both take holistic approaches in preventive and diagnostic care of the mind, body, and spirit. Do you have any advice for me as far as a DO entering a field that is more traditionally treated by MD's? Should I take both COMLEX and USMLE? Are allopathic psychiatry residencies better?

I trained in residency alongside several DOs. They were clearly equivalent in ability, and in some respects, in as much as they had internalized some of that holistic philosophy, they were often superior in attitude. This was in an allopathic-based psych residency. I'm really not aware of any DO-only psych program, but there are many "DO-friendly" residencies in psych. My advice: Go for it, don't apologize for being a DO, and welcome to psychiatry!

 

[OldPsychDoc]

I was recently accepted to medical school but have deferred in an effort to learn more about the field of clinical psychology. I understand the differences between psychiatry and clinical psych, but I am still trying to understand how the two interact with each other professionally. Also, I feel apprehensive about attending medical school, which seems friendlier towards people ambitious to become surgeons or internists or whatever, when the specialty i find most fascinating is psychiatry. As such, I am considering my medical school seat to start (ground up) in an effort to enter clinical psychology. I have to ask you, is it common for someone to go into medical school with a desire to enter psychiatry or is it more commonly stumbled upon at some point? What are the advantages/disadvantages your field has over the clinical psychology field?

It sounds as though this is a pretty personal decision for you, and I wouldn't know enough about you to say what's right or wrong for you, but a couple of things in general.
Yes, med school favors internists and surgeons--they're the majority of physicians after all, and you could say that everything else branches off from those basic disciplines. If you want to be a psychiatrist you must first study to be a doctor, and therein lies the big contrast with clinical psychology. These things have been debated and argued ad nauseum on the Psychiatry and Psychology boards, so I won't go into it here. As psychiatrists, however, we value our medical training. We are often the only doctors our patients see regularly, and we often find ourselves picking up on a dangerous situation that needs attention from primary or specialty care. Our patients get sick a lot more than the general population, and usually have several co-morbid medical conditions that affect our care. Sometimes medical conditions present with psychiatric symptoms, and we need to rule them out. We are prescribing lots of agents with potentially toxic systemic effects, and need to be watchful for that.
Clinical psychologists will spend more of their time formally testing and assessing mental illness, and conducting therapy in treatment of those patients. Those skills are needed, and I personally often refer to a psychologist when I need this expertise. One frankly does not learn much psychology in medical school, nor sad to say, in psychiatric residency. There is somewhat less overlap in our professional roles than one might think.
It is not uncommon for a student to enter med school with a definite interest in psychiatry. I would say it is less common for someone to want to start over (from the ground up you say) in psychology once accepted into medical school. I'd advise you to talk this over with some people who know you before you make your decision.

 

[OldPsychDoc]

I am currently a 2nd year medical student and am considering leaving to go into a PhD Clinical Psychology program. My impression of Psychiatry is that they manage the medications as that is what they are trained for as doctors. I know that medications are necessary for some individuals; however, I don't know that is what I want my career to be. That's why I am thinking I might be better off focusing on a career in behavioral methods. I need to make this decision before too long and too much debt is incurred. Any suggestions?

First off, there are plenty of programs in psychiatry that will school you in various modalities of psychotherapy, and even some that will encourage you to explore one (in your case, likely cognitive-behavioral therapy) in depth. All psychiatrists are expected to be "competent" in therapy, and it's a very important skill to have in practice, even if you primarily perform medication management, in order for you to be fully meeting your patients' needs along all dimensions of the biopsychosocial model. Your desire to work on behavioral therapy is admirable, and will pay off for your patients.

What should you do? Why not take a year off between MS 2 and 3 to explore behavioral methods, maybe in a formal Masters program, or by doing research, or maybe even starting the PhD program to see if it is all that you expect it to be. If you do decide you like psychology better, you'll have a head start on that degree, and if you still want to go the medical route into psychiatry residency, it will enhance your skills and application.

(I'm making the charitable assumption that you're seeking anonymity by asking this question with your first post, and not trying to stir up what has in the recent past been a contentious question: that is, psychiatry vs. psychology--who is best suited to treat the mentally ill? My perspective above reflects my identity as a psychiatrist, and a psychologist may give you a different answer.)

 

[toby jones]

Er... What do neurologists do? I've got the hang of what psychiatrists do (and studied the DSM etc) but where could I find out about what neurologists do?

Sleep disorders?
Acquired Cerebral Injury (is there an overlap here with neuro-psychology and their aphasias etc)?

Do they have a classification that is kind of their version of the DSM?
Do they prescribe psych meds?

(I guess epilepsy... And Epilim etc are used as anti-seizure meds too)...

I was just curious because you mentioned doing some neurology to train as a psychiatrist and I wondered how come. If it was to be able to make differentials (and refer the relevant patients their way) or if it was more that there is an overlap in subject matter (with patients being able to be treated by either)

 

[Ffinnian]

I am new here and hate to start out on a bad note Toby, but the very essence of your query is misinformed. Of course psychiatrists study neurology, as do most psychologists especiallly neuro/medical psychologists. It would make sense to understand the basics of the organ you are treating. Neurologists do not specialize in what the brain produces in the human behavior sense, but rather what it is doing that may or may not be observable. Aphasia is but the tip of the ice-burg in what WE (psychs. neuro) diagnose and treat. Only a portion of the CNS, and brain is devoted to human behavior directly, and neurology mainly treats that part that is not.

 

[toby jones]

> Of course psychiatrists study neurology, as do most psychologists especiallly neuro/medical psychologists. It would make sense to understand the basics of the organ you are treating.

Ah. I'm not asking why psychiatrists study neuro-biology (the brain) I'm asking why psychiatrists study neurology (thats a field of medicine like endicrinology and cardiology and so on and so forth).

I do get that there is a whole bunch of people studying the brain. Neuropsychologists, neurologists, psychiatrists, geneticists. I was just trying to get clearer on the distinction between neurology and psychiatry similarly to how one might want to get clearer on the distinction between any other medical specialities.

> Aphasia is but the tip of the ice-burg in what WE (psychs. neuro) diagnose and treat.

Sorry - is aphasia considered a psychiatric disorder, a neurological disorder, or a cognitive neuropsychological disorder? I guess I don't really understand the difference between neurology (as a field) and cognitive neuropsychology either... I'm trying to get clearer on these.

> Only a portion of the CNS, and brain is devoted to human behavior directly, and neurology mainly treats that part that is not.

So... Sleep... But drug induced movement disorders are part of psychiatry rather than neurology. Is there a text book anywhere that tells you about neurology the way that the DSM tells you about psychiatry??

 

[LadyGrey]

Um, you seem to know about the DSM-IV, so basically neurologists do stuff involving the brain that isn't in there...

Off the top of my head, some things neurologists treat:
stroke
epilepsy
migraine
Parkinson's
Alzheimer's and other dementias
AML, other neuromuscular diseases
Huntington's
multiple sclerosis

And to contrast, psychiatrists treat:
mood disorders
anxiety disorders
personality disorders
addiction
schizophrenia & other psychotic disorders

One way to draw the line might be that neurology generally involves diseases with more hard evidence (in general, if you can see it on an MRI, CT, EEG, EMG, it's more likely to be treated by a neurologist). This is not meant as a slight against psych, so don't take it that way.

An example of why you need to know both: deciding if a patient with hallucinations has schizophrenia (psych) or Lewy body dementia (neuro). Some patients see both kinds of doctors. For example, a neurologist might diagnose an elderly patient with dementia, and a psychiatrist might be involved in treating associated depression.

 

[toby jones]

Thank you, that is very helpful. I was actually really lucky that our department had a talk by a neurologist today and so of course I hit him up about what the distinction was too. I have to say something about this in my thesis, you see. Have been wondering whether there is a principled difference lurking in the background or whether the field divisions were fairly arbitrary. Also just trying to get my head around the intuitive differences.

He said that he probably orders an MRI for about 90% of his patients. So... Neurologists tend to order MRI's (whereas psychiatrists do not). I get that difference He said that clinical cognitive neuroscientists tended to have their batteries of cognitive testing - so he would refer to them for that... And that he would refer to psychiatry if he thought the patient could benefit from psych meds (once he had MRI'd in some instances to try and rule out a diagnosible / treatable 'organic' syndrome). So that was helpful too.

> Off the top of my head, some things neurologists treat:
stroke
epilepsy
migraine
Parkinson's
Alzheimer's and other dementias
AML, other neuromuscular diseases
Huntington's
multiple sclerosis

And that is helpful too...

> One way to draw the line might be that neurology generally involves diseases with more hard evidence (in general, if you can see it on an MRI, CT, EEG, EMG, it's more likely to be treated by a neurologist). This is not meant as a slight against psych, so don't take it that way.

I'm not taking it as a slight... But the concern with this characterisation is that if neuroscience advances such that we can diagnose schizophrenia etc on MRIs (etc) then schizophrenia would be reclassified as a neurological disorder. I guess this is why some theorists (Kandell? could be wrong on that) think that psychiatry will become subsumed under neurology with neurological advances...

 

[Anasazi23]

I certainly wouldn't say that psychiatrists do not order MRIs. You can look up "1st break workup" as an easy and common example of how and why psychiatrists would order all sorts of brain imaging depending on patient presentation. Those psychiatrists specializing in the organic brain syndromes including dementias, post-concussive and TBI related syndromes, psychosis due to general medical conditions, and many others have reasons to order all sorts of brain imaging to assist in diagnosis and to track disease progression.

Geriatric psychiatrists, for example, order many CTs, MRIs, and some order PETs. It's also standard of care for 1st break episodes.

 

[toby jones]

> I certainly wouldn't say that psychiatrists do not order MRIs.

Yeah, that is a problem. For any attempted delineation of the difference between neurology and psychiatry there are the dreaded counter-examples ;-). The question I'm basically trying to grapple with is whether psychiatry is a distinct field from neurology and (more in particular) whether psychiatry will remain a distinct field from neurology with advances that are made in understanding the neurological basis of mental disorders. Some theorists think that psychiatry will disappear as we better understand the neurological basis of disorders such as schizophrenia and depression and (maybe) hysteria and so on and so forth. Other theorists think that there is a principled distinction in the kinds of disorders that psychiatrists (compared with neurologists) treat. I'm trying to firstly - understand the intuitive distinction between the two fields (e.g., by understanding what they treat and why one would want to do one speciality as opposed to the other) in order to secondly - determine whether there might be a principled distinction lurking or not.

> Those psychiatrists specializing in the organic brain syndromes including dementias, post-concussive and TBI related syndromes, psychosis due to general medical conditions, and many others have reasons to order all sorts of brain imaging to assist in diagnosis and to track disease progression.

Hmm. Neuro-guy said that in England (in particular) the lines between neurology and psychiatry were even less clear with some people studying neuro-psychiatry... Guess that might be the case in the US as well. (I'm from Australasia).

 

[OldPsychDoc]

...The question I'm basically trying to grapple with is whether psychiatry is a distinct field from neurology and (more in particular) whether psychiatry will remain a distinct field from neurology with advances that are made in understanding the neurological basis of mental disorders. Some theorists think that psychiatry will disappear as we better understand the neurological basis of disorders such as schizophrenia and depression and (maybe) hysteria and so on and so forth. ...

Personally, I think that neurology is more likely to disappear, or become an organ-based subspecialty of internal medicine (e.g. cardiology for the brain).

Interventional radiology is taking over stroke, rehab & anesthesia are the specialties of choice for chronic pain conditions, and a brain-based psychiatry will cover the management of conditions with behavioral manifestations (because I have yet to meet a neurologist who wants to deal with a crazy patient--even if is due to an identifiable organic cause!) .

 

[solumanculver]

Interventional radiology is taking over stroke, rehab & anesthesia are the specialties of choice for chronic pain conditions, and a brain-based psychiatry will cover the management of conditions with behavioral manifestations (because I have yet to meet a neurologist who wants to deal with a crazy patient--even if is due to an identifiable organic cause!) .

When you say brain-based psychiatry, what do you envision the role of psychotherapy will be? Do you think that it will be more completely taken over by psychologists as psychiatry develops more effective pharmacological tools?

 

[Matasanos]

Does anyone know of psych residencies in NYC that accept COMLEX in lieu of USMLEs? Thanks.

 

[OldPsychDoc]

Hi OPD,
Up until now I've been planning on doing a combined MD/PhD in neuroscience and then going into psychiatry. I'll be starting the MD/PhD program this summer, but I'm beginning to have second thoughts about psychiatry. I'm really interested in mental illness and I would like to focus my research on psychiatric diseases, but I'm beginning to wonder if I really have the type of personality required to actually practice psychiatry. I'm not really interested in talking to people about their personal issues, and I'm very poorly suited for anything that resembles social work. I like to think about brains, and chemistry and that sort of thing... So my question is: Do psychiatrists have to be more empathic, or touchy-feely than other physicians to be good at their job? Also, if it turns out that I'm not suitable for psychiatry, how feasible is it for, say, a physician-scientist to research schizophrenia, but practice clinical neurology? Thanks for your help,
Soluman

Believe it or not, you're not the first person I've known who asks these kinds of questions. As with most things psychiatric, different people choose differing paths.

So should you go into psychiatry if you don't like talking to people? Do I have to be a "touchy-feely" person?
Talking about personal issues pretty much is essential to psychiatry, and honestly, most other branches of medicine as well--except purely diagnostic radiology and pathology. You're right to assume that a psychiatrist should try to be pretty good at talking to people and being at ease with sensitive topics. It certainly helps to be at least a little interested in the patient you're talking to, even if you're not doing in depth analytically-oriented therapy.
To be frank, though, I've known a few psychiatrists in my career that I can't imagine talking to for more than 5 minutes of 'yes' or 'no' answers! Others I've known have gleefully reduced their clinical time to focus on research. (I was working in one doc's lab the day he joyfully announced that he had officially turned in his pager--that he had enough grants to "buy" all of his time, and no longer had any clinical responsibilities. Looking back, that was one on the moments that helped me see that a research career was not in the cards for OPD.)
Point is--psychiatry can be done without being a chick-flickin', Oprah-watching, wine-and-cheesy, turtleneck-wearing Sensitive Soul. On the other hand, having some basic interest in what makes people tick will make you MUCH happier doing it--at least through your residency training.

Could I practice neurology instead, and still research schizophrenia (or other brain-behavior issues)?
I think if you look at certain neurologists out there--Antonio DeMasio, V.S. Ramachandran, for example--you'll see that one can live at the interface. The practicalities will depend on departmental politics, granting and publishing, etc. at the institutions where you choose to train. If you succeed in entering an MD/PhD program, the key will be choosing a research lab that does work applicable to both clinical disciplines. Let people know what you're interested in, and you'll hopefully be led to the right place. After that let your research experience and clinical "hunches" lead you to the right residency. You could end up doing functional imaging in a department of radiology, or molecular biology in a pathology department---not "psych vs. neuro" at all!

Best of luck!
OPD

 

[OldPsychDoc]

solumanculver passed these thoughts on to me in a PM, and I thought they were worth repeating, so with his permission:

"...I think that mental illness is kind of unique among all illnesses in that it touches those things that we use to define who we really are. When a person has heart disease, for instance, they don't consider that they are defective as a person... because we don't define ourselves by how well our hearts function. But when a person has a disease whose symptoms are expressed in thoughts, and beliefs, and behavior, there is a sense that, well... they are broken people... After all, we do define ourselves by what we think and believe, and it seems easy to equate having "bad" (i.e. disordered) thoughts and doing "bad" things to being a "bad" person.

Of course, that's what we do in society as well... everyone wants to sympathize with that brave cancer patient, or brave paraplegic. But who talks about the brave schizophrenic, or brave addict? To society, the addict is not brave, but weak... and the schizophrenic is not only not brave, but in a sense they are barely human... at least that's how we treat them, social embarrassments who we let live on the streets."

 

[OldPsychDoc]

dub7 asks:
Hey Doc, I'll be applying to OHSU's Med School in a few years (after completing the req'd courses).
I would like to have psychiatry experience before I apply - either work or volunteer. At this point I have none.
Any ideas?

Lots. What's right for you will depend to some degree on your own goals and gifts, as well as what's available in your area, but you can make almost anything relevant. Keeping in mind that you're still applying for med school, this would probably all look good for that too. Some will pay, others will just pay off with warm fuzzies, but it's all good. Bottom line--find things that put you in direct contact with people in need.

Clinical stuff that comes to mind--
Paid: personal care attendant, group home attendant or program assistant, nursing assistant on inpatient psych, ward clerk.
Volunteer: recreational programs for inpatient settings--child/adolescent or adult, other "typical" hospital volunteer stuff, community suicide hotline volunteer.

Social work/activist stuff--
Paid: lobbyist/mental health advocate, camp counselor for special needs populations
Volunteer: shadow local case managers, etc.; Work with mental health court programs (where these exist); hang out at local homeless shelters, community youth rec programs, after school tutoring programs, etc..

Also, don't forget research--either basic neuroscience or clinical studies. Can be paid or volunteer.

If anyone else has great ideas to add to this, PM me and I'll expand the list!

 

[OldPsychDoc]

Hi,

I am an MD/PhD student and will be applying for residency to begin July 2009. I am interested in pursuing an academic career and would like to have my hands in both clinical practice and research, though expect to ultimately have a heavy research focus. My interests are definitely strongest with the mind and behavior, but also enjoy the diagnostics of neurology quite a lot; I am passionate about talking to patients about their lives and mental health, but also enjoy the physical exam and the neuro work-up.

I am certain that I will at least pursue psych training, but I am also considering combined neuro/psych programs so that I can enjoy training in the brain from both perspectives. I also think that combined training may provide a more comprehensive understanding of brain function and pathology which may ultimately benefit my research perspective and direction. However, my reservations are 1) that I have heard that neuro/psych training is ultimately not very practical since a choice between in disciplines will eventually have to be made (and my choice would ultimately be psych), and 2) that if I pursue psychiatry alone, perhaps with a research track, that I will have more time to dedicate to research during residency and that that might be a better use of my time than clinical neuro training given my career goals. However even given these reservations, I feel like I would really enjoy training in both fields and that this alone might justify the decision.

As you can see...I am very ambivalent and was hoping that you might have some helpful input. Thank you in advance for your feedback.

-tmudphud

I addressed some of my thoughts about this in my post #3 above in this thread. Personally, I lean toward your point 2) here. Psychiatry residencies are really pretty flexible as far as allowing dedicated research time, especially if you go to a major academic program (as you no doubt will--MD/PhDs are generally salivated over on the interview trail! ) That said, a psychiatrist who can do a good neuro exam is a gem--especially on inpatient and consult rotations. Being able to identify temporal lobe epilepsy in that "psychotic" patient is a treat!

You may also want to explore the nascent field of neuropsychiatry, which will soon be a recognized subspecialty, accessed by post-residency fellowships after neuro or psych residencies. There are numerous other options for you to "float" into a specialization in between the two traditions. Personally, my bias is for you to choose psych--I think you will find the residency training more amenable to your goals both clinically and research-wise.

 

[colleezfascia]

Does anyone know of psych residencies in NYC that accept COMLEX in lieu of USMLEs? Thanks.

Don't be afraid to call the program and ask....I recently called about a dozen programs and asked them this same question. All but one (UVM) accepted COMLEX in lieu of USMLE, including Yale.

Not so sure about NYC programs, off the top of my head, though.

Good luck!

 

[OldPsychDoc]

forex asks: "What do you look into an application that an applicant is not serious in psy? I know PS is part of routine scrutiny. What other factors should make an applicant stand out?"

A few things come to mind that catch my attention as indicating a strong, genuine interest in psychiatry:
1) Strong letters of recommendation from psychiatrists who have observed your actual clinical experience in psychiatry.
2) An ability to discuss current relevant issues in the field--such as parity, stigma, and co-morbid conditions--in a fluent and spontaneous manner that indicates that the applicant has actually encountered these issues with respect to psychiatric patients, thought about them, and has not merely memorized a script of what they hope I want to hear.
3) Possibly some voluntary activities related to advocacy and/or community support for the mentally ill.
4) Electives in psych subspecialties.

So as far as detecting a lack of genuine interest--typically I see an IMG* who has done an observership only in an internal medicine field, whose extracurriculars in medical school overseas were working in free clinics for TB patients, etc., and who cannot even give me a reflective answer about how the practice of psychiatry might be different in the US vs. where they did their required clerkship in medical school. These make me skeptical that this applicant will be happy taking care of our patient population.

*(I need to qualify, I've seen a few AMGs who looked like psych was their last resort, too. I love IMGs. We have astoundingly bright IMGs in our program. But we've also taken care to pick the ones who truly want to be here and who will do well with our patients!)

 

[psych22]

In addition to the requirements for your degree, you must complete (with some minor variations) 2 semesters each of physics, biology, chemistry, and organic chemistry, all with lab.

I have been wondering, does each semester of the science need to have a corresponding lab. Or does the whole 2 semester length of the science course (1 year) need to have a single semester of lab?

I graduated with an Electrical Engineering degree a few years ago but have not taken any Bio or Orgo. I am working and trying to start my unfulfilled pre-reqs now.

Thanks for your help!

 

[Anasazi23]

I have been wondering, does each semester of the science need to have a corresponding lab. Or does the whole 2 semester length of the science course (1 year) need to have a single semester of lab?

I graduated with an Electrical Engineering degree a few years ago but have not taken any Bio or Orgo. I am working and trying to start my unfulfilled pre-reqs now.

Thanks for your help!

I believe the ones that I reference above must have a corresponding lab.

However, I'm years beyond that process. Someone else closer to the process could probably confirm or revise.

 

[pingouin]

I believe the ones that I reference above must have a corresponding lab.

However, I'm years beyond that process. Someone else closer to the process could probably confirm or revise.

Yes, two semesters of lab are required for each discipline, with the possible exception of organic where some schools require two and some schools only require one semester of lab.

Additionally, some schools are starting to accept a semester of biochem in lieu of the second semester of organic lecture. Others require some humanities courses (I recall U of IL as being particularly stringent about this but I know there are others).

There are some threads in the Pre-Allo subforum which track all of these requirements. You can also check individual schools' websites.