Psychiatry has the lowest average step scores

[iqureshi7]

Not that it matters but its interesting to see that Psychiatry has the lowest average step scores for any speciality

Taken from NRMP site : http://www.nrmp.org/data/chartingoutcomes2007.pdf

Step 1/2 averages of those that matched (based on March 15, 2007 Match)

1. Plastic Surgery, Step 1= 243 Step 2= 246
2. Dermatology, Step 1= 240 Step 2= 240
3. ENT, Step 1= 239 Step 2=240
4. Diagnostic Radiology, Step 1 = 235 Step 2= 238
5. Radiation Oncology, Step 1 = 235 Step 2=237
6. Orthopedic Surgery, Step 1 = 234 Step 2= 236
7. Transitional Year, Step 1 = 233 Step 2=231
8. Internal Medicine, Step 1=222 Step 2=228
8. General Surgery, Step 1=222 Step 2=228
8. Pathology, Step 1=222 Step 2=226
11. Medicine-Pediatrics Combined, Step 1=221 Step 2=233
11. Emergency Medicine, Step 1=221 Step 2=228
13. Anesthesiology, Step 1=220 Step 2=224
14. Neurology, Step 1=218 Step 2=226
15. Pediatrics, Step 1=217 Step 2=226
16. Ob/Gyn, Step 1=213 Step 2= 224
17. Family Medicine, Step 1=209 Step 2=219
18. PM&R, Step 1=208 Step 2=214
19. Psychiatry, Step 1=208, Step 2=213

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[whopper]

Psychiatry is the field where you don't have to know the USMLE material as well (except for Neurology & Psychiatry) compared to the other fields.

Yes you will have to know some medicine, some primary practice, but no you will not have to know trauma surgery, pediatric ICU questions or things like that.

Now this low score thing can set some problems.

First, some residents know their score blows and go into psychiatry because of this. They don't know their medicine--and its because they're not good students. You want a good student entering psychiatry, not someone who barely skated by and is now missing obvious medical problems in their psyche patients.

Another problem is with people scoring low, they're even less likely to pass USMLE III given that they will not get much non-psychiatric training and the overwhelming majority of questions on Step III are not psychiatry.

 

[parvas24]

Psychiatry is the field where you don't have to know the USMLE material as well (except for Neurology & Psychiatry) compared to the other fields.

Yes you will have to know some medicine, some primary practice, but no you will not have to know trauma surgery, pediatric ICU questions or things like that.

Now this low score thing can set some problems.

First, some residents know their score blows and go into psychiatry because of this. They don't know their medicine--and its because they're not good students. You want a good student entering psychiatry, not someone who barely skated by and is now missing obvious medical problems in their psyche patients.

Another problem is with people scoring low, they're even less likely to pass USMLE III given that they will not get much non-psychiatric training and the overwhelming majority of questions on Step III are not psychiatry.

possible factors that puts this specialty at the bottom ...
i) 4 yr residency .....
ii) few good fellowships
iii) $$$ pay is low after residency compared to other 4 yr residencies like
Radiology , Rad - onc, Anesthesia , ENT , Opthal, Derm , EM (some).
iv) huge loans to pay back after residency ....
v) other specialties look down on them during and after residency ....
vi) why choose a dead field ? atleast Neurology specialty seems to
be more attractive ...

think carefully the above points .... you only live once.... $$$ do count after residency ....

 

[whopper]

Psychiatry makes more money than you think.

The pay is higher than general practice
From Studentdoc.com
psychiatry pay
lowest average highest
121000 $142610 $189499

IM
117984 $148206 $205096

Family Practice
111894 $142516 $197025

Pediatrics
111113 $143754 $201086

Add to that, Psyche fellowships are easy to get into compared to other fields of medicine. In IM, at least from what I saw, only the best residents got into a fellowship. Almost every single psychiatry resident in my program, even the bad ones got into a fellowship when they pursued it.

Also psychiatrists usually work less hours than other fields with comparable levels of pay---> similar pay for less hrs of work.

IMHO if other fields look down on us, I don't give a damn because this is what I like doing. I didn't take this job because I wanted other doctors to look up to me.

However, and I did mention this a bit, several psyciatrists I know have forgotten their medicine to the point where I think its unexcusable.

 

[OldPsychDoc]

possible factors that puts this specialty at the bottom ...
i) 4 yr residency .....
ii) few good fellowships
iii) $$$ pay is low after residency compared to other 4 yr residencies like
Radiology , Rad - onc, Anesthesia , ENT , Opthal, Derm , EM (some).
iv) huge loans to pay back after residency ....
v) other specialties look down on them during and after residency ....
vi) why choose a dead field ? atleast Neurology specialty seems to
be more attractive ...

think carefully the above points .... you only live once.... $$$ do count after residency ....

Please do us all a favor and don't apply to psychiatry programs, then.

Thank you.

 

[PsychMD2100]

You also have to be suspicious of almost any income survey. It's still taboo in certain circles for physicians to talk openly about money. It's considered counter to the aims of the profession.

Anytime someone tries to do physician salary surveys, you've got to wonder what they will do with the data. Unfortunately, in the era of managed care, many times the goal is to cut our salaries to save a health system some money. Physicians know this and will often under-report their earnings.

Anecdotally, the psychiatrists that I know comfortably make over $200K. As mentioned in another post, many will self incorporate and pay themselves a low salary to avoid higher taxes.

I would rather make less money and have the time to enjoy it than have a huge income that only my wife (or ex-wife) can spend without me.

 

[Doctor Bagel]

IMHO if other fields look down on us, I don't give a damn because this is what I like doing. I didn't take this job because I wanted other doctors to look up to me.

Yeah, it would be pretty idiotic to not do something you enjoy just because other docs might think you're less cool.

As for the board scores, it's possible that people who are strongly drawn to psych are less interested in other subjects and consequently do worse on that part of the boards. Also, people study based on their goals. If your goal doesn't require a 240+ score, it's reasonable not to kill yourself studying for the boards.

 

[psychfriend]

This is why I have a difficult time believing that people sat out a year because they reportedly couldn't get a spot anywhere despite applying "widely." Sorry but the stats just don't support that. There are so many unfilled positions each year. Yes, I know that top programs intentionally fail to fill spots because they were not satisfied with any of the candidates they interviewed. However, that really wasn't the case with psychiatry. I looked at last years' list of programs with unfilled spots (on SDN) and they were not competitive programs in the least bit.

I think if people did sit out, it wasn't because they couldn't get a spot somewhere. It's probably because they were not willing to go to certain programs due to varous reasons. For example, if I'm from the northeast and the only program left is located in some rural area in the southeastern U.S, it's not a big deal to sit out a year and reapply to a program in the northeast. Psych is not very competitive and you can do things in your off-year to improve your chances at the program you are interested in.

 

[mgdsh]

Salary is also misleading in the fact that it doesn't really factor in pay/time spent or pay/hour.

A psychiatrist willing to work 60-80 hours a week could easily make just as much if not more than their counterparts in the fields mentioned above.

 

[whopper]

My dad is a surgeon, my mom is a psychiatrist.

She actually made more money than he did and worked less hrs a week. I'm actually finding that true not just among my parents but among several others as well.

Yes the psyche salary isn't as high as a neursurgeon, but compared to the other fields of medicine it does pretty good for the hrs. If you decide to work the grueling hours that occurs in surgery, and you're a psychiatrist, I'm sure your pay will be much higher than other psychiatrists.

As for prestige--I bring this up whenever this topic occurs. So who cares if that surgeon doesn't look up to me? My marriage is actually working, I can sleep a full night of sleep and enjoy life. I don't think he can say the same. (of course I'm generalizing but you get the point).

And as for money, this is one of the few fields of medicine where you got the time to actually track your investments for real. My dad--the surgeon, his stock portfolio was a joke because he often times had to drop his research time for investing for surgery.

IMHO if other fields look down on us, I don't give a damn because this is what I like doing. I didn't take this job because I wanted other doctors to look up to me.

I went to medschool to be a psychiatrist...PERIOD. I didn't do it because, oh my scores were bad, or oh I couldn't get into surgery.

 

[Anasazi23]

I went to medschool to be a psychiatrist...PERIOD. I didn't do it because, oh my scores were bad, or oh I couldn't get into surgery.

Here, here.

I think that nearly all of us could have done something else if we had chosen to. I know I could have more than easily. I went to med school with the intent of becoming a neurologist or psychiatrist. I chose psychiatry.

 

[RisingSun]

I went to med school with the intent of becoming a neurologist or psychiatrist.

I'm just about to start school and am sort of in the same boat - most interest in neurology, with an interest in some other fields as well (I'm INFJ and interested in all the fields that were mentioned in that other thread on the board).

What made you choose psych?

 

[golfpropsychguy]

possible factors that puts this specialty at the bottom ...
i) 4 yr residency .....
ii) few good fellowships
iii) $$$ pay is low after residency compared to other 4 yr residencies like
Radiology , Rad - onc, Anesthesia , ENT , Opthal, Derm , EM (some).
iv) huge loans to pay back after residency ....
v) other specialties look down on them during and after residency ....
vi) why choose a dead field ? atleast Neurology specialty seems to
be more attractive ...

think carefully the above points .... you only live once.... $$$ do count after residency ....

You should really look up some of the data that you've mentioned. Actually Forbes just did an article on top paying salaries of all fields not just medicine and general psychiatry was # 6. Neuro was not even mentioned. And actually if you read some of the literature out there Neuro is the dying field with all the imaging that is available. You dont need anyone to tell you where the lesion is all you need is to take a picture.

 

[parvas24]

Psychiatry makes more money than you think.

The pay is higher than general practice
From Studentdoc.com
psychiatry pay
lowest average highest
121000 $142610 $189499

IM
117984 $148206 $205096

Family Practice
111894 $142516 $197025

Pediatrics
111113 $143754 $201086

Add to that, Psyche fellowships are easy to get into compared to other fields of medicine. In IM, at least from what I saw, only the best residents got into a fellowship. Almost every single psychiatry resident in my program, even the bad ones got into a fellowship when they pursued it.

Also psychiatrists usually work less hours than other fields with comparable levels of pay---> similar pay for less hrs of work.

IMHO if other fields look down on us, I don't give a damn because this is what I like doing. I didn't take this job because I wanted other doctors to look up to me.

However, and I did mention this a bit, several psyciatrists I know have forgotten their medicine to the point where I think its unexcusable.

didn't mean any offence with my previous post .... I feel that those who apply to this field are really interested .....

 

[billypilgrim37]

The only thing I remember about Step 1 is having at least six questions about gonococcal arthritis. Step II was a parade of "rash plus infection four weeks ago" and "rash plus sore joint" and "rash plus any random symptom we can make up." Frankly, if it's not "rash plus lamotrigine script," I didn't really give two snits about it.

I think all the Philip Roth novels I read during med school were more valuable for a career in psychiatry than any extra studying I could have done for Step exams.

 

[whopper]

Don't worry I don't think you meant any offense.

Actually I should apologize to you because the way I wrote my psots, it seems like I took offense.

 

[Llenroc]

I'm going into Phys. Med. and Rehab. which is tied with Psychiatry for the lowest board scores.

I don't see it necessarily as a bad thing. I'm not desperate; my board scores were decent. I could go into any number of residencies. But the lack of competition makes it easy to get into a program that you actually want to go to. This is a major plus.

People in Psychiatry don't make as much money as surgeons, but they also don't work anywhere near as many hours. They also have the benefit of one of the easiest residencies. Also, a lot of surgeons and even anesthesiologists and cardiologists are burned out by the time they are 55-60, and take retirement. In Psychiatry you can work until the day you die.

 

[billypilgrim37]

Are you suggesting that an MD shouldn't be required for a career in Psychiatry?

Certainly not. I'm saying that an M1 or M2 spending 75 hours a week studying medicine and 5 hours reading Portnoy's Complaint might make a better psychiatrist than an M1 or M2 spending 80 hours a week just studying medicine.

 

[whopper]

IMHO, good life experience is more helpful in psyche than any other field. I think this may be what you mean by the novels you've read?

To understand other people's experiences, you need to have had some good landmark experiences under your own belt.

A guy in my program has been very sheltered throughout his entire life and cannot relate to several people.

 

[billypilgrim37]

Lots of residency programs also have resident or faculty-run movie series for residents and med students. I know Longwood does anyway, and we started a student one here at the University of WhereImAt. Even though psychiatric journals look like neuroradiology lite in a time when other specialties are reaching out to the humanities, psychiatry and art (lit and movies, if you will) still complement each other exceptionally well.

 

[whopper]

My own program: UMDNJ at Cooper Hospital & Atlantic Regional Medical Center also has a movie day. We have it about 3-4 times a year.

 

[Doctor Bagel]

Movie day sounds pretty cool. So any examples of recent movies? Psych's sounding better and better every day.

 

[OldPsychDoc]

Movie day sounds pretty cool. So any examples of recent movies? Psych's sounding better and better every day.

We watched most of the Sopranos' first season as part of our psychoanalytic core didactic.

 

[billypilgrim37]

Movie day sounds pretty cool. So any examples of recent movies? Psych's sounding better and better every day.

Google "Longwood psychiatry movie series" and you'll probably find there's. Hopefully DS can give us some history on that one.

I'm thinking of leading off this year's with "Heathers" for Teen suicide, and then "Ordinary People" or "Love Liza" for depression with grief.

Last year included Zoolander for Narcissistic Personality Disorder, Donnie Darko for paranoid schizophrenia, As Good as it Gets for OCD and OCPD, etc.

Our format was Dinner + 15 minute resident lecture on whichever DSM diagnosis we were drawing attention to with the movie + movie. We tried to match a movie to a diagnosis to really give residents an easy time throwing together an off the cuff lecture. The whole thing was designed mostly to get M1s and M2s exposed to psychiatry, since here at the University of WhereImAt, psychiatry exposure in the first two years is limited to a single week of glory. And that's fairly representative of most preclinical psych curriculums, if I'm not mistaken.

Does someone wanna move the "movies" discussion to its own thread?

 

[Anasazi23]

Google "Longwood psychiatry movie series" and you'll probably find there's. Hopefully DS can give us some history on that one.

I'm thinking of leading off this year's with "Heathers" for Teen suicide, and then "Ordinary People" or "Love Liza" for depression with grief.

Last year included Zoolander for Narcissistic Personality Disorder, Donnie Darko for paranoid schizophrenia, As Good as it Gets for OCD and OCPD, etc.

Our format was Dinner + 15 minute resident lecture on whichever DSM diagnosis we were drawing attention to with the movie + movie. We tried to match a movie to a diagnosis to really give residents an easy time throwing together an off the cuff lecture. The whole thing was designed mostly to get M1s and M2s exposed to psychiatry, since here at the University of WhereImAt, psychiatry exposure in the first two years is limited to a single week of glory. And that's fairly representative of most preclinical psych curriculums, if I'm not mistaken.

Does someone wanna move the "movies" discussion to its own thread?

We've had multiple psychiatry movie threads. Would people like me to break this one off and make it the start of a new one? I'll be happy to do it...

 

[Doc Samson]

PsychCinema at Longwood has been a regular event for 30+ years. Started by Tom Gutheil (as in the forensics textbook), who's still a regular contributor. Here's the last Longwood PsychCinema schedule (it's out of order b/c of the formatting on the website):

Wednesday, July 12
Thomas Gutheil, MD
The Cat's Meow

Wednesday, February 7
Tuesday Burns, MD
Mommy Dearest

Wednesday, August 9
Michael Caplan, MD
Grizzly Man

Wednesday, February 14
Jim Hammel, MD
In America

Wednesday, September 13
Elizabeth Simpson, MD
Naked

Wednesday, February 21
Jay Carruthers, MD
ENRON: The Smartest Guys in the Room

Wednesday, October 11
William Greenberg, MD
Chinatown

Wednesday, February 28
Jason Strauss, MD
Life is Beautiful

Wednesday, November 8
Michael Kahn, MD
T.B.A.

Wednesday, March 14
Jason Petrilla, MD
Buffalo '66

Wednesday, December 13
Steven Jaffe, MD
Burnt By The Sun

Wednesday, April 11
Pamela Peck, PsyD
The Usual Suspects

Wednesday, January 10
Carl Salzman, MD
The Lady From Shanghai

Wednesday, May 9
Leonard Lai, MD
All About My Mother

Wednesday, January 31
Benjamin Brent, MD
Trust

Wednesday, June 6
Mary Anne Badaracco, MD
The Sweet Hereafter

Some of my own PsychCinema favorites from years gone by include Heathers, The Manchurian Candidate (Frank Sinatra, not Denzel Washington), The Lost Boys, X-men (but I'm a comic book geek), Don Juan de Marco, and The Singing Detective (which I highly recommend).

 

[josehernandez94]

Google "Longwood psychiatry movie series" and you'll probably find there's.

Here's the link:
http://healthcare.partners.org/longwoodpsych/academic_psych.html

Notable movies (well, by notable, I guess I mean movies that I've seen) include: Chinatown, The Sweet Hereafter, and The Usual Suspects. Buffalo '66 is also in there... the movie that led to Vincent Gallo wishing that Roger Ebert get "ass cancer," (after Ebert panned the film) then Ebert actually getting rectal cancer.

 

[OldPsychDoc]

No love for "Girl, Interrupted"?

And most importantly, "What about Bob?" ?

From a film and historical perspective, every psychiatrist should have seen "One Flew Over the Cuckoo's Nest".
I also like Hitchcock's "Spellbound" for some freaky psychoanalytic imagery (and just because Ingrid Bergman is a babe in ANY decade! ) Another classic is "The Lost Weekend" for alcoholism.

 

[billypilgrim37]

No love for "Girl, Interrupted"?

With DS around, can we really knock on McLean in public?

 

[Doc Samson]

With DS around, can we really knock on McLean in public?

Hey now... I was a Longwood resident, MGH fellow. You'll find no love for McLean and their rolling green pastures here.

 

[OldPsychDoc]

We've had multiple psychiatry movie threads. Would people like me to break this one off and make it the start of a new one? I'll be happy to do it...

I dunno--it's kind of fitting that a thread that started out discussing our low board scores has (d)evolved into a bunch of psychiatrists sitting around talking about movies! Anyone surprised by this?

 

[BabyPsychDoc]

Fatal Attraction for BPD. The Addams Family Values for (kind of) schizotypal PD.

 

[maranatha]

I dunno--it's kind of fitting that a thread that started out discussing our low board scores has (d)evolved into a bunch of psychiatrists sitting around talking about movies! Anyone surprised by this?

It just means we're "well-adjusted."

 

[Doctor Bagel]

No love for "Girl, Interrupted"?

Man, I hate that movie. I had to write a paper on it for this abnormal psych class I took, and it just got to be painful. My husband read the book and said it was better.

Now I'll have to request some of these other movies from Netflix. Well, except Mommy Dearest -- that one gave me nightmares when I was kid.

 

[whopper]

Hated Girl Interrupted.

During my more histrionic days in my 20s (you're going to have to excuse me, I was in a fraternity), I nicknamed that movie C. Interruptus. I hope you know what the C. stands for.

Here's a interesting & overlooked psyche movie...
http://www.frif.com/new2005/made.html

Mademoiselle and the Doctor (documentary, nonfiction)
Its about a doctor who teaches how to commit suicide. The movie shows several people who want to die, who do not have an Axis I disorder. The lead person (the mademoiselle) for example wants to die with dignity. The problem though is that she doesn't have any terminal illness. She's an old lady who feels she's done it all, and is proud & happy with the life she lived. She just wants to die while she's still healthy, and in full control and sees no reason to continue to live.

 

[psychfriend]

No love for "Girl, Interrupted"?

And most importantly, "What about Bob?" ?

From a film and historical perspective, every psychiatrist should have seen "One Flew Over the Cuckoo's Nest".
I also like Hitchcock's "Spellbound" for some freaky psychoanalytic imagery (and just because Ingrid Bergman is a babe in ANY decade! ) Another classic is "The Lost Weekend" for alcoholism.

I think "What about Bob" is one of the funniest films ever. And yes, everyone I know thoroughly disagrees with me.

 

[josehernandez94]

Incidentally, my scores are pretty decent... will any programs actually care?

 

[Doc Samson]

Incidentally, my scores are pretty decent... will any programs actually care?

For the "upper tier" programs, a lot of the decision to interview or not is made based on the numbers. The Harvard programs routinely receive 400+ apps for ~100 interview spots, so the triage process is heavily number dependent. Of course, remarkable achievements in other areas of the application can boost your chances of getting an interview, even in the setting of less-than-stellar scores.

 

[sga430]

lol...for my interview at SLU i had to psychoanalyze anthony hopkins in "remains of the day." it was interesting to say the least

 

[winchester1615]

To indulge the psych movie theme...


I love love love love "what about bob?" My family constantly quotes their favorite lines from it.

"Fatal attraction" epitomizes borderline personality disorder.

"The squid and the whale." In my opinion, a psychoanalyst's dream...

"The deerhunter" - PTSD

 

[Dienekes]

I think "What about Bob" is one of the funniest films ever. And yes, everyone I know thoroughly disagrees with me.

I agree with you.....I love that movie.

 

[Puffle]

If you read some of the other posts, an inordinate amount of pre-meds and medical students are choosing their specialties based on income. They start day one of medical school knowing they want to put in fake breasts, or do angios, pop pimples. So they also know that they have to have the most completive scores and are gunners right off the starting block. (But the they often are coy when asked what kind of doctor they want to be, and just say "A good one."

I, like a lot of fellow residents, didn't start med school thinking I'd be a psychiatrist. I grew up south of the middle of nowhere and wanted to return, so that I could double the amount physicians in a 50 mile radius. But, cheesy as it sounds, psychiatry "called" to me. My board scores wouldn't have let me go into plastics, but I did have some flexibility.

But I certainly don't think means the majority of psychiatrist are knuckle draggers. As far as stratification goes, this still isn't a bad pile to be on the bottom of, so don't beat yourselves up too much. My C&L rotations have proved to me that there is far too much in medicine from anyone to master completely, and we rely on our colleagues, whether they begrudge for it, or not.

 

[sikegeek]

I say thank goodness.

I don't think having high board scores means you'll be perfect at any particular thing, including psych.
I don't think having low board scores means you'll be bad at everything, including psych.

Granted this does come from someone with sub-par board scores, but possibly a unique perspective. I don't think my board scores necessarily represent clinical performance. (except maybe surgery) "averages" might be confounded by the fact that psych draws certain people who are like me. I'm not impressed by board scores and I don't like how they're put on this pedestal. I know as many answers to pimping questions as anyone else, sometimes more.

 

[cleareyedguy]

It's interesting that the boards were initially created to set a threshold for adequate preparation and were not intended to separate out the people who passed. Further, I'm a big fan of movies and books and am a former English major (and definitely like Philip Roth, despite narcissistic issues that are in the realm of Updike and Mailer--Roth's narcissistic issues, by the way, not mine).

Nevertheless, I'm not especially pleased by the low board score average. I don't know if the average applicant is also a mediocre medical student, but I do know that at my residency, those scores are carefully reviewed, as is the entire transcript. In fact, we probably pay more attention to the evaluation in core medicine than in core psychiatry, since our assumption is that the psych grade is influenced by the evaluator's pleasure at finding someone interested in our field and his/her effort to recruit the student into our specialty. More importantly, we definitely want our residents to be good interns, and then, we want them to be hard working, service-oriented, attentive, committed, likable, curious psych residents. We assume that if you are smart to begin with, and you have those qualities throughout medical school, your grades and board scores should be pretty good...

 

[i61164]

"Capote" for narcisistic PD and sociopath.