Psychiatry more than Pharmacology?

[imsupposedtobeanonymous]

Let me start this off saying I am not trying to bash psychiatry in any way!!! I am very interested in working in child psychiatry in the future but I am worried that I will only be writing prescriptions. I understand this is a very limited perspective but that is exactly why I am posting. I WANT PEOPLE TO TELL ME I AM WRONG. I have only shadowed one psychiatrist and I am hoping he was not a very good representative of the field. Other physicians I have worked with express the same opinion that psychiatry is mainly adjusting medications. Please don't post about how other physicians, talk down about other specialties. I know this and I do not want to waste my time reading your opinion about it. Those physicians were expressing their opinion to me because they understand I value patient interaction. I have read many posts about how psychiatrists adjust the medication after the pt had a session with their therapist. My problem is, I want to be the psychiatrist that provides that therapy and the medication. Also I have read that private practice is a common way for me to do this. But let's be honest, I will not be able to afford this for a while, due to school loans and having no family money. If your answer to me is that I should just get a PhD and be a therapist, well I really want to go to medical school. I love the challenge that the medical field provides and the knowledge/experience I can gain during medical school/residency. I am too fascinated by the function of the human body for me to easily give up going to medical school. I know many students change what they want to do many times during medical school, but I can tell you now, I do not want to treat the body for the rest of my life. This decision is concrete due to many years of work/shadow experience in different specialties and medical settings. I know I will enjoy my time learning about it during medical school and applying it during residency but I want to dedicate the rest of my life treating the mind. I do not want to make the financial and life sacrifices of medical school, if in the end my better match would be a PhD in psychology.


Thank you for your time reading through all this and I truly appreciate the most honest and blunt responses.

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[sunlioness]

Well, psychotherapy informs every patient interaction. But I'm guessing that's not what you mean. You want to meet with your patients every week or two for an hour, yes?

Very few places will allow you to do that. That ones that will don't pay very well. Private practice is your best bet. You will likely want to seek out additional psychotherapeutic training and supervision beyond what is required in residency.


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[OldPsychDoc]

Very few psychiatrists do the therapy-heavy private practice you seem to envision, but some do. What I think is the great pleasure of psychiatry is being the doctors who "bring it all together", who synthesize that comprehensive biopsychosocial formulation that informs therapy choices, lifestyle changes, medication management, and medical conditions. If you want to manage and direct comprehensive care that affects all aspects of patients' lives, then medical education and psychiatry residency is worth it.

 

[J ROD]

If you are all about the therapy, then be a therapist.

 

[nitemagi]

1. The dualism of treating the mind not the body is probably a false dichotomy. You're treating both all the time.
2. If you only want to do therapy, then just get trained as a therapist. If you want to understand how to treat everything, including how therapy changes the brain, then psychiatry is an option.
3. You're pre-med, which means by the time you'd finish no one can say what the field will look like. I'm one of the few that does primarily therapy with some medications. I do it as essentially an entrepreneur, a small business owner, in a private practice with no insurance. I acknowledge that I'm an exception to most psychiatrist's experience. But I'm here because I carved this niche out for myself.

 

[F0nzie]

You need to promote yourself as a psychiatrist and psychotherapist. It's all about self promotion, experience, and skill. Employers will not hire you to offer therapy. This alone should inform you of two things: 1. It doesn't pay and 2. It's very difficult to break into. Do good work and build your reputation and you can make $300+ an hour.

 

[sunlioness]

I know one institution that does pay psychiatrists for psychotherapy. It's in the suburbs of a major NE city and the pay is $165K / year. You're still on 24/7 call for your patients. You'd ultimately do better going it alone if you're willing to put the work in to build your practice. But if you don't mind making less to have the business and staffing stuff taken care of and if it still exists by the time you're done. Well, it's rare. But it exists.


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[wolfvgang22]

Outside of private practice you can do psychotherapy in academia some of the time in Child Psychiatry. I had an opportunity at a position where I would have spent two mornings a week doing nothing but therapy with families. It did pay somewhat less, as many academic jobs do.

 

[Nimuendayub]

Let me start this off saying I am not trying to bash psychiatry in any way!!! I am very interested in working in child psychiatry in the future but I am worried that I will only be writing prescriptions. I understand this is a very limited perspective but that is exactly why I am posting. I WANT PEOPLE TO TELL ME I AM WRONG. I have only shadowed one psychiatrist and I am hoping he was not a very good representative of the field. Other physicians I have worked with express the same opinion that psychiatry is mainly adjusting medications. Please don't post about how other physicians, talk down about other specialties. I know this and I do not want to waste my time reading your opinion about it. Those physicians were expressing their opinion to me because they understand I value patient interaction. I have read many posts about how psychiatrists adjust the medication after the pt had a session with their therapist. My problem is, I want to be the psychiatrist that provides that therapy and the medication. Also I have read that private practice is a common way for me to do this. But let's be honest, I will not be able to afford this for a while, due to school loans and having no family money. If your answer to me is that I should just get a PhD and be a therapist, well I really want to go to medical school. I love the challenge that the medical field provides and the knowledge/experience I can gain during medical school/residency. I am too fascinated by the function of the human body for me to easily give up going to medical school. I know many students change what they want to do many times during medical school, but I can tell you now, I do not want to treat the body for the rest of my life. This decision is concrete due to many years of work/shadow experience in different specialties and medical settings. I know I will enjoy my time learning about it during medical school and applying it during residency but I want to dedicate the rest of my life treating the mind. I do not want to make the financial and life sacrifices of medical school, if in the end my better match would be a PhD in psychology.


Thank you for your time reading through all this and I truly appreciate the most honest and blunt responses.

well I'm a psychiatrist in another country .. in English is not my first language. I understand that still share the same angustias.principalmente considering this over-view of the current biological psychiatry. which is not suitable for me would not be suitable for others as well. always wanted to offer the existential anguish answers of my patients and also offer support to work their conflicts in an appropriate environment. important to have good listening patient, understanding their deep anguish.
well for me, when I finished my medical course started an experiment being analyzed by an experienced psychoanalyst. And after a while I started training as group psychotherapist .. and this also do parallel psychiatry clinic. And now work only in clinical privato and do not want to know of medical insurance.

 

[whopper]

Here's some non-pharmacology I actively recommend to many patients.
1-Psychotherapy
2 Exercise
3- SAD lamps
4- Nutrition (e.g. Vit D, B12, Folic Acid levels in several patients), Omega 3 fatty acids, Anti-inflammatory diet
5-Several non-prescription approaches such as SAM-E and N-Acetylcysteine
6-Alpha-Wave stimulators
7-Sleep Hygiene

 

[Shikima]

Here's some non-pharmacology I actively recommend to many patients.
1-Psychotherapy
2 Exercise
3- SAD lamps
4- Nutrition (e.g. Vit D, B12, Folic Acid levels in several patients), Omega 3 fatty acids, Anti-inflammatory diet
5-Several non-prescription approaches such as SAM-E and N-Acetylcysteine
6-Alpha-Wave stimulators
7-Sleep Hygiene

1-Sleep Hygiene
2-Psychotherapy
3 Exercise
4- SAD lamps
5- Nutrition (e.g. Vit D, B12, Folic Acid levels in several patients), Omega 3 fatty acids, Anti-inflammatory diet
6-Several non-prescription approaches such as SAM-E and N-Acetylcysteine
7-Alpha-Wave stimulators

Fixed.

 

[whopper]

Thanks Shikima.

In terms of market forces they do not favor psychotherapy for a psychiatrist. In terms of a community model there's a shortage of psychiatrists in most areas but not a shortage of psychotherapists. By not doing psychotherapy we free ourselves to do more prescription writing and this can get more people the help they need so long as they see a psychotherapist in addition to the psychiatrist.

That said psychotherapy should be something psychiatrists keep in their bag of tricks cause if we don't use it we lose it. We need to know how it works if only to discuss cases with psychotherapists in a more efficient manner. I recommend psychiatrists carry at least a few therapy-heavy patients to keep the skills sharp.

A private practice can advertise that it does better practice because it maintains good psychotherapy for it's patients. This is one of the only ways I can think of where psychotherapy can be a monetary edge. Only other way is if the psychiatrist charges hundreds of dollars an hour but this can only be done with wealthy patients and they'll likely only want one of the best doctors in the area if they pay them this much.

 

[Shikima]

We often forget Maslow and his hierarchy.

 

[notdeadyet]

We often forget Maslow and his hierarchy.

Yup. I'll gladly cut my patient's psychiatric visits by 50% and psychotherapy visits by 75% in exchange for stable housing. And you'll see clinical improvement.

 

[Ibid]

We often forget Maslow and his hierarchy.

Probably for the best. The first thing a human needs is another human.

It's political.

 

[imsupposedtobeanonymous]

We often forget Maslow and his hierarchy.

Elaborate your comment

 

[Shikima]

Elaborate your comment

Why?

Better yet... http://lmgtfy.com/?q=maslow's+hierarchy+of+needs

 

[DD214_DOC]

I use all that non-pharm stuff in all my patient encounters every single day. The training and education changes how you think and approach things, and eventually it all starts to blend together very nicely.