Retraining in a different residency after years of psychiatric practice?

[nexus73]

Have you seen any psychiatrists go back and become family docs or IM or other specialty after years of being psychiatrists. In my psych residency we had various people, some mid-later career, like IM or ophtho switching into psych.

---

Members don't see this ad.

 

[littlefred]

Which one are you thinking of going into?

Also in before everyone tells you about NP encroachment in whatever that specialty might be.

 

[forchinet121]

Why..

 

[clausewitz2]

Have you seen any psychiatrists go back and become family docs or IM or other specialty after years of being psychiatrists. In my psych residency we had various people, some mid-later career, like IM or ophtho switching into psych.

When I was on the residency trail a few years back I interviewed at a place that had had a CT surgeon retrain in his 40s as a psychiatrist after an accident meant he couldn't operate. After he finished he worked exclusively overnights in the psych ED. I actually don't think I've heard of anyone doing things the other way around; it would be hard not to be way behind in general medical knowledge if you have been practicing primarily psychiatry for any length of time. Closest I can think of is someone who decided to go back and do a palliative care fellowship.

 

[comp1]

I have seen one attending psychiatrist go and try to do a radiology residency because she wanted to do some really specific research. However, she dropped out after about a year. I'm not saying that our minds get necessarily impossibly rigid as we age, but the body does indeed get weak... I've definitely never seen anyone go and do a surgical or medicine residency late or midcareer, nor would I ever recommend that to anyone as even a passing fancy. Further, programs are not going to be interested. They OWN you when you haven't completed a residency yet. It's indentured servitude with just some limits placed by the ACGME. If you're already trained, you could drop out at any time, no issue (and probably will). There are also significant funding issues as a lot of Medicare funding prevents or limits this kind of behavior with year limits on training.

 

[wolfvgang22]

I've only seen doctors flee IM, Family Practice, Pathology, Neurology, and Neurosurgery to become psychiatrists. I've never seen traffic in the other direction.

 

[Sushirolls]

I've had random fleeting thoughts of general surgery, neurosurgery, Forensics, sleep medicine. They only linger a day or less.

Leaving medicine to be a farmer has a greater pull.

 

[comp1]

Omph, no thank you to farming. I like my AC, sleeping in and chair very much.

 

[Psyche0248]

I’ve never seen this happen (psychiatrist retrain as another specialty) but do daydream about doing it, personally…

 

[Celexa]

Have you seen any psychiatrists go back and become family docs or IM or other specialty after years of being psychiatrists. In my psych residency we had various people, some mid-later career, like IM or ophtho switching into psych.

I've never seen this direction. One benefit psychiatry has is the low level of wear and tear on our bodies. Probably the lowest of any specialty. Going back in the other direction, doing overnights and 24s, as a resident? Nooo thank you.

It's not exactly the same but when older medical students (30+ at time of starting medical school) have tried to do very physically demanding residencies (surgery, etc) I have seen it go poorly multiple times. Some parts of medicine really are a young person's game.

If desperate to get out of psych or just to expand, obesity medicine has a CME/practice pathway and a psychiatrist could probably carve out a really nice niche there.

 

[littlefred]

I've never seen this direction. One benefit psychiatry has is the low level of wear and tear on our bodies. Probably the lowest of any specialty. Going back in the other direction, doing overnights and 24s, as a resident? Nooo thank you.

It's not exactly the same but when older medical students (30+ at time of starting medical school) have tried to do very physically demanding residencies (surgery, etc) I have seen it go poorly multiple times. Some parts of medicine really are a young person's game.

If desperate to get out of psych or just to expand, obesity medicine has a CME/practice pathway and a psychiatrist could probably carve out a really nice niche there.

I should really look into getting obesity boarded, but paying fees/dues and whatever requirements for another board is ugh...

 

[nexus73]

When AI makes psychiatry obsolete just wondering about going back to FM or something. I was pretty good a DREs in med school.

 

[Merovinge]

When AI makes psychiatry obsolete just wondering about going back to FM or something. I was pretty good a DREs in med school.

You have to be kidding me if you think psychiatry, the field of medicine most reliant on human connection, is going to be replaced by AI before FM. FM has so much more room for disruption based on vitals, lab data, etc than psychiatry. I am willing to bet that robots are doing surgery autonomously or with minimal human imput before psychiatry is replaced by AI.

Keep in mind that LLMs need data to improve, we have such a hard time having meaningful outcome data for most of our interventions to even know best practices in most places that until every person has a computer chip in their brain, we are not going anywhere.

 

[comp1]

The computer can do a better DRE than you, guaranteed.

 

[forchinet121]

When AI makes psychiatry obsolete just wondering about going back to FM or something. I was pretty good a DREs in med school.

You’re troll right

 

[tr]

The computer can do a better DRE than you, guaranteed.

Suppose that depends on the specific sense of the word "digital"

 

[G Sheb]

I feel like this is a bait thread for another 'hilarious' discussion around AI and NPs.
I'm all in.

 

[G Sheb]

You have to be kidding me if you think psychiatry, the field of medicine most reliant on human connection, is going to be replaced by AI before FM. FM has so much more room for disruption based on vitals, lab data, etc than psychiatry. I am willing to bet that robots are doing surgery autonomously or with minimal human imput before psychiatry is replaced by AI.

Keep in mind that LLMs need data to improve, we have such a hard time having meaningful outcome data for most of our interventions to even know best practices in most places that until every person has a computer chip in their brain, we are not going anywhere.

The way ChatGPT works is that it essentially rehashes whatever it is trained on.
It has no concept of linguistic meaning or understanding. Merely statistical plausability.
Basically it's entirely useless without the humans feeding it data and deciding what is important and what is not.
It also does a fairly terrible job with logical manipulations, because it just goes by statistics.
It has its use, but this is not the revolution that is going to replace human thought.

 

[vanfanal]

You’re troll right

Could be. But to some degree we all bring our worries and questions here, looking for answers and support.

 

[allantois]

ABOUT | Evan Rieder MD

NYC Board Certified Dermatologist & Psychiatrist: Aesthetic & Media Expert

www.drevanrieder.com

Meet Amy Wechsler, M.D. | NYC | Dr. Amy Wechsler Dermatology

Amy Wechsler, M.D. is one of only a small handful of physicians in the country board-certified in both dermatology and psychiatry. Learn more.

www.dramywechsler.com

 

[wolfvgang22]

Tell me more about this obesity medicine opportunity.

 

[allantois]

Tell me more about this obesity medicine opportunity.

antipsychotic - ozempic pipeline anyone?

 

[SeniorWrangler]

One thing I'll warn you, it's a shock, the moment you become a resident or fellow, nobody wants to hear what you think any more. Like Rodney Dangerfield in Back to School, you don't get any respect.

To paraphrase another movie, Air Bud, there's no rule saying that a psychiatrist can't pretend to be a dermatologist. Take some classes, learn some basic procedures, do cosmetic stuff for cash. Don't do this for, like, oncology.

 

[wolfvgang22]

One thing I'll warn you, it's a shock, the moment you become a resident or fellow, nobody wants to hear what you think any more. Like Rodney Dangerfield in Back to School, you don't get any respect.

Maybe a shock for you...same thing different day for me, lol

 

[Dantes]

I've heard of people going from psych to FM or IM which seems to be most common, also neuro, and even one to pathology.

 

[forchinet121]

One thing I'll warn you, it's a shock, the moment you become a resident or fellow, nobody wants to hear what you think any more. Like Rodney Dangerfield in Back to School, you don't get any respect.

To paraphrase another movie, Air Bud, there's no rule saying that a psychiatrist can't pretend to be a dermatologist. Take some classes, learn some basic procedures, do cosmetic stuff for cash. Don't do this for, like, oncology.

I mean I think this is pretty bad advice..you want a psychiatrist to practice dermatology without doing a residency?

 

[SeniorWrangler]

I'm not saying it's a good idea, I'm saying it's an option. Lots of these cosmetic clinics are using half-trained NPs to do the work for the non-dermatologist owner, it wouldn't be hard to do a better job than them.

 

[psyspy]

It can’t be that we still use things like meditech and cerner AND yet AI is somehow going to weave into EMR so well that it takes jobs. Let’s see how long it takes for it to accurately summarize patient charts first. It still gets math wrong as well as actual diagnoses wrong

 

[TexasPhysician]

I haven’t seen this occur, but I’m sure it has happened. I’d ask why you want to do this though.

If you really need change, a fellowship makes more sense. Repeatedly apply pain if needed, addiction, sleep, forensics, obesity medicine, C&L, etc.

Retraining in IM or many other fields is signing up for 3+ years of 80 hour weeks at $50k/year for the potential to make less money. If you really want out, take 2 FT psych jobs making $300k+ each (very doable in 80 hours). Live on $50k for 3-5 years. At the end, you won’t need to take a medical job paying less than psych money. With likely past money you have saved, there should be enough to change careers into almost anything you want.

 

[MacDonaldTriad]

I'm a psychiatrist so my sample may be skewed, but I have seen many, and I mean many doctors leave their specialty to join our ranks. Maybe I don't see those going the other way because of who I am and what I do, but it would be hard to imagine they outnumber the wounded warriors who want to come our way. Our water is Luke warm. The pay is so so but adequate. The work is manageable and doesn't kill your life style. It is hard to find reasons not to recommend us other than applicants fear of telling their parents that they want to become a psychiatrist and hearing about how their relatives thought they were working on becoming a real doctor. If they get over that, they risk becoming really happy and enjoying life. This may be strange for most medical students to grasp.

 

[Stagg737]

antipsychotic - ozempic pipeline anyone?

An article titled “How Ozempic accidentally became an anxiety wonder drug” came across my newsfeed but was behind a paywall. Seems like this could actually become a viable clinic to market…

To OP, I have not seen it but I’m sure it’s possible. Most people change to psych because our job is very chill compared to 95% or more other fields. Most docs looking to switch do so because they do t like working that hard at something they don’t love. At least if you hate psych you can do easy work at a truly half time schedule, still pull in 6 figures, and spend the rest of the time doing what you actually enjoy.

 

[confused_doc]

You have to be kidding me if you think psychiatry, the field of medicine most reliant on human connection, is going to be replaced by AI before FM. FM has so much more room for disruption based on vitals, lab data, etc than psychiatry. I am willing to bet that robots are doing surgery autonomously or with minimal human imput before psychiatry is replaced by AI.

Keep in mind that LLMs need data to improve, we have such a hard time having meaningful outcome data for most of our interventions to even know best practices in most places that until every person has a computer chip in their brain, we are not going anywhere.

Meh I think the "human connection" in psychiatry is overblown. The majority are just like other doctors, I've never noticed a greater amount of compassion or empathy in psychiatrists compared to other doctors.

The patient explains their symptoms, the doctor listens (usually pretty stoically) and prescribes a pill that may help resolve the problem. Very much in line with the rest of medicine.

I think psychs are just as likely as FM doctors to be automated, but fortunately as it stands, that risk is very low at the moment as patients like interacting with humans.

The risk is a head to head study of AI + midlevels vs physicians. If they start getting objectively equal or better outcomes then I can see physicians getting replaced.

 

[clausewitz2]

Meh I think the "human connection" in psychiatry is overblown. The majority are just like other doctors, I've never noticed a greater amount of compassion or empathy in psychiatrists compared to other doctors.

The patient explains their symptoms, the doctor listens (usually pretty stoically) and prescribes a pill that may help resolve the problem. Very much in line with the rest of medicine.

I think psychs are just as likely as FM doctors to be automated, but fortunately as it stands, that risk is very low at the moment as patients like interacting with humans.

The risk is a head to head study of AI + midlevels vs physicians. If they start getting objectively equal or better outcomes then I can see physicians getting replaced.

Yes, I think it's safe to say everyone who posts regularly in this forum agrees that it is very easy to practice psychiatry badly. A vending machine could replace some of the people who practice the way you describe.

 

[G Sheb]

Meh I think the "human connection" in psychiatry is overblown. The majority are just like other doctors, I've never noticed a greater amount of compassion or empathy in psychiatrists compared to other doctors.

The patient explains their symptoms, the doctor listens (usually pretty stoically) and prescribes a pill that may help resolve the problem. Very much in line with the rest of medicine.

I think psychs are just as likely as FM doctors to be automated, but fortunately as it stands, that risk is very low at the moment as patients like interacting with humans.

The risk is a head to head study of AI + midlevels vs physicians. If they start getting objectively equal or better outcomes then I can see physicians getting replaced.

Oh this is hilarious.
AI supervising NPs or the other way around?
Sounds like the perfect power combo to displace physicians.

On a more serious note, the problem with AI isn't particularly the 'human connection'. It's actually remarkable capable of imitating a human.
The issue is that it's incapable of reasoning. So unless it's a slam dunk case, it's just going to throw a dice. You might as well let an NP do the job. It's also unreliable because of this. Do you really want to leave the care of a human being for something that appears to be intrinsically unrelieable?
Not to mention that it's going to miss all the subtleties about psychiatric diagnosis that go beyond language.

See this for an example:

NEDA Suspends AI Chatbot for Giving Harmful Eating Disorder Advice %

An eating disorder advocate blows the whistle on an AI-powered helpline that was giving out dangerous advice.

www.psychiatrist.com

This is not going to be solved by throwing data at it.

 

[finalpsychyear]

I haven’t seen this occur, but I’m sure it has happened. I’d ask why you want to do this though.

If you really need change, a fellowship makes more sense. Repeatedly apply pain if needed, addiction, sleep, forensics, obesity medicine, C&L, etc.

Retraining in IM or many other fields is signing up for 3+ years of 80 hour weeks at $50k/year for the potential to make less money. If you really want out, take 2 FT psych jobs making $300k+ each (very doable in 80 hours). Live on $50k for 3-5 years. At the end, you won’t need to take a medical job paying less than psych money. With likely past money you have saved, there should be enough to change careers into almost anything you want.

This is spot on. It would not be a wise financial decision in any way due to opportunity cost. Also, if someone really hated psych during residency should have tried to transfer out and make life easier going to IM/surgery when more in their youth to endure call, nights, education etc.

If that's not an option and you became an attending and either you had a financial windfall or your married to another doc and money is of minimal concern and you can't fathom anything else for career satisfaction and volunteering in a free clinic doing some basic PE stuff won't cut it or doing international free medical things then sure go back to some type of residency to get your fix.

 

[finalpsychyear]

No specialty will be completely "replaced" by AI, but a large amount of work that is currently done be physicians will be done/informed by AI. Psychiatry is by the far the field that is most well placed for this. The DSM from DSM-III onwards was basically written to computerize psychiatric diagnosis. Bob Spitzer, the architect of the DSM-III project believed that the future of psychiatry was going to be computerized and developed the first program to make computerized psychiatric diagnosis by decision tree as early as the 1960s. Computerized diagnoses can effectively diagnose mood, anxiety, personality disorders, PTSD, addiction, eating disorders and a bunch of other common mental disorders. Psychosis is the one area that has been failed by this approach and it may be much longer that AI can be trained to detect das Praecox-Gefühl.

You also have to remember the levers of power aren't controlled by physicians or patients but corporate hospital systems, private equity, pharma, insurance companies and the federal government. None of these stakeholders care about "human connection" and even if they do, psychiatrists are seen as too expensive to provide this when non-physicians can do this better and more cheaply. We already have collaborative care where patients aren't seen by a psychiatrist and diagnosis and treatment are based on questionnaires and population-based registries. We also have e-consults, asynchronous telepsychiatry, and tech companies who rely on on questionnaires to make diagnoses. Hims/Hers basically has psychiatrist review forms to rx pills. Those ADHD companies like Cerebral and Done had patients complete a 1 min questionnaire to issue an rx for stimulants in lieu of a comprehensive interview. Many psychological tests and their interpretation (even if somewhat wanting) are computerized, in addition to a bunch of companies using cognitive testing and other bedside psychiatric measures. Computerized CBT goes back 20 years, and there are many CBT and mindfulness based apps on the market now. There's also Woebot which is now using LLMs to enhance its delivery of "therapy." Finally, the depth and complexity of our work is not something that the aforementioned stakeholders understand or appreciate.

I believe there will always be a demand and benefit to person-centered, person-provided psychiatric care for those that can afford it. But it is becoming an expensive luxury and everyone else is going to see AI-informed care used to make basic diagnoses of things like depression, anxiety, bipolar, PTSD, ADHD. Psychiatrists will still have a role in more complex cases, psychosis, treatment-resistant cases but a lot of bread and butter mental health cases will experience AI-informed care to dispense SSRIs etc to the masses. Rather than revolution, this is a natural evolution of where mental healthcare has already gone.

All true. Easier to make money now and provide better care then in 5 years when anyone can login into some chat gpt med program get dx with x, y,z and have it signed off by some midlevel/md on the other side of the country and have their rx mailed directly to them.

I've done by best to try and prepare for whatever I can. I am already seeing patients who lose their insurance and can just go online and get refills from x,y, z for 90 days for under 100 bucks or now that everyones a midlevel their "friend" is just going to rx it for now till they get insurance. lol.

 

[clausewitz2]

Psychosis is the one area that has been failed by this approach and it may be much longer that AI can be trained to detect das Praecox-Gefühl.

The more time I spent in settings where "psychosis or not" is a critical question, the more and more I think the praecox feeling is a critical phenomenological tool for making the diagnosis in a valid way. It's a shame, since I have no idea how you'd really operationalize it and it seems extremely operator-dependent as a tool, but there it is. I have seen far too many standardized screens and questionnaires perform poorly in actual practice (as opposed to whether or not they predict someone will endorse the appropriate items in a SCID) to put a lot of weight on them. Certainly when weighing their results against the considered judgment of someone I personally know to be experienced and reliable in this context, I go with the judgment every time.

I believe there will always be a demand and benefit to person-centered, person-provided psychiatric care for those that can afford it. But it is becoming an expensive luxury and everyone else is going to see AI-informed care used to make basic diagnoses of things like depression, anxiety, bipolar, PTSD, ADHD. Psychiatrists will still have a role in more complex cases, psychosis, treatment-resistant cases but a lot of bread and butter mental health cases will experience AI-informed care to dispense SSRIs etc to the masses. Rather than revolution, this is a natural evolution of where mental healthcare has already gone.

I think everyone in private practice or who aspires to be in private practice should be thinking about what kind of value proposition they are offering to potential patients. You need to be able to articulate this beyond "I went to a medical school and did a residency", ideally articulate it in a way that is explicable to the average reasonably intelligent layperson. I would almost go so far as to say that if a patient slots neatly into an algorithm or very much resembles the typical participant in modern pharmaceutical trials, you're probably not going to be necessary. Or at least, it'll become increasingly difficult to justify paying you over someone with a cheaper set of initials after their name.

 

[Merovinge]

No specialty will be completely "replaced" by AI, but a large amount of work that is currently done be physicians will be done/informed by AI. Psychiatry is by the far the field that is most well placed for this. The DSM from DSM-III onwards was basically written to computerize psychiatric diagnosis. Bob Spitzer, the architect of the DSM-III project believed that the future of psychiatry was going to be computerized and developed the first program to make computerized psychiatric diagnosis by decision tree as early as the 1960s. Computerized diagnoses can effectively diagnose mood, anxiety, personality disorders, PTSD, addiction, eating disorders and a bunch of other common mental disorders. Psychosis is the one area that has been failed by this approach and it may be much longer that AI can be trained to detect das Praecox-Gefühl.

You also have to remember the levers of power aren't controlled by physicians or patients but corporate hospital systems, private equity, pharma, insurance companies and the federal government. None of these stakeholders care about "human connection" and even if they do, psychiatrists are seen as too expensive to provide this when non-physicians can do this better and more cheaply. We already have collaborative care where patients aren't seen by a psychiatrist and diagnosis and treatment are based on questionnaires and population-based registries. We also have e-consults, asynchronous telepsychiatry, and tech companies who rely on on questionnaires to make diagnoses. Hims/Hers basically has psychiatrist review forms to rx pills. Those ADHD companies like Cerebral and Done had patients complete a 1 min questionnaire to issue an rx for stimulants in lieu of a comprehensive interview. Many psychological tests and their interpretation (even if somewhat wanting) are computerized, in addition to a bunch of companies using cognitive testing and other bedside psychiatric measures. Computerized CBT goes back 20 years, and there are many CBT and mindfulness based apps on the market now. There's also Woebot which is now using LLMs to enhance its delivery of "therapy." Finally, the depth and complexity of our work is not something that the aforementioned stakeholders understand or appreciate.

I believe there will always be a demand and benefit to person-centered, person-provided psychiatric care for those that can afford it. But it is becoming an expensive luxury and everyone else is going to see AI-informed care used to make basic diagnoses of things like depression, anxiety, bipolar, PTSD, ADHD. Psychiatrists will still have a role in more complex cases, psychosis, treatment-resistant cases but a lot of bread and butter mental health cases will experience AI-informed care to dispense SSRIs etc to the masses. Rather than revolution, this is a natural evolution of where mental healthcare has already gone.

This just does not match my experience of practicing psychiatry at all. I think maybe 5-10% max of my patients would fall into basic uncomplicated text book style cases without significant comorbidity or treatment refractory concerns. In fact ,I recall medical students and residents bemoan the complexity of patients in comparison to step 3/shelf style multiple choice questions. We already have an infrastructure to dispense SSRIs to the masses (or psychostimulants in peds) called primary care, and somehow the wait to see a child/adolescent psychiatrist even with top-of-the-line private insurance is several months at every place within a 30 minute drive of my practice. Say every medicaid patient in the country gets AI based meds with a single group of doctors overseeing that, we would still be unable to simply see every private insurance/cash pay patient in my area.

I am not remotely a luddite or someone downplaying the role of LLMs, there is a huge target on healthcare's back given how bad the system is and how much demand is present (including some obvious latent demand in the mental health space). But there is a huge way to go before this is taking away our work. We've had alienists for a long time and I don't see us disappearing due to this next technologic revolution.