Should I Pursue Psych?

[MRSAful Fate]

Hi,

I'm a 3rd year osteopathic medical student who has been gung-ho about emergency medicine since before medical school and has done a bunch of groundwork towards entering that specialty (research in EM, leadership in EM club stuff, good COMLEX/USMLE). However, I really liked my psych rotation and before I go all in for EM I have been doing research into psych to see if it would be a fit for me.

I did my psych rotation at a state hospital and loved it. I would want to work in this setting but it has been hard for me to get a feel for how competitive it is to land these jobs. Is it reasonable to go into psych if I don't want to do outpatient work ? Also, my preceptor (in California) was making ~250K with a great lifestyle, is that reasonably doable? The prospect of making 115K with 350K of loans is a huge turn off for me.

Finally, the posts about the future of psych on this board are pretty heavy on the doom and gloom. Is the specialty really going down the tubes? Would you do it again or go into something else?

Thanks

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[vistaril]

Hi,

I'm a 3rd year osteopathic medical student who has been gung-ho about emergency medicine since before medical school and has done a bunch of groundwork towards entering that specialty (research in EM, leadership in EM club stuff, good COMLEX/USMLE). However, I really liked my psych rotation and before I go all in for EM I have been doing research into psych to see if it would be a fit for me.

I did my psych rotation at a state hospital and loved it. I would want to work in this setting but it has been hard for me to get a feel for how competitive it is to land these jobs. Is it reasonable to go into psych if I don't want to do outpatient work ? Also, my preceptor (in California) was making ~250K with a great lifestyle, is that reasonably doable? The prospect of making 115K with 350K of loans is a huge turn off for me.

Finally, the posts about the future of psych on this board are pretty heavy on the doom and gloom. Is the specialty really going down the tubes? Would you do it again or go into something else?

Thanks

Several points:

1) State hospital salaries vary a great deal all over the country. Average starting salaries in most states seem to be in the mid 100s to 175k or so, but there are a few outliers(California, Utah to name two). It's important to note that in California in particular, virtually ALL state eployees are massively overpaid. You have state employees in positions making 125k that pay 40k in other states. This is important to note because the system is eventually(and in maybe not too long) going to have to be altered.....look at calpers(sp?) and all the crap surrounding that right now. You can' sustain what is......unsustainable. So if you are a student now, I wouldn't expect those state salaries in the better paying states to necessarily stay there relative to other states. Another note about state hospitals....they aren't exactly where public psychiatry is headed.

2) It's not usual that someone would only be interested in inpatient, especially state inpatient work(a dying area). That's not exactly considered the most interesting, stimulating, or enjoyable work. Doing it for more than a year or two one could easily get in a bigtime rut. You'll be viewed sort of as a commodity/number.

3) EM is a *really good* field fro a $ standpoint. You're looking at 300 dollars+/hr in many regions of the country in some hospitals. In psych you're looking at nothing close to that. Money isn't everything, but money is important. I'd shoot for EM if I were you. I'd also point out that I think it would be harder for a DO to attact high paying cash money outpts in psych, just since those patients have so many choices if they want to fork out that sort of self pay cash. With EM(once you get in, obviously EM is much more competitive), being a DO won't matter at all.

 

[IamPsychiatrist]

Hi,

I'm a 3rd year osteopathic medical student who has been gung-ho about emergency medicine since before medical school and has done a bunch of groundwork towards entering that specialty (research in EM, leadership in EM club stuff, good COMLEX/USMLE). However, I really liked my psych rotation and before I go all in for EM I have been doing research into psych to see if it would be a fit for me.

I did my psych rotation at a state hospital and loved it. I would want to work in this setting but it has been hard for me to get a feel for how competitive it is to land these jobs. Is it reasonable to go into psych if I don't want to do outpatient work ? Also, my preceptor (in California) was making ~250K with a great lifestyle, is that reasonably doable? The prospect of making 115K with 350K of loans is a huge turn off for me.

Finally, the posts about the future of psych on this board are pretty heavy on the doom and gloom. Is the specialty really going down the tubes? Would you do it again or go into something else?

Thanks

Average salaries are closer to 200k today. I think it's hard for psych to make too much less than this... i.e. 175k.

These are means also, there are people earning 300k+.

EM doesn't earn 300/hr (36 hrs a week for 48 weeks per year, that would be 520k annually, WAY OFF). Although the mean salary for EM seems to be closer to 300k. I always liked EM too.

Do what you like.

What if EM got paid less than psych in the future, or vice versa? You need to be happy regardless.

I think 250k is doable, especially if you work hard. Everyone looks at mean salaries so if you want to get to the 75th percentile you can hit 300k.

 

[vistaril]

Average salaries are closer to 200k today. I think it's hard for psych to make too much less than this... i.e. 175k.

These are means also, there are people earning 300k+.

EM doesn't earn 300/hr (36 hrs a week for 48 weeks per year, that would be 520k annually, WAY OFF). Although the mean salary for EM seems to be closer to 300k. I always liked EM too.

Do what you like.

What if EM got paid less than psych in the future, or vice versa? You need to be happy regardless.

I think 250k is doable, especially if you work hard. Everyone looks at mean salaries so if you want to get to the 75th percentile you can hit 300k.

yes, em in many places does earn 300/hr. even closer to 350/hr in some(although rarer). A busy em in a private group in a good payer mix department who works full time(30-35 clinical hours per week) will make about 450k. This is well established and documented again and again on the em boards.

And no 75th% in psych is not 300k. That's above the 90th percentile.

 

[SMC123]

how does the salary and outlook compare with certain fields such as fm, hospitalist, or even pmr

 

[IamPsychiatrist]

how does the salary and outlook compare with certain fields such as fm, hospitalist, or even pmr

FM is likely to go up.

Hospitalists should stay the same.

PMR? Who the hell knows.

Psych, it may go down.

Choosing a field based on salary outlook isn't smart, unless one is going in the tank... and no one can predict that.

 

[rkaz]

I'd also point out that I think it would be harder for a DO to attact high paying cash money outpts in psych, just since those patients have so many choices if they want to fork out that sort of self pay cash.

You may have a point. However, just to add one anecdote: one of the psych faculty at my school (a DO himself) has a cash practice on the side and charges $375/hour. I know because I previously shadowed him and saw his posted rates. There are people who will pay cash to see a DO psychiatrist. I'm not saying that you said anything to contradict this, and your point about it being harder as a DO may possibly have some merit.... but I just wanted to let any medical student reading your post not to feel discouraged, as it can certainly be done as a DO.

 

[WolverineDoc13]

MRSAful (awesome sn, btw), are you near an institution that has a CPEP (comprehensive psychiatric emergency program) or a dedicated psychiatric ED? I suggest doing a rotation in one of those places to give yourself a feel of both at once (EM + psych). I was also thinking about EM, but when I was on call in our psych ED, I was more interested in the psychopathology than the rush and hustle and bustle of the ED environment. You should consider doing a rotation at NYC's Bellevue hospital-- their CPEP will knock your socks off!

One ED attending at my institution mentioned that while EM is exciting, it's more physically taxing than psych. While there are psychiatrists who can practice until their 80's (while sitting in a chair), EM docs find themselves having to retire much much sooner (in their 50's) or take less physically taxing positions. I realize this this long long term, but it's something to think about.

I can't comment on salaries quite yet, but honestly, that shouldn't guide your decision between the two fields. Trends (and salaries) change with time, so it's hard to predict how lucrative certain fields will be in 20-30 years-- especially as the ACA emerges.

Good luck!

 

[wolfvgang22]

I have no clue about Emergency Medicine.
I've been on the interview trail a lot this year as I finish up psychiatry residency.

So far I've found that the public sector has more transparent expectations and less restrictions in employment contracts, for many good reasons.
One can always open a private practice and make $300,000 or more, but you will be working very hard. I know people who are doing this now, but it took them a long time and many hours and a strong business acumen to get to that point.

Inpatient jobs I've looked at in smaller cities under 500,000 people in the midwest and southwest have offered me $235,000 with production bonuses for private practice inpatient positions, and that's low ball offers before any negotiation. I personally don't care for living in a big city too much. Big city = traffic to me, and if I want to visit cultural attractions I feel I can do that on weekends or vacation, as my daily tastes are simple.

I know of one academic center famous for research in my current area has offered residency graduates $150,000 annually for outpatient psychiatry full time, which I think is deplorable with the high cost of living here. Generally in my experiences so far, larger cities and academic centers pay a bit less for new attending level physicians because they don't have as much trouble attracting doctors.

Median pay for southwest U.S. region is about $200,000 annually for outpatient psychiatry, and I get offered $225 and more regularly for inpatient in cities under 1 million people. These are low ball offers before any negotiation. The lowest paying job I have considered seriously for full time work is $190,000, and that is only because I would be working with some dear friends, and the hours and benefits are excellent.

There are some gems out there in the $200K plus range in nice places, but it takes some sifting through a large amount of less desirable positions. The good news is I have found that you can, in fact, start a bidding war to a large degree, and definitely negotiate all sorts of things like time off, scope of practice, relocation, and incentives in addition to base pay. As a male, I do think new female physicians get run over a bit, though this is anecdotal.

 

[Jorje286]

The "doom and gloom" is coming from one or two posters on this board. And if you notice there's doom and gloom everywhere on SDN and the psych subforum is actually one of the most positive. If you really like psychiatry, it's hard to find a better gig in medicine. Sure you'll not be making 400k like in some other specialties, but you'd be almost working like a regular person (40 hour week) for 200k. How can that not be awesome?

 

[masterofmonkeys]

O-care and other things are going to change the payment landscape a lot. I think we're going to see a lot less variation between specialties. Also the reason ED physicians make so much is because they are massive profit generators for hospitals, something that's started to change and will only change more as we see more rationing and more bundling.

I'm not so much concerned about whether psych salaries are going up or down, so much as maintaining the ability to see patients for 30min minimum. I'm MUCH more scared that that's going to be taken away than any money issues.

 

[Armadillos]

Seeing as your picking between pretty "life friendly" fields, I would stick with whatever you find most enjoyable during the time your at work.

That being said, I think the shift work of EM would be absolutely amazing from age 28-33, but would become a bit more of a wash once you have kids and then I imagine it would be miserable in your 40s/50s.

 

[SteinUmStein]

Shift work is one of those things that you have to just do for a while to see how painful it really is. It's fun for a month at a time. It's tolerable for a few years. Beyond that... well, give it a shot and let us know.