Tell me something bad about Psychiatry

[RugbyJC]

I am trying to decide how to rank the three Navy psychiatry sites--San Diego, Portsmouth, and Bethesda/Walter Reed. By next week I will have visited and interviewed at all these sites and did do one AT in San Diego. Of course, every residency director has tried to emphysize why their program is the best and why the others are not as good. I have even asked the question, "What types of issues do residents complain about or where would you like to see improvement" and I get good responses, but nothing that has helped my decision.

So, I am asking that question to this forum. When you rotated through psych as an intern or medical student or even just your experience with dealing with the department, can you comment on the bad experiences you may have had--anything you would want to know as a prospective intern.

Of course, if you can say something good that would help as well. I want to hear things that residency directors often don't advertise.

Thanks!

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[orbitsurgMD]

I am trying to decide how to rank the three Navy psychiatry sites--San Diego, Portsmouth, and Bethesda/Walter Reed. By next week I will have visited and interviewed at all these sites and did do one AT in San Diego. Of course, every residency director has tried to emphysize why their program is the best and why the others are not as good. I have even asked the question, "What types of issues do residents complain about or where would you like to see improvement" and I get good responses, but nothing that has helped my decision.

So, I am asking that question to this forum. When you rotated through psych as an intern or medical student or even just your experience with dealing with the department, can you comment on the bad experiences you may have had--anything you would want to know as a prospective intern.

Of course, if you can say something good that would help as well. I want to hear things that residency directors often don't advertise.

Thanks!

When I was at Portsmouth, the impression I had of Psychiatry was that they were functioning as an acute assessment and treatment service and that anyone with a psychiatric diagnosis that rendered them unfit to deploy was quickly processed for separation. There seemed to be a lack of medium and long-term care experience. Most patients seen in the outpatient clinic were active duty referrals from east-coast commands, there was a large amount of emphasis on fitness for duty assessment, alcohol-dependency evaluation (users of other drugs got administratively separated or prosecuted). The sentiment among psychiatrists I knew who were in military practice who had done residencies at highly-regarded programs (e.g., Duke) was that the Portsmouth program was not strong. But that was a while ago, and things may have changed (or maybe not.)

With the wars on, I would think you will have more PTSD treatment opportunities and more deployment for forward psychiatric evaluation and treatment. If PTSD and alcohol dependency are your thing, the military might be the place to be.

If you ultimately want civilian practice with the usual mix of mood and adjustment disorders, bulemia/anorexia, substance abuse, sexual and thought disorders in your patient population, the military might not be your thing. I would probably also say that if you wanted a peds and adolescent practice, or research/academic practice not with PTSD, the military would not be the best choice. (Although the Navy has sent some psychiatrists for fellowship in peds psych).