Why is Psychiatry not part of the "ROAD" to happiness

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Leukocyte

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Frankly, I do not know much about Psychiatry as a specialty, but from my brief experience in psychiatry in medical school and in family medicine residency, psychiatry seems like a great field as far as life-style in concerned. From my observations:

-Focused medical encounters (unlike FM that is all over the place)

-Few emergencies

-Reasonable work schedule

any here care to give any feedback about what you like or do not like about this field. I know the patients can be challenging and tough sometimes...

Thanks
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Leukocyte said:
Frankly, I do not know much about Psychiatry as a specialty, but from my brief experience in psychiatry in medical school and in family medicine residency, psychiatry seems like a great field as far as life-style in concerned. From my observations:

-Focused medical encounters (unlike FM that is all over the place)

-Few emergencies

-Reasonable work schedule

any here care to give any feedback about what you like or do not like about this field. I know the patients can be challenging and tough sometimes...

Thanks
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Because you don't make near as much money as those other ones plus PROAD isn't a word
 
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I think it's mostly because it would destroy the acronym. PROAD? DROAP? PRADO? You see the difficulty.

The ROAD thing is not going to hold true forever anyways. I know a number of radiologists who are working a LOT more than the Derm guys are, and as a group don't seem very happy right now. Also, they are on the chopping block for CMS cuts, although I think the Ortho guys stand to lose the most...Anyways...

I agree that Psych should be considered a life style specialty. We have great hours, little call (usually), and decent pay (especially if calculated per hour vs other specialties). And with >50% of practicing psychiatrists over 55yo, the shortage will only get worse and pay might rise even more...

Go ROPAD!
 
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Some psychiatrists make outlandish income, but most make <$200,000.

The majority of psychiatrists pulling in really big bucks don't have a very enjoyable job.

Although I don't pay attention to ROAD salaries, I think the average is a lot higher.
 
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Also, I think psych is a very emotionally/mentally taxing specialty that can really take it out of you even if the hours aren't bad.

It's true about the shortage though. It's bad. Where I was before, we had trouble getting inpatients being discharged from the hospital outpatient appointments in less than 3 months unless they were already established somewhere. And at my new place, I can't count the number of people from all branches of the organization who have told me how ecstatic they are that I am here so they can hopefully start to put a dent in their own wait times.
 
BobA said:
Some psychiatrists make outlandish income, but most make <$200,000.

The majority of psychiatrists pulling in really big bucks don't have a very enjoyable job.

Although I don't may attention to ROAD salaries, I think the average is a lot higher.
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The salary surveys put the average between 180k-210k per year, depending on which survey you read. That aligns fairly well with what I've seen in practice so far, as well as our recent, informal SDN poll.

The thing to remember is to calculate the HOURLY wage. Most psychiatrists work 40-50 hours per week. This is not true for many other specialties.

$180/52weeks/40 to 50hours = ~$69-86/hour give or take. The going rate for cash private practice seems to be, from a survey of websites, $200-300/hour.

Either way, psychiatrists get compensated very well for their time. A general surgeon might pull in $250k/yr but they're working 60 hours or so to do it, at least. This is also ~$80/hour.

The ROAD specialties can be higher, yes, but psych has good pay, and a very controllable lifestyle, despite the emotional demands. I would argue that the emotion demands of Radiology are just as difficult, but different. It is hard to sit alone in a dark room all day, every day...
 
sunlioness said:
Also, I think psych is a very emotionally/mentally taxing specialty that can really take it out of you even if the hours aren't bad.
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I agree. Even though from the outside it doesn't sound like hard work, I do find psychotherapy in particular to be emotionally draining.
I think another factor is that a huge portion of psych training involves interacting with people who are seen by society as "undesirable", in sharp contrast to the lack of patient contact in rads (and to a lesser extent anesthesia) or the clean, affluent people that are the majority of a derm practice.
I believe that the majority of people who desire a ROAD specialty would not be happy interacting with the homeless people, prisoners, drug addicts, prostitutes, etc. who are bread and butter patients at many psych residencies.
 
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In psychiatry..you do make just as much if not more than some of those other specialities..thats why I dont get why its not a 'ROAD' specialty either. Optho makes less than us and its way harder to find a job in that specialty..check out their forum. Anethesia is getting run over by CRNAs hence much harder to find a job right now and salaries decreasing. Rads decreasing yet still more than us..for now. Derm..well no argument against that.
 
nitemagi said:
I'd rather work with the homeless than look at skin lesions all day.
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:thumbup::thumbup::thumbup:

Skin lesions are the bane of my medical school existence. I swear, the entire first week of my first FM rotation was nothing but "I have this thing on my skin, what is it?" My doctor must have thought I was a total idiot, because I never had any clue.
 
I liked derm in medical school and think it could be a fun specialty, but I freaking hate dealing with rashes on the psych ward.

Anyway, no ROAD -- don't know. We do have a good lifestyle after residency (and even during residency). It's probably about as good of a lifestyle possible in medicine. But our jobs are unappealing to most medical students, so I guess there's not much envy. Those perceptive folks would probably realize there are things about our jobs that are super hard, too, that negate some of the lifestyle benefits.
 
Also one HUGE plus about psychiatry is that Psychiatrists are the LEAST likely of all physicians to get sued. I find that very strange since most of the psychiatric patients I see as a FM doc are paranoid.
 
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nitemagi said:
I'd rather work with the homeless than look at skin lesions all day.
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Lol, no doubt.

Regarding lifestyle, this is why you do what you have a genuine passion for. Its always people who do it ffor the money who are the most miserable. Money making robots. Who wants to be that?
 
BobA said:
Some psychiatrists make outlandish income, but most make <$200,000.

The majority of psychiatrists pulling in really big bucks don't have a very enjoyable job.

Although I don't may attention to ROAD salaries, I think the average is a lot higher.
Click to expand...

Any psychiatrist earning <$200K chose to make less in exchange for sweet hours, limited call, etc.

200K is a low bid for our graduating residents in the non-academic setting.
 
Psychiatry is a very strong ROAD specialty. But most over-achieving med students have no clue.

Jobs are plentiful, most go into private practice, and the pay far surpasses $200K. You have very controllable hours, and there are endless avenues within psychiatry to pursue. Its flexibility and diversity of subfields is difficult to match in any other specialty. But you should have a real passion for mental health and working with this patient population (which happens to be growing exponentially). I predict psychiatry will be the next derm in 10 years in terms of competitive residency spots once people wake up.

The fault lines of medicine have shifted and ROAD is no longer valid. If I had to pick the top specialties, I can only chose derm, psych, and allergy. So the new acronym is PAD. Do you live in the PAD of happiness?
 
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Want to look DAPPER? Derm, Anesthesia, Psych, Path, ENT, Rads

The real lifestyle list, for now, IMO. You could use RAPED, but that doesn't work as well...hahaha.
 
Here's what I think:

1. Lack of status within the medical profession and general community. Stigma with the mental health profession, etc.

2. Psychotherapy. Not everyone has the capacity to listen to patients rant about their personal problems for extended periods of time. Most people don't go into medicine trying to figure out what it is that makes people cry at night.

3. On the job: not physically exhausting, but mentally exhausting. Ie. dealing with depressed, anxious, irritable, psychotic, paranoid people all the time. Some people just don't want to be in this type of environment on a daily basis. Just like some people don't want to be forensic pathologists looking at dead bodies all the time.

4. Ambiguity. Alot of Grey zone. Lack of definitive answers. Not as cutting edge in terms of research. Feelings of impotence as a clinician. Not as much immediate gratification from "curative" treatment plans. Alot of patients take months or years to get better. This is often times not observed by medical students rotating 5-6 weeks through Psychiatry.

5. About the salary (psychiatrists are in the lower tier compared with other specialties): There are not as many "business savvy" doctors who want to be entrepreneurial to get a "higher hourly rate". (ie, setting up the LLC, payroll, marketing, filing quarterly taxes, legal aspects, hiring secretarial or office management, accounting, business insurance, malpractice insurance personal health insurance, supplies, property/rentals). You don't need to start a business in medicine to realize you can potentially make more money running your own business rather than working for someone else who takes away half your paycheck in overhead and profit.

6. Right now market forces favor other specialties in terms of monetary compensation. If psychiatrists were getting paid more than anesthesiologists and surgeons at hospitals and people STILL weren't going into psychiatry I'd be asking questions.
 
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F0nzie said:
1. Lack of status within the medical profession and general community. Stigma with the mental health profession, etc.
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I'd agree, overall, though I think this comes more from ignorance than anything else.

F0nzie said:
2. Psychotherapy. Not everyone has the capacity to listen to patients rant about their personal problems for extended periods of time. Most people don't go into medicine trying to figure out what it is that makes people cry at night.
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I think you jumped the shark on that one. :D Actually I just wanted to write that.

I'd differ that while many specialties don't encourage listening to people, many Did go into medicine to connect with people. Plus many therapies aren't about letting the pt. rant (CBT and DBT are very directive and focused, for example).

F0nzie said:
3. On the job: not physically exhausting, but mentally exhausting. Ie. dealing with depressed, anxious, irritable, psychotic, paranoid people all the time. Some people just don't want to be in this type of environment on a daily basis. Just like some people don't want to be forensic pathologists looking at dead bodies all the time.

4. Ambiguity. Alot of Grey zone. Lack of definitive answers. Not as cutting edge in terms of research. Feelings of impotence as a clinician. Not as much immediate gratification from "curative" treatment plans. Alot of patients take months or years to get better. This is often times not observed by medical students rotating 5-6 weeks through Psychiatry.
Click to expand...

Agree, it can be emotionally taxing. And one must learn to get comfortable with ambiguity and ambivalence.
 
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nitemagi said:
I'd rather work with the homeless than look at skin lesions all day.
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Most homeless people I've seen don't exactly have pretty skin....
 
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RE: "ROAD" to happiness

"Success is getting what you want; Happiness is wanting what you get." - Dale Carnegie.

Let's have a thumbs up from everyone here on SDN who is a psychiatrist and considers themselves both successful and happy. :thumbup:
 
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digitlnoize said:
:thumbup::thumbup::thumbup:

Skin lesions are the bane of my medical school existence. I swear, the entire first week of my first FM rotation was nothing but "I have this thing on my skin, what is it?" My doctor must have thought I was a total idiot, because I never had any clue.
Click to expand...

:laugh:! Nothing was worse then the "what is this rash" question for me. I was always like "How the f*@$ do I know!"...and I could care less. I do know, however, the difference between a benign drug rash and Stevens Johnson, but that's about it.
 
pingouin said:
This thread makes me feel so much better about not recognizing poison ivy in peds clinic this week. :oops:

I hate skin.

And eyeballs.
Click to expand...

:laugh::laugh::laugh: Me, too! I wonder if there is some connection between hating derm and optho and going into psych? I've tried to think about why...I'm a visual learning, so I'm not sure that's it. Must be a different neuro pathway.
 
Pave your own road to happiness. I don't care if those specialties pay twice as much, I would be miserable reading CTs all day or god forbid dealing with rashes for a living. To each there own though.

As far as the money, sure more is better. But money only counts for so much in the grand scheme of things. If you can't live on $200k a year its likely a problem with you and not with your salary.
 
psychphan said:
Pave your own road to happiness. I don't care if those specialties pay twice as much, I would be miserable reading CTs all day or god forbid dealing with rashes for a living. To each there own though.

As far as the money, sure more is better. But money only counts for so much in the grand scheme of things. If you can't live on $200k a year its likely a problem with you and not with your salary.
Click to expand...

:thumbup:
 
Chimed said:
:laugh::laugh::laugh: Me, too! I wonder if there is some connection between hating derm and optho and going into psych? I've tried to think about why...I'm a visual learning, so I'm not sure that's it. Must be a different neuro pathway.
Click to expand...


I actually kinda liked derm. Never really considered it though because I didn't have the scores. I agree though that ophtho would be miserable. Actually anything surgical would be miserable. Would have seriously considered Gyne if I could get rid of the OB and gyn surgery. So I did IM with a women's health focus for a year, but it still wasn't quite right.
 
Yeah, I don't get the derm hatred. I'd much rather do derm than almost anything in medicine other than psych. I guess rheum could be OK, but you'd have to do a horrible IM residency for that. Path and radiology also have some appeal, but I do actually like interactions with patients.

The rest of the road sounds pretty lame to me, though. Ophthal, yeah, yuck. And they apparently don't make anywhere near as much money as they used to. Anesthesiology - also not a fan. Interestingly, my program has had 2 recent transfer from anesthesia, and we're getting a third. They certainly don't make an anesthesiology residency seem too appealing.
 
I think a lot of it might be that you have to be a certain kind of person to be compassionate enough to listen to other peoples problems all day.

One of the reasons I'm venturing into psych is because I've noticed how over the course of my life, people have always wanted to talk to me about their personal issues and always wanted/valued/trusted my advice. I genuinely like helping people.

The only issue with that is a lot of the time, people tend not to listen and only learn from their own mistakes, but sometimes the important part is simply just listening - and then offer some more real advice when they come stumbling back. Sometimes people just have no one else in their life that is willing to listen to them, so they feel isolated - which can exacerbate little problems into something more serious.

That's obviously more psychotherapy than anything else, but from what I've been reading about the state of psychiatry these days, it really seems to be lacking. (pill pushers having more income etc)

Though I have noticed some of you only prescribe meds as a last resort, which is probably a good thing.

Some people just view listening to others problems as being extremely burdensome, and are simply too selfish to give a damn about anyone else other than themselves, which probably in part explains the lack of popularity amongst the med school crowd. (in addition to how their medical peers view the specialty)

And when you think about that, is that the kind of person you really WANT as a psychiatrist anyways?
 
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What I find to be one of the common links between the ROAD specialties aside from lifestyle and money is that they all require brief to minimal patient interaction.

As a student (thus very small exposure and perhaps skewed perspective) I saw many of the initial psych H&Ps take on average an hour or so.. This might not be the case, but it was the exposure I got and thus Psych was definitely crossed off my list.
 
DrBowtie said:
What I find to be one of the common links between the ROAD specialties aside from lifestyle and money is that they all require brief to minimal patient interaction.

As a student (thus very small exposure and perhaps skewed perspective) I saw many of the initial psych H&Ps take on average an hour or so.. This might not be the case, but it was the exposure I got and thus Psych was definitely crossed off my list.
Click to expand...

This is part of how some of them make as much as they do. Brief interactions = many more procedures per hour and thus higher income per hour. Gas is the exception.

It's too bad that you cross off your list specialties where you actually interact with patients. Why go into medicine at all?
 
nitemagi said:
It's too bad that you cross off your list specialties where you actually interact with patients. Why go into medicine at all?
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True. I thought most of us were drawn to medicine because we liked patient interaction. There are all those basic science students out there complaining about how they don't get to see patients yet. It seems like there's wrong either with medical school admissions or with medical school training if not seeing patients is a desired thing for most medical students.
 
The thing is pre-medical students and MS1s/MS2s do not really know what CLINICAL medicine is. Their impression of clinical medicine is mostly from what they observe, hear about, or experience second hand. Some go to medical school thinking an MD is a science degree (well it is not, it is a professional degree). As medical professionals, we all want to help patients, however, some want to help directly (clinicians) and others in-directly (pathologists and radiologists). Some go into medicine initially wanting to be directly involved with patient care/clinical medicine, but then get "burnt out".
 
nitemagi said:
This is part of how some of them make as much as they do. Brief interactions = many more procedures per hour and thus higher income per hour. Gas is the exception.

It's too bad that you cross off your list specialties where you actually interact with patients. Why go into medicine at all?
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Not necessarily down on interacting in patients, just probing deep into their family, social and psychiatric hx makes many people uncomfortable, especially potentially for hours.

Again, just the common thread I see amongst the ROAD specialties.
Radiology - Little to no patient interaction. More on IR.
Ophtho - brief clinic visits + brief OR procedures.
Anesthesia - brief pre-op visit + brief post op PACU time.
Derm - very brief clinic visits +/- procedures
 
DrBowtie said:
Not necessarily down on interacting in patients, just probing deep into their family, social and psychiatric hx makes many people uncomfortable, especially potentially for hours.
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By people do you mean you?

In a standard psychiatric diagnostic interview we're asking about relevant basic background, not "probing questions." Out of the hundreds (?thousands) of patients I've seen, very few appear uncomfortable during a basic interview. The exception is usually those that don't want to be there (brought in involuntarily).
 
nitemagi said:
By people do you mean you?

In a standard psychiatric diagnostic interview we're asking about relevant basic background, not "probing questions." Out of the hundreds (?thousands) of patients I've seen, very few appear uncomfortable during a basic interview. The exception is usually those that don't want to be there (brought in involuntarily).
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I'd say the vast majority of students feel uncomfortable asking people about SI/HI/delusions, hallucinations, substance abuse details etc, etc.

Four weeks as a student is not enough time to develop a comfort level or flow with these topics. While these things may be natural and second nature to you as an attending, I'd ask you to remember back to a time when you are a 3rd year were discussing other "uncomfortable" topics such as sexual hx, ob/gyn hx. If you can recall those feelings, I think you can see why people would not choose Psych after a 4 week exposure.
 
DrBowtie said:
I'd say the vast majority of students feel uncomfortable asking people about SI/HI/delusions, hallucinations, substance abuse details etc, etc.

Four weeks as a student is not enough time to develop a comfort level or flow with these topics. While these things may be natural and second nature to you as an attending, I'd ask you to remember back to a time when you are a 3rd year were discussing other "uncomfortable" topics such as sexual hx, ob/gyn hx. If you can recall those feelings, I think you can see why people would not choose Psych after a 4 week exposure.
Click to expand...

While I agree it's uncomfortable at first, I can't imagine it being any more uncomfortable than taking a gynecological or urological history. Not to slam the ROAD, but what I get from your post is that ROAD specialties encourage avoidance of challenging social situations.
 
DrBowtie said:
I'd say the vast majority of students feel uncomfortable asking people about SI/HI/delusions, hallucinations, substance abuse details etc, etc.

Four weeks as a student is not enough time to develop a comfort level or flow with these topics. While these things may be natural and second nature to you as an attending, I'd ask you to remember back to a time when you are a 3rd year were discussing other "uncomfortable" topics such as sexual hx, ob/gyn hx. If you can recall those feelings, I think you can see why people would not choose Psych after a 4 week exposure.
Click to expand...

If you can't be comfortable asking about suicide and substance abuse in ANY speciality, you'd best not be entering direct patient care.
 
nitemagi said:
While I agree it's uncomfortable at first, I can't imagine it being any more uncomfortable than taking a gynecological or urological history. Not to slam the ROAD, but what I get from your post is that ROAD specialties encourage avoidance of challenging social situations.
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Yes. Do you not see how that is appealing to most students? Avoiding uncomfortable situations?
 
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