Would you still choose psychiatry if you could do it over again?

[Psychczar]

As someone about to apply into psychiatry, I'm curious to hear some thoughts on whether people in residency and in practice would choose psychiatry again if they could go back? Anybody unhappy with their jobs or regret their specialty choice? If yes, why? If no, what about it keeps you enjoying your job after many years?

It seems the majority of IM and Peds people I have posed this question to would do dermatology; while psychiatry has a similar lifestyle, has reimbursement ever been an issue for you? What about patients who may be less motivated than other fields? I know far too many miserable people in medicine, and while I am sure the amount is fewer in psychiatry, I'd like to hear both sides so I know what to possibly expect.

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[slappy]

Have you read through some of the older threads on similar topics? You can see them compiled under "choosing psychiatry" at http://forums.studentdoctor.net/thr...y-great-articles-books-in-psychiatry.1066849/

 

[PhinyGage]

Absolutely! There are many things I dislike about Psychiatry. However, I simple can't see myself doing anything else in medicine. Truth be told I probably wouldn't have went to medical school had I been less ignorant to what I'd have to do to earn a decent check. A little more strategy would have placed me in a solid Engineering Management and/or Business track with an income portfolio (not succumbing to loans in the red). I wouldn't do anesthesia for 350K and I wouldn't do Dermatology for 300K. And Im already too deficient in Vitamin D to be a radiologist.

 

[PistolPete]

Not sure if I'd do medicine if I could go back (although not sure what else I'd do) but having chosen medicine, I think psychiatry is a good fit, and I'm relatively happy.

 

[st2205]

Prior to entering residency, I could probably list a few specialties that intrigued me. Now, the only other specialty I could see myself doing would be dermatology.

 

[MacDonaldTriad]

Just trying to imagine what a dermatologist is thinking about why a psychiatrist would like derm other than the money. Let see: If it is wet, dry it, if it is dry, wet it… Have you had this before? Yes, well you have it again. Have you had this before? “No” Well you have it now. There is probably a solid science behind derm that I’m not very informed about. Desmosomes and connective tissue disease, fascinating….
Give me a break. Margins of skin cancer and steroids are not that interesting compared to what we see. Money is nice, but it only goes so far once you are on the right side of having enough.

 

[Bartelby]

Currently a PGY3, and I would definitely choose psychiatry again! I love reading and learning more about the field, I see interesting things almost every day I go into work, and there is a lot of room for significantly improving people's lives. I have not started my job search yet so I can't say too much about reimbursement, but based on what others have found I think average yearly pay is in line with other medical specialties that fall on the lower end of the spectrum. If you break it down per hour worked that means psychiatrists do pretty well.

 

[st2205]

Just trying to imagine what a dermatologist is thinking about why a psychiatrist would like derm other than the money. Let see: If it is wet, dry it, if it is dry, wet it… Have you had this before? Yes, well you have it again. Have you had this before? “No” Well you have it now. There is probably a solid science behind derm that I’m not very informed about. Desmosomes and connective tissue disease, fascinating….
Give me a break. Margins of skin cancer and steroids are not that interesting compared to what we see. Money is nice, but it only goes so far once you are on the right side of having enough.

It's not money. And I'm also not making an argument of why derm is better or of why psychiatry sucks. I would say (and did say) that now in hindsight, it's the only other specialty I could enjoy. I like the relatively quick pace. I like being able to do really small, quick procedures (not a fan of big procedures). It'd be nice going to work every day and not worrying about if you're going to kill someone. It'd be nice knowing that the only true dermatological emergencies are handled by medicine. It'd be nice to know you don't have patients in the hospital as primaries.

 

[DermViser]

Just trying to imagine what a dermatologist is thinking about why a psychiatrist would like derm other than the money. Let see: If it is wet, dry it, if it is dry, wet it… Have you had this before? Yes, well you have it again. Have you had this before? “No” Well you have it now. There is probably a solid science behind derm that I’m not very informed about. Desmosomes and connective tissue disease, fascinating….
Give me a break. Margins of skin cancer and steroids are not that interesting compared to what we see. Money is nice, but it only goes so far once you are on the right side of having enough.

 

[F0nzie]

I would not choose a different specialty but if I had a magic wand I would do psych 1 day a week and derm 3 days a week. Excising and freeze blasting lesions is pretty kick ass.

 

[st2205]

I would not choose a different specialty but if I had a magic wand I would do psych 1 day a week and derm 3 days a week. Excising and freeze blasting lesions is pretty kick ass.

Closely approximates my feelings, though I'd probably do 2 days of psych and 1 day of derm.

 

[Doctor Bagel]

It's not money. And I'm also not making an argument of why derm is better or of why psychiatry sucks. I would say (and did say) that now in hindsight, it's the only other specialty I could enjoy. I like the relatively quick pace. I like being able to do really small, quick procedures (not a fan of big procedures). It'd be nice going to work every day and not worrying about if you're going to kill someone. It'd be nice knowing that the only true dermatological emergencies are handled by medicine. It'd be nice to know you don't have patients in the hospital as primaries.

I'm right there with you. Derm is the one other thing that I sometimes regret not pursuing. I don't get why derm get so much negativity in medicine aside of from jealousy. It's actually pretty complex from a learning perspective, limited to a more narrow area, and yeah, you're not killing anyone. Lots of psych overlap with derm, too. I am very happy I didn't push myself to do something like internal medicine because I wanted to be a "real doctor" or whatever.

 

[hamstergang]

I just started my Child/Adolescent Psych Fellowship, and I would certainly choose this all over again. I find it all very interesting and rewarding, and the lifestyle and pay are nice as well.

 

[dl2dp2]

I would not choose a different specialty but if I had a magic wand I would do psych 1 day a week and derm 3 days a week. Excising and freeze blasting lesions is pretty kick ass.

But Dear Fonzie, this would be exactly what your life would look like if you did cash practice 3 days a week and public psych 1 day a week!

I think of private high paying cash practice as the equivalent of derm for your psyche.

 

[vistaril]

Why you guys pontificate on derm and point out similarities to it and psych(?), I'm pretty sure nobody actually doing derm would agree or see it that way....hell half the people doing derm probably have even forgotten that psych is technically a do/md specialty.

 

[bronx43]

Just trying to imagine what a dermatologist is thinking about why a psychiatrist would like derm other than the money. Let see: If it is wet, dry it, if it is dry, wet it… Have you had this before? Yes, well you have it again. Have you had this before? “No” Well you have it now. There is probably a solid science behind derm that I’m not very informed about. Desmosomes and connective tissue disease, fascinating….
Give me a break. Margins of skin cancer and steroids are not that interesting compared to what we see. Money is nice, but it only goes so far once you are on the right side of having enough.

"There is probably a solid science behind derm..." Lol, are you serious? Just like there is "probably some solid science behind heme/onc and immunology." Freaking hilarious that you got a psychiatrist talking about "solid science." Derm, as a field, is FAR more than just cosmetic BS and acne. At my institution, the derm department is within the IM department, and those academic derm people are some of the smartest people I've met. They know IM as well as any internist and they know their basic science like you wouldn't believe. It's fine that you don't think YOU can enjoy derm, but to question the scientific basis of dermatology is just asinine.
And you do realize that your little satire can essentially be used against any field, right? Everything sounds stupid and simple if you break it down to a caricature.

 

[bronx43]

Why you guys pontificate on derm and point out similarities to it and psych(?), I'm pretty sure nobody actually doing derm would agree or see it that way....hell half the people doing derm probably have even forgotten that psych is technically a do/md specialty.

No offense, but I think half the people in health care have forgotten that psych is a MD/DO specialty.

 

[vistaril]

No offense, but I think half the people in health care have forgotten that psych is a MD/DO specialty.

Oh no doubt...

 

[jettavr6]

Why you guys pontificate on derm and point out similarities to it and psych(?), I'm pretty sure nobody actually doing derm would agree or see it that way....hell half the people doing derm probably have even forgotten that psych is technically a do/md specialty.

Friend of mine who is a dermatologist, has a sister who is a psychiatrist - spoke recently about going back to residency to become a psychiatrist if he can't practice derm anymore. I know a plastic surgeon who went back and became a psychiatrist.

What Vistaril needs to realize, and this may come after he spends some time outside the confines of residency, is that psychiatry actually does garner some respect. I would ask why Vistaril continuously pontificates about the inferiority of psychiatry vs. other specialties.

 

[vistaril]

Friend of mine who is a dermatologist, has a sister who is a psychiatrist - spoke recently about going back to residency to become a psychiatrist if he can't practice derm anymore./QUOTE]

Lmao...yes because this is something a lot of derm people wonder about and im sure it somehow naturally came up in the course of conversation.

Most students going into derm view their psych rotation as less than any other rotation. They still tend to rock it because they rock about everything, but it's not something they approach as serious as other rotsations....which is fine.

 

[st2205]

Why you guys pontificate on derm and point out similarities to it and psych(?), I'm pretty sure nobody actually doing derm would agree or see it that way....hell half the people doing derm probably have even forgotten that psych is technically a do/md specialty.

I'm not sure that was anyone's point. It certainly wasn't mine. The relevance of someone in dermatology's opinion on psychiatry and dermatology being less stressful and miserable than other medical fields has, exactly, what bearing on this discussion?

 

[HarryMTieboutMD]

"There is probably a solid science behind derm..." Lol, are you serious? Just like there is "probably some solid science behind heme/onc and immunology." Freaking hilarious that you got a psychiatrist talking about "solid science." Derm, as a field, is FAR more than just cosmetic BS and acne. At my institution, the derm department is within the IM department, and those academic derm people are some of the smartest people I've met. They know IM as well as any internist and they know their basic science like you wouldn't believe. It's fine that you don't think YOU can enjoy derm, but to question the scientific basis of dermatology is just asinine.
And you do realize that your little satire can essentially be used against any field, right? Everything sounds stupid and simple if you break it down to a caricature.

Agreed 100%. I love psychiatry and would not even consider another career, but we really have no business arguing the scientific legitimacy of our specialty vs others, especially concerning current clinical practice. The future of psychiatry is definitely the most exciting, especially as neural networks become elucidated and we can target specific pathways, but other than DBS for OCD and maybe a few other examples in the works, we are essentially using the same pharmacologic principles that have been around for 50 years- and we don't even understand why some of these drugs work. And though ECT and maybe TMS work as well, we still don't understand the mechanism- and ECT has been around forever (I think longer than chlorpromazine and the original anti TB MAOIs). But, with people like Danny Weinberger and Karl Deisseroth, we have the most brilliant scientific minds working towards a better understanding of pathology and ultimately better treatments.

Yes, some dermatologists chose their field because they were AOA and got a 265 on Step 1, then did an easy transition year plus a cush residency, and now make bank in private practice seeing the same thing over and over for 35 hours/week. But some of my friends from medical school who went into derm were some of the sharpest medical students (and now resident physicians) that I have met. They did medicine intern years, are well versed in derm literature and new therapies, and maintain their knowledge of the basic sciences. And some of the things they see are incredibly interesting and really require astute powers of observation. And some of the advanced procedures and biologic therapeutics require intensive training and experience to do correctly, so I have a lot of respect for dermatologists.

 

[jettavr6]

Vistaril --- >Lmao... and im sure it somehow naturally came up in the course of conversation.

Yeah, and?

 

[Doctor Bagel]

No offense, but I think half the people in health care have forgotten that psych is a MD/DO specialty.

People always ask me how my training in psychology is going.

 

[st2205]

People always ask me how my training in psychology is going.

Regarding the post you responded to, none of these are reflections on psychiatry. If someone in healthcare wasn't aware ophthalmology was an MD/DO specialty, or confused it with optometry, then that would reflect solely on the individual making the confusion. Cue vistaril appearance.

 

[NontradCA]

Do you grown adults honestly care about receiving "respect" from "half of the people in healthcare"? This is essentially a good thing when half of the US is waging war on "rich" doctors. Psych seems as if it is amongst the safest fields in medicine, both from politicians and business.

 

[Silent Cool]

I'm right there with you. Derm is the one other thing that I sometimes regret not pursuing. I don't get why derm get so much negativity in medicine aside of from jealousy. It's actually pretty complex from a learning perspective, limited to a more narrow area, and yeah, you're not killing anyone. Lots of psych overlap with derm, too. I am very happy I didn't push myself to do something like internal medicine because I wanted to be a "real doctor" or whatever.

Yeah seriously. I think a lot of people hate on derm because it is competitive, they generally earn quite a bit of $$$, have a good lifestyle, and can escape the hospital if they so desire. In fact, though, derms have a HUGE amount of knowledge to assimilate that is not well appreciated by others in medicine. I believe that the standard used to be that derm was a sort of fellowship of internal medicine.

 

[sunlioness]

Derm is pretty interesting. So is pathology. Some days I think I should have gone into path. But the gunk on a slide stained all pretty path. Not the dead body on a slab path. I think I mostly only feel that way on days I'm tired of people.

 

[PhinyGage]

Umm....is it me, or am I the only one who is witnessing the role of the Psychiatrist growing by rate as fast as the speed of light? Technology advances?! Psh! People are dying daily because of our country's dirty little secret (poor focus on mental health). I would argue that our specialty's percieved inferiority is perpetuated by it's own.....I am very proud to be a budding Psychiatrist, especially since most of my dermatology, orthopedic, and anesthesiology colleagues are likely to end up in my office anyways.

Patients dont care about your technology. They usually just wanna know that you'll listen, you'll care, and you'll try....

The inferiority is a Psychiatry thing, and most likely propagated by Psych docs who thought they should've ended up in something "better" anyways....

 

[Leo Aquarius]

Seeing that I'm a psychiatry resident I'm just getting my feet wet in this field, so no thoughts of switching here. I feel comfortable in my chosen specialty in that it's a very good fit for me, but there are days I imagine myself in the shoes of other fields for curiosity sake. Once I stay in those shoes for too long, things get uncomfortable and I quickly jump back into mine. Thinking about being a surgeon, or radiologist, or internist, is shockingly different than actually doing it.

 

[vistaril]

Vistaril --- >Lmao... and im sure it somehow naturally came up in the course of conversation.

Yeah, and?

just pointing out how ridiculous(and suspicious) your comment in that instance was.

 

[nancysinatra]

Why you guys pontificate on derm and point out similarities to it and psych(?), I'm pretty sure nobody actually doing derm would agree or see it that way....hell half the people doing derm probably have even forgotten that psych is technically a do/md specialty.

Even I had forgotten that psych is technically a specialty.

 

[nancysinatra]

What Vistaril needs to realize, and this may come after he spends some time outside the confines of residency, is that psychiatry actually does garner some respect.

Sure, and it also garners a fair amount of disrespect. If you have ever been consulted by Ob/Gyn in the middle of the night for an "emergency" mild case of depression, you will know what I mean.

 

[nancysinatra]

I would not do psych again. I would either do infectious disease research or cardiothoracic or vascular surgery.

 

[nancysinatra]

The future of psychiatry is definitely the most exciting, especially as neural networks become elucidated and we can target specific pathways,

Do you work for the APA?

Patients dont care about your technology. They usually just wanna know that you'll listen, you'll care, and you'll try....

What patients care about is usually how much Adderall you will give them.

 

[SteinUmStein]

I would not do psych again. I would either do infectious disease research or cardiothoracic or vascular surgery.

What made you choose psych? What's different now? Sounds like you're pretty far from where you want to be.

 

[nancysinatra]

What made you choose psych? What's different now? Sounds like you're pretty far from where you want to be.

Well, I had a great psych clerkship in medical school, and I thought people in psychiatry were nicer than the people in surgery or medicine. I thought psychiatry would be about understanding people's motivations, and helping them steer their lives in the directsion they wanted. I thought all my patients would be motivated, inherently interesting, high functioning people who were psychologically astute and wanted to figure out how they could optimize their lives. I thought psychiatrists could have an impact on the well being of people on a population level by doing this kind of work.

I have totally learned my lesson since then. People in the general population are not as motivated, high functioning or psychologically aware as I had thought. I think we end up diagnosing mental illnesses a lot of the time when really the problem is that our society is going down the tubes. I do try to do the things I just mentioned, and it's rewarding when I'm able to, but those goals do not seem to me to be consistent with where our field is at right now, or what society wants from mental health. I know people will debate me about this and that's fine, but to me psychiatry seems to be about checklists, overdiagnosing, polypharmacy, getting by with as little internal medicine knowledge as possible and putting all of America on disability. Yeah I'm exaggerating but you see my point. I think we are a specialty that is guided mainly by the direction of the wind. For example right now it's in vogue for everyone to have PTSD, so we diagnose a lot of PTSD...

And another thing that bothers me is that no one wants to talk about these problems.

 

[Armadillos]

Well, I had a great psych clerkship in medical school, and I thought people in psychiatry were nicer than the people in surgery or medicine. I thought psychiatry would be about understanding people's motivations, and helping them steer their lives in the directsion they wanted. I thought all my patients would be motivated, inherently interesting, high functioning people who were psychologically astute and wanted to figure out how they could optimize their lives. I thought psychiatrists could have an impact on the well being of people on a population level by doing this kind of work.

I have totally learned my lesson since then. People in the general population are not as motivated, high functioning or psychologically aware as I had thought. I think we end up diagnosing mental illnesses a lot of the time when really the problem is that our society is going down the tubes. I do try to do the things I just mentioned, and it's rewarding when I'm able to, but those goals do not seem to me to be consistent with where our field is at right now, or what society wants from mental health. I know people will debate me about this and that's fine, but to me psychiatry seems to be about checklists, overdiagnosing, polypharmacy, getting by with as little internal medicine knowledge as possible and putting all of America on disability. Yeah I'm exaggerating but you see my point. I think we are a specialty that is guided mainly by the direction of the wind. For example right now it's in vogue for everyone to have PTSD, so we diagnose a lot of PTSD...

And another thing that bothers me is that no one wants to talk about these problems.

While it blows my mind anyone could possibly go through medschool thinking patients in any field would be universally motivated and highly functioning, thats beside the point.

But if you do want patients like that, why not start a private practice catering towards that niche? Or if thats too daunting, why not work in campus mental health at an academically respected university?

 

[mgdsh]

People in the general population are not as motivated, high functioning or psychologically aware as I had thought.

Those are all things that can be worked on

 

[smalltownpsych]

Well, I had a great psych clerkship in medical school, and I thought people in psychiatry were nicer than the people in surgery or medicine. I thought psychiatry would be about understanding people's motivations, and helping them steer their lives in the directsion they wanted. I thought all my patients would be motivated, inherently interesting, high functioning people who were psychologically astute and wanted to figure out how they could optimize their lives. I thought psychiatrists could have an impact on the well being of people on a population level by doing this kind of work.

I have totally learned my lesson since then. People in the general population are not as motivated, high functioning or psychologically aware as I had thought. I think we end up diagnosing mental illnesses a lot of the time when really the problem is that our society is going down the tubes. I do try to do the things I just mentioned, and it's rewarding when I'm able to, but those goals do not seem to me to be consistent with where our field is at right now, or what society wants from mental health. I know people will debate me about this and that's fine, but to me psychiatry seems to be about checklists, overdiagnosing, polypharmacy, getting by with as little internal medicine knowledge as possible and putting all of America on disability. Yeah I'm exaggerating but you see my point. I think we are a specialty that is guided mainly by the direction of the wind. For example right now it's in vogue for everyone to have PTSD, so we diagnose a lot of PTSD...

And another thing that bothers me is that no one wants to talk about these problems.

I loved this post and hope that your frustrations with the field do not lead you away, but instead lead you to continue to talk about these problems and work to change some of them.

I also am thinking that I recognize the hyperbole in your post that others did not and interpreted as just naivete.

One disadvantage of being a psychologist is that I can't prescribe, but that also means that I have to come up with other ways of treating patients. Unfortunately, I see my colleagues falling into the same trap of focusing on medications as if they are a panacea. I have patients with schizophrenia who tell me they are depressed about not being able to work, dealing with a serious mental illness, struggling with relationships, dealing with government bureaucracy, and the mental health workers tell them they need to talk to their psychiatrist about upping their anti-depressant meds!

Too many people in this business are afraid to tell people the truth! Some of that truth is: there is no pill that will make you feel better about dealing with bad stuff in life and even more so there is no pill that will make you not feel bad about the bad choices you make or stop you from making those bad choices.

 

[vistaril]

And another thing that bothers me is that no one wants to talk about these problems.

well, a few opinions on this last statement:

1) most people in mental health don't want to talk about it for obvious reasons. When something is afoul that you wish wasn't afoul, it's easier to just believe all is well unless you can easily make positive change.
2) I think many people in medicine do view psychiatry in the way you describe, but just don't talk about it because they don't care. It really doesn't affect them. Just like they also don't complain about a lot of other things they dont care about.
3) I think amongst the general population, there is a good amount of the sentiment you describe.

 

[nancysinatra]

While it blows my mind anyone could possibly go through medschool thinking patients in any field would be universally motivated and highly functioning, thats beside the point.

But if you do want patients like that, why not start a private practice catering towards that niche? Or if thats too daunting, why not work in campus mental health at an academically respected university?

It's not mind blowing, because I never wanted to go into clinical medicine anyway unless it was something procedure based. And plus there are people who go into Ob/Gyn thinking they'll do nothing but deliver healthy babies to happy families, and then they discover that reality is not like that. I care about my patients of course, but I get bored seeing one after another. I've posted about this before, many times. I'm working my way into a more specialized career path more to my liking, but it takes time.

I think I would have liked being a psychiatrist more in the 1940s, when psychoanlaysis was the main treatment, and my job would have been to "interpret" people's dreams and streams of consciousness. Nowadays we are required to "empathize" and that just wears me out.

It's also not so much that I thought everyone would be high functioning; it's more that I failed to realize how eager so many Americans are to identify with an illness. People come in, having already "diagnosed" themselves off the internet, for example. But then they're not always all that eager to understand the reasons for their actual problems. And if they want a pill, I almost have to give them one, to cover my bases. So I feel like my job is to cater to the dysfunction of the American population.

 

[nancysinatra]

well, a few opinions on this last statement:

1) most people in mental health don't want to talk about it for obvious reasons. When something is afoul that you wish wasn't afoul, it's easier to just believe all is well unless you can easily make positive change.

I agree, and this basically describes the mentality that was in place before the Enlightenment.

 

[nancysinatra]

Too many people in this business are afraid to tell people the truth! Some of that truth is: there is no pill that will make you feel better about dealing with bad stuff in life and even more so there is no pill that will make you not feel bad about the bad choices you make or stop you from making those bad choices.

And sometimes it's out of your control entirely. For example I feel powerless to change the American economy, yet it affects me.

I would totally love to invent a school of psychotherapy that relies entirely upon multivariable calculus, and plug in variables from people's lives and from the world around them, recognizing that some variables are fixed and others are not, and then figure out how to maximize happiness.

 

[mgdsh]

I think I would have liked being a psychiatrist more in the 1940s, when psychoanlaysis was the main treatment, and my job would have been to "interpret" people's dreams and streams of consciousness. Nowadays we are required to "empathize" and that just wears me out.

It's also not so much that I thought everyone would be high functioning; it's more that I failed to realize how eager so many Americans are to identify with an illness. People come in, having already "diagnosed" themselves off the internet, for example. But then they're not always all that eager to understand the reasons for their actual problems. And if they want a pill, I almost have to give them one, to cover my bases. So I feel like my job is to cater to the dysfunction of the American population.

Two thoughts:
- Perhaps its possible to work some smaller aspects of therapy into sessions?
- Could it be something about the office you're working at, such as the demographics of the patients?

 

[Silent Cool]

Friend of mine who is a dermatologist, has a sister who is a psychiatrist - spoke recently about going back to residency to become a psychiatrist if he can't practice derm anymore. I know a plastic surgeon who went back and became a psychiatrist.

What Vistaril needs to realize, and this may come after he spends some time outside the confines of residency, is that psychiatry actually does garner some respect. I would ask why Vistaril continuously pontificates about the inferiority of psychiatry vs. other specialties.

Are you serious? Whatever precipitated that?

 

[Doctor Bagel]

It's also not so much that I thought everyone would be high functioning; it's more that I failed to realize how eager so many Americans are to identify with an illness. People come in, having already "diagnosed" themselves off the internet, for example. But then they're not always all that eager to understand the reasons for their actual problems. And if they want a pill, I almost have to give them one, to cover my bases. So I feel like my job is to cater to the dysfunction of the American population.

This is what working at the VA feels like. I'm feeling a little more negative about psychiatry right now because I'm at the VA and I'm working with a pretty dysfunctional group of people. Not my long term thing. Not that these problems are limited to the VA, but they're endemic here.

The other limitation is that we just don't have time to sit with people and understand them. Everything is focused on cutting costs, which means screening tests, clear diagnoses (which don't really exist imo) and super limited treatment. One rant, though -- people don't seem to realize that they can actually pay for their own treatment even if insurance won't.

 

[nancysinatra]

This is what working at the VA feels like. I'm feeling a little more negative about psychiatry right now because I'm at the VA and I'm working with a pretty dysfunctional group of people. Not my long term thing. Not that these problems are limited to the VA, but they're endemic here.

The other limitation is that we just don't have time to sit with people and understand them. Everything is focused on cutting costs, which means screening tests, clear diagnoses (which don't really exist imo) and super limited treatment. One rant, though -- people don't seem to realize that they can actually pay for their own treatment even if insurance won't.

Yeah, I think my attitude started to sour when I was working at the VA. We had some excellent attendings there, and I liked how they were pretty evidence-based, but it was the service connected disability stuff that soured me.

If the APA would take a stand recommending the federal government stop supporting permanent disability for treatable conditions like anxiety, PTSD, bipolar, etc., I would have way more respect for this field. I wonder if they have a stand on that issue? There is no incentive in our society for peopel to overcome these conditions ever since welfare got eliminated and states started telling people to apply for federal disability benefits based, often, on exaggerated mental health conditions.

It's perverse to encourage people not to get better, and that's exactly what we do, especially with the setup of benefits at the VA.

 

[Salpingo]

Well, I had a great psych clerkship in medical school, and I thought people in psychiatry were nicer than the people in surgery or medicine. I thought psychiatry would be about understanding people's motivations, and helping them steer their lives in the directsion they wanted. I thought all my patients would be motivated, inherently interesting, high functioning people who were psychologically astute and wanted to figure out how they could optimize their lives. I thought psychiatrists could have an impact on the well being of people on a population level by doing this kind of work.

1. This is a great post. I've heard multiple residents complain about the above issues, although they were primarily in medicine. In fact, there's an entire book that goes into these issues at length. I rarely get a chance to speak to surgery residents, but there's probably a reason for that as well. In each of those cases, the answer seems to be "it gets better after residency".
2. I think other doctors (and the population as a whole) generally disrespect mediocre or even average psychiatrists, for the reasons you listed above (checklist medicine, taken in by fads, etc). But the truly excellent ones ran some of the biggest, most prestigious institutions in this country and get national exposure. You can bet when one of them has a depressed child or addicted relative (which is statistically likely to happen), the average physician isn't just going to throw a dart at the Yellow Pages and pick the first psychiatrist/psychic it hits.
3. The midnight mild depression consult is unfortunate, but the reason can range from "the social worker isn't in at night, I'll call the psych resident so that the nurses stop paging me" to "there's something really serious here that I don't understand, and I need an expert opinion."

 

[vistaril]

This is what working at the VA feels like. I'm feeling a little more negative about psychiatry right now because I'm at the VA and I'm working with a pretty dysfunctional group of people. Not my long term thing. Not that these problems are limited to the VA, but they're endemic here.

The other limitation is that we just don't have time to sit with people and understand them. Everything is focused on cutting costs, which means screening tests, clear diagnoses (which don't really exist imo) and super limited treatment. One rant, though -- people don't seem to realize that they can actually pay for their own treatment even if insurance won't.

most VA psychiatrists(if they want to) have more time to spend with patients than outpt(or inpatient) psychiatrists in other settings. From a time per outpt encounter setting, I cant think of many better places to do outpt med mgt and assessment work than the VA. They give you 30 minute followups for every pt at every VA I've been in, and(and this is the big difference), there are also enough gaps in the schedule for various BS things usually that you can actually spend more time than that if you want.

The VA definately has a bunch of problems, but getting time to talk with patients(relative to most other settings) is definately not one of them imo.

And yes of course people can pay for their own treatment........*if* they value it enough. Most people don't.