Pros and Cons of going into Psychiatry

If you read the other threads on this forum, you'll get some good ideas of all the pros/cons of psych.
One of the old jokes is that a good Neurologist can diagnose a patient within 60 seconds, but can't do anything about it. There are more interventions nowadays, but much of neurology is still about defining the deficits - some of which can't be changed, and what can be "treated" is really just slowing the progression.
In psych we have the honor and frustration of treating the person's "self" and personality, and we often do that through using our own "self" and personality. The vast amt of discussion about psych regards pharmacology, but it is still how we go about getting pt's to utilize our treatments (pharm or not) that is often the crux of the matter. I'd bet many of our regular posters would agree that a significant portion of their mental effort each day is spent interacting with patients in order to get them to avail themselves of our treatments.

In psych, some of us also have the honor of treating many of society's most vulnerable and most disregarded. Every once in a great while, with just a short interview, a few well placed words of encouragement, and few strokes of my pen, I get to pull someone out of the gutter and out of the depths of despair and mental self-torture and set him on a path of recovery, dignity, and self-worth.

Those moments are few, but they're why I get up in the morning.
Well, that and my labrador licking my face while her tail thumps the wall because she hopes I might feed her again today.

There is some overlap between the two fields (the neurologist at my hospital spent a lot of time ruling out organic causes for "neurological" deficits and then referring the patient to psychiatry) but I guess one way to try to decide it would be, which do you find more interesting: strokes, headaches, and seizures or depression, anxiety, and schizophrenia?

Psych can be fun and interesting, but here are several things that are frequently brought up as cons about Psych:
Even though having good medical knowledge can help you be a good psychiatrist, many people do not see psychiatrists as being a "real doctor". Most people don't know the difference between a psychologist and a psychiatrist. It's not a field you go into for the prestige.

Interacting with psych patients can be difficult. Sometimes psych patients become aggressive or behave inappropriately. Many psychiatric patients are non-compliant with treatment. You will also see many patients that are not really ill at all but are malingering for secondary gain...for example, getting called to the emergency department to evaluate a homeless person who claims to be suicidal but really just wants to get a bed and food in the hospital.

I guess one thing you should realize that looking at current state of medicine in USA, you will never find an ideal profession. the most unsatisfied physicians are neurosurgeons.So, Every field wether it's psych or non psych have their pros and cons.these days Physicians do not enjoy the level of autonomy and gratitude which they had in past. So choosing a speciality on the basis of interest in extremely important. these days there is so much collateral administrative mess(HMO,buerocracy) ,that if you dont like what you do , you will be a miserable person ,regardless of speciality.
Every psychiatrist will have thier own pros and cons. If i tell you my cons someone might not agree with it. So it's all relative to individual perceptions and experiences.

ronin12 said:

I guess one thing you should realize that looking at current state of medicine in USA, you will never find an ideal profession. the most unsatisfied physicians are neurosurgeons.So, Every field wether it's psych or non psych have their pros and cons.these days Physicians do not enjoy the level of autonomy and gratitude which they had in past. So choosing a speciality on the basis of interest in extremely important. these days there is so much collateral administrative mess(HMO,buerocracy) ,that if you dont like what you do , you will be a miserable person ,regardless of speciality.
Every psychiatrist will have thier own pros and cons. If i tell you my cons someone might not agree with it. So it's all relative to individual perceptions and experiences.

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NS most unsatisfied? Where did you find that statistic?

Psychiatry:

Work on the problems other doctors aren't privy to because of the 'stigma'
Better residency schedule overall
The brain (not the PNS)
More research opportunities (less data to build on)
More of an emphasis on service (some anti-research sentiment)

Neurology:

More procedures and ICU time (can be daunting, if you're anxious/timid)
More puzzle solving (less talking/listening - more detached)
More established research groups (debatable, but overall probably true)
Possibly considered more like 'real' medicine by many MD's
More of a focus on research and academics (less anti-research sentiment)

I realize many of the above points are generalizations and are debatable.

I'd see which one you like better on a day to day basis, and see if you can relate to any of the attendings and residents you're working with in these fields. Which do you enjoy more? Which were you better at?

Tradewind said:

Psychiatry:

Work on the problems other doctors aren't privy to because of the 'stigma'
Better residency schedule overall
The brain (not the PNS)
More research opportunities (less data to build on)
More of an emphasis on service (some anti-research sentiment)

Neurology:

More procedures and ICU time (can be daunting, if you're anxious/timid)
More puzzle solving (less talking/listening - more detached)
More established research groups (debatable, but overall probably true)
Possibly considered more like 'real' medicine by many MD's
More of a focus on research and academics (less anti-research sentiment)

I realize many of the above points are generalizations and are debatable.

I'd see which one you like better on a day to day basis, and see if you can relate to any of the attendings and residents you're working with in these fields. Which do you enjoy more? Which were you better at?

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I'm not so sure that neurology is more research focused than psychiatry. Among the National Institutes of Health, Neurology pretty much has the NINDS only, whereas Psychiatry has NIMH, NIDA and NIAAA. Many more research dollars are spent on psychiatric illnesses, including substance use disorders, than on neurological illnesses. This has to do with the fact that the burden to society is considerably greater from psychiatric illnesses. Many millions of dollars are also spent on "services" research, so being "service" oriented is not antithetical to research by any means.

I would like to add to psychiatry's pros:

- Better able to continue practicing late into their age.

You might think this is insignificant but just look around and see how many old psychiatrists are around as opposed to surgeons or neurologists.

seth03 said:

NS most unsatisfied? Where did you find that statistic?

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locum tenens did a survey. look at their website.

pay is kinda low. but if you LOVE it then i guess its worth it. to me going an additional 1-2 years specializing then coming out making twice what a psych makes sounds more appealing. then again im not even in med school so i dont really know **** and should probably stop pretending I know things.

ThinkTooMuch said:

coming out making twice what a psych makes

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And working 3x the hours.

Faebinder said:

You might think this is insignificant but just look around and see how many old psychiatrists are around as opposed to surgeons or neurologists.

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This could be indicative of the passion of psychiatrists and their old-age-friendly work environment. Or it could be indicative of the fact that most surgeons make a lot more money and are able to retire younger.

Personally, I like the former. A big benefit of psychiatry to me is flexibility. I've met psychiatrists who only want to work two days a week (due to kids) and have been able to find jobs. I've also met psychiatrists in semi-retirement that have gone from working 5 days/week to 2 days/week to 1 day/week. I'd imagine that keeping up with the reading but only dipping your feet in the pool a few times a month must help you keep your marbles rolling nicely in your old age and keep you young.

ThinkTooMuch said:

pay is kinda low. but if you LOVE it then i guess its worth it. to me going an additional 1-2 years specializing then coming out making twice what a psych makes sounds more appealing. then again im not even in med school so i dont really know **** and should probably stop pretending I know things.

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Money is certainly important. I gave serious thought to other fields of medicine (mostly EM) because of my debt and desired lifestyle. However, it really is important that you love what you do. Even tough they both deal with "nerves" the jobs that neurologists and psychiatrists do is SO different on a daily basis.

There are some fields of neurology I might like, such as Sleep, Epilepsy, MS. But I find stroke and neurodegenerative diseases to be extremely depressing. And much less interesting that psych illnesses. Unfortunately, private practice neurologists seem to spend the vast majority of their time treating headaches, "chronic pain", stroke, & essential tremor. Maybe the occasional MS or Parkinson's.

I guess the point of all this rambling is that you could find a something in either psych or neuro that you could like and the it's not as much of a "life and death" as it might seem (or certainly as it seemed to me this time last year).

As an extra point: if you did neuro and didn't like it you could switch to psych after 1-2 years. But if you did psych and didn't like it, you'd have a harder time switching.

strangeglove said:

I'm not so sure that neurology is more research focused than psychiatry.....Many millions of dollars are also spent on "services" research, so being "service" oriented is not antithetical to research by any means.

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True, but it seems that those conducting services research are more closely aligned with clinicians who don't conduct research at all, in terms of academic politics, etc..

Services research is very important, and we've done well there. We should keep doing that. In psychiatry, I think we need better basic research. It's a challenge, and it won't explain everything (I'm not bashing psychotherapy at all), but we need it.

I agree there is more research opportunity in psychiatry, and the access to funding at multiple institutes at the NIH is just one example of that.

I think the type of research that is produced by psychiatrists v neurologists on the whole is different, with the former being more services oriented. There are certainly PhD's conducting basic research in psychiatry that may be skewing some of the figures when considering basic science research output in psychiatry.

Anyway, I chose psychiatry, because I enjoyed it more on a day to day basis, I find the topics in psychiatry more interesting and the research opportunities are greater. In that order. And I have no regrets.