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skimm said:
Current MS3 having a career crisis and would value insight.

I have been targeting ENT since I entered med school. I am very music-minded and have loved the idea of working with performing arts population through laryngology or generally restoring appreciation for music/human voice through otology. I love working with my hands (pianist), and I've particularly enjoyed the smaller, more precise surgeries as opposed to the big, bloody cases. Being in the OR has always been more exciting to me than medicine floor work. I admittedly also weigh compensation quite highly, and being able to reasonably achieve 400-600k as an ENT is attractive. There is an ego component to becoming a surgeon as well that I don't think I would satisfy in most other specialties, and even aside from the OR, watching an ENT resident come down to the floor, intubate a difficult patient, and get a round of applause certainly scratches a certain ego itch. I also enjoy being on the grind, running around, seeing a lot of patients (have also been very interested in EM), so the idea having a rigorous residency/attending life wasn't very off-putting at first.

HOWEVER, I am already feeling the burnout on my clinical rotations. The idea of needing to take an extra research year in med school and then have 70-80+ hour weeks in a 5-year ENT residency is now extremely daunting. As exciting as the OR is now, I know I will lose this starry-eyed perspective and it will eventually become work like any other job - same with my interest in being on the go constantly. I am already feeling the physical burden on my back and shoulders as a young 20 something in the OR, and thus I am really considering my long-term health going into anything surgical. I have many interests outside of medicine (music, literature, etc.), and I value time with my family and friends highly, and although I've talked to many new ENT attendings who talk about how much better it gets, the vacations they're taking etc., I also hear about how the grind, while it gets easier, doesn't every really stop with anything surgical.

Psychiatry has unexpectedly become very attractive to me. I have always been interested in psych, and it was my favorite pre-clinical course, but I chalked this up to it being a generally interesting field at cursory glance (e.g. psychology being the most popular major), and it being a relatively easy pre-clinical course. However, I loved my rotation (inpatient psychotic disorders). Patients were interesting, interviewing was more rewarding than I expected it to be, and although the young attending seemed pretty stressed, watching him finish rounds at 12 and then "chill" in his office for the rest of the day was alluring compared to the OR grind (or even the ENT clinic running through 15 min. patient encounters 9 to 5). I've realized that actually talking to patients has been one of the most rewarding part of every rotation (although likely influenced by the relative incompetence of doing real medicine as a student). Since reassessing how sustainable my love for the grind is, I am very attracted to the lighter residency and attending hours of psych. I am also somewhat entrepreneurial minded (really enjoyed free-lancing in my gap year) and the ability to do self-owned PP is very attractive.

However, I question whether I will be satisfied not cutting, whether I will satisfy my stupid ego without the title of surgeon, whether I will regret the opportunity cost of going for a lower paying specialty, if I'll regret choosing to work with a generally unhealthy as opposed to healthy population, and whether I will feel conflicted not knowing if I chose psych for the right reasons or if I simply wanted an easier road.

Overall, I am trying to value intellectual curiosity and satisfaction with the actual duties of the specialties themselves. In this regard, I feel like I am equally intellectually interested in both, and although I enjoy the invasiveness of surgery, I do feel that psych (as opposed to other nonsurgical specialties) does approximate this feeling due to the intimate nature of psychiatric illness. That being said, since going through the clinical year grinder, I am realizing how important time and my compensation for said time is. Considering lifestyle and compensation is naturally where more conflict arises. I don't know if my physical and mental health can sustain an ENT residency, and even if I can push through, attending lifestyle as a psychiatrist seems clearly lighter and more malleable than ENT both in time and intensity (particularly physically). However, the compensation is clearly better. I am very conflicted on how to weigh the significantly more demanding residency and somewhat more demanding attendinghood of ENT against the significantly greater earning potential. Am I stupid to weigh income heavily in this situation given that psych salaries seem to have improved to a reasonably achievable 300k base for 40 hrs? If I want to can I reasonably work 55 hours in psych with a base job + per diem/locums and satisfy my desire for the grind but also reasonably achieve 400-450k salary?

I appreciate any thoughts on how this reads from another perspective (maybe it's obvious what I should do), as well as any thoughts on making an objective comparison between these two fields.
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It’s difficult to look beyond residency because it is a daunting several years of training and no matter how often we that have gone through it advise med students and residents that it will get better, it’s still something that is just hard to grasp. And these are improtant questions as you’re going through the training as this will be your job for the next 20-30+ years. I love psych and I had similar questions about EM as I had worked as an ER tech for several years as a premed and can’t into school supremely confident that was my speciality of choice. But this might shifts already started weighing on me in my 20’s as I love my sleep and a regular sleep schedule. I am so glad I chose psych. Beyond my enjoyment of really getting to know patients and watching them grow and improve over time, the lifestyle is really hard to beat. You can work less than 40 hrs and make 250-300K. You can work more and make 5-600+ if you wanted to. I’m currently in my first year in civ practice (was Air Force for a few years and got out last summer). I work 40 hrs, 4 days of 10 hrs with a 3 day weekend every weekend, adult outpatient doing med management, TMS, IV ketamine, and I’m pace to make between 350-400. Other psychiatrist working this practice make 5-600 most years but the average is 3-400. If you want to work inpatient, there are jobs where you can see your patients in the morning and leave when the work is done by 1-2 pm, make 3-350. Patients you will typically see lower will likely be lower ses and chronically ill patients. I don’t see a lot of smi in my clinic and generally are a healthier population than what you’d see inpatient. The ego thing never really appealed to me as far as being a glamorous surgeon. Personally I wouldn’t put too much into it. Psych is a great field, generally happy docs and less burnout than a lot of other specialties.
 
You sound a lot like me.

I was also a pianist in my earlier years, and even got a music degree. In high school, I wanted to become either a surgeon or a pianist.

Fast forward 10 years, I am now a psychiatry resident. I was motivated to pursue psychiatry for quite similar reasons as yours.

At this point, I cannot envision doing anything but psychiatry. I am still only a lowly resident though, so take that as you will.
 
I wanted to do surgery. I wanted to do procedures. I published in surgical journals during medical school, ready to do it. I had my LORs from surgeons ready.

I then realized that I hated standing for more than an hour.

Then I realized that I like life outside of work too. There's not enough time to do all the things I'm interested in.

I cherish spending time with my family, but hard to see that as a med student sans spouse/kids.

I chose psych and very happy. You can make $400-450k salary in psych if that's a goal of yours. I make more than that without working 55 hours, but YMMV. Seeing psych patients for 40-55 clinical hours a week is also a grind, not to mention messages and refills from outpatients.

You can be an ENT surgeon and not work 60 hours a week though. You can work 40 hours a week if you choose. ENT is more lifestyle friendly. So is urology, ophthalmology, breast, bariatrics, plastics esp hand and you get to sit for that, and even vascular (I know one who works just one or two grueling weeks a month and take the pay cut for the rest).
 
You don't sound like you're actually interested in psychiatry other than the lifestyle. It's not worth it for that alone. There are other specialties you can find a good lifestyle in as well.
 
Do ent. That's starting salary what you quoted. Youll be pushing close to high 6 figs easy. Retire by 50 in ent easy
 
If you pick one of these and decide to switch to the other, it's a lot easier to switch from surgery to psych

You could work for 15 years as a surgeon and build up your next egg then go back and do a psych residency and work another 25 years as a psychiatrist part time
 
clozareal said:
I wanted to do surgery. I wanted to do procedures. I published in surgical journals during medical school, ready to do it. I had my LORs from surgeons ready.

I then realized that I hated standing for more than an hour.

Then I realized that I like life outside of work too. There's not enough time to do all the things I'm interested in.

I cherish spending time with my family, but hard to see that as a med student sans spouse/kids.

I chose psych and very happy. You can make $400-450k salary in psych if that's a goal of yours. I make more than that without working 55 hours, but YMMV. Seeing psych patients for 40-55 clinical hours a week is also a grind, not to mention messages and refills from outpatients.

You can be an ENT surgeon and not work 60 hours a week though. You can work 40 hours a week if you choose. ENT is more lifestyle friendly. So is urology, ophthalmology, breast, bariatrics, plastics esp hand and you get to sit for that, and even vascular (I know one who works just one or two grueling weeks a month and take the pay cut for the rest).
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I would push back on this some. My SO is a surgeon and thus I spend a lot of time with surgeons and the lifestyle of many of the surgical subspecialists pales in comparison to mine. Reviewing countless job offers and what jobs these surgeon's actually have, they almost all have a significant call element that is not possible to simply not take for reduced compensation. Surgical call, even for subspecialties with far fewer surgical emergencies, is still a painful process of getting woken up in the middle of the night and having to go in from time-to-time. When you are also getting woken up for kids, it absolutely is grueling. Many of the female surgeons I know elected to not have children as a result, including a few that would be great parents, even in a stable marriage to a man who wanted children.
 
I was also between psych and surgery.

When it came down to it, I knew deep down that I enjoyed both. Yes, I loved working with my hands and loved the idea of entering the "arena" aka anatomy, to do a new case of the problem. I enjoyed the skill, learning curve, hell I even loved scrubbing my hands before a case. Something ritualistic about it that made me mentally feel ready for the case and feel locked in.

However, I knew deep down that the love I had for surgery may wear off after the 1500th case. After my 1500th lap appy, or 1500th parathyroidectomy, I knew there would be some feeling I wouldn't get again. I also knew that would not be the case with psychiatry. That after 15 years, I would not be concerned about seeing another patient with schizophrenia as I would be doing one more Nth of a procedure.

I decided psychiatry and never looked back. Best decision I ever made. A lot of the "surgical thinking" made psychiatry very enjoyable for me. However, looking back I think I didnt "have to" be in the OR, and that was a critical distinction that my gut was telling me.

Best of luck.
 
Yep - so I would do a bit of soul searching to answer the question - do I have to be in the OR? If yes, then move forward and don't look back.


skimm said:
This sounds a lot like me. Something about the ritualism, rigidity, developing the fine motor skills, etc. feels very satisfying. I certainly feel more in the zone in the OR than rounding on psych patients, but as you're saying, I feel that may wear off to the point where either is just a job, and I might prefer to not be forced to lock-in and be confined to the OR or speedrunning ENT clinic.
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I never had any desire to be in an OR. I have been a happy psychiatrist for almost 4 decades. I can't imaginer letting income make this decision. Any doctor can retire at 50 if you live below your means to a degree that allows this and makes it your standard of comfort. Comfort is defined as both spending power, but also enjoyment of job. Both have intolerable bottoms, and both can foot the bill. You might be surprised how much 50+ hours a week of misery can be hard to justify with income. To be clear, if you don't like psychiatry, don't go into it. It can also make you miserable. If you like it, don't let your parents talk you out of it. If you are married or in a serious relationship, don't let this decision make you hate your family or you future spouse.
 
skimm said:
I can see how my post comes off that way, but I am very interested in it, the problem is moreso that I am also very interested in surgery. I will say that I found myself more intrigued and invested in my patients on my psych rotation than on any other, and thinking back I was more often telling my partner/friends about the interesting psych patient I saw that day than telling them about the cool surgery I scrubbed in on. Part of me feels that the intriguing nature of psych and the greater connection/empathy component of it may be longer lasting than the "coolness" of surgery - as it stands I find it exciting just throwing a subq after a c-section, but that's sure to wear off quickly.
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Psychiatry has its bread and butter too. I'm just a little burned out at the moment, but frankly certain populations or diagnoses can be exhausting to deal with and it's not rewarding after the 100th time you've dealt with it. You'll see great cases that break it up, but I'm sure that happens in surgery too. I don't want you to think that psychiatry is all "ooh and ahh" all the time just because you're talking to people. Consultations have delirium ad nauseum, ED with the homeless population abusing your resources, it goes on and on.

I don't have much else to contribute other than most people's flowchart for what specialty someone should go into typically leads with "surgery" or "not surgery." If you can live without it, you should.
 
skimm said:
This sounds a lot like me. Something about the ritualism, rigidity, developing the fine motor skills, etc. feels very satisfying. I certainly feel more in the zone in the OR than rounding on psych patients, but as you're saying, I feel that may wear off to the point where either is just a job, and I might prefer to not be forced to lock-in and be confined to the OR or speedrunning ENT clinic.
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Being in ent you don't have any mid level threats. Yes the residency will be tougher but only 1 year longer. You'll make 3x the income of psych unless you hussle and push 50-55 hrs in psych doing multiple gigs which then negates the lifestyle your looking for but still 1.5x the salary for ent.

If you want to maximize income and not deal with mid levels and work hard your first 10 years in ent you can be semi retired by 40-45.
If your heavily interested in psych and ok with 300k then go psych. If you want to make in the 700-900 range and possibly more after a few years in ent you can be as busy as you want or scale back. Good luck
 
I have seen a few med students fall into this trap. At least in my institution, attending finish rounding at noon but they are not "chilling in the office". They usually have more attributions, like taking care of legal cases, or covering colleagues, or doing their own legal paperwork, or talking to insurance or something in between. There are often endless meetings or random issues with nursing staff. 12-4pm it not the hardest job ever, to be clear, but it is also not watching 4h of Netflix (at least not here).

I am not saying not to do psych, but I see people choose it for that. Also, many psych clinics are run at 15min appointments, which is exactly what you don't like. Yes, most are 30min because of 90833 code, but that could change in the future.

By how much things are getting expensive, if you have a partner that has a good income, I think psych is great. If you are going to be a sole provider and want 3 kids, maybe consider ENT.
 
Surgery is much more immune to AI if that’s important to you
 
voxveritatisetlucis said:
Surgery is much more immune to AI if that’s important to you
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This is not really a reason to choose one over the other. As someone who has been in a machine learning lab working with medical imaging and robotic surgery for years, AI-guided robotic surgery has a very promising future. In either case, neither specialty is going to be replaced by AI in the near future so this should not be a major factor in the decision.
 
skimm said:
ENT salary is higher but not routinely 3x psych - median 480k vs 310k with ENT working 6-7 more hrs/wk. Roughly 290k vs 200k after taxes. Considering the opportunity cost for ENT of taking an extra research year in medical school and an extra year of residency (assuming I go generalist with no fellowship), by age 45 that's 3.8m for ENT vs 3m for psych, or 11m vs 8m by age 70.

The investing power of the extra ENT salary will make that disparity larger, the ENT numbers could be deflated from early-career low starting salaries in PP compared to psych being more stagnant, and the ENT ceiling seems to be higher. Overly simplified numbers, but the point remains as to whether a few more Ms makes up for two more years of training, a considerably more brutal residency during the remaining years of my 20s, and the somewhat more intense lifestyle as an ENT.

Having gotten to know the ENT residents at my institution well, their lives are somewhat hellish, whereas the few psych residents I've met seem significantly happier. I don't mean to downplay the rigor of psych training, but I figure the considerably lighter residency may set me up to have the energy to grind for that 400k+ as well as give me downtime to learn the ins and outs of PP.

Mid-level threat is actually one of the biggest deterrents to psych for me, but ultimately it's impossible to know how that will play out, and I find it hard to imagine psych will tumble too far down even with increasing NPs given the huge demand for psychiatric care. I think certain individuals will always pay for an MD regardless, and the low barrier to PP provides an accessible means of accessing this population.

As long as I have the opportunity to make 350-450k in psych working 40-50 hrs/wk, I can't imagine myself regretting psych for that reason. However, if anyone sees in their crystal ball an APP takeover and plummeting compensation in the future, please let me know.
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If u work for a hospital then the numbers u quoted could be true for ent. My friends and family are all in 700 + esp cause u can get ancillary fees in pp with some surgery centers. If ur working hard 1m isn't that uncommon.
 
finalpsychyear said:
Being in ent you don't have any mid level threats. Yes the residency will be tougher but only 1 year longer. You'll make 3x the income of psych unless you hussle and push 50-55 hrs in psych doing multiple gigs which then negates the lifestyle your looking for but still 1.5x the salary for ent.

If you want to maximize income and not deal with mid levels and work hard your first 10 years in ent you can be semi retired by 40-45.
If your heavily interested in psych and ok with 300k then go psych. If you want to make in the 700-900 range and possibly more after a few years in ent you can be as busy as you want or scale back. Good luck
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I work 40 hours per week, off every Friday, no call, nights, or weekends and am on pace for 400 in an outpt psych clinic. A few psychiatrists within the same group are making 5-700K. These jobs are out there for psych although not as common as ent making upper 100’sK. But I knew pretty quick in med school anything in surgery wasn’t for me.
 
skimm said:
Having gotten to know the ENT residents at my institution well, their lives are somewhat hellish, whereas the few psych residents I've met seem significantly happier. I don't mean to downplay the rigor of psych training, but I figure the considerably lighter residency may set me up to have the energy to grind for that 400k+ as well as give me downtime to learn the ins and outs of PP.
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Lol, don't feel bad. Psych is not rigorous at all compared to most other specialties. If a psych resident is working as hard as their IM or neuro counterparts it's either a high-work program or a very chill IM program. People may disagree, but imo <50 hrs/wk is not rigorous work, and that should be true for most psych residencies out there.
 
DOswag said:
I work 40 hours per week, off every Friday, no call, nights, or weekends and am on pace for 400 in an outpt psych clinic. A few psychiatrists within the same group are making 5-700K. These jobs are out there for psych although not as common as ent making upper 100’sK. But I knew pretty quick in med school anything in surgery wasn’t for me.
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In your clinic (and similar types), do you know if there are people 100% remote? I ask because you are describing a job that seems perfect to me: a large practice with few psychiatrist, getting paid by production. Sounds great, but for specific reasons I will need a remote job and I was wondering if private clinics would be interested. Don't really know how I could find them tho.
 
voxveritatisetlucis said:
Surgery is much more immune to AI if that’s important to you
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You don't think Psych is protected from AI encroachment? A huge part of therapeutic benefit comes from rapport, whether it's therapy or even meds alone.

Midlevels are where I would say surgery has an edge over Psych though. Way too much risk for midlevels to be doing surgeries independently anywhere near the scale that they handle psych patients independently.
 
brazilianpsych said:
In your clinic (and similar types), do you know if there are people 100% remote? I ask because you are describing a job that seems perfect to me: a large practice with few psychiatrist, getting paid by production. Sounds great, but for specific reasons I will need a remote job and I was wondering if private clinics would be interested. Don't really know how I could find them tho.
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Our practice does not do remote except for certain circumstances (such as one psychiatrist left a clinic and they had someone else from a different clinic cover via Tele health until they hire another one). There are remote jobs out there but probably not making as much as we do a lot of TMS/ketamine. Pretty sure there are some remote that make 300+ though.
 
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