Advising Undergrads Interested in Psychiatry

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DynamicDidactic said:
I have a few psychology majors interested in pursuing med school training to become psychiatrists. Any resources, information, and advice is welcomed.
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Biggest piece of advice is that they need to want to become a physician, not just a psychiatrist. That means they're going to have to learn all of the biochemistry, physiology, pathology, anatomy, etc of every body system and rotate through numerous fields like OB/Gyn, surgery, IM, EM, etc. It will be a minimum of 4 years before they actually get to focus on psychiatry and it will likely be longer as they will still have to rotate through non-psych fields (IM, neuro, geri, etc) during intern year of residency depending on the program (minimum 4 months of non-psych per ACGME requirements).

I love psychiatry and have been enjoying residency a ton so far. However, if I hadn't wanted to be a physician I would have been completely miserable for the past 4.5 years. I'd willing to bet that if I hadn't wanted to be a medical physician before discovering psychiatry I would probably say it wouldn't be worth it. So my advice to them would be to make sure they actually want to study MEDICINE and not just psychiatry.
 
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Excellent post by Stagg737. If I were to add anything, I might include a discussion about what they ultimately want to do in their day-to-day work. If they want to do mostly therapy or psychological testing, I would suggest becoming a psychologist. If they wish to prescribe medications and be responsible for their patients' physical health (including all that can go wrong with medications), then become a psychiatrist. Taking call is something else to consider. I honestly don't know if psychologists are expected to routinely take call overnight and work weekends, but in residency, and in fellowship, and in my current position as an attending, that's a regular part of the job. I do enjoy being a psychiatrist, at least during my regular 8-5 hours Mon-Fri, but at night and on weekends I sometimes envy the psychologists in our practice.
 
SpongeBob DoctorPants said:
Taking call is something else to consider. I honestly don't know if psychologists are expected to routinely take call overnight and work weekends, but in residency, and in fellowship, and in my current position as an attending, that's a regular part of the job.
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Small percentage do, but this is usually people working in crisis situations. Knew a few people who would work consult services for an ED and get called in on certain psych cases at all hours. Still, fairly low number and it's usually something a psychologist seeks out. Why, I have no idea?
 
Just to echo the above--this field is becoming more and more technical in nature (personally, I'm not sure if this is a good thing, but it is what it is) and not necessarily a good fit for people who come mainly from a psych background. I would add that undergrad training in statistics and pharmacology, and some econ/business training are more important these days for this field than a typical undergrad psych[ology] curriculum.

I've been working on a project that requires having some discussions with psychiatrists nationwide on some practice oriented issues, the general vibe is that the therapy facet is dying a very hard death. People still like to talk about it, yes, but a typical psychiatrist these days feels like any other cognitive specialty MD in their day to day (i.e. a LOT of practice management stuff, supervising midlevels, outcome optimization, insurance, etc). Clinically also tends to be either high volume or very niche. It's not a good fit for people who are looking for a more humanistic career. I think if you don't plan to become a physician in a conventional sense (even beyond the residency training period), being a psychiatrist is more often than not a terrible career choice, unless you "luck into" one of those jobs that's mainly therapy, which is really not the norm--and even then, anecdotally I feel that psychiatrists who do a lot of therapy are typically extremely specialized as well.
 
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I have no experience with this. I took a test in India to get into medical school. At that time I had no idea what specialty I wanted to go into. A couple years later I decided to practice in the US and I knew I had few specialties to match into. I picked psychiatry because I could actually see myself enjoying the work.
 
sluox said:
Just to echo the above--this field is becoming more and more technical in nature (personally, I'm not sure if this is a good thing, but it is what it is) and not necessarily a good fit for people who come mainly from a psych background. I would add that undergrad training in statistics and pharmacology, and some econ/business training are more important these days for this field than a typical undergrad psych[ology] curriculum.

I've been working on a project that requires having some discussions with psychiatrists nationwide on some practice oriented issues, the general vibe is that the therapy facet is dying a very hard death. People still like to talk about it, yes, but a typical psychiatrist these days feels like any other cognitive specialty MD in their day to day (i.e. a LOT of practice management stuff, supervising midlevels, outcome optimization, insurance, etc). Clinically also tends to be either high volume or very niche. It's not a good fit for people who are looking for a more humanistic career. I think if you don't plan to become a physician in a conventional sense (even beyond the residency training period), being a psychiatrist is more often than not a terrible career choice, unless you "luck into" one of those jobs that's mainly therapy, which is really not the norm--and even then, anecdotally I feel that psychiatrists who do a lot of therapy are typically extremely specialized as well.
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Are you mainly talking to institutional psychiatrists? Most private cash psychiatrists (a large % now) have much lower volume and incorporate therapy.
 
TexasPhysician said:
Are you mainly talking to institutional psychiatrists? Most private cash psychiatrists (a large % now) have much lower volume and incorporate therapy.
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That's TRUE to an extent. While doing this project we interviewed both institutional and private doctors. Private doctors do do a lot more therapy in general, but the vast majority of their work--and the portion in demand is the medication portion. Also, it also seems as if many of the MD groups where therapists also exist, MDs rarely do therapy. Institutionally it's very rare, and a lot of organizations are moving in that direction (i.e. managed care, etc).

Is it possible to be doing mostly therapy--yes I think it is. But I think it's gotten a lot harder, and I suspect it'll get harder yet. The field is really getting much much much more medical in the last 10 years...
 
I thought the last couple years saw an increase in private psychiatrists incorporating at least supportive therapy seeing as a 99214+30min therapy add on code for a 30min appointment pays fairly well?
 
Armadillos said:
I thought the last couple years saw an increase in private psychiatrists incorporating at least supportive therapy seeing as a 99214+30min therapy add on code for a 30min appointment pays fairly well?
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I think this made it easier to bill for longer med mgmt sessions--but I think an undergrad psych major who is interested in a career in psychiatry to primarily do humanistic psychotherapy is gonna be very throughly disappointed by the 15 min (add-on) therapy. Plus, even then this is not an "average job". The 15-min "supportive therapy" is very often more about case management, family meetings, etc.

I know a lot of analysts personally actually, and the trend I'm seeing is going backward: lots of MD analysts are dropping out of analysis practices and resuming psychopharm practices, because few people are interested. There's low demand because you can get therapy from literally anyone these days and super cheaply too. You just need a masters (not even in social work) and you can do therapy. It's all dictated by supply and demand. This field is increasingly about managing relatively sick people on fairly complex med regimens from PMD referrals and case management--in facilities it's also not uncommon where all the easy cases are going to NPs. As things like TMS/depot injections, etc gets more widespread it'll go even more in that direction.
 
Stagg737 hit it on the nose. Psychiatry is different than psychology. You’re time in medical school will mold you to think and act as a physician regardless of what specialty you fall into. Vastly differing approaches to psychology. In my opinion medications are our main treatment, augmented with psychotherapy. Kind of like a kickboxer’s hands.
 
To add on to my post, I love psychiatry but I do think there are other fields I could have been happy in. My program has 4 months of IM, and while those rotations were more time intensive and fast paced than my psych rotations, I still enjoyed them (most of the time). Though I'm thrilled with my field and very happy that I get to be a psychiatrist, I do think I could have been happy in IM, EM, PM&R, and a few surgical fields as well.

I think there's a certain maturity required for those with a psychological education to pursue medicine. I do not think an undergrad psychology major who wants to practice mostly or exclusively therapy would benefit from becoming a physician; and I would not encourage that route. I think if an individual has gone through school and has obtained a degree that allows them to utilize psychotherapies to treat patients, has practice for 5-10 years, and still has a yearning to pursue psychiatry to be a more well-rounded clinician then I think one could make an argument for encouraging those individuals to pursue the path to being a physician so long as they understand the path ahead of them.
 
One of my students mentioned that she has been told to avoid mentioning psychiatry in her materials and interviews. Does that sound accurate (remember this is coming from an undergrad)?



On a separate note, I am a bit surprised that many of the replies were discussing the issue of psychotherapy. I don't think my students are interested in psychotherapy but are indeed interested in being physicians. Very little of an undergrad's psychology courses will include anything relevant to clinical practice. Typically, a single lecture in an Intro class (most likely reviewed by someone that isn't a clinical faculty), usually an Abnormal Psychology course is offered, and it can vary widely after that. Maybe an institution offers 1 or 2 other clinically related courses (not the case when I was an undergrad but is the case where I teach now). If anything, I would think this generation of undergrads has had more exposure to psychopharm than psychotherapy and probably watch a lot of medical dramas. The students interested in psychotherapy typically don't ask about psychiatry.
 
DynamicDidactic said:
One of my students mentioned that she has been told to avoid mentioning psychiatry in her materials and interviews. Does that sound accurate (remember this is coming from an undergrad)?
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I just got accepted into med school for this cycle -- I mentioned my interest in psychiatry, and it did not seem to be an issue. Granted, I have experience working with people that have mental illness, and I am a non-trad applicant. So not exactly an undergrad -- but I think if she has relevant experience and can communicate that she is interested in medicine and psychiatry, then she should be fine.

I have been told that focusing too much on mental health will make admissions counselors ask "Why not become a therapist?", so it's important to emphasize one's interest in the larger medical field.

Just my two cents.
 
sluox said:
Just to echo the above--this field is becoming more and more technical in nature (personally, I'm not sure if this is a good thing, but it is what it is) and not necessarily a good fit for people who come mainly from a psych background. I would add that undergrad training in statistics and pharmacology, and some econ/business training are more important these days for this field than a typical undergrad psych[ology] curriculum.

.
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Serious question: how? How is it getting more technical, unless I'm missing the big advances that have made it from research into the clinical world in the last 20 years.

I still think the biggest asset you can bring to the field is both an educated and intuitive understanding of how people tick, even if you're not planning on doing psychotherapy. A grounding in the humanities/behavioral sciences is really the missing link in our training. (which is not saying that technical knowledge isn't a prerequisite).
 
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Stagg737 said:
Biggest piece of advice is that they need to want to become a physician, not just a psychiatrist. That means they're going to have to learn all of the biochemistry, physiology, pathology, anatomy, etc of every body system and rotate through numerous fields like OB/Gyn, surgery, IM, EM, etc. It will be a minimum of 4 years before they actually get to focus on psychiatry and it will likely be longer as they will still have to rotate through non-psych fields (IM, neuro, geri, etc) during intern year of residency depending on the program (minimum 4 months of non-psych per ACGME requirements).

I love psychiatry and have been enjoying residency a ton so far. However, if I hadn't wanted to be a physician I would have been completely miserable for the past 4.5 years. I'd willing to bet that if I hadn't wanted to be a medical physician before discovering psychiatry I would probably say it wouldn't be worth it. So my advice to them would be to make sure they actually want to study MEDICINE and not just psychiatry.
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I can probably offer a somewhat different perspective.

I agree with Stagg that you have to be interested to some degree in science and medicine. You also do have to be interested in being a physician. In a logical sense, he’s right that as a psychiatrist you are a physician first and a specialist second. That being said, the desires to be one or the other don’t have to come up in in a particular temporal order.

I knew since I was in early high school that I wanted to be a psychiatrist (not a psychologist or something general in terms of mental health, but a psychiatrist). In that sense I also knew I wanted to be a physician but a big part of wanting to be a physician to me was wanting to be a psychiatrist. That said, going into medical school, I happened to like medicine in general enough that I saw it as possible that I might actually enjoy something more than psychiatry. Still, I was pretty sure of what I wanted to do.

So overall, I don’t really disagree that you have to have some interest in medicine generally to make it through med school and internship. However, it is possible to reasonably be drawn to medicine because you’re drawn to what a psychiatrist specifically does. It’s just that you need to be sure that the actual process of getting through med school isn’t going to bore the hell out of you and make you quit.
 
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