Alternative Professions for Graduating Psychiatrists

[LasVagus]

I am nearing the end of my third year of psychiatry residency and, more and more, I find myself hating my job. I don't think that I would be better off in another area of medicine, but rather I feel that I am not quite wired to be a practicing physician of any kind. The combination of the thick bureaucracy, the CYA medicine, the malingering, and the pre-contemplative substance abusers has become too much. I was curious as to whether the wise folks on the boards can think of any other profession my training might put me in a position to do when I graduate residency next year. The only thing that I can think of is working for an insurance company, but I assume there are other possibilities. For what it's worth, money is not too important to me, I am not married, and I have no children. In other words, I have quite a bit of flexibility on this.

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[Shikima]

Get you MBA and become a CEO.

 

[MacDonaldTriad]

I was going to say that there are many management jobs for MDs in large systems, but then you said you hate bureaucracy. Maybe a sleep fellowship can take you to places away from malingering and substance abusers. There is also pain, but that wouldn't shield you from what is bothering you now all that well.

 

[FlowRate]

Do you have other skills? Informatics is a lateral move and a developing field. Do you have a brand degree or interest in business stuff? Could get MBA or could go straight to consulting and test the waters. Live in the bay area or another large tech area? Could try to hook up with some startups.

 

[northernpsy]

The tough thing about answering these kinds of questions is that our training is geared towards preparing us for a specific kind of job, so you have to forge your own path if you want to go in a different direction.

If I were you, I'd look for a part time psych job (maybe in telepsych doing something in a job where there isn't an expectation of continuity since I find continuity with patients I dislike drains me worse than one-off encounters do) after graduation just to pay the bills while you figure out what direction you want to go in. Maybe if you cut back to part time you'll find it's easier to tolerate the crappy aspects. If you can afford it, I'd also ask the job to let you start a few months after you graduate so you can take some time just to relax and recover from residency. You could definitely be a bit burnt out and just having some time to rejuvenate yourself might help a lot.

 

[Armadillos]

You could consider trying to work for an EMR company like EPIC. Or work for the government in a nonclinical role at FDA. If you want something very different could consider the CIA.

 

[hamstergang]

I know someone who hated clinical psych so went to work for pharma and loves it.

 

[TexasPhysician]

One of the reasons I chose psych was the diversity of medical roles.

Is it possible that you are just a bit burned out at your program?

Real world psych can be whatever you wish. You could work at an addiction center where everyone is treating the substance abuse. You could do private practice and screen out whatever you wish. You could do locums 1 week/month.

You could also work 1-2 days/week while trying starting an unrelated business or career.

As I've never worked 40 clinical hours/week, I've considered picking up a real estate career. That may happen one day, but right now my children are too fun and distracting.

 

[PistolPete]

You sound burned out. When you're out in PP maybe you could just work 2-3 days per week and hand pick your patients?

What about teaching at a medical school? No patients, just teaching. Beaurocracy may be there though.

 

[michaelrack]

I was going to say that there are many management jobs for MDs in large systems, but then you said you hate bureaucracy. Maybe a sleep fellowship can take you to places away from malingering and substance abusers. .

In sleep, there still is insomnia, and the potential for substance abuser- persons seeking benzo's or stimulants. But not too bad. Sleep can be a nice side gig but to do sleep as a full-time W2 job working for a hospital or a national sleep chain would be soul-crushing. A lot of paperwork and a real grind.

 

[kitsens]

I think you have many many options ahead in medicine and outside of medicine. Finish your residency , finish the Board exam soon after, keep yourself agile and expenses low as best as you can and take a year or two or three to settle into post residency life. If that means locums or working one week out of the month , you'll still at least make a bit above a resident and you can take it from there.

 

[MacDonaldTriad]

You sound burned out. When you're out in PP maybe you could just work 2-3 days per week and hand pick your patients?

What about teaching at a medical school? No patients, just teaching. Beaurocracy may be there though.

It will be there in spades with a little added malignant competition, but not too bad. You have to like to teach and not need more money to make this worth it.

 

[Merovinge]

I am nearing the end of my third year of psychiatry residency and, more and more, I find myself hating my job. I don't think that I would be better off in another area of medicine, but rather I feel that I am not quite wired to be a practicing physician of any kind. The combination of the thick bureaucracy, the CYA medicine, the malingering, and the pre-contemplative substance abusers has become too much. I was curious as to whether the wise folks on the boards can think of any other profession my training might put me in a position to do when I graduate residency next year. The only thing that I can think of is working for an insurance company, but I assume there are other possibilities. For what it's worth, money is not too important to me, I am not married, and I have no children. In other words, I have quite a bit of flexibility on this.

What parts of psychiatry do you/did you like? This would help in giving better advice. I think locumming 10 days/month somewhere would be a great fit right out of training, my friend did this who's not exactly 100% in love with her field and it's been amazing for her.

 

[Candidate2017]

Wouldn't cash pay screen out bureaucracy, malingering and unmotivated substance abusers? There's also the possibility that moving to a different geographic and socioeconomic area will yield a patient population that's different from your residency.

 

[wysdoc]

Counseling center at a college, neuropsychiatric testing for learning disabilities (mostly pediatric but could run through college age), as a couple more ideas

 

[F0nzie]

You can be the prior auth guy


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[dl2dp2]

Wouldn't cash pay screen out bureaucracy, malingering and unmotivated substance abusers?

Not if the well-to-do parents are paying for it.

But yes, if you do cash you will get a different flavor of patients compared to during residency training, but I wouldn't say that it's a panacea with these issues.

 

[MacDonaldTriad]

Joint Commission site visitor, or ACGME site visitor (CLER as well). You would need some experience, but this is the best sublimation for regulatory agency fatigue.

 

[OldPsychDoc]

You can be the prior auth guy

What's the going rate for selling a soul these days?

 

[st2205]

OP doesn't like bureaucracy and we suggest being a PA doc?

 

[randomdoc1]

I work part time for a private practice that gives me a TON of autonomy. So that helps a lot. Also, since you say you are in residency, you may be getting a very different flavor of patients and possibly a very limited exposure to a select population. I remember when I trained I saw a lot of Medicaid and uninsured. So there were a lot of train wrecks, people with a lot of comorbid medical problems, unmotivated people. There is still plenty of that at the VA. But in my private practice most of my people are middle to upper middle class, motivated, bread and butter diagnoses (e.g. depression, anxiety, etc.). For example, I get patients like the married RN with GAD or college student at a first tier university who developed MDD. It is very rewarding and you may still find a good niche for yourself somewhere. I am trying to build up my practice more so I can do all private. And the nice thing about it is that you can pick and choose who you want to see.

 

[industrialengineer]

Counseling center at a college, neuropsychiatric testing for learning disabilities (mostly pediatric but could run through college age), as a couple more ideas

This type of testing is not done by psychiatrists. It is done by neuropsychologists.

 

[LasVagus]

Thank you for all of the thoughtful comments. It has really helped to get my wheels turning. It is certainly true that I am burned out. The deep question is whether I am just burned out or whether my recent demoralization is the product of a more fundamental dissatisfaction with the direction of my life. Time will tell.

I guess what really sticks out to me with reading the above comments is how I have been beaten down so much by medical school and residency and the robotic obsequiousness that both require, that it is hard for me to imagine ever having any control over my life. The broad theme that emerges from your collective wisdom is: Here are different ways you can structure your life (in other words: take control). That seems to be the appropriate attitude for me to adopt at this juncture, but it is also a jarring shift of stance from the fawning and submissiveness that is so heavily rewarded in medical education. It reminds of something else that I have read on the boards: that young physicians often will not negotiate their contract because they don't realize how much they're worth and how many options they have.

FYI: I did look at the positions listed on the CIA website. It doesn't tell you much about what you would do. This somehow makes it more intriguing. Haha. Have a great day everyone!

 

[Merovinge]

FYI: I did look at the positions listed on the CIA website. It doesn't tell you much about what you would do. This somehow makes it more intriguing. Haha. Have a great day everyone!

CIA/FBI recruiting is (obviously) intentionally pretty cryptic. I had a friend interview and all I can say is make sure you are ready for a polygraph, do not smoke weed or do any illicit activities, and have no skeletons in the closet. For the right person, I could see it being a good fit, that right person is just 1 in 1,000,000.

You are in a much better position than you think though, feel free to PM people here, lots of young docs just getting out of training.

 

[SmallBird]

This type of testing is not done by psychiatrists. It is done by neuropsychologists.

It is mostly done by neuropsychologists but it is absolutely also done by child psychiatrists and developmental pediatricians! We don't have close to enough neuropsychologists taking insurance to handle all of this. I am aware of child psychiatrists in my area who will administer the MULLEN, WISC, ADOS, etc. I got trained to do some of these during my residency and one of my colleagues does almost exclusively developmental testing for ASD.

Another thing for which there is a good market is school consults. These can pay very well, and the bureaucracy is minimal since typically you will have a contract with a district and get paid per eval. If you are able to type reports quickly it can be a great gig, although I've heard people say they can complete two evals and reports in a day, and others say they need several hours just to write the report! I would think that almost everywhere CAP training would be essential for doing this, but its certainly a way to diversify from day-to-day outpatient or inpatient work.

 

[Merovinge]

It is mostly done by neuropsychologists but it is absolutely also done by child psychiatrists and developmental pediatricians! We don't have close to enough neuropsychologists taking insurance to handle all of this. I am aware of child psychiatrists in my area who will administer the MULLEN, WISC, ADOS, etc. I got trained to do some of these during my residency and one of my colleagues does almost exclusively developmental testing for ASD.

Another thing for which there is a good market is school consults. These can pay very well, and the bureaucracy is minimal since typically you will have a contract with a district and get paid per eval. If you are able to type reports quickly it can be a great gig, although I've heard people say they can complete two evals and reports in a day, and others say they need several hours just to write the report! I would think that almost everywhere CAP training would be essential for doing this, but its certainly a way to diversify from day-to-day outpatient or inpatient work.

School consults are great and one can absolutely do 2 in a day and still do them justice. Key is to be a good dictator to minimizing the charting time. We do them 30 min with staff, 60 min with pt, 60 min with family, 30 min recommendation with staff. If you can do the report in 30 minutes (it took me 60 as a trainee but I could easily get this down if it wasn't my first foray into them) then you can plug 2 in a 7 hour day with 1 hour lunch. Agree with ADOS being very doable if trained for CAP and Developmental peds (who do almost all of them around me, although my agreement with their results is a different story...).

 

[masterofmonkeys]

DOC

 

[SmallBird]

Agree with ADOS being very doable if trained for CAP and Developmental peds (who do almost all of them around me, although my agreement with their results is a different story...).

Not to derail the thread but couldn't agree more about the reliability of an ADOS, particularly if done in isolation - it has a status as the 'gold standard' but if you have to choose between a developmental history and and ADOS you should always pick the developmental history. Its a great way to describe a phenotype that has a number of causes other than ASD...

 

[Nasrudin]

You can be the prior auth guy


Sent from my iPhone using SDN mobile app

hahaha.

 

[Shikima]

Disability claims.

 

[medhead1990]

Counseling center at a college, neuropsychiatric testing for learning disabilities (mostly pediatric but could run through college age), as a couple more ideas

To quote the great Ben Stiller. "Help kids who want to read good, and do other stuff good too" 🙂

 

[Therapist4Chnge]

.... make sure you are ready for a polygraph, do not smoke weed or do any illicit activities, and have no skeletons in the closet.

The 3 letter agencies have softened their stance on a history of drug use in the past 10-15 years. They are most concerned with honest and consistent answers, though current use is still a no-no. The invasive background check can be a hassle and takes quite a few months. I'd be curious how they'd view student debt, as a red flag for all of them is financial standing bc ppl can be compromised more easily when money is a problem. Just my 2 cents from prior recruitment back in the day.

 

[medhead1990]

MBA to CEO was mentioned a few times in this thread. If you would still like to keep up on some of your psych skills and do some business, one of the better fusions would be a masters in organizational behavior.

This can end up in a few different roles most notibly something within a HR department, consulting (usually hr related stuff such as employee satisfaction, motivational psychology etc.), or c-suite where you end up as COO. This was going to be my backup career if I didn't end up in med school.

 

[J ROD]

After having 2 "real" jobs, I know residency is not a "real" job. More like med school. Just wait until you get out into the "real" world and evaluate the various options. I have known plenty of residents that spoke like you above and now are happy with their professional job as a physician. Just get through this crap!

 

[DrCommonSense]

Do you have other skills? Informatics is a lateral move and a developing field. Do you have a brand degree or interest in business stuff? Could get MBA or could go straight to consulting and test the waters. Live in the bay area or another large tech area? Could try to hook up with some startups.

I think for consulting to pay close to medicine (possibly more) you need to get a TOP MBA or attend a top medical school program/residency. That is the reason I haven't taken the plunge yet for the MBA but it seems like a good idea. Also, its alot of work to get an MBA part time with expense but there is great opportunity cost for a full time MBA in terms of lost salary and price.

 

[psyguru]

Expert witness work. You don't need forensics training if you are specialized (i.e. psychopharmacology or medical director experience for malpractice) though I found it to be helpful.

One new field that opened up is brain injury medicine. You can get board certified without a fellowships. They have some part time fellowships in it I think. Just take a look at the various fellowship options.

 

[FlowRate]

I think for consulting to pay close to medicine (possibly more) you need to get a TOP MBA or attend a top medical school program/residency. That is the reason I haven't taken the plunge yet for the MBA but it seems like a good idea. Also, its alot of work to get an MBA part time with expense but there is great opportunity cost for a full time MBA in terms of lost salary and price.

All of those things are true. That's what I meant by brand (name, oops) degree.

But consulting isn't as easy as a lot of doctors think. They work significantly more hours than the average psychiatrist.

 

[Mad Jack]

I am nearing the end of my third year of psychiatry residency and, more and more, I find myself hating my job. I don't think that I would be better off in another area of medicine, but rather I feel that I am not quite wired to be a practicing physician of any kind. The combination of the thick bureaucracy, the CYA medicine, the malingering, and the pre-contemplative substance abusers has become too much. I was curious as to whether the wise folks on the boards can think of any other profession my training might put me in a position to do when I graduate residency next year. The only thing that I can think of is working for an insurance company, but I assume there are other possibilities. For what it's worth, money is not too important to me, I am not married, and I have no children. In other words, I have quite a bit of flexibility on this.

Go into private practice and only take cash.

>No bureaucracy
>Minimal CYA
>No malingering if you select your patients carefully
>Can screen your practice for substance abusers as you see fit

 

[Mad Jack]

I think for consulting to pay close to medicine (possibly more) you need to get a TOP MBA or attend a top medical school program/residency. That is the reason I haven't taken the plunge yet for the MBA but it seems like a good idea. Also, its alot of work to get an MBA part time with expense but there is great opportunity cost for a full time MBA in terms of lost salary and price.

It's not an opportunity "cost" if it results in higher wages. Of course, only top MBAs are going to pay off, and we're talking like top 10. Part time MBAs typically don't cultivate the sort of connections one needs to really hit the ground running in business, nor do one year programs.

 

[Armadillos]

All of those things are true. That's what I meant by brand (name, oops) degree.

But consulting isn't as easy as a lot of doctors think. They work significantly more hours than the average psychiatrist.

Also depending what sort of work your doing the travel and time away from home can be significant in consulting jobs. Psychiatry is somewhat rare among professions in that if you want to you can easily make 250k+ while sleeping in your own bed 365 days a year.

 

[nancysinatra]

My favorite book, The House of God, needs to be updated with a more modern take on the insanity of medical training. You could do that.