Am I on the right path?

[Psych305]

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Hey guys, I am hoping to get some perspective from current residents and attendings out there...

I had never thought about a career in Psychiatry before third year, but ended up being really surprised by how much I loved my third-year rotation. It felt like a breath of fresh air to actually focus on the patient and have time to genuinely learn about their lives and how mental illness has affected them. I find that what I like most about medicine is talking to the patients. Seeing very sick, psychotic patients improve within days from medication very rewarding. I decided to follow this experience with an elective. While I still enjoyed the work, I started to feel like maybe I wasn't being challenged enough professionally. The treatment options are limited. There wasn't a lot we could do for the patients and since they were mostly homeless and didn't have a lot of resources, they'd bounce back quite frequently within the time I was there. While it didn't bother me too much at the time, how do I know that 10 years down the road this won't wear on me and make me jaded? Also, I will admit that I am sometimes shy about admitting my interest in psychiatry because of the stigma, which I realize is silly but the stigma is there nonetheless. Sometimes I wonder if I will miss being more integrated in the field of medicine because psychiatry is more niche.

I think psychiatry is fascinating and rewarding, but are my reasons for wanting a career in psychiatry enough to find a satisfying career, or am I setting myself up for disappointment later? Did any of you have these types of reservations, and if so, how have they evolved over time?

Thank you so much for your input!

 

[MacDonaldTriad]

If you think psychiatry isn’t challenging, you still need to take a closer look at the practice of psychiatry beyond inpatient pharmacy decisions. I get that there are parts of psychiatry that you find exciting, but being discouraged by the futility is relative. Our illnesses are not like treating infection or an appendicitis, but it isn’t as depressing as neurology or oncology either. There are still many ways to be a hero in our field.

 

[Unico]

There are more options if you're interested in Psych, like double board certified programs in IM/psych, Neuro/psych, and FM/psych.

https://assocmedpsych.org/studentstrainees/

EDIT: Just realized you addressed this post to residents/attendings. Hopefully you find the information useful.

 

[deleted314290]

Helping to provide insight is very rewarding....

 

[Bartelby]

Personally I have not found psychiatry to be boring at all! There are frustrations in psychiatry for sure. I wish we knew more about the etiology of mental illness. I wish we had better tools for those patients who don't respond well to available treatments. I also wish that we had the social will to do things like provide basic housing for the mentally ill (and the non-mentally ill, frankly), and to provide more extensive community-based treatment options.

Despite all of that there is so much fascinating stuff to learn in psychiatry! You have seen a small slice of inpatient psychiatry. You can also work in a partial program, an addiction program, in consultation to a hospital, in consultation to primary care providers, in a specialty clinic, in jails and prisons, in forensic contexts, in a psychotherapy-heavy private practice, in teaching, in research, in ECT, in geriatrics, in neuropsychiatry, and on and on. You can hone psychotherapy skills across multiple schools of thought (CBT, ACT, dynamic, analytic, interpersonal, on and on), all the while getting to think about what makes a good life and what leads to reduced distress. As you've seen you get a window on people's lives that most do not have the privilege to get, and you get to apply and refine ways of using that knowledge to help people. I think it is possible to constrain yourself into boredom and a lack of fulfillment in psychiatry, but it certainly isn't inevitable!

 

[Blitz2006]

Well I'm a Psych resident, and bartelby has made some similar, echoing views to mine. Obviously our opinions on this forum are biased, pro psych, but I honestly think Psych is the most diverse field in medicine. You can literally do inpatient, ER, outpatient, rehab unit all in 1 week if you really wanted to mix it up. Research in psychiatry is presently cutting edge, neuroscience is probably the one area that we know very minimal about. You can get involved in pharmaceutical research if you get bored of clinical work after a few years.

I guess I live in a bubble, but I honestly think the stigma is slowly being stripped away, and I predict in 10-15 years psych/mental health will be pretty much on par with having no stigma. But I'm sure I'll get flamed for that statement, but whatever.

Best part of psych is that you can do so many different types, ranging from ER to Forensic to Addiction. If you really miss "medicine", then go into CL or Geriatric. To be honest, here in outpatient psych, we do a lot of what PMDs do (monitor Hba1C, thyroids, Blood pressure, weight, etc, its a requirement because of psychotropics) If you love neurology, go into neuropsychiatry or sleep medicine. If you like doing procedures, go into pain management. You can be a pain doc doing vertebroplasties, epidural, spinal cord stimulators, scrub into cases with neurosurgeons if you really want to. Theoretically, you could spend 3 days doing ECT, 3 days do epidurals. Pretty cool, and I can't imagine why anyone would have "stigma" from doing brain stimulation/spinal cord injections. Whole spectrum in psych.

The scary part is, about 80% of psych residents don't even know about the existence of neuropsych fellowship, as well as the fact that psychiatrists can apply for sleep + pain. Unreal.

As a medical student, you probably just spend 4 weeks of inpatient and check out. Thats only the tip of the iceberg psych.