Anesthesiology vs. Psychiatry

[jack.jaret]

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I know these are 2 are total opposites, but I'm a 4th year and am down to these 2. I can't figure it out no matter how much I sit and try to evaluate. I was hoping one of you could help.

Anesthesia pros: procedure based, quick and intense patient interaction, lots of money, somewhat controllable lifestyle

Psychiatry pros: lots of interesting patients (I have a history of sexual and physical abuse so am somewhat drawn to them), very controllable lifestyle, decent money

Psychiatry seems more "chill" and lifestyle is huge for me. but sometimes I feel like I may miss out on the OR environment and miss procedures. It's hard to tell as a 4th year. I just don't know how to make such a big life decision based on such short rotations.

 

[nexus73]

Do gas and make some cashola. If you get tired of it retrain in psych starting as a pgy-2.

 

[F0nzie]

If you want to work long hours and make big money don't do psych. It's really hard to deliver quality psychiatric care when you're tired. Documentation is longer adding to the cognitive burden.

If you want a balanced lifestyle and do not mind making low 200s psych is great. What I value most about psych is how much I have grown and how much more I have to give. It caps at 40 hours before I get mental burn out though.

I would not reverse my decision to go into psych. If I reversed my decision and lost my psych experience I feel like I would go back to being ******ed.


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[vm26]

I know these are 2 are total opposites, but I'm a 4th year and am down to these 2. I can't figure it out no matter how much I sit and try to evaluate. I was hoping one of you could help.

Anesthesia pros: procedure based, quick and intense patient interaction, lots of money, somewhat controllable lifestyle

Psychiatry pros: lots of interesting patients (I have a history of sexual and physical abuse so am somewhat drawn to them), very controllable lifestyle, decent money

Psychiatry seems more "chill" and lifestyle is huge for me. but sometimes I feel like I may miss out on the OR environment and miss procedures. It's hard to tell as a 4th year. I just don't know how to make such a big life decision based on such short rotations.

The way healthcare is going, I could see a scenario a few years down the road where gas is substantially infiltrated by CRNAs, driving down demand and reimbursement for MDs while a psychiatrist in the right geographic area and specialty could do way better financially/lifestyle-wise in a cash only business

 

[michaelrack]

If you want a balanced lifestyle and do not mind making low 200s psych is great. What I value most about psych is how much I have grown and how much more I have to give. It caps at 40 hours before I get mental burn out though.

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Dr. FOnzie,

I don't know much about the economics of full-time outpatient psych practice; but I am very familiar with inpatient psychiatric pay. For a board-certified psychiatrist outside of academia and outside of the NE, low 200's would be the minimum pay for a cush inpatient position with minimal call.

 

[psychattending]

I would go with what you find you like most doing. If you enjoy seeing psych patients then do that. If you like more procedure oriented stuff with less face-to-face contact, then do anest. More money won't counteract the longer hours of anest, if you don't like it. Similarly, the better hours of psych won't help you deal with psych patients if you do not find the subject matter interesting.

 

[Shikima]

I would go with what you find you like most doing. If you enjoy seeing psych patients then do that. If you like more procedure oriented stuff with less face-to-face contact, then do anest. More money won't counteract the longer hours of anest, if you don't like it. Similarly, the better hours of psych won't help you deal with psych patients if you do not find the subject matter interesting.

Stopped being interesting after PGY-x and more about continuing with the work to pay off the loans since the soul has been sold.

 

[bonedrone14]

This will obviously be a slanted opinion, but I'm guessing you expected that from posting in this forum. Similar to what fonzie said, all other aspects aside, I feel like I've grown a lot as a person and am much happier because I understand other people and myself better from learning about human behavior.

That said, I was in your shoes 2 years ago, but choosing between em and psych. It's hard to say what you'll want, which you've astutely pointed out. It's kind of a gamble picking what you'll still be able to enjoy/tolerate in 20 years. Maybe a big thing to ask yourself is this: do I want or need my patients to admire me and give me their gratitude for helping them? If thats a yes, then maybe anesthesia will be a more fulfilling field. If you're ok with people disliking you while you do what you feel may be best for them, or helping them figure out their own solutions to problems with them feeling like they solved it themselves, then psych it is. This isn't to say that "if you need adoration pick anesthesia." It's just a perspective I didn't have as a med student regarding some of what we do in psychiatry.

Finally, because it's hard to forecast what you'll enjoy doing in 20 years, that's why I believe lifestyle is important. Find somethi g that allows you to have time for whatever new hobbies you may develop.

Best of luck and feel free to message me if you have any specific questions!

 

[Salpingo]

I know these are 2 are total opposites, but I'm a 4th year and am down to these 2. I can't figure it out no matter how much I sit and try to evaluate. I was hoping one of you could help.

Anesthesia pros: procedure based, quick and intense patient interaction, lots of money, somewhat controllable lifestyle

Psychiatry pros: lots of interesting patients (I have a history of sexual and physical abuse so am somewhat drawn to them), very controllable lifestyle, decent money

Psychiatry seems more "chill" and lifestyle is huge for me. but sometimes I feel like I may miss out on the OR environment and miss procedures. It's hard to tell as a 4th year. I just don't know how to make such a big life decision based on such short rotations.

Gas and psych have some overlap - I remember the comfort and anxiety relief they would provide patients even before the IV went in. You have to know a limited set of drugs (but know them well) and there's a little artistry that comes with experience. There are periods of intense boredom with intermittent high intensity crises (which may or may not be similar to psych, depending on how you practice). And if you go into pain, there's even more overlap.

One big difference is the interaction with other physicians as the "internist of the OR."

My only warning is that a lot of people get burned going into psychiatry because they went into it identifying with the patients, and feeling like they can bring their experience to cure others. For a whole host of reason, that just doesn't work out - not that people with psych history CAN'T be good psychiatrist, it's just a limited motivation. Same thing with the chill lifestyle. Its possible in psych, but not a great motivation.

 

[medhead1990]

You could always do either one and end up in pain... Gas is the more traditional route but if you're the trailblazer type personality you can do it through psych. Then you get a good mix of procedures and the psych stuff.

 

[jack.jaret]

Gas and psych have some overlap - I remember the comfort and anxiety relief they would provide patients even before the IV went in. You have to know a limited set of drugs (but know them well) and there's a little artistry that comes with experience. There are periods of intense boredom with intermittent high intensity crises (which may or may not be similar to psych, depending on how you practice). And if you go into pain, there's even more overlap.

One big difference is the interaction with other physicians as the "internist of the OR."

My only warning is that a lot of people get burned going into psychiatry because they went into it identifying with the patients, and feeling like they can bring their experience to cure others. For a whole host of reason, that just doesn't work out - not that people with psych history CAN'T be good psychiatrist, it's just a limited motivation. Same thing with the chill lifestyle. Its possible in psych, but not a great motivation.

But don't you think that's a great enough motivation? You have issues yourself so have always been fascinated, therefore you choose psych. I'm still interested in it - I guess what I'm asking is what you would consider great motivation?

 

[jack.jaret]

This will obviously be a slanted opinion, but I'm guessing you expected that from posting in this forum. Similar to what fonzie said, all other aspects aside, I feel like I've grown a lot as a person and am much happier because I understand other people and myself better from learning about human behavior.

That said, I was in your shoes 2 years ago, but choosing between em and psych. It's hard to say what you'll want, which you've astutely pointed out. It's kind of a gamble picking what you'll still be able to enjoy/tolerate in 20 years. Maybe a big thing to ask yourself is this: do I want or need my patients to admire me and give me their gratitude for helping them? If thats a yes, then maybe anesthesia will be a more fulfilling field. If you're ok with people disliking you while you do what you feel may be best for them, or helping them figure out their own solutions to problems with them feeling like they solved it themselves, then psych it is. This isn't to say that "if you need adoration pick anesthesia." It's just a perspective I didn't have as a med student regarding some of what we do in psychiatry.

Finally, because it's hard to forecast what you'll enjoy doing in 20 years, that's why I believe lifestyle is important. Find somethi g that allows you to have time for whatever new hobbies you may develop.

Best of luck and feel free to message me if you have any specific questions!

From my very short experience in psychiatry, it seemed that the patients appreciated the psychiatrists a lot more than they appreciated anesthesiologists. Or am I just crazy?

 

[ambo007]

Both are very rewarding fields and they both offer great lifestyles. But they have very different amounts of patient contact. You really need to decide which you enjoy more and go for that. Stop nitpicking the fine details of each speciality.


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[LasVagus]

From my very short experience in psychiatry, it seemed that the patients appreciated the psychiatrists a lot more than they appreciated anesthesiologists. Or am I just crazy?

You're not crazy, but your perspective may change with more exposure. I always tell medical students that if you went into medicine so that people would look up to you and/or be grateful to you, then psychiatry probably isn't a good choice. I also remember a mentor telling me that the only thing he didn't like about being a psychiatrist is that it is the only area of medicine that everybody else thinks they can do (as a typical example, a surgery resident recently asked me why it takes four years of residency to learn how to give someone Haldol). In short, I think psychiatry is heavy on intrigue and intellectual stimulation, but light on respect and gratitude. I'm an introverted ponderer so that works just fine.

 

[TexasPhysician]

From my very short experience in psychiatry, it seemed that the patients appreciated the psychiatrists a lot more than they appreciated anesthesiologists. Or am I just crazy?

I think that poster was describing inpatient psychiatry. In that environment, respect can be low, and patients can desire inappropriate meds.

Outpatient psych can build strong relationships with patients and respect in the community. Procedures are very rare though.

Anesthesia is quite different in that you likely don't have much of a relationship with patients. 99%+ of the time you are calmly managing the patient with rare absolute panic.

 

[bonedrone14]

The two posts above are good counterbalances and articulate what I meant better than I was able to say. You can definitely form meaningful relationships with your patients in psychiatry. And many are grateful to you, definitely moreso in the outpatient realm.

The thing to remember, however, is that while it's not really a big deal in other fields, when your patient begins to idealize you in psych, this adds to the pathology and can cause treatment to go awry. It feels good to be idealized and often this is all at a subconscious level. And this doesn't mean you're a narcissist or not genuinely trying to help the pt. Just a different dynamic that I had no concept of as a med student.

So we've mentioned a lot of deep thoughts here...but here's just some of the reasons I picked psychiatry.
-intrigue regarding psychotic and manic illnesses
-less intrigued by anxiety and depressive disorders, but this has faded and I'm more interested the more I learn
-personality disorders...no one in the hospital knew how to deal with them. I wanted to know and be able to help these folks
-opportunity to become a better interviewer and simply understand people better
-great lifestyle with the ability to work more hours if you feel you can or want to. As a resident even, I'm able to see my kids in the morning before work and be there to put them to bed every evening unless I'm on call.
-psych gets painted as a poor earner in my experience by people outside the field. But for the hours we put in and the flexibility we have, its hard to beat.
-ability to practice in multiple areas of the field without needing a fellowship
-job market is hot hot hot from everything I've been told
-there's more overlap with medicine and "mediciney" things than I was lead to believe in med school. On inpatient you can have your hands in as much or little as you want. Outpatient, some patients you're the only physician these people see, so you need to be on your toes to at least refer them to the right places if you can. I still do physical exams. Not a medicine H&P type, but if there's something that needs to be chased down or looked at, I'm still a doctor so I look at it.
-if just physically being in the OR is something big to you, you can do ECT. definitely not the same thing as typical surgery and you won't be doing the anesthesia...but maybe it could scratch your itch. It's a little more similar to GI lab type procedures (usually use short acting sedatives, quick procedure, no need for overnight stays, etc).

 

[Salpingo]

But don't you think that's a great enough motivation? You have issues yourself so have always been fascinated, therefore you choose psych. I'm still interested in it - I guess what I'm asking is what you would consider great motivation?

Being interested in human beings and the human condition in general, for their own sake, is great motivation. But that's different than being interested in them in relationship to your own personal trauma. Again, not an absolute contraindication, but it becomes messy. Keep in mind that almost everyone in residency faces burnout at some point, and it's that motivating factor that you have to draw up to keep putting one foot in front of the other.

Ultimately, its not really for me to judge you or your motivation, just speaking anecdotally. It's worth bringing up with a therapist or advisor you trust. Splik also has a good post on here about the personal statement archetypes, and he addressed this (albeit humorously).

 

[Salpingo]

You're not crazy, but your perspective may change with more exposure. I always tell medical students that if you went into medicine so that people would look up to you and/or be grateful to you, then psychiatry probably isn't a good choice. I also remember a mentor telling me that the only thing he didn't like about being a psychiatrist is that it is the only area of medicine that everybody else thinks they can do (as a typical example, a surgery resident recently asked me why it takes four years of residency to learn how to give someone Haldol). In short, I think psychiatry is heavy on intrigue and intellectual stimulation, but light on respect and gratitude. I'm an introverted ponderer so that works just fine.

There's often a range of reactions, depending on where you are. You'll hear "I don't know how you do this..." to "I don't know why you do this..." to "deal with this patient so I can practice some real medicine." But yeah, the medication part doesn't really require much training or thought as much as dealing with some of the hardest people/issues in medicine.

One big difference I've found between surgery and psych is the degree we're willing to challenge ourselves. In surgery residency, it seems you're always operating outside of your comfort zone (sometimes literally), while psychiatry you're always being told to stay in your lane. Sometimes that's for the better (I'll see surgery residents fiddling with ventilator settings with maybe a week or two of SICU training behind them, because, hey, how hard could it be?), but you have to be aggressive to stick that first chest tube in.

 

[finalpsychyear]

I know these are 2 are total opposites, but I'm a 4th year and am down to these 2. I can't figure it out no matter how much I sit and try to evaluate. I was hoping one of you could help.

Anesthesia pros: procedure based, quick and intense patient interaction, lots of money, somewhat controllable lifestyle

Psychiatry pros: lots of interesting patients (I have a history of sexual and physical abuse so am somewhat drawn to them), very controllable lifestyle, decent money

Psychiatry seems more "chill" and lifestyle is huge for me. but sometimes I feel like I may miss out on the OR environment and miss procedures. It's hard to tell as a 4th year. I just don't know how to make such a big life decision based on such short rotations.

What exactly do you define as lots of money? Would 330k, 40hrs, 4 day work week qualify?

 

[SeniorWrangler]

Anesthesiology is different than surgery, though. I think frat-boy manners and abusiveness are a much stronger tradition in surgical training than in anesthesia, at least by reputation and according to my experience.

 

[jack.jaret]

What exactly do you define as lots of money? Would 330k, 40hrs, 4 day work week qualify?

Making 250, working 35-40 hours a week, 4 days a week. That's honestly what I'm aiming for. I just have too many interests outside of medicine.

 

[HarryMTieboutMD]

To the OP whatever you go into the novelty will wear off, but both specialties can be either really exciting or really boring. If I didn't do psychiatry I would have done anesthesia mostly because IMO anesthesiologists are the best doctors in terms of knowledge of physiology, pharmacology, procedural skills, critical care etc, and there are times when I'm in clinic doing CBT or MI for some mundane issue a patient is having and thinking "this is why I went to med school... wtf?!" But at the same time I would get really annoyed/bored in the OR, and I would definitely have regretted not doing psych (though I lament not getting ICU exposure). At the end of the day, my passion is (still) psychiatry because the illnesses we treat are the most fascinating and baffling in all of medicine, which is part of what makes it exciting... and every day has the *potential* to bring something new and ridiculous.

And if you know what you are doing and don't attempt to practice in an oversaturated area you can do very well in psychiatry, especially if you do TMS and ECT

 

[calvnandhobbs68]

You're not crazy, but your perspective may change with more exposure. I always tell medical students that if you went into medicine so that people would look up to you and/or be grateful to you, then psychiatry probably isn't a good choice. I also remember a mentor telling me that the only thing he didn't like about being a psychiatrist is that it is the only area of medicine that everybody else thinks they can do (as a typical example, a surgery resident recently asked me why it takes four years of residency to learn how to give someone Haldol). In short, I think psychiatry is heavy on intrigue and intellectual stimulation, but light on respect and gratitude. I'm an introverted ponderer so that works just fine.

You can tell the surgery resident if he's so comfortable with psych meds he can feel free to adjust them himself. Same reason I don't go cutting open people on my own.

The people who feel they need to put other specialities all the time down invariably are covering for some insecurity of their own. Surgery is awash with personality problems.

 

[masterofmonkeys]

At a recent residents' gathering, I listened to an anesthesiology resident literally say nothing but 'lifestyle' and 'money' for 30 minutes straight. On several occasions I tried to shift the conversation to anything. This did not happen. Must be awful to be so damned hollow.

 

[jack.jaret]

At a recent residents' gathering, I listened to an anesthesiology resident literally say nothing but 'lifestyle' and 'money' for 30 minutes straight. On several occasions I tried to shift the conversation to anything. This did not happen. Must be awful to be so damned hollow.

Did he seem happy about it, or did it seem like he was trying to convince himself that he would eventually get great money + lifestyle?

 

[J ROD]

To me, the two fields are pretty easy to separate. You want to do procedures or have more patient interaction and indepth at times conversations. Want to be in the OR or not? Both have lifestyle aspects and enough money. If you just want money do Anes. Don't overthink it.

 

[surfguy84]

To me, the two fields are pretty easy to separate. You want to do procedures or have more patient interaction and indepth at times conversations. Want to be in the OR or not? Both have lifestyle aspects and enough money. If you just want money do Anes. Don't overthink it.

How easy is it to fill up a schedule purely with tele-pscyh? Any chance to do 50 hrs a week or telepsych at rates I've seen posted around here in the past?; i.e. 140-160/hr

 

[Shikima]

How easy is it to fill up a schedule purely with tele-pscyh? Any chance to do 50 hrs a week or telepsych at rates I've seen posted around here in the past?; i.e. 140-160/hr

pretty easy. big need.

 

[surfguy84]

pretty easy. big need.

Thanks for your response.

So what am I missing here? 160*50*48 is almost 400k a year. Working from home. With no call. How are people not fighting hand over foot for something like this in medicine?

 

[J ROD]

Thanks for your response.

So what am I missing here? 160*50*48 is almost 400k a year. Working from home. With no call. How are people not fighting hand over foot for something like this in medicine?

It is something i am considering part time. I prefer to do inpatient work and not consult in the ED. That is what I am used to seeing with telepsychiatry.

 

[Shikima]

Thanks for your response.

So what am I missing here? 160*50*48 is almost 400k a year. Working from home. With no call. How are people not fighting hand over foot for something like this in medicine?

Many do not like ER.

 

[surfguy84]

It is something i am considering part time. I prefer to do inpatient work and not consult in the ED. That is what I am used to seeing with telepsychiatry.

I see. I was actually leaning towards EM before I discovered how much I liked psychiatry. Do you think ER psych might give some nice aspects of both for someone me?

 

[J ROD]

I see. I was actually leaning towards EM before I discovered how much I liked psychiatry. Do you think ER psych might give some nice aspects of both for someone me?

For some folks, it is a good combo. If you like to deal with the BS that comes in......a fair amount is not Psych. Folks faking SI to get a place to stay, get away from the "dopeman", etc. There is a good amount of substance abuse. That I don't mind as bad. It also depends on how the ED docs work. Where I am we get consulted for anything that looks like Psych. In a non-academic setting, I imagine it would be better and more appropriately done. Where I am we are next to Cards and GI in terms of consults in the ED. I thought I would like it too because I was thinking EM and Psych as well. Not a fan after living the life....

 

[surfguy84]

For some folks, it is a good combo. If you like to deal with the BS that comes in......a fair amount is not Psych. Folks faking SI to get a place to stay, get away from the "dopeman", etc. There is a good amount of substance abuse. That I don't mind as bad. It also depends on how the ED docs work. Where I am we get consulted for anything that looks like Psych. In a non-academic setting, I imagine it would be better and more appropriately done. Where I am we are next to Cards and GI in terms of consults in the ED. I thought I would like it too because I was thinking EM and Psych as well. Not a fan after living the life....

Gotcha. Well thanks for the opinion - something I'll definitely keep in mind.