Apprehension about going into psych?

[krazydoc]

Thought I would share some general apprehension/concern I have about entering the field of Psychiatry.. and would be interested in hearing your responses and thoughts on the matter.

And before proceeding, let me say that I am now applying to residency, am a pretty darn competitive and likable applicant, and suspect that I am going to get into one of the better programs out there. I don't think there is any other specialty for me (I didn't like the other ones, I loved behavioral neuroscience even before med school).

But that being said.. I do indeed have a bit of concern that I am picking the right field. Especially after all of these years of studying, investing time and $$, etc. Here are the reasons:

1. Will I still like it years down the road?
2. Will I grow bored of it? Bored with talking with patients? Will I be intrigued with it in the future as much as I am now?
3. Will the financial renumeration be good enough?
4. Will I learn to accept and deal with the issues concerning stigma around mental health and psychiatry, diminished prestige and respect, etc.?
5. Will other mental health providers (social work, nurses, psychologists, etc) and changing national/political/economic landscape significantly adversely affect the field?
6. And in worst case scenario, if I wanted to switch residencies, is it even possible to do so coming from psych? (e.g. other programs respect, losing my IM knowledge, etc).

Anyone else with any last minute jitters?

.. anyone know how *HAPPY* psychiatrists out in private practice are years into it?

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[OldPsychDoc]

Thought I would share some general apprehension/concern I have about entering the field of Psychiatry.. ...

1. Will I still like it years down the road?
2. Will I grow bored of it? Bored with talking with patients? Will I be intrigued with it in the future as much as I am now?
3. Will the financial renumeration be good enough?
4. Will I learn to accept and deal with the issues concerning stigma around mental health and psychiatry, diminished prestige and respect, etc.?
5. Will other mental health providers (social work, nurses, psychologists, etc) and changing national/political/economic landscape significantly adversely affect the field?
6. And in worst case scenario, if I wanted to switch residencies, is it even possible to do so coming from psych? (e.g. other programs respect, losing my IM knowledge, etc).

Anyone else with any last minute jitters?

.. anyone know how *HAPPY* psychiatrists out in private practice are years into it?

1) No one can know--that's the frustrating thing about these decisions. But if this area interested you before medical school and if you have some level of passion for it now, you stand a decent chance of liking it.

2) Bored? Never. Every patient is unique. The stories are incredible sometimes. Sometimes incredibly sad. Sometimes hilarious. If you like talking to people, you won't get bored. (You WILL get bored with the paperwork, though.)

3) Depends on what "good enough" is for you. You won't make a million a year, but you'll be making several times the median income for your chosen local area.

4) If you're worried about YOUR stigma and "diminished prestige and respect" you're going into the wrong field. If you want to FIGHT the stigma faced by your patients and be an advocate for them, then psychiatry will have lot of room for you to serve.

5) Social workers, psychologists, and nurses are your teammates, NOT your competitors. The landscape might look rocky at times, but you will always be needed. Mental illness is NOT going to go away!

6) I've known people whose unhappiness led them to transfer to FP, IM, etc after internship. They had no problem getting into programs. Don't know if they're happier there or not. (I could say their absence made our program happier...but that might be construed as an ad hominem... )
On the positive side, I knew one person who made a considered decision to switch to anethesia, but she had a "calling" of sorts to focus on pain medicine. I'll also say I knew of more docs from other fields whoe were choosing to try to enter psych than who were trying to leave psych!)

 

[MINDOFMYOWN]

Do u know of Psychiatrists making 200K or more a year or is it just close to 150k or less??

 

[OldPsychDoc]

Do u know of Psychiatrists making 200K or more a year or is it just close to 150k or less??

I think some do make that kind of money, but I wouldn't expect to start above $150k in most parts of the us.

 

[la_tortuga]

another psych residency applicant that I met on the interview trail told me that CL was his favorite rotation of any type as a Penn student. While interviewing at Penn, I met with one of the CL faculty who seemed like an awesome guy. Go for it!

 

[la_tortuga]

oops! wrong thread, although my wise words probably apply to your concerns as well. . .

 

[MINDOFMYOWN]

I think some do make that kind of money, but I wouldn't expect to start above $150k in most parts of the us.

So what u are talking about is the starting salary....What about 5 or may be 10 years down the line....how does it go then?? and Thanks for the earlier reply....

 

[OldPsychDoc]

So what u are talking about is the starting salary....What about 5 or may be 10 years down the line....how does it go then?? and Thanks for the earlier reply....

it entirely depends on the part of the country where you practice, what setting you practice in, your sub-speciality, if any, your entrepenurial skills, and numerous other factors. Use the MINDOFYOUROWN to ask some docs in the community where you hope to practice...

 

[marie337]

I definitely want to own my own practice, maybe one or two other docs and a couple of midlevel providers. Is this still possible in psychiatry? I definitely want to be my own boss and my husband has the business sense to help me with the financials. I just want to at least break even. I'm very lucky that my husband makes enough money that I don't need to work if I don't want to. Yes, extra cash would be nice, but doing something I love is much more important.

 

[bth7]

4) If you're worried about YOUR stigma and "diminished prestige and respect" you're going into the wrong field. If you want to FIGHT the stigma faced by your patients and be an advocate for them, then psychiatry will have lot of room for you to serve.

Amen Brother!

 

[whopper]

1) Depends on you. I can't answer that
2) same with #1, depends on how interested you are
3) depends, however now this is more objective.
I can tell you that on average psychiatrists according to some websites I've seen make as much as Internal Medicine doctors, & their hours are much more reasonable, often with fewer on calls and less stressful work during those hours of duty. Being that IM is consdered the most centrist field in terms of pay & care, that's pretty good IMHO.
4) Depends on you. I don't give a damn myself about the stigma.

THIS IS WHAT i WANTED TO DO WITH MY LIFE, IF SOMEONE DOESN'T RESPECT ME AS MUCH AS THE NEXT MD I DON'T CARE. ITS THE FIELD I ENJOY--I DON'T HAVE TO JUSTIFY IT TO SOME OTHER GUY.

I can tell you that from what I've seen many people do seem to be intrigued by psychiatrists in a good way. They seem to believe we shrinks have some type of mystical=we can read your mind powers that other MDs don't have. So in some ways the respect thing can sometimes be better with psychiatry.

5) possibly. I can see this happening. A side gripe but I noticed doctors don't protect themselves as a group. They work hard in their field but everything outside the office they a poor grasp of understanding such as politics.

Anyways many fields of medicine have already been screwed over by various elements--be it malpractice, insurance etc. Psychiatry has been relatively untouched so in this respect its still very good. Things can possibly change though with the new drive to give psychologists prescribing power.

6) its always hard to switch residencies. I have though seen programs such as my own take in IM residents and put them as 2nd year psychiatric residents. Such switches I believe are only allowed if a first year is kicked out or asked not to return for the 2nd year.

I can say from some of your questions that you don't have the gutt satisfaction with psychiatry as I did. I knew I wanted to do psyche beven before I went to medschool. There's nothing wrong with that. I do though reccomend you go into what you want out of love of the field first. Most fields of medicine pay about the same. Money should be a 2ndary factor. If you hate the field, no amount of money will make up for that. If you love a field and forsake it, you'll always regret it.

However if you have no idea, consider other things such as lifestyle, money etc. Psychiatry is much easier compared to other residencies in terms of hours on duty, calls, amount of info you got to memorize, scuttwork etc. You'll get a full night's rest much more than in the other residencies.

 

[hyoglossus]

1) No one can know--that's the frustrating thing about these decisions. But if this area interested you before medical school and if you have some level of passion for it now, you stand a decent chance of liking it.

2) Bored? Never. Every patient is unique. The stories are incredible sometimes. Sometimes incredibly sad. Sometimes hilarious. If you like talking to people, you won't get bored. (You WILL get bored with the paperwork, though.)

3) Depends on what "good enough" is for you. You won't make a million a year, but you'll be making several times the median income for your chosen local area.

4) If you're worried about YOUR stigma and "diminished prestige and respect" you're going into the wrong field. If you want to FIGHT the stigma faced by your patients and be an advocate for them, then psychiatry will have lot of room for you to serve.

5) Social workers, psychologists, and nurses are your teammates, NOT your competitors. The landscape might look rocky at times, but you will always be needed. Mental illness is NOT going to go away!

6) I've known people whose unhappiness led them to transfer to FP, IM, etc after internship. They had no problem getting into programs. Don't know if they're happier there or not. (I could say their absence made our program happier...but that might be construed as an ad hominem... )
On the positive side, I knew one person who made a considered decision to switch to anethesia, but she had a "calling" of sorts to focus on pain medicine. I'll also say I knew of more docs from other fields whoe were choosing to try to enter psych than who were trying to leave psych!)

I certainly had those questions experience in my first year in residency and I feel that you have to be really honest with yourself.

1. If you are a stellar student a part of you may suggest you enter the more " cerebral" specialities... this was a problem for me. But I stood out from the regular IM residents during pimping sessions by attendings during rounds and the senior residents said I ought to be doing IM rather than psychiatry. But I hated the routine of IM, the call schedule ,the lifestyle. It was a personal point to make that be as smart or smarter than the IM residents on their own turf.
But I hated how other physicians thought or behaved as if you were ..not a real doctor.
To cut a long story short, I switched residencies for FP/Psych.
I will enter my 5th year in July, I prefer psych over medicine. I have published in a Psych journal. I am planning for a sleep fellowship in 2006 and my FP knowledge will serve me well but I dont want to practice as a regular FP . Not after 5 years of residency. I need to create a nich for myself utilizing psychiatry, medicine to the full.... hence sleep medicine. Think about sleep during your residency....do an elective. You will certainly earn more than regular psychiatrists. I percieve $$ is important to you.

Remember you can earn $300K if you want..but can you do the time? Can you work most weekends, and average 60 hours Mon-Fri?...if so then you will earn that much. there are opportunities..esp in the smaller cities of non prominent states. Child psych will average $95-120/hr in OH, suburban PA, indiana, Illinois. but if you are an LA guy this geography may be unthinkable.

Leverage yourself though. more states will pass the psychologist prescribing...will that affect psychiatrists probably not....always watch the horizon.

Do you know that 2nd to cardiology is the neurosciences in groundbreaking research and funding. There will be lots of stuff to do and you can determine how you practice for variety.......you will look much younger than your OB or IM colleagues in 15 years. hope this was helpful

 

[bth7]

I certainly had those questions experience in my first year in residency and I feel that you have to be really honest with yourself.

1. If you are a stellar student a part of you may suggest you enter the more " cerebral" specialities... this was a problem for me. But I stood out from the regular IM residents during pimping sessions by attendings during rounds and the senior residents said I ought to be doing IM rather than psychiatry. But I hated the routine of IM, the call schedule ,the lifestyle. It was a personal point to make that be as smart or smarter than the IM residents on their own turf.
But I hated how other physicians thought or behaved as if you were ..not a real doctor.
To cut a long story short, I switched residencies for FP/Psych.
I will enter my 5th year in July, I prefer psych over medicine.

This is a great post. Thanks for your honesty. I think alot of people struggle with this their whole adult lives.

 

[Teufelhunden]

To address #3 - here are some mean annual salaries for general psychiatry as reported in various websites:

$142,610 studentdoc.com
$169,000 www.allied-physicians.com
$160,658 www.physicianssearch.com
$161,590 www.jacksonandharris.com (Northeast region)
$163,144 Bureau of Labor Statistics

Editorial aside: I cannot comprehend why psychiatry isn’t more popular than it currently is. The compensation is excellent when you consider the work hours, paucity of call, other lifestyle factors, etc. As stated by hyoglossus above, the research dollars flowing into the neurosciences are promising, as is the pipeline of drugs coming our way soon (I just read yet another article – supposedly there are at least 40 so-called ‘cognitive enhancers’ in the pipeline!)

 

[whopper]

If someone thinks Psychiatry is not cerebral enough---

Well IMHO this is not a reason to avoid psychiatry. If you're not being challenged enough in the field, push the limits. Do some research. Start getting into consultation Psychiatry or Geriatric which heavily links Psychiatry with medicine.

While on my Family Practice rotation, all my FP docs told me it is heavily linked with psychiatry and that about 25% of their patients had psychiatric issues that needed to be dealt with. If you love medicine, but want to do psychiatry, perhaps consider Family Practice or a combined FP/psychiatry residency.

Psychiatry like all fields of medicine literally has more information than any one person can ever know. If you think you're not being challenged, you're not looking hard enough or pushing yourself hard enough. You might have to do a little work on your own. I noticed some psychiatry attendings have gotten lazy, but I've seen that in every field, psychiatry or not.