Contemplating switching specialties... =/

[Zorko]

I am currently a PGY-2 and first-year radiology resident considering a career change to psychiatry. I never thought that I would find myself in such a position. Perhaps the beginning of July is too early in the game to make any drastic decisions, but I was hoping to at least broach the subject with you all and see if anyone could offer advice or maybe even speak from experience.

For the moment, radiology is not quite what I had imagined, although I performed due diligence researching the field as a medical student. The attendings and residents at my institution are amazingly brilliant and refreshingly down-to-earth, so it's not that I want to leave because I have a beef with the program. It's just that I am not convinced that the specialty itself is the right fit for me.

Fundamentally, I miss the patient interaction and more "humanistic" aspects of medicine, i.e. the opportunity to exercise compassion, empathy, listening skills, etc., which I believe was actually one of my primary strengths as a medical student and intern. I know that this may sound strange given the stereotype that radiologists don't enjoy talking to patients. No doubt, radiology is extremely challenging and intellectually stimulating, but I can't help but feel like a "human computer" or "robot" at times.

I jelled really well with a psychiatry attending during my third-year clerkship as a medical student. It was my experience with him that made me evaluate psychiatry as a future career, although I ultimately chose radiology. He wrote an excellent letter of recommendation that I subsequently incorporated for all of my ERAS applications. Would it be acceptable to contact my letter writer and see if his LoR could be recycled/reused?

Regarding other logistical issues, how would I go about properly initiating a specialty switch? I've done a little bit of digging through the SDN archives as a background effort. Clearly, I would need to notify my current PD of my intentions (the earlier the better) and hope that he/she would be receptive and supportive. I would definitely honor my commitment/contract to my current program and fulfill the requirements for the remainder of this year so as not to hose my fellow residents and wreck the call schedule.

It seems that my best option would be to essentially "start over" and reapply through ERAS as a PGY-1. I already completed an internship that included a couple months of IM and one month of ER but no neurology or psychiatry. Is it realistic to expect at least a portion of my rotations to be transferable?

Would it be difficult to convince PDs of psychiatry residency programs that my interest is sincere? I'm afraid that making such a late specialty switch might be misinterpreted as a sign of immaturity or poor judgment. Also, I haven't had a chance to do a psychiatry rotation since MSIII - would this be a major hindrance/red flag?

Thanks so much for reading. I would welcome any comments or suggestions.

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[splik]

there are many of us defecters from other specialties. you will have to use your application to convince them you are not fickle and really psychiatry is what you want to do and you were scared of lights

There are many programs that have PGY-2 openings, and some programs have specific spots e.g. Stanford, Yale, UW, Hopkins, GWU etc. You will be able to apply as a PGY-2 as you have done a transitional year already. You will have to do some neuro later on but that is fine.

Get that psych letter updated, and it is fine to have 2 non-psych letters as long as they are glowing. I imagine if you were competitive for rads you would be good for psych. You will probably need a letter from your PD, but it is fine to apply and then have that as a 4th letter once you tell him.

I would apply but keep an open mind. You may end up loving radiology. I hated my first week of psychiatry. Everything feels worse when you're just starting out. And there is opportunity for patient interaction if you do breast clinics (ultrasounds, FNAs etc) or interventional work.

 

[peppy]

You *could* start over as a PGY-1 but it would probably be better to aim for places with PGY-2 openings. You shouldn't have any problem getting credit for your PGY-1 and starting as a PGY-2 somewhere that has an opening for a PGY-2. The ABPN will accept a year of medicine rotations as a PGY-1 for psych - it doesn't have to follow the usual format of a psych internship.

It won't seem strange to programs that you're switching. It's very common for people to switch to psychiatry as a second career in medicine. As long as you can get a supportive letter from your PD, I think you'll be able to match into a good psych program easily.

 

[whopper]

Radiology is very competitive so I'd imagine your CV, grades, and such are very good.

Remember when you make this switch it's going to be hard if not impossible to go back. Psychiatry makes less money and you still can have human interactions doing procedures. Further, if you make the switch make sure you will be happy in psychiatry before you do it.

A problem I had with radiology (not saying you have this) is I believe it gave me a bit of seasonal affective disorder. Being away from sunlight for hours a day affected me. Just make sure you don't switch out for a reason like that because it's perfectly treatable. (No I wasn't in radiology residency, I'm talking my rotations).

 

[BobA]

You should expect to start as a PGY-2.

 

[SomeDoc]

I am currently a PGY-2 and first-year radiology resident considering a career change to psychiatry. I never thought that I would find myself in such a position. Perhaps the beginning of July is too early in the game to make any drastic decisions, but I was hoping to at least broach the subject with you all and see if anyone could offer advice or maybe even speak from experience.

For the moment, radiology is not quite what I had imagined, although I performed due diligence researching the field as a medical student. The attendings and residents at my institution are amazingly brilliant and refreshingly down-to-earth, so it's not that I want to leave because I have a beef with the program. It's just that I am not convinced that the specialty itself is the right fit for me.

Fundamentally, I miss the patient interaction and more "humanistic" aspects of medicine, i.e. the opportunity to exercise compassion, empathy, listening skills, etc., which I believe was actually one of my primary strengths as a medical student and intern. I know that this may sound strange given the stereotype that radiologists don't enjoy talking to patients. No doubt, radiology is extremely challenging and intellectually stimulating, but I can't help but feel like a "human computer" or "robot" at times.

I jelled really well with a psychiatry attending during my third-year clerkship as a medical student. It was my experience with him that made me evaluate psychiatry as a future career, although I ultimately chose radiology. He wrote an excellent letter of recommendation that I subsequently incorporated for all of my ERAS applications. Would it be acceptable to contact my letter writer and see if his LoR could be recycled/reused?

Regarding other logistical issues, how would I go about properly initiating a specialty switch? I've done a little bit of digging through the SDN archives as a background effort. Clearly, I would need to notify my current PD of my intentions (the earlier the better) and hope that he/she would be receptive and supportive. I would definitely honor my commitment/contract to my current program and fulfill the requirements for the remainder of this year so as not to hose my fellow residents and wreck the call schedule.

It seems that my best option would be to essentially "start over" and reapply through ERAS as a PGY-1. I already completed an internship that included a couple months of IM and one month of ER but no neurology or psychiatry. Is it realistic to expect at least a portion of my rotations to be transferable?

Would it be difficult to convince PDs of psychiatry residency programs that my interest is sincere? I'm afraid that making such a late specialty switch might be misinterpreted as a sign of immaturity or poor judgment. Also, I haven't had a chance to do a psychiatry rotation since MSIII - would this be a major hindrance/red flag?

Thanks so much for reading. I would welcome any comments or suggestions.

As someone who was in very similar shoes as yourself, congratulations for taking the courage to consider such a change! I can say I shared many of your feelings, but ultimately, at the end of the day, doing what you enjoy is priceless. You can certainly apply for positions as a PGY-2 as there are some programs that will accept you after doing a surgery or IM internship year. Once again, congratulations on considering such a brave decision. I can say without question that I am very lucky and grateful to have landed in such a great field that I enjoy, is fulfilling, and has great perks. It's not for everyone, but for those who make a good fit, its a great place to be.

 

[whopper]

Would it be difficult to convince PDs of psychiatry residency programs that my interest is sincere?

If I saw someone in your shoes during the interview process, I'd think not. Radiology is more competitive and makes more money than psychiatry, so if someone made a switch, I'd figure it'd most likely be because you truly wanted to be a psychiatrist. Either that or I'd be looking into your record for something extremely blemishing (e.g. like you got kicked out of the program for blowing up in anger at a patient). Since the latter doesn't seem to be the case I'd be very enthusiastic to see a candidate like you make such an unorthodox but brave switch.

Now that's my opinion. I can't speak for many others but I do think several would agree.

Regarding other logistical issues, how would I go about properly initiating a specialty switch?

Talk to you PD. I'm assuming your PD is open-minded about these things and won't pull the narcissistic and egotistical attitude of "you better be a radiologist or else." Honor your commitment to finish your year so you don't screw over the program your in. Do you still have at least some interest in radiology? Reason why I ask is some programs such as U of Cincinnati are doing research into using brain scans to advance their use in diagnostic psychiatry. You could be a boon to the field in that regard.

I'd also start thinking of making a personal statement on why you're doing the switch and try to get your PD to emphasize that you were a good resident and the switch is apparently based on your passion for psychiatry.

I've said this in other threads. I got an unofficial 1/3 go into psychiatry because their "lazy" (better call schedules), 1/3 go in because they're "crazy" (they got a psychiatric issue, and yes I know the use of the word crazy is not PC, and somewhat inappropriate. I use it because it rhymes with "lazy"). The last 1/3 go in because of a passion for the field. The latter two categories are compatible. I've met several in the field who suffered from a psychiatric disorder who are great psychiatrists.

You certainly would appear to be someone in the latter 1/3 category and that's the person I'd want in my program. You could start as a PGY-2, but you could also be opening your field and gaining more choices for entry if you start over.

 

[Medstudentquest]

If I saw someone in your shoes during the interview process, I'd think not. Radiology is more competitive and makes more money than psychiatry, so if someone made a switch, I'd figure it'd most likely be because you truly wanted to be a psychiatrist. Either that or I'd be looking into your record for something extremely blemishing (e.g. like you got kicked out of the program for blowing up in anger at a patient). Since the latter doesn't seem to be the case I'd be very enthusiastic to see a candidate like you make such an unorthodox but brave switch.

Now that's my opinion. I can't speak for many others but I do think several would agree.


Talk to you PD. I'm assuming your PD is open-minded about these things and won't pull the narcissistic and egotistical attitude of "you better be a radiologist or else." Honor your commitment to finish your year so you don't screw over the program your in. Do you still have at least some interest in radiology? Reason why I ask is some programs such as U of Cincinnati are doing research into using brain scans to advance their use in diagnostic psychiatry. You could be a boon to the field in that regard.

I'd also start thinking of making a personal statement on why you're doing the switch and try to get your PD to emphasize that you were a good resident and the switch is apparently based on your passion for psychiatry.

I've said this in other threads. I got an unofficial 1/3 go into psychiatry because their "lazy" (better call schedules), 1/3 go in because they're "crazy" (they got a psychiatric issue, and yes I know the use of the word crazy is not PC, and somewhat inappropriate. I use it because it rhymes with "lazy"). The last 1/3 go in because of a passion for the field. The latter two categories are compatible. I've met several in the field who suffered from a psychiatric disorder who are great psychiatrists.

You certainly would appear to be someone in the latter 1/3 category and that's the person I'd want in my program. You could start as a PGY-2, but you could also be opening your field and gaining more choices for entry if you start over.

I think part of the problem is that rads is in a difficult position right now. Lots of uncertainty, crappy job market, salaries have dropped, with much more work than a field like psych. So while psychs are starting off in the 200's, and rads in the 300's, psychs work far less than rads. I've even seen jobs that offer the 200k range for 32 hours of work so realistically, it's not a bad salary at all for the hours worked.

 

[MrJiggles]

I think part of the problem is that rads is in a difficult position right now. Lots of uncertainty, crappy job market, salaries have dropped, with much more work than a field like psych. So while psychs are starting off in the 200's, and rads in the 300's, psychs work far less than rads. I've even seen jobs that offer the 200k range for 32 hours of work so realistically, it's not a bad salary at all for the hours worked.

I doubt that they'd earn as little as Psychiatrists though, not that they earn "little". I wonder, do you guys think that Psych salaries will increase with the ACA and Mental Health Parity? Should I bring this up in another thread?

I also wonder about the 200K salary bit, I was looking up salaries in NY and around (where I plan to stay for some time) and I can't seem to find a consensus on the matter. I realize that Psychiatrists make less in NYC, but the salaries I found online seemed to be in the 150-160K range... I doubt a Radiologist would ever be earning as little as that, right?

Also dont radiologists get more vacation time? There is no continuity of care. In any case, I wouldn't give up patient interaction for the world but I'm a naive MS4 applying to Psych.

 

[Medstudentquest]

I doubt that they'd earn as little as Psychiatrists though, not that they earn "little". I wonder, do you guys think that Psych salaries will increase with the ACA and Mental Health Parity? Should I bring this up in another thread?

I also wonder about the 200K salary bit, I was looking up salaries in NY and around (where I plan to stay for some time) and I can't seem to find a consensus on the matter. I realize that Psychiatrists make less in NYC, but the salaries I found online seemed to be in the 150-160K range... I doubt a Radiologist would ever be earning as little as that, right?

Also dont radiologists get more vacation time? There is no continuity of care. In any case, I wouldn't give up patient interaction for the world but I'm a naive MS4 applying to Psych.

I have personally never seen salaries in the 150-160k range for psych, usually 180k + with the most common ones in the 200k range.

 

[whopper]

I wonder, do you guys think that Psych salaries will increase with the ACA and Mental Health Parity? Should I bring this up in another thread?

Honestly don't know about this. I personally think it'd go up but I wouldn't bet on it.

I have personally never seen salaries in the 150-160k range for psych, usually 180k + with the most common ones in the 200k range.

I've seen 150K, but that particular place was freaking slow. It was the old state job I had. I literally had nothing to do after 3 hours a day. What I did was I mixed it up with private practice and a court gig, and I could spill the work from the other 2 gigs into the state gig becuase I had so much time on my hands with nothing to do without cutting quality.

The reason why I had nothing to do was most of my patients were stable but I couldn't discharge them until a judge okayed it. The judges were slow. E.g. they'd give me a response 3 months after I wrote a letter requesting the guy be discharged.

The big grab with this state job in addition to it being slow was that if you put in 25 years, you could get 1/2 your salary as a pension for the rest of your life. The risk being the state may go back on this at any time (though they haven't for decades and I'd bet they wouldn't). Most other state jobs I've seen pay better but they did expect more work. I was considering perhaps returning to the state job as a type of pseudo-retirement because it was so slow I figure if I was 90 I could still do it. The other draw was the institution knew they didn't pay well so they were very very very flexible on a lot of things. E.g. as long as I showed up to do my hours, they didn't care as long as I did at least 4 hours a day during regular business hours. I could've showed up 10:30 and they wouldn't have cared.

I'm on a salaried position paying well through a university, but I could leave, do my own private practice and likely make about 1/3 more. The thought does cross my mind from time to time. At least for now I'm happy where I'm at and the thought that I'm working with some of the best people I've ever seen (literally) in this profession has me stoked.

 

[notdeadyet]

I have personally never seen salaries in the 150-160k range for psych, usually 180k + with the most common ones in the 200k range.

Then you've likely never looked at academic postings. $150-160K would be a great salary for an acadmic where I live. Does seem on the low side for private practice though.

 

[Medstudentquest]

Then you've likely never looked at academic postings. $150-160K would be a great salary for an acadmic where I live. Does seem on the low side for private practice though.

I was not talking about academics, I was talking about private practice, etc. Do you really think that rads in academics are ranking in 400k? not so. And I've never been able to understand the crappy academia salaries. 150k is easily obtainable in many careers these days. How is that an incentive to be a dr?

 

[MrJiggles]

I suppose there may be more career satisfaction for some folks in an academic setting, or they may be more interested in research or teaching. I'm at a state school in NY, I looked up the salary for one of my attendings (public information), and his salary was 138k. But he loves to teach, loves his research and all that, and in general its a pretty laid back inpatient gig. Granted, NY sucks for medicine salaries in general, but I was certainly shocked to see that he earned so little.

How is that an incentive to be a dr?

I mean, look at pediatricians. Where I am, a general pediatrician will come out of residency routinely making <100k. I guarantee you, even if doctor's salaries plummet (which...they may), people will still want to be, and still be fascinated by doctors.

 

[Medstudentquest]

I suppose there may be more career satisfaction for some folks in an academic setting, or they may be more interested in research or teaching. I'm at a state school in NY, I looked up the salary for one of my attendings (public information), and his salary was 138k. But he loves to teach, loves his research and all that, and in general its a pretty laid back inpatient gig. Granted, NY sucks for medicine salaries in general, but I was certainly shocked to see that he earned so little.



I mean, look at pediatricians. Where I am, a general pediatrician will come out of residency routinely making <100k. I guarantee you, even if doctor's salaries plummet (which...they may), people will still want to be, and still be fascinated by doctors.

i doubt salaries will *plummet*, they may be reduced somewhat but doubt they will plummet. also remember that a large chunk of primary care and peds are foreigners, so making 120k or whatever it is that peds make these days is much better than what the conditions are in other countries. but if salaries continue to decrease, you'll see more and more foreign people. just not enough incentive to make the same as a nurse with the work, liability, etc that it takes to be a doc

 

[Zorko]

Thanks for everyone's encouraging and informative replies. I was certainly glad to hear that a PGY-2 position may be feasible. Specific mention was made of Stanford, Yale, UW, Hopkins, et al. I imagine that all of these programs would be highly competitive, especially since there are not as many PGY-2 positions to go around. Does anyone know of other programs (perhaps a bit less prominent) that are routinely open to accepting transfers? As far as "numbers" are concerned, I do believe that I could offer a competitive application. During medical school, I was fortunate to make AOA and honor all of my third-year clerkships. Step 1/2 scores were 260+. Step 3 was 240+. Negatives would be no real research and no formal psychiatry experience since MSIII.

Would I be at a significant disadvantage starting as a PGY-2 in terms of knowledge? Most programs seem to feature six months of psychiatry as a PGY-1. Not to mention that I would miss a year's worth of didactic lectures and other informal teaching. I do not necessarily have a problem starting over as a PGY-1 as it may afford more options (location, program type, etc.) at the expense of an extra year.

Thanks again for everyone's input. You all are a great group and sound like you would make fine colleagues.

 

[Leo Aquarius]

I doubt that they'd earn as little as Psychiatrists though, not that they earn "little". I wonder, do you guys think that Psych salaries will increase with the ACA and Mental Health Parity? Should I bring this up in another thread?

I also wonder about the 200K salary bit, I was looking up salaries in NY and around (where I plan to stay for some time) and I can't seem to find a consensus on the matter. I realize that Psychiatrists make less in NYC, but the salaries I found online seemed to be in the 150-160K range... I doubt a Radiologist would ever be earning as little as that, right?

Also dont radiologists get more vacation time? There is no continuity of care. In any case, I wouldn't give up patient interaction for the world but I'm a naive MS4 applying to Psych.

Just started psychiatry residency and really enjoy the close interaction with patients and the study of human behavior and its fascinating yet unfortunate derangements.

Regarding salaries, as a psychiatrist you can elect to make as much as you want. Some psychiatrists consult for geriatrics all week long and bill Medicare for each 20-min visit. Medicare pays them around $90 for a visit. In this way they rake in over $300K per year.

Want more vacation? Then do consult work for 9 months out of the year and go travel for 3. It's very flexible. Just don't make the mistake of passing up on psych because you think they max out around $160K or something ridiculous like that. It's all up to you. EM docs make around $150 to $170 per hour. Psychiatrists can see Medicare patients and earn $270 per hour.

It's not about the money though. Follow your heart. In medicine you won't find something as exhilarating as being an Olympic champion or rock star, but you can pick a field that you enjoy. Pick one you enjoy.

Radiology is fascinating and I had the stats to go into it, but missed patient interaction which is what I love doing. Just yesterday I counseled two suicidal 20-something year olds whom I felt a connection with and they thanked me for being the only one to listen and talk to them in a deep way. They had no body else in their lives. I did something that helped them in some small way. Nothing can replace that feeling. And yes, sometimes a good psychiatrist can save someone's life as I see my attendings do.

 

[MrJiggles]

Just started psychiatry residency and really enjoy the close interaction with patients and the study of human behavior and its fascinating yet unfortunate derangements.

Regarding salaries, as a psychiatrist you can elect to make as much as you want. Some psychiatrists consult for geriatrics all week long and bill Medicare for each 20-min visit. Medicare pays them around $90 for a visit. In this way they rake in over $300K per year.

Want more vacation? Then do consult work for 9 months out of the year and go travel for 3. It's very flexible. Just don't make the mistake of passing up on psych because you think they max out around $160K or something ridiculous like that. It's all up to you. EM docs make around $150 to $170 per hour. Psychiatrists can see Medicare patients and earn $270 per hour.

It's not about the money though. Follow your heart. In medicine you won't find something as exhilarating as being an Olympic champion or rock star, but you can pick a field that you enjoy. Pick one you enjoy.

Radiology is fascinating and I had the stats to go into it, but missed patient interaction which is what I love doing. Just yesterday I counseled two suicidal 20-something year olds whom I felt a connection with and they thanked me for being the only one to listen and talk to them in a deep way. They had no body else in their lives. I did something that helped them in some small way. Nothing can replace that feeling. And yes, sometimes a good psychiatrist can save someone's life as I see my attendings do.

I'm so glad you posted this! Myself, I came into medicine wanting to do Oncology, ended up loving Psych for the same sort of interactions you described. Paying back my loans scares the crap out of me, but I'm pretty sure doing something that I don't like scares the crap out of me even more.

On a side note, its funny, ever since I've started telling attendings and residents that I'm pursuing Psych, I've had many of them randomly pull me aside and ask me to think about some person they dont like, or some social situation, or some difficult patient they had. As if I have some sort of sage-like insight into the human soul that they do not in all of my 25 years...

 

[whopper]

If I wanted to do so, I could make about 350K a year. I'd have to leave my current job, do a few things, it'd take a year or two of making about 200K, but after that it'd eventually grow to 350K, but it's perfectly within my power to do so. At this time I choose not to do that.

 

[aphenomenon]

Thanks for everyone's encouraging and informative replies. I was certainly glad to hear that a PGY-2 position may be feasible. Specific mention was made of Stanford, Yale, UW, Hopkins, et al. I imagine that all of these programs would be highly competitive, especially since there are not as many PGY-2 positions to go around. Does anyone know of other programs (perhaps a bit less prominent) that are routinely open to accepting transfers? As far as "numbers" are concerned, I do believe that I could offer a competitive application. During medical school, I was fortunate to make AOA and honor all of my third-year clerkships. Step 1/2 scores were 260+. Step 3 was 240+. Negatives would be no real research and no formal psychiatry experience since MSIII.

Would I be at a significant disadvantage starting as a PGY-2 in terms of knowledge? Most programs seem to feature six months of psychiatry as a PGY-1. Not to mention that I would miss a year's worth of didactic lectures and other informal teaching. I do not necessarily have a problem starting over as a PGY-1 as it may afford more options (location, program type, etc.) at the expense of an extra year.

Thanks again for everyone's input. You all are a great group and sound like you would make fine colleagues.

Don't sell yourself short of applying to those listed programs, sounds like you'd be a good applicant. Just develop a good narrative about yourself as relates to psychiatry.

 

[F0nzie]

Some psychiatrists consult for geriatrics all week long and bill Medicare for each 20-min visit. Medicare pays them around $90 for a visit.

Any idea what billing code that is?

 

[markglt]

whopper, i never entered into medicine for the money...but 350k sounds nice. how would you do that....i think you did forensics if im not mistaken....is that 350 mark only with a fellowship...i shouldnt be asking these questions, but curious minds, ya know.

 

[SomeDoc]

whopper, i never entered into medicine for the money...but 350k sounds nice. how would you do that....i think you did forensics if im not mistaken....is that 350 mark only with a fellowship...i shouldnt be asking these questions, but curious minds, ya know.

Regarding info on salaries, perhaps we should be discussing these with private messages? SDN is a public forum...

 

[markglt]

perhaps

 

[toothless rufus]

Want more vacation? Then do consult work for 9 months out of the year and go travel for 3.

How would you set something like this up? If you have an employer, they aren't going to be happy when you leave for extended periods of time.

Or if you are a private contractor I'm sure whomever you are contracting with would also get annoyed.

When I am finished with residency I plan on doing something like this. I love taking months and months off at a time. But how can you set it up so the work is there when you want it?

 

[whopper]

Okay here's how.

1) Suboxone-makes good money, but it is cumbersome and you have to get used to a portion of the patients lying and cheating. No it's not all of them, it's a minority, but a minority to the degree where I got to deal with bogus BS calls requesting Suboxone because the dog ate the homework at least every few days. That'd make 100-150K a year for about 2 days of work a week.

2) I got a court gig I used to do and it did $150 per eval. The fact of the matter was some of the evals only took a few minutes because the patient would try to punch me within the first few minutes. Eval over, I made $150, once the judge hears the guy tried to attack me he's fine with me ending the eval there. On avg. it made around $250/hr. If I left my previous job and took up the court gig, that'd make about 50K a year for 3/4 a day's worth of work, plus once it's over it's over. No calls, no angry patients calling in the middle of the night, it's over.

You didn't need the forensic fellowship for it, but the court wants fellowship trained people, and you will do a better job because of it.

The only downside of the job was that you COULD NOT TAKE ANY DAY OFF unless you found someone to cover you ahead of time. If you didn't, you could be found in contempt of court if you took a day off (no I don't think they'd actually put the doctor in jail, I think they'd fire the doctor first). They did not have anyone on back-up for you. You had to ask other doctors, though they would call the few doctors they did know if you gave them advance warning.

3) Private practice to fill up the rest of the time. That'd bring in I figure about $250+ an hour. I figure with 6 months to one year it could bring in about 300+ per hour.

4) A local addiction clinic offered me a job to do evals at about $200 per eval taking about 30-45 mintues per eval.

The problems with these jobs are I don't know if I'd be as happy, I'd be isolated from working with other colleagues I like and respect, and the retirement package with the university or the state hospital are way good.

Now how did I get to this point? I tried a little of a lot after fellowship. Had I just stayed in one place doing one thing, I wouldn't have known of any other job opportunities. Further, I'd like to think I at least developed a decent rep in the area. Once you've practice in an area for a few years, people will know if you are good or not. Always do a good job. Aside from the ethics, your rep will follow you.

I'm planning on staying with the university, but if I ever left, I don't know if I'd ever go for the max-profit route. I think I'd rather go a mix of the state hospital + a suboxone + court evaluator side gig because I'd still make good money (about 250K) plus I'd still be setting aside a lifetime pension of about 90K+ a year with full-benefits by the time I retired in that route assuming the state doesn't take away pensions. It could, but I haven't seen it happen yet. After I left the state hospital, within 2 months they offered me a job back there in the 3rd highest position in the hospital (in administration), with a yellow-brick road to eventually be the top guy in perhaps 10 years of sticking with them. Plus I'd be working with a very good friend who I've seen as a semi-mentor, big-brother type in my forensic training.

 

[toothless rufus]

Okay here's how.

1) Suboxone-makes good money, but it is cumbersome and you have to get used to a portion of the patients lying and cheating. No it's not all of them, it's a minority, but a minority to the degree where I got to deal with bogus BS calls requesting Suboxone because the dog ate the homework at least every few days. That'd make 100-150K a year for about 2 days of work a week.

2) I got a court gig I used to do and it did $150 per eval. The fact of the matter was some of the evals only took a few minutes because the patient would try to punch me within the first few minutes. Eval over, I made $150, once the judge hears the guy tried to attack me he's fine with me ending the eval there. On avg. it made around $250/hr. If I left my previous job and took up the court gig, that'd make about 50K a year for 3/4 a day's worth of work, plus once it's over it's over. No calls, no angry patients calling in the middle of the night, it's over.

You didn't need the forensic fellowship for it, but the court wants fellowship trained people, and you will do a better job because of it.

The only downside of the job was that you COULD NOT TAKE ANY DAY OFF unless you found someone to cover you ahead of time. If you didn't, you could be found in contempt of court if you took a day off (no I don't think they'd actually put the doctor in jail, I think they'd fire the doctor first). They did not have anyone on back-up for you. You had to ask other doctors, though they would call the few doctors they did know if you gave them advance warning.

3) Private practice to fill up the rest of the time. That'd bring in I figure about $250+ an hour. I figure with 6 months to one year it could bring in about 300+ per hour.

4) A local addiction clinic offered me a job to do evals at about $200 per eval taking about 30-45 mintues per eval.

The problems with these jobs are I don't know if I'd be as happy, I'd be isolated from working with other colleagues I like and respect, and the retirement package with the university or the state hospital are way good.

Now how did I get to this point? I tried a little of a lot after fellowship. Had I just stayed in one place doing one thing, I wouldn't have known of any other job opportunities. Further, I'd like to think I at least developed a decent rep in the area. Once you've practice in an area for a few years, people will know if you are good or not. Always do a good job. Aside from the ethics, your rep will follow you.

I'm planning on staying with the university, but if I ever left, I don't know if I'd ever go for the max-profit route. I think I'd rather go a mix of the state hospital + a suboxone + court evaluator side gig because I'd still make good money (about 250K) plus I'd still be setting aside a lifetime pension of about 90K+ a year with full-benefits by the time I retired in that route assuming the state doesn't take away pensions. It could, but I haven't seen it happen yet. After I left the state hospital, within 2 months they offered me a job back there in the 3rd highest position in the hospital (in administration), with a yellow-brick road to eventually be the top guy in perhaps 10 years of sticking with them. Plus I'd be working with a very good friend who I've seen as a semi-mentor, big-brother type in my forensic training.

Very nice. Thanks for taking the time to post this, and thanks for the examples. Its hard to know what opportunities are available, its such a varied specialty.

 

[whopper]

Mentioned this before. Do side gigs, do good work, and more people will get to know you and you'll hear more and more opportunities available. I get at least a call a month asking me to join a place and I'm in a position where I can tell the guy that I have competing good offers and if he could match them, though I don't plan on leaving the University at this time.

I've known a lot of people that took a job and then the professional blinders went on from there. This is how some docs get locked into 150K-170K jobs they don't even like. I'd recommend keeping a good network of colleagues, and trying a few side gigs here and there to make your rep known in an area right after residency. While in that gig, make good connections, do good work, and scope it out for what it can offer you. Once you've figured it out, leave on good terms, and begin scouting for the other jobs in the area. After a few years I figure I got this area down and know what to do if I start a private practice--including the area where it should be, who I should work with, etc.

I also know enough to know that I do have it good where I'm at now and maybe I shouldn't mess with it. Had I not done the above, I'd always be wondering what if. I've done enough to sate that curiosity for now.

Just to let you know I've turned down two offers to take over a highly lucrative private practice, turned down a job to work at a highly prestigious private institution, turned down an administrative job offer (mentioned above), a chance to start a Suboxone clinic as an owner with the plan to eventually sell it to a national healthcare chain for much more than what I'd put into it as an initial investment, and work with one of the top docs in the state (in terms of business administration) in a very lucrative C & L position where I'd get paid good money per evaluation. All of these offers were within one year.

I only got these from getting to know people, networking, working at different places, and trying to do consistent good work. Another guy I know who graduated from the same fellowship in the area, and is known to be a somewhat cutting the corners guy. He's not getting any of the offers I am. As a buddy of mine told me "there's a reason why no one's wanting him to join them."

And some of those doors opened because I did some volunteer teaching here and there. The professors in those programs figured I really got to love this field if I worked on a powerpoint presentation for days for free only because I wanted to teach. Those profs then started talking about me to other people and some momentum developed.

 

[pre med 2014]

I wonder how Thomas Szasz switched from a medical residency into psychiatry?

No way his personal statement said 'I want to make the switch so I can expose psychiatry with authority'

He must have 'faked' his interest, otherwise they would have never let him in.

 

[whopper]

The only two factors making me think he at least thinks he's legit on some level is he's from a country where psychiatry was used as a political weapon to silence dissidents, back in the day the state of the technology was much worse (e.g. some people thought schizophrenia was due to psychodynamic reasons), and a much lower standard of care existed-not just with meds but with patient's rights. If you mix that with the possibility that maybe he's one of those docs that just didn't learn anything after 1980, maybe he on some level actually believes his own stuff.

 

[pre med 2014]

The only two factors making me think he at least thinks he's legit on some level is he's from a country where psychiatry was used as a political weapon to silence dissidents, back in the day the state of the technology was much worse (e.g. some people thought schizophrenia was due to psychodynamic reasons), and a much lower standard of care existed-not just with meds but with patient's rights. If you mix that with the possibility that maybe he's one of those docs that just didn't learn anything after 1980, maybe he on some level actually believes his own stuff.

I didn't mean that he pretended to believe his own stuff. I meant he had to have pretended to believe in psychiatry to get into a program because no one would let him into a residency had they have known his stance on the involuntary portion.

 

[markglt]

always awesome posts whopper!!
thanx!!

 

[vistaril]

If I wanted to do so, I could make about 350K a year. I'd have to leave my current job, do a few things, it'd take a year or two of making about 200K, but after that it'd eventually grow to 350K, but it's perfectly within my power to do so. At this time I choose not to do that.

but almost anyone in medicine can say that....well at least up to maybe 300ish.

A family medicine person could take a job in where they do extremely high volume acute(not really) care outpt mixed with contracting with a less desirable er part time 20-25 hrs a week and hit 350 for example.....most dont for the same reason you dont choose to maximize your income- bc you dont want to because it involves stuff you dont enjoy as much.

Fields like cardiology and int radiology involve the same choices....but instead of from 175 to 300k those choices are from 400k to 800k.......

 

[vistaril]

I am currently a PGY-2 and first-year radiology resident considering a career change to psychiatry. I never thought that I would find myself in such a position. Perhaps the beginning of July is too early in the game to make any drastic decisions, but I was hoping to at least broach the subject with you all and see if anyone could offer advice or maybe even speak from experience.

For the moment, radiology is not quite what I had imagined, although I performed due diligence researching the field as a medical student. The attendings and residents at my institution are amazingly brilliant and refreshingly down-to-earth, so it's not that I want to leave because I have a beef with the program. It's just that I am not convinced that the specialty itself is the right fit for me.

Fundamentally, I miss the patient interaction and more "humanistic" aspects of medicine, i.e. the opportunity to exercise compassion, empathy, listening skills, etc., which I believe was actually one of my primary strengths as a medical student and intern. I know that this may sound strange given the stereotype that radiologists don't enjoy talking to patients. No doubt, radiology is extremely challenging and intellectually stimulating, but I can't help but feel like a "human computer" or "robot" at times.

I jelled really well with a psychiatry attending during my third-year clerkship as a medical student. It was my experience with him that made me evaluate psychiatry as a future career, although I ultimately chose radiology. He wrote an excellent letter of recommendation that I subsequently incorporated for all of my ERAS applications. Would it be acceptable to contact my letter writer and see if his LoR could be recycled/reused?

Regarding other logistical issues, how would I go about properly initiating a specialty switch? I've done a little bit of digging through the SDN archives as a background effort. Clearly, I would need to notify my current PD of my intentions (the earlier the better) and hope that he/she would be receptive and supportive. I would definitely honor my commitment/contract to my current program and fulfill the requirements for the remainder of this year so as not to hose my fellow residents and wreck the call schedule.

It seems that my best option would be to essentially "start over" and reapply through ERAS as a PGY-1. I already completed an internship that included a couple months of IM and one month of ER but no neurology or psychiatry. Is it realistic to expect at least a portion of my rotations to be transferable?

Would it be difficult to convince PDs of psychiatry residency programs that my interest is sincere? I'm afraid that making such a late specialty switch might be misinterpreted as a sign of immaturity or poor judgment. Also, I haven't had a chance to do a psychiatry rotation since MSIII - would this be a major hindrance/red flag?

Thanks so much for reading. I would welcome any comments or suggestions.

well first, if I was a pd type I'd glady take you obviously, but the real question is why the hell you picked rads in the first place?

you have to keep in mind in some settings you can literally make SIX TIMES as much doing high volume int rads as doing psychiatry......so you better really like psych.

also, you better not care about image or prestige....because psych and rads/IR are much different in that regard.

 

[whopper]

but almost anyone in medicine can say that....well at least up to maybe 300ish.

True. Anyone can say they can earn something and realistically so if they're only willing to work, oh, maybe 100 hours a week.

The options I mentioned could have me earning about 350K a year doing about 50 hours a week, but honestly I don't think I'd like the job as much and I choose not to do that because doing that max-profit route will also not give me benefits. I think the long-term max profit over a lifetime option would earn me about 250K-275K a year doing about 45-50 hours a week with very good benefits + a lifetime pension of around 100K+ when I retire (and this would make more money over the long-run assuming I live to a ripe old age). If I chose that road I'd have to leave my current job (that I like) work for the state and mix it with private practice and my court gig.

I was doing that before I left my state job for the university, earning about 230K a year but if I return to the state job they've offered me a promotion as the #3 doctor in the hospital with a pay bonus. Further, I've learned since then and know how to make more money doing the same gigs.

The court gig earned about 50K+ a year for doing 6 hours (one day) a week. Its available 3 days a week. I could just take up the rest of the days (but that'd only be an option if the two other doctors eventually leave--and they will though it could be a few years) and if I took that up and just did Suboxone + private pay only patients (very few) I'd make 350K a year, it'd take a few years, but I don't think I'd like the job as much, no benefits, but the hours would only be about 9-4 5 days a week.

I've decided that I will either stay with the university until I retire, do the state job mixed with some private practice. The university earns me actually very good money compared to jobs at other universities with opportunities to teach and I love that. I'm definitely staying here for at least some time. At some point I figure my desire for money, not so much for the money, but to help my kids' futures may eventually supercede my desire to stay in this job.