Dealing with the stigma

[Sartre79]

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I'm a M3 who is heavily leaning toward Psych, but am discouraged by how much other students, residents, and attendings bash the specialty. Sometimes it's very discouraging to listen to others do this. Anyway, how do you guys deal with this issue?

 

[animas]

Don't mean to sound cheesy, but just remind yourself of that Robert Frost poem... and just think about what a positive difference a good psychiatrist can make.

Who cares what other people think. It's your life, be true to yourself.

***
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I--
I took the one less traveled by,
And that has made all the difference.

***

 

[Sophie]

You know, as soon as I decided on psych at the beginning of 3rd year, I was expecting to run into lots of mean comments from my attendings and residents on other rotations. Surprisingly, the worst I've gotten was a few joking "psychiatrists are crazy" type comments, and way more "you know, I was thinking about psych" or "that's a good field". My fellow med students have been equally stigma-free, usually responding with "Niiiiice lifestyle", "I really wish I had fallen in love with psych", or just "that's awesome/congrats". I'm not saying the stigma doesn't exist, since I'm sure it does, but it's not nearly as prevalent as I thought it'd be. This may partly be due to my attitude, though. I'm in love with psychiatry, and it shows on my face and in my voice when I tell people what I'm going to specialize in.

If you really love psychiatry and psych patients, and think you'd be happier practicing psychiatry than any other specialty, stigma shouldn't matter. If someone were to bash psychiatry in front of me, I'd probably just think that they have no idea what they're missing out on, or that they're jealous (of how fascinating our cases are, nice hours, easy ability to become our own bosses, ability to split our weeks up into ER + private practice or teaching + inpatient or research + C/L or numerous other mixtures, fun and interesting colleagues, etc). I definitely wouldn't feel ashamed or down on myself because of what someone else thinks of my field.

 

[Sneezing]

If they bash it, provide a few counterpoints in a professional manner and leave it at that.

I have only had one real ernest psychiatry bashing. It was an ER attending I was stuck with on multiple occaisions who road me hard for being the fledgling psych. According to this winner, psychiatry wasn't a real specialty, depression wasn't a real illness, and a few more things I won't mention on the internet. The guy was definitely in the terminal stages of ER burnout. I didn't try to explain the merrits of the specialty to this doc.

 

[Regnvejr]

Lots are making jokes, but the moment their post-op patient goes delirious, the're on their knees, begging for you to help them 🙂

 

[pingumd]

I agree with what others have said that you really have to go with your heart. You will spend so many hours a day doing your job you better love it. The 2 minute interactions with the burned-out and bitter physicians who bash psych will start to roll off your back.

The other thing is that I do think the stigma is lifting. I swear on every interview I went on people were talking about how many MD/PhDs from ivy schools went out this year in psych. It think part of the stigma lifting has to do with the increasingly technical nature of psych. Now that neurosurg can bill for DBS procedures I bet depression will be considered a "real illness". The drugs are also getting complicated as are the "genomics" aspect of things.

Combine that with the freedom to set up a private practice with little overhead and have some cash only patients and I think psych is going to be more competitive in the years to come. Reimbursement for many specialties will go down but there will always be some people willing to pay cash because they dont want a record of psych illness on the books.

 

[notdeadyet]

Everyone bashes everyone.

• ER thinks the IM guys are pansies who block every admit.
• Peds folks think ER folks can't write up a decent SOAP.
• Surgeons think IM folks round like the Bataanese death march and can't settle on a diagnosis.
• IM folks think Surgeons don't look beyond their scalpel.
• Etc.

At the end of the day, when you really talk to most docs, I think you'll find a lot of the bashing is really just people saying, "God, I could NEVER do that..." and it gets pointed at every specialty by someone or another. Everything's an acquired taste.

And speaking as an older guy, trust me when I say with a lot of confidence that as you get older, you're going to care less and less what people think of you or your career choice or any choices at all. You'll be more concerned with what your spouse and children think of you (certain age groups mercifully excluded) and most of all if you're comfortable with what you see in the mirror. Folks impressions of your job registers less and less with the years if you're happy with what you do.

 

[Saluki]

Everyone bashes everyone.

• ER thinks the IM guys are pansies who block every admit.
• Peds folks think ER folks can't write up a decent SOAP.
• Surgeons think IM folks round like the Bataanese death march and can't settle on a diagnosis.
• IM folks think Surgeons don't look beyond their scalpel.
• Etc.

At the end of the day, when you really talk to most docs, I think you'll find a lot of the bashing is really just people saying, "God, I could NEVER do that..." and it gets pointed at every specialty by someone or another. Everything's an acquired taste.
.

I love this!

And to the OP... I felt the same way for a while... For the longest time, even after I knew in my heart I wanted to do child psych, I kept saying "I'm deciding between peds and child psych"... I didn't want to admit that I had given up on being a real doctor. But the shocking thing is that even on surgery, most of the attendings think it's great. One of the gyn surgeons spent half an hour telling me about the great time he'd had on his child psych rotation in med school.

There are stereotypes about psychiatry... And some of it is rooted in reality- there are more strange neurologists and psychiatrists than strange pediatricians. I think it's something about the desire to work with the brain. But there are more narcissistic folks in cardiac surgery, more jocks in ortho, etc.

Then there's an idea that you're not a real doc. But the radiologists and pathologists get the same thing, and we all (especially the surgeons!🙂 depend on them despite that...

In the end, I want to enjoy my work, do good for some kids, be in a less cutthroat group, and have enough free time to watch the Olympics, go for a run, etc. And child psychiatry provides all of that. If that means, that for the rest of my life, the other docs at the hospital are going to keep calling me a "peds psychologist" I guess I can live with that 😛

 

[gdbaby]

Some of my replies to nay-sayers.

"Life is too short to not do what makes you happy."

"There is a reason psychiatry is the #1 choice for physicians' second careers."

"It is one of the only specialties, IMHO, where you LITERALLY save people's lives."

and if those responses fail:

"What? What's that you say? I can't hear you over the sound of my boat."

 

[luft]

Whenever I get the "psychiatrists are crazy" line, I just arch one eyebrow sagely and tell them that we are all crazy in some way and most psychiatrists have realized this and have tried to do something about it for themselves. Then whoever made the comment usually looks uncomfortable and usually changes the subject.

 

[doomedgloomed]

Well I think the worst part is not the stigma but the fact that you will forget most medical type stuff that is not associated with psychiatry. This becomes annoying when family members (who assume because you're a doctor you know absolutely everything there is to know about the human body) ask questions about various ailments they have. Hey I don't remember a lot of nephrology that i learned in 3rd yr of med school, and i kind of forgot what a baker's cyst was. I mean it's there but i have to look things up.
Also psychiatric questions often don't come up from family members either from embarassment that they or their family members are sick--depression, delusions whatever and /or have to take a psyc med. Also if you happen to have a mentally ill family member, you're lucky if they'll even let you talk to their psychiatrist--hippa
Maybe this is just me but i don't remember a lot of stuff i learned in med school; u lose what u don't use

 

[235750]

The fact that many of our peers dislike psychiatry should be considered a benefit of the field.

Two words: The Match.

Think about it. What if your interest was in something very competitive, say derm? You'd constantly be stressing out if you could match or not, and you'd be fretting over step scores, etc.

Now, that's not to say that psychiatry applicants don't have to worry about doing well. But as an AMG I know that unless I rob a bank, I will match somewhere in psych, and almost certainly in the state I want. How great is that? Not all applicants to other fields of medicine can make these claims.

I think myself fortunate that I have an interest in a non-competitive field. This means I can concentrate on learning in med school and not necessarily studying for exams (which I think can be two very different things).

I really like notyetdead's post too 👍

 

[psychotrope]

I'm a M3 who is heavily leaning toward Psych, but am discouraged by how much other students, residents, and attendings bash the specialty. Sometimes it's very discouraging to listen to others do this. Anyway, how do you guys deal with this issue?

the stigma within the medical field is a million times less than the "stigma" within the community as a whole.......I think that angle is what bothers many people going into psych.

*BUT* it depends on what you expect wrt that. I mean will your neighbors or your aunts/uncles or whoever in the community think of you in the same way they think of a cardiologist or a general surgeon or whatever? No, absolutely not. That doesn't bother me, but if it bothers anyone interested in psych I could see it playing a factor in their decision.....

 

[Dr OBeara]

Sartre, this is a totally legitimate feeling by you. I'm an MS4 applying in psych, and I had similar stuff except, to be honest, a lot of the stigma for me was coming from myself. The truth is, I had a fantasy about myself as a future doctor (dramatic, saving lives, hero, etc) and the fantasy didn't involve corny jokes about mind reading and people calling me a shrink. But I had to get over it, because Psych was the only thing I loved doing in med school.

My recommendation for dealing with the stigma though is this: talk to your psych patients. They are, in my experience, often the loneliest, saddest, most unhappy patients out there, and they badly need help. At the end of the day, your compassion for the mentally ill is what will sustain you if you're a good psychiatrist. Not the admiration of others (which, for the record, will not sustain you in the "coolest" of specialties).

 

[Sartre79]

Your words are all too familiar...and I take comfort that I'm not alone in my experience. I'm trying to embrace my decision, but I still often hesitate when others inquire about my career intentions. I think it was Kierkegaard who said, "once you label me, you negate me"...too bad more medical students don't read more philosophy 😀. Hopefully I can get over it soon

Sartre, this is a totally legitimate feeling by you. I'm an MS4 applying in psych, and I had similar stuff except, to be honest, a lot of the stigma for me was coming from myself. The truth is, I had a fantasy about myself as a future doctor (dramatic, saving lives, hero, etc) and the fantasy didn't involve corny jokes about mind reading and people calling me a shrink. But I had to get over it, because Psych was the only thing I loved doing in med school.

My recommendation for dealing with the stigma though is this: talk to your psych patients. They are, in my experience, often the loneliest, saddest, most unhappy patients out there, and they badly need help. At the end of the day, your compassion for the mentally ill is what will sustain you if you're a good psychiatrist. Not the admiration of others (which, for the record, will not sustain you in the "coolest" of specialties).

 

[babel]

Well I think the worst part is not the stigma but the fact that you will forget most medical type stuff that is not associated with psychiatry. This becomes annoying when family members (who assume because you're a doctor you know absolutely everything there is to know about the human body) ask questions about various ailments they have.

I completely understand what you're saying here. When I entered medical school I really saw myself going into a field with a very broad knowledge base like FM/IM/EM. My mom is an FM doc, and growing up I could go to her with any general ailment or question - sore throat, new rash, upset stomach, URI, fatigue, new drug or treatment in the newspaper, or some rumor I heard from elementary school friends - "mom, do you really get hemorrhoids from sitting on cold concrete?" - and she could come up with some DDx and/or solution. I thought it was so cool that she seemed to know so much about so many different things. My dad on the other hand is a general surgeon, and the few times I brought such things up to him, he would just give me a strange look, and say "I think you'll live through the night." Then again, when sliced my forehead open after falling off my bike at age 10, he was happy to sew me up right on the living room couch, which was cool in its own way, too.

I guess my point is that if what you value most is being the "doctor" to your family & friends, you really have to go into one of those broad fields - and even then, you are not going to have the answer to everything, and will have to learn have to confidently navigate around that. Medicine is uber-specialized these days, and doctors in most fields are going to have big gaps in their knowledge by default. Pediatricians won't know how to manage HTN, general surgeons won't know how to deliver a baby, and the medicine guys won't know how to treat autism or refractory MDD. Great - that's what all the specialties are for!

Despite all that, as a perhaps *naive* MS3 I look at myself as still having far more medical knowledge than the average person, and as such think that I can still be a help to family, friends, and of course, patients. I mean, the fact that you have some inkling of what a Baker's cyst is and can quickly look it up and explain it to someone really is a huge thing. The average person hasn't the slightest clue to basic human anatomy or physiology (I know I sure didn't before I started medical school - I was a very late-blooming pre-med), and the fact that you can be their translator & guide through medical terminology, diagnosis, and treatments is not insignificant.

And if all else fails, fake it till you make it. 😉

 

[psychotrope]

I completely understand what you're saying here. When I entered medical school I really saw myself going into a field with a very broad knowledge base like FM/IM/EM. My mom is an FM doc, and growing up I could go to her with any general ailment or question - sore throat, new rash, upset stomach, URI, fatigue, new drug or treatment in the newspaper, or some rumor I heard from elementary school friends - "mom, do you really get hemorrhoids from sitting on cold concrete?" - and she could come up with some DDx and/or solution. I thought it was so cool that she seemed to know so much about so many different things. My dad on the other hand is a general surgeon, and the few times I brought such things up to him, he would just give me a strange look, and say "I think you'll live through the night." Then again, when sliced my forehead open after falling off my bike at age 10, he was happy to sew me up right on the living room couch, which was cool in its own way, too.

I guess my point is that if what you value most is being the "doctor" to your family & friends, you really have to go into one of those broad fields -

But while it's true people don't "look at" a family medicine physician and urologist(just to pick one) the same way, they also don't think of a psychiatrist and urologist in the same way....for different reasons.

People think of the urologist as being "very medical but not knowing a lot about every ailment since he specialized". People think of the family medicine doc as "very medical but not an expert in any area since he didn't specialize". People think of the psychiatrist as "not very medical...." period.

Again, it doesn't bother me that much, but it's not a question of generalist vs specialist in the general populations mind. It goes far beyond that, and many pas/nps will be seen by the general population as having a more "medicine oriented" job than us.

 

[Siggy]

If they bash it, provide a few counterpoints in a professional manner and leave it at that.

I have only had one real ernest psychiatry bashing. It was an ER attending I was stuck with on multiple occaisions who road me hard for being the fledgling psych. According to this winner, psychiatry wasn't a real specialty, depression wasn't a real illness, and a few more things I won't mention on the internet. The guy was definitely in the terminal stages of ER burnout. I didn't try to explain the merrits of the specialty to this doc.

Just call him a glorified triage nurse.

/hopeful glorified triage nurse.

 

[psychotrope]

Just call him a glorified triage nurse.

/hopeful glorified triage nurse.

but if ed's didn't exist(a fictional world obviously), ed physicians would still work at the bazillion number of fast care/acute care popups currently staffed with 70% fm's/15%ed's/15%internists......

I think there are a lot of jokes *within* the medical community about ed's, but I think outside the medical community(even amongst professional people) it's rare...I think professionals outside of medicine view ed's as sorta like primary care docs but with an emphasis on acute care stuff rather than long term management stuff......

whereas professionals outside of medicine view psychs as not like primary care medicine docs, not like specialists in medicine....really not like anything in medicine.....

 

[SpiritiualDuck]

Stigma? Yes, I too had some reservations about doing psych. But I enjoy the field; And I know more about management of MDD/Anxiety/Psychotic d/o than FM/IM. We have a different language and understanding of mental illness than others.

When I was in medical school, I had attendings in other fields tell me that I was too good to go into psych, etc. Many of us have heard that, but when they need us, they call.

Learn and trust your abilities and be proud of what you do. Medicine is too specialized for you to know every disease your family will ask you about. But when it comes to URI/GI complaints, we can offer some advice, but I defer to their docs unless it's a case of something like mild viral gastroenteritis and I'll tell them to rest/stay hydrated/etc.

We've worked hard to get here.

 

[Regnvejr]

...The truth is, I had a fantasy about myself as a future doctor (dramatic, saving lives, hero, etc) and the fantasy didn't involve corny jokes about mind reading and people calling me a shrink. ...

Remember, that psychiatrists save lives. Quite a few lives, as a matter of fact. Psychiatric patients are at high risk of death.

 

[doomedgloomed]

"When I was in medical school, I had attendings in other fields tell me that I was too good to go into psych, etc. Many of us have heard that, but when they need us, they call. "


haha when i was in med school nobody told me i was too good to go into psych but i had a fellow med student who i was on internal medicine rotation who was told that by our attending. it made me feel kind of bad actually like 'well why wasn't i too good to go into psyc"; but i guess in medicine you have to grow some tough skin, at least try to grow tough skin so i got over it. plus any attending who says that is a ****(put in any 4 letter word you like)

 

[Regnvejr]

...haha when i was in med school nobody told me i was too good to go into psych but i had a fellow med student who i was on internal medicine rotation who was told that by our attending. it made me feel kind of bad actually like 'well why wasn't i too good to go into psyc"; but i guess in medicine you have to grow some tough skin, at least try to grow tough skin so i got over it. plus any attending who says that is a ****(put in any 4 letter word you like)

And when the same attending run into a shcizophrenic, or a hospital patient with delerium....?

 

[silas2642]

I'm a M3 who is heavily leaning toward Psych, but am discouraged by how much other students, residents, and attendings bash the specialty. Sometimes it's very discouraging to listen to others do this. Anyway, how do you guys deal with this issue?

We were talking about choosing a specialty with my clerkship director last week and how to go about it-- he said something that I found useful. He said that you need to do what you love because when that pager goes off at 3am and you're stuck in that crappy call room with a cold piece of pizza you damned well better love what you're doing because all those peope who are steering you towards different specialties aren't going to be there with you-- your mother, your father, your attending, it's just you who has to wake up every day and go to your job.

 

[whopper]

Hey, the more nonpsychiatric doctors try to turn off medstudents from our field, the better for us.

We enjoy high salaries because of that attitude.

If someone wants to go into IM, a much more labor intensive field for less money per hour so they can avoid the bullspit criticism of others (which IMHO is no better than high school gossip) let them.

Not that IM is not an important field, any field in medicine is. Just that I love psychiatry, so it all works out for me. You really have to go into what field you love.

Besides, by the time you enter residency, all those colleagues of yours, you may probably never see again.

 

[Sust]

I agree with what others have said that you really have to go with your heart. You will spend so many hours a day doing your job you better love it. The 2 minute interactions with the burned-out and bitter physicians who bash psych will start to roll off your back.

The other thing is that I do think the stigma is lifting. I swear on every interview I went on people were talking about how many MD/PhDs from ivy schools went out this year in psych. It think part of the stigma lifting has to do with the increasingly technical nature of psych. Now that neurosurg can bill for DBS procedures I bet depression will be considered a "real illness". The drugs are also getting complicated as are the "genomics" aspect of things.

Combine that with the freedom to set up a private practice with little overhead and have some cash only patients and I think psych is going to be more competitive in the years to come. Reimbursement for many specialties will go down but there will always be some people willing to pay cash because they dont want a record of psych illness on the books.

I agree with the above poster. We're at a very interesting time in neuroscience whereby the brain is a literal hotbed of discovery that could be very relevant and very sexy with profound implications for not just the mentally ill, but for the "normies" as well. Clinical medicine is faster than the legal field in picking up on cutting edge science, but I wouldnt have expected the non-psychiatrists who graduated even 10 years ago to really appreciate some of the nuggets that have emerged recently on areas such as cognition, emotion, addiction, and development. I anticipate the general public being even slower to pick up on scientific discovery and the stigma of mental illness will probably remain well beyond DSM-10 until we figure out how the brain actually works so do what interests you now and ignore the mob.

However, I'm ashamed to admit that I had to cowardly hide my interest in psych throughout 3rd year b/c I didnt want to be left on the sideline during all of the other interesting things that happened on other services. All too often, when someone is interested in psych, people tend to dismiss you as either dis-interested or (worse) lazy, but I didnt work this hard, come this far, and cough up this much money to be scratching my arse through the most formative year of a young doctor. It's a shame that psych-hopefuls have picked up this stereotype, but I wasn't tough enough to try and fight other peoples' pre-conceived notions. Thus, I have been carrying the stone of shame.

 

[psychotrope]

Hey, the more nonpsychiatric doctors try to turn off medstudents from our field, the better for us.

We enjoy high salaries because of that attitude.

If someone wants to go into IM, a much more labor intensive field for less money per hour so they

this is *very* variable....location, setup, etc....

the bottom line is if you want to eventually make 750k(which a LOT of cards and GI people do in some areas), do IM......

because almost nobody in psych(unless they are some otherwordly businessperson) is clearing that.........

my basic point is that it is not fair to compare psych salaries to IM salaries for good grads, because most every good grad going into IM is eventually going to do a GI or cards fellowship....which(despite what surverys say which are completely unverifiable and nonsense) GI and cards as a partner have MASSIVE $$ potential...low 7 figure potentials....

unfortunately for me I don't care about money so will be happy with psych 🙂

 

[whopper]

this is *very* variable....location, setup, etc....

true

 

[masterofmonkeys]

I think I echo someone else who said that a lot of the stigma came from myself. Although I never seriously wavered from wanting to do psych. Did consider FM or IM/psych though. I hated the fact that people would either a) think I wasn't very good at general medicine, or b) think I was wasting my talent. I have had to deal with both of those assumptions, from family and family friends (I'm Indian, so everyone wondered why I didn't do IM/cards or ortho or something), as well as c) that I was too lazy to go into a more 'hardcore' field.

I realized I don't need external validation to be half decent at general medicine. A lot of general surgeons are quite competent at a good chunk of general medicine. Because they take it as a point of pride not to need to run screaming to the IM doc if they see a systolic of 140 or an FSBG of 200. Nothing is stopping me from doing my darnedest to stay competent at general medical issues except me. And heck, in my opinion it's roughly 1 trillion times more appropriate for a psychiatrist to handle common general medical issues than it is for an FM or IM doc with minimal exposure to psych to do the same.

I also realized I'm incredibly egotistical and don't really care what other people think about me because I already know I'm a badass.

 

[whopper]

In medical school, several students develop a type of peer pressure/high school mentality IMHO concerning which fields should be respected more than others.

E.g. neurosurgery, opthamology, dermatology.

The bottom line, however, should be based on which field best suits your personal interests and inspires you to be the best doctor you can be. My cousin-in-law for example is one of the top scoring medical students in her school, a top scorer on the USMLE and "oh no!" she wants to go into pediatrics. Oh no, her fellow medical students don't approve.

A lot of this is baloney. Any field of medicine can benefit from having one of the best and brightest go into it. Will she, the world, her colleagues really be better off if she went into the field of dermatology? A field where many enter simply to have a better lifestyle?

Or how about internal medicine? Wouldn't the best and brightest be better going into a field that's considered the backbone of all medicine? Where you have to know a little of everything? It's no longer sexy going into that field anymore, and for all the wrong reasons.

She is passionate about what she wants to do, and frankly, she'll probably never see any of those medstudents again, and even if she does, it'll be in an environment where this type of peer-pressure bull will no longer exist. Her colleagues probably won't even remember their pre-conceived notions of which fields are supposed to be better or worse.

 

[thamsenman]

In medical school, several students develop a type of peer pressure/high school mentality IMHO concerning which fields should be respected more than others.

E.g. neurosurgery, opthamology, dermatology.

The bottom line, however, should be based on which field best suits your personal interests and inspires you to be the best doctor you can be. My cousin-in-law for example is one of the top scoring medical students in her school, a top scorer on the USMLE and "oh no!" she wants to go into pediatrics. Oh no, her fellow medical students don't approve.

A lot of this is baloney. Any field of medicine can benefit from having one of the best and brightest go into it. Will she, the world, her colleagues really be better off if she went into the field of dermatology? A field where many enter simply to have a better lifestyle?

Or how about internal medicine? Wouldn't the best and brightest be better going into a field that's considered the backbone of all medicine? Where you have to know a little of everything? It's no longer sexy going into that field anymore, and for all the wrong reasons.

She is passionate about what she wants to do, and frankly, she'll probably never see any of those medstudents again, and even if she does, it'll be in an environment where this type of peer-pressure bull will no longer exist. Her colleagues probably won't even remember their pre-conceived notions of which fields are supposed to be better or worse.

May this post be tattooed on the skull of all pre-meds in the SDN pre-allopathic forums from this day foreward. 👍

 

[NJWxMan]

this is *very* variable....location, setup, etc....

the bottom line is if you want to eventually make 750k(which a LOT of cards and GI people do in some areas), do IM......

because almost nobody in psych(unless they are some otherwordly businessperson) is clearing that.........

my basic point is that it is not fair to compare psych salaries to IM salaries for good grads, because most every good grad going into IM is eventually going to do a GI or cards fellowship....which(despite what surverys say which are completely unverifiable and nonsense) GI and cards as a partner have MASSIVE $$ potential...low 7 figure potentials....

unfortunately for me I don't care about money so will be happy with psych 🙂

What?

Firstly, many many EXCELLENT IM grads do not get into fellowship because they don't have the research experience. Most programs today basically require previous research or connection to the specialty. My chief residents at my university's large IM program are all EXCELLENT (some are better than most attendings), and yet they are 4th yr IM residents because they were denied fellowships. Most just move on after they make their first attempt at fellowship.

Secondary, you first quoted 750G then went on to quote low 7 figures? MAYBE, some of the interventional cards guys, but GI? You clearly are not up-to-date on re-imbursement. GI got hammered the past five years. In fact ,most gen. surgeons dropped doing colonscopies because it's no longer worth their time. Normal re-imbursement just 7 yrs ago was around $1200-1400 for colonoscopy based on the market place (NYC vs S AL). Today, re-imbursement is $300-400. Just wait until they cut down re-imbursements for rads by 40% (they know it's coming).

BTW, I do know several psychiatrists that are clearing easily 500G. Some of them definitely compete with with some of the specialty guys. How? Suboxone clinic, ECT, 3-5 mid levels practicing under them, sleep lab, court testifying, etc. If you want to make money, it's there. Word on the street is that there is one psychiatrist in town with a cash practice of only 500 patients and her secretary laughs when new patients call to make an appointment. The discussion normally ends with the secretary saying "You can't afford her." Rumor has it that she gets $400/hr.

 

[Gooner007]

I'm a M3 who is heavily leaning toward Psych, but am discouraged by how much other students, residents, and attendings bash the specialty. Sometimes it's very discouraging to listen to others do this. Anyway, how do you guys deal with this issue?

I'm the in the exact same boat! Initially, my family were a little surprised and probably disappointed. But after talking about psychiatry, they could tell I was really interested in it and were happy for me. As for my close colleagues, they all completely understood why I would choose psych. They pretty much see me as a psych kind of guy. As for my friends, they all just think its cool.

I've only had problems with colleagues who don't know me as well, and doctors outside of psychiatry. I'm studying in Poland, so I'm not sure how the situation is in the States. Over here, docs I've spoken to don't think highly of psych.

End of the day, go into what you love. You're the one waking up every morning going to work. To me, that overpowers what anybody might say about psychiatry.

If other people do feel negatively about psych, ask them why. It may be a petty reason, or may in fact encourage to to pursue psych even more!

 

[carlosc1dbz]

I'm the in the exact same boat! Initially, my family were a little surprised and probably disappointed. But after talking about psychiatry, they could tell I was really interested in it and were happy for me. As for my close colleagues, they all completely understood why I would choose psych. They pretty much see me as a psych kind of guy. As for my friends, they all just think its cool.

I've only had problems with colleagues who don't know me as well, and doctors outside of psychiatry. I'm studying in Poland, so I'm not sure how the situation is in the States. Over here, docs I've spoken to don't think highly of psych.

End of the day, go into what you love. You're the one waking up every morning going to work. To me, that overpowers what anybody might say about psychiatry.

If other people do feel negatively about psych, ask them why. It may be a petty reason, or may in fact encourage to to pursue psych even more!

Lets not encourage anyone to go into psych. Lets just keep it all to ourselves. lol. I think its great that psych is not super comp. It gives us the freedom to get a residency in any state we want. I am excited about that.

 

[Therapist4Chnge]

BTW, I do know several psychiatrists that are clearing easily 500G. Some of them definitely compete with with some of the specialty guys. How? Suboxone clinic, ECT, 3-5 mid levels practicing under them, sleep lab, court testifying, etc. If you want to make money, it's there. Word on the street is that there is one psychiatrist in town with a cash practice of only 500 patients and her secretary laughs when new patients call to make an appointment. The discussion normally ends with the secretary saying "You can't afford her." Rumor has it that she gets $400/hr.

Two words to build wealth....Passive. Income. If you can accomplish multiple revenue streams that are not dependant upon your hourly contribution, you should be in a very comfortable position.

 

[carlosc1dbz]

Two words to build wealth....Passive. Income. If you can accomplish multiple revenue streams that are not dependant upon your hourly contribution, you should be in a very comfortable position.

You are absolutely right. No one gets rich working. Dont believe anyone that says the key to becoming rich is saving, because inflation will always bite you in the butt. You need to become a businessman or woman and start passive income streams. There are many good ones, example building storages, low maintenance and a lot of money. Anyone else care to provide some more passive income ideas?