Debating Between Psychiatry and Radiology

[SomeDoc]

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As I have progressed through my rotations, I have narrowed down my interests to Psychiatry and Radiology. While both fields seem to have little in common (which they do), the one thing that drew me to either field was that in each, patient care is carried out noninvasively. I have never been one who enjoyed working with my hands, and to this extent, enjoyed both fields for these very reasons. I am very much a solitary individual, and yet, I get much satisfaction from one-on-one interaction (with other professionals, or patients), especially when I am assuming a teaching role.

Psychiatry was the only field where, during my rotations, there were multiple days where I found myself thinking... "wow, I can't believe that I would be getting paid to do this!" The satisfaction from seeing patients improve before my very eyes, the gratitude, and appreciation I would get from patients in my interactions with them was unparalleled than in any field of medicine I had since experienced...the only other field similar in such an experience was internal medicine in an inner city (of which patients were very happy to see me, or were very grateful for patient care delivered). However, it is important to note that during my Psychiatry rotation, there were a few days in the morning where I felt like I did not want to go to the floors at the start of the day. Was it because I was tired, or was in need of solitude in a bustling inpatient floor, I do not know. What I do know, is that I find myself to be at ease when interacting one-on-one with patients when talking about psychiatric issues, and patients have often opened up to me very easily, revealing things that have often surprised my internal medicine rotation attendings. I would hope to think that patients feel comfortable opening to me. They are often appreciative of suggested ways in how they can deal with social issues which may impact their psychiatric health.

With Radiology, there were days where I found myself thinking, "wow, this is really neat to be looking at images all day, working steady hours in an office like setting, and in a fairly physically-non-demanding setting in relative solitude, and to get paid very, very handsomely for it. Finding out about patient interaction, while minimal, in diagnostic radiology, was icing on the cake. However, it is important to note, that during my rotation, there were a few times when I would look at the studies needing to be read and would dread seeing such a pile of papers near the end of the day. What this means, I do not know, maybe it was that I was tired, maybe it meant something else, but I do know that attendings would have similar feelings, as evidenced by behaviors or verbalizations. Due to my desire in having patient contact, I considered interventional radiology (IR) as a possibility after radiology residency- but the schedule of working a surgeon's hours would disallow me to do what I want out of life aside from my professional life (to spend time with my family, and to do things outside of medicine, to experience as much as I can out of the human experience before my time is up). It is a great field with lots of perks; great technology, stable hours, handsome pay as previously mentioned, the ability to work in relative solitude, and opportunities for patient contact (relatively minimal in diagnostic radiology, or extensive and questionably at the expense of quality of life in Interventional Radiology).

I understand that it is truly a blessing/a very fortunate position to be in; I am appreciative of the fact that regardless of what field I go into, I will be very lucky. Reflecting on my thoughts, it appears that Psychiatry is where my heart is and Radiology is where my mind is.

Any comments are welcome and appreciated.

 

[animas]

As I have progressed through my rotations, I have narrowed down my interests to Psychiatry and Radiology. While both fields seem to have little in common (which they do), the one thing that drew me to either field was that in each, patient care is carried out noninvasively. I have never been one who enjoyed working with my hands, and to this extent, enjoyed both fields for these very reasons. I am very much a solitary individual, and yet, I get much satisfaction from one-on-one interaction (with other professionals, or patients), especially when I am assuming a teaching role.

Psychiatry was the only field where, during my rotations, there were multiple days where I found myself thinking... "wow, I can't believe that I would be getting paid to do this!" The satisfaction from seeing patients improve before my very eyes, the gratitude, and appreciation I would get from patients in my interactions with them was unparalleled than in any field of medicine I had since experienced...the only other field similar in such an experience was internal medicine in an inner city (of which patients were very happy to see me, or were very grateful for patient care delivered). However, it is important to note that during my Psychiatry rotation, there were a few days in the morning where I felt like I did not want to go to the floors at the start of the day. Was it because I was tired, or was in need of solitude in a bustling inpatient floor, I do not know. What I do know, is that I find myself to be at ease when interacting one-on-one with patients when talking about psychiatric issues, and patients have often opened up to me very easily, revealing things that have often surprised my internal medicine rotation attendings. I would hope to think that patients feel comfortable opening to me. They are often appreciative of suggested ways in how they can deal with social issues which may impact their psychiatric health.

With Radiology, there were days where I found myself thinking, "wow, this is really neat to be looking at images all day, working steady hours in an office like setting, and in a fairly physically-non-demanding setting in relative solitude, and to get paid very, very handsomely for it. Finding out about patient interaction, while minimal, in diagnostic radiology, was icing on the cake. However, it is important to note, that during my rotation, there were a few times when I would look at the studies needing to be read and would dread seeing such a pile of papers near the end of the day. What this means, I do not know, maybe it was that I was tired, maybe it meant something else, but I do know that attendings would have similar feelings, as evidenced by behaviors or verbalizations. Due to my desire in having patient contact, I considered interventional radiology (IR) as a possibility after radiology residency- but the schedule of working a surgeon's hours would disallow me to do what I want out of life aside from my professional life (to spend time with my family, and to do things outside of medicine, to experience as much as I can out of the human experience before my time is up). It is a great field with lots of perks; great technology, stable hours, handsome pay as previously mentioned, the ability to work in relative solitude, and opportunities for patient contact (relatively minimal in diagnostic radiology, or extensive and questionably at the expense of quality of life in Interventional Radiology).

I understand that it is truly a blessing/a very fortunate position to be in; I am appreciative of the fact that regardless of what field I go into, I will be very lucky. Reflecting on my thoughts, it appears that Psychiatry is where my heart is and Radiology is where my mind is.

Any comments are welcome and appreciated.

You have written a well thought out post. Can understand what it's like to be torn between two different specialties. However, I personally just don't think even if there are opportunities for patient contact in radiology it can compare to the interactions you will have with patients in psychiatry. You know yourself best and will continue to have to do some soul searching to ultimately decide what stimulates and inspires you the most now and 20 years from now when life may be different. If it's difficult to just choose one (which I recommend really trying), maybe you can apply to both and as you go through 4th year rotations and the interivew process, you'll have learned more about yourself to know what's right for you. Fourth year was a period of growth just as third year was for me... Dunno if any of this helped. Wanted to at least say something to you because been there myself recently!

 

[Manicsleep]

I hate to be the one to tell you not to pick psychiatry but have you considered a non interventional radiology field that allows for patient interaction?

On the contrary have you considered doing some kind of combination. It would not be brand new. There are neuroradiologists who work in psychiatric departments, although perhaps not in the capacity that you have envisioned.

 

[masterofmonkeys]

Radiologists who specialize in breast do a lot of patient interaction, although they do have to work with their hands a bit (needle loc).

The other possibility is to do IR and NOT work surgeon's hours. If you work 40 hrs a week doing IR, you will still be clearing well over 200k.

 

[whopper]

"wow, I can't believe that I would be getting paid to do this!" The satisfaction from seeing patients improve before my very eyes, the gratitude, and appreciation I would get from patients in my interactions with them was unparalleled than in any field of medicine I had since experienced..

That's ironic because at least from my own training (and maybe where you trained it was very different), psychiatry was the field that in general, you have to tell the patient to do things they don't want to do the most. We are then, as a result, thrust into the position of telling the patient what is best for them even though they do not want to do it.

This isn't true of all branches of psychiatry, but in ER, involuntary units, addiction, and forensic psychiatry, this is quite common.

 

[peppy]

That's ironic because at least from my own training (and maybe where you trained it was very different), psychiatry was the field that in general, you have to tell the patient to do things they don't want to do the most. We are then, as a result, thrust into the position of telling the patient what is best for them even though they do not want to do it.

That's more in keeping with my experience too.
At first I was very surprised that the OP talked about psych patients being so grateful, but then I realized that maybe the patients were friendlier to him than they would have been to the resident or attending because the med student isn't the person who testified against the patient in court about why the patient needs involuntary hospitalization. 🙂
Some patients are grateful, of course...but you have to be prepared to deal with a lot of unhappy people in psych.

 

[peppy]

I understand that it is truly a blessing/a very fortunate position to be in; I am appreciative of the fact that regardless of what field I go into, I will be very lucky. Reflecting on my thoughts, it appears that Psychiatry is where my heart is and Radiology is where my mind is.

You could try going for Radiology with Psych as a backup. I don't think you can really go wrong since they're both good fields. Another thing about aiming for rads is that the internship year in Rads would count for your PGY-1 if you end up deciding you want to switch into psych as a pgy-2, so someone switching from rads to psych can still graduate on time, whereas the reverse isn't true.

A couple things to be aware of:
The compensation in Rads is probably going to decrease over the longterm, so I wouldn't go into it just for the money, just if you honestly enjoy the work.

Another issue in Rads is that because it is so easy to transmit studies electronically nowadays that it's a field that is particularly vulnerable to outsourcing.
There are some people looking at "telepsychiatry" too, but I feel psych is relatively safe from outsourcing since the personal touch and communication are a big part of the job (especially if you do psychotherapy, though many psychiatrists don't anymore).

As for psych, as I commented to whopper, I am really surprised that you apparently found a place where psych patients are polite and well-behaved. Did your rotation site have a lot of involuntary psych patients? I would try to seek out that experience if not and see if you can picture yourself being okay with dealing with patients who really, really are not happy to see you (even if it is the only way to keep the person safe).

As for the issue of dreading going into work in each field, I wouldn't worry about that. No matter what you do, hey, it's still work. If any job was really so great, they wouldn't need to pay people to do it.

 

[SomeDoc]

You could try going for Radiology with Psych as a backup. I don't think you can really go wrong since they're both good fields. Another thing about aiming for rads is that the internship year in Rads would count for your PGY-1 if you end up deciding you want to switch into psych as a pgy-2, so someone switching from rads to psych can still graduate on time, whereas the reverse isn't true.

A couple things to be aware of:
The compensation in Rads is probably going to decrease over the longterm, so I wouldn't go into it just for the money, just if you honestly enjoy the work.

Another issue in Rads is that because it is so easy to transmit studies electronically nowadays that it's a field that is particularly vulnerable to outsourcing.
There are some people looking at "telepsychiatry" too, but I feel psych is relatively safe from outsourcing since the personal touch and communication are a big part of the job (especially if you do psychotherapy, though many psychiatrists don't anymore).

As for psych, as I commented to whopper, I am really surprised that you apparently found a place where psych patients are polite and well-behaved. Did your rotation site have a lot of involuntary psych patients? I would try to seek out that experience if not and see if you can picture yourself being okay with dealing with patients who really, really are not happy to see you (even if it is the only way to keep the person safe).

As for the issue of dreading going into work in each field, I wouldn't worry about that. No matter what you do, hey, it's still work. If any job was really so great, they wouldn't need to pay people to do it.

By observation, approximately 20-40% of the patient population were involuntary admissions, with a good remaining portion made up of patients well known by staff to have psychiatric illness for years in the community (inner/major city), who would arrive to the hospital due to lack of access to preventive care, or due to unique socio-economic reasons. While I admit that this could get frustrating at times, I realize that this is an issue not unique to psychiatry, and can depend on practice type. I felt comfortable around such patients; schizophrenic patients were another group I felt comfortable interacting with, provided they were not in acute psychosis. The depressed patients who were emerging out of an acute episode, and schizophrenic patients with returning insight were a group of patients who seemed to be very appreciative days later after treatment.

There are times where I feel I would be missing out on much in life in terms of experiences, exposure to situations, and novel situations, by working in the environment typical in a radiology practice. There was not a single day during my psychiatry rotation that was the same- despite seeing many cases with the same pathology (i.e. depression, schizophrenia, bipolar disorder), every patient was inherently different by a function of who they were, and had at the very least, some differences in their personal stories. The socioeconomic and personal backgrounds of patients I got to interact with during my rotation was unpararelled. I found these aspects satisfying.

 

[prone2xl]

By observation, approximately 20-40% of the patient population were involuntary admissions, with a good remaining portion made up of patients well known by staff to have psychiatric illness for years in the community (inner/major city), who would arrive to the hospital due to lack of access to preventive care, or due to unique socio-economic reasons. While I admit that this could get frustrating at times, I realize that this is an issue not unique to psychiatry, and can depend on practice type. I felt comfortable around such patients; schizophrenic patients were another group I felt comfortable interacting with, provided they were not in acute psychosis. The depressed patients who were emerging out of an acute episode, and schizophrenic patients with returning insight were a group of patients who seemed to be very appreciative days later after treatment.

There are times where I feel I would be missing out on much in life in terms of experiences, exposure to situations, and novel situations, by working in the environment typical in a radiology practice. There was not a single day during my psychiatry rotation that was the same- despite seeing many cases with the same pathology (i.e. depression, schizophrenia, bipolar disorder), every patient was inherently different by a function of who they were, and had at the very least, some differences in their personal stories. The socioeconomic and personal backgrounds of patients I got to interact with during my rotation was unpararelled. I found these aspects satisfying.

What path did u decide to take ?

 

[SomeDoc]

What path did u decide to take ?

I chose psychiatry, and have enjoyed residency.

It has been an experience with many opportunities for both professional and personal growth, and (satisfying) patient interaction.

As formal training comes close to an end, its also nice planning ahead on some of the more systems-based aspects of psychiatric practice (business models, referrals, revenue sources, etc).

 

[prone2xl]

That's awesome... ! tried to PM you but couldn't see your profile... as the match draws closer, I'm hoping that i'm making the right choice with psych. I keep wondering about radiology, b/c i haven't done a rotation in it, but hear from friends applying that it's not as competitive this year and hope that i'm not missing out! haha what made you choose in the end and do you ever regret it ?

 

[klake3]

I know this is an old post but radiology seems like an odd choice for someone who doesn't like working with their hands... doesn't rads have a ton of procedures like biopsies, placing lines, etc.? Not to mention a mandatory rotation on interventional which is almost surgical in nature.

 

[FranzLO]

This is refreshing since these are probably my top 2 with psych in the lead and ophtho third. It confuses people when I say that since they're so different. Glad to hear psych worked well!