Do DO psychiatrists face a double stigma?

[Chuckwalla]

This is a completely honest question. From what I have seen both psychiatrists and DOs face stigmas (unwarranted in my opinion), so it makes sense that being in both would create more of a problem. If my perception is off, forgive me.

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[HCE]

This is a completely honest question. From what I have seen both psychiatrists and DOs face stigmas (unwarranted in my opinion), so it makes sense that being in both would create more of a problem. If my perception is off, forgive me.

no more so then Harvard Philosophy majors...

 

[whopper]

IMHO yes.

Though I do not hold anything against DOs or psychiatrists. However, I also believe that if a DO psychiatrist were to do a good job, that stigma would be erased because that doctor's colleagues would see the good performance.

 

[MaddieMay]

Every profession carries stigmas. Forget those losers that generalize and assume.

 

[Chuckwalla]

Every profession carries stigmas. Forget those losers that generalize and assume.

Sadly those losers often have a direct and strong impact on you.

 

[GATORANALYST]

Sadly those losers often have a direct and strong impact on you.

When considering a career in psychiatry I never even gave a second thouht to the chance that I could be looked at negatively by my peers. If this is really an issue for you I don't think Psychiatry is for you. Consider one of the more prestigious fields if others opinions of your career choice is what fills your self esteem.

I can't see myself doing anything other than psych. In fact there are times when I wonder how anyone would not want to do what I do on a daily basis.

 

[billypilgrim37]

When considering a career in psychiatry I never even gave a second thouht to the chance that I could be looked at negatively by my peers. If this is really an issue for you I don't think Psychiatry is for you.

I don't think we should confuse honest introspection with vanity.

If you're so self-confident that you never worried about how your peers would think of you, that's great. But that puts you two standard deviations above the mean in that regards. It's much healthier to explore these feelings now than to find out that as a PGY4 that you're really bothered by the way psychiatry is viewed by other specialties. There's nothing illegitimate about that concern.

You can either a) not care, or b) decide not to care about what other people think about you. Either way clears the path for you to get where you want.

 

[Chuckwalla]

When considering a career in psychiatry I never even gave a second thouht to the chance that I could be looked at negatively by my peers. If this is really an issue for you I don't think Psychiatry is for you. Consider one of the more prestigious fields if others opinions of your career choice is what fills your self esteem.

I will take it to an extreme to make my point. Lets say you get a MD degree from the worst Caribbean medical school, lets make it one of those online ones. You can be perfectly fine with that and not care what people think. However, your career will be greatly hindered. It has nothing to do with self-esteem.

So that is what I am asking. Do DO psychiatrists have to deal with a double stigma and if so does it greatly hinder them?

 

[HCE]

I will take it to an extreme to make my point. Lets say you get a MD degree from the worst Caribbean medical school, lets make it one of those online ones. You can be perfectly fine with that and not care what people think. However, your career will be greatly hindered. It has nothing to do with self-esteem.

So that is what I am asking. Do DO psychiatrists have to deal with a double stigma and if so does it greatly hinder them?

I have not seen or read of any evidence to indicate that DO Psychs are hindered professionally one bit due to their profession or DO-ishness.

 

[whopper]

I have not seen or read of any evidence to indicate that DO Psychs are hindered professionally one bit due to their profession or DO-ishness.

But were any studies done?

I graduated from a foreign medical school, and I'll completely admit it was because my undergrad GPA wasn't a 3.9, it was a 3.4. (I transferred to Rutgers. Had I stayed in my original school, my GPA probably would've been around a 3.7-3.9)

During applications to residencies--that was held against me by several programs. E.g. went to a lecture, got into a very good conversation with the lecturer after the lecture, and then the lecturer even asked me to apply to his program and said he'd remember my name. Asked me which school I went to, then he said, "oh"---pause---"oh, we don't accept foreign graduates or D.O.s". He did though reccomend that I apply to his program's fellowhips which he said were open to foreign grads who have completed U.S. residencies.

(At least that comment was good fodder for jokes. A buddy of mine from the same medschool was present when the lecturer made the comment & he imitated the "oh"---pause---"oh" perfectly).

I have seen some people mention they do not want a D.O. doctor. Some say when they choose a doctor, they will only take an M.D.

Again, I do not have any prejudice against D.O.s, but I have seen several show a prejudice against them.

The better question--will it hinder a D.O.?

I think there will be barriers, but once you establish yourself in your job, you'll be fine. I think the biggest barriers will be when applying to residency & fellowship. However once those obstacles are overcome, the problems will decrease. Once you're at your job, people will judge you for the job that you do, not because of the school you graduated from. No nurse or patient will think less of you if you're doing a good job, especially when there's a bunch of M.D.s out there that they think are jerks. Mentioned this a few times but my own program's 2 worst residents that were kicked out during my 4 years (and my dept head mentioned they were the 2 worst residents ever--ever!) were US M.D. grads.

And belittling a point I made above, yes there are those who do not want a D.O., but the majority of patients I've seen don't even know the difference.

 

[HCE]

But were any studies done?

I graduated from a foreign medical school, and I'll completely admit it was because my undergrad GPA wasn't a 3.9, it was a 3.4. (I transferred to Rutgers. Had I stayed in my original school, my GPA probably would've been around a 3.7-3.9)

During applications to residencies--that was held against me by several programs. E.g. went to a lecture, got into a very good conversation with the lecturer after the lecture, and then the lecturer even asked me to apply to his program and said he'd remember my name. Asked me which school I went to, then he said, "oh"---pause---"oh, we don't accept foreign graduates or D.O.s". He did though reccomend that I apply to his program's fellowhips which he said were open to foreign grads who have completed U.S. residencies.

(At least that comment was good fodder for jokes. A buddy of mine from the same medschool was present when the lecturer made the comment & he imitated the "oh"---pause---"oh" perfectly).

I have seen some people mention they do not want a D.O. doctor. Some say when they choose a doctor, they will only take an M.D.

Again, I do not have any prejudice against D.O.s, but I have seen several show a prejudice against them.

The better question--will it hinder a D.O.?

I think there will be barriers, but once you establish yourself in your job, you'll be fine. I think the biggest barriers will be when applying to residency & fellowship. However once those obstacles are overcome, the problems will decrease. Once you're at your job, people will judge you for the job that you do, not because of the school you graduated from. No nurse or patient will think less of you if you're doing a good job, especially when there's a bunch of M.D.s out there that they think are jerks. Mentioned this a few times but my own program's 2 worst residents that were kicked out during my 4 years (and my dept head mentioned they were the 2 worst residents ever--ever!) were US M.D. grads.

And belittling a point I made above, yes there are those who do not want a D.O., but the majority of patients I've seen don't even know the difference.

I took the OP to be asking about stigma as it pertains to a DO Psychiatrist, i.e. someone who is already out of residency. I know that Columbia and UPenn won't interview DOs for psychiatry residency, but know of no others.

I stand by my earlier statement....I know of no evidence to indicate DO psychiatrists experience a single stigma or the double whammy.

 

[OldPsychDoc]

There may be more prejudice against D.O.s in general in the northeast, as opposed to the midwest. It's never been a big deal where I've trained and worked--but there were strong D.O. programs nearby, so more people had positive firsthand experiences with D.O.s.

 

[whopper]

There may be more prejudice against D.O.s in general in the northeast, as opposed to the midwest

That could be true. In NY & NJ, there's a very high amount of students attemping to get into medical schools, and pretty much all the students I've met that go DO attempted an MD school but couldn't get in--which helps to create the stigma. I don't know about California, but that state also has a very high amount of students who attempt to get into medical school vs the midwestern states.

 

[kstotes]

As a soon-to-be-DO who has gone through the match I can tell you that it is incontrovertible (shift+F7) that there is a stigma to get past. There is no way around it-- our average MCAT scores are lower, our average on the USMLE is significantly lower, and the number of DO's banging out top research grants is almost nil. And while, as mentioned, there are few places that are no-DO, many rarely take beyond one or two. And any DO student knows the famed "patch-face" when someone peeps out the name of your school emblazoned on your shoulder. The pervading thought, whether IMG or DO is-- there's a reason you didn't go MD, what is it?

That said it really is only a problem when programs have to decide which applicants to grant interviews to. If they have no idea who you are, our numbers don't stack up head to head, usually. That's why audition rotations are so huge. Once we go work somewhere we can knock down Ivy League positions no problem. On the whole I never felt like my being an osteopathic student brought me down rank lists once I got my interview.

Not to soap-box too much but the real reason this stigma exists is because we as osteopaths perpetuate it. We take a different board exam when we really should be required to take the USMLE and an extra OMM specific exam; we do not allow allopaths to rotate at our hospitals (by in large); we do not allow allopaths into our residencies; and don't get me started on my theory that the osteo traditional year was created to bring our applicants up to par and fill hospitals no one wants to work at.

 

[Suedehead]

As a soon-to-be-DO who has gone through the match I can tell you that it is incontrovertible (shift+F7) that there is a stigma to get past. There is no way around it-- our average MCAT scores are lower, our average on the USMLE is significantly lower, and the number of DO's banging out top research grants is almost nil. And while, as mentioned, there are few places that are no-DO, many rarely take beyond one or two. And any DO student knows the famed "patch-face" when someone peeps out the name of your school emblazoned on your shoulder. The pervading thought, whether IMG or DO is-- there's a reason you didn't go MD, what is it?

That said it really is only a problem when programs have to decide which applicants to grant interviews to. If they have no idea who you are, our numbers don't stack up head to head, usually. That's why audition rotations are so huge. Once we go work somewhere we can knock down Ivy League positions no problem. On the whole I never felt like my being an osteopathic student brought me down rank lists once I got my interview.

Not to soap-box too much but the real reason this stigma exists is because we as osteopaths perpetuate it. We take a different board exam when we really should be required to take the USMLE and an extra OMM specific exam; we do not allow allopaths to rotate at our hospitals (by in large); we do not allow allopaths into our residencies; and don't get me started on my theory that the osteo traditional year was created to bring our applicants up to par and fill hospitals no one wants to work at.

nailed it

 

[RaistlinMajere]

The best way for anyone who is concerned about stigma to put it to rest is to be a competent, thoughtful, and caring physician. Be good at what you do and people won't care about the letters that come after your name.

 

[crippledoc]

If they do, it's certainly warranted.

 

[billypilgrim37]

Man, I go to bed early one night, and I miss the Great Troll Shoot!😉

 

[JMC_MarineCorps]

If you're worried about the stigma, I suggest you go to the gym and lift some weights...this tends to balance things out a bit when getting razzed by your peers.

There is no shortage of 'crazy' in the U.S., but there is a shortage of warm bodies to treat these folks. Job opportunities abound and your D.O. degree will serve you just as well as those FMG online M.D. degrees. Fortunately for us, there will continue to be a great need for our services for many years to come.

So you might not train at MGH, but Harbor/UCLA just accepted 3 DO's this year. Cedars-Sinai picked up another one this year too. I don't think there's much for you to stress about. The burden of the stigma you will face as a psychiatrist far outweighs the one that you will face as a D.O. psychiatrist.

Dr. Charles Sophy, Paris Hilton's shrink famous for getting her released from jail prematurely, is a Beverly Hills D.O. psychiatrist. http://www.drsophyonline.com/about.html

The point to remember here is easily simplified by this equation:
You + Gym + High weight/low reps = Reduced Stigma

I have no scientific data to support this, but if nothing else, it stands to reason that this technique may at least abate one's own anxiety about said stigma.

 

[BNSN]

I don't say this with any authority at all, but yes, DO psych does probably face a stigma. Psych is considered "fake" by a lot of people and DO is considered to be less than an MD by many people.

But, I think it's important to remember that no mature person will judge you solely by the letters after your name or your college name. Be good at what you do, treat your patients well, and you'll earn the respect of everyone -- from your patient to your boss.

 

[marie337]

I'm working with a female, DO, child psychiatry resident right now. She says that her old-fashioned father-in-law had a really rough time with this at first. Once he realized how much money she will be making, however, he got over it!

 

[Iquitos]

I don't say this with any authority at all, but yes, DO psych does probably face a stigma. Psych is considered "fake" by a lot of people and DO is considered to be less than an MD by many people.

But, I think it's important to remember that no mature person will judge you solely by the letters after your name or your college name. Be good at what you do, treat your patients well, and you'll earn the respect of everyone -- from your patient to your boss.

Forget about the DO part for now, but is there really that big of a stigma/fakeness associated with psych? Maybe I'm just in a bubble, but all of the psychiatrists I have known were all respected as physicians or "Dr's" as far as I could tell. Granted, I did not walk in their shoes on a daily basis, so I might have missed something. But if psych is so fake, then why are all the psych jobs blowing FP out of the water as far as starting salaries go, especially considering that FP's deal with a lot of psych issues in day to day practice? Why isn't FP considered fake?

 

[Chuckwalla]

I don't say this with any authority at all, but yes, DO psych does probably face a stigma. Psych is considered "fake" by a lot of people and DO is considered to be less than an MD by many people.

Bingo, thank you for putting it so eloquently. This is exactly what I was thinking.

 

[whopper]

There's a few stigmas.

1-Several nonpsychiatrist doctors get this attitude that our field is the field that medstudents go into that didn't want to hack what they thought were much more difficult fields such as surgery or Ob-Gyn where you work at some places over 80 hrs a week.

2-some people don't believe in mental illness.
3-some do not respect the field because of the lack of objective data.

1-true. Psychiatrists at most places don't work crazy hours. Want to respect me less? I don't care. If that doc is all proud that they work 100 hrs a week, while their personal life blows & they fall asleep in the middle of surgery, I'm not going to debate them, while I go home to my wife, have a good dinner & take it a bit easier

2-don't believe in mental illness? Fine by me too. Several people want the help and those that we treat that don't want the help are to the point where they're dangerous to themselves or others so I don't got an ethical beef with it. Some people think the sun revolves around the Earth. So what, I'm going going to lose sleep over that?

3-lack of objective data. Actually I too have a problem with this, but that only emphasizes the need that we psychiatrists currently use as many objective markers in our clinical judgement as possible. I've seen plenty of lazy docs see a suicidal patient (suicidal because he's psychotic, not because he's depressed) and put a Depressive DO NOS diagnosis because they just want to get out of that office ASAP without really using real DSM criteria to get to a clinically acceptable diagnosis. As bad as that sounds, I've seen this happen in every field. I've seen lazy IM docs, general pracitioners, ER docs, surgeons...Some such as scientologists try to point out mistakes psychiatrists make as a reason to put down the entire field of psychiatry. Every field has its fair share of good & bad. I don't see them going after the ER doc that gave my father in law the wrong antibiotic after he got bitten by a cat. That was a mistake that I picked up and I had to correct that ER doctor, who got upset to be corrected by a psychiatrist. I don't see them going after a surgeon who amputates the wrong limb.

However let's look at this subjectivity as a reason why we as a field need to prevent those in our own field from being lazy. IF we see docs not doing their work we need to work within our own profession to stop poor practice.

#1&3 can come into a mutual problem. Some medstudents come into this field because they are lazy. I personally came into it becuase I love psychiatry. If you got a lazy medstudent--they could become a lazy psychiatrists. Again--even more need for us to be on top of these people & regulate our own profession.

 

[erg923]

To the OP: I wouldn't be too concerned with it if your are (or will be) a DO. Much like the Psy.D. in psych, some hirers might have biases, but you have to think of the big picture. This will rarely actually prevent you from obtaining a position, and patients would could care less......🙂 Unless you want to do research as well, I would be more worried what my potential clients thought of my credentials vs a high and mighty MD psychiatrist.....

 

[RaistlinMajere]

Great insight, Whopper.

I think physicians who believe point 1 are not considering that it's not the sheer number of hours worked, but rather the type of work too that is important. Psychiatrist have great hours, but many of my fellow classmates tell me "how drained" they feel at the end of the day. I actually think this is why psych really doesn't seem to come to people's minds when you ask them to name lifestyle specialties.

If you believe in point two you are definitely 3 standard deviations away from the norm. Seriously, that's like not believing in diabetes or HTN. Even classmates I have that aren't into psych acknowledge that mental illness exists. Do you know anyone who honestly believe that?

Point 3 is legit, but I think this is a problem faced with any field with controllable hours. I've heard that PM&R residency programs are afraid of this in their applicants. Bottom line, if you're lazy and don't actually enjoy psychiatry--or any field for that matter--you are making a pretty big mistake. Being a physician means taking care of patients. I don't see that as compatible with being lazy. What I respect is doctors who are highly competent and efficient enough to get there work done so they can still have a life outside of the hospital. I know a few general surgeons who have carved out a life for themselves.

As a tangent, more and more physicians are trying to balance work with family lives. There was an article on this in the WSJ the other day. Here's the link:

http://online.wsj.com/article/SB120942599600151137.html?mod=WSJBlog

 

[MaddieMay]

If you believe in point two you are definitely 3 standard deviations away from the norm. Seriously, that's like not believing in diabetes or HTN. Even classmates I have that aren't into psych acknowledge that mental illness exists. Do you know anyone who honestly believe that?

Oy vey, I should introduce you to my mom. She can't make left turns or drive on the highway and insists that there's nothing wrong with that because those two activities are dangerous. On top of that, she believes all mental illness is just a matter of people who are faking and need to just "straighten up and fly right."

 

[sunlioness]

If you believe in point two you are definitely 3 standard deviations away from the norm. Seriously, that's like not believing in diabetes or HTN. Even classmates I have that aren't into psych acknowledge that mental illness exists. Do you know anyone who honestly believe that?

I do know people who believe that. I even know psychiatrists who believe that certain DSM-IV-TR diagnoses don't exist. We were asked in a case conference the other day by an attending who wanted to know "Who believes in X diagnosis?" Never would have been asked that about something like bipolar disorder, let alone something like diabetes or htn. I think I am going to decide not to believe in the common cold. 😉

But I really don't want this to turn into a debate over whether certain DSM-IV diagnoses are real, so I'll leave it at that for now. I just wanted to make the point that not believing in mental illness at all really isn't as "out there" as it initially seems, especially when people within the field have doubts about certain things. 🙂

 

[RaistlinMajere]

I do know people who believe that. I even know psychiatrists who believe that certain DSM-IV-TR diagnoses don't exist. We were asked in a case conference the other day by an attending who wanted to know "Who believes in X diagnosis?" Never would have been asked that about something like bipolar disorder, let alone something like diabetes or htn. I think I am going to decide not to believe in the common cold. 😉

But I really don't want this to turn into a debate over whether certain DSM-IV diagnoses are real, so I'll leave it at that for now. I just wanted to make the point that not believing in mental illness at all really isn't as "out there" as it initially seems, especially when people within the field have doubts about certain things. 🙂

Yeah, let's not hijack this thread, but that's interesting to me. I do think there's a difference between debating diagnoses vs. accepting that the disorder exists at all. Regarding those physicians that don't believe in mental illness, I think the level of their ignorance is actually kinda pathetic and possibly dangerous depending on their specialty. 1st and 2nd year med students I could understand, but not someone who has experienced some degree of clinical training in psychiatry.

I like your idea about not believing in the common cold. I have my peds rotation next so I think I'll also adopt that view and that all these kids are just pulling a "Ferris Buller."

Back the stigma. I think most MDs who look down upon DOs probably haven't worked with enough of them to realize that they are competent clinicians. Or assuming like most populations, there is a normal distribution of talent level among DO providers, some MDs have experience the bottom 1 percentile and now mistakenly think that every DO is at this level. It's kinda like being a 3rd medical student where everyone considers you the worst student they have ever met until you prove otherwise. Others probably are academic snobs who will never come around, so there's no point in trying to win them over.

At the end of the day, if you like psychiatry then you will probably put in the extra time and effort required to become successful in the field whether you are an MD or DO.