Endocrinology or Psychiatry residency

[MyGenome]

Hi everyone, I posted this in the IM forum, but thought I should post it here instead. I really would appreciate your help, suggestions, or advice on this. I am choosing between these two specialties, but feel about equally interested in both. In terms of interest in the subject matter of the field, I currently have slightly more interest in endocrinology, but it is very slight and I have gone back and forth before.

For this reason, I am looking into secondary (and less important) criteria to choose between them. The secondary criteria seem to outweigh this slightly greater interest I have in endocrine. Any insight is appreciated, feel free to disagree with/correct my reasons (I am not in the field yet, so what I know is based only on online searches here, and what other people have told me):

Secondary criteria for Endocrinology:
-more effective/ better arsenal of treatments/medications
-greater respect for physicians in this field
-safer field in terms of patient violence
-use of the core medicine learned in med school


Secondary criteria for Psychiatry:
-greater earning potential
-better hours/lifestyle
-greater independence (easier to run a private practice)
-friendlier colleagues (and attendings during residency)
-greater job satisfaction (in terms of surveys)
-more family friendly residency experience
-greater demand for psychiatrists/job security
-less malpractice

Would greatly appreciate your thoughts! Am I missing anything? How should I weigh these?

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[OldPsychDoc]

As one of my colleagues put it--"Two words: diabetic feet."

 

[michaelrack]

would you rather receive a call in the middle of the night from a patient who is suicidal or a patient with a finger stick glucose of 700?


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You could do a med/psych residency and then a fellowship in endo

 

[billypilgrim37]

would you rather receive a call in the middle of the night from a patient who is suicidal or a patient with a finger stick glucose of 700?

I think most psychiatrists would rather receive a call in the middle of the night from a patient with a finger stick of 700! As long as it wasn't that high because their psychosis tells them the insulin is poison, and they get to meet Jesus when it hits 1000.

 

[Sneezing]

Look at the intrigue of things. Most of endocrinology now is diabetes ~90%. Can the 10% of other issues sustain you while you wade through diabetes blood sugar logs patient after patient? In psych, you'll see Bipolar, schizophrenia, Borderline, Depression, etc. Over and over and over. But, each disease will present with a different twist. Plus, the history and understanding of the patient is relevant to the treatment. You won't be an intepretor of numbers and labs with a pinch of history like in endocrinology... You will be an interpretor of human emotion, behavior, and cognition which is a more complex domain to understand. Naturally, I'm biased, but I would only last 10 years in endocrinology before I was bored out of my mind or crawling back to academics with hopes to be able to do zebra workups. Choose Psychiatry.

 

[michaelrack]

Look at the intrigue of things. Most of endocrinology now is diabetes ~90%. .

Don't forget hypothyroidism and adjusting synthroid doses. That's about 20% of endocrinology

 

[IAmAUser]

.

 

[peppy]

Endocrine is definitely not a bad gig (and the endocrinologist I rotated with in med school was very respectful of the importance of psych because he did see some psych issues crop up with his diabetic patients). I could have been very happy as an IM subspecialist, if it didn't mean enduring three years of general IM wards.
One of the reasons I chose psychiatry is because I like bread and butter psychiatry better than bread and butter IM. Lots of people end up deciding not to pursue a fellowship even though they originally intended to, so I think it's best to try to get into a field where you like the bread and butter stuff.
You know, if you like the idea of dealing with hormones, maybe you could go into psych and do research on issues like postpartum depression/psychosis.

 

[michaelrack]

Look at the intrigue of things. Most of endocrinology now is diabetes ~90%..

Endocrinology was a much more interesting specialty back in the old days, when it was combined with nephrology (not that I was even alive back then).

sorry, realize that this comment is totally irrelevant

 

[MyGenome]

Thanks for these great replies. I am in fact leaning towards psychiatry for the reasons some of you have mentioned (eg I do like bread and butter psychiatry more than bread and butter IM). While I find diabetes fascinating, I can imagine that it would become monotonous and possibly frustrating if 90% of my patients were seeing me for diabetes.

I had (have?) a [slightly] higher interest in endocrine because of the zebra type cases and the logical physiology it involves, but these may not be good enough reasons. I also feel like those three years of IM would be UNenjoyable, not because I don't think what I would be learning is interesting, but because it is so intense (esp while having a family).

I am interested in hearing more of your thoughts on what else I should consider about psych or endocrine, that a typical medical student may have not considered or may have overlooked.

One person mentioned he or she feels the secondary criteria I listed are not agreed upon. I realize not all people will agree on these things, but I would like to hear more thoughts on what is generally true, in most cases, most of the time. I hadn't heard otherwise on those criteria, which is why I formed that list as it is.

 

[masterofmonkeys]

Psychoneuroendocrinology is a growing field of research with a lot of potential for therapeutic benefit.

I am psych, and actually very psychodynamically oriented, but the research I'm trying to get into is looking at things like GH, cortisol, sympathetic reactivity, and even insulin resistance in the context of psychiatric disease as well as behavioral/nutritional interventions that can impact these variables.

I honestly think about these things and incorporate them into my interventions for patients already in the limited ways I can.

So I'd say there's plenty of scope for getting the intellectual interest in endocrine you have through psych. Whereas as an endocrinologist, you are going to be fundamentally limited in your exploration of psych by your training, regardless of your interest in it.

 

[Sneezing]

One downside you should prepare for with psych is emotional baggage. You will be loaded with a lot of it. Damn near every one is raped as a child by someone. Most people love drugs and are still in the precontemplative stages of change. A large component of psychiatry isn't psychiatry but social issues, poor coping skills, and lack of resources.

A sense of peace can come with endo by not having as much of the lack of resource burden so you can focus on the lab values at hand. Conversely, this sense of peace can quickly degrade into boredom and career resentment...

 

[peppy]

I imagine Endo is less emotionally taxing than fields like psych where you hear a lot of tragic stories or other areas of medicine that more often diagnose problems with a dismal prognosis, but I imagine that endos do get worn down by seeing people who are too uneducated or lack the money/resources to be able to take care of their diabetes properly.

 

[masterofmonkeys]

I imagine Endo is less emotionally taxing than fields like psych where you hear a lot of tragic stories or other areas of medicine that more often diagnose problems with a dismal prognosis, but I imagine that endos do get worn down by seeing people who are too uneducated or lack the money/resources to be able to take care of their diabetes properly.

I think you mean unmotivated/lazy/entitled/apathetic. Maslow was a douche.

 

[Doc Samson]

Maslow was a douche.

Oh no you didn't!

 

[Doc Samson]

I had (have?) a [slightly] higher interest in endocrine because of the zebra type cases

I give a talk on CL work where I describe CL docs as "zebra hunters". I tell anyone who's interested in both medicine and psychiatry to take a long hard look at CL.

 

[MyGenome]

Thanks for the replies everyone. In comparing psych vs IM residencies, is it possible that an IM program ever be less intense than a psych one? Or is that highly unusual?

 

[nitemagi]

Thanks for the replies everyone. In comparing psych vs IM residencies, is it possible that an IM program ever be less intense than a psych one? Or is that highly unusual?

I'm sure if you compared a small community IM program with psych at MGH it would be less intense, but you're looking at the two ends of the spectrum.

 

[whopper]

Someone I knew in medschool was torn between surgery and GI.

What made the decision more difficult was that while he knew he wanted GI more than surgery, he also knew that GI required IM, and once he was in IM, he might not get into a GI fellowship. He didn't want to do IM, he wanted GI or surgery.

That too must factor into your equation. You might not get into an endocrinology fellowship and be stuck doing IM when you could've been happier doing psychiatry.

I want to comment on the following
-greater respect for physicians in this field
-safer field in terms of patient violence

These are highly relative. I agree that the respect thing occurs in medical school, but after medical school, an environment that's IM-centric and you get to hear all the IM attending's little prejudices that often go along with medical doctor narcissistic personalities (oh those surgeons keep on dumping their patients onto me.....woe is me....) it's to the point where it's almost non-existent in several places after medical school. In residency, since you're surrounded almost all the time by psychiatrists, you are more exposed to the psychiatry-centric opinions and then you notice that this "respect" thing is bull. In fact I've noticed that outside of the medical arena, people tend to have a fascination, almost mysticism with psychiatrists vs other medical doctors.

I wouldn't base my decision on a career you'd have the rest of your life based on the "respect" thing given that at least from my experiences, it has no bearing on anything after medical school.

As for safety, that too is highly relative depending on the setting. Some hospitals have excellent security. Others carry an inpatient involuntary unit but for some reason have decided to only have a 75 year old man as the security guard who is more likely to run away from a patient than a nurse when things get tough. In outpatient, there rarely is a danger factor if you are working in private practice and are for the most part dealing with patients with a GAF of 50 or better.


-greater independence (easier to run a private practice)

This too is relative. It could be harder to run a PP depending on the situation. Since there in general in a shortage, it's easier to fill up your schedule with patients in psychiatry, but you can get some very interesting ( in the bad sense of the word) patients, and because of the shortage, you may have problems finding doctors to join in practice to cover for you when you want vacation time.

 

[billypilgrim37]

You might not get into an endocrinology fellowship and be stuck doing IM when you could've been happier doing psychiatry.

I thought they gave endo fellowships away for free on craig's list. The point is well made with GI, but I'm pretty sure you'd have to commit a few felonies during residency to not match endo.

 

[michaelrack]

These are highly relative. I agree that the respect thing occurs in medical school, but after medical school, an environment that's IM-centric and you get to hear all the IM attending's little prejudices that often go along with medical doctor narcissistic personalities (oh those surgeons keep on dumping their patients onto me.....woe is me....) it's to the point where it's almost non-existent in several places after medical school. In residency, since you're surrounded almost all the time by psychiatrists, you are more exposed to the psychiatry-centric opinions and then you notice that this "respect" thing is bull. In fact I've noticed that outside of the medical arena, people tend to have a fascination, almost mysticism with psychiatrists vs other medical doctors.
.

My experience is that respect for psychiatrists is slightly less than for internists. However, there is still a lot of respect for psychiatrists. Assuming a medical student finds both general psychiatry and general IM equally interesting, I think psychiatry is a better career choice in terms of $ and lifestyle.
However, the equation may change if subspecialties are considered.

 

[whopper]

I thought they gave endo fellowships away for free on craig's list. The point is well made with GI, but I'm pretty sure you'd have to commit a few felonies during residency to not match endo.

That may be true now. When I was a medical student, it seemed that it was tough to get into any post-IM fellowship period. Even the easier to get into ones were still considered tough and there were no garauntees. I could of course have been wrong but I was basing this on what I heard from IM residents at the time.

But in any case, even if I was right for my time, given that this board is for medical students and residents, not attendings, what was going on then should not be broadcasted as what's going on now.

My experience is that respect for psychiatrists is slightly less than for internists.

I've noticed the respect thing go up several notches with forensic psychiatry, but as my opinion has always been, I'm not so much into the "respect" thing. I'm more into the "do I like my job" thing, and "does that doctor do a good job" thing regardless of what field it is. This respect thing is also IMHO causing problems in the field because doctors are factoring into going into a field, not because of the need for doctors, but because it's seen as "competitive." E.g. The medical field needs more PCPs than dermatologists.

 

[michaelrack]

I'm not so much into the "respect" thing. I'm more into the "do I like my job" thing, and "does that doctor do a good job" thing regardless of what field it is. .

 

[masterofmonkeys]

Have to concur with DS on CL docs being the zebra hunters in medicine. This last week has been particularly ridiculous, but all I've been doing is addressing and finding medical conditions whose most obvious manifestations of psych. Good CL docs also seem to engender a lot of respect if that's what you're into. I'm not personally. But I find it gratifying to be called in for a 'psych consult' and leave saying 'delirium 2/2 wound infxn...that you didn't notice. You might want to treat it.' Or, 'her schizophrenia isn't uncontrolled, she's getting agitated by her air hunger 2/2 her COPD. Give her 2.5 of oxy and she'll settle down'. Or just finally get a patient the right dx of PTSD, scream at her PCP for calling her bipolar, talk with her, listen to her cry about her trauma, and bring her a measure of relief that comes from knowing her problem is finally going to be addressed.