FM vs Psych -- can't decide.
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I don't really have any advice for you, but there was a thread in the FP forum quite awhile ago and several people planning to do FP were also planning to do a lot of psych in their practices after residency. Maybe if you absolutely can't decide between the two, that might be a reasonable compromise? There are also FP/PSYCH residencies. It seems from reading here that overall, it's not a residency that leads to most people practicing both, but it would buy you some more time to decide.
Good luck with your decision🙂.
Good luck with your decision🙂.
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What are the aspects that you find appealing about the two fields? That might help clarify which one is really for you.
Personally, I was scared off of FM because I'm concerned about the future of the specialty with midlevel providers now doing so much primary care.
Even though I do think primary care medicine would be a very interesting and rewarding field in an ideal world setting, I feel like the real world trends right now are worrying.
With Psychiatry, the movement to give psychologists prescribing rights doesn't seem to have as much traction as the multitudes of NPs and PAs in primary care seem to have. I also felt like psychiatrists have more flexibility in what sort of practice setups and payment models they can use if indeed the business climate for psychiatry takes a downturn because of midlevel encroachment.
Another issue for me was that I tend to prefer the more complicated and acutely ill psychiatric patients that you wouldn't see much of in an outpatient primary care setting. I think they are more interesting than the bread and butter anxiety or depression outpatients.
Those reasons may not apply to you though...good luck in deciding!
Personally, I was scared off of FM because I'm concerned about the future of the specialty with midlevel providers now doing so much primary care.
Even though I do think primary care medicine would be a very interesting and rewarding field in an ideal world setting, I feel like the real world trends right now are worrying.
With Psychiatry, the movement to give psychologists prescribing rights doesn't seem to have as much traction as the multitudes of NPs and PAs in primary care seem to have. I also felt like psychiatrists have more flexibility in what sort of practice setups and payment models they can use if indeed the business climate for psychiatry takes a downturn because of midlevel encroachment.
Another issue for me was that I tend to prefer the more complicated and acutely ill psychiatric patients that you wouldn't see much of in an outpatient primary care setting. I think they are more interesting than the bread and butter anxiety or depression outpatients.
Those reasons may not apply to you though...good luck in deciding!
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FM residency requires you to do horrible things like peds, ob and surgery. I'm personally thrilled to know that I'll never have to deliver another baby, do a newborn exam or do peds wards after this month. I guess if you'd regret not doing these things then FM might be for you. There's also FM/psych.
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One of the happiest moments of my MS4 year was the final shift on EM, knowing that I had just done my last pelvic exam EVER...
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Hear interesting stories vs. asking "Have you had a bowel movement today?" No comparison, Psychiatry is interesting and exciting.
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I tend to agree. Every time I have my mind made up that psych is for me, I get the urge to look at an ECG or suture someone up. There is a lot of crap about FM I didn't like, however, most notably the patients who just don't give a damn or the twentieth refill on Lortab for LBP.
If the Army still had its FM/psych program this wouldn't have even been posted, but unfortunately they don't.
One somewhat minor issue is the availability of training locations in the Army. I get a whopping two -- Washington DC and Honolulu. While this would be a godsend for most people, my parents are older and the though of being thousands of miles away is a bit of a turn off. The downside to DC is that I believe the program does not focus as much on therapy as the HI program.
I actually turned down doing a Pelvic on my ER rotation. Probably 90% of medicine I"m pretty apathetic about, but I did get really excited when I talked to a 26 yo BPD in an acute manic phase.
Regardless, I have to decide in like two weeks because I need to schedule my audition ADTs.
The pros of psych: intellectually stimulating (I never had to force myself to study it), I think I have a somewhat natural "knack" for it, and I find the idea of improving quality of life much more appealing than curing someone's sinusitis. I think treated psych patients tend to be a helluva lot more grateful as well.
The 16 year old male pt I had on the CSP who saw, "Oprah Winfrey monsters", thought alarm clocks meant Jesus was having sex, and would regularly get naked a copulate with the floor was 100x more interesting than the noncompliant idiot T2DM with an A1C of 22%
Honestly, if I didn't feel like doing psych would remove me from everything else I have been studying for the past four years none of this would be an issue.
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It sounds like you're one of us.
We'll let you re-train us old attendings how to read those ECGs (for real, not "ortho-style"--looking at the "answer" on the top. Though that computer always seems uncannily aware that the ECG came from a Borderline!
) If you really want to, we'll let the ED page you to stich up those pesky wrist lacs, too.
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I think tons of us have that reservation, and yet we find out that there are plenty of other things to fill up our days and our brains. And it's not really true that you will be removed from "everything else you have been studying." You probably won't have to initiate treatment for much of it, and you probably won't have to diagnose much of it, but your psych patients will have all those disorders you've learned in medical school, and if you don't know something about them, you could really do some damage. And YOU are the doc on the case. People expect you to have a clue. And with good training, you will. Whopper can probably add some great stories about all the patients he's had that were "cleared" by the ED which subsequently had broken this-that-or-the-others.
You sound like a psychiatrist waiting to happen. I loved family medicine, and I think there's a good portion of psychiatrists whose personality draws them to both fields. Plenty of have to get over the idea of giving up "real medicine," because we realize that what the "other people" call "real medicine" isn't much more real than what we do.
I think most family docs would trade their stethoscopes for a good borderline detector any day 😀.
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There is a lot of medicine in psychiatry. You might well be the only one who can stand listening to the patient, and often any physical complaint get dismissed by other physicians. After all, they have a psych diagnosis on the chart, so any symptom must be "all in their head."
I believe the statistics are that psychiatric patients die on average 10 years early when of preventable illnesses, simply because other attendings don't care, and because we might forget to check. After all, they have a primary care physician that we assume is actually treating our patient rather than just dismissing their symptoms (a dangerous assumption in Psychiatry).
So if you retain your "medical" or "real doctor" skills you will no doubt save lives. That aside, I agree that you sound like you're already of a psychiatry mindset. Welcome!😍
I believe the statistics are that psychiatric patients die on average 10 years early when of preventable illnesses, simply because other attendings don't care, and because we might forget to check. After all, they have a primary care physician that we assume is actually treating our patient rather than just dismissing their symptoms (a dangerous assumption in Psychiatry).
So if you retain your "medical" or "real doctor" skills you will no doubt save lives. That aside, I agree that you sound like you're already of a psychiatry mindset. Welcome!😍
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LOL. I got one. 3rd patient ever in residency was a 70'ish lady from an outlying ED, "medically cleared" and assured to be healthy. Arrives with BP 210/170 after 3 hrs in ambulance. ED records 3-4 hrs earlier showed BP 180/110 or so.
Needlessly, that's when I learned to ask for records faxed before accepting acute inpatient dump-jobs.
(Oh, and she was from the next state, and we were not in network, so their medicare refused coverage. They graciously allowed 12 hrs because of her BP, though)
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Thanks for the info. I'm pretty sure I will be applying psych in June. How I just have to worry about matching into one of the Army's two programs. My grades aren't bad, my Level I score wasn't great -- I passed to say the least. But, at the time I wasn't gunning for a high score anyway. Would this be a problem?
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My friend who matched at Tripler did an away there. I think it was probably unnecessary, but it certainly made him matching there a "without a doubt" situation. So, while I usually discourage people strongly from doing aways, the military situation might make it worthwhile to consider.
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I was planning to do an away at both programs, basically just because of my Level I score. What were his numbers like?
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there are some med-psych units that are run by psychiatrist - where medicine is consulted as needed. I get the impression though that the psychiatrist on these units does quite a bit of medicine and some procedures - I think things like putting in feeding tubes. Maybe some others here know more...
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I tend to agree that away rotations are unnecessary. However, in the Army match, it is expected that you do an away rotation in order to be competitive, although it's not absolutely required. The military has a smaller pool of applicants and a smaller number of programs, so they like to evaluate applicants directly. As for me, I'll be milking it by spending 5 weeks at Walter Reed in DC and 5 weeks at Tripler in Hawaii, all paid for. 🙂
