FM vs Psych

[DD214_DOC]

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So I have been struggling to make this decision for awhile. With the residency application timeline moved up considerably for us military folks, I don't have much time left to make up my mind.

I have heard the points/arguments from the psych guys and would like to hear it from the FM guys. Why should I do FM over psych and/or why should I not? Thanks for the help

 

[aparecida]

As an FM "guy" (ahem) who considered both FM and psych, I think you should do whichever appeals to you most....

But here's what made the decision for me.

First, I was never really comfortable with the idea of not using my physical exam skills any more, or doing physical procedures (other than ECT). I spoke to a child psych fellow who had a stethoscope in his office that he said basically only got used to take blood pressure occasionally. It seemed sort of wasteful to me to learn so much medicine and physical exam and not use it.

Second, I realized that most of what I liked was garden variety depression and anxiety, the sort of thing that gets treated by PCPs a lot of the time anyway. I didn't have much interest in inpatient psychiatry.

Third, I just liked lots of other things besides mental health. I loved ambulatory peds. I loved well-woman exams. I wasn't willing to give that up.

 

[iatrosB]

So I have been struggling to make this decision for awhile. With the residency application timeline moved up considerably for us military folks, I don't have much time left to make up my mind.

I have heard the points/arguments from the psych guys and would like to hear it from the FM guys. Why should I do FM over psych and/or why should I not? Thanks for the help

FM = psych

It's the same work.

 

[Drawing Dead]

I wanted to do psych until my psych rotation as a 3rd year. As aparecida pointed out, you don't really use your physical exam skills as a psychiatrist, as well as not liking inpatient psych. I felt as if psych was just "slinging meds" and not much therapy like psychologists do (my then girlfriend, current ex was a psychologist, which piqued my interest at the time in psych). And it is true, we do manage much of depression, anxiety, dementia in the FM world. And our residency is shorter.

 

[iatrosB]

Plus, honestly, have you ever met a normal psychiatrist?

Sometimes it helps to think about who you'd rather have as peers. As one attending told me: "who would you rather have a beer with".

 

[aparecida]

To add -- you will treat "challenging" patients in both FM and psych. For every nonadherent diabetic in FM, there is a pregnant opioid addict in psych. For every sinus infection in FM, there is an ADHD med check in psych.

On the other hand, you will have "exciting" things in both specialties. You'll have your florid psychotics in psychiatry, and your febrile HIV patients in FM; your conversion disorder zebras in psychiatry, and your polyendocrinopathy zebras in FM.

Either way you will do a lot of good in the world, if you're passionate about your field and good at it. Which one do you think is "you"? Go with your gut.

 

[cali-ob]

To add -- you will treat "challenging" patients in both FM and psych. For every nonadherent diabetic in FM, there is a pregnant opioid addict in psych. For every sinus infection in FM, there is an ADHD med check in psych.

On the other hand, you will have "exciting" things in both specialties. You'll have your florid psychotics in psychiatry, and your febrile HIV patients in FM; your conversion disorder zebras in psychiatry, and your polyendocrinopathy zebras in FM.

Either way you will do a lot of good in the world, if you're passionate about your field and good at it. Which one do you think is "you"? Go with your gut.

yes, but the difference is in FM that non adherent diabetic or that febrile HIV patient, might also be floridly psychotic. And then guess what service they're coming to? hint: it's not psych!
You will get plenty of psych in FP. You won't have time to miss it.

 

[deleted87716]

You get plenty (more than your fair share, usually) of psych in FM. The biggest problem (IMO) is getting the ones who really need to see a psychiatrist to go to one!

I use the "specialist" analogy all the time. "Look, what we've done so far isn't working. You need to see a specialist." That usually goes over better than "You need to see a shrink." 😉

 

[aylwang]

go FM.. seriously

 

[DrJosephKim]

It depends on what types of disorders you enjoy treating. In FM, you'll deal with depression, anxiety, etc. All the bread and butter mental health issues. However, you won't be dealing with severe psychosis, mental hospitals, etc. If you choose psych, then you won't have to deal with colds, flu, ear aches, back pain (which is huge in FM), and other common issues.

 

[DD214_DOC]

Although I don't like my EM rotation (lack of continuity, the pace, etc) I did learn that I enjoy doing minor procedures. (Actually I want to be a surgeon, but I refuse to put my family before my career so that's out) Do you really get the opportunity to do procedures in FM? I also seem to like a good mix of inpatient and outpatient care.

I am a bit concerned about what FM will look like in 5-10 years, what with the push for NPs to become autonomous. Any insight into this?

Also, what sort of home life can I expect as a family doc? I doubt the hours are as cush as psych.

 

[superoxide]

Although I don't like my EM rotation (lack of continuity, the pace, etc) I did learn that I enjoy doing minor procedures. (Actually I want to be a surgeon, but I refuse to put my family before my career so that's out) Do you really get the opportunity to do procedures in FM? I also seem to like a good mix of inpatient and outpatient care.

I am a bit concerned about what FM will look like in 5-10 years, what with the push for NPs to become autonomous. Any insight into this?

Also, what sort of home life can I expect as a family doc? I doubt the hours are as cush as psych.

🙄

 

[deleted87716]

I am a bit concerned about what FM will look like in 5-10 years, what with the push for NPs to become autonomous. Any insight into this?

If you're really worried that you could be replaced by a nurse, you probably should be.

Also, what sort of home life can I expect as a family doc? I doubt the hours are as cush as psych.

Your life is what you make of it. If you play your cards right, FM really is the ultimate "lifestyle specialty."

 

[lowbudget]

Although I don't like my EM rotation (lack of continuity, the pace, etc) I did learn that I enjoy doing minor procedures. (Actually I want to be a surgeon, but I refuse to put my family before my career so that's out) Do you really get the opportunity to do procedures in FM? I also seem to like a good mix of inpatient and outpatient care.

I am a bit concerned about what FM will look like in 5-10 years, what with the push for NPs to become autonomous. Any insight into this?

Also, what sort of home life can I expect as a family doc? I doubt the hours are as cush as psych.

Really? No. Definitely not worried about NPs or DNPs or whatever. I've worked under & side-by-side NP's and had their students work with me in clinic. No. Definitely not worried for numerous reasons.

If anything, psych should be worried about DNP's, in my opinion. Nursing philosophy is super in-line with psychosocial model and you give them just enough superficial bio to make it biopsychosocial... and that's what psychiatrists do!

I mean, think about it. Social workers (who train as counselors) and psychologists do a whole lot of psych. And psychologists do a great deal of psychological testing that physicians don't do. The only thing that differentiates psychiatrists from all these other people is the ability to prescribe medication (both on and off label). Now... DNP's with prescriptive powers... there's little difference. Psych is already multidisciplinary. It's only a small step to replace the physician. Plus, nurses will tell you that they "talk" with patients better than physicians do.

Whatever, to add insult to injury, nurses have a crap load of psychiatric issues that they'd love to share with their patients. At least the ones I know. And... the nurses I know get plenty of sharing-is-caring practice when they talk about their own psychiatric problems with my patients when they put my patients in the room... so... I can't compete with that. I mean, with all that practice? Hell, they're practically earned their PhD's on the job. All Doctor Crazy Nurse and ****.

Don't get me wrong. NP's are great yadda yadda. And psychiatrists are great too because I sure hell couldn't manage these complex psych cases. But that's not what DNP's are talking about, are they?

Look... If anything, I would think that DNP's would over take psychiatry before they over run primary care. So... why is it that DNP's aren't talking about overtaking psych?

Money.

 

[lowbudget]

Do you really get the opportunity to do procedures in FM? I also seem to like a good mix of inpatient and outpatient care.

Also, what sort of home life can I expect as a family doc? I doubt the hours are as cush as psych.

Got sidetracked.

Yes, you get to do procedures so long as you're trained to do them AND you learn how to handle complications. That all depends on the training program you choose. The best programs are the ones that'll get you that experience AND train you on when to do procedures and when not too. That's what separates you, a doctor, from a midlevel or a technician. The brain behind the hands...

So don't get lulled into the world of procedure, procedure, procedure. There're plenty of proceduralists, surgeons, podiatrists, and chiropractors out there ready to proceduralize because it pays well...

Who said psych has cush hours? My psych attendings in private practice are either borderline bankrupt or working early morning to late night to see their inpatients & outpatients to get their $200k. Just cuz psych rotation is cush doesn't mean real world psych is cush. And anyone who promises you big money without doing your homework is better known as Bernie Madoff.