tatabox80

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Hi there,
I am currently a 3rd year med student on their last rotation...psych. I was just wondering if anyone here was having difficulty making the decision and if so, what made them ultimately decide on one vs the other. Thanks.
 

sophiejane

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I briefly considered psych (but then, I also briefly considered medicine, surgery, OBGYN, and peds, also ;) )...

I thought psych was a blast. Every day was a bizzare new experience. But it was frustrating to me the narrow range of modalities they have to work with. You either get rehab, drugs, or psychotherapy. Drugs seemed to have by far the best outcomes, but even then, it was often hit and miss, and the side effects were often worse than the disease.

Also, there is something incredibly sad about the chronically mentally ill. Not only are they sick, but they are shunned by society, whereas at least the hypertensive obese diabetic can still participate in society. Our mental health system is really really screwed up..
 

dulceleche

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tatabox80 said:
Hi there,
I am currently a 3rd year med student on their last rotation...psych. I was just wondering if anyone here was having difficulty making the decision and if so, what made them ultimately decide on one vs the other. Thanks.
Hi,

There is much psych in FP but not much FP in psych. I thought about doing psych too, however, I realized that unless the patients were really ill they rarely saw a psychiatrist. The ones who were really sick needed to see a psychiatrist more often. Some of the psychiatrists were jaded and disillusioned by these patients because there is no cure and some patients never seemed to improve over time. The psychiatrists assumed that there was not much hope for patients with recurring symptoms of schizophrenia, bipolar, etc. that they tended to treat them as ill patients rather than people. Also, psychiatry is very limited since psychiatrists tend to deal with the symptoms of patients with mental illness rather than the holistic perspective of treating the whole patient as in FP. The wide variety of the types if patients one sees in FP is also more stimulating for me.

If you are interested in lifestyle, the FP residency is much harder and demanding than psych but afterwards if you want to do FP without call and work a 8-5 week this is possible with FP. Also as an FP one can work at resorts, on cruises, in rural or urban areas. Moreover, if a FP just wants to work in a specific area in the city or town all one has to do is open an office may be in a shopping center, in a hospital, or community clinic whereas psychiatists really need to go wherethe jobs are. Psychiatrist are limited in pratice where they can go because not everybody needs to see a psychiatrist but most patients need to see a primary care physician.

The stigma about mental illnesses is still very bad. I saw alot of patients in FP who would not see a psychiatrist because they did not want to be labeled as a mentally ill person. These were the type of patients who were doing well enough that all they needed were there meds. They did not care to see a psychiatrist.

About salaries- general psych makes a little bit more than FP, however, if you do urgent care or become a hospitalist, one can make good money well above a general psychiatrist. There are fellowships in FP to become hospitalists and I believe there is now a fellowship in urgent care. Of course,there are sports medicine fellowships in which a FP can make alot more money than most other FPs. I believe child fellowships in psych lead to good paying jobs too. However, one has to create a niche for one's practice. You can't just pitch a tent and think that children and their parents are going to come to you without a referral. You need to develop a reputation to get alot of patients in psych or child psych or any type of psych. Also, there are no procedures that can be done in psych whereas FP can do them and that is really where the money is anyways. In any field in medicine the doctors who do many procedures are the one rolling in the dough.

For you to decide, I would take as many electives possible in FP and psych. You probably will need a a lor from each so I would start working on getting one. I did electives in both and decided that psych was not my strength and really what I wanted to do for the rest of my life.Psych is all about lifetstyle but as I say one can create a good lifestyle with FP also.

In the end, I enjoyed working with FPs more than psychiatrists. What I considered was that I did rotate in state mental hospital also and I hated it not only because of the patients but also the type of psychiatrist who work there. Also, the VA is another area where one can work as a psychiatrist and but the types of patients one sees is quite limited again: PTSD, psychotic illnesses, malingerers, etc.

I wish you the best and hope you make a good decision for yourself. You should ask this same question in the psych area. You probably will get a good idea about what psych entails.

dulce

Addendum: sorry the above message sounds disjointed but I wrote it at 3 am.

I have been looking at the average salaries for general psychs and I think it is about 177000$ whereas FP is in the 160s. These average salaries are not very accurate because you have to consider where you plan to practice. If you want to be a rural FP this would be a financial advantage for you because more patients would come to you since you are probably one of the few doctors in town. Also, I mentioned urgent care and hospitalist care. You don't have to do a fellowship in either especially not in urgent care. It would be wise though to do a fellowship in hospital care since FP residency training really does not focus entirely on in-patient care. I'm of course a FP advocate but really this society does need good psychiatrists which are few and far in my opinion and if you think you can be one of them who truly cares for your patients with mental illness, I say go for psych. I met some jerks who were psychiatrists so may be you can take their place and represent the field as a good and caring psychiatrist, instead of a med pusher. I just was so disappointed by some of the attitudes that some psychiatrists have that I got turned off really fast. But, this should not dissuade anyone from a specialty because there are jerks in every field. I like what I do and am thinking about doing missionary work as a short-term possibility. I think with FP the options are vast that if you want to work in any part of the country or in another country you will be in demand. I am biased of course.

You should decide for yourself and not let someone else such as me influence you one way or the other. You will have to find out for yourself. Do some electives in both. I did and am glad that I had the chance of working with the best psychiatrists- I rotated at one of the top insitutions for psych, and also the best FPs. In my world, FP is the best!

dulce