FPs and residents, this kid needs your help!

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I'm really glad you put this up! I have been lurking around the FM forums for the last couple days trying to figure out how to duplicate the thread without violating forum rules ;)

Please, if FM docs could chime in your input would be really appreciated!
 
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Bump for @SXMMD ! Surely you weathered veterans have some words of advice!
 
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I'm really glad you put this up! I have been lurking around the FM forums for the last couple days trying to figure out how to duplicate the thread without violating forum rules ;)

Do you mean this post?

Hello all,

I'm a 3rd year Carib med student applying for the 2015 Match. I'm interested in psych but also torn by the idea of turning away from FM.

I enjoy being able to walk into the hospital or clinic and being able to take care of the physical ailments people bring in, work through puzzling cases and using my hands occasionally to provide treatment. I enjoy longitudinal relationships with my patients but also get a rush out of acute cases. I enjoy working with people of all age groups, particularly kids and the elderly.

On the other hand, I hate the overbearing weight of administrative/political nonsense that hangs over primary care docs heads and realize that the type of practice I want to run will clash with the financial/legal/political realities of medicine in the U.S. On top of that, I've found in my rotations that we med students sometimes romanticize the impact medical services have on our patients. For many people getting their illness treated is like getting a burger from McD when you're hungry; you eat it and move on, life doesn't really change for the better, except you're no longer in acute pain/hunger.

This is where pysch comes in. The work is often interesting, cases can be super esoteric at times, the patients are turning out to be interesting and rewarding to work with and every pysch resident/attending I've worked with seem so happy with life in general, especially relative to their counterparts in IM/FM. On top of that, through my limited experience with psych I find that the work that psychiatrists do generally has a greater ability to improve people's experience of life, which to me is a core part of what I want to accomplish with the care that I provide to patients.

So now I'm torn between FM and Pysch, and could use some advice. Anyone feel the same way before making the leap to psych? Any "rose-tinted views" shattering information about practice after residency to share with me? And any advice about reading materials, journals etc one could look into to further explore psych as an option for residency?

Look forward to your responses!
 
I don't think anyone is going to be able to tell you what you should do. I certainly can't.

You're going to deal with administrative BS and insurance hassles in every field of medicine. Psych is no exception. As for the nature of the patients and their diseases, and your perceived ability to make a difference in their lives, it's really more about what you enjoy doing every day. You'll see "esoteric" cases mixed amongst the common stuff in every field of medicine. You shouldn't live for those, however, because most of your time will be spent treating the common disease states in whatever field you're in. Most psych problems are not acute problems, and you're not going to fix them quickly. Psych is more like chronic disease management than urgent care. Finally, don't judge a field by the people you encounter in it. Whether doctors are happy or not will have more to do with their personal situations or the work conditions in a particular institution or locale than it will with the specialty in general.
 
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@SXMMD I'm only a second year student, but during few FM preceptorship experiences (where I was doing some basic histories on my own before the attending came in) I saw a couple of psychiatric related issues as the chief complaint. And it was very interesting, and rewarding listening to them, and seeing their relief when they knew they were going to receive the help they (hopefully) need (including directing them to a quality psychiatrist, who seem pretty darn in demand btw). BUT… it was pretty cool to bounce from the patient suffering from PTSD to the next patient with possible Graves disease… then to a MSK issue… and so on and so forth. I liked the mixed-bag flow. Yeah, just a preceptor experience, but still had me thinking "this FM stuff could be cool… and it's sure gonna keep me busy learning."
 
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@cabinbuilder: honestly, been working that out as I type lol.

I'm just a little lost trying to decide what the heck I really want out of a future specialty. Like I said in the post in the psych forum, I enjoy FM. I like seeing kids and old people, treating acute problems and managing chronic ones. I like being capable of seeing and managing or at least coordinating care for a variety of systems (as opposed to just pulm, cardio, GI or whatever). I hate politics, fighting to get paid and especially the feeling of having no control over the work I set out to do with all these third parties coming in between me and my patients. I saw a ton of that in primary care, and am having second thoughts about pursuing it.

Short version: I like FM, I'm not confused about that. Question is: is it worth the hassle to do what I enjoy?

Blue Dog touched upon that in his post (thank you Blue Dog!), but I'd love to have your input too. I have been following your threads about traveling and doing locums so I've definitely wondered whether or not I could do something like that. What are some things one should consider before jumping to follow your footsteps?


@Dharma: Being that first person who gets to see and work up the patient is a blast. I couldn't stick to a single organ system for the rest of my life! Common things are common, I'm ok with that, but still would prefer to be the first person to make contact with a whole spectrum of disease vs being a consult!
 
Based on the above post, what's the big attraction of psych, then? Outpatient psychiatrists nowadays are basically med managers. Few spend very much time with their patients, and few do any significant amount of psychotherapy. It just doesn't pay.

I suppose the same could be said about primary care or any other specialty. Most fields have been forced to see certain patient volumes simply because of the realities of third-party reimbursement. However, primary care docs tend (in general) to have more opportunity to get to know their patients as "whole persons" because, in reality, we're treating the whole person.
 
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