Has anyone switched from Psychiatry to IM or FM?

[sunshine1160]

Hi,
I know the reverse is usually true but I was wondering if some people have decided to quit Psychiatry and go into another field (like IM or FM)? Maybe after a year, you decide this is not what you want to do anymore? I know that most Psychiatry rotations probably won't carry much besides some elective credit, but I was wondering if anyone has had a change of heart like that? Did you ever think that Psychiatry was too mentally draining for you? Do you have any regrets about switching from psych?
Thanks

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[Shikima]

I changed. Internship counted for first year by ABPN and just need a letter from them saying that. Your new program will take care of those details for you.

 

[J ROD]

I have heard of someone that switched. I think every now and then you will find someone that misses the more medicine side of things. But in general, those that chose Psychiatry have already sort of selected themselves out.

 

[Shikima]

I got out of that game because I hated working 80-120 hours in a week.

 

[J ROD]

I got out of that game because I hated working 80-120 hours in a week.

For Psychiatry.....you putting in those hrs?

 

[Shikima]

For Psychiatry.....you putting in those hrs?

Not anymore - unopposed rural FM program I was. Residency it got up to 60 hrs a week. Now I'm about 45 hours a week.

 

[J ROD]

So you went from FM to Psychiatry? I am confused as hell. OP asked anyone switch from Psy to IM/FM.

 

[splik]

you cannot get credit for psychiatry. you would have to complete the entire FM/IM residency program. also because of service requirements, it would be highly unlikely that they would be inclined to give you credit for prior rotations even if they could. It is possible, though it is much harder to switch out of psych because you're damaged goods now. you would have to be a better applicant to overcome the taint of having been a psychiatry resident.

 

[J ROD]

I am not sure about the "taint" of Psychiatry. I believe nowadays it is easier to get into FM than Psy.

But, I agree I doubt you would get credit. Maybe for a some but not the whole year. Maybe half a year.

 

[splik]

I am not sure about the "taint" of Psychiatry. I believe nowadays it is easier to get into FM than Psy.

it has always been easier to get into FM. the point is for whatever reason there is a bias in medicine against psychiatry as the ugly stepchild and people who go into psychiatry are often looked at as if there is something wrong with us. This does make it more difficult to escape and I know of a number of cases where this was the case. That said I know of people who have gone from psych to IM, peds, anesthesia, even derm, so it is possible but it's more difficult that from other specialty.

you would think FM would be very open to having someone with some psychiatric experience. I have no idea if that is true or not. It would be very unusual for someone to go from psych to FM

 

[J ROD]

I am not that familiar with switching so I will just take your word for it.

 

[nexus73]

I know of psych to internal medicine switches while in residency. I've never met anyone who switched after completion of residency.

 

[Amygdarya]

I wonder if OP is more likely to find what (s)he's looking for on IM/FM forums since people who quit psychiatry are more likely to hang out there than here.

 

[J ROD]

Yeah, if you go all the way, then you must have made your peace. I know I would never do that. But, I do know folks that have gone back after completing OBGYN.

 

[Shikima]

Yeah, I misread it. My bad.

I know of people who have done that, and because the new PD liked her, she got to start as an off-cycle IM intern with some requirements already complete. Needed to do all of the rest.

 

[FlowRate]

It's not as bad as some switches, since you're funded through PGY-4.

 

[Amygdarya]

It's not as bad as some switches, since you're funded through PGY-4.

Isn't length of funding kind of an urban legend though? As in people switching from 3-year programs in IM or FM to 4-year programs in psychiatry have no problems with funding (yes, I understand that their IM or FM intern year can count toward psychiatry residency requirements, but they will still end up doing 4 years instead of the "originally funded" 3 years).

I think the point that confuses some people^ is that *a residency position* is funded for a certain number of years, not an individual.
(Heck, some people do two full time residencies.)

^ - edit: apparently I was confused about this myself. See below.

 

[FlowRate]

Isn't length of funding kind of an urban legend though? As in people switching from 3-year programs in IM or FM to 4-year programs in psychiatry have no problems with funding (yes, I understand that their IM or FM intern year can count toward psychiatry residency requirements, but they will still end up doing 4 years instead of the "originally funded" 3 years).

I think the point that confuses some people is that *a residency position* is funded for a certain number of years, not an individual.
(Heck, some people do two full time residencies.)

Funny enough, I edited it out of my post, but I originally had "Is that actually a thing?" Feels like something I "know" but can't remember seeing a super-great source for it. After some quick googling I came across this but it's old, so not sure if things changed. Also this.

 

[Doctor Bagel]

One of my co-interns switched from psychiatry to internal medicine. I think she got some credit for something and wound up graduating mid-academic year. She wound up staying at the same institution, but I don't think she had much of an issue transferring. She was probably a pretty strong applicant to begin with, though.

I guess I've had a weird training experience because I feel like I know a ton of people who transferred in one way of another (transferred programs, transferred specialties, took time off and then transferred specialties, etc). From what I've seen, it seems like transferring is pretty doable for applicants without red flags (also assuming you're an AMG and all). Maybe I'm a few years out of date, though.

 

[Amygdarya]

Funny enough, I edited it out of my post, but I originally had "Is that actually a thing?" Feels like something I "know" but can't remember seeing a super-great source for it. After some quick googling I came across this but it's old, so not sure if things changed. Also this.

It looks like you're right actually: residents are fully funded only for the duration of their original residency, and then it gets complicated (Medicare funds only 50% after the initial length of training). Though, based on the people who switch from IM/FM to longer residencies, this usually gets worked out somehow. I guess it helps that, as was discussed on our very own SDN, there is more than one source of funding. But you're right.

 

[Gavanshir]

I didn't want to make a new thread since this already exists but I'd like to pose this question again from the board.

Tonight is the deadline to submit the NRMP rank list. I'm a current psychiatry PGY-1 and have interviewed at 4 IM programs. My initial goal for applying to IM was two-fold. 1) Because of certain doubts that came up for me in regards to how much I wanted to become a psychiatrist and how much I missed medicine, etc. and 2) in order to try to get closer to my family in another state.

Now while one of my IM interviews is near family and I will no doubt rank it, the other 3 are not near family so ranking them would have to be for the sole purpose of changing my field from psychiatry to medicine. I have spent months thinking about the decision to rank or not and I'm sad to say that I still have not found an answer. My decision usually changes depending on the factors that I'm considering on a given day. There are pros and cons to both options and I can try to sum them up as follows.

My fear about matching into IM is that I would end up with a difficult lifestyle, with little autonomy and lower income potential. I don’t have a very clear fellowship goal in mind but I do have areas of interest and know that I would like to subspecialize. My IM interviews are not at top notch programs so I don’t expect to have my pick of the lot when it comes to fellowships and will have to work hard to get in. I also did not have stellar Step scores, part of me is even worried about struggling with the IM board exam in the future.

I don't know how exaggerated the lifestyle issues are but I fear that by switching from psych to medicine, I'm guaranteeing that I will have a crappy family life, no free weekends and little time for hobbies, essentially requiring a strong commitment to my work, whereas staying in psychiatry represents a large bit of freedom and time to pursue hobbies, family life and even a second career. Is this unrealistic?

My qualms with staying in psychiatry are multifold. I feel that I am not respected just as the profession lacks respect. Few care about my role in the hospital (ie. the health care system) including the hospital admin, my patients and my patients' families. I have not seen the level of disregard that some patients' families have for what I do during my medicine rotations, where I sometimes had to plead with patients and their families to stop thanking me for having scheduled a follow-up appointment for them. It's my impression that many work with the unstated understanding that we are struggling to make any difference at all in this field. I once made a small comment to an attending psychologist in a private area of the unit and she suddenly opened up about her own frustrations with psychiatry pushing down medications onto patients so that their admission would be covered by insurance and her commentary was riddled with hints of "anti-psychiatry" throughout, and this is from an ivy-league trained psychologist who has seen that medications rarely help our patient population. Almost all of my hospitalized patients are difficult as all hell and some days I'm tired of having to manipulate my patients or put discharge as a carrot on the stick in order for them to take their medications. Or to have to threaten them with future hospitalization if they dont take their meds and keep their outpatient follow-ups. Sometimes I ask myself if I entered medicine to be placed in such a position to have to coerce my patients into compliance.

In addition, my fellow co-residents don’t inspire me and seeing them struggle in our medicine rotation whereas I felt very comfortable made me question my residency choice, at times wondering if I was “overqualified” to be a psychiatry resident. I know the usual spiel that to become great at psychiatry is challenging, but the standard is low enough that you don't have to be great at psychiatry at all and will do just fine. It also seems to me that the outcomes achieved by great psychiatrists are not that different from those achieved by mediocre ones. The medications don't work well enough and they are the only thing differentiating us in our field from the psychologists, NPs, PAs and social workers. Part of me is worried that there will be a great big controversy in the near future about psychiatry being the least evidence-based and scientific of all medical specialties.

I do worry about missing the mind. It remains the most interesting area of medicine for me and I would be excited to remain involved in innovative research in the field. Though I also ask myself if innovation is nothing but an illusion given the glacial pace of progress in the field as compared to the rest of medicine. Internal medicine looks nothing like it did 10-20 years ago with incorporation of new technologies and higher standards of care whereas psychiatric units are literally unchanged from the 1960s, with the use of the same medications. How do we continue to operate in this field and not be discouraged by this fact in comparison to the rest of our coworkers?

I still love psychiatry, and I love you all for your input on this board because I have learned much from you that I would not have otherwise learned from interacting with my co-residents. Perhaps I will rank all my options and if I am to end up in IM, I will always have the future option of trying to continue my psych residency as a PGY-2 (if in 3 years I'm truly miss being a psychiatrist or hate being an internist).

 

[postbacpremed87]

They would go from Psychiatry to IM/FM back to Psychiatry (as a patient). That move has to be part of some DSM5 diagnostic criteria for mental illness.

 

[Merovinge]

I didn't want to make a new thread since this already exists but I'd like to pose this question again from the board.

Tonight is the deadline to submit the NRMP rank list. I'm a current psychiatry PGY-1 and have interviewed at 4 IM programs. My initial goal for applying to IM was two-fold. 1) Because of certain doubts that came up for me in regards to how much I wanted to become a psychiatrist and how much I missed medicine, etc. and 2) in order to try to get closer to my family in another state.

Now while one of my IM interviews is near family and I will no doubt rank it, the other 3 are not near family so ranking them would have to be for the sole purpose of changing my field from psychiatry to medicine. I have spent months thinking about the decision to rank or not and I'm sad to say that I still have not found an answer. My decision usually changes depending on the factors that I'm considering on a given day. There are pros and cons to both options and I can try to sum them up as follows.

My fear about matching into IM is that I would end up with a difficult lifestyle, with little autonomy and lower income potential. I don’t have a very clear fellowship goal in mind but I do have areas of interest and know that I would like to subspecialize. My IM interviews are not at top notch programs so I don’t expect to have my pick of the lot when it comes to fellowships and will have to work hard to get in. I also did not have stellar Step scores, part of me is even worried about struggling with the IM board exam in the future.

I don't know how exaggerated the lifestyle issues are but I fear that by switching from psych to medicine, I'm guaranteeing that I will have a crappy family life, no free weekends and little time for hobbies, essentially requiring a strong commitment to my work, whereas staying in psychiatry represents a large bit of freedom and time to pursue hobbies, family life and even a second career. Is this unrealistic?

My qualms with staying in psychiatry are multifold. I feel that I am not respected just as the profession lacks respect. Few care about my role in the hospital (ie. the health care system) including the hospital admin, my patients and my patients' families. I have not seen the level of disregard that some patients' families have for what I do during my medicine rotations, where I sometimes had to plead with patients and their families to stop thanking me for having scheduled a follow-up appointment for them. It's my impression that many work with the unstated understanding that we are struggling to make any difference at all in this field. I once made a small comment to an attending psychologist in a private area of the unit and she suddenly opened up about her own frustrations with psychiatry pushing down medications onto patients so that their admission would be covered by insurance and her commentary was riddled with hints of "anti-psychiatry" throughout, and this is from an ivy-league trained psychologist who has seen that medications rarely help our patient population. Almost all of my hospitalized patients are difficult as all hell and some days I'm tired of having to manipulate my patients or put discharge as a carrot on the stick in order for them to take their medications. Or to have to threaten them with future hospitalization if they dont take their meds and keep their outpatient follow-ups. Sometimes I ask myself if I entered medicine to be placed in such a position to have to coerce my patients into compliance.

In addition, my fellow co-residents don’t inspire me and seeing them struggle in our medicine rotation whereas I felt very comfortable made me question my residency choice, at times wondering if I was “overqualified” to be a psychiatry resident. I know the usual spiel that to become great at psychiatry is challenging, but the standard is low enough that you don't have to be great at psychiatry at all and will do just fine. It also seems to me that the outcomes achieved by great psychiatrists are not that different from those achieved by mediocre ones. The medications don't work well enough and they are the only thing differentiating us in our field from the psychologists, NPs, PAs and social workers. Part of me is worried that there will be a great big controversy in the near future about psychiatry being the least evidence-based and scientific of all medical specialties.

I do worry about missing the mind. It remains the most interesting area of medicine for me and I would be excited to remain involved in innovative research in the field. Though I also ask myself if innovation is nothing but an illusion given the glacial pace of progress in the field as compared to the rest of medicine. Internal medicine looks nothing like it did 10-20 years ago with incorporation of new technologies and higher standards of care whereas psychiatric units are literally unchanged from the 1960s, with the use of the same medications. How do we continue to operate in this field and not be discouraged by this fact in comparison to the rest of our coworkers?

I still love psychiatry, and I love you all for your input on this board because I have learned much from you that I would not have otherwise learned from interacting with my co-residents. Perhaps I will rank all my options and if I am to end up in IM, I will always have the future option of trying to continue my psych residency as a PGY-2 (if in 3 years I'm truly miss being a psychiatrist or hate being an internist).

Loaded post but just a few things I noticed:

1) It sounds like your program is... not great. That might related to your step scores or just bad luck. Good psychiatry looks nothing like care from midlevels, trust me I spent 30 minutes Sunday helping a non-psychotic pt get his frustrations out over his NP provider on the inpatient unit and not suing the hospital (with her documentation, he'd have won). This women then asked me how to bill an inpatient consult for delirum "He was A&Ox4 so he's fine, what should I put as the diagnosis". You can probably access more good psychiatry as you go along in training.

2) I do "medicine" all the time, from a recent narcolepsy patient (dur hur visual hallucinations its psych's problem), to REM sleep disorder, limbic encephalitis, and that's in 2017.

3) Psychiatry has had some pretty big changes from the 60's. It's not as much as some other fields but start a first break psychosis pt on Abilify and then Haldol and see which one they like being on more. There are some drugs in the pipeline but it is admittedly complicated to get psychiatric drugs that are effective developed.

4) Not sure if CAP is an interest but stimulants make a hell of a difference. It's quite rewarding. There's some real internal satisfaction getting someone's anxiety treated on an SSRI and CBT vs becoming a benzo4lifer. Treating first break psychosis is the most gratifying experience I have had in all of medicine or at least very similar to heme/onc level of emotionally charged dx and tx.

5) I have never really seen this lack of respect thing. If you dress and act the part of a doctor, I find you get the respect of a doctor. I've had a handful of medical students that had PDs rail against having to do a psychiatry rotation but attendings usually LOVE to have access to psychiatric consultation and appreciate the fact that you know WTF they are talking about vs talking to a social worker.
5a) I actually get thanked by my patients a lot. I was feeling unappreciated a month ago and just started to literally record the compliments and thanks I got; it was a ton and I was simply not paying attention to it

IM as a field has a lot of pitfalls but some of the subspecalities can be in a really good space. Hospitalist is an option to give a great lifestyle, although the work is not for a lot of people, particularly not for more than a few years. If you are comfortable having your encounters reduced to the time you get in IM and are really worried about staying in psych then I think it is a reasonable switch. There are so many options if you do complete psych that would let you get more "IM" like experience (sleep, pain, neuropsych, CL) so don't forget about the delayed gratification.

 

[Gavanshir]

Loaded post but just a few things I noticed:

1) It sounds like your program is... not great. That might related to your step scores or just bad luck. Good psychiatry looks nothing like care from midlevels, trust me I spent 30 minutes Sunday helping a non-psychotic pt get his frustrations out over his NP provider on the inpatient unit and not suing the hospital (with her documentation, he'd have won). This women then asked me how to bill an inpatient consult for delirum "He was A&Ox4 so he's fine, what should I put as the diagnosis". You can probably access more good psychiatry as you go along in training.

2) I do "medicine" all the time, from a recent narcolepsy patient (dur hur visual hallucinations its psych's problem), to REM sleep disorder, limbic encephalitis, and that's in 2017.

3) Psychiatry has had some pretty big changes from the 60's. It's not as much as some other fields but start a first break psychosis pt on Abilify and then Haldol and see which one they like being on more. There are some drugs in the pipeline but it is admittedly complicated to get psychiatric drugs that are effective developed.

4) Not sure if CAP is an interest but stimulants make a hell of a difference. It's quite rewarding. There's some real internal satisfaction getting someone's anxiety treated on an SSRI and CBT vs becoming a benzo4lifer. Treating first break psychosis is the most gratifying experience I have had in all of medicine or at least very similar to heme/onc level of emotionally charged dx and tx.

5) I have never really seen this lack of respect thing. If you dress and act the part of a doctor, I find you get the respect of a doctor. I've had a handful of medical students that had PDs rail against having to do a psychiatry rotation but attendings usually LOVE to have access to psychiatric consultation and appreciate the fact that you know WTF they are talking about vs talking to a social worker.
5a) I actually get thanked by my patients a lot. I was feeling unappreciated a month ago and just started to literally record the compliments and thanks I got; it was a ton and I was simply not paying attention to it

IM as a field has a lot of pitfalls but some of the subspecalities can be in a really good space. Hospitalist is an option to give a great lifestyle, although the work is not for a lot of people, particularly not for more than a few years. If you are comfortable having your encounters reduced to the time you get in IM and are really worried about staying in psych then I think it is a reasonable switch. There are so many options if you do complete psych that would let you get more "IM" like experience (sleep, pain, neuropsych, CL) so don't forget about the delayed gratification.

Thank you for your reply to my indeed loaded post. Well, it's over now and I can't explain exactly why but with seconds left to the submission deadline, I removed 3 out of the 4 IM programs from my rank list, essentially guaranteeing that I will be staying in psychiatry. There was a TED talk that I saw recently by a philosopher named Ruth Chang who gave the example of herself choosing between philosophy and law school. I couldn't help but relate to the example. She went with law school initially and later made the change to philosophy, her takeaway point was that in the end we all make a choice and it's not because one choice is actually better or worse than the alternative, but once the decision has been made, we compile our own unique reasons to justify our existence and it's those very reasons that make us into who we are. I thought it was a refreshing perspective after months of weighing pros and cons.

 

[postbacpremed87]

Thank you for your reply to my indeed loaded post. Well, it's over now and I can't explain exactly why but with seconds left to the submission deadline, I removed 3 out of the 4 IM programs from my rank list, essentially guaranteeing that I will be staying in psychiatry. There was a TED talk that I saw recently by a philosopher named Ruth Chang who gave the example of herself choosing between philosophy and law school. I couldn't help but relate to the example. She went with law school initially and later made the change to philosophy, her takeaway point was that in the end we all make a choice and it's not because one choice is actually better or worse than the alternative, but once the decision has been made, we compile our own unique reasons to justify our existence and it's those very reasons that make us into who we are. I thought it was a refreshing perspective after months of weighing pros and cons.

Perfect.

 

[Merovinge]

Thank you for your reply to my indeed loaded post. Well, it's over now and I can't explain exactly why but with seconds left to the submission deadline, I removed 3 out of the 4 IM programs from my rank list, essentially guaranteeing that I will be staying in psychiatry. There was a TED talk that I saw recently by a philosopher named Ruth Chang who gave the example of herself choosing between philosophy and law school. I couldn't help but relate to the example. She went with law school initially and later made the change to philosophy, her takeaway point was that in the end we all make a choice and it's not because one choice is actually better or worse than the alternative, but once the decision has been made, we compile our own unique reasons to justify our existence and it's those very reasons that make us into who we are. I thought it was a refreshing perspective after months of weighing pros and cons.

Oh absolutely. If I was given another 5 lives to live/careers to have I would 1) Become an ED psychiatrist and suicidologist 2) Become a sex therapist 3) Become an economist 4) Take a crack at an MBA and finance 5) Do peds heme/onc. If you love the brain and patients you will go far in psychiatry.

 

[QueryNeurology]

Thank you for your reply to my indeed loaded post. Well, it's over now and I can't explain exactly why but with seconds left to the submission deadline, I removed 3 out of the 4 IM programs from my rank list, essentially guaranteeing that I will be staying in psychiatry. There was a TED talk that I saw recently by a philosopher named Ruth Chang who gave the example of herself choosing between philosophy and law school. I couldn't help but relate to the example. She went with law school initially and later made the change to philosophy, her takeaway point was that in the end we all make a choice and it's not because one choice is actually better or worse than the alternative, but once the decision has been made, we compile our own unique reasons to justify our existence and it's those very reasons that make us into who we are. I thought it was a refreshing perspective after months of weighing pros and cons.

I don't get how that made you decide to stay in Psychiatry?

 

[deleted343839]

her takeaway point was that in the end we all make a choice and it's not because one choice is actually better or worse than the alternative, but once the decision has been made, we compile our own unique reasons to justify our existence and it's those very reasons that make us into who we are

This same reasoning has guided some of my career moves, and it has worked out OK. But see also: sunk cost fallacy.

 

[smalltownpsych]

I once made a small comment to an attending psychologist in a private area of the unit and she suddenly opened up about her own frustrations with psychiatry pushing down medications onto patients so that their admission would be covered by insurance and her commentary was riddled with hints of "anti-psychiatry" throughout, and this is from an ivy-league trained psychologist who has seen that medications rarely help our patient population. Almost all of my hospitalized patients are difficult as all hell and some days I'm tired of having to manipulate my patients or put discharge as a carrot on the stick in order for them to take their medications. Or to have to threaten them with future hospitalization if they dont take their meds and keep their outpatient follow-ups. Sometimes I ask myself if I entered medicine to be placed in such a position to have to coerce my patients into compliance.

I completely get the criticisms and I often take an anti-medication and anti-coerced treatment stance as I do feel that we, as a society, rely too much on medications and control dynamics when it comes to mental illness. In my mind, someone who is questioning their path for some of these reasons is demonstrating that they are probably making the right choice both for themselves and society. From my perspective as a psychologist, a good psychiatrist is not only the expert on the medications and biological aspects, but also should have a solid grasp on the psycho-social-cultural aspects, as well. The system wants to make you into just a pill-pusher and wants to make me into just a technician administering manualized treatments with measurable goals. Meanwhile our patients are struggling with a complex interwoven array of issues that this reductionist approach is just going to make worse.

 

[HarryMTieboutMD]

I completely get the criticisms and I often take an anti-medication and anti-coerced treatment stance as I do feel that we, as a society, rely too much on medications and control dynamics when it comes to mental illness. In my mind, someone who is questioning their path for some of these reasons is demonstrating that they are probably making the right choice both for themselves and society. From my perspective as a psychologist, a good psychiatrist is not only the expert on the medications and biological aspects, but also should have a solid grasp on the psycho-social-cultural aspects, as well. The system wants to make you into just a pill-pusher and wants to make me into just a technician administering manualized treatments with measurable goals. Meanwhile our patients are struggling with a complex interwoven array of issues that this reductionist approach is just going to make worse.

Change psychiatrist to physician. Our illnesses behave like other chronic illnesses in terms of noncompliance, public health costs, recidivism, etc.

And I have yet to see a midlevel who is an accurate diagnostician or competent psychopharmacologist.

 

[nancysinatra]

Thank you for your reply to my indeed loaded post. Well, it's over now and I can't explain exactly why but with seconds left to the submission deadline, I removed 3 out of the 4 IM programs from my rank list, essentially guaranteeing that I will be staying in psychiatry. There was a TED talk that I saw recently by a philosopher named Ruth Chang who gave the example of herself choosing between philosophy and law school. I couldn't help but relate to the example. She went with law school initially and later made the change to philosophy, her takeaway point was that in the end we all make a choice and it's not because one choice is actually better or worse than the alternative, but once the decision has been made, we compile our own unique reasons to justify our existence and it's those very reasons that make us into who we are. I thought it was a refreshing perspective after months of weighing pros and cons.

I'd love to respond to your earlier post, but I'm sure someone would say my response was "loaded" and I'd be reported as a troll. I left psych after finishing a residency and working a few years. I much prefer my new specialty, although I plan to keep up my connection with psych, and stay with it part of the time. What I've learned in the last year is that I like variety. I don't hate psych, but I did hate doing it every day. And I hated knowing that there was this knowledge of the rest of medicine that was getting farther and farther from my memory. I currently do some psych moonlighting, and because it's infrequent enough, I can honestly say that I almost enjoy those hours I spend moonlighting in psych. (I say almost because it's on the weekend, when I'd rather be skiing, or at the zoo, or whatever.) I take more time with the patients and enjoy working with the staff more.

I felt just like you are describing during my own intern year. I too considered switching but did not. I wish I had listened to my gut. There wasn't an IM spot in my own hospital's program, but I could have gone across town, to the slightly less prestigious hospital, and done IM there. It just suits me better, and if that makes me a troll, so be it. I'm sad, looking back, that I was too caught up in the issues of the time - salary, my student loans, my rent, the prestige of my program vs the one across town - to prioritize my basic aptitudes and interests. I wish I had transferred to IM or maybe EM at that other hospital. But I didn't. The upshot is, no matter where I go from here, I have a psych background, and it is very in demand and very marketable!

 

[FlowRate]

I'd love to respond to your earlier post, but I'm sure someone would say my response was "loaded" and I'd be reported as a troll. I left psych after finishing a residency and working a few years. I much prefer my new specialty, although I plan to keep up my connection with psych, and stay with it part of the time. What I've learned in the last year is that I like variety. I don't hate psych, but I did hate doing it every day. And I hated knowing that there was this knowledge of the rest of medicine that was getting farther and farther from my memory. I currently do some psych moonlighting, and because it's infrequent enough, I can honestly say that I almost enjoy those hours I spend moonlighting in psych. (I say almost because it's on the weekend, when I'd rather be skiing, or at the zoo, or whatever.) I take more time with the patients and enjoy working with the staff more.

I felt just like you are describing during my own intern year. I too considered switching but did not. I wish I had listened to my gut. There wasn't an IM spot in my own hospital's program, but I could have gone across town, to the slightly less prestigious hospital, and done IM there. It just suits me better, and if that makes me a troll, so be it. I'm sad, looking back, that I was too caught up in the issues of the time - salary, my student loans, my rent, the prestige of my program vs the one across town - to prioritize my basic aptitudes and interests. I wish I had transferred to IM or maybe EM at that other hospital. But I didn't. The upshot is, no matter where I go from here, I have a psych background, and it is very in demand and very marketable!

Sometimes I worry that this is going to be me, but that I'm just not willing to admit it to myself. I got asked all the time during my medicine months why I chose psychiatry (asked such that the context was because I was obviously enjoying + good at the medicine stuff). I still think I like psychiatry the most, we'll see.

 

[st2205]

Sometimes I worry that this is going to be me, but that I'm just not willing to admit it to myself. I got asked all the time during my medicine months why I chose psychiatry (asked such that the context was because I was obviously enjoying + good at the medicine stuff). I still think I like psychiatry the most, we'll see.

I knew I always wanted to do psychiatry. I liked the idea of some fields, particularly the idea of a combo medical/surgical field, and liked a lot of IM subspecialties. I generally enjoyed all my rotations. I did wonder in the back of my mind if I would want something else. The more through residency I've gotten the more solidified I am in my decision, especially now.

 

[Merovinge]

Sometimes I worry that this is going to be me, but that I'm just not willing to admit it to myself. I got asked all the time during my medicine months why I chose psychiatry (asked such that the context was because I was obviously enjoying + good at the medicine stuff). I still think I like psychiatry the most, we'll see.

I was a bit worried doing peds neuro my intern year that I would have preferred that side of the brain. Didnt help that they also asked me to switch into the field (which has such bizarre requirements that you wouldn't even lose a year). Having gone back to the same clinic during my CAP fellowship I am 1000% sure psychiatry was the right choice.

 

[MacDonaldTriad]

I committed to psych over 30 years ago and I don't think I have ever questioned that decision. Sure, there are days I hate my job, but I believe that would be the case in all fields. Maybe we should have only 3 months of medicine in the first year and ten days of ward medicine in every other year of training. That would probably drive the psychaphilles deeper into psych and the wanderlust psych residents would be pushed to cut bait before they are done. My observation is that when ever someone does two trainings, they practice the second one. When every anyone does a combined psych program, they practice psych with a few rare exceptions.

 

[justfolks]

Just a patient, but I thought it might help to know that some of us actually do appreciate our psychiatrists. It's a hard job, and not everyone is great at it, but when you find someone really good, they can literally be lifesavers. I don't know why mine likes his job, but he clearly does. Which is very, very fortunate for me.

 

[Merovinge]

My observation is that when ever someone does two trainings, they practice the second one. When every anyone does a combined psych program, they practice psych with a few rare exceptions.

I generally have had the same experience. Interestingly know of a consult attending who did a full psych residency first, went back for IM, and now does mostly psych with about 20-30% of his time in straight IM. Combined folks seem to always do psych fully after completion.

 

[nexus73]

Specialty preference aside, just looking at workload and pay, I think psych beats out FM/IM. I have a psychiatrist friend married to a family doctor. They both work in a gigantic corporate medical clinic, and he typically gets home at 5pm, she gets home at 6:30. They're both considered 1.0 FTE full time. And she makes less than him.