Help with Specialty Selection (Endocrine vs. Psychiatry)

[Eddard]

Hey, guys!

Long time lurker here posting for the first time! I am trying to decide on my specialty between Medicine (with the end goal of doing Endocrinology) and Psychiatry. I have to make a decision on a research year before I can do sub-Is and electives in these specialties, and am currently finishing up my clinical year, having had both my psychiatry and medicine rotations and enjoying them both. I am interested in both Psychiatry and Endocrinology from a pathophysiology/patient population/research perspective and the second most important thing I am looking for in my future specialty is lifestyle. I am interested in working in an academic outpatient setting and eventually possibly opening up a private practice in addition to my academic work, but this is by no means a requirement.

I appreciate anyone's input/feedback into anything that could help make my decision easier and any insight into the future of the fields and what I should base my decision on. I am not as interested in other medical subspecialties, but I would be open to one or two other medical fellowships if Endocrinology does not end up working out.

I in no way intend to brag, but in order to make the picture clearer, I attend a top 10 Medical School and I intend to work in academic medicine on the East Coast.

Thank you for your time and help! I appreciate all input!

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[J ROD]

Endocrine and Psych are pretty different in patient population. I would use that as my breaking point. I thought about Medicine and then doing Rheum but I really enjoy Psych and now I could not see myself doing anything else. I love the patient population and dealing with psychosis and at times substance abuse. Both offer outpatient and good hours. I think Psych has more need and better job outlooks but if you want academic then you will be in about the same boat in that aspect.

 

[DocWinter]

If lifestyle is a main goal you cannot go wrong with psych.

 

[J ROD]

Yeah, it ain't bad!

 

[Eddard]

Thank you, guys!

 

[Peach Newport]

I actually know a lot of people who struggled with the "endocrine vs psych" decision. On the surface, they seem to have a lot in common.

Every single one chose psych.

 

[Peach Newport]

Just a student, but how about IM/Psych (5 years I believe?) and then do Endo. Yeah it's a helluva long time, but I could see a great niche in academia as many psychiatric disorders have endocrine differentials (hypothyroidism, Cushing's, and Addison's to name a few). Also, many endocrine conditions may have psychiatric consequences (depression)

Yikes.

-Maintaining a triple board certification
-7 years in residency and fellowship (and 7 years of compound interest!)
-...only to end up with an academic salary?

Sounds like a recipe for a really bad time to me!

 

[sloop]

Just a student, but how about IM/Psych (5 years I believe?) and then do Endo. Yeah it's a helluva long time, but I could see a great niche in academia as many psychiatric disorders have endocrine differentials (hypothyroidism, Cushing's, and Addison's to name a few). Also, many endocrine conditions may have psychiatric consequences (depression) and some psychiatric medications (anti-psychotics) can cause endocrine issues.

Endocrinological differentials of psychiatric diagnoses fall squarely within the realm of psychiatry proper and I don't think the board certification would add that much.

Any good psych program will teach you to work up suspected endocrine causes of psychiatric symptoms. If you want to become especially skilled at this stuff you become a C-L psychiatrist.

P.S. Psych is awesome. There's nothing I would rather do. If you really want to do endocrine and feel the way I feel about psych about that field, do it. I'll just say that you should take a good look at yourself and try to decide if you're not just tentative about psych because of some insecurity about being "a real doctor." I had one friend who wasted an extra year of med school before realizing this was what her hang up was. I can assure you we are very much real doctors.

 

[Tenk]

Every endocrinologist I ever met seemed pretty burnt out (n=prolly like 5 or so?). They go into the field for all these super cool rare diseases and all they see is diabetes, diabetes and diabetes (even had one tell me that haha). Sure you get other stuff but it's like sprinkles on a seven layer cake of diabetes. If you super, ultra, love diabetes and love calculating insulin regimens for like 9/10 patients, go endocrine. If this sounds mundane, stay away from endocrine!

 

[Merely]

Endocrinological differentials of psychiatric diagnoses fall squarely within the realm of psychiatry proper and I don't think the board certification would add that much.

Any good psych program will teach you to work up suspected endocrine causes of psychiatric symptoms. If you want to become especially skilled at this stuff you become a C-L psychiatrist.

P.S. Psych is awesome. There's nothing I would rather do. If you really want to do endocrine and feel the way I feel about psych about that field, do it. I'll just say that you should take a good look at yourself and try to decide if you're not just tentative about psych because of some insecurity about being "a real doctor." I had one friend who wasted an extra year of med school before realizing this was what her hang up was. I can assure you we are very much real doctors.

 

[sloop]

Ha. I've seen that video. It's so stupid. There aren't any biological tests to diagnose Alzheimer's, Parkinson's or any of a wide array of other clinical diagnoses, either. Like these disorders, mental disorders do have tests that support their diagnosis, including brain imaging findings, etc. In any case, mental illnesses often represent something heritable and people with genetic loading for, say, affective or psychotic illness are much more likely to develop it themselves.

On the other hand, no psychiatrist in their right mind claims that the origin of all mental illnesses is entirely (or even primarily) biological. Some illnesses, like bipolar disorder, schizophrenia and many cases of unipolar depression where there is a clear episodic, syndromal presentation with heavy genetic loading are true diseases, but many others are not diseases in the same sense. Addictive disorders, pathological gambling, eating disorders and the like are primarily disorders of conditioned learning that occur in otherwise normal brains. Still other disorders are the consequence of a person's personality characteristics or cognitive faculties lying on an extreme of normal variation and leaving them vulnerable to maladaptive responses to provocations or are the reaction to extreme things that have happened to an otherwise normal person (adjustment disorders, stress disorders, etc.)

So yes, many psychiatric disorders are diseases and come with the heritability, biological/anatomical correlates, etc. that one would expect as such. Others are not clearly diseases but are still disorders in a very real sense, profoundly negatively impact people's lives and are indeed treatable. Further, even those disorders that are not diseases have biological targets for pharmacological symptom relief.

 

[AlbinoHawk DO]

Go for psych. Have an easy life.

 

[michaelrack]

Yikes.

-Maintaining a triple board certification
-7 years in residency and fellowship (and 7 years of compound interest!)
-...only to end up with an academic salary?

Sounds like a recipe for a really bad time to me!

no need to do the endocrinology fellowship. Just do the med/psych residency and you will be good.

 

[Peach Newport]

Ha. I've seen that video. It's so stupid. There aren't any biological tests to diagnose Alzheimer's, Parkinson's or any of a wide array of other clinical diagnoses, either. Like these disorders, mental disorders do have tests that support their diagnosis, including brain imaging findings, etc. In any case, mental illnesses often represent something heritable and people with genetic loading for, say, affective or psychotic illness are much more likely to develop it themselves.

On the other hand, no psychiatrist in their right mind claims that the origin of all mental illnesses is entirely (or even primarily) biological. Some illnesses, like bipolar disorder, schizophrenia and many cases of unipolar depression where there is a clear episodic, syndromal presentation with heavy genetic loading are true diseases, but many others are not diseases in the same sense. Addictive disorders, pathological gambling, eating disorders and the like are primarily disorders of conditioned learning that occur in otherwise normal brains. Still other disorders are the consequence of a person's personality characteristics or cognitive faculties lying on an extreme of normal variation and leaving them vulnerable to maladaptive responses to provocations or are the reaction to extreme things that have happened to an otherwise normal person (adjustment disorders, stress disorders, etc.)

So yes, many psychiatric disorders are diseases and come with the heritability, biological/anatomical correlates, etc. that one would expect as such. Others are not clearly diseases but are still disorders in a very real sense, profoundly negatively impact people's lives and are indeed treatable. Further, even those disorders that are not diseases have biological targets for pharmacological symptom relief.

Dude I was going to type out a whole rebuttal to, but I decided it just wasn’t worth it. Good on you.

 

[kb1900]

but it's like sprinkles on a seven layer cake of diabetes.