How did you make up your mind on Psychiatry?

[Nasrudin]

First. Thanks to all of you. I've been reading here and learning a lot.

As I begin to wrap up my undergraduate medical years. I wanted to have some ideas about how to evaluate this field against other fields. And on what criteria are sound enough to base a fit decision. I'm doing some shadowing interest group stuff etc. And am interested. But waiting for the evidence to emerge from my experience. What would constitute this...I'm not entirely sure.

So what was your decision science on choosing Psychiatry?

(Appreciate any insight.)

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[OldPsychDoc]

Compare and contrast:

1) tweaking antihypertensives and montioring A1Cs in 68 yr old vs. intervening in major depressive episode in 23 yr old.

2) lifestyle of PGY3 in IM vs. lifestyle of PGY3 in psych.

 

[Nasrudin]

Compare and contrast:

1) tweaking antihypertensives and montioring A1Cs in 68 yr old vs. intervening in major depressive episode in 23 yr old.

2) lifestyle of PGY3 in IM vs. lifestyle of PGY3 in psych.

Will do. Thanks.

 

[digitlnoize]

First. Thanks to all of you. I've been reading here and learning a lot.

As I begin to wrap up my undergraduate medical years. I wanted to have some ideas about how to evaluate this field against other fields. And on what criteria are sound enough to base a fit decision. I'm doing some shadowing interest group stuff etc. And am interested. But waiting for the evidence to emerge from my experience. What would constitute this...I'm not entirely sure.

So what was your decision science on choosing Psychiatry?

(Appreciate any insight.)

For me, it was simply about experiencing each field during 3rd year, and finding the one I liked best. I think there are a few BIG questions you should ask yourself:

1. Do you want to do procedures? If yes, consider: Surgery (and Uro, ENT, etc), OBGYN, EM, FM, IM subspecialties, Anesthesia, etc. If no, consider: General IM, Psych, FM, Rads, Path, Neurology, etc.

2. Do you want to talk to your patients? If yes, consider psych. If no, consider rads, path.

3. What type of practice environment do you want? If you want to be an employee, pretty much every field is fair game. If you want your own private practice, psych is very conducive to this, with the low overhead.

4. What type of lifestyle do you want? For a controllable life, 8-5, little call, go with: psych, FM (mostly), hospitalist (be ok with some nights/weekends), EM (also, some nights/weekends), derm, ophtho, or some other specialties if you're ok with being in a large group.

5. Most importantly, What do you ENJOY? Which field is most interesting to you? I like the barometer of: Which journal would you rather read? or When you pick up JAMA, do you search out the psych articles (as I do), or do you gravitate to the new HTN study?

Another good thought experiment: Imagine yourself in an FM office or ER. There are 10 different patients to see, but you can only pick one. None are dying or emergent. One is a psych patient, one needs a lap chole, one is pregnant or STDs, one is HTN management, etc etc etc for each field. Which one do you go see?

Finally, don't forget when choosing to imagine yourself 10-20 years in the future. You may not be married with kids NOW, but you might be in another 5-10 years. Do you really want to be a busy neurosurgeon at THAT point in your life?

Psych, to me, is a fairly distinct field in medicine, and most people either like it or they don't. In that respect it's similar to Rads (you either like sitting alone in a dark room all day with no patient contact, or you don't) and Path (you either like staring at microscope slides all day, or you don't). Try it, see if you like it. If so, welcome to what I feel is the most interesting and rewarding field in all of medicine...not to mention the hidden "lifestyle" field.

 

[nitemagi]

First off, my compliments on the avatar. Can't wait to see the new film.

I've posted on this before. I had multiple bars set to pick a specialty.

My first resident during 3rd year(great guy, med-peds), used to say "When you look around at your colleagues and say to yourself 'these are my people', you're in the right place."
Psych had some of that, though I found myself departing from some people in psych, and appreciating other ppl such as in IM. So that was neither necessary nor sufficient for me.

My first attending (outpt family practice) used to say "the biggest problem after 10 years of practice for a physician is burnout and boredom." Psych has much higher risk for the former than the latter. But I saw few other specialties that didn't put me at risk for boredom. Burnout I tackled early on, and more or less have it managed. Sometimes less.

My first residency mentor put it another way - He used to plan on doing cardiology, had all the murmurs and subtle heart sounds mastered. Then one day he realized what the life of a cardiologist (or any IM sub-specialist) is like - Wake up early Every day, do some caths, round on your inpatients, then rush to eat something and get to your clinic to see patients all afternoon. Substitute other basic procedures for caths (dialysis, for example). But that's your life for your whole career.

Psychiatry is an incredibly diverse and flexible field. You make more than IM for less hours, with almost no ceiling potentially. Patients are never boring. One can get by doing basic med management, but the pendulum is swinging back to incorporation of more and more psychotherapy skills. Psychotherapy is tough to explain to a student, but in many ways akin to a procedure, yet using yourself as the instrument. It's skill based, operator dependent, and can actually change the way someone feels and thinks through your interactions, talking and listening.

Then throw in the job flexibility. There's a shortage of psychiatrists, everywhere. You can work one job for 2 days a week and another job another 2 days a week. Do 1 job in the mornings and another in the afternoons. Change job locations, patient populations, every few years if that's what appeals to you. Treat totally different diseases. How about 1-year fellowships? Consult-Liaison understanding a lot of medicine and continuing to use that? Child/Adolescent (most underserved medical specialty there is)? Forensics, Addiction, Geriatrics, Sleep, Pain? Gimme a break.

It was also the only rotation I looked forward to going to in the morning, and felt good about my work when I went home at night.

 

[OldPsychDoc]

For me, it was simply about experiencing each field during 3rd year, and finding the one I liked best. I think there are a few BIG questions you should ask yourself:

1. Do you want to do procedures? If yes, consider: Surgery (and Uro, ENT, etc), OBGYN, EM, FM, IM subspecialties, Anesthesia, etc. If no, consider: General IM, Psych, FM, Rads, Path, Neurology, etc.

2. Do you want to talk to your patients? If yes, consider psych. If no, consider rads, path.
...

Seems a good moment to repost this:

 

[Nasrudin]

Thanks all. Really thoughtful replies. I'm glad I have a list of ideas to find easily and to reference as I move along.

I'll pass on the thoughts to any psych-interested colleagues. Or people having trouble deciding.

@nitemagi. I agree. Jim Henson is one of of the greatest artists of all time. And glad his studio is keeping at it.

@Digitlnoize. Very helpful.

@Oldpsychdoc. Crazy. check. Attention span. Check. Looking good then.

 

[sunlioness]

I love that algorithm. It lands me in psychiatry, medicine or derm depending on how crazy or hard-working I'm feeling that day. Today was a derm day. Though I toured the lab at the place I just started working and it was so cool I had a brief "I should have been a pathologist" fantasy. I'm feeling better now.

 

[animas]

First. Thanks to all of you. I've been reading here and learning a lot.

As I begin to wrap up my undergraduate medical years. I wanted to have some ideas about how to evaluate this field against other fields. And on what criteria are sound enough to base a fit decision. I'm doing some shadowing interest group stuff etc. And am interested. But waiting for the evidence to emerge from my experience. What would constitute this...I'm not entirely sure.

So what was your decision science on choosing Psychiatry?

(Appreciate any insight.)

if you like asking pt's personal questions because you genuinely want to know their stories and what makes them tic in order to help them as you get to know them, psychiatry may be for you.

also, think about how you feel during didactics. are you coming up with questions for your instructors without even trying hard to come up with them? i.e. do you feel intelluctually stimulated, challenged, and fascinated about psych-related topics?

 

[NoNoNoNo]

I never wanted to be a "doctor," per say, I went to med school to be a psychiatrist. Yes, for many of the reasons stated above.