How Do You Interpret It When Someone Says "You'd Make A Good Psychiatrist?"

[ZBend]

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So I've been told by a couple of patients, classmates, and friends throughout the year that "You'd make a good psychiatrist." But what does that mean to you when you hear it?

I mean, I think I'm a good listener and I tend to be "that friend" who many of my friends go to in order to vent or confide things in. But is that really a quality exclusive enough to associate with psychiatrists primarily? I like talking about people's backgrounds and not just their symptoms or medical background and psych patients don't really bother me that much anymore after I got used to them. Also, I find the material really interesting, but I wouldn't necessarily put my interest in it leagues above any other medical subjects (which is to say I could see myself doing a lot of different things, but not everything, so no Family Medicine).

Basically, this is partially masquerading as a "What should I do with the rest of my life?" thread b/c I'm still trying to find justifications to that question myself, but I'd also genuinely like to hear what you all think makes for good psychiatrist qualities?

 

[image187]

It probably means you make these people feel calm or comfortable and they perceive you to care about their real-world problems more than most people do. But chances are these people really have no idea about what it takes to actually be a good psychiatrist.

I think if this thread really is about you wondering about what you should go into, you should try to get more experience in psychiatry and see if you like doing it!

 

[MacDonaldTriad]

http://forums.studentdoctor.net/showthread.php?t=991083

http://forums.studentdoctor.net/showthread.php?t=994723

If someone says you would make a great psychiatrist and you cannot smile and say "thank you", then you probably do have some thinking to do. Here are a couple of threads related to people's debate about going into psychiatry. In the second one, nitemagi lists about 10 similar threads.

Good luck with your decision.

 

[ZBend]

http://forums.studentdoctor.net/showthread.php?t=991083

http://forums.studentdoctor.net/showthread.php?t=994723

If someone says you would make a great psychiatrist and you cannot smile and say “thank you”, then you probably do have some thinking to do. Here are a couple of threads related to people’s debate about going into psychiatry. In the second one, nitemagi lists about 10 similar threads.

Good luck with your decision.

Oh, I didn't take it negatively or anything, I just realized that was the most common compliment I've gotten in general during rotations. Granted it wasn't more than a handful of times from different people, but it's sorta stuck in my head. I guess what I'm mainly worried about is finding something I can love doing. A bunch of friends knew what they wanted to do from the get go or had that "aha moment" when something clicked, but I don't think I have had that. There are a lot if things I have liked, and I can see myself doing a lot of things, but nothing really has taken the lead in a significant way. That's sorta why I'm now fixating on the whole "you'd make a good psychiatrist thing." Maybe outside sources are seeing something I'm not. I am interested in psych but I can't really say there was that instant attraction at least I don't think so, though I definitely had a better experience in that block than many of the others.

 

[MacDonaldTriad]

It is hard to be so far in education and have to make this large decision with only a year of clinical work. I know the place you are in is not uncommon. Sometimes I think medical students are the sub group of premeds who somehow failed to drop out (joke).

I think people become really good at what interests them more often than people are interested in what they are good at. Psychiatry is full of late converts, but I haven't seen many people who started psych run away from it. Maybe a few should, but it is the kind of field people can generally tell if they have the un-teachable skill sets needed.

Do an elective in something very different from your core psych experience. You will be able to figure this out.

Best of luck

 

[nancysinatra]

So I've been told by a couple of patients, classmates, and friends throughout the year that "You'd make a good psychiatrist." But what does that mean to you when you hear it?

If it's the OB/Gyn clerkship director saying this, then it probably means you just tanked on that fetal tracings exam they just gave.

 

[ZBend]

It is hard to be so far in education and have to make this large decision with only a year of clinical work. I know the place you are in is not uncommon. Sometimes I think medical students are the sub group of premeds who somehow failed to drop out (joke).

I think people become really good at what interests them more often than people are interested in what they are good at. Psychiatry is full of late converts, but I haven’t seen many people who started psych run away from it. Maybe a few should, but it is the kind of field people can generally tell if they have the un-teachable skill sets needed.

Do an elective in something very different from your core psych experience. You will be able to figure this out.

Best of luck

I think one of the reasons I'm having such a hard time figuring all of this out is because I may be burned out. I have really enjoyed learning "on the job," but more and more I've just been too tired and uninterested to study afterwards, which then makes me unprepared for the next day which then affects my confidence and so on and so forth. Since I had psychiatry early on, I was rested, prepared and confident so I'm sure that's impacting my current mindset. I just want to figure out if my interest in Psychiatry or any other specialty is legitimate or if it's just because I was prepared. Any tips to figure this out would be appreciated.

 

[OldPsychDoc]

What do you think it means?

 

[billypilgrim37]

It really depends on who is saying it.

When the chair of neurology said it to me, it was back-handed.

When the pediatrician said it, it was a glowing recommendation.

 

[nancysinatra]

When the pediatrician said it, it was a glowing recommendation.

Did you have to ask them for it? ;-)

 

[ZBend]

I think people become really good at what interests them more often than people are interested in what they are good at. Psychiatry is full of late converts, but I haven’t seen many people who started psych run away from it. Maybe a few should, but it is the kind of field people can generally tell if they have the un-teachable skill sets needed.

It's sorta "chicken or the egg" in regards to whether I do well b/c I'm interested or if I'm interested b/c I do well, but regardless, Psychiatry has been consistently one of my best subjects in med school thus far. I find the field interesting, but I also feel it comes easier to me as well (ie, I feel like I grasp psych concepts faster than most other medical concepts).

Since starting this thread, I've been trying to come up with pros/cons for everything, but I'm not really making much headway in terms of actually narrowing down my choice of specialty. I just feel like I have enjoyed nearly all of my rotations while in the moment, so my emotions aren't helping much in that regards. I'm trying to include other factors (eg, pt population, common cases, lifestyle, compensation, etc.), but that's proving tricky too. At this rate, I really feel like it's going to be a "down to the wire" decision based on my feelings that day and that kinda scares me.

Has anyone tried applying to 2 specialties? I know you shouldn't apply to the same institutions, but are there any other things to consider? Also, in regards to Letters of Recommendation, would it matter if you had a slew of letters from different fields? I'm hoping to figure things out before it comes to that, but I'd like to prepare for it just in case.

 

[vistaril]

If it's the OB/Gyn clerkship director saying this, then it probably means you just tanked on that fetal tracings exam they just gave.

agreed...in most cases it is probably not a compliment.

I mean usually there are elements of it that can be seen as a compliment. For example, the clumsy but sorta quirky student on surgery who is far from a star rotator but really empathizes with patients may be told that he is a 'good fit' for psychiatry. But the high achieving star rotator who is tying faster than everyone else and all the surgery residents want to work with won't be told he is a 'good fit' for psychiatry.....even if he also really empathizes with pts well.

 

[PrideNeverDie]

agreed...in most cases it is probably not a compliment.

I mean usually there are elements of it that can be seen as a compliment. For example, the clumsy but sorta quirky student on surgery who is far from a star rotator but really empathizes with patients may be told that he is a 'good fit' for psychiatry. But the high achieving star rotator who is tying faster than everyone else and all the surgery residents want to work with won't be told he is a 'good fit' for psychiatry.....even if he also really empathizes with pts well.

agreed

here is another one i commonly get "you're too smart for psychiatry"

 

[vistaril]

agreed

here is another one i commonly get "you're too smart for psychiatry"

I've said this before, but a disproportionate of our negative interactions tend to come with family med physicians, internists, em physicians, etc..........now obviously part of this is because we interact with these people more than any others. Even though psychiatrists aren't technically primary care physicians(are we?), like family med phycisians and general internists we tend to frequently be either first-line providers or in some cases a patient's only provider. A urologist is almost never a pt's first line provider or only provider by contrast.

But I think part of the reason why we never get in arguments with dermatologists, opthos, ents, radiation oncologists, etc is because they don't percieve us as even being one of them. Which hey if it ain't broke don't fix it imo. We're just the friendly quirky outsiders.....

So whereas the ent or urologist or radiation oncologist may look down at a family medicine physician, I think they view us differently. They view us in much the same way they would an accountant or whatever....just in a completely different and unrelated field.

 

[billypilgrim37]

So whereas the ent or urologist or radiation oncologist may look down at a family medicine physician, I think they view us differently. They view us in much the same way they would an accountant or whatever....just in a completely different and unrelated field.

I've treated the children of physicians from these specialties for ADHD, OCD, depression, et al, and I have to say that is complete unmitigated horse ****.

 

[OldPsychDoc]

I'm glad the guy putting a scope into my shoulder next week wasn't "too smart to be an orthopod." 😉

 

[vistaril]

I've treated the children of physicians from these specialties for ADHD, OCD, depression, et al, and I have to say that is complete unmitigated horse ****.

personally I think it is a good thing.....they tend to be curious and ask questions....Maybe related to true curiosity or maybe related to just normal courtesy. much in the same way if my neighbor was a firefighter I might ask him questions about thatout of curiosity. They certainly aren't asking the same sort of questions to the fam medicine physician. Of course a lot of that is because they are more familar with what they do and day to day activities of those guys.

and I wasn't neccessarily making a value judgement. My guess is some of these subspecialists think highly of some psychiatrists and less so of others.

But given the choice of my profession being thought of as different vs inferior by these people, I'd much prefer different than inferior.

 

[vistaril]

I'm glad the guy putting a scope into my shoulder next week wasn't "too smart to be an orthopod." 😉

although we've all probably heard ortho jokes(where do you hide a 100 dollar bill from an ortho), virtually everyone in medicine understands that ortho is a very competitive match where excellent grades, step1 score(>240 average),etc are required to be an excellent ortho candidate. There may be some good natured bantering between medicine subspecialists and gunner ortho types rotating through, but such comments are what they are- good natured and with the understanding between both parties that it is a compliment(acknowledgement that he is smart and can do pretty much what he wants).....


ortho guys are almost certainly some of the smartest people in medicine on average....right up there with other surgical subspecialists.

 

[billypilgrim37]

But given the choice of my profession being thought of as different vs inferior by these people, I'd much prefer different than inferior.

That makes sense, though I think you might underestimate the degree to which many non-IM/peds/gen surg subspecialties fall into this bucket. Same thing true to some degree with pm&r, rads, path, rad onc, etc. These things are all very "different" too. Most of these folks appreciate the role of the non-generalist specialist and know they have expertise that is very valuable, even as they would not be so good at, say, the outpatient management of DM2.

 

[notdeadyet]

I find on these discussions that the level of inferiority with which people think other doctors view psychiatrists is really a barometer of how inferior these psychiatrists view themselves.

 

[PrideNeverDie]

I find on these discussions that the level of inferiority with which people think other doctors view psychiatrists is really a barometer of how inferior these psychiatrists view themselves.

spoken like a true psychiatrist haha

 

[notdeadyet]

spoken like a true psychiatrist haha

Which is ironic, as I am about the least psychodynamic person I can think of…

 

[vistaril]

That makes sense, though I think you might underestimate the degree to which many non-IM/peds/gen surg subspecialties fall into this bucket. Same thing true to some degree with pm&r, rads, path, rad onc, etc. These things are all very "different" too. Most of these folks appreciate the role of the non-generalist specialist and know they have expertise that is very valuable, even as they would not be so good at, say, the outpatient management of DM2.

I think with many people though there is a very basic idea that a pm&r physician, who is going around sticking needles in tiny spaces all day and injecting stuff into those tiny spaces under ultrasound, is just more 'medical'....simply because they do procedures.

Pathology I agree with and has stigma in much the same way psych does(although they are often different stigmas). And I don't think it is a coincidence that path and psych are arguably(throw family in too) the least competitive specialties.

I don't think it's so much 'specialist' vs generalist in that case. I think psychiatrists, even though they aren't pcps, have to take on much of the same mindset as a pcp. Depending on circumstances of course(a community psychiatrist would obviously would obviously be doing this a lot more)....

child psychs can probably position themselves as that sort of a specialist moreso than most adult psychiatrists.

 

[Jorje286]

My experience with the whole stigma thing has been a little different. Admittedly, it's still a narrow experience. Most of the stigma I get when I mention I'm interested in psych is from people outside of medicine all together, who have absolutely no clue about most fields. Med students in my class acknowledge that you will not use much of your medical knowledge, but they absolutely do realize that psychiatry has its own special subset of important skills, which some view as even harder than memorizing a textbook. They look at it as something different, on its own, but not necessarily inferior or requiring little skill.

Unfortunately though the truth that psychiatry can be a dumping ground for all of those who couldn't do anything else because they found out they are bad at medical school fuels the negative perception. So part of the stigma is about what kind of psychiatrist you are, rather than about the practice itself.

 

[vistaril]

My experience with the whole stigma thing has been a little different. Admittedly, it's still a narrow experience. Most of the stigma I get when I mention I'm interested in psych is from people outside of medicine all together, who have absolutely no clue about most fields. Med students in my class acknowledge that you will not use much of your medical knowledge, but they absolutely do realize that psychiatry has its own special subset of important skills, which some view as even harder than memorizing a textbook. They look at it as something different, on its own, but not necessarily inferior or requiring little skill.

Unfortunately though the truth that psychiatry can be a dumping ground for all of those who couldn't do anything else because they found out they are bad at medical school fuels the negative perception. So part of the stigma is about what kind of psychiatrist you are, rather than about the practice itself.

I think psychiatry and psychiatrists know what we need to do to gain more respect from physicians and those outside medicine- spend more time with patients.

We are either unwilling to do that or can't do that because of economic realities.(unless you work in academia or for the VA).

When we become seen as people who just tinker with medications/dosages in 5-10 minute meetings where we run through the usual checklists and then adjust dosages and medications(which as we all know arent very good for many/most patients) based on answers to those same checklist questions in that 5-10 minute visit, OF COURSE many people inside and out of health care are going to have a low opinion of us.

I challenge you guys to look up some of the articles written by journalists over the last decade+ on the shift towards the non minimum timed med mgt codes/pt visits only to see the hundreds of comments written beneath the article. They are all the same.....

"he just asked me some basic questions and refilled my meds"

"spent five minutes with me"

"rushing patients in and out as fast as he can"

"didn't have time to talk about any of my real problems"

and on and on. Now you could argue part of this is the fault of these patients. After all, it's they who insist on only spending a 15 dollar copay. But that gets to the heart of the problem- a family medicine physician or internist can do high volume work(in terms of many patients in an hour) because it is understood by most people(rightly or wrongly) that a lot of the decisions to be made depend on lab tests, imaging results, etc....but because psychiatry is so fundamentally different, most patients and physicians understand that it requires a lot more time to really figure things out...time with the patient. But our time with the pt is not valued by insurance companies in that way(which Im not saying is wrong), so what we have is what you get......

Do the math on a psychiatrist working 8 hours a day and seeing only scheduling 16 followups per day. Look up the average reimbursement for all these if they are filed through insurance in your area. Then since you're dealing with insurance, factor in all the overhead needed to process it. And the worker(s). And the rent, electrcity, insurance, water. Now add in billing/collections %. And add in the 5-7% hit you are going to take on copay collections as everyone pays with a card. And add in no shows. And add in declined reimbursements from insurance companies(after all if you are seeing followups for a whole 30 minutes you are going to feel you deserve at least 90213's for most patients, and you can bet the insurance companies are going to be declining some of those and knocking some of those down).......even if you are in a group and manage a 30% overhead rate, that's 30% of collections...NOT billing.

That's why so many psychiatrists need to see 4-5 people in followups per hour rather than 2. Which is the biggest reason why so many patients and other health care professionals view us like they do. The problem is I don't see any way to shift the model to one more favorable.

 

[SteinUmStein]

That's why so many psychiatrists need to see 4-5 people in followups per hour rather than 2. Which is the biggest reason why so many patients and other health care professionals view us like they do. The problem is I don't see any way to shift the model to one more favorable.

This is exactly what I've been hearing on my other rotations. It's discouraging when you begin to realize that the lack of respect for psychiatry is not because we work with mentally ill patients or that our applicants are less competitive, but rather what we are doing (and not doing) on a daily basis as a profession. Of course family docs and internists disrespect psychiatrists when they hear from their patients that they're just tinkering with meds after a 10 minute chat and using little to no evidence based medicine. I can't see a current way around this without taking a huge compensation hit or going into academia and/or the VA.

 

[vistaril]

This is exactly what I've been hearing on my other rotations. It's discouraging when you begin to realize that the lack of respect for psychiatry is not because we work with mentally ill patients or that our applicants are less competitive, but rather what we are doing (and not doing) on a daily basis as a profession. Of course family docs and internists disrespect psychiatrists when they hear from their patients that they're just tinkering with meds after a 10 minute chat and using little to no evidence based medicine. I can't see a current way around this without taking a huge compensation hit or going into academia and/or the VA.

agree 100%.....

I never buy this line of "oh they don't think highly of us because our patients are stigmatized"......maybe this occurs to some degree, but a much bigger problem is patients going back to their internist and saying "oh yeah, he just talked to me for 5 minutes and switched me from the prozac you were prescribing to cymbalta"....how in the world is that internist going to have a positive view of psychiatry if that is our contribution to care? the alternative is to spend some actual time with that pt, get to know them, maybe do some brief cognitive interventions during appts, build a real therapeutic rapport with them. But then you won't be paid like a medical doctor....and money is going to win most every time.

 

[SteinUmStein]

For those of you who chose to go into psychiatry with a clear understanding of the limitations inherent in the field as it currently exists as well as the limitations in what we have to offer patients, what helped you make your decision? Is it enough to have a passion for mental healthcare and to want to work with the mentally ill?

 

[ZBend]

For those of you who chose to go into psychiatry with a clear understanding of the limitations inherent in the field as it currently exists as well as the limitations in what we have to offer patients, what helped you make your decision? Is it enough to have a passion for mental healthcare and to want to work with the mentally ill?

I'd like to hear the answer to this as well. I like spending time with patients so I don't really like the idea of these "5 minute" med checks. I mean, I know you can tailor your practice however you want to spend more time with patients, but the economic realities always seem to rear their ugly head. For all the attendings in private/group practice doing mainly med management, how much time do you usually reserve for each patient and still feel like you're not just rushing them in and out the door? also, how much does insurance typically reimburse for each appointment?

 

[Armadillos]

I think part of it is that these sorts of discussions always seems to have statements like well "you can't spend more than 5 minutes with a patient ... unless you do academics... or the VA ... or certain state funded positions... or some of the Kaiser type jobs... or cash only practice, etc. "

While each one of those things may be a smallish percent of total psychiatrists, if you add all them up I would guess its probably like a third of total psychiatrists, so if your inclined to want to work in one of those situations where you get to spend more time with patients then there are plenty of options.

 

[OldPsychDoc]

I think part of it is that these sorts of discussions always seems to have statements like well "you can't spend more than 5 minutes with a patient ... unless you do academics... or the VA ... or certain state funded positions... or some of the Kaiser type jobs... or cash only practice, etc. "

While each one of those things may be a smallish percent of total psychiatrists, if you add all them up I would guess its probably like a third of total psychiatrists, so if your inclined to want to work in one of those situations where you get to spend more time with patients then there are plenty of options.

That 5 minute stuff is an exaggeration. There are plenty of settings where a psychiatrist can spend more time with patients and still make a good income. The problem is medical students and residents take a narrow view of the field, generalize that what they've heard about is the same everywhere, and then reinforce what they think they know via confirmation bias. When I was doing salaried outpatient for a multispecialty group we were set up for 20 minute revisits and 60 minute intakes--and that was strictly med mgmt, because I really wasn't interested in doing therapy. Too long for some patients, too short for others--all averaged out in the end.

 

[shan564]

To the OP - I'll tell you about my experience, since it sounds like yours might be somewhat similar.

I was always interested in psych because I've always been the confidant-type for a lot of close friends. I've always enjoyed being the guy who can help people work through problems and can communicate effectively with all sorts of different people. On a related note, I was a pretty good salesman in my Circuit City years...

But I also had the misconception that psychiatry is mostly just med management. When I did my psych rotation, that impression changed. It was pretty clear that this field appealed to me more than any other. It just had that "aha" factor.

I always thought that I did well on psych exams because they were easier. I was generally an average-ish student in med school, but I had my highest grade (by far) on my psych clerkship exam. Then I did even better on my psych clinical exam (the clerkship director later told me that it was one of the highest grades that she'd ever seen, but I didn't know this at the time). So my first inclination was just that psych was easier than other subjects.

Then I talked to some of my friends whose grades in psych were just like the others. I have one close friend who aced the surgery exam and barely passed the psych exam, while I aced the psych exam and barely passed the surgery exam. He also had trouble passing the psych clinical exam, and he couldn't believe it when I said that I had some trouble with my 2nd-year OSCEs. So like you, I found that this material just came naturally to me, just like surgery came naturally to my friend. As a side note - he decided not to become a surgeon because of the hours...


Re: 5-minute med checks: I've read a lot about these, and I know that a lot of psychiatrists do it, but I've never seen it myself. I recognize that my experience is VERY limited, but for the benefit of the people with even less experience than me, 5-minute (or 10-minute) med checks are certainly not the norm, and are definitely not necessary in order to sustain a comfortable income.


As far as "limitations inherent in the field" - this is one of the biggest things that attracted me to psychiatry. In other fields, I feel like doctors are always saying "well, the evidence says that option A is the best" or "the American College of Flowchartology says that the next best step in this situation is X." The limitations inherent to psychiatry mean two things:
1. More so than in other fields, psychiatrists have to rely on experience-based clinical judgement rather than the flowchart that tells you what to do.
2. If you're interested in research, we have a LOT to learn to help resolve some of the limitations that are currently considered "inherent" to the field.

As a corollary to #1, I was also attracted to the fact that experienced psychiatrists get so good at communicating with people whose mental status is quite different from the "norm." I think those are the major reasons why people say that psychiatry probably has a higher art:science ratio than other fields of medicine.

 

[Leo Aquarius]

That 5 minute stuff is an exaggeration. There are plenty of settings where a psychiatrist can spend more time with patients and still make a good income. The problem is medical students and residents take a narrow view of the field, generalize that what they've heard about is the same everywhere, and then reinforce what they think they know via confirmation bias. When I was doing salaried outpatient for a multispecialty group we were set up for 20 minute revisits and 60 minute intakes--and that was strictly med mgmt, because I really wasn't interested in doing therapy. Too long for some patients, too short for others--all averaged out in the end.

I really reject this narrow view of the field, which only exists because we let it exist as you point out based on what people hear. Like ugly gossip. It doesn't have to be this way, and I make an effort to not perpetuate it.

I'm determined to give enough time to each patient to really hear their challenges and and know them well, to offer the right therapy and medication for that person. I went into psychiatry to talk to patients, not to manage medications.

 

[notdeadyet]

I really reject this narrow view of the field, which only exists because we let it exist as you point out based on what people hear. Like ugly gossip. It doesn't have to be this way, and I make an effort to not perpetuate it.

Yeah, OPD nailed it there. You hear the 5 minute thing tossed around, but have you ever been in an environment that did it? It's so outside the norm as to be negligible. And if you run across it, just don't take the job.

The norm that I'm seeing (outside of academia) is 20 minutes, with a fair bit of 15. I can't think of anyone I've talked to who does 10 minute checks.

 

[vistaril]

Yeah, OPD nailed it there. You hear the 5 minute thing tossed around, but have you ever been in an environment that did it? It's so outside the norm as to be negligible. And if you run across it, just don't take the job.

The norm that I'm seeing (outside of academia) is 20 minutes, with a fair bit of 15. I can't think of anyone I've talked to who does 10 minute checks.

In the outpt world, quick med checks in private practice are the norm more than the anomoly.

 

[alina_s]

I worked in a rural community mental health clinic and I was scheduled 20 minute appointments, which would have been ok, except that I got 3 appointments/hour x 8 hours =24 patients/day from the very start, with no chart review, phone call, or note writing time. Then the choice was either working a much longer day or cutting the appointments short, and there was still no time to communicate with any other providers in the agency, much less the community. There was another doctor there who wasn't on salary and he saw 4 patients/hour and got double-booked. And there was someone else in the community who was notorious for his 5 minute visits; patients who just wanted their Xanax refills loved him, but he wasn't popular with others.

 

[shan564]

patients who just wanted their Xanax refills loved him

As long as that patient demographic is around, there'll be a group of doctors ready to serve them.

 

[vistaril]

I worked in a rural community mental health clinic and I was scheduled 20 minute appointments, which would have been ok, except that I got 3 appointments/hour x 8 hours =24 patients/day from the very start, with no chart review, phone call, or note writing time. Then the choice was either working a much longer day or cutting the appointments short, and there was still no time to communicate with any other providers in the agency, much less the community. There was another doctor there who wasn't on salary and he saw 4 patients/hour and got double-booked. And there was someone else in the community who was notorious for his 5 minute visits; patients who just wanted their Xanax refills loved him, but he wasn't popular with others.

all pretty typical examples.....3 patients/hr is actually a pretty decent deal. Could have been 4 or 5.

 

[ZBend]

To the OP - I'll tell you about my experience, since it sounds like yours might be somewhat similar.

I was always interested in psych because I've always been the confidant-type for a lot of close friends. I've always enjoyed being the guy who can help people work through problems and can communicate effectively with all sorts of different people. On a related note, I was a pretty good salesman in my Circuit City years...

But I also had the misconception that psychiatry is mostly just med management. When I did my psych rotation, that impression changed. It was pretty clear that this field appealed to me more than any other. It just had that "aha" factor.

I always thought that I did well on psych exams because they were easier. I was generally an average-ish student in med school, but I had my highest grade (by far) on my psych clerkship exam. Then I did even better on my psych clinical exam (the clerkship director later told me that it was one of the highest grades that she'd ever seen, but I didn't know this at the time). So my first inclination was just that psych was easier than other subjects.

Then I talked to some of my friends whose grades in psych were just like the others. I have one close friend who aced the surgery exam and barely passed the psych exam, while I aced the psych exam and barely passed the surgery exam. He also had trouble passing the psych clinical exam, and he couldn't believe it when I said that I had some trouble with my 2nd-year OSCEs. So like you, I found that this material just came naturally to me, just like surgery came naturally to my friend. As a side note - he decided not to become a surgeon because of the hours...


Re: 5-minute med checks: I've read a lot about these, and I know that a lot of psychiatrists do it, but I've never seen it myself. I recognize that my experience is VERY limited, but for the benefit of the people with even less experience than me, 5-minute (or 10-minute) med checks are certainly not the norm, and are definitely not necessary in order to sustain a comfortable income.


As far as "limitations inherent in the field" - this is one of the biggest things that attracted me to psychiatry. In other fields, I feel like doctors are always saying "well, the evidence says that option A is the best" or "the American College of Flowchartology says that the next best step in this situation is X." The limitations inherent to psychiatry mean two things:
1. More so than in other fields, psychiatrists have to rely on experience-based clinical judgement rather than the flowchart that tells you what to do.
2. If you're interested in research, we have a LOT to learn to help resolve some of the limitations that are currently considered "inherent" to the field.

As a corollary to #1, I was also attracted to the fact that experienced psychiatrists get so good at communicating with people whose mental status is quite different from the "norm." I think those are the major reasons why people say that psychiatry probably has a higher art:science ratio than other fields of medicine.

Thanks for your input. I'm still trying to figure out exactly what I want to do. Psychiatry remains high on my list, but every time I consider making it "official," I can't help but feel a slight tinge of regret, like I'm leaving a lot on the table in terms of the wider scope of medicine. It's strange because I don't really want to do general primary care, but I think I'd still miss doing a physical exam or using my stethoscope. I dont know if this is just a med school "being in the thick of it" thing, or if I'll keep feeling like this in like 20 years.

Also, for those of you who do strictly med management: why did you choose that practice modality?

Maybe it's just because many psych patients are "long term projects" that you never see again within the rotation to be able to assess their progress (and see if the medications even work), but sometimes I felt personally unsatisfied with just giving the patient medication. With that being said though, I can't see myself doing psychotherapy simply because I know I'd get emotionally burnt out doing it constantly. I dont know, does anyone else feel like that?

I guess I'm just more of an "instant gratification"-type person, but I like seeing results relatively quickly. Or at the very least, even if it takes awhile, I like being able to work towards actually "curing" things. It's times like that where I feel my personality/feelings really conflict with my interests, because although I find the material in psychiatry fascinating, I get frustrated with the actual practice of it at times.

 

[Leo Aquarius]

No one field will have everything. You sacrifice something no matter what you choose. Look at other factors, such as how important is lifestyle, job market, income, physician satisfaction, malpractice rates, diversity of what you will see, etc.

You may dismiss these now while you carry a med student mentality, but they become HUGE factors once you hit your 30s, start a family, are 20 years into your career, etc.

 

[ZBend]

No one field will have everything. You sacrifice something no matter what you choose. Look at other factors, such as how important is lifestyle, job market, income, physician satisfaction, malpractice rates, diversity of what you will see, etc.

You may dismiss these now while you carry a med student mentality, but they become HUGE factors once you hit your 30s, start a family, are 20 years into your career, etc.

Yeah, I realize what's important to me right now is likely to change down the road, but it's so hard to predict what things will and what wont.

As far as satisfaction goes, I've seen the Medscape report and anecdotal evidence on this board and in my limited real-life encounters seems to support it as well, but I'm curious: what exactly makes psychiatrists seem so satisfied with the field?

I know it'll be different for everyone, but I'm just curious to see some examples.

 

[vistaril]

Yeah, I realize what's important to me right now is likely to change down the road, but it's so hard to predict what things will and what wont.

As far as satisfaction goes, I've seen the Medscape report and anecdotal evidence on this board and in my limited real-life encounters seems to support it as well, but I'm curious: what exactly makes psychiatrists seem so satisfied with the field?

I know it'll be different for everyone, but I'm just curious to see some examples.

satisfaction surveys can be a bit misleading....if you look at the medscape report, for example, although psychiatry was at or near the top the difference between the top and middle was very small.....

And I think a lot of psychiatrists are satisfied because psychiatry is so different than the rest of medicine and they wouldn't like doing more 'mediciney' things....so they are grateful they aren't doing such things. IOW, that is nothing remotely similar that a psychiatrist could be doing. OTOH, a cardiologist isn't going to have the same "well thank god there is this different thing I can do" mindset because there are other similar things they would have easily picked were it not for cardiology.

 

[Armadillos]

satisfaction surveys can be a bit misleading....if you look at the medscape report, for example, although psychiatry was at or near the top the difference between the top and middle was very small.....

And I think a lot of psychiatrists are satisfied because psychiatry is so different than the rest of medicine and they wouldn't like doing more 'mediciney' things....so they are grateful they aren't doing such things. IOW, that is nothing remotely similar that a psychiatrist could be doing. OTOH, a cardiologist isn't going to have the same "well thank god there is this different thing I can do" mindset because there are other similar things they would have easily picked were it not for cardiology.

I know vistaril has observed this among his fellow residents but is this really true other places? Im wondering if this is a "culture" thing that may be different at different medschools. Because of the 4th years I've talked to who just matched psych from my medschool, almost all of them were debating hard between psych and lots of other fields.

(Neuro, IM and Peds being the fields that were most often considered, but the couple AOA people were considering pretty much anything you can think of)

 

[Leo Aquarius]

As a 4th year I was considering Emergency Medicine, Peds, even had a phase considering Neurosurgery.

As I resident, I love pulling out my medicine knowledge working in the hospital, but I'm very glad I don't work like a medicine resident. So I love the reasonable work load that psychiatry offers, and I enjoy bringing in my internal medicine knowledge to my day to day work.

 

[shan564]

As a 4th year I was considering Emergency Medicine, Peds, even had a phase considering Neurosurgery.

As I resident, I love pulling out my medicine knowledge working in the hospital, but I'm very glad I don't work like a medicine resident. So I love the reasonable work load that psychiatry offers, and I enjoy bringing in my internal medicine knowledge to my day to day work.

Yeah, I felt the same way during my 4th year, except for the neurosurgery part. Even if I was that masochistic, they never would have let me in.

But yeah, internal medicine is great as long as you don't have to do it every day.