How many of you wanted to be a psychiatrist while in med school?

[ShrunkenHeads]

And how many of you decided to do it and were pleasantly surprised, or on the flipside, how many wanted to do it - but are now not as happy? What were some of the things that surprised you, be it in a positive or negative way?

As a returning student, and as someone who left a good career job/career finance because he felt it to be empty, how much of an influence does Big Pharma really have? I've gathered enough over the past several months to discern that - to an extent - this is a personal choice some psychiatrists make, though it seems to pervade much of the industry. I do see psych drugs being important in extreme conditions. I also think the medical model works well because many psych patients may have other underlying health problems not seen by other mental health professionals.

How many of you have questioned yourself as to if you were doing the right thing? I suppose that question could be passed along to any doctor, but I mean specifically with prescribing meds, rather than wondering about if you prescribed the right one, and yes I also realize a "good psychiatrist" will not prescribe meds when he doesn't need to.

How many of you have done research, and what were the end results of your research - as in, was it recognized (published) in any fashion and widely implemented by the industry or by fellow psychiatrists?

I still have a couple of years prior to deciding what I want to do. I also realize that this is a world in which people want a quick fix, but it's not something I would give to a person in good conscience.

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[NeoShrink]

Im only going to answer the initial question: No I didn't know id end up in psych. I decided late on clinical rotations.

 

[OldPsychDoc]

I was 95% certain.
It's turned out better than I expected.

 

[F0nzie]

Emergency Medicine, Surgery, Pathology.... That didn't pan out.

 

[milesed]

I was 95% certain.
It's turned out better than I expected.

Same here.

 

[digitlnoize]

I initially went to med school thinking, as a pre-med, that I wanted to be a radiologist. Got to med school and hated anatomy. Started to look into other things.

By 3rd year, I had a short list of things I thought I might like and things I didn't. The maybe list included: IM, FM, EM, Psych, Cardiology, Anes. The "no way" list included: Surgery, OBGYN, Path, and most of the "surgical-like" things like Ophtho, Uro, etc.

Did my 1st psych rotation early in 3rd year and loved it. Pretty much knew then. Did a 2nd rotation later in 3rd year to make sure. Knew for sure by the 1st week of rotation 2.

It wasn't until I started to work on my personal statement that I really started to analyze WHY I liked psych. In retrospect, I should've been into it from the start, but somehow had missed it. Go figure.

 

[sunlioness]

I came in to school thinking infectious disease or pediatrics (though not peds ID). Liked kids okay, couldn't stand their parents. Thought whacky tropical diseases were highly cool. C. diff, not so much. Matched into IM and jumped ship after a year. Spend a bit of time thinking maybe I should have done palliative/hospice. Still could if I really wanted to. Going to try some volunteer work first though, I think.

 

[billypilgrim37]

i was going to be an oncologist or an endocrinologist. then i was going to be an ob/gyn so i could get blown up in an abortion clinic, but all the ob/gyn folks were miserable human beings.

 

[whopper]

I knew I wanted to be a psychiatrist while a psychology major in college.

 

[toothless rufus]

I knew I wanted to be a psychiatrist while a psychology major in college.

I thought I wanted to be a psychologist while a psychology major in college.

While very interested in psychology, (still am) the path to the PhD didn't end up interesting me, or the more circumscribed role (to me) in treatment.

Worked at a PES with a CSU and Detox while in school, and realized I was much more interested in the medical aspects, so went into nursing for a year (psych nurses where I worked as a tech had great schedules (we followed their's too: awesome!)and well, wanted more of a challenge academically and briefly persued biological chemistry with PhD in mind...then realized I liked clinical stuff and wanted to be the "decision maker", so...I knew before med school it was psychiatry.

And I actually also like general mediciney type stuff. But never enough to sway me from psychiatry for long (although neuro was close, but I get my fill of the neuro I find most interesting in psychiatry)

Naively, I also thought I wanted the "experience" of med school, haha.

Arcane and profound knowledge of the human mind and body and all that hubris.

 

[belle54321]

i was going to be an oncologist or an endocrinologist. then i was going to be an ob/gyn so i could get blown up in an abortion clinic, but all the ob/gyn folks were miserable human beings.

Hey watch it! You are talking to one of these miserable people! Though, I am now joining you guys, so maybe there is some truth to what you are saying.

 

[notdeadyet]

I was interested in Emergency Medicine while applying but had a great faculty member keep me with an open mind through the first two years of medical school, and I really enjoyed psych. It was driven home after my third year psych rotation. Any plan for specialty pre-third year is mostly guesswork.

 

[splik]

I wanted to do FM and I still believe in some sort of idealized version of family medicine that probably doesn't really exist, but I hated my FM rotation and left thinking they were all charlatans. I enjoys peds but the training is ridiculously long in my home country (10 years!!) and all the child protection stuff. So really it was neuro or infectious diseases or psych or palliative medicine. I also like public health and occupational medicine. I have decided to combine them altogether and become a tropical neuropsychiatrist! The good thing is psych allows you to train in palliative medicine, and there are opportunities to do public health and occupational medicine (which is mainly mental health nowadays) so im sorted.

I would also say Pharma looms large in internal medicine as well. Is it more of a problem in psychiatry? Yes. That is partly historical. In the 1950s and 60s when the new drugs were coming in psychiatrists did not have any/much experience dealing with the pharmaceutical industry and drug reps compared to other medical specialties meaning they were easier to manipulate, and it became easier for Pharma to worm its way into organized psychiatry. Then it turned out that psychiatric drugs like miltown, valium, haldol, prozac, paxil, seroquel etc. were blockbuster drugs, and by working with psychiatry to expand the scope of psychiatric practice, they would increase their markets. This is true for other blockbuster drugs (the idea that everyone should be on a statin, continuously decreasing the threshold for treating hypertension, the concept of pre-diabetes), the difference is that in psychiatry there are not 'objective' biological markers, but you have to question how 'objective' the biological markers for the conditions mentioned above really are too.

There has certainly been a sea-change in recent year. With Pharma being exposed for burying negative results, with leading researchers shown to have taken large kick-backs from industry, with the failure of many new drugs to show efficacy in phase II or III trials, and with a hyperawareness of the effects of pharma on psychiatry, efforts have been made to clean up psychiatry. Many academic institutions ban reps from grand rounds, or ban pharma-lunches. Journals now require declaring conflicts of interest much more detailed than in the past. Corrupt psychiatrists are exposed in congress or by scientologists. Clinical trials need to be registered so negative trials cannot simply be buried as if they never happened. We have a lot more exposure to reps than our predecessors in the 60s and have a better grasp on handling them and not buying everything they say. Some drug companies (e.g. astrazeneca have stopped doing psychiatric drug research entirely). In the past 10-15 years psychotherapy has become recognized as more important, and psychiatry residencies are putting more emphasis on therapy compared to the 90s. This may be too little too late but there you go.

 

[Scorcher31]

I went in thinking ER, Surgery or Family Medicine. Although I found psychology interesting in college, i hadn't considered psychiatry as a career option. Then I did my psych core for my second rotation and the psychiatrist I worked with did a great job of selling me on all the pluses of the field, gave me a great eval and letter, and it was an all around interesting rotation. I did surgery and hated it, never got to do ED till the end of fourth year, and well family i did enjoy but it was missing most of the pros of a job in psychiatry. So for my 1st fourth year elective I went with my med schools psych program director on the consult service and it was an amazing experience. My 2 psych rotations sold me on the field without a doubt. I couldn't be happier with my decision.

 

[kugel]

And how many of you decided to do it and were pleasantly surprised, or on the flipside, how many wanted to do it - but are now not as happy? What were some of the things that surprised you, be it in a positive or negative way?

As a returning student, and as someone who left a good career job/career finance because he felt it to be empty, how much of an influence does Big Pharma really have? I've gathered enough over the past several months to discern that - to an extent - this is a personal choice some psychiatrists make, though it seems to pervade much of the industry. I do see psych drugs being important in extreme conditions. I also think the medical model works well because many psych patients may have other underlying health problems not seen by other mental health professionals.

How many of you have questioned yourself as to if you were doing the right thing? I suppose that question could be passed along to any doctor, but I mean specifically with prescribing meds, rather than wondering about if you prescribed the right one, and yes I also realize a "good psychiatrist" will not prescribe meds when he doesn't need to.

How many of you have done research, and what were the end results of your research - as in, was it recognized (published) in any fashion and widely implemented by the industry or by fellow psychiatrists?

I still have a couple of years prior to deciding what I want to do. I also realize that this is a world in which people want a quick fix, but it's not something I would give to a person in good conscience.

I'm going to pick up on the "meds or no meds" part of your post, and I'm going to be polemical. No disrespect intended. Your questions are important.

Without even talking about psychotic disorders, to meet DSM criteria for Major Depressive Disorder or Bipolar 1 Disorder or OCD or most Personality Disorders, or ADHD, etc., you have to have significant distress or dysfunction, i.e. pretty miserable.
If someone is miserable, why would I NOT provide the option of meds that may help? Why would anyone think it nobler for me to force him to suffer longer because I happen to think it's somehow better for his soul?
Is there some strong evidence that moderately or severely depressed patients reach remission more often if they are told they must struggle through without meds?

Now that doesn't mean I'm going to feed him Ativan, but I am going to use various tools available, and meds are a primary one. Would you refuse to authorize crutches for someone if the crutches have a 50:50 chance of getting him back to work 50% sooner?

I recommend therapy all the time and talk about how they should be willing to go if they were willing to come see me at the psych ER. In my position, I can't make them go. Many don't have the resources (very little therapy available for the indigent, and when it is some would be spending 4 hrs round-trip by bus).

Refusing to consider meds in most of these cases would be as silly as me telling someone whose marriage is falling apart, "Don't go to marriage counseling. It makes you a whimp. If your marriage survives, you'll be glad you didn't go to counseling."

 

[ZigPig]

I am an MS3, I finished my psychiatry clerkship yesterday. A month ago I decided I wanted to go into psych. Throughout med school I had an open mind, and I had temporary thoughts about radiology, neurology, IM, OB/GYN, but the majority of the time I thought I was going to head into FM... until I unexpectedly enjoyed my psych rotation.

 

[billypilgrim37]

Without even talking about psychotic disorders, to meet DSM criteria for Major Depressive Disorder or Bipolar 1 Disorder or OCD or most Personality Disorders, or ADHD, etc., you have to have significant distress or dysfunction, i.e. pretty miserable. If someone is miserable, why would I NOT provide the option of meds that may help? Why would anyone think it nobler for me to force him to suffer longer because I happen to think it's somehow better for his soul?

"And the crowd goes wild!"

 

[aphenomenon]

I went to med school to become a psychiatrist. Tried to keep an open mind and really liked infectious disease, emergency medicine, and hospice/palliative care. Though I liked all of those clinically, psychiatry is the only specialty where not only do I enjoy the clinical aspects, but I also highly enjoy the content, the academics, the philosophy, the ethics, etc. These can come up in medicine, too, but I feel - for me - they fit more naturally (and have to) with psychiatry.

 

[samwise2]

I came to medical school thinking that I would be a psychiatrist, went away from it for awhile because I was frustrated with current standard of care in field (thought about surgery), and came back to it at the end of third year. I came back because I realized that every field requires patient collaboration with treatment and has limitations. I felt that I could change people's lives in an incredible way by being a psychiatrist, and I always loved the brain best.

Also have finance background. Re: big pharma, some doctors will serve as "consultants" to the companies, but that is by no means necessary, and I have no interest in being a consultant. In my opinion, it's all about your training--if you go to a place for residency where most people do not participate in pharma activities, and where behavioral methods of treatment are also taught well, in the end you will be able to make appropriate decisions to care for your patients, without being influenced by conflicting incentive structures. Also, because you were in business you have the advantage of seeing money-related incentive structures in a different way. For instance, before I listen to a speaker at a conference (esp if it's about pharmacotherapy), I always look in the program for their disclosures so that I can know where they are coming from and how that will affect their arguments.

You might like research because of your technical/spreadsheet background--I know I do. You should check it out in medical school.

Good luck!

 

[Leo Aquarius]

I decided on psychiatry early in my 4th year after trying EM and Radiology. MD student here. Had published research (not in psych), strong LORs, so-so grades, leadership positions. I'm in my 30s and had prior work experience - worked for an international company before medical school, volunteer work too. Interviewed at top places like Harvard, Stanford, UCLA (all 3), UCSD, etc. Ended up at one of those institutions and am very pleased. My scores were decent but not super. Bring to the table real life experience and you will understand people much more and also do better in the match. Research, leadership, all those things help as well.

Psychiatry is a marvelous field as I love people and helping them through their struggles. No other field pays so much attention to the entire biopsychosocial spectrum of a person (which I believe medicine should be about). And if you want to make $300K you totally can. But know yourself, and what turns you on, and do that.

 

[Fifty 3rds]

I decided on psychiatry early in my 4th year after trying EM and Radiology. MD student here. Had published research (not in psych), strong LORs, so-so grades, leadership positions. I'm in my 30s and had prior work experience - worked for an international company before medical school, volunteer work too. Interviewed at top places like Harvard, Stanford, UCLA (all 3), UCSD, etc. Ended up at one of those institutions and am very pleased. My scores were decent but not super. Bring to the table real life experience and you will understand people much more and also do better in the match. Research, leadership, all those things help as well.

Psychiatry is a marvelous field as I love people and helping them through their struggles. No other field pays so much attention to the entire biopsychosocial spectrum of a person (which I believe medicine should be about). And if you want to make $300K you totally can. But know yourself, and what turns you on, and do that.

Leo,

I appreciate your posts. I'm in the process of deciding whether or not I want to go back to school. I'm currently in the transition to consulting, which may entail some international work, and I'm trying to decide what I want to do when this field dries up (2-5 years). I've been seriously considering medicine and dentistry, so at this point my goal is to save up the money to go back to school and not be overwhelmed by the debt.

Psychiatry has a very strong appeal because it relates to so much of what I've seen in the day-to-day grind of the business world. I work in a Health IT sector and it has completely changed how I view things. With a big salary in my current negotiations, the job becomes less about the money and more about the satisfaction. I really want to be connected in this life. I want to help people, I want my existence to be sustainable and I want to have a family. Psychiatry sounds like it meets those requirements in spades. I hope most people are happy with their choices, the money truly does not bring happiness.

 

[Leo Aquarius]

Hello Fifty 3rds,

Isn't it interesting how a high-end job transforms your perspective and illuminates motivations. Like you, I reached a point in my life where I realized there is much more to this road than feeling cushy and going along for the ride. Life had to be about playing a key role in enhancing the lives of others, self challenge, an element of sacrifice through service, and constant learning, and medicine presented a great opportunity for this. In business, I grew tired of the 'it's all about me' attitude. Everyone really pined to climb the corporate ladders to the loss or gain of others. It didn't feel right. I don't think humans are designed to be completely satisfied under these circumstances, or else it's a pseudo-satisfaction and you're only fooling yourself to one day wake up and realize it's too late to leave because you have a family to provide for (one salesman in my former company shared this one day).

Now is your time, a keystone moment to re-cast your net in new waters. Psychiatry is a special field that is very satisfying and interesting. If you have an element of storytelling in you, and enjoy hearing the lives of others, even better. You have time for family. Earning a good living comes with the territory. You even have time for hobbies. It's a real privilege to be entering this field. And remember, business experience will serve you well later on. I'm glad to have made the change now now rather than later. Feel free to PM me if you like.

Godspeed.

 

[Ph4ntomlimb]

I entered med school knowing I was headed for either neurology or psychiatry; I did my undergrad degree in neuroscience so I was already a huge neuronerd!

All it took was some elective time in neurology to rule out that field... Peripheral nerve dysfunction and myopathies hold no interest to me at all, I found out that as soon as an axon descended through the foramen magnum I got bored. Psychiatry is endlessly fascinating, extremely rewarding, and provides a lifestyle my wife appreciates. Also, if you are a neuro junkie like me, there is more than enough research and neuroscience material within the field to keep you busy (the good stuff like affective and social neuroscience )

And of course, psychiatry provides a knowledge base that heightens our understanding of ourselves and the interpersonal relations within our lives. As I write this, my wife is watching the bachelorette, and it makes the show more palatable that I can sit and observe the clash of cluster b traits!

Psych FTW