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You're assuming I want a big house and multiple cars... which I don't.
How the competitiveness of medical specialties should be...
- Thread starter Leo Aquarius
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You're assuming I want a big house and multiple cars... which I don't.
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Sigh.
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Because if I tried to make a living out of my passion painting un-noteworthy pictures, it would no longer be a hobby and I would derive less pleasure.
Half the fun of hobbies is that they are by definition done only for they joy of doing them. When you have to start making a business out of it, you lose that.
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Hahahaha Bronx you liar...
A day in the life of IM: Rush in to work around 6:30am, run up and down stairs (because elevators are just too slow) to find your 8 patients. Print out all patients. Track down each nurse to get a quick report. Grab the chart and read through it for any overnight events. Check the computer - running slow - for vitals and lab results. Scribble those down fast. Time is ticking because you have 30 minutes left before your team expects you to be at the resident's lounge at which point you're expected to know everything about each patient. 8 divided by 30 gives you a little under 4 minutes per patient. "You idiot, you should have arrived by 6:00am but you're too exhausted." You round with your team at 7am. You're 2 minutes late to and they let you know you're 2 minutes late. The team goes through all 20 patients in a rather faster-than-comfortable manner. By 8am you're back on your feet running up and down the stairwells to place orders, make phone calls, write notes, don't forget to place your consults first in 5 different ways because GI consults requires a separate form from Cards remember? Today you're "long call" so you accept new patients up until 10pm. Your pager beeps. New patient. You run up to see the new patient. It takes 45 minutes to talk to family, interview the patient, write orders, talk to nurse. Pager beeps again. New patient. You run down the stairs to see the new patient but, oh no, pager beeps. Please clarify your orders to the pharmacy. "Order of bactrim ds needs ID's approval." Now you have to see a new patient, page ID and talk to them, and see current patients. Wait, it's 10:00am, time for rounds with attending. you look stupid in some strange way. Now it's 11:55am. Lunch time. Should I eat today, or keep working? Maybe that old candy bar from yesterday is still in my pocket. It is! Nice! Keep working.... repeat this regimen until 6pm but include all the hassles of discharging patients too. It's 6pm. Now you just hang out and wait for your pager to beep for new intakes. Pager beeps. New patient. Pager beeps, New patient. It's 9:45pm but you have to finish up your new intake. Ok. done by 10:30pm Now I go home. Be sure to wake up 30 minutes earlier to get to work by 6am tomorrow Idiot. Repeat for 3 years.
A day in the life of a psych resident: Arrive by 8:30am. I'm 10 minutes late, but nobody cares. I round on my 5 patients who are all in the same locked ward and make it to rounds by 9:15am comfortably. Around 10:30am rounds end. Attend to the orders, notes, and the rare consult for those patients. Go to lunch. Eat for an hour. Back around 1pm. Continue my work on the 5 patients. Discharged one. Down to 4. Tomorrow I'll be back to 5 patients. Done by 4:30 or 5pm. Home. Repeat for 1 year. Next year it's outpatient office work and hospital consult work.
Now, you tell me which one is borderline easy?
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Yeah, no s*** when did I say internal medicine is easier than psych? I said IM at a supportive program is BORDERLINE easy. Psych is straight up EASY.
Most days in my life on service (only 4 months this year): Stroll in at 7am, take checkout from overnight coverage. Find out big events, because I don't give a rat's ass that Mr. Johnson got potassium or melatonin. Any codes? No? Ok. Any rapid responses called? No? Ok. Any critical labs or imaging results? No? Ok. Go to conference room. Look at world news and stocks while looking up labs, vitals, current orders. Go see today's discharges and maybe 1-2 other patients with active change in plans. Rounds start. Rounds over. Shoot the **** with the attending. Go eat lunch and make social rounds with other teams. Come back to the conference to check up on my interns and med students. Teach a bit, then send students home. Finish up notes that interns didn't finish (5 minutes/note max). All this time, MAYBE do 1-2 admissions per day since we're capped out by night float, and we don't discharge until afternoon. Don't get me wrong, maybe once a week you get a crashing patient and have to hustle, but that is why I love medicine.
The only semi-tough year was intern year, but even that was largely benign. There's a steep learning curve the first 6 months, but you get the hang of it, and you can cruise the rest of the way. Second and third years are a breeze. The toughest part of my year this year is hitting 100k+ with moonlighting, lol.
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I have to say that Leo's description of psych is a pretty accurate description of what my elective experience is currently like. Except we get 1hour 30 minutes for lunch. 
But it's also interesting...until the entire team starts suspecting that one of the patients may be a PD/malingering.
But it's also interesting...until the entire team starts suspecting that one of the patients may be a PD/malingering.
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PD/Malingering/PNES are all actually quite fun in inpatient locked units.
There's also always an element of hilarity in psychiatry that seems to be missing in IM/neurology. That, to me, was a big factor.
There's also always an element of hilarity in psychiatry that seems to be missing in IM/neurology. That, to me, was a big factor.
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You're right. We do laugh a lot.
Spot on for my medicine months as well as psych residency (except we usually carried 7-8 patients). Hahaha well done!
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Don’t underestimate how much being a physician gives you an identity. I’m not saying early retirement doesn’t sound nice. I would also like to do what I do, just less of it with more disposable income to enjoy my time off, but to start with a boat load of money and find my way to a meaningful life may not have worked out so well. There are times when I hate my job and I can fanaticize about being a trust fund baby who accidentally got switched at birth, but not that often. A quarter of a century ago, I wouldn’t be so sure I would do it the same all over again, but I feel sure now.
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Same here. Except 7-10 patients. Long call till 10, out by 11 hopefully, Cap at 5 new admissions on a long call day, 3 on a regular day. Out by 6:30 on a real normal good day. Q4. Easily cruising past 80hr/week. Told you won't be reporting hours accurately.
I'm getting faster. And good days are starting to get more frequent. But according to bronx I'm at a sweatshop and it's not normal. Idk. But from my n=1, general medicine wards is horrible.
I'm actually curious now just how sweaty my shop is.
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Duty hours duty hours. If there were X number of patients and Y number of Indians to see them, the work is the same no matter how you chop it up. If your department expands its number of chiefs so as to unburden Indians, this doesn’t always help unless a large culture change occurs within the context of added resources.
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@Leo Aquarius
Another way I like to think of the issues you posted:
The RATIO of Money/lifestyle : BS
So, it's not just that a field has tons of cash, but that for a given amount of BS it offers the best return. For instance, Neurosurgery has huge $$$, but terrible lifestyle and tons of BS, so the ratio is terrible.
Psych, obviously, has a GREAT ratio!!
Another way I like to think of the issues you posted:
The RATIO of Money/lifestyle : BS
So, it's not just that a field has tons of cash, but that for a given amount of BS it offers the best return. For instance, Neurosurgery has huge $$$, but terrible lifestyle and tons of BS, so the ratio is terrible.
Psych, obviously, has a GREAT ratio!!
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Yep. A tiny BS ("bull ****" for those who couldn't guess) factor shoots that ratio way up.
So a revised ratio could be:
Value = [(Passion & Interest)(Income)(Lifestyle)(Mobility)(Demand)(Autonomy)] / [(BS)(Malpractice Rate)(Stress)(Hours)(Absorption by corporate entity)(Midlevel or overseas threat)]
So a revised ratio could be:
Value = [(Passion & Interest)(Income)(Lifestyle)(Mobility)(Demand)(Autonomy)] / [(BS)(Malpractice Rate)(Stress)(Hours)(Absorption by corporate entity)(Midlevel or overseas threat)]
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Let's try pathology:
Passion/interest: personal variable (X)
Income: an "all or none" field. you're either making 150k as a clin associate or labcorp organ donor, or you're the boss making 5x that (so, let's say 5 out of 10)
Lifestyle: excellent (10)
Mobility: nonexistent because of the oversaturated job market. (1)
Demand: job market, as above (1)
Autonomy: less than desired (4)
BS: low (2)
Malpractice rate: low (2)
Stress: mid (3)
Hours: good (1)
Managed care: doesn't really apply (1)
Midlevel threat: nonexistent (1)
so:
Value = [x)(5)(10)(1)(1)(4)] / [(2)(2)(3)(1)(1)(1)]
Pathology = 2000x/12 = 166.66667x
Passion/interest: personal variable (X)
Income: an "all or none" field. you're either making 150k as a clin associate or labcorp organ donor, or you're the boss making 5x that (so, let's say 5 out of 10)
Lifestyle: excellent (10)
Mobility: nonexistent because of the oversaturated job market. (1)
Demand: job market, as above (1)
Autonomy: less than desired (4)
BS: low (2)
Malpractice rate: low (2)
Stress: mid (3)
Hours: good (1)
Managed care: doesn't really apply (1)
Midlevel threat: nonexistent (1)
so:
Value = [x)(5)(10)(1)(1)(4)] / [(2)(2)(3)(1)(1)(1)]
Pathology = 2000x/12 = 166.66667x
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Psychiatry
Income: 3
Lifestyle: 10
Mobility: 10
Demand: 10
Autonomy: 9
BS: 4
Malpractice rate: 1
Stress: 3
Hours: 1
Managed care: 9
Midlevel threat: 6
3*10*10*10*9/4*1*3*1*9*6=41.667
Income: 3
Lifestyle: 10
Mobility: 10
Demand: 10
Autonomy: 9
BS: 4
Malpractice rate: 1
Stress: 3
Hours: 1
Managed care: 9
Midlevel threat: 6
3*10*10*10*9/4*1*3*1*9*6=41.667
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No guys. You missed what I was getting at for two of the denominators.
I had to modify my equation to be more accurate to the real world. Absorption by corporate entity and midlevel or overseas threat.
Pathology is facing tremendous absorption by corporate entities, and they are threatened by image reads by foreign doctors similar to sending a radiological read overseas.
Try running numbers reflective of these.
Given over 70% of psychiatry is done in a private clinic setting, your 9 for managed care threat is unrealistic. Id give it a 2 given primary care docs and NPs and PAs would prefer a psychiatrist prescribe and manage psychotropics. Anyway, legislative efforts keep getting shot down.
I had to modify my equation to be more accurate to the real world. Absorption by corporate entity and midlevel or overseas threat.
Pathology is facing tremendous absorption by corporate entities, and they are threatened by image reads by foreign doctors similar to sending a radiological read overseas.
Try running numbers reflective of these.
Given over 70% of psychiatry is done in a private clinic setting, your 9 for managed care threat is unrealistic. Id give it a 2 given primary care docs and NPs and PAs would prefer a psychiatrist prescribe and manage psychotropics. Anyway, legislative efforts keep getting shot down.
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Foreign reads off domestic soil aren't a problem in pathology since we haven't gone digital, nor will we ever due to increased regulatory burden (WSI is a class 3 device!) and the reality that most pathologists are used to their second-world, Leitz ways.
We have plenty of foreign reads on domestic soil, however, given that over half of all pathologists are foreign medical graduates.
The main issue in pathology is the oversupply. What's worse is that the representative organization for pathologists, the CAP, does not acknowledge an oversupply, and instead insists that there is a looming shortage all while supporting their assertions with flawed self-published methodology. Meanwhile many pathologists, usually the FMG stragglers that came from upstate New York programs and other such places, are signing out prostate biopsies for unscrupulous urologists at 10 bucks a pop while the urologist pockets the rest.
I agree that the number I came up with is too high, but it accurately uses your equation. Thus the equation must be modified. There has to be a place there for "power" or "leadership competence" because if that was there, path would go way down, and things like derm would go way up.
We have plenty of foreign reads on domestic soil, however, given that over half of all pathologists are foreign medical graduates.
The main issue in pathology is the oversupply. What's worse is that the representative organization for pathologists, the CAP, does not acknowledge an oversupply, and instead insists that there is a looming shortage all while supporting their assertions with flawed self-published methodology. Meanwhile many pathologists, usually the FMG stragglers that came from upstate New York programs and other such places, are signing out prostate biopsies for unscrupulous urologists at 10 bucks a pop while the urologist pockets the rest.
I agree that the number I came up with is too high, but it accurately uses your equation. Thus the equation must be modified. There has to be a place there for "power" or "leadership competence" because if that was there, path would go way down, and things like derm would go way up.
A
arkenstone
Been through a lot of deliberations the past few years, and a lot of what you guys are discussing has been saturating my mind for years (interesting work vs. lifestyle vs. money, etc.) Too much deliberation, I guess. Good thread, though.
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Thank you for sharing. I hope this community can help you along your journey.
If you come home interested in your pre-med notes, listen to that itch. Medical school is a hundred times more interesting than pre-med material (and much more exhausting too but worth it if you enjoy it). Think about it carefully.
Psychiatry is never boring. A different day brings a different set of patients with very different presentations and interactions. In this field people thank you for changing their lives. Families thank you. A cherished psychiatrist is worth his or her weight in gold. While psychiatrists don't make the biggest dollars in medicine, they make good money, enjoy plenty of time for personal life and are in high demand. Plus, there are ways to make a strong hourly wage if you play your cards well (I mean c'mon, how many people in the general population make $200, $300, or up per hour).
Every day with my patients and coming home to my wife make me thankful to be in psychiatry more and more, especially seeing the crap my colleagues go through in other specialties.
If you come home interested in your pre-med notes, listen to that itch. Medical school is a hundred times more interesting than pre-med material (and much more exhausting too but worth it if you enjoy it). Think about it carefully.
Psychiatry is never boring. A different day brings a different set of patients with very different presentations and interactions. In this field people thank you for changing their lives. Families thank you. A cherished psychiatrist is worth his or her weight in gold. While psychiatrists don't make the biggest dollars in medicine, they make good money, enjoy plenty of time for personal life and are in high demand. Plus, there are ways to make a strong hourly wage if you play your cards well (I mean c'mon, how many people in the general population make $200, $300, or up per hour).
Every day with my patients and coming home to my wife make me thankful to be in psychiatry more and more, especially seeing the crap my colleagues go through in other specialties.
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I totally second Leo above.
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As a 4th year med student I obviously don't have a lot of experience in the field of Psychiatry but what I have experienced so far has been extremely rewarding. I am very very grateful to have chosen this field. As I walk to my car at the end of the day I will typically be seen with a smile on my face as I think about a patient who has inspired me with their story. Best field for me.
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Closest thing to "stress" across a wide array of specialties that I could find (2013 data):
http://img.medscape.com/pi/features/slideshow-slide/lifestyle/2013/public/fig2.jpg
Burnout rates among residents (I found it surprising that Gen Surgery residents only showed a 40% rate here compared to OBGYN's 75%...granted these are rather small response groups):
http://link.springer.com/article/10.1176/appi.ap.28.3.240/lookinside/001.png
The most interesting part is that the 'split' between the least and most burned out specialties isn't all that big, at least if the top data is to be believed...30% at best versus just over 50% for the worst.
Wow.
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Leo,
Could you elaborate on the "never boring" part of your statement? Could you describe to us a day in psychiatrist's life? The last thing I want is to pursue a career that is algorithmic and routine.
Thank you,
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Sure.
An inpatient psychiatrist visits all of the patients in a psychiatry ward of a hospital, spending time evaluating them and talking to nurses and social workers (and residents if it's a teaching hospital) every day. These patients are more ill than your average outpatient. People with severe psychosis, delusions, paranoia, depression, catatonia, etc.
An outpatient psychiatrist manages people who can function at home but who typically carry very fascinating or devastating personal stories and experiences. These can lead to anxiety disorders, mood disorders, mixed pictures, personality disorders, and addictions. You handle all of these as a psychiatrist.
So patient A with a fear that naked trolls are poisoning his food and refusing to eat or drink will require a very different treatment plan than patient B who sits with a blank stare repeating everything you say to her with her arm stuck in a extended position. Then there's your outpatient C who feels anxious and nervous in public, and patient D who has major depression and drinks alcohol every day. Patient E was abused in childhood and was victim of violent trauma who is too scared to hold down any job let alone walk outside. And I haven't even touched the child and adolescent cases.
You get the picture. The typical day varies vastly that I can't really give one. That should be a good sign to you, because it's testimony to the fact that nothing in psychiatry is algorithmic and routine. If you want routine, go talk to a hospitalist or breast surgeon (I shadowed both in medical school.)
An inpatient psychiatrist visits all of the patients in a psychiatry ward of a hospital, spending time evaluating them and talking to nurses and social workers (and residents if it's a teaching hospital) every day. These patients are more ill than your average outpatient. People with severe psychosis, delusions, paranoia, depression, catatonia, etc.
An outpatient psychiatrist manages people who can function at home but who typically carry very fascinating or devastating personal stories and experiences. These can lead to anxiety disorders, mood disorders, mixed pictures, personality disorders, and addictions. You handle all of these as a psychiatrist.
So patient A with a fear that naked trolls are poisoning his food and refusing to eat or drink will require a very different treatment plan than patient B who sits with a blank stare repeating everything you say to her with her arm stuck in a extended position. Then there's your outpatient C who feels anxious and nervous in public, and patient D who has major depression and drinks alcohol every day. Patient E was abused in childhood and was victim of violent trauma who is too scared to hold down any job let alone walk outside. And I haven't even touched the child and adolescent cases.
You get the picture. The typical day varies vastly that I can't really give one. That should be a good sign to you, because it's testimony to the fact that nothing in psychiatry is algorithmic and routine. If you want routine, go talk to a hospitalist or breast surgeon (I shadowed both in medical school.)
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Thank you very much.
From reading about the field, I'm falling in love with psychiatry. I'm now just waiting till third year psych rotation comes to see if I am cut for the field. Until then, I will try to shadow some psychiatrists if time allows and keeping reading and learning about the field, especially from your posts
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Hey Ibn Alnafis MD, what has happened with your quest for surgery? cause I know you have been interested in surgery for a long time...Thank you very much.
From reading about the field, I'm falling in love with psychiatry. I'm now just waiting till third year psych rotation comes to see if I am cut for the field. Until then, I will try to shadow some psychiatrists if time allows and keeping reading and learning about the field, especially from your posts
3 months into med school, I already can see psych or FM in my future... I also plan to shadow a psychiatrist next summer... Med school is a beast!
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Thank you very much.
From reading about the field, I'm falling in love with psychiatry. I'm now just waiting till third year psych rotation comes to see if I am cut for the field. Until then, I will try to shadow some psychiatrists if time allows and keeping reading and learning about the field, especially from your posts
Your welcome. Glad to help.
I know a surgery resident who switched into psychiatry. If you hesitate going into surgery, then don't go into it was his bottom line to others.
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