May 8, 2013
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So here I am, in a very lucky place, really. I've found a specialty I really love. I feel compelled to help the patients in this field and I'm fascinated by the science behind it. It gives me a sense of motivation unlike anything else. In addition to this, it happens to be a field that offers a great lifestyle, huge demand, and awesome pay. I love psychiatry. No matter how many times I try to lie to myself, I love it. I should feel very fortunate that I've found something that I really want to pursue, but I feel like something is wrong with me.

I'm not going to beat around the bush. For some reason, I seem to care too much about what others will think. For some reason I care that lay people may not know that psychiatrists are physicians. For some reason I care that people won't know the differences between a psychiatrist and psychologist. All these little, petty things, for some reason, get to me.I know that these are stupid, superficial, and even insecure things. I am fully aware of this. I know I may get judgmental thoughts for saying these things, but I am just being honest with myself so maybe I can get through it. I'm also aware that if/when I begin practicing psychiatry, I may not care about these things anymore. However, in the meantime, I was just wondering if anyone here has felt the same way. If so, how did you get over it? Is this perception that I have of how others view psychiatrists even valid?

Thank you guys. As a regular browser, I can definitely say that the psychiatry forum is the coolest one on SDN.
 

MacDonaldTriad

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I will not going to tell you that how we are viewed by our peers isn't important. It comes down to how you define "peers". So how do you view you psychiatry mentors? These are the people you will be working with. I'm guessing some psychiatry mentor impressed you in some way. If you really look at what some of the other specialties do, a lot of it lacks glamor.
 

TexasPhysician

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You will never escape stigma from any medical field.

I have good friends in a variety of fields, and we all jokingly rag on each other over these stigmas.

Just some examples:
To peds: How many well children did you help today?

To EM: If you keep asking for help, admin will realize that you don't do anything.

To derm: where do you keep the coin in your white coat to help you decide - steroid or anti-fungal?

I find the stigmas quite hilarious, but when needed, we all appreciate the expertise each of us brings to the table.
 

northernpsy

Psychiatrist. No, I'm not analyzing you
Jan 20, 2016
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No judgement from me. Totally a normal human reaction to care about what others think even if we know it shouldn't matter.

If it helps, here's what I think about this kind of thing:
Just speaking as an attending physician, specialty aside, I truly feel that being a doctor in general doesn't mean as much as it used to. In the old days, when doctors had more autonomy, people in general society had more respect for authority, and people tended to see the same doctors over many years, I think there was a lot more prestige in being a doctor than there is nowadays.
In the modern system, a lot of patients don't even actually understand who is a doctor and who isn't. I very frequently see people admitted to my unit who think the NP or PA that they see for their primary care checkups is their "doctor" and will even call the PA "Dr. So-and-So". On the flip side, as a female physician, I have had patients who thought I was their nurse even after I specifically introduced myself to them as Dr. Northernpsy.
Even if patients understand that you really are a doctor, that doesn't mean they will be impressed. A lot of laypeople don't like or trust doctors very much nowadays. They think we're greedy, we don't spend enough time with them, we're "pharma shills" who are paid off by big companies to push drugs (except for when we're being sadistic by NOT prescribing controlled substances), we don't know as much as Dr. Google. Pediatricians callously poison kids with "toxic" vaccines. OBs are selfish enough to slice laboring women open with unneeded c-sections just because they're tired of waiting for the kid to pop out and want to go play golf.

Just take a look at some of the alternative medicine, anti-vaccine, and home birth websites out there and you'll see just how alienated a significant portion of society nowadays feels from conventional medicine.
Yes, the hardcore anti-vaxxers and home birthers are a bit on the fringe of society, but there are a lot of people who sympathize with these ideas to some extent...especially with the way social media has created an echo chamber for fringe beliefs. I have seen more than one Facebook friend, including my relative who is a NURSE (!!!), sharing things on Facebook about how doctors are intentionally suppressing the truth about the cure for cancer (spoiler alert: this "cure" is either some scammy natural supplement regimen or just good old fashioned marijuana, depending on who you ask).

So, long story short, I would not count on getting a lot of admiration or respect from others regardless of what specialty you do. No matter what specialty you go into, there will be some people who respect what you do and admire you for doing it, and some who look down on you for it. This is as true of psychiatry as it is for all the other specialties. Yes, I have run into people who think psychiatry is BS and that I am a weirdo for being interested in mental illness, but I've also met people who think it is important, who have had personal experience with mental illness and suicide, and think my job is very interesting.

Oh yes, and if you really miss being a "real doctor", check out Psychosomatic Medicine as a fellowship option. :)
 
Mar 24, 2014
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I hear ya. My own mother still doesn't know the difference between a psychologist and a psychiatrist. :arghh:
For me the important thing is that I recognize the value that I bring and the importance of the professional mantle that I have adopted. I try not to compare myself to other professionals because as I have heard said "comparison is the thief of joy". Each day I try to be the best psychologist that I can for my patients and try not to waste too much time on irrational and unproductive thought processes that are often tied into my own maladptive core beliefs. It is not just our patients that can benefit from a little CBT. :) Also, like I tell my patients, if you don't respect yourself, others won't respect you. The thinking flaw that many of us have is that if others respect us more then we'll feel better about ourselves when it is actually the other way around.
 

st2205

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I can't offer you anything that would help you deal with stigma now. However, I can say that, regardless of what specialty you choose, there will come a point after you've been beat down enough about training that you're honestly going to stop giving any kind of care to what anyone, no matter how close, thinks of your profession.
 

twright

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I've actually never personally encountered this stigma, either at the institution where I trained or where I am now. When interacting with other specialties they always seem to be thankful we are around. And I've never heard of someone being denigrated for going into psych.
 
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hebel

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I completely understand those feelings, and felt them so strongly when I picked psychiatry as an M4. I've been an intern for only a few months now, but those feelings are almost gone completely.

I think if you like what you do and take pride in the work you're accomplishing, others opinions of it and you quickly fade to the background.
 

bonedrone14

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Oct 11, 2014
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Current intern here also. I felt exactly the way you're describing and was mad at myself for it. I'd told people for years I was doing ortho and then to switch to the "soft science" field of psych made me embarrassed. Well, as others have said, the more you go through training, the less you care what others think. Talking to my friends who picked other fields and comparing their lives to mine, they can have their prestige. I get to go to work and enjoy what I do rather than complain about my patients and my upper levels/attendings being passive aggressive all day. If you enjoy it then I think I've learned that's what really matters. The older you get the less you care what people think anyway. You just have to decide if your perceived lack of prestige is a deal breaker.
 

bedevilled ben

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Don't apologize for how you feel! Just recognizing and putting a name to the feelings is an important part of "mindfulness," being aware of how you're feeling and why you're feeling it. Being able to analyze your own motivations for your feelings is an important step to understanding the motivations of others, which is a big part of psychiatry in general. Everybody has insecurities, but admitting them and recognizing the impact they can have on our decision-making is really tough sometimes.

Personally I can relate very well to what you're feeling, I was torn between Psych and IM right up until submitting my ERAS applications. I was lucky enough to have a great mentor for my psych rotations, and he told me to "pick the rotation where you came in early and stayed late" (which of course was psych). But even as an intern on an inpatient floor, there are still plenty of medical problems that need addressing, and one of your roles as an inpatient psychiatrist is deciding which medical problems need escalating to consults or transfers. You're a physician first and a psychiatrist second. There can be as much or as little of medicine in your future practice as you would like.
 

Information Underload

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When you have a full patient load and are struggling to return phone calls and get your documentation done in a reasonable hour to get home to your wife and kids, prestige matters a lot less. Better like what you are doing and better care for your patients, even if they are anti-vaccers and anti-meds. Hey, I am a sinner, and I am not a perfect husband or dad. Humility in life makes the occasional thank you all that more meaningful. Meet people where they are is the best advice I got in training. And choose an employer that values you and your autonomy or work for yourself.
 
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Current intern here also. I felt exactly the way you're describing and was mad at myself for it. I'd told people for years I was doing ortho and then to switch to the "soft science" field of psych made me embarrassed. Well, as others have said, the more you go through training, the less you care what others think. Talking to my friends who picked other fields and comparing their lives to mine, they can have their prestige. I get to go to work and enjoy what I do rather than complain about my patients and my upper levels/attendings being passive aggressive all day. If you enjoy it then I think I've learned that's what really matters. The older you get the less you care what people think anyway. You just have to decide if your perceived lack of prestige is a deal breaker.
Considering the types of folks that seem to go into ortho, I have no idea why you would need to apologize for choosing psych. Just cause they can bench press more, I mean really. :p
 
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bonedrone14

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Considering the types of folks that seem to go into ortho, I have no idea why you would need to apologize for choosing psych. Just cause they can bench press more, I mean really. :p
I figure now maybe we can get to work on stealing their thunder one day as far as putting up some big weight...
 
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bonedrone14

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Also, to the op...I've been really pleasantly surprised at how much medicine is still a part of my daily life on psych. I get to do some detective work and start some work ups, find some interesting things, and then turf to medicine or whoever else I'd appropriate once you hit the tedious micromanaging parts lol.
 
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I think it's something you quickly forget about once you start residency. I also used to worry about those things as a med student. Few people, it seems, even know what a psychiatrist does. When I told my mother about my interest in practicing psychiatry, her response was "But I thought you were going to medical school!" Lay people confuse psychiatrists with pyschologists all the time... you'll get used to it. (I wonder if there are ophthalmologists who complain about being called optometrists?) Then there are those who know a bit about psychiatry and yet are opposed to what we do. I remember trying to search online for videos about psychiatry to learn more about it, and almost everything I found was anti-psychiatry. Once you start treating patients, however, and see them get better and have their families thank you, and doctors in other specialties appreciate your work, you quickly forget what some people may think of you.
 
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Blitz2006

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Like I've said for the past few months, resident told me when I was in medical school, "Picking a speciality is like buying a stock, you want to buy low and sell high".

Well you're buying "low" in Psych, but given the last 2 years stats, I think the future of psych is bright, and I expect it to be a moderatively competitive/"respected" speciality in 10 years. And you'll be the last one laughing at everyone else.

But like everyone else is saying, just be awesome at what you do and you'll enjoy it.

Sure, there may be stigma, but guess what, when you finish residency you're gonna be cherry picking your job (Unlike a lot of other specialities). You're gonna be making pretty decent money compared to other specialities, and you're going to be entering a speciality that is ultra flexaible/diverse. You can throughout your career switch back and forth from outpatient/inpatient/consults/jails/methadone-suboxone clinic/child psych, etc. I mean, psych is one of the few (only?) specialities where you can treat kids and adults the same day if you want...(assuming you do Child psych fellowship).

And if you're really missing out on "real medicine", then do a fellowship in CL/Neuropsych/Sleep, and if you miss using your hands, go for Interventional Pain Management. If you enjoy doing procedures, enter the cutting edge world of brain stimulation (ECT/rTMS/tDCS/VNS)....

A lot of scope for psych.
 
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Gavanshir

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I felt the stigma as a medical student and I feel it now as a PGY-1 resident. I haven't yet found an effective and lasting method of blocking it out. It doesn't help that I've started my program with 2 months of inpatient psych unit with 99% involuntary commits who constantly complain of the side effects of the medications that they've been on for years. Often times in trying to convince my patients of the benefits of taking the medications, I do question my own certainty in regards to the benefits and wonder if the patient might be better off without them. Seeing patients not improve is no fun but it happens a lot, more often than those miracelous improvements. Dealing with these types of patients on a daily basis can wear you down and make it hard to imagine how it would be possible for psychiatrists to have the same level of respect as other physicians in the community. I do still think that this time last year I had the chance to be in a field where I would be respected but now I'm in a field where I have to change people's pre-concenived minds about me and my career.

I've considered reapplying again to IM or something, but then I look at all the hobbies that I'm able to do as an intern, which is an absolute impossibility in pretty much every other residency. I have so much free time, it's great. It's really the one thing that keeps me going these days. I like psych, it's interesting and stimulating for me, but it comes too easy and the daily pace is too slow. I don't see the challenge in it which is why my FMG co-residents with huge cultural and language boundaries can for the most part do the same job as I do, heck even psychologists and social workers are able to do 80-90% of my job. Sure there is a degree of pride that I put into my work and like to believe that my patients are getting better care because of how much attention I give them, the questions that I ask and the notes that I write, but in the end the outcomes are generally the same. Poor.
 

northernpsy

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Jan 20, 2016
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Seeing patients not improve is no fun but it happens a lot, more often than those miracelous improvements.
I think internal medicine and other "respectable" fields have their own versions of these kinds of discouraging situations.
I always read the local newspaper obituaries for the communities where I did my internal medicine rotations as a med student and intern, and I can remember every time I was done with an inpatient IM rotation I would see so many obituaries for patients we had taken care of on IM over the weeks and months that followed. It was amazing how many people died - many of them weren't even all that sick when I saw them. They were just elderly folks with lots of medical issues and hence prone to dying regardless of what we did for them. I can also remember the morally ambiguous ICU admissions such as being obliged to give aggressive care to a frail demented nursing home patient where the attending intensivist was like, "Why didn't they make her DNR? We're torturing this poor patient."

Between those kinds of morally ambiguous cases, the frequent fliers (CHF exacerbations and such), and the deaths, I didn't really feel like our efforts on the IM service were actually curing very many people.
Still, I do hear what you're saying about getting discouraged over the patients who don't get better. I do think that it can be frustrating to deal with the limitations of what society is willing to do for mentally ill people as well as the limitations of what the current science can tell us about how to help certain people.
 

Nasrudin

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I understand.

But you need to embrace your inner G. It's your life. It's you the people who roll with you no matter what against the world. Ride or die.

If they're not going to help you bury the body. Or hide out from the loan sharks. Or go on the run from the po-po. Then who are they really to you.

We could totally learn from our patients.

We're doctors man. And among those, we're wizards amongst muggles. Who's ignorance of our art is astounding.

To your patient's you're quite often the person who knows them better than anyone. And everyone of our encounters is a universe unto itself.

We're not just repairing a nameless, faceless ACL.

Sure. We're languishing in the complexities of human consciousness, while other, more simple, direct fields advance. So what... we've got the guts to do this.
 

Gavanshir

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I understand.

But you need to embrace your inner G. It's your life. It's you the people who roll with you no matter what against the world. Ride or die.

If they're not going to help you bury the body. Or hide out from the loan sharks. Or go on the run from the po-po. Then who are they really to you.

We could totally learn from our patients.

We're doctors man. And among those, we're wizards amongst muggles. Who's ignorance of our art is astounding.

To your patient's you're quite often the person who knows them better than anyone. And everyone of our encounters is a universe unto itself.

We're not just repairing a nameless, faceless ACL.

Sure. We're languishing in the complexities of human consciousness, while other, more simple, direct fields advance. So what... we've got the guts to do this.
Lol, that made my morning.
 
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northernpsy

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Jan 20, 2016
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Can we sticky this thread so that any time someone brings up concerns about this it will be easy to point to Nasrudin's post?

I understand.

But you need to embrace your inner G. It's your life. It's you the people who roll with you no matter what against the world. Ride or die.

If they're not going to help you bury the body. Or hide out from the loan sharks. Or go on the run from the po-po. Then who are they really to you.

We could totally learn from our patients.

We're doctors man. And among those, we're wizards amongst muggles. Who's ignorance of our art is astounding.

To your patient's you're quite often the person who knows them better than anyone. And everyone of our encounters is a universe unto itself.

We're not just repairing a nameless, faceless ACL.

Sure. We're languishing in the complexities of human consciousness, while other, more simple, direct fields advance. So what... we've got the guts to do this.
 

Shikima

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The stigma is quite real in terms of how reimbursement is made with insurance companies and how we have a harder time with medical complexity for the higher billing levels.
 
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Blitz2006

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I felt the stigma as a medical student and I feel it now as a PGY-1 resident. I haven't yet found an effective and lasting method of blocking it out. It doesn't help that I've started my program with 2 months of inpatient psych unit with 99% involuntary commits who constantly complain of the side effects of the medications that they've been on for years. Often times in trying to convince my patients of the benefits of taking the medications, I do question my own certainty in regards to the benefits and wonder if the patient might be better off without them. Seeing patients not improve is no fun but it happens a lot, more often than those miracelous improvements. Dealing with these types of patients on a daily basis can wear you down and make it hard to imagine how it would be possible for psychiatrists to have the same level of respect as other physicians in the community. I do still think that this time last year I had the chance to be in a field where I would be respected but now I'm in a field where I have to change people's pre-concenived minds about me and my career.

I've considered reapplying again to IM or something, but then I look at all the hobbies that I'm able to do as an intern, which is an absolute impossibility in pretty much every other residency. I have so much free time, it's great. It's really the one thing that keeps me going these days. I like psych, it's interesting and stimulating for me, but it comes too easy and the daily pace is too slow. I don't see the challenge in it which is why my FMG co-residents with huge cultural and language boundaries can for the most part do the same job as I do, heck even psychologists and social workers are able to do 80-90% of my job. Sure there is a degree of pride that I put into my work and like to believe that my patients are getting better care because of how much attention I give them, the questions that I ask and the notes that I write, but in the end the outcomes are generally the same. Poor.
You raise some valid points, some of which I agree with.

However, with regards to psych meds. I honestly think that while the effect size of certain psych meds is relatively low, (0.3-0.4), I think in the "real" world its even lower because I think many psychiatrists don't know how to prescribe properly, and therefore, efficacy is much lower. If psychiatrists on the whole knew their psychopharm much better, I think we would be seeing better "results". This is just based on my observation of admissions of psych patients coming from the community, and some of the 'interesting' medication regimens I come across.

I agree with the free time (particularly on inpatient), but the beauty about psych is that you can also work like a maniac if you want, and there is enough work to go around. For example, I know attendings personally that start at 6:30am (ECT x 2 hours), then round on inpatients from 8:30am-11:30am and then do pp/OPD from 1pm to 6pm. Solid 12 hour day, 30 minutes lunch. Other attendings I know do CL/ER psych from 8-5, then PP at night from 6-10pm. And right now as a resident, with the free time, I try to use it by reading/doing research. You can never read too much in Psych....

You're right about psychologists/social workers being able to a lot of our "work". But this is why I especially like brain stimulation/neuropsych. Psychologists/social workers can't do ECT/rTMS/VNS or treat/evaluate different types of dementia. I'm biased, because I love psychopharm, but I personally think also that some psychiatrists don't know their psychopharm inside out as they should. I think all psychiatrists should know half-lives/receptors of all our drugs, inside out. There aren't that many psych drugs commonly prescribed (25-30?). 4 years of residency we should try our best to master all of them. And as I said earlier in this thread/like a broken record, if you feel compromised in psych on your medical knowledge, then you can always go into CL/Sleep/Pain/Geriatric...

and with regards to IM, I mean, I did 4 months of floor medicine in my intern year. I had so many bounce backs for CHF/COPD exacerbation which was spent on me re-ordering prednisone tapers or pushing lasix up and down. I'm not trying to belittle our IM colleagues, I'm just trying to show that every specialty has repetition/frustration. Its like General Surgery who get consulted for every "obstruction" and it turns out to be just benign constipation. My friend is on cardiology consults, and he said 70% of 'chest pain' consults end of being GERD....How do you think cardiologists feel about having done "all that training" to be consulted and recommend some TUMS?

Just some food for thought.
 
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TheOther

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Like I've said for the past few months, resident told me when I was in medical school, "Picking a speciality is like buying a stock, you want to buy low and sell high".

Well you're buying "low" in Psych, but given the last 2 years stats, I think the future of psych is bright, and I expect it to be a moderatively competitive/"respected" speciality in 10 years. And you'll be the last one laughing at everyone else.

But like everyone else is saying, just be awesome at what you do and you'll enjoy it.

Sure, there may be stigma, but guess what, when you finish residency you're gonna be cherry picking your job (Unlike a lot of other specialities). You're gonna be making pretty decent money compared to other specialities, and you're going to be entering a speciality that is ultra flexaible/diverse. You can throughout your career switch back and forth from outpatient/inpatient/consults/jails/methadone-suboxone clinic/child psych, etc. I mean, psych is one of the few (only?) specialities where you can treat kids and adults the same day if you want...(assuming you do Child psych fellowship).

And if you're really missing out on "real medicine", then do a fellowship in CL/Neuropsych/Sleep, and if you miss using your hands, go for Interventional Pain Management. If you enjoy doing procedures, enter the cutting edge world of brain stimulation (ECT/rTMS/tDCS/VNS)....

A lot of scope for psych.
Thanks for the insight as far as flexibility/diversity. Really brings psych up my list of potential fields -- especially knowing that I could also work in an academic setting and do research too.
 

nancysinatra

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Do six months of medicine as an intern to see what living as a "real" doctor actually means if its not the field you love.
I loved my medicine months. My 3.5 years of psychiatry training was a cruel joke by comparison. We cured no one. We fixed nothing. Now, I realize, internal medicine has its problems. But I'm so glad I was required by the ACGME to do those 6 months off service, because that's where I learned that I wanted to leave psych - and I'm so glad I finally did! So yeah, go ahead and recommend "6 months of internal medicine" for anyone "considering" psychiatry...
 

northernpsy

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Jan 20, 2016
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I loved my medicine months. My 3.5 years of psychiatry training was a cruel joke by comparison. We cured no one. We fixed nothing. Now, I realize, internal medicine has its problems. But I'm so glad I was required by the ACGME to do those 6 months off service, because that's where I learned that I wanted to leave psych - and I'm so glad I finally did! So yeah, go ahead and recommend "6 months of internal medicine" for anyone "considering" psychiatry...
I am glad that you were able to move on to something else if Psych wasn't your liking. What did you end up doing? Did you go back to an IM residency or do a fellowship like pain/sleep? I am curious just because it seems really rare for attendings to switch specialties compared to residents switching.
 

nancysinatra

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I am glad that you were able to move on to something else if Psych wasn't your liking. What did you end up doing? Did you go back to an IM residency or do a fellowship like pain/sleep? I am curious just because it seems really rare for attendings to switch specialties compared to residents switching.
I wish I could say - but I'm not ready to. I'm worried that my identity will be apparent if I say what field I have migrated to, because, while there are a million of us working in psychiatry, when you cross-correlate that with other fields, well, the numbers quickly become tiny. I'm not doing pain or sleep medicine. (For one thing, I hate dealing with either insomnia or chronic pain! I hate chronic anything! I like dealing only with acute, concrete, time limited conditions that can be handled procedurally, with minimal ambiguity, and most of all, with minimal need for social work type interventions such as obtaining collateral information. So basically, anthrax, necrotizing fasciitis, the like... Another thing is, I only like dealing with a motivated population of patients. As long as those needs are met, I'm reasonably happy at work.) What I'm doing now requires complete retraining, but it isn't on the order of, say, orthopedic surgery. I feel like I'm now doing something useful and meaningful with my time, and my life. I didn't feel that way when all I did was ask patients how they feel about this or that. I mean, seriously, who cares how people feel? What matters is whether your body is working or not, right? That's going to determine how long you live.
 
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nancysinatra

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You will never escape stigma from any medical field.

I have good friends in a variety of fields, and we all jokingly rag on each other over these stigmas.

Just some examples:
To peds: How many well children did you help today?

To EM: If you keep asking for help, admin will realize that you don't do anything.

To derm: where do you keep the coin in your white coat to help you decide - steroid or anti-fungal?

I find the stigmas quite hilarious, but when needed, we all appreciate the expertise each of us brings to the table.
These are examples of inter-specialty teasing, but that's not the same as stigma. Nationwide, and worldwide, there is a particular form of shame and embarrassment associated with mental illness, and that is the origin of "stigma" in this context. This type of stigma is not found in most medical conditions. So, for example, the pediatrician who sees only well children may be wasting their time, but they are not dealing with a "stigmatized" patient population.
 

TexasPhysician

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These are examples of inter-specialty teasing, but that's not the same as stigma. Nationwide, and worldwide, there is a particular form of shame and embarrassment associated with mental illness, and that is the origin of "stigma" in this context. This type of stigma is not found in most medical conditions. So, for example, the pediatrician who sees only well children may be wasting their time, but they are not dealing with a "stigmatized" patient population.
Maybe I misread the OP, but I understood the concern as being about a psychiatrist's lack of respect or stigma, not the patient population.

I have patients that think a radiologist is nothing more than a technician. Educated patients even tell me they steer their kids away from peds because of its low-paying stigma.

While psychiatrists may see more stigma than most fields by the general population, I find that other medical specialties highly appreciate my availability. Knowledgeable patients admit that I chose the best medical field, I agree.
 
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I wish I could say - but I'm not ready to. I'm worried that my identity will be apparent if I say what field I have migrated to, because, while there are a million of us working in psychiatry, when you cross-correlate that with other fields, well, the numbers quickly become tiny. I'm not doing pain or sleep medicine. (For one thing, I hate dealing with either insomnia or chronic pain! I hate chronic anything! I like dealing only with acute, concrete, time limited conditions that can be handled procedurally, with minimal ambiguity, and most of all, with minimal need for social work type interventions such as obtaining collateral information. So basically, anthrax, necrotizing fasciitis, the like... Another thing is, I only like dealing with a motivated population of patients. As long as those needs are met, I'm reasonably happy at work.) What I'm doing now requires complete retraining, but it isn't on the order of, say, orthopedic surgery. I feel like I'm now doing something useful and meaningful with my time, and my life. I didn't feel that way when all I did was ask patients how they feel about this or that. I mean, seriously, who cares how people feel? What matters is whether your body is working or not, right? That's going to determine how long you live.
On a related note, someone with a solid understanding of behavioral principles would say it doesn't matter how you feel, what matters is what you do. Besides patients hate the overuse of the "...and how did that make you feel?" line anyway. :rolleyes: Whenever they tell me about ineffective therapists, that is one line they key in on. The other sign of bad therapists is "they never said anything, they just wrote down notes on a pad." If a psychiatry resident does either of those too much, they will get no respect and rightly should be made fun of and ridiculed. :p
 
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northernpsy

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I wish I could say - but I'm not ready to. I'm worried that my identity will be apparent if I say what field I have migrated to, because, while there are a million of us working in psychiatry, when you cross-correlate that with other fields, well, the numbers quickly become tiny.
Oh ok. I try to be vague enough with what I post here to prevent people from identifying me, so I understand!

I like dealing only with acute, concrete, time limited conditions that can be handled procedurally, with minimal ambiguity, and most of all, with minimal need for social work type interventions such as obtaining collateral information. So basically, anthrax, necrotizing fasciitis, the like... Another thing is, I only like dealing with a motivated population of patients. As long as those needs are met, I'm reasonably happy at work.)
I would have to agree that someone with those preferences probably isn't someone who is destined to be happy in Psych. :) Back when I was a med student, I definitely could see the appeal in specialties such as Gen Surg of being able to actually cure people and then move on rather than spending many years managing chronic illnesses as so many non-surgical fields do.
I didn't LOVE procedural/surgical work enough to do it myself, but I totally get why it appeals to people.

What I'm doing now requires complete retraining, but it isn't on the order of, say, orthopedic surgery. I feel like I'm now doing something useful and meaningful with my time, and my life.
Wow, that is pretty unusual, to re-do residency, but I think it's a brave choice and it sounds like it definitely was the right choice in your situation. I think it is pretty unrealistic to expect everyone to pick the right specialty on their first try, so I wish it was easier to re-train in a different specialty than it is. Over the course of a 30-40 year career, no doubt a lot of people end up having different interests and priorities even if they do initially really love their specialty.

How did that work logistically? Did you have to get new letters of recommendation? Did you have to set up shadowing or rotations in your chosen specialty? Did programs give you a hard time for having "used up your funding" on your first residency or question how sincere you were about switching? I would imagine that some residencies might be concerned that someone who has already graduated from one residency might be a flight risk if they don't really need to do the second residency.

I know that switching INTO Psych is pretty easy, but I haven't heard that much from people like you who are switching out and it makes me curious about how that even works.
 

Salpingo

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However, in the meantime, I was just wondering if anyone here has felt the same way. If so, how did you get over it? Is this perception that I have of how others view psychiatrists even valid?
That's certainly an issue. The best way to get over it is to talk to people who have been helped by psychiatrists, which includes family members and other providers taking care of the patient. I used to be (and still am) a little embarrassed to share what I do in social situations. But then I'll find someone who had a father whose life was turned around by their psychiatrist, something I would never have known unless I spoke up. Also, every reasonable person in the hospital, from nursing to chief of a department, recognizes that a truly excellent mental health professional is worth their weight in gold.

The next step is actively looking for those psychiatrists/therapists in your department, and keeping an image of them in mind every time you start to doubt yourself, and give yourself something to aspire to.
 
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Salpingo

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Maybe I misread the OP, but I understood the concern as being about a psychiatrist's lack of respect or stigma, not the patient population.
We're identified with our patient population in a unique way. For instance, people who don't think that mental illness is "real", or think its some instrument to keep the masses in check, won't see us as "real." Even if people confuse the role of an ophthalmologist or radiologist, they still recognize vision loss and X-rays as something substantial. That changes when people witness serious mental illness, but thats the nature of stigma: people often don't talk about it, or are ashamed to acknowledge it.

I wish I could say - but I'm not ready to. I'm worried that my identity will be apparent if I say what field I have migrated to, because, while there are a million of us working in psychiatry, when you cross-correlate that with other fields, well, the numbers quickly become tiny. I'm not doing pain or sleep medicine. (For one thing, I hate dealing with either insomnia or chronic pain! I hate chronic anything! I like dealing only with acute, concrete, time limited conditions that can be handled procedurally, with minimal ambiguity, and most of all, with minimal need for social work type interventions such as obtaining collateral information. So basically, anthrax, necrotizing fasciitis, the like... Another thing is, I only like dealing with a motivated population of patients. As long as those needs are met, I'm reasonably happy at work.) What I'm doing now requires complete retraining, but it isn't on the order of, say, orthopedic surgery. I feel like I'm now doing something useful and meaningful with my time, and my life. I didn't feel that way when all I did was ask patients how they feel about this or that. I mean, seriously, who cares how people feel? What matters is whether your body is working or not, right? That's going to determine how long you live.
You're very lucky to have had such a good medicine experience. Personally, I never felt more knowledgable than the last day of my medicine year, but I also felt like a sponge about to burst. And it wasn't just me; we've had to deal with literally dangerous levels of burnout in our local medicine residencies. Part of it is the hours and demands, but also the fact that you felt like a hamster on a wheel, and no matter how hard you ran, you wouldn't get anywhere. Medicine apparently gets a lot better the further away you get from intern year, start doing electives/outpatient/supervision of interns/etc, but it was a real trial by fire for us.
 
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Merovinge

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Medicine apparently gets a lot better the further away you get from intern year, start doing electives/outpatient/supervision of interns/etc, but it was a real trial by fire for us.
I'm not entirely sure about that. I know several hospitalists (all of which are young) and they are happy with the pay/hours, but I don't get the feeling that any of them like their job. Seems great if you like a normal lifestyle with good pay but I think day-to-day satisfaction is much like a hamster on a wheel.
 

SeniorWrangler

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The stigma is quite real in terms of how reimbursement is made with insurance companies and how we have a harder time with medical complexity for the higher billing levels.
This right here.
 

calvnandhobbs68

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These are examples of inter-specialty teasing, but that's not the same as stigma. Nationwide, and worldwide, there is a particular form of shame and embarrassment associated with mental illness, and that is the origin of "stigma" in this context. This type of stigma is not found in most medical conditions. So, for example, the pediatrician who sees only well children may be wasting their time, but they are not dealing with a "stigmatized" patient population.
You're a real pleasant person aren't you?
 

calvnandhobbs68

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I wish I could say - but I'm not ready to. I'm worried that my identity will be apparent if I say what field I have migrated to, because, while there are a million of us working in psychiatry, when you cross-correlate that with other fields, well, the numbers quickly become tiny. I'm not doing pain or sleep medicine. (For one thing, I hate dealing with either insomnia or chronic pain! I hate chronic anything! I like dealing only with acute, concrete, time limited conditions that can be handled procedurally, with minimal ambiguity, and most of all, with minimal need for social work type interventions such as obtaining collateral information. So basically, anthrax, necrotizing fasciitis, the like... Another thing is, I only like dealing with a motivated population of patients. As long as those needs are met, I'm reasonably happy at work.) What I'm doing now requires complete retraining, but it isn't on the order of, say, orthopedic surgery. I feel like I'm now doing something useful and meaningful with my time, and my life. I didn't feel that way when all I did was ask patients how they feel about this or that. I mean, seriously, who cares how people feel? What matters is whether your body is working or not, right? That's going to determine how long you live.
So you only like acute, procedural conditions that only require you to work with a motivated patient population. Who in the world knows why you chose to do psychiatry. Time to switch to private pay derm then?
 
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Merovinge

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So you only like acute, procedural conditions that only require you to work with a motivated patient population. Who in the world knows why you chose to do psychiatry. Time to switch to private pay derm then?
I actually think REI might be the best field for someone with that desire. That said, you need a lot of empathy and listening skills in that field too, they have hour long intakes like psychiatrists!
 
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So you only like acute, procedural conditions that only require you to work with a motivated patient population. Who in the world knows why you chose to do psychiatry. Time to switch to private pay derm then?
Is it bad to like quick procedure driven medicine? Or medicine that pays well? NS likes what she likes. Good for her for moving on and getting out of a field she doesn't like.

For current interns and premeds, though -- if you find yourself liking your IM months a lot more than your on service months (and you can separate that out from any particular pathology of your individual program), that might mean you should think about switching special tie earlier because I think it's pretty rare for psych residents to feel that way.
 

calvnandhobbs68

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Is it bad to like quick procedure driven medicine? Or medicine that pays well? NS likes what she likes. Good for her for moving on and getting out of a field she doesn't like.

For current interns and premeds, though -- if you find yourself liking your IM months a lot more than your on service months (and you can separate that out from any particular pathology of your individual program), that might mean you should think about switching special tie earlier because I think it's pretty rare for psych residents to feel that way.
That's all well and good but when she comes and talks crap about psychiatry all over these boards, it should be pretty clear to everyone that she should have never been in the field to begin with. That needs to be in the mind of everyone who encounters these consistently negative posts.

The overall attitude of that poster also just oozes ignorance of both psychiatry and other fields. Saying crap like "pediatricians may be wasting their time seeing well children" won't get you too many sympathy points in my book.
 
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That's all well and good but when she comes and talks crap about psychiatry all over these boards, it should be pretty clear to everyone that she should have never been in the field to begin with. That needs to be in the mind of everyone who encounters these consistently negative posts.

The overall attitude of that poster also just oozes ignorance of both psychiatry and other fields. Saying crap like "pediatricians may be wasting their time seeing well children" won't get you too many sympathy points in my book.
Not to mention, with the examples were "anthrax, necrotizing fasciitis." So maybe theres a job in ID, although for every anthrax and nec fas you'll have 1000 diabetics and HIV patients who have chronic disease and are not motivated, maybe general surgery / plastics but again you'll be dealing with plenty of unmotivated chronic offenders, and maybe dermatology but derm is never actually going to treat anthrax or nec fas. An auto mechanic might satisfy the criteria... "acute, concrete, time limited conditions that can be handled procedurally, with minimal ambiguity, and most of all, with minimal need for social work type interventions" and everyone is motivated to get their car working again!
 
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Is it bad to like quick procedure driven medicine? Or medicine that pays well? NS likes what she likes. Good for her for moving on and getting out of a field she doesn't like.
Of course everyone should pursue their own particular interests and aptitudes.

But it's pretty lame to spend 4 years in psych residency, manifestly learn nothing at all about how to do psychiatry, and then blame one's own shortcomings on the field as a whole.

By her own admission this poster knows nothing about basic motivational interviewing, has never cured a patient of anything (so must not have had any training in exposure therapy or CBTi), and lacks the most basic information about the morbidity and mortality of psychiatric illness.

It's quite hard to imagine how she made it through residency this way, and frankly appalling when she presumes we are all as ineffectual as she presents herself to be.
 
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splik

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Of course everyone should pursue their own particular interests and aptitudes.

But it's pretty lame to spend 4 years in psych residency, manifestly learn nothing at all about how to do psychiatry, and then blame one's own shortcomings on the field as a whole.

By her own admission this poster knows nothing about basic motivational interviewing, has never cured a patient of anything (so must not have had any training in exposure therapy or CBTi), and lacks the most basic information about the morbidity and mortality of psychiatric illness.

It's quite hard to imagine how she made it through residency this way, and frankly appalling when she presumes we are all as ineffectual as she presents herself to be.
She never said she didn't know what motivational interviewing is, and just because she takes an extreme position that you disagree with does not mean she has learned "manifestly nothing at all about how to do psychiatry". The reality is the overwhelming majority of psychiatry residency programs suck and do not provide adequate training in psychotherapy or exposure to the full breadth of the field. This, added to the fact the field has historically attracted the dregs, contributes to the appallingly low standard of care, and the terrible practice that represents psychiatry in this country. It is very geographically dependent too, with the quality of care being better in more desirable parts of the country. There are many reasons to be embarrassed about this field. Nancy's posts may be overly negative, but it is also the case that this forum tends to be overly positive