How'd you decide on psych?

[Magree]

Hi:

I enjoyed psych but only did it for a short period (month long rotation after 3rd year core rotation). How did you guys decide that psych was for you? What made you choose it over other specialties? Any help or insight would be really helpful.

Also, a lot of the people I talk to say that its hard to make a living in psych - since mental health is so poorly funded. Is this true? I know there is a big need for psychiatrists - but a lot are uninsured.


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[dr. strangelove]

the field of psych is pretty much wide open right now. not many people want to go into it for many reasons, the most is i believe is that they just feel uncomfortable working with mental health patients. you can pretty much get a job as a psychiatrist anywhere in the US right now, some areas are just dying for psych docs. as for compensations, the bay area in SF has an average salary of 175k, which isn't that bad at all. most psychiatrists who run private clinics don't worry about insurance at all as they only take the best ones and/or cash only. i asked a psychiatrist about this and he looked at me funny and said he only takes cash only for his private clinic, therefore reimbursement is great! obviously it depends on the clinical setting. the training for residency, your patients are going to vary from the poor and destitute to the upper middle class of society. as a private doc, you can choose who you'd like to work with.

however, average salary is probably around 125k nationwide. the draws are however that you can spend time with your family and kids. nothing like being able to take care of yourself physically and mentally during residency.

the residents i worked with always said that there were no boring days for them, with plenty of things that they would see that made them go hmmmmm...

 

[tetris]

dr. strangelove, what you say is very interesting and helpful. thanks.

but what about some other drawbacks that many people have about psych.? for example, the fact that you have to talk to each patient for a long time (30 min. or more), the acute Psych. ward and the ER that have scary, creepy patients in them, the suicidal patients, the violent ones, and the drug addicts. [feel free to add to this list, everyone].

i guess my point is that i like psych quite a lot, especially the way we learned about it in med school, but some things about it are very annoying. and when you add the lower income than other specialties, it turns people away. your thoughts, please?

 

[dr. strangelove]

I guess that's how you know if you are going to like psych or not. I personally liked the acute psych ward and much preferred it over the more mundane outpatient clinic. I liked the acute psychotic patients and generally the ones with more advanced etiologies. Yes, I agree with you, there definitely are more 'creepy' ones in those settings, at least more outwardly so than any other patients in any specialty. As for interviewing a patient for 30 minutes or more - that's one of the biggest reasons that people go into the field. They have time to spend with the patient and become more 'in tune' with the treatment protocol that they need to tailor for each individual patient.

As far as reimbursement, psych docs typically make as much or more than internal med docs (depends on specialty of course, but then again some private practice psych docs make well over 200k), family docs and definitely more than peds docs. Imagine yourself at home sitting on your porch sipping on some cognac with your feet propped up on a stool talking with your spouse and hanging out with your family...and it's only 7.30 p.m. Lifestyle in psych is pretty darn nice.

 

[Magree]

Hi:

Thanks everyone - really appreciate your input. I'm currently doing a lock-ward inpatient rotation and finding that I really enjoy it - its nice to have as much time as I need to assess patients and I don't mind the acute psychotics. In fact its kind of gratifying when they improve.... guess I'm heading into psych. Its nice to know there are reimbursement options other than just fighting insurance companies.

thanks again

M-

 

[Magree]

Hi:

Thanks everyone - really appreciate your input. I'm currently doing a lock-ward inpatient rotation and finding that I really enjoy it - its nice to have as much time as I need to assess patients and I don't mind the acute psychotics. In fact its kind of gratifying when they improve.... guess I'm heading into psych. Its nice to know there are reimbursement options other than just fighting insurance companies.

thanks again

M-

 

[Thewonderer]

What do you guys think about med-psych?

I was thinking about it as it will allow me to treat the patient as a whole, both physically and mentally. I also noticed that a lot of psychiatrists, when admitting patients who also have hypertension, diabetes, etc. are not too comfortable with those meds. Their general attitude is that if we don't know for sure that the patients are on those meds, just take them off those meds even though the patients will go cold turkey. I want to be comfortable with treating medical conditions like those. And especially dealing with patients who have alcoholics and liver cirrhosis where the medical and psychiatric problems interwine.

I met some of those outwardly scaring patients. I am an ok size guy so I never felt too intimidated. In the ER and inpt wards, there are also lots of staff/policeman (the ER police office is conveniently located right across the hallway, about 4 steps away) who can help subdue the pts. I also love the 30+ minutes you get to spend with the patients. This is also a field where once you are willing to sit down and listen to the patients, you have already helped them (instead of like anesthesiology where you have to gain IV access, pump in the drugs, turn on the ventilator, etc. to actually begin "working" on the patients). Maybe by listening to someone, you have not led to an immediate cure. But the fact that you are willing to sit down and offer your help mean a lot to psych patients who are otherwise ostracized by others around them.

I have met a lot of resistence from the people around me, actually even more so from my med student friends! They are like, "how can you stand listening to people's problem for so long. You WILL go crazy listening to them for 30 years. You will put yourself and others around you in danger of some pyschotic, crazy patients...." I will have to deal with that soon!

 

[Magree]

Hi wonderer:

I agree about psychiatrists often being uncomfortable with medical management. One option for you is to do a strait med internship and then apply into psych programs as a PGY2. You will have less electives in your 4th year since you'll have to "make up" 2 months of neuro. But you will have a more solid internal medical experience. You could also so a transitional year which might allow you to take the neuro as a PGY1. Just a thought.


M-

 

[Thewonderer]

Hi Magree,
Good suggestion! HOwever, I just think that if you do a medicine internship, it will still be 3 more years of psych and no internal medicine before you get board certified and practice on your own. I just won't trust myself with internal med patients through that training.



how many of you are seriously considering about psych?

 

[Magree]

Hi wonderer:

Your right - if you want to handle a lot of internal medicine then more than 1 year is necessary. However, if you want to manage smaller issues that occur with psych patients then a good medicine internship is probably sufficient. Having med-psych would give you a lot more options however.

M-

 

[Delvonik]

I'm a new comer to the Psychiatry forums.I'm an undergrad,I'd like to know about how many hours Psychiatrists work per week.I'm guessing it's between 40-50 hours,right? And,which do you think would be more helpful in medical school : An undergraduate degree in Biology or Physical Therapy ?

 

[badassy]

Id like to be a psychiatrist but the whole not having a hands on approach turns me off about it.

 

[Thewonderer]

Originally posted by Delvonik
I'm a new comer to the Psychiatry forums.I'm an undergrad,I'd like to know about how many hours Psychiatrists work per week.I'm guessing it's between 40-50 hours,right? And,which do you think would be more helpful in medical school : An undergraduate degree in Biology or Physical Therapy ?

I don't think that ANY doctors work 40 hours a week nowadays. Once you factor in the call schedule, it is always 50+ hours. Maybe 50-60 hours a week for psychatrist?

I don't believe that it matters what you do for an undergraduate degree. If you like physical therapy, then go ahead. But if you like biology more, then major in that.

 

[dr. strangelove]

there are actually many fields in medicine where you can still get away with a 40 hour work week. of course this is after residency. a private practice psychiatrist can work whatever hours he or she wants really, with acute inpatient work held off till the next morning/day. a dermatologist works 40 hours or less a week in general private practice (worked with a derm in a community setting). also, rad/onc docs have very nice lifestyles as well with almost no call. least but not last, pathologists too have great lifestyles.

if you're really worried about lifestyle however, medicine may not be your best bet.

 

[rockindr]

Hi, I'm new to this forum, but I couldn't help joining the fray. I'm about to finish a psychiatry program at the University of Iowa. For those of you thinking about psychiatry, I have to say, it is a great job. I like to say that there is actually more blood and guts in psychiatry than in surgery. The opportunity for a great lifestyle is there as well as solid earning potential if done correctly. I plan on working 40-60 hours and will likely make over 200K. I plan to open a cash only practice and do some indigent work as well. Some psychiatrists I know work very hard (like 80-100 hours a week) and pull closer to half a million. The average academic shrink makes low to mid 100's. It can be very relaxing and very rewarding work. You may be stigmatized a little by your medical peers for choosing psychiatry, but that's their problem. They'll be happy to call you when their kids get panic attacks or develop schizophrenia. If you have any interest at all, you should seriously check it out. You get to sit around in a comfy chair and hear great stories all day. What fun!

 

[pschmom1]

I am currently an under grad majoring in psychology! I love psych and plan to specialize in it. I am facinated to hear of people looking forward to spending time with their patients. The mental health have a huge stigma and that is left to people like us, just pursueing it, to shatter this stigma (if possible) and provide the adequate treatment necessary. I understand that it is a job and you want to go home and be with your family, but even if you are on call, is it really a job? If you like what you do and you and you find gradification through helping your patients, is that work? I mean I know it's work, and I know that there are as much ups as downs and not everybody is satisfactory, but ya know what I mean? If it's something that you love and have a passion for, I would have to think that it would be better than getting called in to fix somebodys furnice or air conditioner. I just think it is the most interesting feild and I literally can not wait until I have the pleasure of being a part of it.