I like Psych, my parents don't...

[DebDynamite]

That about sums it up.

It's not as if this fact is hindering my entering the field. It isn't even keeping me up at night. I just think it sucks. I know my dad wanted me to end up some type of surgeon, and my mom, I can just tell that she thinks "the church" can take care of "all things psychological". This means that they have this sort of quiet air of being let down whenever the field is brought up these days (which it is quite a bit as I'm entering MSIV). They focus more on the fact that I'm about to be "a doctor" than what type of doctor- oh well...

I'm not really surprised by their response and I see it a learning exercise in accepting their lack of approval, but it blows. The other thing that's annoying about it is that they don't even really understand what the field entails. I'm wondering if anyone else out there went through a "transition" period with their parents when they announced they were going into Psychiatry?

---

Members don't see this ad.

 

[MacGFlow]

yeah man, i hear ya. i'm dealing with all this right now as well. after years of having to deal with the question, "what field of medicine are you going into?," i finally have an answer and i'm excited about it...but now there's all this junk. you can't let it get you down, though, and it seems like you really haven't. it's your own life after all, nobody else's. and as far as your parents go, it's all about education. i basically sat down with my parents and explained to them how much i enjoyed my clerkship and what i did and how i saw it was beneficial in so many ways and how the demand is so great. and i did some research and found so much literature on this very topic. it's a common issue many fourth years go through...

i don't know if you're an apa member or not, but i found this and e-mailed it to my parents. they were appreciative.

http://www.psych.org/edu/med_students/Spring04MSN.pdf

cheers to your decison! and good luck!
--
looks and feels

 

[DebDynamite]

yeah man, i hear ya. i'm dealing with all this right now as well. after years of having to deal with the question, "what field of medicine are you going into?," i finally have an answer and i'm excited about it...but now there's all this junk. you can't let it get you down, though, and it seems like you really haven't. it's your own life after all, nobody else's. and as far as your parents go, it's all about education. i basically sat down with my parents and explained to them how much i enjoyed my clerkship and what i did and how i saw it was beneficial in so many ways and how the demand is so great. and i did some research and found so much literature on this very topic. it's a common issue many fourth years go through...

i don't know if you're an apa member or not, but i found this and e-mailed it to my parents. they were appreciative.

http://www.psych.org/edu/med_students/Spring04MSN.pdf

cheers to your deicison! and good luck!
--
looks and feels

Hey thanks. I'm joining apa next week (everything is "next week"- after step 2), and may pass this on to the parents.

My mom had surgery in May and told me, about 5 weeks post op, that ever since her surgery she just could not stay asleep longer than 1.5 hrs. Having never suffered from insomnia before in her life, she tried both Ambien and Lunesta, neither worked. I had just learned about Rozerem and suggested to her that she take it, along with melatonin, and instructed her about how it can take "weeks" to work (which I learned actually at a dinner by the Stanford doc who's currently doing the Rozerem tour- oops his name I do forget...). She's been getting more relief (and the Rozerem is kicking in at week three nicely) from this combo than anything else. I pointed out to her that the only reason I knew anything about this drug at this level of my training (her GP didn't know it can take weeks to kick in) is that I'm going into Psych. She didn't say anything. I think things like this are going to slowly put her more at ease, but it is annoying. Parents.

 

[billypilgrim37]

Once they realize that psychiatrists get paychecks like anybody else, they may back off.

My mother had the same reaction, until she started working as a kindergarten teacher in an 80% free lunch elementary school. Suddenly all of my child psychiatry aspirations made lots of sense. And there's a bit of a hoot in the family, sense my cousin who's going to Podunk Medical School is planning on doing a surgical residency at BFE Community Hospital, while I'm going to be leaving Top Ten Medical School to head off to Probably Respectable University for an academic career in psych. Given that cousin has a father who is a pharmacist who keeps telling me "You better not be prescribing those amphetamines!" every time he seems me, you've got the makings of a nice sitcom.

Besides, if your mom goes to the church of D2 blockade, she might be on to something.

Look at it this way. At least you're not going into PM&R.

"So you're going to be a physical therapist?"
"No, I'm going to be a physiatrist."
"Why did you go to medical school to be a psychiatrist? Those aren't real doctors!"
"Not a psychiatrist, a physical therapist."
"Oh, okay."

 

[DebDynamite]

billypilgrim37, you are too funny.

 

[psychfriend]

That about sums it up.

It's not as if this fact is hindering my entering the field. It isn't even keeping me up at night. I just think it sucks. I know my dad wanted me to end up some type of surgeon, and my mom, I can just tell that she thinks "the church" can take care of "all things psychological". This means that they have this sort of quiet air of being let down whenever the field is brought up these days (which it is quite a bit as I'm entering MSIV). They focus more on the fact that I'm about to be "a doctor" than what type of doctor- oh well...

I'm not really surprised by their response and I see it a learning exercise in accepting their lack of approval, but it blows. The other thing that's annoying about it is that they don't even really understand what the field entails. I'm wondering if anyone else out there went through a "transition" period with their parents when they announced they were going into Psychiatry?

I'm getting the same thing now and I just laugh. Pretty much my entire family consists of physicians and none of them are psychiatrists. They aren't taking me seriously. My dad, a urologist, has 3 or 4 friends that are psychiatrists and told me they were all nuts and that the field made them crazy. My sister, a cardiologist, asked me the difference between a PharmD and Psychiatrist in regards to prescribing prowess since psychiatrists prescribe few meds in comparison to internists and other physicians. Lastly, all of them are under the impression that psychiatrists make no money. Honestly, I think that's the biggest criticism of psychiatry. If it had a better reputation as a money-making field, I think psychiatry would be more competitive and respectful. When you mention psychiatry, the first thing many people think is "lowest paying field" They just assume you will be poor if you become a psychiatrist, which is hardly the truth. Instead I have noticed that a lot of psychiatrists work for hospitals and there are far less private groups than internal medicine and other fields which can lower the average psychiatrist salary. However, the private practice psychiatrists tend to do really well from what I've seen.

 

[Anasazi23]

My sister, a cardiologist, asked me the difference between a PharmD and Psychiatrist in regards to prescribing prowess since psychiatrists prescribe few meds in comparison to internists and other physicians. Lastly, all of them are under the impression that psychiatrists make no money. Honestly, I think that's the biggest criticism of psychiatry. If it had a better reputation as a money-making field, I think psychiatry would be more competitive and respectful. When you mention psychiatry, the first thing many people think is "lowest paying field"

Psychiatrists make more money on average than internists.

http://www.bls.gov/oco/ocos074.htm

 

[positivepsych]

:Hold clamp: Cut umbilical cord

Problem solved.

 

[SpiritiualDuck]

Come on, you're going to be a doctor and you're worried about what Mommy thinks. Mommy?

You're going to be responsible for the health of others, but you're worried about what your Mommy and Daddy thinks.

This is your choice.

 

[BabyPsychDoc]

Come on, you're going to be a doctor and you're worried about what Mommy thinks. Mommy?

You're going to be responsible for the health of others, but you're worried about what your Mommy and Daddy thinks.

This is your choice.

Guys, if you (and positivepsych) do not have anything useful to say, why bother posting? It is healthy to wish for a harmonious relationship with your parents - and when they disagree with you on something major (like your career choice) it can be quite upsetting, especially if you enjoy a close relationship with them otherwise. If you have got some issues with your parents, sort them out, instead of posting silly remarks with bad grammar.

 

[jjbmsiv]

I would tell your parents to shut the bleep up if they keep up this behavior. You REALLY do not need to tolerate that kind of thing, especially as you are an adult yourself. Someone does indeed need to do some growing up here, and it isn't you.

 

[PsychMD2100]

I always thought of Peds and FP as being the lowest paid specialties. I guess they are according to the Bureau of Labor Statistics. Thanks 'sazi.

My parents are very important to me, as are the opinions of others. However, it is a very personal decision and you've got to choose for yourself. If you know Psych is right for you, then you'd be very unhappy if you went through the pain of residency in a specialty that wasn't you.

I'd say apply to Psych and give it a shot. Even if you do a year and decide to switch, you'll at least know that Psych wasn't for you. People switch all the time--just look at these forums. Every couple weeks there are postings for new openings and questions from people wanting to switch specialties.

If psych is right for you, then do it. If it turns out that it's not, then you'll find another specialty.

 

[psychfriend]

Psychiatrists make more money on average than internists.

http://www.bls.gov/oco/ocos074.htm

I really don't place much faith in these surveys in general. Every survey will say something different. There is a site that compares the various surveys against one another and the disparity is astonishing. Although this is a govt report, their source is based on another private company's report, in this case the Medical Group Management Assocation's report http://www.mgma.com There are also surveys that have IM making more money such as this one: http://www.allied-physicians.com/salary_surveys/physician-salaries.htm Therefore, every survey has it's own biases and will present different information and anyone could argue one field earns more than another if they cite the appropriate survey. These surveys in general are misleading in my opinion. These salaries include academic positions, and hospital based salaried positions. That's fine but it provides the false impression that one can only earn say 220K because a salary survey said the "high" was 220K. Some are based on W2's which we know is not an accurate measure of one's income especially in regards to a physician who owns his practice. He might pay himself a salary of 100K while his "corporation" aka practice earns much more.

I personally have seen what both internists and psychiatrists earn in a successfull private practice. While both seem to earn comparable salaries, the internists seem to work a lot harder for the same income. I'm sure you have noted the same thing Anasazi. That's a huge difference in my opinion. Lifestyle is everything. The psychiatrist and internist were both earning over 400K but the psychiatrist worked about 10-15 hrs less with no call or weekends. Also, the internists was working at a frenzied pace to see about 40 patients while the psychiatrist was seeing about 20-25 patients. If you are so busy that you can't take lunch or even have a moment to breathe, that's a big difference.

And I knew that psych wasn't the lowest paying field but rather I was speaking in regards to the general perception that medical students and physicians have in regards to what they perceive as the lowest paying field; family, peds and psych have all been mentioned.

I think the reason parents don't attack their kids for going into IM is they assume you will subspecialize since there are so many IM subpecialties and even the non-competitive ones like rheumatology and nephrology pay considerably more than general IM. I know subspecialties exist for psych, peds and family but they don't pay much more than their general fields. Just look at psych; with the exception of child psych, most of the psych fellowships are not that competitive nor do they pay much more than general psych. Even forensics isn't that competitive because you don't need the forensics fellowship to get involved with that field.

Regardless, I think a lot of people are hyperbolizing their family's comments. My family is ultimately happy with whatever I do but they are going to speak their mind as they care about me. Yes, maybe if some stranger told me not to go into psych, I would be offended. However, I'm secure enough with choice of psych that I could care less what my family says. Again, I'll have the last laugh when I'm earning as much as my sis and working 30 less hours per week. (okay, maybe that's a slight exaggeration as well)

 

[SpiritiualDuck]

Babypsychdoc,

You reprimand me for my comments by being passive aggressive yourself. How does insulting me make you better than me? You write about how I have unresolved issues with my parents. I suspect you have penis envy.

I stand by my assertion that it's pathetic to let your Mommy's uninformed opinion matter. His states that his mother believes that the Church should handle issues around psych.


It's truly about cutting the umbilical cord.

 

[sikegeek]

Just think of it as ignorance. A certain population, physicians included, just have no idea how critical taking care of mental illnesses is. An internest surely couldn't stabilize a schizophrenic, except with sedation. Psychiatrists really help people live fulfilled lives who would otherwise be miserable- maybe even suicidal.
So whatever, you know what you are doing is incredibly important. If they are saying those things because they will be embarrassed when they tell people whot field of medicine their child chose, then they are being kinda selfish. Only you know what it took to get yourself to get to where you are today.
Also, you colud explore what maladaptive defense mechanisms they are using .

 

[psychfriend]

Just think of it as ignorance. A certain population, physicians included, just have no idea how critical taking care of mental illnesses is. An internest surely couldn't stabilize a schizophrenic, except with sedation. Psychiatrists really help people live fulfilled lives who would otherwise be miserable- maybe even suicidal.
So whatever, you know what you are doing is incredibly important. If they are saying those things because they will be embarrassed when they tell people whot field of medicine their child chose, then they are being kinda selfish. Only you know what it took to get yourself to get to where you are today.
Also, you colud explore what maladaptive defense mechanisms they are using .

I was chatting with my neighbor who is not in medicine. He is a pretty successfull business owner who specializes in putting granite in kitchens, bathrooms etc. I told him I was going into psychiatry and expecting his response to be less than stellar. He was telling me how exciting and "cool" that field must be. A lot of people outside of medicine share this same response. It made me realize the perception of our peers differs greatly from the perception of the general public. We tend to get overly concerned with our peers' opinion, which is natural considering we are constantly surrounded by them. Our peers judge fields based on their competitiveness, which the public doesn't do. For example, the public doesn't know dermatology is one of the most competitive fields in medicine. They just think they are ordinary skin doctors. Seinfeld joked and called them pimple popper M.D.'s We have to remember that our peers make up a tiny fraction of society. Once you get out in the real world, you are going to associate with a lot of people outside of medicine and they aren't aware of this false and superficial hierarchy. You should do what you enjoy and can see yourself realistically doing every single day. My sister is a cardiologist. Regardless of it's income and prestige, I couldn't do that job every day. It doesn't interest me and I would get tired of seeing that same patient profile not to mention not being able to get a good night's sleep knowing my pager will go off.


Quoting the Digital Underground: "Do whatcha like"

 

[PsychMD2100]

psychfriend,

That was one of the better posts that I've read recently.

It's important to recognize that, for every detractor, there's also a good number of supporters out there as well.

 

[jjbmsiv]

I was chatting with my neighbor who is not in medicine. He is a pretty successfull business owner who specializes in putting granite in kitchens, bathrooms etc. I told him I was going into psychiatry and expecting his response to be less than stellar. He was telling me how exciting and "cool" that field must be. A lot of people outside of medicine share this same response. It made me realize the perception of our peers differs greatly from the perception of the general public. We tend to get overly concerned with our peers' opinion, which is natural considering we are constantly surrounded by them. Our peers judge fields based on their competitiveness, which the public doesn't do. For example, the public doesn't know dermatology is one of the most competitive fields in medicine. They just think they are ordinary skin doctors. Seinfeld joked and called them pimple popper M.D.'s We have to remember that our peers make up a tiny fraction of society. Once you get out in the real world, you are going to associate with a lot of people outside of medicine and they aren't aware of this false and superficial hierarchy. You should do what you enjoy and can see yourself realistically doing every single day. My sister is a cardiologist. Regardless of it's income and prestige, I couldn't do that job every day. It doesn't interest me and I would get tired of seeing that same patient profile not to mention not being able to get a good night's sleep knowing my pager will go off.

The counterpoint to this (and FAR more likely) is that they will likely confuse psychiatrist and psychologist, and not think you are a physician at all!

 

[PsychMD2100]

And you don't think radiologists and ophthalmologists don't have people doubting whether they're physicians?

 

[jjbmsiv]

To the same extent/degree as a shrink? Not a chance in hell.

 

[mgdsh]

To the same extent/degree as a shrink? Not a chance in hell.

2nd.

 

[PsychMD2100]

I'd have to disagree on that. Being close to both a radiologist and an ophthalmologist, both of them routinely receive blows to their ego.

Many people don't realize that there are doctors devoted to reading x rays. They think that every doctor simply interprets his/her own imaging studies. Moreover, radiologists are mistaken sometimes for being x ray technicians. The radiologist will hear from others, "My cousin just finished her associate's and she's now a radiologist."

The ophthalmologist is often asked if he's considered working at Walmart since there's a Super Walmart opening up down the road. He's told by well-meaning patients that Walmart is where the real opportunities lie for an eye doctor given the volume seen at Walmart. Ophthalmology is one of the most competitive fields in the medical profession, yet many lay people don't know this and continue to mistake ophthalmologists for optometrists.

We have to live our lives regardless of the number of people who view us as "real doctors." Even if more people think radiologists/ophthalmologists are "real doctors," who cares?

 

[Doctor Bagel]

Once they realize that psychiatrists get paychecks like anybody else, they may back off.

This is part of my mom's hangup. She's somehow convinced that it's hard for psychiatrists to make any money because of insurance reimbursement issues. I keep on telling her the average salary reports, but she doesn't seem to buy it.

Other funniness with my mom -- whenever anybody asks me what specialties I'm thinking about, I always answer psych and add that I'm considering a few other things like IM subspecialties but won't know for sure for a while. My mom is apparently telling people that I want to do IM.

 

[psychfriend]

The counterpoint to this (and FAR more likely) is that they will likely confuse psychiatrist and psychologist, and not think you are a physician at all!

That's a weak counterpoint because any Joe on the street can tell you that a psychologist can't prescribe meds. They may not know the difference in regards to training between a psychologist and a psychiatrist but they sure as hell know that their psychologist can't write them a prescription for their favorite anti-depressant. When that changes, you will have a point! But until that policy extends beyond a handful of rural states(which it will never likely extend beyond), people will know the difference. And this isn't medicine circa 1980. This is the age of the internet and commercialized medicine. When Joe sees a new drug during the Superbowl for his bipolar disorder, guess who he makes an appointment to see...nope...not the psychologist. When Mom sees Billy jumping up and down on the sofa for 30 minutes, she isn't making an appointment to see a psychologist for therapy. She is seeing a psychiatrist to put Billy on stimulants she read about during a google search.

Remember, the general public knows medical fields according to how they are displayed in pop culture aka television, movies etc. Psychiatrists are well published in pop culture whether you are referring to the Sopranos or the movie a Beautiful Mind. I doubt people are that unaware of psychiatrists being physicians. I think that's just a paranoid fear that medical students create to justify avoiding psychiatry.

 

[billypilgrim37]

The difference is that radiologists and ophthalmologists can laugh about the ignorance of the public together on the golf course Friday morning since they can work 30 hours a week and still pull in a half million a year

And while they're out golfing, we'll probably be admitting someone who keeps trying to assure you that "popcorn" is Satan's favorite flavor of jelly bean (as if even the devil would eat that nasty stuff!)

 

[psychfriend]

This is part of my mom's hangup. She's somehow convinced that it's hard for psychiatrists to make any money because of insurance reimbursement issues. I keep on telling her the average salary reports, but she doesn't seem to buy it.

Other funniness with my mom -- whenever anybody asks me what specialties I'm thinking about, I always answer psych and add that I'm considering a few other things like IM subspecialties but won't know for sure for a while. My mom is apparently telling people that I want to do IM.

I'm pretty supportive of psychiatry as all of you know. However, I will acknowledge your mother's concern. There are no procedures in psychiatry and that is a valid concern from a financial standpoint. Even Family practice physicians and an internists can perform many minor procedures in a location with several competing specialists. They can remove warts, perform flex sigs, draw up their own labs, and perform some minor cosmetic procedures like Botox. Many will often peform their own X-rays and ultrasounds and then outsource them to a radiologist and make a tiny fee on each image.

However, I think the demand for psychiatry is going to increase. Psychologists won't pose a threat because they can't prescribe medication. The states in which they are allowed priviledges are areas that have a drastic demand, and the psychiatrists in those states are extremely busy. You will not see psychologists being given these priviledges in areas where demand is met or slightly below demand. I don't see this occurring in California but I can see it occuring in mountain states like Montanta, Wyoming and North & South Dakota. The public is more tolerant and accepting of psychiatry as well. In the past it was taboo to see a psychiatrist. Now, it's becoming more acceptable and people are seeing them for conditions they may have ignored in the past like depression or anxiety.

I'm going into psychiatry knowing this risk. I support the field but I do acknowledge that psychiatry could be hit the hardest when medicare continues to lower reimbursements. I do think you have to enter psychiatry knowing you may not make as much money as some of your other colleagues. You have to be content with that notion otherwise you shouldn't go into the field. There are a lot of other perks such as lifestyle. Another perk is that you can practice psychiatry well into your 60 and 70's. You can't do that in other fields of medicine in which you rely on your hand skills and energy level. I know a lot of surgeons who are forced to retire because their hands begin to shake or they can't keep up from a stamina point of view. Even non-surgeons like OB/GYN's and cardiologists simply get burned out by their late 50's. But psych is one of those fields that you can practice for a long time because it's not physically demanding. I know semi-retired doctors will remove the more physical elements of their practice but then they cut their income in half as well (example:OB's who only do GYN)

 

[psychfriend]

The difference is that radiologists and ophthalmologists can laugh about the ignorance of the public together on the golf course Friday morning since they can work 30 hours a week and still pull in a half million a year

And while they're out golfing, we'll probably be admitting someone who keeps trying to assure you that "popcorn" is Satan's favorite flavor of jelly bean (as if even the devil would eat that nasty stuff!)

One of the psychiatrists I rotated with worked 30 hours a week and made well over 500K. He gave talks and did forensics on the side. On one case, he worked 20 hours and made 15K. Not bad! I should also add that some of his patients are cash paying (10%)

And I've noticed that the people who enjoy the popcorn flavored jellybean are the same folks enjoy the black licorice flavored one...yuk

 

[OldPsychDoc]

...There are no procedures in psychiatry and that is a valid concern from a financial standpoint. ...

ECT counts as a procedure.

 

[positivepsych]

That's a weak counterpoint because any Joe on the street can tell you that a psychologist can't prescribe meds. They may not know the difference in regards to training between a psychologist and a psychiatrist but they sure as hell know that their psychologist can't write them a prescription for their favorite anti-depressant...

Remember, the general public knows medical fields according to how they are displayed in pop culture aka television, movies etc. Psychiatrists are well published in pop culture whether you are referring to the Sopranos or the movie a Beautiful Mind.

I respectfully disagree. I meet a lot of people in the real world that don't know the difference between a psychologist and a psychiatrist, and which has prescription privileges. Maybe people who are educated know the difference, but not all of your average Joe Schmos.

Furthermore, your argument that the public bases it on TV/movies also adds to my point. TV Psychiatrists (Frasier Crane, Sopranos, etc.) are old-school and primarily do talk therapy like psychologists. Thus, most people still believe Psychiatrists do a lot of talk therapy, instead of the reality of almost exclusive psychopharmacology practices these days.

 

[DropkickMurphy]

ECT counts as a procedure.

How often does that actually happen though? No, seriously, do they still actually do that?

 

[billypilgrim37]

How often does that actually happen though? No, seriously, do they still actually do that?

You've obviously never been witness to the anesthesia assembly line Thursday morning in the PACU...

Shock, shock, shock, everybody shock... not just for ACLS anymore...

 

[sikegeek]

How often does that actually happen though? No, seriously, do they still actually do that?

They do it at my hospital. My impression is that it is the "when all else fails? thing to do.

 

[PsychMD2100]

The difference is that radiologists and ophthalmologists can laugh about the ignorance of the public together on the golf course Friday morning since they can work 30 hours a week and still pull in a half million a year

And while they're out golfing, we'll probably be admitting someone who keeps trying to assure you that "popcorn" is Satan's favorite flavor of jelly bean (as if even the devil would eat that nasty stuff!)

A Radiologist or Ophthalmologist making half a million working 30 hours a week? I'd like to know where they do that. I need to tell the ones I know about those opportunities.

The Rads/Ophtho guys making those numbers will tend to work 6 days a week for roughly 10 hours a day. They don't take lunch breaks because they're either dictating or operating.

I think many people have too rosy a picture of how other specialties do. Managed care has cut sharply into both of the said fields. While that may have been reality 20 years ago, it's no longer the case.

A perfect example is that in the 1980s, a cataract used to pay $2000 per eye. Nowadays, it's a success if they collect $800 for both eyes! Imagine working 5 times as hard for the same amount of money. That's to say nothing about inflation over 2 decades.

One thing not mentioned is the amount of liability incurred by those other docs. Do you have any idea how much they pay in malpractice? It's usually 2-3 times what a psychiatrist will pay. They're much more likely to be sued and for greater sums of money. Even if a patient didn't follow instructions after their surgery, they'll still sue for postop complications. They'll either settle for the half million you mentioned or a jury will award even more.

For the right people, psych is a great field. If you're having this many doubts about what we do, then this may not be the right place for you. If you have a genuine curiosity for psychiatry and have a good work ethic, the future is wide open.

 

[OldPsychDoc]

How often does that actually happen though? No, seriously, do they still actually do that?

In my hospital, M-W-F AMs for inpatients, T-Th AMs for outpatients.

Yes, seriously, DkM, we do still do that, and it's a very important, effective, and well-established treatment.

 

[DropkickMurphy]

You've obviously never been witness to the anesthesia assembly line Thursday morning in the PACU...

Shock, shock, shock, everybody shock... not just for ACLS anymore...

Yeah, the OR and PACU are about the only areas I didn't see much of as an RT.

Yes, seriously, DkM, we do still do that, and it's a very important, effective, and well-established treatment.

I knew it had a high degree of efficacy, but I wasn't sure if it had fallen by the wayside as pharmaceuticals became more effective. You know, sort of like lobotomies for schizophrenics.

 

[psychfriend]

ECT counts as a procedure.

But it's not a routine procedure and most psychiatrists don't perform it. I was referring to procedures that one could realistically perform on a routine basis. I only listed procedures that FP and IM routinely and realistically perform. If I wanted to be technical, I could have listed colonoscopies and caths but they don't routinely perform these for several reasons. In my city, there is only one hospital that still performs ECT and none of the private practice outpatient psychiatrists are involved with it. I live in a very large city (top 10 pop). I'm not arguing about it's efficacy. It's a well respected procedure but most psychiatrists don't perform it because they lack experience or are uncomfortable with it. The ones who do it in my city are the inpatient psychiatrists that are employed by the hospital and have signficant experience performing it.

 

[OldPsychDoc]

And it's rarely performed. I was referring to procedures that one could realistically perform and bill for. In my city, there is only one hospital that still performs it and none of the private practice outpatient psychiatrists go near that. I live in a very large city (top 10 pop)

Umm--you speak with a great deal of confidence for one who knows so little.

According to the paperwork in front of me right now, I personally have performed it 52 times in this calendar year to date, and the hospital has billed $18,757 on my behalf. (And I personally only cover ~25% of our ECT service.) So "rarely performed" is all relative, I guess...

 

[psychfriend]

I respectfully disagree. I meet a lot of people in the real world that don't know the difference between a psychologist and a psychiatrist, and which has prescription privileges. Maybe people who are educated know the difference, but not all of your average Joe Schmos.

Furthermore, your argument that the public bases it on TV/movies also adds to my point. TV Psychiatrists (Frasier Crane, Sopranos, etc.) are old-school and primarily do talk therapy like psychologists. Thus, most people still believe Psychiatrists do a lot of talk therapy, instead of the reality of almost exclusive psychopharmacology practices these days.

The people who seek treatment know the difference especially since most patients are likely seeking their psychiatrist to acquire some type of medication. And let's just say there are a lot of people who are seeking treatment.

 

[psychfriend]

A Radiologist or Ophthalmologist making half a million working 30 hours a week? I'd like to know where they do that. I need to tell the ones I know about those opportunities.

The Rads/Ophtho guys making those numbers will tend to work 6 days a week for roughly 10 hours a day. They don't take lunch breaks because they're either dictating or operating.

I think many people have too rosy a picture of how other specialties do. Managed care has cut sharply into both of the said fields. While that may have been reality 20 years ago, it's no longer the case.

A perfect example is that in the 1980s, a cataract used to pay $2000 per eye. Nowadays, it's a success if they collect $800 for both eyes! Imagine working 5 times as hard for the same amount of money. That's to say nothing about inflation over 2 decades.

One thing not mentioned is the amount of liability incurred by those other docs. Do you have any idea how much they pay in malpractice? It's usually 2-3 times what a psychiatrist will pay. They're much more likely to be sued and for greater sums of money. Even if a patient didn't follow instructions after their surgery, they'll still sue for postop complications. They'll either settle for the half million you mentioned or a jury will award even more.

For the right people, psych is a great field. If you're having this many doubts about what we do, then this may not be the right place for you. If you have a genuine curiosity for psychiatry and have a good work ethic, the future is wide open.

PsychMD2100

Much props! You took the words right out of my mouth. I'm glad you stated this because I know several radiologists and the ones who are earning 500K + are not doing teleradiology on some beach in Maui. It's a big misconception that radiology is a lifestyle field. For the type of income they make, their lifestyle is nice relative to surgery, interventional cardiology and OB but it's not a true lifestyle field in the same way that allergy, derm, and psych are and a radiologist wouldn't argue otherwise. Radiologists take call and work evenings. Their salaries depend upon how many films they bill for, so a radiologist has to make certain their volume of films get read. If that means working late then they have to stay and do it.

The opthalmologists that are earning high incomes are the ones doing lasik and other laser related procedures. Most of these doctors started their practice at least 10 years ago and had to pay 500K to 1 million just to buy the machine. Now the field is becoming saturated and prices have dropped considerably.

Even the plastic surgeons that you see on television did 5 years of general surgery, 2-3 years of plastics fellowships and sometimes 1-2 years of research. Then they apprenticed under another physician for 2-3 years before opening their own practice. And when they opened their own practice, they had to establish it; patients didn't just come in right away. It's not like Nip/Tuck in which you have a young good looking guy in his late 30's driving Lamborghinis. Most established plastic surgeons are in their early 40's at their youngest.

 

[psychfriend]

Umm--you speak with a great deal of confidence for one who knows so little.

According to the paperwork in front of me right now, I personally have performed it 52 times in this calendar year to date, and the hospital has billed $18,757 on my behalf. (And I personally only cover ~25% of our ECT service.) So "rarely performed" is all relative, I guess...

I know a lot in regards to the business aspect of this field. Yes it is relative, you are an Attending at a hospital that performs ECT so it's safe to say that you don't fit the profile of most psychiatrists. I also never denied that ECT is performed. I just stated the obvious that it's not routinely performed nor is it performed by most psychiatrists. It's performed in select hospitals by a select number of psychiatrists who are comfortable doing it. You might as well argue that all internists can do colonoscopies because some guy in a rural town does 200 a year.

The point is that a psychiatrist in private practice isn't going to just set up ECT in another room if he wants to add additional procedures to increase income. It's not the same as an internist doing a pulmonary lung function test or removing a wart. Sorry but you don't have to be an attending to have common sense

 

[OldPsychDoc]

I know a lot in regards to the business aspect of this field. You are also employed by a hospital and are an impatient psychiatrist. I also never denied that ECT is performed. I just stated the obvious that it's not routinely performed nor is it performed by many psychiatrists. It's performed in select settings by a select number of physciains who are comfortable doing it. You might as well argue that all internists do colonoscopies because some guy in a rural town does 200 a year.

The point being is that a psychiatrist in private practice isn't going to just set up ECT in another room if he wants to add additional procedures to his practice. I think even you know this. This is an issue of common sense more than it is an issue of particular experience.

I may indeed be an "impatient psychiatrist"--but you use words such as "rare" and "not routinely" to describe a procedure which is not uncommon and which is indeed performed routinely and billed for (and reimbursed!) "realistically". When you stated rather absolutely that "There are no procedures in psychiatry and that is a valid concern from a financial standpoint", I merely pointed out that there IS a procedure in psychiatry. You didn't specify "procedures easily accomplished in a standard outpatient office". (As you say in your redacted post, cardiologists don't have a cath lab on site, either...).
For the inpatient psychiatrist (as well as the "impatient" psychiatrist--ie. wanting a robust, rapid antidepressant response), ECT is indeed routine, realistic, and reimbursed. It seems to me that you are generalizing from your "particular experience" (or lack thereof), rather than "common sense" about how words are usually interpreted.

 

[psychfriend]

I may indeed be an "impatient psychiatrist"--but you use words such as "rare" and "not routinely" to describe a procedure which is not uncommon and which is indeed performed routinely and billed for (and reimbursed!) "realistically". When you stated rather absolutely that "There are no procedures in psychiatry and that is a valid concern from a financial standpoint", I merely pointed out that there IS a procedure in psychiatry. You didn't specify "procedures easily accomplished in a standard outpatient office". (As you say in your redacted post, cardiologists don't have a cath lab on site, either...).
For the inpatient psychiatrist (as well as the "impatient" psychiatrist--ie. wanting a robust, rapid antidepressant response), ECT is indeed routine, realistic, and reimbursed. It seems to me that you are generalizing from your "particular experience" (or lack thereof), rather than "common sense" about how words are usually interpreted.

sigh...it was a typo...I meant to wrint iNpatient not impatient. Nonetheless, it is funny that you assumed that I was genuinely referring to you as being impatient.

I also listed a limited number of procedures that family practice and internists perform. You had no problem accepting those absolute statements. You could have made the same argument you are doing now. You could have contradicted me by saying that FP and Internists can perform more than the aforementioned procedures. You didn't do so because you understood that I was referring to routine procedures. Likewise, I think you should learn to make some logical inference based on the discussion. I'm aware that ECT exists as a procedure. I'm also aware that it's not routinely performed. You are an attending at a hospital that performs it so you are in a unique position. Many hospitals don't offer it and many psychiatrists never receive training in it. And the reality is that many psychiatrists will not perform it regardless if you did 52 in a given year. So for you to imply that a psychiatrist can simply adopt ECT to increase additional income doesn't make much sense. I really feel like you are arguing for the sake of argument. Also, while many cardiologists don't have cath labs on site, many hospitals do whereas the same can't be said of hospitals offering ECT.

Okay, since you are an attending, please tell us what percentage of psychiatrists perform ECT. You are an attending as you have mentioned on several occassions so why don't you tell us the answer to this You should know this right because after all you are the attending. After all, if a select number of hospitals and psychiatrists perform this, I hardly see how this is a routine procedure as you would put it. And in regards to "generalizing based on one's experience", can't the same be said of an attending who performs 52 ECT's a year at a hospital that just happens to offer the procedure. hmmmm

 

[OldPsychDoc]

...how are things going with your parents?

Living well is the best revenge...

What any healthy parent wants is just for their kids to be healthy and happy. Hopefully as you pursue this field, work through your own ambivalence (which we all have), and get to regale your family at holiday dinners with some wild manic-psychotic patient stories, they'll come around. Dad may see that you're happier and healthier than his ideal of Surgeon Daughter. Mom may even see that many church people see God work miracles via well-trained therapists and psychopharmacology.

Good luck and keep us updated.

 

[psychfriend]

to describe a procedure which is not uncommon and which is indeed performed routinely and billed for (and reimbursed!) "realistically".

By three-tenths of 1 percent, is this what you would refer to as ECT being "performed routinely" and regular. I take it the APA is wrong?

Extent of Use
Psychiatrists are very selective in their use of electroconvulsive therapy. According to the National Institute of Mental Health, approximately 33,000 hospitalized Americans received ECT in 1980, the last year for which NIMH has figures. That comes out to only three-tenths of one percent of the 8.6 million who suffer with depression, the 2.1 million who suffer with schizophrenia and the more than one million who suffer with mania during any given year. Some patients also undergo ECT as an outpatient procedure.

http://www.psych.org/research/apire/training_fund/clin_res/index.cfm

 

[jjbmsiv]

Dude, you can be an dingus. Chill out.

 

[psychfriend]

Dude, you can be an dingus. Chill out.

I'm an dingus because I provided a link from the APA that directly contradicted his statements about ECT being routine, especially when he was being condesceding because I disagreed with him initially??? That hardly seems fair. If he wants to dispute the facts below, he may do so.

Extent of Use
Psychiatrists are very selective in their use of electroconvulsive therapy. According to the National Institute of Mental Health, approximately 33,000 hospitalized Americans received ECT in 1980, the last year for which NIMH has figures. That comes out to only three-tenths of one percent of the 8.6 million who suffer with depression, the 2.1 million who suffer with schizophrenia and the more than one million who suffer with mania during any given year. Some patients also undergo ECT as an outpatient procedure.

http://www.psych.org/research/apire/..._res/index.cfm

 

[OldPsychDoc]

I also listed a limited number of procedures that family practice and internists perform. You had no problem accepting those absolute statements. You could have made the same argument you are doing now. You could have contradicted me by saying that FP and Internists can perform more than the aforementioned procedures. You didn't do so because you understood that I was referring to routine procedures. Likewise, I think you should learn to make some logical inference based on the discussion.

The absolute statement I took issue with was simply that ECT was "rarely performed". There was no reason for me to argue about procedures FP and IM do and do not do.

I'm aware that ECT exists as a procedure. I'm also aware that it's not routinely performed. You are an attending at a hospital that performs it so you are in a unique position. Many hospitals don't offer it and many psychiatrists never receive training in it.

Then according to our accrediting organizations, their training is deficient.

From ACGME residency training guidelines:
b) Clinical training should provide sufficient
experiences in:
....
v) electroconvulsive therapy, a somatic therapy
that is viewed as so important that its
absence must be justified (Examples of other
somatic therapies include biofeedback and
phototherapy.);
(bolding my emphasis, wording is verbatim from the guidelines)

And the reality is that many psychiatrists will not perform it regardless if you did 52 in a given year. So for you to imply that a psychiatrist can simply adopt ECT to increase additional income doesn't make much sense. I really feel like you are arguing for the sake of argument. Also, while many cardiologists don't have cath labs on site, many hospitals do whereas the same can't be said of hospitals offering ECT.

I never implied that ECT was to be "simply adopted" to "increase additional income". I stated matter of factly that it is a procedure. (And I haven't gone back and edited my posts to further elaborate my points.) You made the inference about income, dear friend of psych. I have merely responded to the words you place on the screen.

Okay, since you are an attending, please tell us what percentage of psychiatrists perform ECT. You are an attending as you have mentioned on several occassions so why don't you tell us the answer to this You should know this right because after all you are the attending. After all, if a select number of hospitals and psychiatrists perform this, I hardly see how this is a routine procedure as you would put it. And in regards to "generalizing based on one's experience", can't the same be said of an attending who performs 52 ECT's a year at a hospital that just happens to offer the procedure. hmmmm

You cite numbers from 1980--more than a quarter century ago. More current estimates suggest that 100,000 patients receive it annually in the US. I do not have the numbers of physicians who do it at my fingertips, though I spent some time looking. I am sure it is a decent proportion of those psychiatrists with inpatient credentials. Merely to illustrate, not to generalize, from the case of our hospital, which "just happens" to do about 800 treatments on approximately 100 individual patients annually, but here 4 of our 10 inpatient staff rotate routinely on the service, and others are credentialled to do so. We are not in a "top 10" city by population, but at least 3 other hospitals within 10 miles of us also offer this service, so I continue to find myself rather amazed that you think me "unique". In the much smaller city where I trained, ECT was performed at all 3 hospitals in the county, and almost all inpatient psychiatrists I knew there were credentialled for it. I am aware that there is some regional variation in practice. I do believe that ECT will grow as more people are treated for depression, and as the more difficult-to-treat depressions filter through the multiple medication trials which are more "acceptable", and as more psychiatrists are properly exposed to and trained in the safety and efficacy of this modality of treatment. In saying it's not rare, I'm not saying that it's for everybody, but it's a vital part of psychiatric treatment.

Again, DebD, I apologize for the direction this thread has taken.

 

[OldPsychDoc]

sigh...it was a typo...I meant to wrint iNpatient not impatient. Nonetheless, it is funny that you assumed that I was genuinely referring to you as being impatient.

Just because the ACGME requires us to be competent in psychoanalytic therapies, doesn't mean that every psychiatrist will interpret every little parapraxis that comes along...

Of course, I do think that ECT is a good treatment for the impatient inpatient...!

 

[soopa]

why do some people say that psychiatry might pay less in the future? instead, i thought the opposite was occuring. I have heard many attendings say that their salaries are actually increasing.

check out this site
"Over the year 2005, the 2006 figures seem to have gone up by 5-10%."

http://mdsalaries.blogspot.com/2005/10/psychiatrist-salaries.html

 

[Doc Samson]

Psychfriend... you're hearing it from 2 asst mods now (us greybeards like to stick together): ECT is a commonly performed procedure. I know of at least 5 hospitals in Boston alone that have full inpatient and outpatient ECT schedules. 1980 was the nadir of ECT, it has significantly risen (and continues to rise) in popularity since it's safe, it works, and it works quickly.