I’m lost

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Kyle Broflovski

Kyle Broflovski

New Member
2+ Year Member
Joined
Mar 18, 2019
Messages
9
Reaction score
9
Members do not see this ad.
I’m a 3rd year medical student. After considering nearly every specialty I feel the greatest calling to psychiatry. I thought I wanted to do surgery or a specialty with procedures but through my rotations I’m finding that once the novelty and excitement of the surgery/procedure wears off it becomes more like drudgery. I find myself drawn to patients with depression/anxiety/mental illness etc. I’m interested in their stories and why they feel the way they do. I feel a strong urge to help them.

I’ve mentioned to my wife, my parents, and a few other students that I’m really interested in psychiatry. The response has been less than enthusiastic. “I thought you wanted to do surgery.” “Psych? That’s not really medicine is it?” “You won’t be able to help people if they get sick.” These statements are kind of getting to me. Did any of you go through the same experience?

I resonate with psychiatry and value the work/life balance. Since starting my journey into medicine my perspective has changed about what I value and want in life. I don’t think surgery and many other specialties fit with those values.

I know family medicine deals with a lot of psych related issues, but I’m not nearly excited about managing DM, HTN, back pain, what’s this lump on my arm, etc. as I am about mental health. However, I am strongly considering family med or IM fellowship tracks to “live up to expectations” and not “waste” my medical education.

I guess this post is more of a vent for me to get some things off my chest. I feel drawn to psych but other forces are pulling me away in different directions and I don’t know what to do.
 
Yes.

Now, remember, all things will become routine and a drudge. You need to wake up every morning when your alarm goes off and go do your work. Your family won't be you and living your life. Be true to yourself and chase the specialty you think is most likely to yield happiness. Happiness already a fleeting goal that is unlikely to be achieved anyways, so simply pick the flying contraption that will get you closer to the sun.

You don't want to be disgruntled 15 years from now scrubbing in for cholecystectomy thinking I pleased other people. Why didn't I do what I wanted?
 
Good vent, my man. If you did want some advice, I have some. I've seen so many different scenarios throughout the application/schooling/etc process that display this same problem.

For example: I want to go to X med school that I've been accepted to, but Y medical school that I've also been accepted to is much more prestigious and the diploma would look a lot cooler on my office wall. Another example: I hate doing research and don't want to do any in medical school. I would love to do family medicine, so I don't need to do research, but every other med student is doing research and will be a better applicant to the surgical residencies so I probably should too so I don't look like I'm lazy.

My advice: do psychiatry, for goodness sake! It may feel like a shot to your pride right now, and that's hard to take, but once you're in the world of psychiatry you won't feel that way. You'll be challenged, you'll be well-compensated, you'll have countless opportunities to gain respect and admiration in your field and in the community where you practice, and - most importantly - I'd bet you anything that not a single one of your future patients will feel that you "wasted" your medical education.
 
A few things I wanted to say from reading your post:

1. This is not a unique occurrence. Often times you realize you want something different with your medical education, and if its psych, its not unusual for people to respond as you've described. That doesn't really matter. Only you will have to live with your career. You might have to live with comments, but when its all said and done, who care if you're happy doing what you're doing.

2. When you say you are interested in their stories, I think you described one of the best things about psych, and I would encourage you not to let that go.

3. When you say you have a strong urge to help them, just make sure you're not dipping into countertransferrence. Wanting to help patients is one thing, but over-identifying with them or feeling the need to be their savior is dangerous territory. That's not psychiatry, and if anything can be even worse for a vulnerable population.

4. When it comes to "wasting" medical education, I think this depends heavily on how you practice, and I know quite a few psychiatrists that very much do not do that in any way. Even the ones who don't touch anything basic medicine related are actively using what they've learned. This becomes less of an issue the further you go in training. You will lose some of your training with every specialty no matter what you do.

5. There are IM-Psych/FM-Psych options if you're interested in that, but from the sound of it you'd only be doing it to either appease others or make it feel like you are using your training, in which case, I would recommend against doing combined training for those reasons.

In the end, the decision is yours, but I will say you are not alone in your worry and are not the first person experiencing it. Most people are happy with the choices they make for themselves. You need to choose what you actually want to do for yourself, not for others, they won't be there on those tough days.
 
Went through it myself. Wanted to do a procedurally heavy specialty at first. Then wanted to do radiology. Felt like I would be giving up true medicine if I went into psychiatry. That feeling quickly went away during my first week of residency.

You and your family/friends are right, but only partially. You do give up some aspects of medicine. If you become a psychiatrist, you will almost be guaranteed that you won't get to perform surgeries (other than ECT) anymore. You won't get to sit in a room reading film after film. You won't get to intubate trauma patients or fix broken bones. You most assuredly give up something when you differentiate and become less pluripotent after medical school. This is the primary psychosocial developmental conflict of a pre-match, third year medical student.

Where you are right and your wife, parents, and other medical students (unfortunately) are wrong is that psychiatry is not medicine, that you won't get to help sick people. that comes more from a place of ignorance of the public perception of psychiatrists. Here are reasons why they are wrong:
  1. As physicians, we ascribe to the medical model of diagnosis and treatment.
  2. There are 120+ medicines that are considered psychotropic and many others that are commonly used (e.g., metformin for antipsychotic induced weight gain, statins for high cholesterol from antipsychotics, beta blockers for lithium induced tremors, etc). I'm excited by the renewed interest in psychedelic and other forms of psychiatric treatment (ketamine, LSD/psilocybin, MDMA, TMS). You definitely practice "medicine" because you will be prescribing all kinds of medications.
  3. I regularly order labs for my patients to evaluate their thyroid function, vitamin B6/12 levels, liver function tests to determine any drug-induced hepatocellular vs cholestatic injury, ECGs, MRIs of the brain, and more recently, EEGs and autoimmune encephalitis panels.
  4. I treat patients who have addiction to all kinds of substances as well as overdoses from illicit substances or prescription medications that can cause all kinds of toxidromes.
  5. On the other hand, psychiatry is so much more than the medical model. That's what drew me into it. There's no one explanatory model for the kinds of suffering that is characterized by the human condition. There seems to be no limit to the span and breadth of human misery from problems in living, to behaviors, to disorders of thought and emotion, to frank diseases of the brain. We draw on multiple explanatory models (neurobiological, psychodynamic, cognitive behavioral, systemic, feminist psychology, social constructivist, social realist, cultural, postmodernism, etc) to make sense of people's problems.
  6. If you're interested in the patient's stories and why they feel the way they do, you'll find much satisfaction in psychiatry as the most effective interventions are not always the ones that are pharmacological, rather they can be psychological, behavioral, social, spiritual, and environmental.
Your work life balance will definitely be much more easily found in psychiatry than your colleagues in surgery, even during residency/fellowship, but especially as an attending. That doesn't mean that those in surgery or other fields won't find their balance, but that it's probably a bit more tough.
 
Last edited:
I wanted to go into psychiatry but I had faculty, family, and even my mother asking me why and it was a waste of my talent. I went full ahead and have no regrets. If you do consults, I promise you will use your medical knowledge or even on an inpatient unit. I often times manage HTN, DM, GERD, UTI, pain, etc.

I do just enough medicine to make me happy I am a psychiatrist!
 
I find that others will comment no matter what you choose.

Plastic surgery: So you don’t want to actually treat any real illness?

Pediatrics: All of medical school to be paid the least?

ER: You plan to be an advanced triage nurse?

Radiology: Couldn’t figure out how to do a physician exam?

All that really matters is doing what you enjoy. The comments, good and bad, will always come from critical people. You have to do the job for the long haul. You should enjoy your next 20+ years.
 
All residencies are hard. Being in a specialty you don't actually want to be in is hell. Your family doesn't have to show up to your work every day. With the extra time you'll have in psych residency you can find a good therapist to process these issues (only partly joking, here).
 
I would not focus on BS reasons like uninformed opinions from family members.

If we break down the BS here are the bottom line points: I would not do IM. If that was your choice.

Right now psychiatry as a field is having a resurgence after a long lull and is growing in "fanciness" and competitiveness, and all indication says this will last another decade at least until NPs take over and the job description changes.

Informed people in medicine (i.e. US medical school grads) now think of psych as a fairy fancy mid-tier competitive lifestyle subspecialty. IM has a much worse reputation, and deservedly so. The median general IM job is inferior in every way conceivable, and desirable specialties have long training tracks and often worse lifestyle after. So unless you like the actual content of IM, it's not a worthwhile pursuit. Especially with recent cycles (~ last 5 years), the quality of students in psych improved substantially and everyone in the system is aware. With that the "respectability" factor also improves. Especially in high-end programs, a large portion of the IM residents are now lower quality students. Everyone knows this (few say that out loud...) Psych residents I've seen in the hospital are starting to act more and more like derm and ophthal residents. I'm not even joking. It used to be that psych residents feel bad about not knowing internal medicine, now they just don't care--do derm residents care? It's not a very value-add knowledge-base.

Psych also has a very high degree of institutional flexibility which is rare in other specialties.

Surgery in general is just very different experience/career. Subspecialty surgeries are probably still superior to psych, but general surgery is also frankly a worse job. They also aren't all that well respected in the hospital. You can very easily out-earn a general surgeon and do sort of fancier sounding things as a psych.

My mom also didn't not like the idea that I went into psych. She is now constantly in shock of how much money I make (and more than other doctors she knows). You need to learn to cut the BS out in life.
 
Last edited:
I had similar reactions when I decided on psychiatry and my parents didn’t seem to understand that psychiatrists were MDs. That said, who cares. I agree with the sentiment of others - at the end of the day, you’re going to be the one doing the work for 30+ years, so your opinion is what matters most. In the rat race of trying to get into the highest paying, most competitive specialties, I think a lot of medical students lose sight of the fact that you have to be truly interested in your work, and something about the work has to captivate you, otherwise you’re going to burn out.

There were a few fields that interested me in medical school - I loved my surgery rotation and, in another life, probably would’ve been a surgeon. I had zero interest in psychiatry and had never considered it before my clerkship. A lot of what drove me to psychiatry was very pragmatic: it was a relatively less competitive specialty which meant that my wife and I would have a better chance of going somewhere we wanted to go for residency, I liked the idea of being able to start a private practice relatively easily, and the work/life balance was a draw, though I have ended up basically working like a surgeon.

Medical school is not well-tailored to preparing you to be a psychiatrist. You get such little exposure to the field and the entire educational track is designed to prepare you to enter just about any other field of medicine. I empathize with what I’m reading between the lines to be a sense of feeling that your medical education would be “wasted” if you go into psychiatry. That really isn’t the case, especially if you work in a more acute setting (e.g., C/L, inpatient). I think your experience is pretty common. I certainly went through it. Now that I’m done with training and out in practice, I have no regrets about my decision and love my job and what I do.
 
Very normal to feel, OP! Looking back, the stigma and lack of prestige with psych was the major factor I had to get over in choosing it.

Here's a little anecdote about what helped me realize how miserable you could end up if you prioritize prestige when making life decisions: I was doing a sub-i for EM as a 4th year. I was staying with my sister in law, who hosted a cook-out with a bunch of their friends. People were going around the table sharing their professions, and when it got to me I was able to say that I was applying to be an ER doctor. This got the "oohs and ahhs" I was expecting and enjoyed, but guess what?...those lasted about 10 seconds and about an hour later I had to leave the party early to do a miserable overnight shift in the ED.

Now, that prestige-focused neurotic medical student culture feels like a distant memory. Good on you for seeing it, and for realizing how sucky life can be if you're basing you're life too much on the opinion of others.
 
As someone who was fairly recently in your shoes, I experienced the same questioning from family (even with a psychiatrist in the family!) and some attempted to pressure me to do IM or some other specialty. Glad I stuck with what I wanted.

I'm sure there's someone out there that chose psychiatry over other specialties and regretted it, but I have never met that person and honestly, wouldn't be surprised if I never did. I have already met several people who were in other specialities and switched to psychiatry, some of whom had the same thought/decision process you're having.

As others have mentioned, your priorities change every few years and unless you're very unhappy 5-10 years from now, chances are this decision will occupy very little of your brain space. I can't remember the last time I thought about "what if I went into another specialty" - if anything, I see my non-psychiatry MD colleagues working 24-hr medicine shifts, always on call, etc and am grateful I didn't choose that path.

If you really think you'll enjoy the work and it feels like more of a calling to you than other specialties, go with your gut - worst case it ends up being "just another job" but at least you have the work/life balance to find fulfillment in other activities while making a great salary. More likely though, you'll find that like many of us, you learn a great deal about yourself and the people around you and find that you can help patients in ways that few others can. I like to think of my job as helping people improve/regain mental ability and function, and there's been very few things that are as fulfilling as helping someone "do better" at life.

Long story short - go with your values!
 
People always make dumb comments. It's hard as a student not to be affected by them. Much of this because the stigma of mental illness is alive and well, and psychiatrists are tarred with stigma by association. Many people still feel very uncomfortable talking about emotions, personal struggles, and personal or family history of mental illness. That is what drives people to denigrate psychiatry. It doesn't help that there are also a lot of bad psychiatrists out there and it doesn't have the best history as a profession. That can lead some people to be dismissing or disparaging of psychiatry and psychiatrists. However, if you do good work you will be highly sought after and highly respected. It also doesn't hurt that if you do good work, people will be willing to pay top dollar for that work.

But ultimately what matters is whether you feel excited and passionate about what you do. That will ultimately get you through the burnout and dark days that are part of the warp and woof of medicine, regardless of specialty. I hope in time that your family will be able to share in that excitement with you too.
 
rjs2131 said:
I'm sure there's someone out there that chose psychiatry over other specialties and regretted it, but I have never met that person and honestly, wouldn't be surprised if I never did. I have already met several people who were in other specialities and switched to psychiatry, some of whom had the same thought/decision process you're having.
Click to expand...
I think the reason few people regret choosing psychiatry is not because psychiatry is so inherently awesome, but rather because fewer people have historically chosen it for the wrong reasons. Most people who go into psychiatry either went to med school in order to become a psychiatrist, or had to do some soul-searching. I expect this will change as psychiatry has become more competitive and thus a more acceptable choice (as a semi-prestigious lifestyle specialty) in some peoples' eyes.
 
Old&InTheWay said:
I think the reason few people regret choosing psychiatry is not because psychiatry is so inherently awesome, but rather because fewer people have historically chosen it for the wrong reasons. Most people who go into psychiatry either went to med school in order to become a psychiatrist, or had to do some soul-searching. I expect this will change as psychiatry has become more competitive and thus a more acceptable choice (as a semi-prestigious lifestyle specialty) in some peoples' eyes.
Click to expand...
Historically a large chunk who choose Psychiatry was because its lack of competitiveness and there wasn't much choice in the matter, especially for a lot of IMG. I know of one person who wanted to be IM subspecialty but settled for Psychiatry and loathed it.
 
Sushirolls said:
Historically a large chunk who choose Psychiatry was because its lack of competitiveness and there wasn't much choice in the matter, especially for a lot of IMG. I know of one person who wanted to be IM subspecialty but settled for Psychiatry and loathed it.
Click to expand...
This is something I noticed early on in medical school when I began to look into psychiatry in earnest (this was 6+ years ago), however there seems to have been a significant shift since then as it's become (slightly) more competitive. Certainly what Old&InTheWay mentioned may become an issue, but from what I can tell a vast majority of my fellow residents specifically chose psychiatry for their interest in the field and desire to focus on more comprehensive approaches to health care (of course there will always be exceptions). Like everyone else mentioned, there's ample opportunity to flex your medical muscle in any setting where you'll be prescribing medications and it'll be up to you to decide to what extent. If you are certain of your interest in the day-to-day work of being a psychiatrist, then the opinions of your (possibly well-meaning but nonetheless uninformed) family/friends should take a backseat.
 
Kyle Broflovski said:
“I thought you wanted to do surgery.” “Psych? That’s not really medicine is it?” “You won’t be able to help people if they get sick.” These statements are kind of getting to me. Did any of you go through the same experience?
Click to expand...

I also did, and I'll admit that some of my preconceptions of psych during pre-clinical years were along those lines. These are statements that are made out of ignorance and those who only have a Hollywood understanding of what psychiatry is. As others have said there is plenty of medicine in psychiatry. If you're a decent psychiatrist, you'll still have to retain some knowledge from other fields as you'll at least need to know medication interactions (assuming you're prescribing meds).

Kyle Broflovski said:
I resonate with psychiatry and value the work/life balance. Since starting my journey into medicine my perspective has changed about what I value and want in life. I don’t think surgery and many other specialties fit with those values.
Click to expand...

Very few fields consider <40 hours a week to be full-time and you can easily make $200k+ doing that in psych, likely over $250k. If you want to make surgeon money in psych, you can do it if you're working surgeon hours. I'd rather take $250k/yr working 30-35 hours a week than $350-400k/yr working 55+ hours. If you value work/life balance and enjoy the field, it's likely the best choice in terms of happiness.

Also, there are very few docs making significantly more than others doing clinical work. Those who are killing it financially are doing it either through managing/owning their clinic(s) or through passive income/projects outside of medicine. Very few fields allow the time to start another business on the side or work on other projects like psychiatry. I'd argue that those who are truly financially savvy would find the work schedule in psychiatry very attractive.

clozareal said:
  1. On the other hand, psychiatry is so much more than the medical model. That's what drew me into it. There's no one explanatory model for the kinds of suffering that is characterized by the human condition. There seems to be no limit to the span and breadth of human misery from problems in living, to behaviors, to disorders of thought and emotion, to frank diseases of the brain. We draw on multiple explanatory models (neurobiological, psychodynamic, cognitive behavioral, systemic, feminist psychology, social constructivist, social realist, cultural, postmodernism, etc) to make sense of people's problems.
  2. If you're interested in the patient's stories and why they feel the way they do, you'll find much satisfaction in psychiatry as the most effective interventions are not always the ones that are pharmacological, rather they can be psychological, behavioral, social, spiritual, and environmental.
Click to expand...

This is also something I love about psych. Patient stories (especially psychotic patients) are fascinating to me. Psych allows and actually encourages this aspect of history where most other fields don't. The biopsychosocial model of healthcare is essential for some patients, and I think some other fields tend to miss the psychosocial aspect of treatment too much.

Adding to the above, one of my favorite things about psych is that I fairly frequently get to take patients off of meds. Over-prescribing or inappropriate prescribing is too common in our field, and patients are (almost) always grateful when I tell them they only need to take 2 pills per day instead of 10. Along the same lines, sometimes meds aren't needed in the first place and when you get a patient the right resources (usually with plenty of help from case management/social workers) it can completely turn someone's life around. I do love the pharm side of psychiatry, but being able to help patients in many other ways as well is rewarding in a unique way that I never really felt in other fields (other than occasionally in PM&R).
 
TexasPhysician said:
I find that others will comment no matter what you choose.

Plastic surgery: So you don’t want to actually treat any real illness?

Pediatrics: All of medical school to be paid the least?

ER: You plan to be an advanced triage nurse?

Radiology: Couldn’t figure out how to do a physician exam?

All that really matters is doing what you enjoy. The comments, good and bad, will always come from critical people. You have to do the job for the long haul. You should enjoy your next 20+ years.
Click to expand...

I've found that true for nearly every field but I have not heard hardly a single peep from anyone about trauma, neuro, CT, transplant. or vascular surgery (other than God complexes to varying degrees but certainly not lack of skill/prowess). I can't imagine picking my specialty based on how cool other people think you are, but if that's you I highly recommend one of those five fields. Let us know how it's going on year 2 of 24 hour call.
 
Merovinge said:
I've found that true for nearly every field but I have not heard hardly a single peep from anyone about trauma, neuro, CT, transplant. or vascular surgery (other than God complexes to varying degrees but certainly not lack of skill/prowess). I can't imagine picking my specialty based on how cool other people think you are, but if that's you I highly recommend one of those five fields. Let us know how it's going on year 2 of 24 hour call.
Click to expand...

No field is immune.

Want to know how the divorce process goes? Go talk to the trauma surgeon on call again.

Any cardiovascular surgery field is on life support. Interventional cards and interventional rads are stealing your turf.

Ever told someone they aren’t getting a transplant and options are out?

Neuro and oncology lead the depressing competition. A clinic full of dementia, stroke, and Neurodegenerative conditions is rough if you don’t absolutely love it.

The above is not trying to belittle any field. All medical specialties have merit. No matter what you choose, there will be people that greatly appreciate your work and those that wonder why you made such a “poor” decision. You won’t escape the comments in any field. My buddy is a pediatric hand surgeon. He still gets them.

Ignore the noise and choose whatever you enjoy, whether it is psych or anything else.
 
From a reddit post a while back:

Gas? lol good luck w/ CRNAs and never getting recognition, say bye-bye to ur job / lol surgeon's bitch / lol what do you even do?
Derm? lol nice job $elling out / lol u were one of those bitchy mean girls in high school, huh?
EM? lol have fun dealing with the dumping grounds of the US healthcare system and never actually fixing something interesting / lol with all the **** you take from everyone you might as well have been a gastroenterologist
FM? lol u dumb?
IM? lol you're probably at least 27 years old, stop delaying specialty decisions and actually pick something, you're an adult / lol gl with a ****ty job if you don't get fellowship
IM-Peds? lol even worse than IM
Medical Genetics? lol this is an option? should've just been a phd, broski
Neurosurg? lol i can hide a $20 bill from you by taping it to your kid's head, anyway when's the divorce?
Neuro? lol couldn't cut it for neurosurg, huh?
OB/Gyn? lol way to be a stereotype, lady / lol get ready to have patients hate you and thinking you're creepy for having a penis, my dude / lol not a real surgeon
Ophtho? lol glorified optometrist / lol good luck with cataract surgeries all day every day / lol lemme guess, daddy's an ophtho?
Ortho? lol HURR DE DURR DE DURR DE DURR ME CUT GOOD-LIKE
ENT? lol not a real surgeon, have fun with the flaps / lol nosejobs much?
Path? lol nerrrrrrrrrrrrrrrrrrrrd, no jobs 4 u
Peds? lol good luck with ****ty parents / lol way to be a stereotype, lady / lol get ready for being accused of being a creep, my dude, better have a lady scribe with you at all times, lol she might have a better salary than u too
PM&R? lol physiatry? what is that like podiatry? lol what do you even do?
Plastics? lol boobie jobs much?
Preventative Medicine? lol not a real doc
Psych? lol afraid of procedures, gl w/ the crazies / lol not a real doc
Rad Onc? lol all ur patients die
Rads? lol get back to the basement, nerrrrrrrrrrrd. you'll be replaced by an AI or some teleradiologist in god-knows-where, anyway
Gen Surg? lol get ready to hate your life, bitch
CT Surg? lol get ready to hate your life even more, bitch
Vascular Surg? lol get ready to hate your life even more, bitch
Urology? lol what's with the dick obsession, homo / hussy / creep?
Other [combined] specialty? lol stop trying to be such a special snowflake, there's no job market for you
 
I think the OP's experience is more common than not in terms of family. If you really feel the need to debate this with them, go over the actual lifestyles and work hours of a surgeon or internist. Psych beats them hands down and even more so when you take in pay per hour. I think a lot of my family wanted free medical care and advice. Well, that shouldn't be happening anyways, regardless of specialty and everyone, even the FP, is going to be limited in terms of what they can offer. The OP sounds like they are going to be pretty miserable in something other than psych, so if you can match into it and it's definitely not a guarantee any more, you really should.
 
I was in a similar position between anesthesia and psych with peer and family pressure to not do psych. I matched into anesthesia first, hated it, dropped out, reapplied to psych and am much happier in my work life now.

However, when I'm not at work, I wish I could say I was an anesthesiologist. My social and dating life was easier when I was an anesthesia resident. It feels like people put expectations on you when they find out you're a psychiatrist, as if I'm a pastor or a priest or something.
 
Man I had the same dilemma and I'm so happy I am doing psych. Stuck between gas and psych. End of the day, waking up early, answering to surgeons, blah blah blah....this just did not compare despite the fact I found the physiology really fascinating.

You can so easily find jobs working from the comfort of your home with benefits, other plentiful locums jobs at 200/hr, and a multitude of practice options not found in other fields. Pulling 400 doing locums is very easily achievable and that leaves plenty of time to do other stuff particularly when you're doing 4x10s which seems to be very common these days. Psych all the way.
 
neverdone said:
However, when I'm not at work, I wish I could say I was an anesthesiologist. My social and dating life was easier when I was an anesthesia resident. It feels like people put expectations on you when they find out you're a psychiatrist, as if I'm a pastor or a priest or something.
Click to expand...
That's hilarioius. And btw, you kinda are, just the kind that actually generates value and gets paid a lot more for it.
 
sluox said:
That's hilarioius. And btw, you kinda are, just the kind that actually generates value and gets paid a lot more for it.
Click to expand...

It's not for nothing that E. Fuller Torrey wrote a book called "Witchdoctors and Psychiatrists." Very intensive specialized therapies are one thing but what is Never-Ending Supportive Therapy if not filling in for the agony aunts or community mediators of yore? Priests with a prescription pad is not a terrible summary of outpatient psychiatry.
 
To all MS3s who like psychiatry and are afraid to drink the Kool Aid. Your family's success in instilling high expectations have helped to drive you to this impressive position. The value of that motivation has worked well for you but it will have diminishing returns and you should consider your personal individuation relative to those who don't get into medical school. If you are like the majority of MS3s, you have never been a rebel and you are adverse to disappointing anyone in your support system. The flip side is that if you let this stable and successful family dynamic continue as it steers you into a lifetime of doing something you don't like and if it will make you bitter for life, that will be on you. Go with your gut and do what you want. Have confidence that you aren't a failure. If your family is disappointed in your becoming a psychiatrist, they are the dysfunctional part of your relationship with them.
 
If you’re an M3 reading this don’t go into a field that can be overtaken by mid levels. Go do something where the bread and butter is elective procedures.
 
ThatSerb said:
would what be an example of this?
Click to expand...
Many examples above. Evaluating clozapine effects with regular ANC/CBC, differentiating side effect from BEN. A1c and lipid screening for neuroleptics, and initiating metformin or statins when necessary. The biggest thing being differentiating psychiatric illness from underlying medical illness (e.g. screening for hypo/hyperthyroidism in the cases of depression/panic attacks, among many others, etc). You are still a doctor even if you are strictly doing even outpatient psychiatry.
 
There hasn't been any practicing psychiatrist who hasn't found themselves over their head at least once while in practice. If you take the term mid level concretely, they are probably over their heads more than half the time. I think psychiatry is relatively impervious to med level take over. If we doubled in numbers and gave up a quarter of our pay, there wouldn't be any mid levels in the field.

I'm not suggesting we do this, but I am saying we should not become chicken little over this issue.
 
MisterKitty said:
If you’re an M3 reading this don’t go into a field that can be overtaken by mid levels. Go do something where the bread and butter is elective procedures.
Click to expand...

Even these may not be safe in the future. There are (very few) NPs performing cardiac caths, and "aesthetic"/derm clinics are extremely popular with NPs and NP students right now. Outside of complex surgical subspecialties that absolutely require that knowledge (neurosurgery, CT surg, transplants, etc) no one is completely safe, even procedural fields.

That being said, for many reasons already stated here and in other threads, I'm not particularly worried about mid-level encroachment in psych in the next decade, and if you make yourself indispensable with unique skills, you'll never have that concern.
 
*Snape voice*

I can give you pills that will reshape the mind and alter the senses. They'll battle childhood demons, kill cravings, give an unparallelled sense of calm, or kill you if you don't follow my instructions to the letter. Still think I'm not a doctor?
 
Last edited:
You must log in or register to reply here.

Similar threads

milan95
Do child psychiatrists actually make up for the “lost” attending year from fellowship?
Replies
9
Views
1K
clozareal
clozareal
T
Paid off 220k loans. I’m finally free!!!!
Replies
6
Views
1K
finalpsychyear
F
lockian
Another I’m getting close to burnout post
Replies
46
Views
3K
smalltownpsych
smalltownpsych
H
  • Locked
I barely passed Step 1 (194) and I’m so disappointed. Is there still hope for me to match?
Replies
3
Views
2K
smq123
smq123
C
Lost my first patient
Replies
10
Views
3K
Messerschmitts
Messerschmitts
Top