I'm not sure I like being a doctor

[ConcertaisCandy]

What do you guys know of nonclinical positions for psychiatrists? I asked my adviser about this and seeing as how they've been in academia for their whole career, they weren't too knowledgeable about my options.

I just feel like I haven't really liked any of my rotations in residency or fellowship. I only look forward to days with a light work load or non-call weekends. The days leading up to call weekends are completely anxiety-ridden (even though logically I know that even if I'm busy it's really not that big of a deal.) Returning patient calls or seeing some of my poorly behaved patients with dysfunctional social situations makes me feel like Robin Williams' character in What Dreams May Comes when he's traveling through hell- all those moaning faces and hands trying to drag him down. I'm just sick of sitting through appointments listening to a litany of complaints and feeling completely impotent. I hate dealing with insurance companies and their denials or stupid hoops. I hate writing notes, perhaps more than anything else. All of these things will get worse when I'm an attending and my patient load balloons way past what a fellow would see.

Whew, that was a lot of whining, but the point I'm trying to convey is that being a clinician may not be right for me. I'm not interested in the tedium of research at all. Also it's nice to bitch anonymously.

Suggestions?

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[erg923]

What do you guys know of nonclinical positions for psychiatrists? I asked my adviser about this and seeing as how they've been in academia for their whole career, they weren't too knowledgeable about my options.

I just feel like I haven't really liked any of my rotations in residency or fellowship. I only look forward to days with a light work load or non-call weekends. The days leading up to call weekends are completely anxiety-ridden (even though logically I know that even if I'm busy it's really not that big of a deal.) Returning patient calls or seeing some of my poorly behaved patients with dysfunctional social situations makes me feel like Robin Williams' character in What Dreams May Comes when he's traveling through hell- all those moaning faces and hands trying to drag him down. I'm just sick of sitting through appointments listening to a litany of complaints and feeling completely impotent. I hate dealing with insurance companies and their denials or stupid hoops. I hate writing notes, perhaps more than anything else. All of these things will get worse when I'm an attending and my patient load balloons way past what a fellow would see.

Whew, that was a lot of whining, but the point I'm trying to convey is that being a clinician may not be right for me. I'm not interested in the tedium of research at all. Also it's nice to bitch anonymously.

Suggestions?

Nonclinicaldoctors.com

 

[thoffen]

Well you can work for the insurance companies and be on the other side of the denials and stupid hoops.

You can try to explore whether or not you think your anxiety around your job relates to something you have control over -- e.g. your specific job and not the career or an anxiety problem you have that you can get treatment for.

Forensic evaluations might be a better option since you don't actually have a treatment relationship and instead have a responsibility to render your opinions objectively (although it's even more writing).

You could switch to academia and be on a clinical / teaching track where you'd probably have to see a lot less patients and not need to do research but get paid less and still have to put up with plenty of political bull****.

For me, I balance the stuff you're talking about with therapeutic work. I find a purely therapist relationship with patients a place with much tighter boundaries to contain those frustrations. Mostly I just have to ask whether a patient is going to do something dangerous between now and the next time they see me and not get so anxious about what's happening in between or are things getting better. I still have to take stock into whether or not the therapy is right for them and my conceptualization of them is accurate, but real therapeutic effects are often subtle and involving a lot of appearance of 3 steps forward 2 steps back. Most of the best therapy involves simply tolerating frustration alongside a person and maintaining a stable relationship with them despite that. Sooner or later you'll look at things and realize they are doing that in their lives without you and something about the way they see themselves in the world is materially different than when they started. And then you'll have to think about termination.

 

[nitemagi]

Take a vacation.

As someone in the middle of some career transitions, I'm not moving into a new industry viewing it as any better. This is one of the most respected, humane, publicly beneficial jobs you could ever find. Every industry is a grind. The key, IMHO, is finding joy, gratitude and satisfaction in whatever you're doing. I would be clear as to whether you don't like clinical work, or if you're just burnt out and want a break from working in general. Which is understandable for all of us. It may very well be the former, but far more often it's the latter.

 

[Attending1985]

Have you thought about retraining in another field. I know all doctors listen to complaining but I think psych is unique in the severe degree of impotence and social dysfunction department.

 

[tr]

Returning patient calls or seeing some of my poorly behaved patients with dysfunctional social situations makes me feel like Robin Williams' character in What Dreams May Comes when he's traveling through hell- all those moaning faces and hands trying to drag him down. I'm just sick of sitting through appointments listening to a litany of complaints and feeling completely impotent.

You don't have to, and shouldn't, accept the idea that you are personally responsible for fixing patients' psychosocial issues. Instead, consider yourself a warm, supportive, and helpful guide along their path towards fixing their *own* problems. When a patient tells you about their dysfunctional social situation you should nod and express lots of empathy without offering any solutions. "It sounds like this is really difficult/troubling/frustrating/whatever." Then when they are done venting, ask, "It sounds like this is something that is really bothering you. Is it something you would like to work on fixing?" Sometimes people just want to vent, and if that's what is happening, allow yourself to take a warm and supportive but also uninvolved stance. This is not your problem, but you can help by listening empathetically. Or, if they have already expressed that they want to fix it, "What thoughts have you had about how you would like to address this problem?" This makes it clear that the responsibility is on them to fix their problems, not on you.

The stress comes from being made to feel a responsibility for problems that you have no way to fix. Taking the stance that these problems are *not* your responsibility, that they are the patient's to fix, will help you feel better and will help the patient take some agency for their problems and thus have a much better chance at getting them addressed.

 

[nitemagi]

I agree with tr -- with the addition that you should get into therapy.

 

[OldPsychDoc]

Well you can work for the insurance companies and be on the other side of the denials and stupid hoops....

...and be hated by your colleagues instead of your patients.

 

[smalltownpsych]

What do you guys know of nonclinical positions for psychiatrists? I asked my adviser about this and seeing as how they've been in academia for their whole career, they weren't too knowledgeable about my options.

I just feel like I haven't really liked any of my rotations in residency or fellowship. I only look forward to days with a light work load or non-call weekends. The days leading up to call weekends are completely anxiety-ridden (even though logically I know that even if I'm busy it's really not that big of a deal.) Returning patient calls or seeing some of my poorly behaved patients with dysfunctional social situations makes me feel like Robin Williams' character in What Dreams May Comes when he's traveling through hell- all those moaning faces and hands trying to drag him down. I'm just sick of sitting through appointments listening to a litany of complaints and feeling completely impotent. I hate dealing with insurance companies and their denials or stupid hoops. I hate writing notes, perhaps more than anything else. All of these things will get worse when I'm an attending and my patient load balloons way past what a fellow would see.

Whew, that was a lot of whining, but the point I'm trying to convey is that being a clinician may not be right for me. I'm not interested in the tedium of research at all. Also it's nice to bitch anonymously.

Suggestions?

Love the reference and have felt that way too. It took me four years of this current job with a 40 hour session after session grind including young kids and I don't even like working with young kids) to get burned out. Even with that, I still am helping a few patients each day and sometimes dramatic change. Most of the time during my training I felt that I was making a difference. I am not sure why you are feeling so impotent. I am kind of thinking that either no one is showing you how to do it or you are in the wrong career.

By the way, I just accepted a position where I won't be so overwhelmed by the moaning faces because I will be supervising other therapists, managing a program, and mainly working indiviudally for ten or so sessions a week with patients that I choose.

 

[LasVagus]

For what it's worth, I asked almost the exact same question about a year ago. Here is what people shared at that time: Alternative Professions for Graduating Psychiatrists
I'm actually feeling a lot better about being a psychiatrist these days.

 

[MedMan80]

I ran into similar challenges as you, but try to look at any positive aspects of the work you do, ie: helping a patient calm down their mania and the gratification you can receive from the family, the little thank you's you get here and there, all help make the job worthwhile...that and looking forward to the financial freedom you will get once out of training (assuming you're still in training).

 

[aim-agm]

Maybe try to set up an ECT gig? There's a lot of need, from what I've seen there's very limited discussion with patients, you're not impotent (fast and reliable results for what it works for), and it seems like a regular workday without need for much call.

 

[Monocles]

Well you can work for the insurance companies and be on the other side of the denials and stupid hoops.

You can try to explore whether or not you think your anxiety around your job relates to something you have control over -- e.g. your specific job and not the career or an anxiety problem you have that you can get treatment for.

Some of my academic attendings actually do this as their side gig (lol). Does anyone know how much it pays?

 

[FlowRate]

Some of my academic attendings actually do this as their side gig (lol). Does anyone know how much it pays?

Old article says ~$100-200 per hour: Medscape: Medscape Access

 

[HButler]

What do you guys know of nonclinical positions for psychiatrists? I asked my adviser about this and seeing as how they've been in academia for their whole career, they weren't too knowledgeable about my options.

I just feel like I haven't really liked any of my rotations in residency or fellowship. I only look forward to days with a light work load or non-call weekends. The days leading up to call weekends are completely anxiety-ridden (even though logically I know that even if I'm busy it's really not that big of a deal.) Returning patient calls or seeing some of my poorly behaved patients with dysfunctional social situations makes me feel like Robin Williams' character in What Dreams May Comes when he's traveling through hell- all those moaning faces and hands trying to drag him down. I'm just sick of sitting through appointments listening to a litany of complaints and feeling completely impotent. I hate dealing with insurance companies and their denials or stupid hoops. I hate writing notes, perhaps more than anything else. All of these things will get worse when I'm an attending and my patient load balloons way past what a fellow would see.

Whew, that was a lot of whining, but the point I'm trying to convey is that being a clinician may not be right for me. I'm not interested in the tedium of research at all. Also it's nice to bitch anonymously.

Suggestions?

I went to medical school to become a psychiatrist, became one, and decided at the end of the residency to retrain in another specialty. Psychiatry has helped, and I like the new field more because of it. My wife is a pediatrician from Austria who trained here.
Not to worry. You will figure this out.
H
Cell Phone: 757 377 7775

H. E. Butler M.D.,, F.A.C.S.,
Instructor, Psychiatry, E.V.M.S.
Commander, U.S.N.R., Fleet Reserve