I'm torn between FM and Psych :(

[deleted1178095]

So I never thought I'd be in this situation but here I am.

Fourth year dual applying psych and FM (combined is not an option for me). Started medical school stuck between the two. Same situation now despite having more info about both specialties.

At this point I have interviewed at great programs for both specialties, none are very prestigious but they're community programs that have exactly what I want from either specialty. And maybe everyone feels this way, but a couple of my interviews went really well at my top choice programs in both specialties and I have compelling reason to believe I could match whatever specialty I rank #1 based off of conversations with PDs and other ties and stuff.

The dilemma stems from my perception that...

• if I chose Psych, it would be great pay for a phenomenal lifestyle starting as soon as next July and then onward through the rest of my life. I love the cases and atmosphere too, and I would want to do acute inpatient and dabble in outpatient. I would live in the city and have great money and what I perceive to be a pretty easy job (all just my subjective opinions), but, I definitely wouldn't feel like "a doctor" and I would be missing some small piece of me that wants to be super practical and know how to handle a lot of medical things and still do physical exams and just walk around the hospital and clinic and be an ordinary freaking doctor... Like I hate to say it, but some stuff in psych just seems kinda BS? lol. Like for better or worse, and I really like psychopharm. So not trying to offend anyone but I think you get what I mean. ... And then,
• if I chose FM, it would be pretty good pay but at the expense of being brutal in residency and then being way harder than psych (again, IMO) on a day to day basis in life. CAVEAT: I am only considering rural and full spectrum programs though, so I am talking about doing inpatient/outpatient and at least during residency some OB and ER and stuff. FM is really appealing to me given the scope I can practice it in smaller towns, but also I know that getting myself up to that knowledge level would be absolutely brutal for me. I mean learning to run codes, read EKGs, deliver babies, inpatient/outpatient... all the stuff that makes me want to do it is the same stuff that would make it hard. I'm not opposed to working and getting up to that level, I even kind of like the idea of just being put in the middle of it all during intern year, but **** compared to psych it's like I would be kissing that perfect lifestyle goodbye and trading lifestyle for what *might* be a more fulfilling day-to-day job? I'd also be kind of pissed that as a PGY-2 FM I'd still be busting my ass learning all this stuff while PGY-2 psychs are moonlighting and nearly making attending salaries. And not to mention, FM means I would be living in a small town (which I am used to and do enjoy), its just that still the two are just so different and my type A personality wants to know what's in store and what to look forward to already.

Basically I can picture myself doing either one, but it means imagining the rest of my life two completely different ways which makes it difficult and you should feel bad for me xD... Also I'm already somewhat of an imposter, and then I read these threads of people saying FM isn't really qualified to do OB/ER/etc and that my patients are gonna get **** care and OB cases are gonna go wrong and babies will die and I'm just like yea, nope nope nope. Let me talk about feelings and crap instead.

So I'm trying to picture how I'd be thinking if down the line I chose the wrong specialty and was having a midlife crisis. If I went FM, I'd be thinking "wow psych was getting more competitive and I gave up the chance to match--its such an easy lifestyle and great pay and I could've been working on my hobbies and myself and getting fit and living life more instead of getting **** on by residency/paperwork/other specialties." If I chose psych it would be, "Ok work is boring maybe I'll start a private practice or retire early and do something else entirely, and maybe I should've been an FM doc and I'd be working hard but happier in my job and really know my **** about medicine and be picking up inpatient shifts and grinding and being the family doc of some small town."

FYI if I had to only do outpatient FM clinic the rest of my life then I would rather do psych, but like I said the rural programs I'm looking at train you to do so much more and those are the only places I'm considering. Also with FM I could do Doctors Without Borders and stuff like that that really interests me

TLDR **** idk. I guess I'd be happy either way but I have to rank programs eventually and it's killing me. I'll go on some auditions and do second looks at programs and maybe that'll sway me one way or the other. I just hope I don't make a huge mistake (((

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[cj_cregg]

I'm a new attending doing rural FM with clinic, inpatient coverage for my own patients, and prenatal care (but no deliveries). Also doing some global health work internationally. The way my practice is set up I have a VERY cush schedule, no nights/weekends, 40 hrs a week or less, etc. Residency was tough but I'm glad I did it now that I'm on the other side. Loving the work I'm doing. Feel free to PM me if I can give you any insight that may be helpful!

 

[mistafab]

GO with where your passion is. If it is FM, then do FM.

Again and again, people that love their jobs tend to earn more money and be more satisfied. If you love FM, you will figure out how to make the life/balance work and get the money you want.

 

[Waraba]

I know someone who faced this same decision. Liked psych and found it interesting but chose FM. IIRC it was mostly because of an impression that treatment options were mostly drugs that (perhaps) had bad side effects. And, to a lesser degree, because of an apprehension about years of dealing with psych patients.

 

[RangerBob]

They’re both great options.

Sounds like you’d probably be really happy in both, but always wonder if the grass was greener on the other side. I know I still wonder at times (I was torn between PM&R and psych).

So it’s really a question of which specialty would you be slightly happier in. Which one would you prefer to be in, doing the same thing/Rx’ing the same treatments for a few decades.

I felt the medicine side of things would get kind of boring/mundane, and the “art of medicine” and interaction with my patients/staff would be what kept me going.

 

[PathNeuroIMorFM]

Both have comparable lifestyles (or lifestyles that can be customized).

Both have great residency options.

Both can do inpatient and outpatient work.

Both are badly needed (and better compensated) in rural areas.

Both are "real-medicine", although you get a lot more IM-esque medicine if you do a consult-liaison fellowship for psych.

Both earn a comfortable salary that ranges based on your willingness to increase output, setting, and

Moonlighting does not earn near an attendings salary.

Go with passion.

 

[deleted1178095]

Thanks everybody 🥲

 

[pazzer2]

If you train in FM, its possible to tilt your practice towards psych. I knew one FM attending who did that. He mostly saw depression, anxiety, substance abuse, ADHD. Also did group and individual therapy. It takes a while to build up a practice like this. But he devoted prob 3 days a week to psych related stuff, and the rest of the time was standard FM.

 

[Mad Jack]

Your major draw to psych appears to be the lifestyle. As an attending inpatient psychiatrist, I've got to say there are a lot of misconceptions about what an inpatient psychiatrist does and can do. I medically manage all of my patients, and can request help from the hospitalists if needed, but I'm expected to still have the basics down, as well as how to work up typically encountered issues. I had your same concerns about not feeling like a doctor, but when you're doing consults and the primary team is struggling with something that is basic within your skillset, you realize just how valuable your skills and knowledge are.

And inpatient looks easy to a medical student, but there is much to be done that is often behind the scenes. Contacting lawyers, obtaining documents, trying to dig up collateral in more unusual cases, coordinating complex medical care, and providing guidance and reassurance to families are tasks that are critical to making sure quality care is being provided to my patients that students and even residents rarely see. You could be a half-day sort of attending that does clinic in the afternoon, but I prefer fully investing myself in more complex inpatient cases.

That being said, if a mix of psychiatric care, medical care, legal wrangling, care coordination, and working with families sounds less appealing than the diverse and broad experiences of FM, do FM. Ultimately only you can answer whether you're more a med or psych applicant. One thing I've noticed over the years, however, is that every person I've ever met that was dual boarded chose psych as their ultimate career aside from one guy that was neuro/psych and clearly should have been a neurologist. Most psych people couldn't deal with the day-to-day of medicine and vice versa (something many dual and triple boarders quickly figure out), so you have to think about where you'll thrive.

 

[ooh a bean]

You sound like you are more passionate about FM than psych, which imo makes the choice pretty clear.

 

[Osminog]

I definitely wouldn't feel like "a doctor" and I would be missing some small piece of me that wants to be super practical and know how to handle a lot of medical things and still do physical exams and just walk around the hospital and clinic and be an ordinary freaking doctor... Like I hate to say it, but some stuff in psych just seems kinda BS

Listen to that small piece of you. If you want to be able to do full physical exams, review a broad range of labs/tests/images, perform medical procedures, etc., then psychiatry may not be a great fit for you. You say that you want to "know how to handle a lot of medical things," so would you be fulfilled by a career as a specialist—let alone one who specializes in matters that are often not even perceived as "medical" by the healthcare community at large?

A career as an attending in family medicine can be very lifestyle-friendly.

You will be in this profession for decades of your life. Don't choose a specialty based on how easy or difficult you expect residency would be. Pursue the specialty that would offer you a fulfilling, purposeful career that you'd be able to look back on fondly.

 

[esob]

And inpatient looks easy to a medical student, but there is much to be done that is often behind the scenes. Contacting lawyers, obtaining documents, trying to dig up collateral in more unusual cases, coordinating complex medical care, and providing guidance and reassurance to families are tasks that are critical to making sure quality care is being provided to my patients that students and even residents rarely see.

This ^. I still send my medical students out by noon a lot of days, but I am still working til 5-6 pm. Some of the above, though, depends on your institution and program. Where I'm at, none of my attendings do any of the "scut" work (calling collateral, getting records, consulting other services), as those are the domain of residents.

 

[Mad Jack]

This ^. I still send my medical students out by noon a lot of days, but I am still working til 5-6 pm. Some of the above, though, depends on your institution and program. Where I'm at, none of my attendings do any of the "scut" work (calling collateral, getting records, consulting other services), as those are the domain of residents.

I could have others do it, but I tend to prefer hearing important collateral first hand, especially if it is a case that might require a hearing. I've got social workers for the routine stuff, and I have residents for prior auths, contacting pharmacies, etc

 

[annoyedpsychiatrist]

Im a psych attending. There is no attending job that is "easy" there are just jobs and specialities that are likely less stressful than others. Psych has a good lifestyle but it has its own stress at times. Easy patients tend to be more outpatients in a private clinic, but you compensate for the easier ones by seeing a higher volume of patients which isnt always easy.

As a psychiatrist, I likely know a lot more neurology than the average PCP. I still have a decent number of PCP skills but i wouldnt say im a skilled PCP. I still order labs, interpret them, work up things etc. I have patients all the time that come in for acute mental status changes and i do full workups on.

As far as the BS stuff, depends on what you're referring to, lol. Most med students probably dont have the strongest idea of what psychiatrists do because psych is variable in that you can do multiple types of practices.

Realistically I cant complain, my lifestyle is good. However, it can be stressful seeing sick patients and it can be hard not bringing that home with you. A lot of psychiatrists are overall happy, but were all stressed in one way or another. That is inevitable with being an attending.

 

[Hollow Knight]

I'm a new attending doing rural FM with clinic, inpatient coverage for my own patients, and prenatal care (but no deliveries). Also doing some global health work internationally. The way my practice is set up I have a VERY cush schedule, no nights/weekends, 40 hrs a week or less, etc. Residency was tough but I'm glad I did it now that I'm on the other side. Loving the work I'm doing. Feel free to PM me if I can give you any insight that may be helpful!

Not trying to hijack this thread but I wanna be you when I grow up my dude!

@familymed_or_psych - do you have any interest in serving specific populations? I grew up in "the boonies" so for me, FM is almost a social justice kinda thing. The patients I want to serve need an FM doc because there are basically no other doctors out there, and FM is the base of the pyramid that is healthcare. Or maybe you're just crazy interested in mental health, in which case do psych.

then I read these threads of people saying FM isn't really qualified to do OB/ER/etc and that my patients are gonna get **** care and OB cases are gonna go wrong and babies will die

I'm sure I will offend some attendings by saying this, but it's the truth: these statements are coming from attendings who really don't know any better. Yes, many FM programs will not train you to do these things. However, there are FM docs who are qualified to work ER or do C sections; I round with them all the time. You just have to find the right residency program. So if it's the stigma that's stopping you, don't listen to those docs saying that, all specialties bash all specialties unfortunately.