IM vs Psych

[lotus]

Anyone having a really hard time deciding whether to go
into internal medicine or psychiatry. I can't put my finger
on exactly why, but I'm drawn to both fields for various
reasons. I realize this is a very personal/individualized
decision, but I'd like to hear from those who were on the
fence why they decided one way or another.

Thanks!

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[OldPsychDoc]

Anyone having a really hard time deciding whether to go
into internal medicine or psychiatry. I can't put my finger
on exactly why, but I'm drawn to both fields for various
reasons. I realize this is a very personal/individualized
decision, but I'd like to hear from those who were on the
fence why they decided one way or another.

Thanks!

Lifestyle, lifestyle, lifestyle. Compare and contrast PGY3 schedules for residents in IM vs. psych.

Also--life-years impact, direct and indirect. E.g--you can tweak HTN, DM2, and cholesterol meds all you want in a 65 year-old, and you might eke out an extra year or two of life. Intervene in a depressed and suicidal 20-something, and you've given them 60 years, to say nothing of their kids' lives...

 

[fiatslug]

you might want to scroll down to the "psych vs fp" post on this forum for similar discussion. Amen to OPD's thoughts above--the misery index for IM seems very high indeed.

 

[prominence]

Lifestyle, lifestyle, lifestyle. Compare and contrast PGY3 schedules for residents in IM vs. psych.

to play devil's advocate, compare and contrast PGY4 schedules for residents in IM vs. psych....Ooops, IM does not have a bs PGY-4!

nevertheless, i have to agree...psych has a better residency lifestyle overall compared to IM,

 

[OldPsychDoc]

to play devil's advocate, compare and contrast PGY4 schedules for residents in IM vs. psych....Ooops, IM does not have a bs PGY-4!

Yeah, but every IM resident worth their salt wants to go on to do cards, pulmonary, or GI fellowships in PGY 4...not exactly cush, especially compared to the elective-heavy 9-5 coast of the Psych Sr. Resident! I stand by my point!

 

[Hurricane]

Yeah, but every IM resident worth their salt wants to go on to do cards, pulmonary, or GI fellowships in PGY 4...not exactly cush, especially compared to the elective-heavy 9-5 coast of the Psych Sr. Resident! I stand by my point!

Yeah, I think the GI fellow on call quite possibly has the worst job in the hospital.

 

[fiatslug]

Yeah, I think the GI fellow on call quite possibly has the worst job in the hospital.

Hmmm, I don't know... I see more suicidal ideation among medicine interns than on call in the ER in January!

 

[goldennugget]

Anyone having a really hard time deciding whether to go
into internal medicine or psychiatry. I can't put my finger
on exactly why, but I'm drawn to both fields for various
reasons. I realize this is a very personal/individualized
decision, but I'd like to hear from those who were on the
fence why they decided one way or another.

Thanks!

Yes I am having a very hard time deciding between the two also. I am a 4th year student and I just finished my medicine subinternship. I have always wanted to go into psych but after finishing my medicine subI, Ive been thinking, "hmmm...medicine isn't too bad either."
I think the two main reasons I'm drawn to psych is that I find pleasure in being able to make a change in one's mental health, and also that the residency is survivable. However, the two main reasons I'm drawn to medicine is that it is great being able to utilize such a great fund of knowledge to treat such a wide variety of illnesses, and also everything appears very logical.
For me Ive had a hard time deciding what is more important to me...but then I tried to imagine myself sitting in a chair when I am a 45 year old attending. Would I enjoy having to deal with chest pain, leg ulcers, hyponatremia, and acute renal failure? Or rather would I enjoy talking to someone about their life struggle, or helping a kid overcome ADD?
Theres something beatiful i noticed about psychiatry. Whereas in medicine, one's diagnosis of chest pain is from CAD, cocaine, PE, etc. There are a limited number of causes. But in a diagnosis of depression, virtually ANYTHING can cause it because every person had a different life story. And that's what makes it more interesting to me.
Thus I'm thinking as a 45 year old attending, I will get really tired of my 1,000th admission for chest pain. But as a psych attending, even the 1000th case of depression may have a new interesting story with something to learn.

 

[Doc Samson]

Yes I am having a very hard time deciding between the two also. I am a 4th year student and I just finished my medicine subinternship. I have always wanted to go into psych but after finishing my medicine subI, Ive been thinking, "hmmm...medicine isn't too bad either."
I think the two main reasons I'm drawn to psych is that I find pleasure in being able to make a change in one's mental health, and also that the residency is survivable. However, the two main reasons I'm drawn to medicine is that it is great being able to utilize such a great fund of knowledge to treat such a wide variety of illnesses, and also everything appears very logical.
For me Ive had a hard time deciding what is more important to me...but then I tried to imagine myself sitting in a chair when I am a 45 year old attending. Would I enjoy having to deal with chest pain, leg ulcers, hyponatremia, and acute renal failure? Or rather would I enjoy talking to someone about their life struggle, or helping a kid overcome ADD?
Theres something beatiful i noticed about psychiatry. Whereas in medicine, one's diagnosis of chest pain is from CAD, cocaine, PE, etc. There are a limited number of causes. But in a diagnosis of depression, virtually ANYTHING can cause it because every person had a different life story. And that's what makes it more interesting to me.
Thus I'm thinking as a 45 year old attending, I will get really tired of my 1,000th admission for chest pain. But as a psych attending, even the 1000th case of depression may have a new interesting story with something to learn.

I entirely agree. I was a dead-set lock for IM all the way through medical school, until I did a CL-psychiatry rotation. Then, I figured out that I could keep all the things I loved about IM:

-being in the general hospital
-taking care of sick patients (both physically and psychiatrically)
-get to figure out complicated diagnoses based on history, physical exam, and lab studies

all without getting stuck in the algorithm based life of IM. Chest pain, DM, HTN all get the same work-up and treatment protocol, whereas every pt I see requires a different approach in terms of both diagnosis and treatment.

Another plus, is that we get the most interesting IM (and surgery, neuro, OB, etc.) cases by process of elimination, because we get consulted when the primary team has no f#$@ing idea what's going on. In the past week I've diagnosed: partial complex seizures of the amygdala in a 42 yo man; refeeding syndrome in a 61 yo man; and NPH in a 67 yo woman - all of which the consultee had been completely missing.

4 years of residency can be a bit of a flog, but I was half-time CL for my entire PGY-4 year, in addition to being half-time CL for 6 months of PGY-3. The first month of fellowship has been really busy, but a lot of fun.

 

[Poety]

I entirely agree. I was a dead-set lock for IM all the way through medical school, until I did a CL-psychiatry rotation. Then, I figured out that I could keep all the things I loved about IM:

-being in the general hospital
-taking care of sick patients (both physically and psychiatrically)
-get to figure out complicated diagnoses based on history, physical exam, and lab studies

all without getting stuck in the algorithm based life of IM. Chest pain, DM, HTN all get the same work-up and treatment protocol, whereas every pt I see requires a different approach in terms of both diagnosis and treatment.

Another plus, is that we get the most interesting IM (and surgery, neuro, OB, etc.) cases by process of elimination, because we get consulted when the primary team has no f#$@ing idea what's going on. In the past week I've diagnosed: partial complex seizures of the amygdala in a 42 yo man; refeeding syndrome in a 61 yo man; and NPH in a 67 yo woman - all of which the consultee had been completely missing.

4 years of residency can be a bit of a flog, but I was half-time CL for my entire PGY-4 year, in addition to being half-time CL for 6 months of PGY-3. The first month of fellowship has been really busy, but a lot of fun.

Hey DS, you going ot the APA meeting this year? If you do I have GOT to meet you, I'll wear my smiths tshirt

 

[Doc Samson]

Hey DS, you going ot the APA meeting this year? If you do I have GOT to meet you, I'll wear my smiths tshirt

I'm not sure... where is it? I'm already booked for the Academic Psychiatry meeting in San Francisco, and might try to get to the Psychosomatic Medicine meeting in Tucson.

 

[Poety]

I'm not sure... where is it? I'm already booked for the Academic Psychiatry meeting in San Francisco, and might try to get to the Psychosomatic Medicine meeting in Tucson.

I dunno Im new at this - meet me in the carolinas


eta: and yeah you were right, I'm over my medicine obsession now ugg

 

[peppy]

I entirely agree. I was a dead-set lock for IM all the way through medical school, until I did a CL-psychiatry rotation.

Your post has piqued my curiosity, as yet another person who is interested in both psych and IM. Thanks for giving us all something more to think about.
Are there any aspects of CL work that are particularly frustrating or difficult that those of us considering it should be aware of?

 

[tr]

I think the two main reasons I'm drawn to psych is that I find pleasure in being able to make a change in one's mental health, and also that the residency is survivable. However, the two main reasons I'm drawn to medicine is that it is great being able to utilize such a great fund of knowledge to treat such a wide variety of illnesses, and also everything appears very logical.

I'm having the same issue. I loved my psych rotation and was dead set on psych; but out of the blue I also find I'm totally loving my medicine rotation.

Medicine seems to involve a degree of problem-solving; and I'm finding myself unexpectedly good at it. I wasn't any kind of star in the preclinical years, but I seem to have a knack for putting it all together and I'm rocking my medicine rotation and having a great time.

[dons flame-******ant suit]Psych just doesn't seem to carry the same degree of intellectual challenge, because there's no pathophysiology.

It also kind of annoys me that people expect psychiatrists not to know any medicine. I'm not even a psychiatrist yet - just a student - and yet my medicine attending has said things like "that's pretty good for a psychiatrist." That burns me up in a way, but it also makes me sad because presumably there's a grain of truth to it. Psych is pretty far removed from the rest of medicine, and I don't know how you could expect to keep your medicine skills fresh if you don't use them frequently.[/flame-******ant suit]

 

[Doc Samson]

Your post has piqued my curiosity, as yet another person who is interested in both psych and IM. Thanks for giving us all something more to think about.
Are there any aspects of CL work that are particularly frustrating or difficult that those of us considering it should be aware of?

Let me borrow that flame ******ant suit for a second...

The most frustrating thing is the ever-astonishing levels of laziness and stupidity that you face from your med/surg/whatever colleagues who repeatedly call consults for "assess depression" when even a 3rd year med student can see the pt is wildly delirious, dose agitated pts with massive amounts of benzos because "it's gotta be withdrawal", and will ascribe any (and I mean ANY) set of symptoms to psychiatric illness if the pt so much has a history of dysthymia.

Aside from that, I love my job. No two days are ever the same, you get to think about pts that your med/surg/whatever colleagues have failed to diagnose, and believe me - there's a lot of pathophysiology to think about. Neurology is one thing, but the behavioral manifestations of neurologic derangement tends to fall outside of the training of most neurologists. At least once a week there's a psych vs. neuro stand-off about psychiatric symptoms of partial complex seizures. They just don't get it, so they sign-off, and the CL psychiatrist essentially manages the case. Just today, I have recommended:
EEG
Tilt-table testing
Colonoscopy
Urine cathecolamines
and, of course, lots and lots of IV Haldol.
Remember, the new official name of CL Psychiatry is Psychosomatic Medicine, which is clumsy and has unfortunate associations for the lay public, but really does describe what we do.

 

[Anasazi23]

[dons flame-******ant suit]Psych just doesn't seem to carry the same degree of intellectual challenge, because there's no pathophysiology.
[/flame-******ant suit]

What's more challenging....assessing a patient and piecing together an amalgam of biological, psychiatric/psychologic, neurological and psychosocial conditions manifested by symptoms, while (without the aid of an algorithm) developing a set of differentials that encompass every branch of medicine while simultaneously calling on your hopefully developed classical psychiatric case formulation and use of descriptive psychopathology along with pharmacological intervention to better a patient's symptoms, or...

downloading the latest set of cookbook recommendations for htn, cellulitis, dm, chf and pna, and referring anything remotely out of the typical IM repetoire to the appropriate nephrologist, endocrinologist, oncologist, etc.

Of course, I'm exaggerating for effect, but IM to me was actually much less intellecutally stimulating. There is critical thinking and many cases don't fit into preconceived molds, but there is a hell of a lot of cookbook medicine. K low? Replace K. ABG off? Adjust O2. I didn't want to chase lab values for the rest of my life.

Hypertension, cellulitis, and pneumonia are boring.