In need of some validation

[redbandit]

So I matched into psychiatry and I am ecstatic. I applied to psychiatry and internal medicine (as a back up) and I was about 75% sure I wanted psychiatry, and 25% IM. So, I went with my gut. As happy as I am, I feel as though I am going to miss IM. But the thought of rounding for countless hours, and the thought of a brutal IM residency turned me away. In speaking with my family, they appear superficially happy, but at the same time, I feel as though they would have been more proud of me, if I had done IM. Now, I know I don't need their approval, but it is still bit upsetting. In the culture my parents were raised, there was very little emphasis on mental health and there was / still is a bit of stigma attached to psychiatrists, from their point of view. I've done my best to help them understand the legitimacy of the field I am entering, and I just hope they understand. Can anyone shed some guidance with respect to this?

It's really hard to say why I chose psychiatry over IM, but I think what stands out the most to me is the difference in lifestyle. I know that is a bit shallow, but I do not wish to work 60+ hours a week for the rest of my life just to follow what I feel is an algorithm. I just wanted some validation from those that may have experienced something similar, or have been in the field, and can help me feel at ease about my choice.

Ps. The only thing I'm afraid of with psychiatry is the really verbal / physically abusive patients. I know that is not the norm, but I just finished a forensic psychiatry rotation, and that was pretty much the gist for a month, lol. Is that something that's easy to get accustomed to? Also, how true is it that psychiatry can burn you out mentally, given that so much energy is placed on potentially "difficult" patients. I appreciate all the help. I am a long time lurker and finally decided to make an account, haha.

---

Members don't see this ad.

 

[nexus73]

They're both good. You get 4 months internal medicine as an intern. If you find you really prefer medicine you can try to switch programs for pgy-2. Most internists don't work 60 hour weeks. It's typically 7 on 7 off, 12 hours per shift. So average is 42 hours each week.

 

[Crayola227]

They're both good. You get 4 months internal medicine as an intern. If you find you really prefer medicine you can try to switch programs for pgy-2. Most internists don't work 60 hour weeks. It's typically 7 on 7 off, 12 hours per shift. So average is 42 hours each week.

ugh, what??

math is off anyway

that week on is a hell week, hospitalists bust their ass

of course, general internists also can work primarly outpt as well

 

[redbandit]

They're both good. You get 4 months internal medicine as an intern. If you find you really prefer medicine you can try to switch programs for pgy-2. Most internists don't work 60 hour weeks. It's typically 7 on 7 off, 12 hours per shift. So average is 42 hours each week.

Is it easy to obtain a PGY 2 spot in internal medicine after finishing a year of PGY1 psych? Is that even possible or do I have to repeat PGY1 year, and participate in the math again. I don't even want to think like that because then I'm setting myself up for failure in psychiatry, but it would be good knowledge.

 

[OldPsychDoc]

Is it easy to obtain a PGY 2 spot in internal medicine after finishing a year of PGY1 psych? Is that even possible or do I have to repeat PGY1 year, and participate in the math again. I don't even want to think like that because then I'm setting myself up for failure in psychiatry, but it would be good knowledge.

Probably easier to find PGY2 IM or FP position from psych than going the other way right now--but in my experience, the expectations for an IM PGY2 would be pretty hard to meet with only 4 months IM as an intern, and they'd likely have you functioning as an intern for awhile anyway.

 

[redbandit]

How mentally draining is psychiatry? This may sound silly but will I retain my sanity after 10 years of practice?

 

[Merovinge]

Ps. The only thing I'm afraid of with psychiatry is the really verbal / physically abusive patients. I know that is not the norm, but I just finished a forensic psychiatry rotation, and that was pretty much the gist for a month, lol. Is that something that's easy to get accustomed to? Also, how true is it that psychiatry can burn you out mentally, given that so much energy is placed on potentially "difficult" patients. I appreciate all the help. I am a long time lurker and finally decided to make an account, haha.

This might sound dumb but I really liked getting training with the verbally abusive patients. I spent a lot of day rotations and call at one of the toughest VA's in the US and got a lot of exposure to threats ranging from simply killing me to raping and killing all of my extended family. I have a pretty calm disposition but internally have a huge autonomic response, which I think is greater than most docs, so these exposures where exactly what I needed to learn to keep calm despite a ton of adrenaline flowing. It's really helped me out in challenging situations both at work and in my personal life. I was attracted to psychiatry by good C/L psychiatrists who seemingly could deal with any situation and I think exposure to violent folks really helps with that.

 

[smalltownpsych]

How mentally draining is psychiatry? This may sound silly but will I retain my sanity after 10 years of practice?

Based on the incoherent rambling, ranting and raving of the posts from the attending psychiatrists on this site, guess the answer is pretty apparent. I have been working with patients for over ten years now and I think I am doing just fine.

 

[redbandit]

This might sound dumb but I really liked getting training with the verbally abusive patients. I spent a lot of day and call at one of the toughest VA's in the US and got a lot of exposure to threats ranging from simply killing me to raping and killing all of my extended family. I have a pretty calm disposition but internally have a huge autonomic response, which I think is a greater most docs, so these exposures where exactly what I needed to learn to keep calm despite a ton of adrenaline flowing. It's really helped me out in challenging situations both at work and in my personal life. I was attracted to psychiatry by good C/L psychiatrists who seemingly could deal with any situation and I think exposure to violent folks really helps with that.

I appreciate the feedback. Totally what I needed. I think I'd consider a CL fellowship so that I can be involved in medicine as well. I'm sort of the person that avoids confrontation, but you bring about a very good point in that exposure to tough patients will only make me stronger.
Is there anything that you dislike about psychiatry, or find malignant?

 

[OldPsychDoc]

How mentally draining is psychiatry? This may sound silly but will I retain my sanity after 10 years of practice?

12 years and not TOO unbalanced.
I think...

 

[redbandit]

I'm a Carib background. Psych vs IM, which would give me a better lifestyle/ compensation? I think the competitive fellowships in IM would be out of the question for me. I just want to know / hope I made the right decision in going to psychiatry bc switching after pgy1 year would be a pain in the arse.

 

[michaelrack]

I'm a Carib background. Psych vs IM, which would give me a better lifestyle/ compensation?

psychiatry

 

[Merovinge]

I'm a Carib background. Psych vs IM, which would give me a better lifestyle/ compensation? I think the competitive fellowships in IM would be out of the question for me. I just want to know / hope I made the right decision in going to psychiatry bc switching after pgy1 year would be a pain in the arse.

If that's your question, I am going to recommend doing IM. I think it's easier to be a generic doctor if your main concern is $$/lifestyle then psychiatry which I have experienced requires actually caring about the field to do a decent job. IM you can follow more algorithms, work 5 on 5 off or what have you and call it a day when you leave hospital.

 

[Stagg737]

@redbandit , have you considered focusing a psych career as a consult at hospitals? You'd still be doing psych work, but you'd be dealing with all the patients you'd be seeing with inpatient IM and be constantly exposed to the medicine side of the patients as well as the psych side. Idk how feasible it is to do only consulting work, but I know a few psychiatrists who do enough consulting that they spend more time seeing the medicine patients who need a psych referral than actual psych patients.

 

[CompensationExpert]

@redbandit From a compensation perspective, your overall target for higher compensation will occur in IM. This is more of a broad need across all geographical areas. As for psych, the salaries can be higher but this is highly dependent on the employer and the work. Some organizations in need under an employed model might offer great pay while others might offer a pretty insignificant package. I cannot speak to the work life balance though. In general, IM is going to provide you with a higher salary than psych plus you can pick up work on the side as a hospitalist and such. Just my thoughts.

 

[michaelrack]

Outpatient psych makes much more than outpatient general IM/primary care. On paper, IM hospitalist jobs pay similar or maybe a little higher than inpt psych. however, psych inpatient jobs tend to take a lot less actual time and it is easier to have lucrative side jobs in psychiatry than IM.

However, to make more in psych, you do need to be tied to your cell phone

 

[Monocles]

Good job OP, you made the right life choice.

Don't worry you'll be doing medicine months as a psych intern and thinking "what the hell people choose this voluntarily? I'm glad I'm out of here in 3 months". The first day that I had to wake up at 4:30 to go pre-round on patients I thought "f this I'm glad I'm a psychiatrist".

 

[redbandit]

Medical school is so IM heavy; I'm just a little upset that I will forget all of IM. I have a primary care doctor, but I like knowing that I have a good understanding of my body / the minor illnesses I may get, etc. it's a little scary knowing that I might forget all of that. Do you guys feel you can still retain the practically important parts of IM so that at least I'll be competent understanding the basics of taking care of the physically ill? I hope that makes sense..I just don't wanna lose all of medicine. If I did a CL fellowship, will thst bring me closer to medicine? Ie. Treating somatic issues, reading ekgs, etc. you all have been amazing supporting me

 

[michaelrack]

Medical school is so IM heavy; I'm just a little upset that I will forget all of IM. I have a primary care doctor, but I like knowing that I have a good understanding of my body / the minor illnesses I may get, etc. it's a little scary knowing that I might forget all of that. Do you guys feel you can still retain the practically important parts of IM so that at least I'll be competent understanding the basics of taking care of the physically ill? I hope that makes sense..I just don't wanna lose all of medicine. If I did a CL fellowship, will thst bring me closer to medicine? Ie. Treating somatic issues, reading ekgs, etc. you all have been amazing supporting me

NO you won't be able to retain IM (well maybe for a few years, but by 5 years out of psych residency it will all be forgotten); and an CL fellowship won't help that much

 

[redbandit]

Ah, that really is something I'll have some trouble getting over. Any tips on how I can cope with knowing that I'll basically forget everything I've learned so far?

 

[OldPsychDoc]

Ah, that really is something I'll have some trouble getting over. Any tips on how I can cope with knowing that I'll basically forget everything I've learned so far?

I think 4 months of IM in internship will show you things that you will wish to forget.

 

[thepoopologist]

Ah, that really is something I'll have some trouble getting over. Any tips on how I can cope with knowing that I'll basically forget everything I've learned so far?

Switch into IM if it is really bothering you that much. You've been posting the last several days about it. It seems what you really want is lifestyle/compensation/medicine and you will get 2 out of the 3 with psychiatry. If retaining your IM knowledge takes precedent over the other two then you know what you have to do.

 

[carbaspazapine]

Ah, that really is something I'll have some trouble getting over. Any tips on how I can cope with knowing that I'll basically forget everything I've learned so far?

I had a last-minute IM vs. Psych dilemma (but in fairness, I had always intended to do Psych). It helped me to realize that most other specialties *also* forget a lot of IM, because they just don't deal with the breadth of medicine that IM does. How much do you think an oncologist, or surgeon, really remembers about managing acute decompensation of CHF? Each specialty spends N years in residency learning their trade; some build on medicine more than others, and perhaps psych least of all, but they all still do it at the expense of med school knowledge.

 

[michaelrack]

I had a last-minute IM vs. Psych dilemma (but in fairness, I had always intended to do Psych). It helped me to realize that most other specialties *also* forget a lot of IM, because they just don't deal with the breadth of medicine that IM does. How much do you think an oncologist, or surgeon, really remembers about managing acute decompensation of CHF? Each specialty spends N years in residency learning their trade; some build on medicine more than others, and perhaps psych least of all, but they all still do it at the expense of med school knowledge.

I would think that an oncologist, due to their full IM residency, would know something about managing an acute decompensation of CHF- especially if the oncologist was in academia and attended on an oncology ward

 

[carbaspazapine]

I would think that an oncologist, due to their full IM residency, would know something about managing an acute decompensation of CHF- especially if the oncologist was in academia and attended on an oncology ward

Sorry, I was thinking of these examples as experienced attendings, not fresh out of residency/fellowship. But you're right, perhaps dermatology would be a better example.

 

[clausewitz2]

I would think that an oncologist, due to their full IM residency, would know something about managing an acute decompensation of CHF- especially if the oncologist was in academia and attended on an oncology ward

On the other hand you probably don't want your oncologist titrating your insulin if you're, say, Type 1.

 

[michaelrack]

On the other hand you probably don't want your oncologist titrating your insulin if you're, say, Type 1.

On an academic inpatient oncology ward, they (or their resident) would. IN real life (non-academia), they would probably consult endocrinology

 

[nancysinatra]

Ps. The only thing I'm afraid of with psychiatry is the really verbal / physically abusive patients. I know that is not the norm, but I just finished a forensic psychiatry rotation, and that was pretty much the gist for a month, lol.

I want to take issue with this because it is an unfortunate misunderstanding many people - even psychiatrists - seem to have about "forensic" psychiatry. Most forensic trained psychiatrists don't work in state forensic hospitals with dangerous patients. They may evaluate such patients for the courts, but they will be sure to set the interview up so that they are safe.

Psychiatrists who actually work in forensic state hospitals day in and day out are usually not forensic trained. They're often general psychiatrists, and their job is to practice general psychiatry in a forensic hospital. Whereas I believe most forensic psychiatrists set up private practices and hand pick their cases, which can be civil or criminal. It's lucrative work. Of course there are exceptions though.

 

[northernpsy]

If you like other areas of medicine and want to keep a toe dipped in the non-psych world of medicine, I would agree with the suggestion to consider a fellowship in Psychosomatic Medicine. Having knowledge and interest in other areas of medicine will always help when you are trying to do consults, and I think you will find that many people interested in psychosomatic medicine are similar in wanting to maintain some of their non-psych medical knowledge.

However, even just sticking with general psychiatry, you will have opportunities to use your general medical knowledge if you do inpatient psych. On the psych unit I work at, it is pretty common to deal with minor general medical issues on our own, and unfortunately sometimes the "medical clearance" that people get before admission is sub-par so we have to remember enough medicine to assess if someone is stable enough to stay on the psych unit.

Perhaps you'd like working with eating disorder patients since they can have medical sequelae from their illnesses. Same goes with addiction patients for that matter.

Really, it is up to you how much of your general medical training you retain. Regardless of what specialty you train in, you will need to make an effort to educate yourself on changes to how medicine is being practiced once you leave residency.
There is nothing stopping you from reading journal articles and doing CME on topics from other medical specialties if you are really interested in keeping up to date with other areas of medicine.

When you see that many psychiatrists don't maintain their general medical knowledge, remember that a lot of people do psych because they don't LIKE other areas of medicine and don't want to stay in that world.

As far as lifestyle goes, I definitely think that psychiatry in general allows for an easier life and easier ways to earn decent money than primary care IM/FM does. I know way more bitter, burned out family medicine docs and internists than bitter, burned out psychiatrists.

I also feel like we in medicine tend to expect our jobs to give our lives purpose and be completely satisfying because we give up so much for our work, when in most other jobs I don't think people expect that much from their working lives beyond a paycheck.
My job is occasionally fun and interesting, but most of the time it's just..."ok". I don't hate it, it could be a lot worse, but I also can't honestly say I LOVE it either (keep in mind, though, that this is my first job out of residency and I took the job partially due to loan debt rather than because it was an ideal working environment).
That's okay, though, because when I leave work, I have a lot of other stuff going on in my life that gives me satisfaction and meaning (my family, hobbies, community involvement). It's easier to make time for those other parts of life when you work in a specialty that has a controllable lifestyle than if you're being worked to death.

To me, the direction that things are going in with primary care is really unfortunate. If it were still possible to practice primary care the way it used to be in the good old days when docs had more autonomy and saw the same patients cradle to grave, I would probably love it, but the world and the medical system have changed so much. Midlevels are trying their best to take over both psych and primary care, but I think primary care will fall to the NPs before psych does.

 

[redbandit]

Just wanted to update-
I can't believe I wrote this a year ago. I am very happy with my decision to go into psychiatry and feel like an idiot for having second guessed myself. Working internal medicine was brutal, and I cannot imagine doing 3 years of that for residency. There are things I may not be too happy with, in my program, but it does not compare to the borderline slave labor status of an IM residency. My family has also turned things around, and has been far more understanding, and actually feel proud of what I went into. It's funny to think, my mom basically went into full blown depression when she found out I was going to be doing residency in psychiatry. She has since spoken to her friends, colleagues, etc. and is WAY more understanding. It's kind of sad how Indian families can be shallow sometimes, but ultimately, time was my friend. I am writing this in hopes that if anyone this week (match week) is struggling / having mixed feelings, go with your gut and stick with it! It is well worth it!

 

[Horners]

Just wanted to update-
I can't believe I wrote this a year ago. I am very happy with my decision to go into psychiatry and feel like an idiot for having second guessed myself. Working internal medicine was brutal, and I cannot imagine doing 3 years of that for residency. There are things I may not be too happy with, in my program, but it does not compare to the borderline slave labor status of an IM residency. My family has also turned things around, and has been far more understanding, and actually feel proud of what I went into. It's funny to think, my mom basically went into full blown depression when she found out I was going to be doing residency in psychiatry. She has since spoken to her friends, colleagues, etc. and is WAY more understanding. It's kind of sad how Indian families can be shallow sometimes, but ultimately, time was my friend. I am writing this in hopes that if anyone this week (match week) is struggling / having mixed feelings, go with your gut and stick with it! It is well worth it!

I’m glad you came back and updated us on this thread. As a student interested in psychiatry you reassured me just as much you reassured yourself. Thank you


Sent from my iPhone using SDN mobile

 

[DisorderedDoc417]

Medical school is so IM heavy; I'm just a little upset that I will forget all of IM. I have a primary care doctor, but I like knowing that I have a good understanding of my body / the minor illnesses I may get, etc. it's a little scary knowing that I might forget all of that. Do you guys feel you can still retain the practically important parts of IM so that at least I'll be competent understanding the basics of taking care of the physically ill? I hope that makes sense..I just don't wanna lose all of medicine. If I did a CL fellowship, will thst bring me closer to medicine? Ie. Treating somatic issues, reading ekgs, etc. you all have been amazing supporting me

Don’t worry. You will be an expert in psychopharmacology, and you will know the meds most doctors are afraid of and use them regularly. There’s plenty of real medicine in bread and butter psych. There’s nothing exciting about tittering lasix... your feelings will fade away as you start residency. Also, there will be a steep curve in psych as med school has likely failed you by way of basically avoiding any real nuance in the subject aside from teaching you the basic idea of depression, bipolar disorder, and a few immature ego defenses. You will be busy and learn lots, it is fun!

 

[WingedOx]

But the thought of rounding for countless hours,

Just use this as a mantra every time you second guess your decision.

edit: dammit. didn't check the date of the OP. Still, good advice even though things are going well.

 

[Bad Moose]

So I matched into psychiatry and I am ecstatic. I applied to psychiatry and internal medicine (as a back up) and I was about 75% sure I wanted psychiatry, and 25% IM. So, I went with my gut. As happy as I am, I feel as though I am going to miss IM. But the thought of rounding for countless hours, and the thought of a brutal IM residency turned me away. In speaking with my family, they appear superficially happy, but at the same time, I feel as though they would have been more proud of me, if I had done IM. Now, I know I don't need their approval, but it is still bit upsetting. In the culture my parents were raised, there was very little emphasis on mental health and there was / still is a bit of stigma attached to psychiatrists, from their point of view. I've done my best to help them understand the legitimacy of the field I am entering, and I just hope they understand. Can anyone shed some guidance with respect to this?

It's really hard to say why I chose psychiatry over IM, but I think what stands out the most to me is the difference in lifestyle. I know that is a bit shallow, but I do not wish to work 60+ hours a week for the rest of my life just to follow what I feel is an algorithm. I just wanted some validation from those that may have experienced something similar, or have been in the field, and can help me feel at ease about my choice.

Ps. The only thing I'm afraid of with psychiatry is the really verbal / physically abusive patients. I know that is not the norm, but I just finished a forensic psychiatry rotation, and that was pretty much the gist for a month, lol. Is that something that's easy to get accustomed to? Also, how true is it that psychiatry can burn you out mentally, given that so much energy is placed on potentially "difficult" patients. I appreciate all the help. I am a long time lurker and finally decided to make an account, haha.

No one lives your life but you. It is not shallow to be concerned about your work schedule it is prudent. My family was similar in their attitude, evening going so far to say "why did I quit medical school?" when I told them I was going into psychiatry.

I loved internal medicine, actually I found something I loved in all of my rotations. I choose psychiatry because my favorite part of being a doctor isnt coming up with a Dr. House level diagnosis, but to relieve suffering. In psychiatry I get that opportunity every day.

You will still need to know medicine, It is the mother of all our specialties.

Finally to address your concern about abusive patients; I have found that dealing with difficult people is a skill that is useful not only with patients, but with your peers, administration and especially insurance companies. I have been pulled up by my white coat by a frantic husband after he demanded me to save his terminally ill wife. I have encountered dangerous situations more in the ER and in the ICU much more frequently than in psychiatry outpatient. The inpatient psych can be dangerous but only if you seek to actively confront people in closed places in my short experience.

I find the best way to convince people that "Im a real doctor" is to wait until they or their loved one is suffering from mental illness. Otherwise I realize that should not need to seek validation from others when I am sad about "the lack of respect".

 

[SeniorWrangler]

Congratulations redbandit, you're a real doctor now!