Infectious disease via IM vs. Psychiatry

[Darkskies]

Hi everyone,

I've been a member of sdn for quite some time now. I'm currently a third year medical student and although I haven't yet had my IM rotation, by far my most favorite subject from the basic science years has been microbiology. I'm still transitioning into third year as I had expected medicine to be more like detective work(kind of like how the board exams were) in that a patient presents with a variety of symptoms, you diagnose the patient based on their history, physical exams, and labs, and then give them the appropriate treatment. Instead on the rotations I've had so far medicine seems to be far more about paperwork like disability forms, prior auths,etc., managing diabetes, hypertension, cholesterol, musculoskeletal pain, and referrals(especially in family medicine). I hate admitting this but sad to say I think I might even prefer the basic science years now looking back than third year so far.

I really hated musculoskeletal anatomy and I find treating back pain, neck pain,etc. is nearly 50% of all of what family medicine consists of. Just shoot me lol.. What's even more upsetting is that these patients don't even seem to get better.

I don't think I want to do a heavily procedure based specialty and I haven't had internal medicine yet but I have heard that the residency is very overwhelming even if the subspecialties you have access to afterwards are far more enjoyable. Does general IM have as much inane paperwork and managing musculoskeletal pain as family medicine? Also, I know finances shouldn't really come in the way of my decision but I will have upwards of 300k in loans and average ID salaries are one of the lowest across the board, even lower than family medicine! It doesn't make sense that an ID doc who has 2 years of fellowship on top of 3 years of general medicine ends up making less than a hospitalist or family med doc. Still, like Psychiatry it's supposed to be a field where no day is ever boring. Someone did mention to me that ID has a restricted job market and that a better reason for choosing ID is if you want to do research in the field rather than clinical practice. Also, as I've noticed on rotations, perhaps the study of the subject might actually be rather different than what it's like in the applied field.

I think I would greatly enjoy Psychiatry as you get to treat just one area of a patient's health concerns instead of having to manage 10-15 different conditions in all organ systems and multi-tasking while likely doing it only superficially since you have around 10 minutes to see each patient. The qualms I have with the field are the usual in that it is a more subjective specialty, many of the psychiatry medications' mechanisms are still unknown, and some in the field are indiscreet pill pushers/med managers. I was thinking that if I do choose to pursue Psychiatry, I would focus more on the severely mentally ill since that is where I think I could do the most good.

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[Instatewaiter]

Does general IM have as much inane paperwork and managing musculoskeletal pain as family medicine?

No it does not

Also, I know finances shouldn't really come in the way of my decision but I will have upwards of 300k in loans and average ID salaries are one of the lowest across the board, even lower than family medicine! It doesn't make sense that an ID doc who has 2 years of fellowship on top of 3 years of general medicine ends up making less than a hospitalist or family med doc. Still, like Psychiatry it's supposed to be a field where no day is ever boring. Someone did mention to me that ID has a restricted job market and that a better reason for choosing ID is if you want to do research in the field rather than clinical practice. Also, as I've noticed on rotations, perhaps the study of the subject might actually be rather different than what it's like in the applied field.

You'd still be stuck doing psychiatry.

I think I would greatly enjoy Psychiatry as you get to treat just one area of a patient's health concerns instead of having to manage 10-15 different conditions in all organ systems and multi-tasking while likely doing it only superficially since you have around 10 minutes to see each patient. The qualms I have with the field are the usual in that it is a more subjective specialty, many of the psychiatry medications' mechanisms are still unknown, and some in the field are indiscreet pill pushers/med managers. I was thinking that if I do choose to pursue Psychiatry, I would focus more on the severely mentally ill since that is where I think I could do the most good.

See above. Spend some time in IM and psychiatry and then make your choice. No specialty is perfect, especially not IM but if you love what you do, everything else will fall into place.

 

[Darkskies]

Thanks for the reply, Instatewaiter. Since this is the IM forum, I would have thought more people would have chimed in about ID. What are the pros and cons of ID or if I end up not going in that direction, what are the pros and cons of being a hospitalist especially vis a vis Psychiatry? Thanks!

 

[Pinkleton]

I think you're getting ahead of yourself. Just see how you like your IM rotation and it'll become clear to you. It takes 2 different types of people to do ID vs psych I think. I've decided on ID myself, but initially thought about IM/psych combo and realized it wasn't for me. There's a million reasons not to do ID but one really good reason to do it: you can't see yourself fully fulfilled in any other field

 

[jdh71]

Thanks for the reply, Instatewaiter. Since this is the IM forum, I would have thought more people would have chimed in about ID. What are the pros and cons of ID or if I end up not going in that direction, what are the pros and cons of being a hospitalist especially vis a vis Psychiatry? Thanks!

The pros of ID are that you get to do ID. The cons of ID are that you get to get ID.

Spend some time and you'll see what I mean.

 

[Darkskies]

I think you're getting ahead of yourself. Just see how you like your IM rotation and it'll become clear to you. It takes 2 different types of people to do ID vs psych I think. I've decided on ID myself, but initially thought about IM/psych combo and realized it wasn't for me. There's a million reasons not to do ID but one really good reason to do it: you can't see yourself fully fulfilled in any other field

Thank you for your reply. I won't have my IM rotation until late next semester and likely won't have a chance to do a rotation on ID until the very end of third year or even the beginning of fourth year. Do you mind taking the time to expound on what made you choose to go the route of IM then ID? I know you can't see yourself fulfilled in any other field, but why is that? I wish I could know this when it comes to my decision as well but as I said, I won't be able to rotate in IM until late next semester and ID would be an even later elective rotation.

 

[Rocher]

Hi everyone,

I've been a member of sdn for quite some time now. I'm currently a third year medical student and although I haven't yet had my IM rotation, by far my most favorite subject from the basic science years has been microbiology. I'm still transitioning into third year as I had expected medicine to be more like detective work(kind of like how the board exams were) in that a patient presents with a variety of symptoms, you diagnose the patient based on their history, physical exams, and labs, and then give them the appropriate treatment. Instead on the rotations I've had so far medicine seems to be far more about paperwork like disability forms, prior auths,etc., managing diabetes, hypertension, cholesterol, musculoskeletal pain, and referrals(especially in family medicine). I hate admitting this but sad to say I think I might even prefer the basic science years now looking back than third year so far.

I really hated musculoskeletal anatomy and I find treating back pain, neck pain,etc. is nearly 50% of all of what family medicine consists of. Just shoot me lol.. What's even more upsetting is that these patients don't even seem to get better.

I don't think I want to do a heavily procedure based specialty and I haven't had internal medicine yet but I have heard that the residency is very overwhelming even if the subspecialties you have access to afterwards are far more enjoyable. Does general IM have as much inane paperwork and managing musculoskeletal pain as family medicine? Also, I know finances shouldn't really come in the way of my decision but I will have upwards of 300k in loans and average ID salaries are one of the lowest across the board, even lower than family medicine! It doesn't make sense that an ID doc who has 2 years of fellowship on top of 3 years of general medicine ends up making less than a hospitalist or family med doc. Still, like Psychiatry it's supposed to be a field where no day is ever boring. Someone did mention to me that ID has a restricted job market and that a better reason for choosing ID is if you want to do research in the field rather than clinical practice. Also, as I've noticed on rotations, perhaps the study of the subject might actually be rather different than what it's like in the applied field.

I think I would greatly enjoy Psychiatry as you get to treat just one area of a patient's health concerns instead of having to manage 10-15 different conditions in all organ systems and multi-tasking while likely doing it only superficially since you have around 10 minutes to see each patient. The qualms I have with the field are the usual in that it is a more subjective specialty, many of the psychiatry medications' mechanisms are still unknown, and some in the field are indiscreet pill pushers/med managers. I was thinking that if I do choose to pursue Psychiatry, I would focus more on the severely mentally ill since that is where I think I could do the most good.

My thoughts.. You say you want to focus on the severely mentally ill, but then talk about about how MSK pain patients don't get better and that you wouldn't want to work with them. The severely mentally ill are a really tough population, and in my limited (and probably short-sighted) experience, they don't get drastically better very often. Also, you state that you don't want to spend only 10 minutes with each patient, but that's about all the time the inpatient psych docs were spending with their patients during my rotation. Now I'm sure there are tons of exceptions to this and there is the possibility of doing talk therapy, but that isn't what most people do in psychiatry. Plus the patients with the most severe mental illnesses aren't usually the ones receiving talk therapy.

There are lots of great reasons to choose psychiatry or ID, but every field is going to have it's downsides.

From your post it sounds like you might like heme/onc, I'd try to do a rotation in it.

 

[Pinkleton]

Thank you for your reply. I won't have my IM rotation until late next semester and likely won't have a chance to do a rotation on ID until the very end of third year or even the beginning of fourth year. Do you mind taking the time to expound on what made you choose to go the route of IM then ID? I know you can't see yourself fulfilled in any other field, but why is that? I wish I could know this when it comes to my decision as well but as I said, I won't be able to rotate in IM until late next semester and ID would be an even later elective rotation.

During my ID rotations, I have felt more alive and mentally stimulated than any other rotation. The days go by in a flash. I have to try and keep myself awake on any other service due to boredom. I love microbiology and antibiotics, I enjoy every organ system of the body but not any one particularly to devote my life to it. In ID you get to see so many complicated cases and are often consulted when others have reached a dead end on where to go next. You have to be a superb internist. So many mysteries, and even though a lot of times your plan ends up working, you still don't have all the answers as to what all was going on exactly; I enjoy the journey more than the destination. I love that there are a lot of possible diagnoses and having the option to in different directions with the assessment and plan. It tickles me when we find weird organisms in weird places. I like hypothesizing on what all could be going on, and coming up with contingency plans. I like the challenge of breaking up symptoms into various combinations of infectious vs noninfectious etiologies

ID sucks though because you get paid **** (no procedures to do) and you work very hard, and are underappreciated. I really wish I didn't like ID so much. Not much of a choice for me. The heart wants what the heart wants

 

[Trogghunter]

ID gets **** pay, no procedures, overworked, underappreciated but damn they are vital. It's appears to be an exhausting career path.

You'll be writing lots of long, detailed notes with meticulous chart review, however.... ID is actually meaningful. I don't need a 5 page consult on my patient for someone to recommend increasing seroquel.

 

[thierryhenry]

During my ID rotations, I have felt more alive and mentally stimulated than any other rotation. The days go by in a flash. I have to try and keep myself awake on any other service due to boredom. I love microbiology and antibiotics, I enjoy every organ system of the body but not any one particularly to devote my life to it. In ID you get to see so many complicated cases and are often consulted when others have reached a dead end on where to go next. You have to be a superb internist. So many mysteries, and even though a lot of times your plan ends up working, you still don't have all the answers as to what all was going on exactly; I enjoy the journey more than the destination. I love that there are a lot of possible diagnoses and having the option to in different directions with the assessment and plan. It tickles me when we find weird organisms in weird places. I like hypothesizing on what all could be going on, and coming up with contingency plans. I like the challenge of breaking up symptoms into various combinations of infectious vs noninfectious etiologies

ID sucks though because you get paid **** (no procedures to do) and you work very hard, and are underappreciated. I really wish I didn't like ID so much. Not much of a choice for me. The heart wants what the heart wants

+1

 

[tartesos]

If you like curing things= id.
If don't like curing things= psychiatry.

The only non surgical diseases that you can cure are infections...

In the end, it is what you like to do, find the area of medicine that you can see yourself doing for ever.
It's still early for you, don't rush and be open to all experiences, you have plenty of time.

 

[mercaptovizadeh]

They are such completely different fields. I mean, ID is so much based on evidence and pathology. There is such a clear chain of causality that doesn't exist in most other medical subspecialties, much less psychiatry. Foreign organism > colonization/infection > host disease. Kill the organism > heal the host. Compare that to the deranged and murky physiology of type 2 diabetes or cardiorenal syndrome or even lupus. The only thing I can really compare it to in medicine is oncology. Sure they often have to hedge their bets and go with empiric therapy first, but they always try to be systematic with their cultures. Not to mention that despite all the other procedural and pharmaceutical advances in medicine (whether that's steroids or aspirin or amiodarone or caths or colonoscopy or intubation and mechanical ventilation...), by far the greatest number of lives have been saved - and indeed the modern world and the modern family are the way they are today (i.e. half the children haven't died in infancy these days) - due to advances made in the control of infection. Sanitation, sterile technique, vaccines, and antibiotics. Nuff said.

Compare that to psychiatry, where they fling antipsychotics at depression and antiepileptics at bipolar (often with very limited effect or evidence to support it) and use messy terminology (schizoaffective disorder, MDD with psychotic features, etc.), and where they need a DSM book to define what disease is....and it's utterly bewildering to me that you would find both of these specialties interesting.

I, too, am super sad that ID is not paid better than it is. It might make me veer towards heme-onc, which has some similar themes running through it - just because ID is so utterly unappreciated and unfairly compensated compared to many other specialties.

 

[Darkskies]

They are such completely different fields. I mean, ID is so much based on evidence and pathology. There is such a clear chain of causality that doesn't exist in most other medical subspecialties, much less psychiatry. Foreign organism > colonization/infection > host disease. Kill the organism > heal the host. Compare that to the deranged and murky physiology of type 2 diabetes or cardiorenal syndrome or even lupus. The only thing I can really compare it to in medicine is oncology. Sure they often have to hedge their bets and go with empiric therapy first, but they always try to be systematic with their cultures. Not to mention that despite all the other procedural and pharmaceutical advances in medicine (whether that's steroids or aspirin or amiodarone or caths or colonoscopy or intubation and mechanical ventilation...), by far the greatest number of lives have been saved - and indeed the modern world and the modern family are the way they are today (i.e. half the children haven't died in infancy these days) - due to advances made in the control of infection. Sanitation, sterile technique, vaccines, and antibiotics. Nuff said.

Compare that to psychiatry, where they fling antipsychotics at depression and antiepileptics at bipolar (often with very limited effect or evidence to support it) and use messy terminology (schizoaffective disorder, MDD with psychotic features, etc.), and where they need a DSM book to define what disease is....and it's utterly bewildering to me that you would find both of these specialties interesting.

I, too, am super sad that ID is not paid better than it is. It might make me veer towards heme-onc, which has some similar themes running through it - just because ID is so utterly unappreciated and unfairly compensated compared to many other specialties.

Thanks for such a great post. The reason I think I would find ID to be very enjoyable is that I loved Microbiology to an extent that I didn't know I would have. I like solving puzzles and being a 'detective'. I thought that the actual practice of medicine would be using the evidence at hand to parse out the diagnosis and give the appropriate treatment or at least be somewhat similar to answering questions on the board exams. However, most of medicine seems to be about following protocols and filling out paperwork. and doing everything as quickly as possible. I think ID would also be fulfilling since I could help a lot of people and actually cure them. In both ID and Psychiatry the fields easily lend themselves to working with the underserved which is another aspect that interests me. Psychiatry also involves thinking outside of the box as does ID so there are some more similarities than would appear at first glance.

What worries me is that I haven't exactly enjoyed third year thus far and I find managing 10-15 medical problems per patient at a speed of 10 minutes per patient, rather exhausting. I feel like I can't tell when to only address the patient's diabetes or hypertension versus addressing all of their issues. Also, for example when a patient comes in with an unstable gait or a headache, I can't tell whether I should do the million dollar work up or just send them home with a referral to the PT or an NSAID prescription. I suppose I would gain these skills over time though.

Since you have to be a superb internist in order to be a good ID doctor, does the fact that I'm not so great yet at the practical aspects of medicine be a detriment? Since I will have upwards of 300k in loans, if ID does end up becoming a specialty I'm well versed in or enjoy very much, would the sacrifices in pay,location(since jobs are hard to come by, I hear) and lifestyle be worth it? IM residency is supposedly brutal and it makes me wonder if I would be able to handle that for 3 years straight before landing an ID fellowship.

Psychiatry, on the other hand, seems much more manageable from a lifestyle perspective, provides a decent salary, and I hope I would have some knack at being good at it. I've always excelled in the humanities though I'm not sure if that really translates to many aspects of the way Psychiatry is practiced nowadays. It would give me the option to have a life outside of work and enjoy my hobbies. The main downside is that patients take a long time to improve and many never do. The vibe I got from the culture of the staff at an inpatient Psychiatry unit was negative and pretty disheartening. I would feel rather sad if my 30+ years of work in Psychiatry was not meaningful and if I didn't really help anyone get better. But is that really the case? Thoughts? Thanks!

 

[Darkskies]

Sorry for bumping this thread but could someone address my question of how brutal IM residency is and whether it's manageable over time? Is it really true that you have to be a superb internist to be a great ID doc?

 

[gutonc]

Sorry for bumping this thread but could someone address my question of how brutal IM residency is and whether it's manageable over time? Is it really true that you have to be a superb internist to be a great ID doc?

Brutal compared to what? It's better than surgery, not as easy as Path. And programs will vary. So it's kind of a meaningless question.

But it certainly helps to be a great internist if you want to be a good ID (or any other medicine subspecialty) doc.

 

[Darkskies]

Brutal compared to what? It's better than surgery, not as easy as Path. And programs will vary. So it's kind of a meaningless question.

But it certainly helps to be a great internist if you want to be a good ID (or any other medicine subspecialty) doc.

Just based on what I've heard, it takes quite a while to get used to the pace and hours, doesn't it? I'm trying to assess whether I'm cut out for the hours and the BS you have to deal with as a medicine resident as compared to other fields like Psychiatry, Pathology, PM&R, EM,etc. I guess that's hard to do until you're actually experiencing it or in the thick of things.. As an ID doc, would I be responsible for any general medicine issues in my day to day practice? Like managing diabetes, HTN, COPD,etc. or am I free to just focus on patients afflicted with infectious diseases and not have to worry so much about managing their other medical problems?

 

[Lawgiver]

this post really struck a nerve. great food for thought.