Interests in field vs. Actual Job

[mistafab]

---

Members don't see this ad.

So I am having a sort of inner debate about what I could see myself doing for a specialty.

I have always been interested in psych and the brain. I love to think about it, I like to come up with research ideas, and I have the ability to think in abstract ways that tends to help me grasp psych related things.

However, the actual jobs are kinda dull. Consult/liason work which seems the best fit for me is kind of... meh. I love the brain, however, the consult service even in an academic setting is getting called most the time for aggressive behavior or delerious patients. Where I am, there are lots of drug and addiction calls too. It just isn't as stimulating as the type of work that interests me.

Meanwhile, general surgery is a job that I really like the work of but the subject matter is nothing to write home about. Doing shadowing, scrubbing in, suturing, and stapling intestines was freaking cool. The job just seems awesome. Going to work and just having people on the table and doing physical stuff and having a skill that you get better and better at mechanically like a game or a hobby is just cool. I am the type of dude that likes having a job where I can get better and better and see the results. I really like responsibility, high stakes, and being the expert. I also do not really care for home life and I hate kids. Plus, I actually like work and being good at something.

So in sum - help me spitball here. Anyone with similar forks in the road for interests? Not looking for someone to just "give me the answer" - but maybe give me something to think about or another perspective to look at.

TL;DR - OP likes subject matter of psychiatry but thinks the job is not really stimulating. OP finds the work of general surgery stimulating however the subject matter is just alright. Help him think about this stuff.

 

[PrettyLadyDoc24]

From what I'm reading I think you'd be better suited for Surgery instead of Psychiatry. I know what you mean by having an interest versus putting something into practice, and if you plan to work for the next 30-40 years in something, it should be enjoyable and intellectually stimulating. For what it's worth too I was die hard about Psych for a very long time until I went on rotation and realized that I was way too emotional for the actual job of being a psychiatrist.

Good luck!

 

[bashwell]

So I am having a sort of inner debate about what I could see myself doing for a specialty.

I have always been interested in psych and the brain. I love to think about it, I like to come up with research ideas, and I have the ability to think in abstract ways that tends to help me grasp psych related things.

However, the actual jobs are kinda dull. Consult/liason work which seems the best fit for me is kind of... meh. I love the brain, however, the consult service even in an academic setting is getting called most the time for aggressive behavior or delerious patients. Where I am, there are lots of drug and addiction calls too. It just isn't as stimulating as the type of work that interests me.

Meanwhile, general surgery is a job that I really like the work of but the subject matter is nothing to write home about. Doing shadowing, scrubbing in, suturing, and stapling intestines was freaking cool. The job just seems awesome. Going to work and just having people on the table and doing physical stuff and having a skill that you get better and better at mechanically like a game or a hobby is just cool. I am the type of dude that likes having a job where I can get better and better and see the results. I really like responsibility, high stakes, and being the expert. I also do not really care for home life and I hate kids. Plus, I actually like work and being good at something.

So in sum - help me spitball here. Anyone with similar forks in the road for interests? Not looking for someone to just "give me the answer" - but maybe give me something to think about or another perspective to look at.

TL;DR - OP likes subject matter of psychiatry but thinks the job is not really stimulating. OP finds the work of general surgery stimulating however the subject matter is just alright. Help him think about this stuff.

Neurosurgery. Since you don't appear to be bothered by the general surgery lifestyle, you like high stakes, you don't care about a home life or kids, you love the brain.

 

[DrWhozits]

My concern would be...everything eventually becomes a job. What happens if those surgeries begin to lose their luster and you have no real interest in the work you are doing.

For example, I think working on a car is really cool. You can do technical things and see the result of fixing the car. However, I'm not running off to be a mechanic, because after the 1000th car, it starts to seem mundane, and I have no actual intellectual interest.

If the working bits are boring, but the overarching job is interesting, that seems to me like a more fulfilling career.

The day to day will probably suck regardless of specialty, field, career, etc. at some point.

 

[mistafab]

I like the insights so far - appreciate the input. I definitely will keep thinking about this, and I don't really think I had given too much thought to what the difference between 30 years at a job vs 10 years. I also hadn't thought about neurosurgery, may be a stretch for me because of my limited intellectual capacity however maybe that could be in the cards. I am also good to hear someone dissenting and saying to stick to what is intellectually stimulating since the novelty of the "mechanic" job might run out.

Anyway, thanks for the insights so far. Keep em coming if you can!

 

[longhaul3]

I like your question. The academic:work ratio is probably higher in med school than it will ever be in training/attendinghood (unless you take a physician-scientist track), so consider that you might be biased now, i.e. psych is as good now as it's ever going to be for you. If you go into psych, it will only be "downhill" in your view from here (less academic, more work), whereas surgery will only get better (less academic, more work).

I also do not really care for home life and I hate kids.

How old are you? In my experience and my observation of others, I've seen this change rather abruptly in the mid-20s. Both my wife and I once felt the same way as you—I once made my mom cry when I was in my mid-20s and told her that I didn't want kids—but all of a sudden we both reversed course. The same has happened to a lot of my friends and classmates once they settled more comfortably into adulthood.

 

[DrWhozits]

I like your question. The academic:work ratio is probably higher in med school than it will ever be in training/attendinghood (unless you take a physician-scientist track), so consider that you might be biased now, i.e. psych is as good now as it's ever going to be for you. If you go into psych, it will only be "downhill" in your view from here (less academic, more work), whereas surgery will only get better (less academic, more work).

This is a fair point. Although, what if he finds that surgery doesn't get better?

I think truly you could pick correctly either way........or incorrectly either way. But you won't know until you know sadly.

 

[longhaul3]

Although, what if he finds that surgery doesn't get better?

I got the sense from his post that he likes the work of surgery already, just not the academic side of it, so since it will only become more "work-like" from here, it's basically guaranteed to get better. Meanwhile, he likes the academic part of psych, which will only get less and less relevant from here. My reasoning can't account for the car mechanic analogy, though.

I agree with you: no way to know until you just know.

 

[mistafab]

Thank you for your inputs.

On the children and family front - I have always been pretty detached and low-maintenance in the family life kind of way. In the same light, I understand that I am still pretty much a kid in my mid twenties and am open to what life changes may happen - even changing perspectives. It is something to consider for sure.

On academic vs. actual job stuff - could I ever find myself ever stimulated mentally besides skill-wise in surgery 10 or even 20 years down the road? I enjoyed the surgeries I've been involved in lots. However, who wakes up at night contemplating gut or mid-section anatomy? I'm not sure if research in general surgery would call to me the same way psychiatry research has. However, I realize that I am naive and have not been exposed to much more than what my particular school is interested in researching. In psychiatry, I am still not sure about the job even though I've spent a few years working with psychiatrists in different settings and have spent considerable pre-med and med time shadowing. I enjoy the research a whole lot - but when it comes down to it I have to realize that I am not training to be a researcher. I enjoy the process of science and new knowledge so maybe I could find pleasure in applying my love of the process to things I wouldn't think are particularly interesting.

Anyway, good stuff. Open to anything else people think about.

I like your question. The academic:work ratio is probably higher in med school than it will ever be in training/attendinghood (unless you take a physician-scientist track), so consider that you might be biased now, i.e. psych is as good now as it's ever going to be for you. If you go into psych, it will only be "downhill" in your view from here (less academic, more work), whereas surgery will only get better (less academic, more work).



How old are you? In my experience and my observation of others, I've seen this change rather abruptly in the mid-20s. Both my wife and I once felt the same way as you—I once made my mom cry when I was in my mid-20s and told her that I didn't want kids—but all of a sudden we both reversed course. The same has happened to a lot of my friends and classmates once they settled more comfortably into adulthood.

This is a fair point. Although, what if he finds that surgery doesn't get better?

I think truly you could pick correctly either way........or incorrectly either way. But you won't know until you know sadly.

 

[Amygdarya]

OP, this is my very subjective response to your dilemma, but I personally chose psychiatry, among many other reasons, precisely because I expect it to never become boring for me, unlike many if not all other medical specialties. Why? Because patients' personalities, personal histories etc are very different and actually matter in psychiatry (especially over a long term, but even in the ED). I've been doing my best to get as much psych clinical experience in different settings as I can, and for me it never gets boring - even when I see the third depressed suicidal patient in psych ED that day, it never gets boring because patients are individuals and they are all unique. I'm also *intellectually* very interested in neurology but I enjoy getting to know my psychiatric patients more than anything in daily neurology work, so I guess I went with the "actual job" (though I find psychiatry intellectually stimulating as well, if in a different way).

I don't mean to sound all touchy-feely or anything; my point is, just as you realize yourself, you're interested in the research, not the practice aspect of psychiatry. And, if you put some effort into it, it's possible to create a research psychiatry career (though you'll still have to suffer through residency). In fact, there are opportunities to study the brain in other specialties - neurology and neurosurgery, obviously - but also, say, anesthesiology (just think of all the recent research on general anesthesia effects on cognition etc.) On the other hand, I strongly believe that for clinical practice in psychiatry one has to be genuinely interested in patients as individuals, otherwise 1) yes, it gets boring; and 2) it's a downward slope to becoming one of the many cr@ppy psychiatrists who throw the same kinds of drugs at every patient without giving it much thought (and with predictably lousy results).

Also, you may want to consider this: sounds like you've been interested in psychiatry since you were a premed, but then you got kind of disappointed in it once you had your psych rotation. And it's ok. It's normal for people to realize it's not what they want to do once they get a taste of it (which is not at all the same as shadowing or doing research in the field). Many people come to med school with preconceived ideas of their specialties but change their minds. Some of them may feel weird about it and may cling to their original choice and prolong the agony of specialty decision making (so dramatic huh!😛) because of some sort of "emotional involvement sunken cost" fallacy - like, "I've always thought I'll be X, how come I'm not going to be X anymore?" Just something to consider.

 

[ACSurgeon]

Mechanic analogy is faulty. Even breast and endocrine surgery are stressful not infrequently. Once you become a master surgeon, operating becomes more like professional athlete playing his sport. You always compete with yourself, and there's always more you can do to fine tune. Also, if nothing else, being an academic surgeon allows you to continually teach novice surgeons how to operate. This too requires constant fine tuning.

OP- you should be a little more passionate before committing to surgery. While there's plenty of fascinating research (immunology for transplant, oncology, basic science, clinical research etc), you have to be able to be efficient and decisive on the clinical side. You can land a job with 50-70% research, where you can spend all day contemplating biochemical pathways or whatever, but that won't fly as a resident on a day to day basis. You have to have the ability to see things, quickly evaluate, and move on.

Everyone coming through surgery enjoys some aspects of "doing things". What separates us from the rest is our interest in the overall package: GI pathophys, the breadth of general surgery training and potential fellowship options, our pride in what we do (and how we do it). I was always proud of how hard I worked, and how little crap I took from any other service.

OP- you seem more interested in psych. If you don't have a burning desire to actually fix problems definitively, you probably won't have enough interest to get you through training. Psych almost never fixes anything and a lot of the time seems to come in short compared to medical specialties that manage chronic conditions. The fact that you're ok with not fixing problems suggests you'd be happy not being a surgeon.

 

[Electric Head]

What job would you like to have when your 50 years old? Will you have the stamina to do surgery and will you continue to feel engaged at that age? Will you hate your job and wish you never went to medical school at 50 if you choose psychiatry? It seems to me you've already made up your mind to shoot for surgery. It'll be 5 years of residency hell but you can have a family and be a surgeon. Many people do.

 

[Blunt Dissection]

I was told once by an attending that if you had a hard time deciding between 2 specialties, think about it this way: if you were out to dinner with your wife or if it were 3AM Christmas morning and you were wearing the pager, which specialty would make you more likely to go "Shoot, I need to take this" versus "****, I have to take this." He says the one that you are more likely to be ok with leaving your home life for is the one that you should choose because it becomes a common thing during residency.

 

[ACSurgeon]

I was told once by an attending that if you had a hard time deciding between 2 specialties, think about it this way: if you were out to dinner with your wife or if it were 3AM Christmas morning and you were wearing the pager, which specialty would make you more likely to go "Shoot, I need to take this" versus "****, I have to take this." He says the one that you are more likely to be ok with leaving your home life for is the one that you should choose because it becomes a common thing during residency.

There's some truth to that, and that's why I became a surgeon. Figured if I'm gonna be up all night doing something, it should be something fun.

Reality: Most of us will ultimately care more about our families and important life events than our career. So, being upset that someone woke you up in the middle of the night or made you miss Christmas with your family will suck no matter how much you enjoy the work.

Finally- surgery is much more likely to not only have you get called in the middle of the night, but also taken into the hospital where you might have to operate for several hours. Most non-operative fields have home call that rarely requires you drop everything and run to the hospital.

 

[LyMed]

Interventional neuro?

 

[Stagg737]

Mechanic analogy is faulty. Even breast and endocrine surgery are stressful not infrequently. Once you become a master surgeon, operating becomes more like professional athlete playing his sport. You always compete with yourself, and there's always more you can do to fine tune. Also, if nothing else, being an academic surgeon allows you to continually teach novice surgeons how to operate. This too requires constant fine tuning.

OP- you should be a little more passionate before committing to surgery. While there's plenty of fascinating research (immunology for transplant, oncology, basic science, clinical research etc), you have to be able to be efficient and decisive on the clinical side. You can land a job with 50-70% research, where you can spend all day contemplating biochemical pathways or whatever, but that won't fly as a resident on a day to day basis. You have to have the ability to see things, quickly evaluate, and move on.

Everyone coming through surgery enjoys some aspects of "doing things". What separates us from the rest is our interest in the overall package: GI pathophys, the breadth of general surgery training and potential fellowship options, our pride in what we do (and how we do it). I was always proud of how hard I worked, and how little crap I took from any other service.

OP- you seem more interested in psych. If you don't have a burning desire to actually fix problems definitively, you probably won't have enough interest to get you through training. Psych almost never fixes anything and a lot of the time seems to come in short compared to medical specialties that manage chronic conditions. The fact that you're ok with not fixing problems suggests you'd be happy not being a surgeon.

I think the mechanic analogy is actually pretty apt for surgery. Sure, there are always things you can fine tune and keep working to improve. And sure, you'll encounter those cases where something is really odd or off every so often. At the end of the day though, a lap chole is a lap chole. At the core, I found most surgeries to be really repetitive with small variations between cases. The exception I saw was trauma surgery where you can walk in and not be sure what you're going to find. Surgery was way up my list of fields I wanted to enter going into third year, but halfway through my surgery rotation the whole process starting feeling pretty tedious and monotonous. Maybe there are other surgical fields or sub-specialties that aren't like that (trauma), but from what I saw that seemed to be the case for gen surg and ortho.

On the other hand, psych was one of the 2 fields I was 100% sure I didn't want to enter going into third year and after rotations it was my favorite by far. It was a lot like @Amygdarya described in the sense that there may not be a huge variety of diagnoses, but they can present in 1,000 different ways. Yes, there are similar themes, but stories can vary immensely between patients. People's reasoning, mindset, ways to effectively communicate with them, treatment modalities, and many other aspects are unique to each individual in a way that you just don't see in most other fields, especially surgical fields. The other thing about this is that I felt like on my psych rotations, I'd come home every day with some new story that was just crazy (no pun intended) and amazing, which just wasn't true about other rotations. Genuinely not trying to knock surgery or anything, just letting my bias towards psych show a little.

@mistafab a few things to keep in mind:

1) The first is that no one on here really knows you well enough to tell you what you're going to enjoy. The best way to figure out whether you're going to enjoy working in a certain field is to do a rotation in it. If I hadn't rotated in psych, I'd never have tried to go for it. Likewise, if I hadn't done an actual surgery rotation where I got to scrub in and be first assist on a bunch of surgeries, I'd probably still think it was something I'd really want to do. Until you've got some actual firsthand experience with the different fields, you're not really going to know which ones are a decent fit for you (this is coming from someone who had several hundred hours of surgical shadowing going into clinical rotations).

2) Most of the time, limitations of what you can do in a field are only limited to available funding and your own imagination. If there's one thing I'm grateful for about doing 3rd year rotations at a DO school without an associate hospital, it's that I've got to rotate with some physicians who have taken some pretty unique career paths. I won't elaborate too much to maintain anonymity, but you can do some pretty interesting things with your degree once you're done with residency in many different fields.

3) I realize you said you like working and aren't prioritizing family, but you can do that as a psychiatrist. No one would be stopping you from pulling extra shifts or a ton of hours as a psychiatrist if you wanted. On the other hand, psych is truly a lifestyle specialty, meaning that you could easily pull in 6 figures working part time (30ish hours a week) and leave yourself time to pursue other areas of interest in your life. Before starting med school I met a doc (I think he was FM) who worked 2-3 days a week seeing patients and then flipped houses the rest of the time. I love working with my hands, and part of what I like about psych is the idea that can have the opportunity to pursue other interests outside of that if I wanted to. Not saying you couldn't do that with surgery or many other fields, but it's certainly easier to do in some fields than in others.

It's good that you're thinking about this stuff early, but I also think that you're not really going to have the ability to really narrow things down until you get actual exposure to more field. For now, if you know you're interested in 2 fields, you may want to try and get in contact with physicians in those fields (on here or irl) and try and have a conversation about what residency is like, what a "typical" career in the field is like, if there are unique opportunities/paths available, and what the field is like 30 years down the road (including what direction it may be headed in).

/essay

 

[mistafab]

Hey everyone, I've got to say thank you for your additional input.

@Amygdarya thanks for your insight. Yes, I think you hit the nail on the head. I am interested in the questions that psychiatry is asking, however, I got turned off a bit when I became a med student and continued to shadow/socialize with psychiatrists wearing my new med student lenses. How does this practice work? What limitations are placed on the psychiatrist's work when he is working for a hospital, or for him/herself? How much does he get to know this patient? How many cases like this does he see a day? What opportunities is this psychiatrist given to think deeply or theorise about psychiatry, or improve as a psychiatrist? I definitely have more reflection to do and more psychiatry work to see in order to feel comfortable with any answers - and what then? I tend to question myself a lot so I do hope to be realistic with myself about if I am clinging to old ideas or if I am just being wooed by another seductive career idea. Psychiatry is a wonderful specialty and I look up to many psychiatrists - I would never be ashamed to jump in if I do decide that psychiatry is the path for me.

@lazymed I appreciate your response. As a resident in surgery, I am grateful that you wrote out your perspective a bit. I think you talking about not just desiring to "fix things" is a good thing to think about. Do I just like to fix things? Everyone likes to feel helpful - so I definitely should have deeper interests, pride, and perhaps even grit if I am truly considering persuing surgery.

@Electric Head thank you for writing. Yes, this long-term perspective is tough for me to really think about. Being in my mid-twenties, I have a difficult time considering these questions. However, this is precisely why they must be considered.

@FenderBenderEmergency thanks for chiming in. Yup - definitely a good thought. I still haven't fully grasped what life will be like in residency. I am not sure I can at this point however I will definitely ask myself again in a year or so.

@LyMed Something to consider. It wouldn't be real procedures. However, if I spent some time seeing what their time is like, maybe i'd like it.

@Stagg737 Thank you for this post. Yes, maybe the variations in narrative can make cases that appear similar to pique my interest. In my previous work, I still remember some of the most interesting stories that came out during our psych interviews. You are right to say that I could strike a good research/clinical balance. I have to think about whether or not I would enjoy the clinical 50 as much as the research 50. I want to do predominantly clincal work however I have always found myself getting involved in projects along the way so I doubt that the research would ever stop. You are also right that psychiatry would offer me the flexibility should I want to persue something outside of my career more later down the road. It is rare to have that kind of flexibility, especially for a career. I will definitely take up getting more face to face or digital interaction with both fields just to see where it all goes.


Anyway, thanks everyone for spitballing here with me and helping me to think about things I just wouldn't think up myself. I think this thread has given me exactly what I wanted out of it. I did not expect to come to a decision now, however, I do think I am better equipped to think about this decision later down the road. As always, best of luck everyone. I'll definitely update here with what I eventually decide to pursue. Thanks again.