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Is Psych a Lifestyle Specialty?
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Only if you like psychiatry.
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I love it except for the stigma
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I would say not especially. Most employed jobs require taking call. You can find outpatient jobs in peds, im and family med without call easily. And most inpatient jobs are mon-Friday not the 7 on 7 off.
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This will certainly come as news to 95% of the CMHC psychiatrists in the country. Even our academic system is full of folks who don't do a lick of call.
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I should say hospital employed.
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Not in my experience. I've seen plenty of jobs with no call or very, very little call (and all home call). I've also seen a lot of 7 on, 7 off jobs.
Yes, I do think it's a lifestyle specialty. Most of the jobs I've seen allow you to work 5-day weeks or 4-day weeks, 40 hours/week, with reasonable duties depending on whether you want academic, community hospital, private practice, etc.
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Yes.
Per JAMA articles the only fields which work less hours than psych are EM, PM&R, derm, and occupational health. Psych has a much lower pace than derm and typically deal with lower stress cases than EM. PM&R and OH are probably the only two fields that are truly less stressful than psych, and that depends on what areas of the fields you're working in. Even for those taking call I know exactly zero attendings for whom it isn't home call. It takes a different mindset to work psych than the rest of medicine, but if you're into it I think it's definitely a lifestyle field. You can even argue that compared to most other fields it's a lifestyle residency.
Per JAMA articles the only fields which work less hours than psych are EM, PM&R, derm, and occupational health. Psych has a much lower pace than derm and typically deal with lower stress cases than EM. PM&R and OH are probably the only two fields that are truly less stressful than psych, and that depends on what areas of the fields you're working in. Even for those taking call I know exactly zero attendings for whom it isn't home call. It takes a different mindset to work psych than the rest of medicine, but if you're into it I think it's definitely a lifestyle field. You can even argue that compared to most other fields it's a lifestyle residency.
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Yes.
Psychiatry is absolutely a lifestyle specialty. It also has a lot of flexibility compared to most other jobs.
Psychiatry is absolutely a lifestyle specialty. It also has a lot of flexibility compared to most other jobs.
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I would say psychiatry is definitely a lifestyle specialty if you find the right position and research how to set up the right practice.EM, derm, PM&R may be more reliably pro-lifestyle (ie, the average position beats the average psychiatry position) without being too creative.
During residency, you really need to learn about the private practice model and related business aspects. I don't make neurosurgeon money, but I may beat them on a per hour rate
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I totally get wanting to dissuade people from entering the field for the wrong reasons...but c'mon. Psych is a lifestyle specialty.
How many doctors can work from the cabana next to the pool in their backyard, while naked from the waist down?
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I would say psychiatry is definitely a lifestyle specialty if you find the right position and research how to set up the right practice.EM, derm, PM&R may be more reliably pro-lifestyle (ie, the average position beats the average psychiatry position) without being too creative.
During residency, you really need to learn about the private practice model and related business aspects. I don't make neurosurgeon money, but I may beat them on a per hour rate
I really want to do private practice/work as an independent contractor, possibly with a side of addiction medicine. I'll be starting residency (god willing) in 10 months. What should I be doing to learn about the private practice model to hit the ground running when I'm finished with residency?
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This is the third thread where you’ve asked how to make a bunch of money in psychiatry at this point. How about you actually get into residency first.
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Fiine.
Certainly is for me. Given I'm working outside the US precise dollar figures aren't easily compared, but I can say that last financial year I earned about 6 times the median FT salary working 12-20 hours/week. By time, this was split into outpatients (12 hours) and inpatients (0-7) with earnings roughly at a 2:1 ratio. Will probably add another half-day session of outpatients at some stage, but there isn't any immediate financial imperative to do so.
Part of me still can't quite believe it.
Part of me still can't quite believe it.
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Most medical specialties get to optimize 2 of these at the cost of the other 2: work stress/hours, prestige, hourly rate, location.
Psychiatry can usually optimize 3 of them, and in some unusual situations all 4. We're in rare company. This means yes, we're a lifestyle specialty at least for now. The pendulum always swings.
(Prestige here means leadership positions at famous places)
Psychiatry can usually optimize 3 of them, and in some unusual situations all 4. We're in rare company. This means yes, we're a lifestyle specialty at least for now. The pendulum always swings.
(Prestige here means leadership positions at famous places)
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Running your own private practice can be a slippery slope. With caution my friend.
Even in residency it is lifestyle specialty. Currently going to residency as a ppy2 in the heart of NY, and all my rotations this year have the weekend off. If I'm on call during the weekend, then no, but still, that is pretty sweet gig compared to my first year of neurology residency where that was definitely not the case.
Also if you look at all the state employed state psychiatrist in different states, some of the highest paid employees are psychiatrist (excluding university presidents, athletic sports teams, and government employed surgeons). You can make good coin if you work hard in this field.
www.cantonrep.com/news/20180331/ohio-psychiatrist-is-states-highest-paid-employee
"Zinovi Goubar, a psychiatrist with the Ohio Department of Mental Health and Addiction Services who gets $117 an hour, made $590,005 last year, including $357,593.92 in overtime, according to state payroll records requested by GateHouse Media at the beginning of January.
In fact, 16 of the 20 highest-paid workers have the same job with the state’s mental-health facilities, where being on call entitles them to “on duty” pay under their union’s collective bargaining agreement."
Also if you look at all the state employed state psychiatrist in different states, some of the highest paid employees are psychiatrist (excluding university presidents, athletic sports teams, and government employed surgeons). You can make good coin if you work hard in this field.
www.cantonrep.com/news/20180331/ohio-psychiatrist-is-states-highest-paid-employee
"Zinovi Goubar, a psychiatrist with the Ohio Department of Mental Health and Addiction Services who gets $117 an hour, made $590,005 last year, including $357,593.92 in overtime, according to state payroll records requested by GateHouse Media at the beginning of January.
In fact, 16 of the 20 highest-paid workers have the same job with the state’s mental-health facilities, where being on call entitles them to “on duty” pay under their union’s collective bargaining agreement."
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Most definitely it is. The flexibility is unparalleled. telepsych (which is burgeoning right now), city, country, or even work from outside the country, ER, outpatient, inpatient, private practice, Insurance, full time, part time, 7/7 or 14/14 for that matter.. you name it. We have it all. And the salaries are certainly far from shabby.
It's hard to argue that psychiatry is not medicine's best kept secret. Maybe PM&R/Rheuma can give it a run for its money.
EM has one of the highest burnout rates. The shifts are intense. I would not put it with psych when it comes to lifestyle. You can still pull out shift work in in psych ER with like half the stress involved.
It's hard to argue that psychiatry is not medicine's best kept secret. Maybe PM&R/Rheuma can give it a run for its money.
EM has one of the highest burnout rates. The shifts are intense. I would not put it with psych when it comes to lifestyle. You can still pull out shift work in in psych ER with like half the stress involved.
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Best post I have probably ever read here.
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This psychiatrist is also 66 years old, so I assume his pay gradually increased each year working for the state.
Listen man. I know a psychiatrist in his 40s clearing 500k. He does moonlighting and covers nursing homes during the day. His pay is not experienced based. If you work alot of hours in psych you can make great money.
Also the psychiatrists in the article base pay is 210-230k.
In the article his base pay per hour is 117 hr which is actually pretty low. The reason his pay is high is because of overtime. Like I said, hard work.
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Hopefully someone can correct me if I'm wrong, but from what I can tell it's absolutely a lifestyle specialty.
1) The money is good. There are psychiatrists out there working 2-3 gigs that one thoughtful psychiatrist would work. These guys can pull in 500+/yr.
2) The time investment is minimal. This is a population that almost no one cares about. If you get a good inpatient contract job, you can evaluate your patients with some brief checklist medicine (run though sigecaps/digfast/check for psychoses, then diagnose and prescribe) pretty quick. Then for follow-up you can just check appetite, mood, and some side effects.
3) The population is often mentally/socially incapable of suing you. Then, on the rare occasion that they do, standard of care is incredibly inconsistent from psychiatrist to psychiatrist. This makes it very difficult to say you're practicing bad medicine, because there's almost always a psychiatrist who would practice similarly.
I honestly get the impression that the less you care about the population, the more formulaic you can be. And the more lifestyle friendly it can be. The way psychiatry is currently practiced, it is a relatively cush job compared to the rest of medicine. Hopefully that will change, but I don't have high hopes. I'm going psych. Really hoping I end up at a program that sees patients as more than cogs in the machine, but who knows. It's still certainly better than years before where we just shoved everyone inpatient.
1) The money is good. There are psychiatrists out there working 2-3 gigs that one thoughtful psychiatrist would work. These guys can pull in 500+/yr.
2) The time investment is minimal. This is a population that almost no one cares about. If you get a good inpatient contract job, you can evaluate your patients with some brief checklist medicine (run though sigecaps/digfast/check for psychoses, then diagnose and prescribe) pretty quick. Then for follow-up you can just check appetite, mood, and some side effects.
3) The population is often mentally/socially incapable of suing you. Then, on the rare occasion that they do, standard of care is incredibly inconsistent from psychiatrist to psychiatrist. This makes it very difficult to say you're practicing bad medicine, because there's almost always a psychiatrist who would practice similarly.
I honestly get the impression that the less you care about the population, the more formulaic you can be. And the more lifestyle friendly it can be. The way psychiatry is currently practiced, it is a relatively cush job compared to the rest of medicine. Hopefully that will change, but I don't have high hopes. I'm going psych. Really hoping I end up at a program that sees patients as more than cogs in the machine, but who knows. It's still certainly better than years before where we just shoved everyone inpatient.
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How do people arrange zero call? Are other group members covering? I've seen it argued that there should be some sort of specialty-specific MD with access to the patient's chart available for a patient 24/7, albeit maybe not immediately.
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Absolutely love this. My thoughts exactly everytime talks about how they can make so much money blah blah blah. Scary that’s how we’re attracting people.
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There are plenty of outpatient physicians offices of all specialties that don't have 24 hour phone coverage and just have a voicemail saying to call 911 if there's an emergency, otherwise call back during business hours. Granted, there has been debate on here about if there's some kind of ethical obligation to have coverage (I'm of the opinion there is no such obligation for outpatient physicians of almost any kind). If there are physician offices that have after-hours coverage most of the time its a nurse phone line first that triages away like 90% of the calls based on an algorithm and pages for the few they can't answer.
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Thanks. I've seen a couple residents and at least a couple attendings with this mentality, but they barely knew they had it. No insight, lol. When you're working with a population like this, greed verges on a personality disorder.
One challenge is homeostasis and the fact that we eventually will normalize our situation, meaning that even with a much more laid back specialty we will eventually complain just as much as our ob/gyn and gen surg colleague who work 3x the hours. You probably have a much greater appreciation coming from neuro (which I assume was mostly general medicine without the outpatient clinic or elective time), and hope you can hold onto it, although my guess that by PGY-4 year you will be complaining every time you need to take your q3week call that involves sleeping through most of the night.
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just had an idea. let's stop talking about this being a lifestyle specialty before it stops becoming one.
Psychiatry? don't even consider it. Patients can hit you without warning, half the time you won't understand what they're saying and that'll make YOU crazy; you might be admitted; get zapped in the brain by ECT; the hours are long; the pay is LOW; we're psychologists with a prescription pad; don't believe the hype!
Psychiatry? don't even consider it. Patients can hit you without warning, half the time you won't understand what they're saying and that'll make YOU crazy; you might be admitted; get zapped in the brain by ECT; the hours are long; the pay is LOW; we're psychologists with a prescription pad; don't believe the hype!
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We're screwed as a field if we start attracting students primarily for the "lifestyle" pull but without the genuine interest that will propel them through mentally taxing interactions and the days that seem to be chock full of them sometimes.
A 45 hour week dealing with complicated cases (and personalities) can be draining. Example: I recently gave away a moonlighting shift (one where I probably would have made an extra grand) because I was feeling the burnout creep in. And this is coming from someone who likes (sometimes loves) psychiatry. Burnout is real and genuine interest in the field and your patients will help stave off that burn.
If you just look at the numbers and have not been in the trenches... well... then you have NO IDEA what you're talking about here.
Please go somewhere else if lifestyle is the most attractive aspect of psychiatry... for your own sake.... because you may find yourself quite miserable otherwise and quite likely doing a great service to patients who deserve a helluva lot more.
A 45 hour week dealing with complicated cases (and personalities) can be draining. Example: I recently gave away a moonlighting shift (one where I probably would have made an extra grand) because I was feeling the burnout creep in. And this is coming from someone who likes (sometimes loves) psychiatry. Burnout is real and genuine interest in the field and your patients will help stave off that burn.
If you just look at the numbers and have not been in the trenches... well... then you have NO IDEA what you're talking about here.
Please go somewhere else if lifestyle is the most attractive aspect of psychiatry... for your own sake.... because you may find yourself quite miserable otherwise and quite likely doing a great service to patients who deserve a helluva lot more.
At my program for psych, you don't take call in 4th year. And you only take overnight call 1st and 2nd year. So once im done with this year, everything will start to look up
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To me, it's only a matter of time before psych becomes a lifestyle field which will increase the quality of psychiatrists. It has the increasing money, demand, low mal practice and hours.
In my first year of neuro residency, I did inpatient neuro, neuro IR, medicine, icu, and family medicine. The stress level and difficulty of work is nowhere near comparable. Im in pgy 2 and have to do 24+3 hour call, and I still feel like this is way easier. Also my attendings are much more likeable, less intense and easier to get along with. Psych is definitely a way more chill field compared to others
In my first year of neuro residency, I did inpatient neuro, neuro IR, medicine, icu, and family medicine. The stress level and difficulty of work is nowhere near comparable. Im in pgy 2 and have to do 24+3 hour call, and I still feel like this is way easier. Also my attendings are much more likeable, less intense and easier to get along with. Psych is definitely a way more chill field compared to others
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I knew a psych resident who struggled in residency. He had a hard time with the patients, so I guess that's not a lifestyle specialty for him if he doesn't enjoy it.
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Sometimes I wish I had chosen to go somewhere like that. We take overnights PGY 1-3 and busy supervisory home call (with possibility of being called in physically) 4th year.
We take weekend call q4weeks in third year. But it's not overnight
If you struggle in psych residency, you will almost be guaranteed to struggle in all other residencies. Hands down.
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Yes it’s very lifestyle friendly. I remember thinking how nice it was the week of Christmas to get shot at and watch someone shoot themselves in the head. In fact, last week I got spit on for the first time! Like God just raining down his speckles of love on my face. So blessed.
Stuff likes this happens to people who don't take precautions. None of this has happened to me and I go to residency in a very, very rough area. You probably got spit on because you failed to recognize how agitated the person was and did not keep your distance. I remember I was talking to a pt during medical school who was very angry in the psych ED. Tried to calm pt but it did not work so I did not push it any further and left to report to the attening. The physican assistant student went and kept asking her questions despite her screaming and cursing at him and got really close to her. She ended up punching him in the face. Honestly, you could see that a mile away. In psych, you have to recognize danger and take precautions.
Also getting shot at and watching someone shoot themselves in the head is rare. That can happen at any job to be completely honest. Ive talked to different psychiatrists and that kind of danger doesn't happen oftern
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You've never had someone go from "asleep" to exploding at you? There's even a disorder named after such a thing.
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I think you missed the point. I can see where he is coming from. After a few resident clinics with train wreck after train wreck coming in on 2 benzos, a stimulant, Wellbutrin, and an SSRI, as well as muscle relaxants and opiates, trying to tell you the vyvanse needs adjusting because X,Y, and Z. I could mentally handle more hours of family med clinic than psych clinic. And in that respect I don’t think it’s necessarily all fun and games. Getting desperately dependent people resources is draining, and we don’t get the easy, first time, mild depression cases the same way FM docs get a few easy coughs or well-child’s.
To be sure, if the resident is struggling with the work load, it is reasonable to believe he would struggle with the much higher work load in other cases as well. That piece I agree with.
Especially in the hospital, most pts escalate before they become agitated or violent. I've seen it happen all the time. They will wait in the ED for hours while being ignored and get upset. They will ask for medication or food, and then get madder when no one helps and then go crazy. Or they will get in a back and forth argument with another pt or nurse. Etc. Many times, doctors won't be there until you have to medicate pt. But a good psychiatrist will see what stage of crisis they are in and act accordingly.
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Most psych outpatient cases in my opinion have been straight forward. These individuals have one or two psych issues and you titrate the meds. The therapist will do therapy, the case worker and social work will help out on their financial situation and living arrangements.
In family med, I find it way more difficult. I have had more drug seeking in FM clinic than psych. Psych patients will drug seek for benzos. FM will get pts who seek for benzos and opiates hence more. Also family med docs usually will have to address all of a pts psych and medical issues. Many family medicine docs prescribe psych meds so you will also get some "crazy" or emotionally draining people in that line of work.
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Family med gets plenty of psych. No doubt. But it’s not all psych. It sounds as if you have an ideal, if not misrepresentative population in residency. It is rare for my patients to have less than 2-3 chronic psychiatric problems requiring addressing. Mostly 99214’s and 5’s.
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You act like I don’t have common sense. After getting shot at I’m pretty weary of all my patients. Not much I can do when the patient is sitting calmly there, I go up and say hi to them immediately spitting.
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Deescalate.
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Or you'll walk in on the guy you had a relatively pleasant conversation with earlier in your ED shift and he'll suddenly try to attack you out of the blue because he's tired of waiting for placement. I kept my distance, as I always do when waking up patients, and got out of the way in time, but that's not because he was slowly escalating, as you describe. (Personal experience.)
Or you'll get punched in the back of a head, completely out of nowhere, by a patient who had been slowly walking around the unit, talking to himself, looking withdrawn, but never seeming agitated, violent, or paranoid. (One of our unit staff.)
Sure, you're right that most violence is predictable but blaming victims of patient violence for not being vigilant enough is downright ignorant to the realities of this job based on the fact that you and your colleagues have been lucky enough to not end up in a suddenly and unpredictably violent situation.
I would argue he did slowly escalate but you were not there. You said it yourself
You had a conversation with a pt, then left him alone for certain period of time and had him sit in the ED. It was most likely a build up of huffing and puffing, asking the nurses when he was going to be placed and feeling like he was not getting a significant answer. Its just you were not around to these things happen. If you had checked on him sooner, the situation could have been avoided guaranteed.
Also, I would bet that the pt even if he was withdrawn, he probably looked upset before he did the act. Also, assessing any changes in his behavior would have been clues (does he not normally talk to himself, was he raising his voice, what was his facial expressions). Even pt's who are withdrawn escalate. You've never seen a regular, normal person not say a word but get angrier and angrier to the point of boiling over (like a person waiting in line at the DMV haha)? Im just saying there are signs.
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deleted736562
Are you really arguing that you can predict and prevent violent behavior every single time? That's a little haughty (and silly).
The risks are real. I know 3 attendings who, at one point or another, got beaten. But let's not overstate things. This will depend on setting and resources and the large majority of providers will not experience violence. Plus, if you're really worried about this there's always the webcam.
