Late Switch into Psych

[ortho2psych]

TLDR; set up to pursue ortho as a 4th year. Having second thoughts and considering psych because it's the only other rotation I enjoyed. Go all in on psych or nah?

DO student here. I'm all lined up for ortho, but honestly, I'm not thrilled at the thought of the next 4 months of aways/auditions. The only other rotation I really enjoyed was psych -- but shoved it under the rug for silly (yet personally important) reasons. I like to work with my hands, love the OR, love the biomechanics of injuries/fractures, I'm a sports guy. Psych felt less like "medicine" and more like a therapy sesh (forgive me, I only did outpatient private practice). But there's something powerful about navigating a patient's story and forming a plan that takes trust on both ends. Those follow-up visits where patients seemed like completely different people...whoooo, it blew my mind. The days flew by. I'm a good listener (or so my wife says) so apart from how taxing it can be mentally/emotionally, it just felt right.

A few miscellaneous points:

1. My favorite UW questions are psych hah.
2. I like the hospital so I imagine I'd like inpatient psych even more.
3. I can always occupy my hands with woodwork and my wife (namsaynnn?).
4. To be completely honest, I'm burnt out and tired and the thought of putting on my A game for four months of ortho just sounds like hell. I'm trying to sort out if this apprehension is coming from my fatigue or because I genuinely feel psych would be a better fit. I'm not wanting to jump on the psych wagon because it's easier, I do enjoy the field...but it is also nice that it's less demanding than anything surgical. As I'm sure you've gathered by now, I like my time with my wife.

So my question is this: does anyone have advice on how to navigate these next 6 months based on experience? When I share these hesitations, I'm often met with "you shouldn't do surgery". So do I just jump ship and dive into psych? My stats are Step 1 240/Level 1 650/passed Level 2 PE and I'd like to stay west coast/PNW but I would apply broadly.

Thanks in advance.

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[Unico]

If you’re interested in psych, you really need to set up an in-patient elective.

Why not split your electives? 2 ortho and 2 psych?

Nothing is set in stone until you submit your rank list. So apply to both and see where the chips land. This is your one shot, don’t pigeon hole yourself this early in the game

 

[Merely]

You don’t strike me as the psychiatry type. Stop being lazy and do ortho.

 

[SpinDktr]

Agree with Unico. You have time 4th year, branch out, do some inpatient work (very different experience than outpatient).

 

[MacDonaldTriad]

I'm always critical of medical schools that have core psychiatry rotations that are 100% involuntary inpatient psychiatry and nothing else. Watching a psychiatrist do his outpatient practice and calling that a psychiatry experience sounds even worse. Do some C&L, some inpatient or some ER psychiatry. You will figure this out soon enough. Impressions of specialties can be highly influenced by the qualities of your teachers. You should get at least one more experience before you decide.

 

[TexasPhysician]

Most ortho people I know were drooling to do more ortho rotations.

 

[ortho2psych]

Most ortho people I know were drooling to do more ortho rotations.

This is the main reason that got me rethinking my specialty of choice.

Thank you all for your input so far. I'll switch one of my electives to inpatient psych and see where it takes me. What setting would you recommend as away season is in full swing? Inpatient psych at a residency program as a non-subi or regular elective, or a community setting?

 

[Celexa]

This is the main reason that got me rethinking my specialty of choice.

Thank you all for your input so far. I'll switch one of my electives to inpatient psych and see where it takes me. What setting would you recommend as away season is in full swing? Inpatient psych at a residency program as a non-subi or regular elective, or a community setting?

An away rotation at an MD residency program that yields a letter will open some doors for DOs. At least it does at my medical school's residency.

Inpatient or CL (consult psych) will be the best rotations to do. I'm impressed you have any interest in psych at all after doing just outpatient as a med student. Even most of us who went into psych at my school had meh outpatient experiences during our core rotation. You'll probably like inpatient and CL even more.

 

[Attending1985]

Envision yourself as an attending. What do you really want? It’s easy to get discouraged but but don’t let that rob you of your potential. Get in touch with what inspired you to choose medicine. Hard work is unavoidable in medicine choose the work you truly want to be doing.

 

[ortho2psych]

An away rotation at an MD residency program that yields a letter will open some doors for DOs. At least it does at my medical school's residency.

Inpatient or CL (consult psych) will be the best rotations to do. I'm impressed you have any interest in psych at all after doing just outpatient as a med student. Even most of us who went into psych at my school had meh outpatient experiences during our core rotation. You'll probably like inpatient and CL even more.

Awesome. If I end up going for psych fully, I'll definitely be doing 2 sub-is at MD residency programs I'm interested in that will hopefully get me letters. I imagine it's a bad idea to have my first inpatient psych rotation be a sub-i when all I have is outpatient experience, right? Or should I shoot to do 3 sub-i's with my first being at a less desirable program where I can just get a feel for the specialty and being on a sub-i?

Doing outpatient only probably contributed to me putting it on the shelf haha. So I'm glad I'll get to try out inpatient as well.

 

[Celexa]

Awesome. If I end up going for psych fully, I'll definitely be doing 2 sub-is at MD residency programs I'm interested in that will hopefully get me letters. I imagine it's a bad idea to have my first inpatient psych rotation be a sub-i when all I have is outpatient experience, right? Or should I shoot to do 3 sub-i's with my first being at a less desirable program where I can just get a feel for the specialty and being on a sub-i?

Doing outpatient only probably contributed to me putting it on the shelf haha. So I'm glad I'll get to try out inpatient as well.

TBH the subi vs. elective thing is more label than meaningful distinction as far as I (a soon to be psych intern) can tell. There are schools where all M4 psych rotations are labeled as electives, but if you are planning to go into psych and you show up as an M4 you bet your ass you're being treated as much like an intern as possible.

I'd just focus on finding rotations where you'll get robust clinical exposure and face time with attendings. It may also be worth it to choose rotations where at least some of the residents are DOs because you know the residency leadership will be open minded to DOs there.

 

[NontradCA]

You don’t strike me as the psychiatry type. Stop being lazy and do ortho.

 

[SeniorWrangler]

If you draw a line between Ortho and Psychiatry, the midpoint of that line is PM&R.
Psychiatrists spend a lot of time sitting down talking to people; Orthopedists spend a lot of time standing up in the OR using power tools. PM&R docs do lots of detailed evaluations and can also do lots of procedures. Some PM&R do sports and spine stuff and work closely with orthopedic surgeons, others specialist in head injury and are more like neurologists or psychiatrists. Check it out as a specialty, it might fit your interests really well.