Many questions about Psychiatry (Highschool Student)

[Fai]

Hello everyone! Here's a small intro about my situation: I've always wanted to be a lawyer until I actually took the time to research about the profession and my reality was twisted, especially how graduates have a terrible time finding jobs, if at all. After many many MANY suggestions of becoming either a psychologist or psychiatrist (I am aware of the differences) I actually took the time to learn about both professions. I've ALWAYS been interested in biology, neurology, psychology etc. I have always said to myself that if for whatever reason I don't become a lawyer I'd become a psych because I love to help people and I can handle such heart-wreacking stories without getting attached to the person (I'm everyone's journal who replies back.)

But anyway, as someone who MAY be cemented into the Psychiatry, I have many questions and concerns. First off, let me say that money is NOT of a big importance to me. It's more-so schedule flexibility. I'll be more than content with just 70k a year. I have a legitimate interest in helping people as well as understanding the huge responsibility of being there for the clients and taking personal time off for them. I am not at all impressed by doctors who are drug-pusher happy and/or just in it for the money. Now, since that's out of the way...

1. How is the schedule flexibility for beginning Psychiatrists after residency?
I'm not quite sure what KIND of psychiatrist I'd be, but I'm leaning towards child & adolscence. I have absolutely no problem working 50 maybe even 60 hours a week. However, anything over 60 (NOT including emergencies, just normal work times) may be a repellent. I've been told that Psychiatrists can work 3 days a week, so the flexibility is phoenominal. However, I'd prefer a 4-5 day of work from times like 8:30am - 4pm if that's realistic?

2. How hard is it really to keep up with new technology and medications?
I understand and accept that Psychiatrists and other M.Ds have the responsibility to do thorough research and self-education about new technology/medication that came out. I personally love to research and basically that's all I do. It's a hobby. But, is it truely hard and overwhelming?

3. What would be a psychiatrist's salary and hours if USA has a free health care? Can psychiatrists make six-figure?
Now, the salary itself isn't a huge concern of mine. I'd be pretty upset however if I make under 70k a year with barbaric hours(soley because of all the schooling I'd have to go through). I'm assuming if USA had a healthcare similar to Canada's. My Canadian friend says that doctors make 55k a year and have very long, exhausting and non-flexible hours. Flexibility is a huge thing for me, being normal work times since I'd have no problem opening up lets say a weekend for some of my clients. As for six-figure, could a good psychitraist have such income before and after free health care?

4. Do psychiatrists take weekends/holidays off?
Again, NOT including emergencies. Also, an answer for both a hosiptal environment AND a private clinic environment. I heard hospital psychiatrists have rougher hours?

5. Could a psychitraist do psychotherapy? If for whatever reason a psychitraist wanted to become a psychologist later in their years, could they switch?
Now, I ask this question because I saw, from someone on this forum I believe that Psychiatrists are "Psychologists with everything, but more." is this true?

And finally...

6. Do newly-minted Psychiatrists have trouble finding jobs?
My family always say that "Everyone needs doctors, but not everyone needs a lawyer." since the law field is completely over-saturated in America, but I'd figure doctors would be as well.

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I'd like to thank EVERYONE in advance and apologise for such a long post xD I'd like to know for sure what I'm getting into before I cement this. Feel free to ask any questions, as well!

And for those who ask, yes. I do have a slight fear of free health care in the USA if modeled after Canada's health care. Why? It's not because of the money, it's mostly because I can't work in a private clinic environment and lose my flexibility. ANY ressaurances (even though it's anyone's call) would be lovely. I DO love helping people, and I help them all the time and even go out of my way for my friends and such (different, I know. Must not be personal with clients!) and very interested in the human mind so I'm sure the work wouldn't be too much of a bore.

Again, thanks!

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[digitlnoize]

I'm just a 4th year med student, but I'll do my best to answer your questions. I'll keep it fairly brief because many of these answers can be found on SDN using the SEARCH function up there ^^^. They're good questions though, so mad props there. Congrats on realizing the folly of Law School. You are correct about the post-grad job market there. Being a lawyer only pays off if you go to a great school and are very good and work very hard. Med school is very difficult though, so be prepared to work your butt off and sacrifice a lot to get there. I think it's worth it though. You could also, for the sake of completeness, consider careers in mid-level fields like PA or Psychologist (I know, not really a mid level, blah blah blah).

I will also add that you should spend some time in the FAQ in the top of this forum, and maybe considering volunteering or shadowing a psychiatrist in a mental health hospital (outpatient office is a little more tricky, but you can try). It's still VERY early in the process for you and you don't have to be "cemented" into anything right now. Just make sure you do well in school and get into a good college, and do well there. Get the best grades you can, it will help regardless of what field you decide to go into.

How is the schedule flexibility for beginning Psychiatrists after residency?

I'd say very good. Many psychiatrists work 8-5-ish with very little on-call duties compared to other specialties. If you want to own your own practice, that's also comparatively easy, as you can get by with a smaller staff, and mostly set your own hours based on how much you want to make.

How hard is it really to keep up with new technology and medications?

I wouldn't say it's hard, but you do have to do it. Fortunately, all docs have to do a certain amount of "Continuing Education" credits each year, so we get ample opportunity to keep up with things...often while on "vacation" in Vegas or some other fun spot. Most people also subscribe to a few magazines/journals and, as long as you find your subject interesting, it's pretty easy and fun to read these and keep up. The internet has also helped a lot. I follow various medical news feeds, medscape is a good place to start.

What would be a psychiatrist's salary and hours if USA has a free health care? Can psychiatrists make six-figure?

Average psychiatrist salary is currently sitting at around the $180-200k mark. Obviously this can vary a lot depending on how much you want to work, location, etc. I know one recent grad who just started at $250k. There are people making much more than this. There are people working two days a week making much less. Basically, expect at least ~$100/hr regardless of what happens with US healthcare. Possibly more.

Do psychiatrists take weekends/holidays off?

Yes, often. Depends on the person. I do think someone offering weekend/evening hours could attract more patients, or charge more for those convenient times. In-hospital does tend to have more extended hours simply due to the nature of the work, but it's not "grueling" by any means. At least, not compared to many other fields. It's easier than working retail.

Could a psychitraist do psychotherapy? If for whatever reason a psychitraist wanted to become a psychologist later in their years, could they switch?

Do a bit more research here, as you seem a bit confused. Many psychiatrists do psychotherapy, and many residencies include therapy training. There has been a recent trend away from therapy for psychiatrists, mostly due to money issues (non-therapy pays better right now), but this may not hold true forever. If it interests you, you can do it as an MD/DO. Psychiatrists vs Psychologists is a much more in-depth topic that I won't really get into right now, except to say that while they are similar, psychologists tend to do more therapy and less (or ZERO) prescribing of drugs.

Do newly-minted Psychiatrists have trouble finding jobs?

No, and not for the foreseeable future. 55% of practicing psychiatrists are over age 55, and headed towards retirement. To make this worse, it is one of the slowest growing fields. On top of that, there is already a HUGE shortage. Most people have no trouble finding jobs, although if you really want a specific area, it can be tough (if you're set on that one small town, with one psych office, with no openings for example.)

 

[loveoforganic]

Understanding of an incoming first year med student (so mostly based on reading with just a little first hand mixed in)

3. What would be a psychiatrist's salary and hours if USA has a free health care? Can psychiatrists make six-figure?
Now, the salary itself isn't a huge concern of mine. I'd be pretty upset however if I make under 70k a year with barbaric hours(soley because of all the schooling I'd have to go through). I'm assuming if USA had a healthcare similar to Canada's. My Canadian friend says that doctors make 55k a year and have very long, exhausting and non-flexible hours. Flexibility is a huge thing for me, being normal work times since I'd have no problem opening up lets say a weekend for some of my clients. As for six-figure, could a good psychitraist have such income before and after free health care?

No one will be able to predict this with any degree of certainty. There are too many variables at play. The way it is currently sounding to me is we're going to be coming somewhat close to approximating Germany's system, on the national level, except with a much looser mandate to buy coverage, less control over what insurance companies have to offer beneficiaries, and a less capitated payment system (unless the market drives us there). State-by-state, there's going to be more variability, and can't say yet. Germany doesn't have the same state-by-state variability.

4. Do psychiatrists take weekends/holidays off?
Again, NOT including emergencies. Also, an answer for both a hosiptal environment AND a private clinic environment. I heard hospital psychiatrists have rougher hours?

My understanding is that there is a "duty to not abandon a patient" or some such. In hospitals (psych-specific, not emergency department psych departments), this seems to generally be covered by rotating call schedules with other psychiatrists on staff, with either one or zero psychiatrists (can't remember) being on site after regular business hours (5 pm/weekends). In pp, what seems common is setting up a voicemail that says "If you have an emergency, please dial 911," although I've heard mixed things about whether this actually CYA or not (and even if it does, if it's still ethical).

5. Could a psychitraist do psychotherapy? If for whatever reason a psychitraist wanted to become a psychologist later in their years, could they switch?
Now, I ask this question because I saw, from someone on this forum I believe that Psychiatrists are "Psychologists with everything, but more." is this true?

Psychiatrists absolutely can do psychotherapy. In private practice where you're the boss, you can do as much as you want. It doesn't bill as well though, so there's a strong incentive to pass on the psychotherapy to others, with that incentive being not so much an incentive as a requirement of the job if you're employed by someone. That is in the traditional sense of psychotherapy. Psychotherapeutic techniques can be incorporated into med management.

Are psychiatrists as well trained in psychotherapy as psychologists is hotly debated around here. My general intuition is "at present and on the average, no." That doesn't change what they can do however.

"Psychologists with everything, but more." - As far as scope of practice... very technically, I think so. In actuality, no. Psychiatrists (to my understanding) have the potential to be "psychologists + more" without adding any more letters after their name, and this is not true in the reverse case. However, the breadth of training psychologists receive in research methods and psychometrics is not likely to be met by many psychiatrists.

Can you change your mind and become a psychologist? Absolutely. It will just be one more application cycle, and ~5-7 more years of training

And finally...

6. Do newly-minted Psychiatrists have trouble finding jobs?
My family always say that "Everyone needs doctors, but not everyone needs a lawyer." since the law field is completely over-saturated in America, but I'd figure doctors would be as well.

Training is tightly regulated for physicians (including number produced), which isn't the case for lawyers. The profitability of owning a law school is leading to an abundance of schools and hurting law as a profession. Not currently the case for medicine, although the tightest regulation occurs at the residency, rather than med school, level. I'll leave the job q for others, but my understanding is no.

 

[cara susanna]

No, a psychiatrist can't just turn around and become a psychologist. The training is very different. It's not necessarily better or worse, just different.

 

[Fai]

Wow, a lot of great responses! Thanks everyone!

Training is tightly regulated for physicians (including number produced), which isn't the case for lawyers. The profitability of owning a law school is leading to an abundance of schools and hurting law as a profession. Not currently the case for medicine, although the tightest regulation occurs at the residency, rather than med school, level. I'll leave the job q for others, but my understanding is no.

That makes a lot of sense and I know it's a bit foolish to try to link the two when it's about just graduating freshly from the schools. However that's really refreshing to hear because I always thought that doctors (in the USA at least) are over-saturated here as compared to lawyers, but I guess that's all based on specialities.

No, a psychiatrist can't just turn around and become a psychologist. The training is very different. It's not necessarily better or worse, just different.

Ah, figured. Even if it's a MD/PhD? (Sorry for the silly question, I still have lots of more research to go, I just know now that Law is definitely not the field for me so I'm checking out Medical with the interests that best applies.)

Average psychiatrist salary is currently sitting at around the $180-200k mark. Obviously this can vary a lot depending on how much you want to work, location, etc. I know one recent grad who just started at $250k. There are people making much more than this. There are people working two days a week making much less. Basically, expect at least ~$100/hr regardless of what happens with US healthcare. Possibly more.

Wow o___o that's a lot more than I figured an average would've been for a Psych. Guess the debt would be easily paid off in a few years with a salary like that. It's very refreshing to hear this as well because I wouldn't want to go through a really expensive medical school just to come out with a cap of 55k which wouldnt be great to pay of debt ANY time soon. As long as the times with future health care are flexibile my salary can be anything.

Psychiatrists absolutely can do psychotherapy. In private practice where you're the boss, you can do as much as you want. It doesn't bill as well though, so there's a strong incentive to pass on the psychotherapy to others, with that incentive being not so much an incentive as a requirement of the job if you're employed by someone. That is in the traditional sense of psychotherapy. Psychotherapeutic techniques can be incorporated into med management.

Oh okay, yeah not full psychotherapy but an intergration of the two does sound kinda neat.

Again, thanks all! Looks like I have to refer to more research about the Psychiatry profession, and re-look the Psychology part to see if I'm sealed.

However I guess the only question that stands now is an intergration of decent psychotherapy and med-checks by Psychiatrists with MD/PhDs?

 

[OldPsychDoc]

When one speaks of MD/PhD programs, one is typically describing an MSTP (Medical Scientist Training Program) track, in which the PhD is earned in a clinically-relevant basic science field (e.g. neuroscience, molecular biology, pharmacology, etc.). It is NOT a combination of an MD with a Clinical Psychology PhD. I have known a few--very few, actually--cases in which a PhD Clinical Psychologist chose to go to medical school after the fact and ended up in psychiatry. They were good psychiatrists, no doubt, but it's not a pre-requisite for integrating therapy with medication management in practice.

 

[splik]

3. What would be a psychiatrist's salary and hours if USA has a free health care? Can psychiatrists make six-figure?
Now, the salary itself isn't a huge concern of mine. I'd be pretty upset however if I make under 70k a year with barbaric hours(soley because of all the schooling I'd have to go through). I'm assuming if USA had a healthcare similar to Canada's. My Canadian friend says that doctors make 55k a year and have very long, exhausting and non-flexible hours. Flexibility is a huge thing for me, being normal work times since I'd have no problem opening up lets say a weekend for some of my clients. As for six-figure, could a good psychitraist have such income before and after free health care?

Sadly the USA will never have free health care or a national health service, but it is hopefully moving towards universal coverage. This is a good thing and there is no evidence to suggest those working in primary care fields will have their salaries reduced (although this is not true for procedure-based specialties). The notion that physicians in Canada make 55k on average is laughable! Psychiatrists in canada earn 3-4 times that on average (http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf) In the UK, where healthcare is free at the point of use, a new consultant psychiatrist can expect to make ~$160k equivalent which increases with experience and has the potention to earn over $300k just from the government and not including private practice, medical reports, insurance reports and consulting work. Whilst the income potential in such countries in theoretically less (although I know a psychiatrist in the UK who earns over $600k from private practice directing a major addictions clinic) there are much smaller disparities in what you earn cf. the US.

In terms of flexibility - you do not have to be your own boss to have flexible hours. However there may be less flexibility or difference in the service you offer your patients in a government-led system. All the talk of people not wanting government deciding healthcare is ludicrous - I would much rather a benevolent government decide what treatments I should get then a profit-making insurance company which is what currently happens! Remember also the satisfaction rates for patients receiving VA and medicare/medicaid is higher than those with private insurance.

The standards in private practice psychiatry in the US are a national disgrace because of a lack of regulation. If a patient presents to 10 different psychiatrists they should all make roughly the same diagnosis and provide roughly the same treatment. Sadly this is not what happens.

I remember seeing a patient who had been diagnosed with Adult ADD and prescribed Adderal. He never had ADD and was in fact a meth addict. He developed amphetamine-induced psychosis and threw himself off a bridge which is how I ended up seeing him. This sort of thing would never have happened in a system where there were very clear guidelines on standards of care that were enforced. Time and time again, I saw similar patients who were the victims of the lack of uniformity of care encouraged by unregulated private practitioners. I concede that private practice also affords one the opportunity to offer the best possible care as well.

In the UK there are national guidelines for the treatment of borderline personality disorder. They state very clearly that meds should not be used ot treat BPD, only comorbid conditions, and that the treatment should be a psychotherapeutic approach such as DBT, MBT, psychodynamic psychotherapy, or schema-focussed CBT. Thus if psychiatrists wish to deviate from this (they are guidelines, not hard and fast) there has to be good justification. Which means, in theory, less inappropriate prescribing.

Don't believe the propaganda that you've been fed! Universal healthcare and universal coverage is a good thing! It is a good thing for patients, and ultimately a good thing for doctors. Physician salaries have fallen significantly in the past 30 years under a for-profit insurance led system. In contrast in countries with government-led health services salaries have increased.