Matched and already regretting psychiatry

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We don't have a true med/psych unit (though we are trying to open one in the near future), but as we are connected to a major academic medical center by tunnel, we have a fair amount of medical acuity in our inpatients. Definitely have people with with PICCs, on dialysis, getting IV abx, hospital beds, with trachs, and up to 8L O2 by NC. We have our own (small) dedicated medicine service in the building and all interns spend a month with the doing the medical stuff for our inpatients, which I think is possibly the most relevant possible training. We have a small army of PAs doing most routine primary care stuff on our floors so the MDs handle things that are trickier (Type 1 DM), minor procedures (I&D's and the like). Our major limitation is our nurses can't start IVs (we can call the hospital IV team to do this) and can't do IV push meds due to regulations. There are some former CC nurses who behind closed doors are willing to "assist" an MD in placing an IV but they are not supposed to do this. We have a dedicated wound care nurse as well so are fine with vacs and what not. There is also an eating disorder inpatient unit, so many of our residents end up being called in the middle of the night to replace or troubleshoot NG tubes.

We have a geriatric floor with 40 beds, so I can't imagine how that could even work if we couldn't take care of basic inpatient medical stuff. Obviously we also do consult various specialists as appropriate but it is not like we have endocrine managing everyone with diabetes.

It sounds like at facilities with less intensive supports outpatient medicine might be more relevant, although I wonder if emergency medicine would be better to some extent (practice triaging into sick who need to go to the medical side and not-sick who don't).

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We don't have a true med/psych unit (though we are trying to open one in the near future), but as we are connected to a major academic medical center by tunnel, we have a fair amount of medical acuity in our inpatients. Definitely have people with with PICCs, on dialysis, getting IV abx, hospital beds, with trachs, and up to 8L O2 by NC. We have our own (small) dedicated medicine service in the building and all interns spend a month with the doing the medical stuff for our inpatients, which I think is possibly the most relevant possible training. We have a small army of PAs doing most routine primary care stuff on our floors so the MDs handle things that are trickier (Type 1 DM), minor procedures (I&D's and the like). Our major limitation is our nurses can't start IVs (we can call the hospital IV team to do this) and can't do IV push meds due to regulations. There are some former CC nurses who behind closed doors are willing to "assist" an MD in placing an IV but they are not supposed to do this. We have a dedicated wound care nurse as well so are fine with vacs and what not. There is also an eating disorder inpatient unit, so many of our residents end up being called in the middle of the night to replace or troubleshoot NG tubes.

We have a geriatric floor with 40 beds, so I can't imagine how that could even work if we couldn't take care of basic inpatient medical stuff. Obviously we also do consult various specialists as appropriate but it is not like we have endocrine managing everyone with diabetes.

It sounds like at facilities with less intensive supports outpatient medicine might be more relevant, although I wonder if emergency medicine would be better to some extent (practice triaging into sick who need to go to the medical side and not-sick who don't).
Wow, this sounds like great training.
 
If you're really longing to switch into Peds after the first year, I'm quite certain (based on comments on this board) that you'd find someone willing to outright trade positions with you.
THIS
 
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Seems like there's a lot of unnecessary callousness ITT. OP, you can always transfer into Peds if you still want to later. I know a lot of people who have transferred specialties or programs. You'd probably have to redo intern year or at least part of it but if Peds would make you happy and psychiatry won't it's definitely worth it. You'd lose (maybe) one year in the span of a 25+ year career.
 
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Seems like there's a lot of unnecessary callousness ITT. OP, you can always transfer into Peds if you still want to later. I know a lot of people who have transferred specialties or programs. You'd probably have to redo intern year or at least part of it but if Peds would make you happy and psychiatry won't it's definitely worth it. You'd lose (maybe) one year in the span of a 25+ year career.

Thank you. Psych is a fantastic specialty (that's obviously why I applied and ranked it!) but one week after match and I am still feeling terrible. I am going to give my program my all and be a good resident, but I think this is a really unfortunate situation of not realizing that Peds was really what I truly wanted until it was too late. I feel horrible that I took a psych spot from someone else.
 
Thank you. Psych is a fantastic specialty (that's obviously why I applied and ranked it!) but one week after match and I am still feeling terrible. I am going to give my program my all and be a good resident, but I think this is a really unfortunate situation of not realizing that Peds was really what I truly wanted until it was too late. I feel horrible that I took a psych spot from someone else.

It's not unreasonable to have a feeling like that fleetingly, but you made your rank list in good faith. At the time, you thought it was what you wanted. You did all that anyone could expect you to do and didn't do anything wrong. Making a decision like this is very difficult for anyone. Hopefully, your feelings of guilt won't linger too long. Whoever you're thinking of may not have matched in psychiatry regardless. This year in psychiatry may end up making you a better doctor or you may change your mind and decide to stick with psych or pursue a Triple Board position. A lot of people who are initially disappointed by their match end up happy and some who are initially happy end up disillusioned and frustrated. My advice is just to get the most you can out of the year. You won't be able to apply for a transfer until late August or September so try to use that time to be sure of your decision.
 
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Seems like there's a lot of unnecessary callousness ITT. OP, you can always transfer into Peds if you still want to later. I know a lot of people who have transferred specialties or programs. You'd probably have to redo intern year or at least part of it but if Peds would make you happy and psychiatry won't it's definitely worth it. You'd lose (maybe) one year in the span of a 25+ year career.

25 years? How do I retire at 55 on a peds salary... now THAT is a good question.
 
It's not unreasonable to have a feeling like that fleetingly, but you made your rank list in good faith. At the time, you thought it was what you wanted. You did all that anyone could expect you to do and didn't do anything wrong. Making a decision like this is very difficult for anyone. Hopefully, your feelings of guilt won't linger too long. Whoever you're thinking of may not have matched in psychiatry regardless. This year in psychiatry may end up making you a better doctor or you may change your mind and decide to stick with psych or pursue a Triple Board position. A lot of people who are initially disappointed by their match end up happy and some who are initially happy end up disillusioned and frustrated. My advice is just to get the most you can out of the year. You won't be able to apply for a transfer until late August or September so try to use that time to be sure of your decision.

That was extremely well said.
 
Is that actually possible, though? Surely I will not have the training required for a PGY-2 position in peds.
They will likely give you credit for some of your rotations. I did a traditional rotating internship and then psych. I realized first year of psych residency I didn't want to stay in psych. I rotated with a PD who wrote "Born to be a physician" "God's gift to medicine" on my eval for FP. He became the PD of a new FP residency program and PROMISED me a PGY2 spot because I did a TRI. I had a spot as a second year at one FP program during my psych residency as well as one in IM. BUT I trusted this other PD could get me my second year spot in FP when I was done with psych. Unfortunately, he didn't realize he was a PD in name only. It wasn't a great program, but it was a program and I thought finishing in psych was not a bad idea, I like about ten hours a week of seeing therapy patients, but when it came time to interview, he couldn't even get me an interview. My PD letter is coming from someone awesome but insists I pass the Psych boards (failed 2x) so I am retaking it again next year and applying for a second residency in FP. You may like psych more than you think, you can always try for a peds residency next round if you are still feeling this way. I would advise you to apply to peds if you strongly feel this way. I SO wish I would have left psych for FP or IM. I doubt I will match into FP, residency is very profitable for hospitals. As a second residency, the hospitals would only get half funding for me, not to mention the gazillions of other red flags on my application. Good luck with your decision.
 
Psych is a highly specialized field - peds is primary care + annoying parents on top of the scut work. You made the right decision.
 
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Psych is a highly specialized field - peds is primary care + annoying parents on top of the scut work. You made the right decision.

I understand that a lot of people feel that way. A lot of people made that argument to me in fact, which is part of why I ranked a psych program first. Post-match, I'm feeling a lot of grief and like peds is where I'm really meant to be. Hopefully during intern year my feelings will change, and I will remember why I loved psych. In the meantime I'm heading back to my last rotation of medical school tomorrow, which is, surprise, a peds rotation. That's going to be rough.
 
I was torn all year between psych and peds. I believed that I genuinely loved both fields and couldn't choose between them. In the end, I ended up ranking a psych program that actively recruited me and was a great fit for me #1, and then a ton of peds programs 2-6. As soon as my rank list was in, I regretted my decision, and began hoping I would match into peds. I matched at my #1 and will be going into psych.

I'm devastated. Trying hard to be positive, but really struggling to deal with the loss of practicing more hands on medicine. I also feel guilty since I know people who were better candidates than me failed to match into psych this year.

Does anyone have any advice about dealing with this? Right now I can barely get out of bed and am dreading the rest of my life. I want to make the best of this and be a good resident for my program and a good doctor for my patients.

I understand that a lot of people feel that way. A lot of people made that argument to me in fact, which is part of why I ranked a psych program first. Post-match, I'm feeling a lot of grief and like peds is where I'm really meant to be. Hopefully during intern year my feelings will change, and I will remember why I loved psych. In the meantime I'm heading back to my last rotation of medical school tomorrow, which is, surprise, a peds rotation. That's going to be rough.

Do you want everyone to hold your hand, hug you, and tell you everything in life is perfect response or honesty? Accept responsibility and adjust accordingly. Grow up and prepare for residency and/or enjoy your free time. 4th year has been Hell for a lot of people, including me. I wish your version of Hell was my reality. You had control of your destiny and you dropped the ball. I would love that luxury.

Go out there and help a lot of people the best you can with the time you have at this program and try to transfer in the future if you feel that is best for you. So many people don't match because of complete BS, and you matched to something you didn't like because you spent 4th year with your mind elsewhere...
 
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Do you want everyone to hold your hand, hug you, and tell you everything in life is perfect response or honesty? Accept responsibility and adjust accordingly. Grow up and prepare for residency and/or enjoy your free time. 4th year has been Hell for a lot of people, including me. I wish your version of Hell was my reality. You had control of your destiny and you dropped the ball. I would love that luxury.

Go out there and help a lot of people the best you can with the time you have at this program and try to transfer in the future if you feel that is best for you. So many people don't match because of complete BS, and you matched to something you didn't like because you spent 4th year with your mind elsewhere...
This is totally unhelpful. If you want to be any kind of decent psychiatrist/human being you need to develop some empathy. You are acting out of you own distress which this individual is not responsible for.
 
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Do you want everyone to hold your hand, hug you, and tell you everything in life is perfect response or honesty? Accept responsibility and adjust accordingly. Grow up and prepare for residency and/or enjoy your free time. 4th year has been Hell for a lot of people, including me. I wish your version of Hell was my reality. You had control of your destiny and you dropped the ball. I would love that luxury.

Go out there and help a lot of people the best you can with the time you have at this program and try to transfer in the future if you feel that is best for you. So many people don't match because of complete BS, and you matched to something you didn't like because you spent 4th year with your mind elsewhere...

Certainly don't expect people to hold my hand or for life to be perfect - my life, and my med school experience, has been far from perfect. Was just responding to the poster who was saying that psych was the clearly better choice - a lot of people make that argument, I think it's a worthy argument, and it's an argument that I bought into. And then I realized that unfortunately that argument didn't apply to me. Believe me, I'm fully aware of the fact that this situation is 100% my own fault, which is part of what makes it difficult.

I'm sorry your 4th year has been Hell - mine has too, and not just because of this. Here's hoping residency is better for both of us.
 
Certainly don't expect people to hold my hand or for life to be perfect - my life, and my med school experience, has been far from perfect. Was just responding to the poster who was saying that psych was the clearly better choice - a lot of people make that argument, I think it's a worthy argument, and it's an argument that I bought into. And then I realized that unfortunately that argument didn't apply to me. Believe me, I'm fully aware of the fact that this situation is 100% my own fault, which is part of what makes it difficult.

I'm sorry your 4th year has been Hell - mine has too, and not just because of this. Here's hoping residency is better for both of us.

Same, and I appreciate your response. I have had almost no reassurance or justification for my situation either. Dust it off and move on. At the end of the day, living and breathing people in your own life care very little about you outside of your closest family and friends, and they either don't care or have no clue about what they are talking about. This is called being "human." Now imagine what those on the internet can provide.

I have sought so much guidance about how to handle this process and it turns out the faculty, administrators, and many posters here were wrong. I didn't mean to insult you, because as far as I know you are the most resilient person there is or as weak as they come. I do not know but I genuinely hope the best for you. However, the fact you are seeking help shows you are going through a difficult time. It seems that doing intern year and trying to find programs to transfer to is your best option. This isn't set in stone, and trying to mold your reality to fit what is best for you is never an impossibility.
 
This is totally unhelpful. If you want to be any kind of decent psychiatrist/human being you need to develop some empathy. You are acting out of you own distress which this individual is not responsible for.

Thanks. Apparently you are an expert on human emotion. I am acting the same way as the advice I was given but in the end it was sufficient. I did not match but I still have the opportunity to help people who really need it. Everyone should choose to appropriately and professionally transfer to another specialty while fulfilling the responsibilities they agree too. The same way there was a spot for the OP to be a psychiatrist, there may be a place for them to also be a pediatrician. Don't tell me for a second I don't understand empathy.

Empathy and all of the basic emotions I have as a person are the reason I did not match. If all of us who are in non-ideal situations told each other to be strong and fight for what we feel we want we would all be better off. I can have patience for an eternity for most people but its important for people to own their reality and change it. I will never understand my situation, but I can make the most out of what I was given.

Everyone should look themselves in the mirror and really think about their reality, but instead we look for justification for our mistakes. Strength is not magic. OP will succeed in anything they do but reinforcement of their mistake is not helpful. Decide what you want to do and go for it. The feelings you have are natural and if you really want you can absolutely change your situation in anyway you choose. Just about 100% of these posts are looking for justification. If you made a mistake, decide through experience if this is how you really feel while simultaneously exploring other options and applying to them.

Regardless, there are physically and mentally ill children and adults who need your help and dedication while you decide on what is best for you.
 
Certainly don't expect people to hold my hand or for life to be perfect - my life, and my med school experience, has been far from perfect. Was just responding to the poster who was saying that psych was the clearly better choice - a lot of people make that argument, I think it's a worthy argument, and it's an argument that I bought into. And then I realized that unfortunately that argument didn't apply to me. Believe me, I'm fully aware of the fact that this situation is 100% my own fault, which is part of what makes it difficult.

I'm sorry your 4th year has been Hell - mine has too, and not just because of this. Here's hoping residency is better for both of us.

No...your posts were what they were. You created this thread. I responded to the thread as a whole. Take it or leave it. Reassurance and people telling you everything will be fine without knowing your exact situation or without meeting you in person is a complete lie.
 
No...your posts were what they were. You created this thread. I responded to the thread as a whole. Take it or leave it. Reassurance and people telling you everything will be fine without knowing your exact situation or without meeting you in person is a complete lie.

Tact might be something you consider for interview season next year.
 
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Thanks. Apparently you are an expert on human emotion. I am acting the same way as the advice I was given but in the end it was sufficient. I did not match but I still have the opportunity to help people who really need it. Everyone should choose to appropriately and professionally transfer to another specialty while fulfilling the responsibilities they agree too. The same way there was a spot for the OP to be a psychiatrist, there may be a place for them to also be a pediatrician. Don't tell me for a second I don't understand empathy.

Empathy and all of the basic emotions I have as a person are the reason I did not match. If all of us who are in non-ideal situations told each other to be strong and fight for what we feel we want we would all be better off. I can have patience for an eternity for most people but its important for people to own their reality and change it. I will never understand my situation, but I can make the most out of what I was given.

Everyone should look themselves in the mirror and really think about their reality, but instead we look for justification for our mistakes. Strength is not magic. OP will succeed in anything they do but reinforcement of their mistake is not helpful. Decide what you want to do and go for it. The feelings you have are natural and if you really want you can absolutely change your situation in anyway you choose. Just about 100% of these posts are looking for justification. If you made a mistake, decide through experience if this is how you really feel while simultaneously exploring other options and applying to them.

Regardless, there are physically and mentally ill children and adults who need your help and dedication while you decide on what is best for you.

Don't need to be an expert to see through your post.
 
Tact might be something you consider for interview season next year.

Wow. I did get a spot as one was created for me but I appreciate how thoughtful you are...

Don't need to be an expert to see through your post.

If this is the reality of future psychiatrists, then you are as weak as I expected you to be while hoping you weren't. I am literally embarrassed that this profession is going in this direction. Apparently the future of psychiatry is lies and medication rather than a middle ground that finds the strength within oneself while using medication to bridge this divide, with therapy, ECT, etc. as helpful mediators on the way. I can't say I am shocked but keep thinking you are right and reinforce each other's nonsense and see the result. There is nothing wrong with acknowledging the weakness within a person and doing everything you can to help them and ultimately putting the ball in their court. My fear was that psychiatry was a profession of the weak and you are all proving that to be the case.

See whatever you want, but I will be a practicing psychiatrist in 4 years. I am the first in my family to even go to college and now I will be a physician in a residency soon. You should do the same as OP, grow up and help others as much as you can but also consider what is best for you at the same time. If psychiatry is not for you, get out. I have no forgone conclusions about how I will view the mental health field but your response is meaningless, and that is how it deserves to be treated.

I think society would be better off if everyone just asked a rhetorical question and we gave them the answer they wanted to hear...This obviously helps the advancement of humanity, right? Give me an f'ing break. Think before you respond because of how "triggered" you are and give what actually helps people. The answer that makes us feel warm inside is not always what gets us to where we want to go.

All I am saying is do your best with what you have while trying to get into a pediatrics residency. Did the fluff around it offend you? Go for a walk, count to 10, and think before you speak.
 
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Did any of you apply to psychiatry residency even remotely recently? Nothing I have said even remotely compares to what I and others have heard from program directors. Psychiatrists should be the most emotionally stable of them all. I am starting to cringe at these reactions. Psychiatry program directors pretend to care and act like many situations are reality when they are not. It helps fill their rank list with eager applicants.

All I am saying to OP is that I am sorry you feel you have made the wrong choice but there is time to change. There are several options that exist to help you find programs in your desired specialty. Regardless about what you say, you clearly wanted pity. Apparently pity is something to envy. I am in my 20's and that is the last thing I want. Brutal honesty would have been very helpful over the last few months to years. I am sure more nonsense will follow, and you will ignore my words and accept theirs because it feels better. Go at it. I just want capable and motivated people to be physicians. There is a lot of nonsense that traps debt-ridden students and it kills me, and I have had enough. You are no longer a child with hundreds of thousands of dollars of debt.

If you want nonsense listen to the three PDs or so on here lol.
 
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Yeah - I definitely think this thread has gone off the rails. Thanks to everyone who has given me good advice, or who has PMed me with their thoughts. Here's hoping I come back with an update in a year about how I am happy and thriving and loving psychiatry!
 
This thread isn't off the rails. This is simply another avenue for random people on the internet to pat themselves on the back and feel like they helped someone. The long term result does not matter to them. Its funny because regardless of the responses that come, this thread will surely die and be archived on SDN into oblivion.
 
I feel bad for your future patients. Okay, that is all. Toodles.

The average state of psychiatrists. How am I not surprised? Toodles. Don't worry, I would always lay my coat down on a puddle for a nice lady like you.
 
Wow. I did get a spot as one was created for me but I appreciate how thoughtful you are...


You are quite the feisty and presumptuous one. No one can say anything you agree with without you trying to split them into this group of “incompetent weaklings”. Maybe do a little reading, I would suggest Linehan. You don’t get to speak to the current state of psychiatry, you’re a lay-person when it comes to the field.

Remember going into next year that your position wasn’t “made special for you”. You’re lucky. You will have to work hard. You will be at the bottom of the food chain. And... if you speak to your upper level residents, let alone nurses or colleagues with the tone you currently choose to speak with, you will earn for yourself a reputation. Don’t be that intern.
 
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I'm not even reading the posts in this thread anymore, but I do get annoyed when someone says something along the lines of, "your post here on the Internet shows a bad emotion or something, therefore you must display that in real life and that's bad for your patients." It seems to imply that people can't separate the way they act in professional environments from the way they act on an online forum.
 
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Thank you. Psych is a fantastic specialty (that's obviously why I applied and ranked it!) but one week after match and I am still feeling terrible. I am going to give my program my all and be a good resident, but I think this is a really unfortunate situation of not realizing that Peds was really what I truly wanted until it was too late. I feel horrible that I took a psych spot from someone else.
So how has your Psych experience been so far? Curious to know as I am also choosing between IM/Peds and Psych.
 
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