May I ask an honest question?

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126455

I'm doing my IM residency now and planning to do an ID fellowship after that. However, I'm having second thoughts about doing the fellowship.

So, my question is, in private practice, is it absolutely necessary to specialize for maximum income and reputation? I am asking this because I am afraid I will get bored of doing the same things over and over again. Variety is the spice of my life, any day.

How would you rate your job satisfaction and quality of life as a specialist private practitioner?

Thank you!
 
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To address your first post, reports on the death of psycotherapy have been greatly exaggerated. As time goes on, the pharmacological approach as sole treatment has lost a lot of credibility. Medications are wonderful for symptom management, but they can't fix flawed logic and negative perspective, they don't address impaired psychosocial functioning, and they don't replace poor support structures. Perhaps old-school psychoanalysis is going the way of the dinosaur, but the world is wide-open when it comes to time-limited and manualized therapies like CBT, DBT, IPT, and time-limited psychodynamics. Evidence is still building in these areas and will always be somewhat limited by practical limitations of small sample sizes and poor funding opportunities (no drug company $$$ and less-than-ideal NIH support), but we can already draw conclusions that they are at least as good as medications in the treatment of depression anxiety and most likely better in the long-term.

Payout is decent and will get better due to mental health parity laws as well.

Drugs are here and here to stay, and for the most part it's a good thing. I want depressed patients in my care to learn the mental and psychological strategies to get better and stay better, but I'm not averse to lessening the severity of symptoms with an antidepressant. I work with a lot of people in the gym with neck, shoulder, and back pain, because I think musculoskeletal dysfunction is the root of these problems, but I hardly discourage them from using ibuprofen, and if necessary, muscle relaxants, just to draw an analogy.

As for your criteria, I think few fields are as intellectually stimulating as brain science. It's the last great unknown. Money is better than most of the other fields I find intellectually stimulating like physics, kinesiology/nutrition, and evolutionary biology. Not as good as many other specialties but more than enough to have a good life, not lack for anything, and have enough money to have some fun with travel, expensive toys, and the like. The only medical fields that I think are as intellectually stimulating are cardiology (especially electrophys) and to a lesser degree endocrinology, and while the pay is better, I think psych would be more rewarding. And the lifestyle in psych is pretty good.

The director of psychiatry for the largest statewide medical system here is a brown man. And he does a heck of a lot of psychotherapy. I'm planning on being a brown man who does a lot of psychotherapy myself. I've already achieved being brown, just have to work on the psychotherapy now. The fact that I come from a middle-tier school has had about a trillion times more influence on me so far than the fact that I'm brown.

As for your FMG questions, most of us here are AMGs and citizens, those questions might be better answered in a sub-board or another forum for FMGs.
 
Honest question, honest answer:

Please keep in mind that you end up spending a lot of time with troubled people and most won't thank you much for it. It's not like surgery where one spends 20 mins with a patient and is showered with chocolates & flowers. You got to be self-motivating.

If you thrive on other people giving you positive feedback, psychiatry isn't for you. Definitively! You will surely hear the disappointed "oh, I see, you are a psychiatrist" at parties and lots of "normal" people will be surprised that you even are a "real doctor"... 🙄

If you are unsure psychiatry is your field and since you did ask whether it was intellectually stimulating, my advice would be that it might not be right for you.

On the positive checklist, you might want to consider that some of your patients might, for some reason, prefer (what you call) a "brown man".

All the best with your future career decisions. 🙂
 
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Also, what are the requirements for setting up a private practice by an IMG other than a Green Card or American citizenship? Also, how hard is it to get the same?

Thanks!

Medical licensure in the US, which almost always requires residency training in the US. You actually don't need a green card or US citizenship, since there are variety of H and J visas that can get you here for training and beyond. As above, I think you'd find better answers to this question on another forum directed to IMGs.
 
a brown man

Hmm, well hey, the ethnic divide can be strange these days. Some people think being a "brown" man can be the in thing these days.

Skin color I wouldn't worry about. I would though encourage that your communication skills be good if you go into psychiatry. Dont' know what is the spoken language in your geographic area, or if you have a strong accent.
 
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