Military Psych

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May 13, 2003
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OK, I'll throw my lure in again trolling for info/opinions about another medical field in the military (I hope this info is helpful to others, as well).

What do y'all who are in the know, know about the practice of psychiatry in the military. Are psychiatrists in demand? Do they practice shoreside, or do they also float (sorry - NAVY bias there)? Are the billets attached to a command, base, or unit - any or all of these? Any idea what the typical disorders seen (bread and butter) are? Are the Ready Reserves typically looking for them?


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I'll give my DMO, fleet opinion on Navy psychiatry, with the upfront admission that I would rather chop off my right arm than practice psychiatry.

Psychiatry is in high demand by sailors in the fleet and the commands that must deal with them. There are a huge number of personality disorders out there that become very problematic for ships and other commands. Borderlines cutting themselves, narcissistic types who can't believe they're being made to chip paint, etc. Unfortunately, a lot of these end up getting dumped on psych. I always tried to deal with them myself, I wouldn't refer every ankle sprain to Ortho so I tried not to bag psych with garbage. However, often times the command wanted "psych's ink" in the chart so they could start a paper trail to admin sep the guy. Sorry, but psych gets a lot of this.

Psychiatry is in low demand from Navy one wants to be in the residencies. The psych internships fill last, any intern who wants to train straight through without a GMO tour will be able to, and not many return from the fleet, though the ones who do are excellent because they really want to be there.

There is real pathology in the military. Depression is common, as is Suicidal ideation and frequent attempts. With all of those males age 18-28, psychotic breaks are frequent, and we see that a fair amount. You will see dependents in the hospitals, so the range is large.

They now station psychologists on carriers, but not psychiatrists. You will be based out of a hospital. There are some "deploying" psychiatrists with certain teams for crisis intervention (USS Cole) as well as psychiatrists on the fleet hospital teams who deploy for war (OIF).

My friends who are Navy psychiatrists seem to enjoy what they do, thankfully 'cause someone has to do it. There's plenty of demand, just not always appropriate use. Hope this helps.

Much of what DiveDoc said applies to the Army as well: lots of maladjusted young folks who just can't cut it get dumped on psych. I did a psych rotation at Walter Reed when I was a med student and spent my whole month doing admin separations for personality disorders. Believe it or not, I'm glad I did it 'cause up until then I had been considering psych. The experience quickly changed my mind. Aside from that, you get the usual depression and anxety disorders, a few interesting psychotics, and lots of substance abuse. Also, don't forget that you will probably see dependents (the troubled spouses and kids of the troubled service members -- "birds of a feather. . .").
Psychiatrists deploy quite frequently in the Army, since there is a lot of attention paid to combat-related stress and mental health issues.
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Thanks to both of you for the replies. Sounds like psych is a bit different in the military than outside, though that's not unexpected.

R-Me-Doc, quick follow-up. Did you know any psychiatrists who actually enjoyed what they were doing, or was it a dead-end time killer to tick off the years of obligation? Pretty clear that you didn't think that well of it. ;) What are you doing now?

Navy Dive Doc said:
The psych internships fill last, any intern who wants to train straight through without a GMO tour will be able to...

I've always heard that this was the conventional wisdom re: navy psych. However, this year only 7 of 15 psych interns continued into PGY2 spots. What do you attribute this to? Is it probable that eight returning GMOs applied for PGY2 psych spots?

I'm starting psych internship at Portsmouth this year, and was really counting on being able to go straight through. However, last years numbers don't look too good. Any idea what's happening? Is Navy psych getting more popular?