Need Career Advice

[ukdoc74]

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Hello everyone,
Just wanted some honest input on a career in Internal Medicine vs Psychiatry. I really don't want to subspecialize and enjoy each specialty equally. If you had to pick one which would you pick and why.

Also, can anyone compare factors such as lifestyle, call, job opportunties, stress, malpractice, salary etc.

Thank you very much.

XOXO

 

[Rendar5]

Hello everyone,
Just wanted some honest input on a career in Internal Medicine vs Psychiatry. I really don't want to subspecialize and enjoy each specialty equally. If you had to pick one which would you pick and why.

Also, can anyone compare factors such as lifestyle, call, job opportunties, stress, malpractice, salary etc.

Thank you very much.

XOXO

Internal Medicine can go into: hospital-based medicine or outpatient clinic medicine or a combination of both.
Psychiatry can become an outpatient psychiatrist, inpatient psychiatric consult (for a general hospital I believe), or inpatient psychiatric medicine or can work at programs that transition inpatient to outpatient. This is not counting the subspecialties of psychiatry.

And I hate to say this but honestly, listing the pros and con's of each field would not be useful as they are very different fields You can create the lifestyle you want in either field. The best way to compare it to see which makes you the happiest is to shadow doctors in each field and to complete your required 3rd year clerkships.

 

[BlueElmo]

Yeah, I would think it would be most helpful to rotate through your 3rd year IM and Psych clerkships.

 

[TexasPhysician]

I'm going into psychiatry, so I obviously think the field is hands-down the best out there.

Huge need, good salary for the hours, less call on average compared to most fields, and lots of fun patients.

 

[ukdoc74]

Hello everyone I am confused that beat down residents in surgery and medicine that claim they would have chosen dentistry if they had a chance to redo it. They claim that dentists have great lifestyle with low malpractice and no call. That dentists get weekends, holidays, and nights off.

My question is this. If people trule felt this way why not pick psychiatry. Psychiatrists have private practices making dentist money with no call, weekends, or hoildays.

 

[rock_climber]

My question is this. If people trule felt this way why not pick psychiatry. Psychiatrists have private practices making dentist money with no call, weekends, or hoildays.

Because if you did that you would have to practice psychiatry.

Also, I personally would rather work harder doing something I love than have an easier schedule doing something I hate.

 

[ukdoc74]

You would rather work weekends, nights, and holidays. Psychiatrists clear 200k by just listening to people. If medicine is not a callung why not pick the field with the best lifestyle.

 

[Winged Scapula]

1) because psychiatrists don't do procedures
2) because psychiatrists DO take call
3) because psychiatrists DO work holidays, weekends, etc. (even in private practice, someone has to take call for the practice)
4) because they may not be interested in psychiatry
5) because psychiatrists generally make nowhere near dentist or surgeon money; they do not "clear" $200K in most instances in the US (the Park Avenue Psychiatrists and Department Chairs are not representative of the field)
6) dealing with psychologically ill patients is very stressful
7) there is less control over your practice (ie, psych emergencies are very common) than in dentistry

But what does it matter what OTHERs think? You are struggling with the decision between IM and Psychiatry. Pick what's best for you. Since this is not a residency issue but rather a med student one, I'm moving back to Allopathic where you started this discussion.

 

[howelljolly]

You would rather work weekends, nights, and holidays. Psychiatrists clear 200k by just listening to people. If medicine is not a callung why not pick the field with the best lifestyle.

What WS said...

Plus...

Psychiatry isnt "just listening to people"

And, I dont know about you, but I can't stand doing what I don't like to. Period. A big fat paycheck does not make up for it. I refuse to drag myself to work every day, and the car Im driving to work doesnt make it any more exciting.

 

[gluon999]

If I enjoyed psych as much as IM, I'd def go for psych. Overall, they have less headaches during residency and after. You could do therapy sessions and charge ridiculous amounts of money. Plus you wouldn't have to deal with dumps from other services for frivolous issues. Also, you'd be a specialist, not a PCP who has to deal with multiple problems in 15 minutes or less per patient. Overall it'd would be a more satisfying experience.

 

[ukdoc74]

Winged scapula thanks for the information but private practice psychiatrists that have their own practice do not work nights, weekends, or holidays. Furthermore the starting salary of psychiatrists are now at 180K a year. This is for 45 hours a week. Some pick up extra shifts and easily clear 200k. Lastly, malpractice insurance is lowest for psychiatry. This is because they dont do procedures. Procedures are great but it carries major liability.

Surgery is a great field and they are by far the hardest working physicians however the lifestyle of a psychiatrist is the same as a dentist. This is because psychiatrist can have cash based practices without hospital privileges. They cater to affluent women and men with depression and stress disorders. If peiple didnt have such a negative bias against psych they will see that psych has no call, weekends, or hoildays. Private practice psychiatrists are different than acadmic psychiatrists that most physicians are aware of.

1) because psychiatrists don't do procedures
2) because psychiatrists DO take call
3) because psychiatrists DO work holidays, weekends, etc. (even in private practice, someone has to take call for the practice)
4) because they may not be interested in psychiatry
5) because psychiatrists generally make nowhere near dentist or surgeon money; they do not "clear" $200K in most instances in the US (the Park Avenue Psychiatrists and Department Chairs are not representative of the field)
6) dealing with psychologically ill patients is very stressful
7) there is less control over your practice (ie, psych emergencies are very common) than in dentistry

But what does it matter what OTHERs think? You are struggling with the decision between IM and Psychiatry. Pick what's best for you. Since this is not a residency issue but rather a med student one, I'm moving back to Allopathic where you started this discussion.

 

[michaelrack]

1) because psychiatrists don't do procedures
2) because psychiatrists DO take call
3) because psychiatrists DO work holidays, weekends, etc. (even in private practice, someone has to take call for the practice)
4) because they may not be interested in psychiatry
5) because psychiatrists generally make nowhere near dentist or surgeon money; they do not "clear" $200K in most instances in the US (the Park Avenue Psychiatrists and Department Chairs are not representative of the field)
6) dealing with psychologically ill patients is very stressful
7) there is less control over your practice (ie, psych emergencies are very common) than in dentistry

.

1. some do ECT
2. There are plenty of psychiatry positions at state hospitals/community mental health centers with no/minimal call or optional call (in which you are paid extra if you agree to take call).
3. Some work weekends, some don't. Most psychiatrists in private practice do some call by phone; a few don't. Psychiatrists rarely go into the ER or hospital in the middle of the night.
4. true
5. It's not to hard to clear 200k as a psychiatrist. Most psychiatrists make more than dentists. A psychiatrist who does a 1 year sleep fellowship can make more than most general surgeons.
6. Not as stressful as dealing with an acute MI or ruptured AAA!
7. Disagree strongly with this statement. There are alot of psychiatrists with part-time private practices with cherry-picked patients (with few emergencies), who combine this with hourly work at comm mental health centers, prisons, state hospitals, etc. I think that psychiatry is the medical specialty that gives you the most control of your career and your practice.

 

[howelljolly]

.

 

[Doctor Bob]

... but private practice psychiatrists that have their own practice do not work nights, weekends, or holidays.

I... uhmm... huh? They may not have office hours but if a patient comes into my ED with a psych emergency, then their private psychiatrist better have someone on call for me to talk to or there'd be some legal implications. And for the private practice doc, it's them 24 hours a day seven days a week. Now granted, they probably get called fairly infrequently.

As for the IM vs Psych, I have to echo the sentiment of "it doesn't matter how much you get paid, it's not worth it if you hate it". And I don't think we can really persuade/dissuade you one way or another. We all have our own biases and preferences. I have friends in psych who love their job and think I'm crazy for doing EM (and they're emminently qualified to determine that). I love my field and can't imagine why they wouldn't want to do it. But at the end of the day, it's because we all like different things that we have people in all the different fields. It will come to you eventually.

 

[michaelrack]

I... uhmm... huh? They may not have office hours but if a patient comes into my ED with a psych emergency, then their private psychiatrist better have someone on call for me to talk to or there'd be some legal implications. And for the private practice doc, it's them 24 hours a day seven days a week. Now granted, they probably get called fairly infrequently.
.

IN most states there is no legal requirement to do call. It is a condition, however, of many insurance contracts as well as a requirement at many hospitals for staff privileges. If a private psychiatrist carefully selects which insurance plans, if any, he takes and is not on staff at a hospital, in many states he can get away with a message on his answering machine directing the patient to go to the ER if there is an emergency.

 

[Prime2000]

IN most states there is no legal requirement to do call. It is a condition, however, of many insurance contracts as well as a requirement at many hospitals for staff privileges. If a private psychiatrist carefully selects which insurance plans, if any, he takes and is not on staff at a hospital, in many states he can get away with a message on his answering machine directing the patient to go to the ER if there is an emergency.

Thank you for bringing the facts to the board.

 

[ukdoc74]

If it is a cash based practice, there is no obligation to take call. In fact many psychiatrists are cash based.

 

[howelljolly]

If it is a cash based practice, there is no obligation to take call. In fact many psychiatrists are cash based.

perhaps youve already arrived at your conclusion?

 

[ukdoc74]

Plus psychiatrists can set up shop in rich affluent areas and become the therapist for the prvileged. Also cosmetic psychiatry will boom in ten years.

 

[michaelrack]

Even if a psychiatrist doesn't take formal call, he still needs to let them know what to do in case of an emergency. If you do direct your patients to go to the ER, it would be good to make sure that the local ER does have contact info for you.

I don't practice psychiatry anymore, other than some consulting at group homes for the mentally ******ed. However, up until December 2009 I was doing some suboxone treatment. When I initiated suboxone treatment I would typically give the patient my cell phone # and tell them that I was available most of the time, but if they had problems with suboxone initiation and weren't able to get a hold of me, they should go to the ER.

My main sleep lab runs overnight sleep studies 6 nights a week, so most of the time one of my current sleep patients can get a hold of me by calling the lab and speaking to the technician, who will call me if necessary.

I guess what I am trying to say is that a psychiatrist should try to be available to his patients, but you don't have to spend your whole life on call, even in a solo practice.

 

[Law2Doc]

Because if you did that you would have to practice psychiatry....

Agreed. I think you have to realize that if you don't enjoy a particular specialty, it would be truly painful to do it full time for the next 40 years. I think this is what some of the younger crowd misses when they focus on perqs like lifestyle. This is a nice side benefit, but the practice itself is the meat and something you have to enjoy. Part of the reason psych is less competitive is that many people truly do not enjoy it. Fortunately for the field, the folks who go into it do.

 

[ukdoc74]

And staring at teeth all day is very fulfilling? I hope the people that argue dentistry is a good field can chime in on this. Dentistry a goog gig ? Give me a break. Those that say dentistry trumps have to explain it. It is puzzling to me.

 

[peppy]

And staring at teeth all day is very fulfilling? I hope the people that argue dentistry is a good field can chime in on this. Dentistry a goog gig ? Give me a break. Those that say dentistry trumps have to explain it. It is puzzling to me.

Even if you do luck out and manage to establish a practice in an affluent area as an attending (though those tend to be the kind of places that are already saturated with doctors so I wouldn't count on it being easy to cater to the rich crowd), in residency you will most likely deal with many poor and homeless people who don't have good dental care. If you work with enough poor people who truly do have terrible teeth (and are often suffering a lot of pain because of it), you will appreciate the role that dentistry fills.