Ob/Gyn or Psych

[johnnytest]

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Hi,

Posting for a friend who's finishing 3rd year. She's torn between the two. She prefers a lifestyle where she can spend time with family, doesn't have to be on call too much, doesn't have to wake up early, various/different patient experiences, money does not matter much. She's big on women's health hence OB/gyn but also really enjoys psych patient cases and can relate to them as some members of her family have mental illnesses. If it matters, most likely she will practice in NYC. What should she do for her career? Since I'm an MS-0, I know very little so I would appreciate your feedback.

TL;DR, Please vote at least!

 

[qw098]

Psych... IMO psych is ganna soon be a ROAD speciality soon even though the "ROAD" acronym isn't that relevant nymore.

 

[Dave89]

If she really is torn between the two, Psych any day of the week, and twice on Sundays. Of course, there will be no Sundays for her in Psych. Ob/Gyn OTOH...

 

[Kaustikos]

So she basically has no interest in ob/gyn, likes psych and finds interests with women's health issues.
Go psych. Or stay away from ob/gyn. You don't have to be ob/gyn to wanna deal with women's health. Family medicine does it, too.

 

[BearAttack]

There is so much to do with women's health in psych. You can be interested in women's health and not do OB/Gyn. After all, women are more than the sum of our reproductive organs, right?

As a psychiatrist you can (informally) specialize your practice to work with primarily women, you can do research on mental health issues that disproportionately affect women (depression, somatization d/o, anxiety, etc). You can work with mental health organizations that serve women such as crisis centers and women's shelters.

I say this as a future OB/Gyn: don't do it if you don't love it. She will be miserable.

 

[Donald Juan]

Based on what you have said she wants, psych is the obvious answer.

 

[NickNaylor]

NYC is a great (if crowded) market to open up a psych practice. From lifestyle considerations alone I agree with others in that psych is the obvious choice. My guess is that her concerns are largely related to the feeling of psych being a "less competitive" specialty and "not what she went to school for" despite her interests given the rather large differences in traditional medicine and psych. If my intuition is correct, these are things all psych applicants struggle with to some extent.

 

[Frazier]

Psych 100%

 

[Shipping News]

Hi,

Posting for a friend who's finishing 3rd year. She's torn between the two. She prefers a lifestyle where she can spend time with family, doesn't have to be on call too much, doesn't have to wake up early, various/different patient experiences, money does not matter much. She's big on women's health hence OB/gyn but also really enjoys psych patient cases and can relate to them as some members of her family have mental illnesses. If it matters, most likely she will practice in NYC. What should she do for her career? Since I'm an MS-0, I know very little so I would appreciate your feedback.

TL;DR, Please vote at least!

The bolded are all the antithesis of ob/gyn. It has a horrible lifestyle, with tons of call, lots of early days (for surgery and deliveries that happen whenever they want to), and there is a fairly narrow scope of practice. It's the opposite of what your friend wants.

Psych is the obvious answer. Anybody who likes psych should just go ahead and do it. It's got a great lifestyle and the $ ain't bad. I hate talking to crazy people so I decided against going into it but totally see its merits.

 

[22031 Alum]

It really sounds like this friend is only considering OB/Gyn because of this vague interest in "women's health." That is a terrible reason. She wants to be a psychiatrist. Down the road, if she's still interested, there is definitely a market for psych with a women's health focus. Just to give an example, one of the talks at our recent annual meeting was by a psychiatrist who has made studying perinatal depression her entire career.

 

[PlasticBag]

If she googles "reproductive psychiatry" or "perinatal mental health", she will probably find there the best of both worlds. Reproductive psychiatry is a growing field, especially in places like NYC.

 

[J ROD]

Psy...no question. OBGYN blows.

 

[W19]

Psych... IMO psych is ganna soon be a ROAD speciality soon even though the "ROAD" acronym isn't that relevant nymore.

Oh no! That means I will need 240+ in step 1 to have a chance to match...

 

[touchpause13]

I mean there is nothing preventing a psychiatrist from focusing on women's health issues and that would certainly hit all the lifestyle factors. That's basically what I'm planning on doing

 

[charmiedermie]

Oh no! That means I will need 240+ in step 1 to have a chance to match...

I hope you're kidding and not just pseudo freaking out. You do not need a 240 to get into Psych. There is enough to freak out about in med school. This isn't one of them.

 

[W19]

@charmiedermie I was kidding, but I predict that in 5 years one might need 235+ to be competitive for psych and FM...

 

[charmiedermie]

@charmiedermie I was kidding, but I predict that in 5 years one might need 235+ to be competitive for psych and FM...

Sorry, was hard to tell since you seem to freak out a lot. You're lucky I like Renaissance art. It takes a big change for a huge shift as what you're predicting, which just isn't there. Just do your very best on Step 1.

 

[W19]

-

Sorry, was hard to tell since you seem to freak out a lot. You're lucky I like Renaissance art. It takes a big change for a huge shift as what you're predicting, which just isn't there. Just do your very best on Step 1.

Will be shooting for 230+ in step 1. I am always worried about the future.

 

[charmiedermie]

-

Will be shooting for 230+ in step 1. I am always worried about the future.

It's ok to worry if it is realistic - it's just that some things in med school are worth worrying about, and other things in med school aren't and can throw you off balance if you do, when you were doing fine.

Use good books and questions and you can hit the average with no problem.

@W19, listen to her:

 

[Mass Effect]

I don't know which 5 people voted for OB/Gyn, but they clearly didn't read the original post. If they did and voted OB anyway, I would seriously question their literacy and/or judgment.

The answer couldn't be more clear if it came up behind you and clawed at your back. Psych. Do it and don't look back.

 

[Shipping News]

-

Will be shooting for 230+ in step 1. I am always worried about the future.

I never understand why people say they are going to "shoot" for a certain score. Why not just get the best possible score you can get and hope for the best?

 

[W19]

I never understand why people say they are going to "shoot" for a certain score. Why not just get the best possible score you can get and hope for the best?

I meant to say anything less than 230 will be a disappointment... Of course I will try to get 300.

 

[qw098]

@charmiedermie I was kidding, but I predict that in 5 years one might need 235+ to be competitive for psych and FM...

Why do you say that? Because psych/FM getting more competitive or because step 1 scores getting higher every year?

 

[W19]

Why do you say that? Because psych/FM getting more competitive or because step 1 scores getting higher every year?

If you look at the last charting outcomes, these two had the highest increase in score. People are starting to realize the flexibility and lifestyle of FM/psych

 

[charmiedermie]

If you look at the last charting outcomes, these two had the highest increase in score. People are starting to realize the flexibility and lifestyle of FM/psych

That next to last charting outcomes was 4 years ago (so they took it in 2009). Pretty sure people have known about the Psych lifestyle long before you entered med school. It's not a secret.

 

[J ROD]

Psychiatry will only become so competitive due to the nature of the work.

 

[W19]

That next to last charting outcomes was 4 years ago (so they took it in 2009). Pretty sure people have known about the Psych lifestyle long before you entered med school. It's not a secret.

Maybe med students now value lifestyle more than prestige...

 

[Slack3r]

If you look at the last charting outcomes, these two had the highest increase in score. People are starting to realize the flexibility and lifestyle of FM/psych

Neither of these specialties will ever be competitive barring absolutely seismic shifts in healthcare in the U.S.

 

[royalmedicus]

Maybe med students now value lifestyle more than prestige...

ihope they still value prestige, so that we can have the best people in cardio/intensive neuro/pulm ccm and other very essential fields.

 

[W19]

@royalmedicus The best are in derm--a very exciting and essential field. 🙄

 

[qw098]

Yes, FM is very flexible, has nice hours, good lifestyle... but how is pay? Very low... no?

 

[W19]

@qw098 I guess to each his own.

 

[charmiedermie]

Maybe med students now value lifestyle more than prestige...

I don't think the valuing of lifestyle has seismically changed from charting outcomes 2011 to charting outcomes 2014. You make it seem like people just discovered the secret of Psych, when everyone rotates in it in third year.

You don't see hordes of people going for Rads.

 

[W19]

@charmiedermie All I am saying is: maybe med students start to value these things more... Radiology was a difficult field to match into few years ago and now it has close to 100% match rate. Do you think it is just a mere coincidence?

 

[charmiedermie]

@charmiedermie All I am saying is: maybe med students start to value these things more... Radiology was a difficult field to match into few years ago and now it has close to 100% match rate. Do you think it is just a mere coincidence?

I think that is more the fear of not having a job at the end of residency, however short-sighted or irrational that fear might be. I don't think Radiology lifestyle has changed a lot a few years ago to now. Psych definitely hasn't.

 

[WingedOx]

If you want to be a psychiatrist and train with a women's mental health focus, I can give you the names of about 10 hospital systems that would hire you on the spot.

 

[Slack3r]

@charmiedermie All I am saying is: maybe med students start to value these things more... Radiology was a difficult field to match into few years ago and now it has close to 100% match rate. Do you think it is just a mere coincidence?

Could be that their pay was cut significantly and imaging continues to have a major target on its back. Coupled with the difficult job market, it's not hard to see why radiology is all of a sudden much less competitive.

But totally what you said...

 

[notbobtrustme]

If you look at the last charting outcomes, these two had the highest increase in score. People are starting to realize the flexibility and lifestyle of FM/psych

Remember, 100% of all med students do rotations in psych and FM. Only about 10-15% will match into these specialties in any given class. And at that, the vast majority choose FM over Psych.

They are not competitive specialties by any means. FM is not a lifestyle specialty anyways, not in the way most people envision. You are overworked, deal with tons of paperwork and need a full slate of patients every day just to stay in place. It's not uncommon for a FM doc to see 30-40 patients a day. If you want to see your patients in the hospital, it's even more demanding. Most med students see practitioners 15-30 years into their career and think "damn they got it made" and not realizing they spent the entire 90s on call, in the clinic and in the hospital.

Psych is even less competitive. Like it or not, but most med students don't see psychiatrists as doing real doctor work. Moreover, the pay sucks. Unless you hit a homerun and set up a cash only practice hawking zoloft to anxious soccer moms, chances are you are going to do 60 med checks a day just to stay afloat. On my psych rotation, outpatient psych was the fcking worst; ask 3-4 generic questions, continue management (or change from zoloft to prozac or w/e is covered by insurance), see you in 6 weeks. If you can be professionally satisfied by that, then go ahead.

Don't look at the people who hit homeruns, look at the average/median physician because statistically, that's where you'll end up. FM/psych running cash-only practices with 8 patients a day is not the norm. Working 3 full days, one half day and having a 3 day weekend is not the norm. These are people who cashed in during medicine's heyday, when having an MD and a license guaranteed you 250k+. Have tempered expectations when it comes to your career aspirations, not pie-in-the-sky expectations.

Finally, many people underestimate their competitiveness. Ask your school where some people match with your range of board scores, you'll be very surprised at the results.

 

[J ROD]

Moreover, the pay sucks.

Not sure what you are hearing.....but 200K on average for about 40hrs.....not too bad. Now granted, this was inpatient work. It is different from medical per se but many times esp in ED things get dumped as Psy which are not and the Psy MD has to know his medical knowledge in order to treat the patient. Also, while on geriatric Psy, I used a fair deal of IM and Neuro. So, it is different and you may not use it all day but you do use your medical knowledge. And also pharm.

Hence, probably why I even like Psy more......it brings my knowledge sets together well.

 

[Armadillos]

Moreover, the pay sucks.

Psych pay obviously sucks compared to the high end procedural specialties, but in general its not bad. For a concrete example, go to one of those government salary search websites and check out your VA attendings. At our VA the psych attendings make about 30k more than inpatient IM and outpatient IM/FM.

 

[Dral]

A new record...it took me like three threads on the gen board before I found a comment ripping on Derm. Heh.

Should I go back to studying for boards now? Why bother? I'm clearly not essential. Lol

 

[touchpause13]

A new record...it took me like three threads on the gen board before I found a comment ripping on Derm. Heh.

Should I go back to studying for boards now? Why bother? I'm clearly not essential. Lol

Because you can one day wipe ur arse with $20s.

 

[NontradCA]

A new record...it took me like three threads on the gen board before I found a comment ripping on Derm. Heh.

Should I go back to studying for boards now? Why bother? I'm clearly not essential. Lol

That must've been emotionally devastating to you.

 

[Dral]

Hay! Maybe I'm going into academics.

 

[WingedOx]

Remember, 100% of all med students do rotations in psych and FM. Only about 10-15% will match into these specialties in any given class. And at that, the vast majority choose FM over Psych.

They are not competitive specialties by any means. FM is not a lifestyle specialty anyways, not in the way most people envision. You are overworked, deal with tons of paperwork and need a full slate of patients every day just to stay in place. It's not uncommon for a FM doc to see 30-40 patients a day. If you want to see your patients in the hospital, it's even more demanding. Most med students see practitioners 15-30 years into their career and think "damn they got it made" and not realizing they spent the entire 90s on call, in the clinic and in the hospital.

Psych is even less competitive. Like it or not, but most med students don't see psychiatrists as doing real doctor work. Moreover, the pay sucks. Unless you hit a homerun and set up a cash only practice hawking zoloft to anxious soccer moms, chances are you are going to do 60 med checks a day just to stay afloat. On my psych rotation, outpatient psych was the fcking worst; ask 3-4 generic questions, continue management (or change from zoloft to prozac or w/e is covered by insurance), see you in 6 weeks. If you can be professionally satisfied by that, then go ahead.

Don't look at the people who hit homeruns, look at the average/median physician because statistically, that's where you'll end up. FM/psych running cash-only practices with 8 patients a day is not the norm. Working 3 full days, one half day and having a 3 day weekend is not the norm. These are people who cashed in during medicine's heyday, when having an MD and a license guaranteed you 250k+. Have tempered expectations when it comes to your career aspirations, not pie-in-the-sky expectations.

Finally, many people underestimate their competitiveness. Ask your school where some people match with your range of board scores, you'll be very surprised at the results.

tell us how you really feel about psych.

 

[Frazier]

tell us how you really feel about psych.

Oh he has made his stance apparent many times:

http://forums.studentdoctor.net/search/12246975/?q=Psych&o=relevance&c[user][0]=407371

http://forums.studentdoctor.net/search/12247026/?q=psychiatry&o=relevance&c[user][0]=407371

Maybe he is a scientologist. Maybe he is a "psychiatry survivor". Maybe he is an arrogant med student who knowns it all after a 6 week rotation. Maybe he is just a regular guy with an opinion.

No problem either way, differing opinions are good things. Everyone is entitled to one.

That said, many of his underlying points have some truth to them...

...It is a non-competitive field.

...There are many unknowns regarding treatment given the complexity of the pathology (ie, the etiology might be biological, social, or psychological, or any given mixture of the 3). Unlike radiology, currently one cannot "spot the lesion" in 10 seconds such as sometimes possible in the reading room. Unlike surgery, you can't fix the patient in one quick, neat procedure in the OR.

...There aren't as many emergencies that require coming in at midnight compared to most other specialties.

He just presents these points in somewhat less than cordial ways.

 

[WingedOx]

Oh he has made his stance apparent many times:

http://forums.studentdoctor.net/search/12246975/?q=Psych&o=relevance&c[user][0]=407371

http://forums.studentdoctor.net/search/12247026/?q=psychiatry&o=relevance&c[user][0]=407371

Maybe he is a scientologist. Maybe he is a "psychiatry survivor". Maybe he is an arrogant med student who knowns it all after a 6 week rotation. Maybe he is just a regular guy with an opinion.

No problem either way, differing opinions are good things. Everyone is entitled to one.

That said, many of his underlying points have some truth to them...

...It is a non-competitive field.

...There are many unknowns regarding treatment given the complexity of the pathology (ie, the etiology might be biological, social, or psychological, or any given mixture of the 3). Unlike radiology, currently one cannot "spot the lesion" in 10 seconds such as sometimes possible in the reading room. Unlike surgery, you can't fix the patient in one quick, neat procedure in the OR.

...There aren't as many emergencies that require coming in at midnight compared to most other specialties.

He just presents these points in somewhat less than cordial ways.

Most likely it's because he's at RFU, a place with a basement-quality psych program.

 

[Mass Effect]

Psychiatry will only become so competitive due to the nature of the work.

This is absolutely true. The only reason psych isn't competitive, in my opinion, is that a lot of people don't like dealing with the mentally ill.

I think that is more the fear of not having a job at the end of residency, however short-sighted or irrational that fear might be. I don't think Radiology lifestyle has changed a lot a few years ago to now. Psych definitely hasn't.

The lifestyle in psych has continued to evolve. There are more and more concierge psych practices than ever before and sub-specialties like reproductive psych and neuropsych are growing. And it's a fact that psych had a bump in apps/scores for residency. I think that's because students are finding that psychiatry no longer refers to simply doing inpatient work at the state hospital or outpatient med checks. You can pretty much tailor your practice to whatever you enjoy and make good money while working relatively shorter hours.

Psych is even less competitive. Like it or not, but most med students don't see psychiatrists as doing real doctor work. Moreover, the pay sucks

Uh, the pay sucks? Really? If you're looking at salary info without taking into consideration hours worked, sure, you can draw that conclusion. But then you're not getting the whole story. As a psychiatrist, you can get paid more money than primary care while working only 40 hours a week. If you choose to work 60 hours or more, you can make a lot more.

Your rotation is not representative of the field of psychiatry and it's a shame that that's the experience you had. In the real world, a psychiatrist does not have to do med checks all day unless they want to. Plenty of psychiatrists do a variety of work, which includes both inpatient and outpatient. Some do therapy (in fact, some of those "couples retreats" you read about where a couple pays $10,000 for a week in some small town in Maine for intensive couples counseling to save their marriage are run by psychiatrists making bank). Some forensic psychiatrists get paid a ton of money to fly around the country as expert witnesses in trials. Some choose to do consult psych as a career where they see medical inpatients all day to determine if there's a psychiatric component to their illness. Some choose neuropsych where they're consulted on patients with neurologic deficits rather than pure psychiatric pathology. Others choose reproductive psych where they manage only pregnant and post-partum women. I've never actually counted, but just based on experience, I think psych has the highest number of available fellowships and the most flexibility in tailoring your job to your own interests.

 

[WingedOx]

This is absolutely true. The only reason psych isn't competitive, in my opinion, is that a lot of people don't like dealing with the mentally ill.

Of course if you think you aren't going to have to deal with them nearly every day in a specialty like IM or gen surg, you're more delusional than the guy who comes into the ER every week claiming that Obama has a series of towers assembled every four blocks which causes all weather patterns in the city.

I never understand the attitude where people feel like it's some sort of perverse point of pride that they can't do a decent mental status exam/recognize delirium/etc.

And for all of @notbobtrustme's snark about psych competitiveness, it's all true that to get into any psych residency you probably just need a pulse, but if you want a program with a solid neuropsych foundation, women's psych, forensic exposure, exposure to a variety of pathologies, your need to be able to weasel your way into only a few of the better academic centers, which are getting tougher and tougher to get into every year. His bragging that his school only exposed him to some random clinic in Schaumburg or wherever isn't exactly something to be proud of.

 

[Frazier]

Of course if you think you aren't going to have to deal with them nearly every day in a specialty like IM or gen surg, you're more delusional than the guy who comes into the ER every week claiming that Obama has a series of towers assembled every four blocks which causes all weather patterns in the city.O

I never understand the attitude where people feel like it's some sort of perverse point of pride that they can't do a decent mental status exam/recognize delirium/etc.

And for all of @notbobtrustme's snark about psych competitiveness, it's all true that to get into any psych residency you probably just need a pulse, but if you want a program with a solid neuropsych foundation, women's psych, forensic exposure, exposure to a variety of pathologies, your need to be able to weasel your way into only a few of the better academic centers, which are getting tougher and tougher to get into every year. His bragging that his school only exposed him to some random clinic in Schaumburg or wherever isn't exactly something to be proud of.

We had a delusional schizophrenic pt with very eccentric behaviors on our medicine floor recently getting treated by my team. This pt was always the 15-minute high point for me during those hours and hours of morning bedside rounds.

Sorry to see the pt get discharged. 🙁