Peds v Psych

[toska]

I gotta figure this out soon, really appreciate any thoughts.

General considerations: Strong applicant scores-wise with H in both peds and psych rotations. Restricted by spouse's job to a city with ~5 psych residencies, and ~7 peds residencies. Of course will apply elsewhere but would suck big time not to match here. Want to have a couple kids, work life balance is important to me.

Peds
Pros:
-Loved my outpatient peds rotation, could really see myself as a gen pediatrician. My dream job would be working 4 days per week. Love kids. Don't mind parents (but maybe I got lucky so far). Love explaining medical information to parents and kids. Not a huge fan of inpatient medicine, but residency is only 3 years.
-Enjoy the pathology a lot, didn't mind studying peds stuff at all (unlike adult stuff like COPD/CHF which makes me so bored)
-Like the preventative aspect
Cons:
-Worried about the higher liability/responsibility. I'm a high stress person and the idea of missing something leading to bad outcome in a kid is terrifying.
-Not the hottest at the physical exam currently. Worried about getting good enough at murmurs/throat/ear exams/etc. Obviously this is what training is for, though. I enjoy small procedures like skin stuff but not sure how I'll do with larger procedures in residency eg LPs, lines.
-$$ (lack thereof).

Psych
Pros:
-Also enjoyed my psych rotation a lot, enjoy reading/learning about psych diseases and liked thinking about the whole person and social context.
-Lifestyle and $ are great. Diversity of job opportunities.
-Fewer emergencies, less liability
-No physical exam, get more time to talk with patients and form a relationship
-Have a ton of empathy for psych patients, got a lot of good feedback on my interview skills/ability to get relevant info from psych patients
-Field is changing rapidly, very interesting future
Cons:
-Giving up a lot of medicine I've learned would be sad. The stigma. Have never seen myself as a psychiatrist, but I think I could get over this if I committed to psych.
-Have some reservations about efficacy of current psych treatments. But I've seen sketchy/non evidence based medicine practiced in all specialties, so this isn't that specific to psych.
-Find the heavy conversations/finding the right words to say/interacting with the difficult personalities exhausting after a while.

Thanks for reading!!

---

Members don't see this ad.

 

[Stagg737]

There are some 'happy mediums' that you can try and shoot for depending on how committed to these fields you are. There are Med/psych residencies, one of the residents I worked with wanted to run his own practice where he could see psych patients but also take care of all their medical needs as well. Basically wanted to set something up where he could monitor all their meds and control interactions without having to worry about some other physician screwing around with them. If you want to focus on peds, there are even "triple board" programs where you can get boarded in gen psych, C&A psych, and peds. Or you could just do psych and do a C&A fellowship if you really want to work with kids and educate their parents. There's a lot of ignorance about mental health in general out there, and the parents of kids with potential problems is no exception. That might not be as medically stimulating as pure peds, but you'd get some of both fields anyway.

Are you in 3rd or 4th year? If 3rd, I'd suggest exploring various programs more. If you're a 4th year, it sounds like your priorities are lifestyle and general career satisfaction as opposed to being super passionate about one field (correct me if I'm wrong, but I don't see anything wrong with that). If that's true, I think psych probably offers an easier lifestyle with more flexibility than peds would. Plus there can be enough time for other side projects as well, which is much harder to do in other fields. So question becomes how passionate are you about these fields vs. looking for something you enjoy that will also afford you the lifestyle you want? I think figuring out where that balance is will help you answer that question more than you'd think.

 

[mvenus929]

Have you done both consult liaison and outpatient psych?

Psych is paid less than peds on most national compensation surveys. Both are at the lower end of the spectrum. You also have to know a lot about regular medicine to figure out if someone's psychiatric findings are due to a medical disease or not. That means being able to do a decent physical exam.

But you can always go for peds psych too. Much needed field.

 

[W19]

Have you done both consult liaison and outpatient psych?

Psych is paid less than peds on most national compensation surveys. Both are at the lower end of the spectrum. You also have to know a lot about regular medicine to figure out if someone's psychiatric findings are due to a medical disease or not. That means being able to do a decent physical exam.

But you can always go for peds psych too. Much needed field.

Not true according to every single survey that I have seen out there...

 

[Reveler]

Having narrowed it down to two specialties, my advice would be to spend as much time rotating through these specialties as you can over the next 6-8 months. Spending as much time in both inpatient/outpatient scenarios will help you get a better idea about both residency training and practice. If you only did outpatient peds, you might find that inpatient peds isn't up your alley. For instance, your "high stress" personality may not be able to handle caring for premies in the NICU. (just an example)

Also, it's not uncommon for ERAS applicants to be applying to two specialties. And if you REALLY need to be in that location bc of your spouse's career, then you could hypothetically rank 12 programs in that city and increase your chances of matching there (that is, if it's still a toss-up once you get that far along).

 

[christmasindr]

Not true according to every single survey that I have seen out there...

I agree. Peds paid much less and work much harder during residency and beyond.

I think it is hard for us to advice the OP on what field to take on as each of them comes with pluses and minuses. The cons you mentioned for peds aren't that important I think: every field deals with liability, including psych. You aren't dealing with surgery or OBGyn, so the likelihood of getting sued is much less. Physical is just something that comes with time and all pediatricians will master it at some point.

 

[W19]

I agree. Peds paid much less and work much harder during residency and beyond.

I think it is hard for us to advice the OP on what field to take on as each of them comes with pluses and minuses. The cons you mentioned for peds aren't that important I think: every field deals with liability, including psych. You aren't dealing with surgery or OBGyn, so the likelihood of getting sued is much less. Physical is just something that comes with time and all pediatricians will master it at some point.

I agree... I usually tell people to choose the specialty with better lifestyle and better income potential whenever they undecided about two specialties... In OP's case, psych is the clear winner.

 

[NickNaylor]

I was in a somewhat similar position in medical school in that I really enjoyed peds and was planning on going into peds until I did my psychiatry clerkship. I ended up going into psychiatry.

Factors that went into it for me: pediatrics is basically an internal medicine residency, which means that it is demanding. Practice after residency is also not all that dissimilar than internal medicine residency, although you’ll get to see kiddos which may or may not bring you more satisfaction to your work. Lots of opportunities to subspecialize if that’s your thing and/or if you’re more interested in procedures.

I don’t think any of the cons that you listed for psychiatry or unreasonable. I also had doubts about the field because I felt like I would be throwing away much of the knowledge I just spent 4 years learning. This really isn’t all that true; while you’re not going to be regularly managing complex medical issues, having a solid foundation of medical knowledge and using that knowledge is still extremely important, particularly if you’re working in an inpatient setting, and it’s knowledge that you will use. Stigma within the medical field is certainly present but really not something that I deal with on a regular basis. On C/L rotations, you are a mystical behavioral god as non-psychiatrists have no idea what the hell it is we do or how our medications work, so you really are “the expert” and treated as such, even as a junior resident. Many of your patients will be immensely thankful for your care, and the gratitude they express to you may be greater than the gratitude most other non-psychiatrists receive in their day-to-day work.

You’re right that many of our treatments leave much to be desired. This is certainly something that is a “weakness” of the field. However, you can still do quite a bit with the treatments that we do have available, and the number of people that receive no benefit at all from your management is really quite low. You may not be able to “cure” whatever their complaints are, but you can certainly get to some degree of improvement in nearly all cases.

Talking with people about their psychiatric issues can be draining, but you will learn how to approach these issues with just enough attachment to be empathetic while still not getting sucked into someone’s life drama. I think you’re probably undervaluing the benefit for patients of simply having someone to talk to about whatever bizarre, sad, or unusual experiences that are happening in their life. Having good relationships with patients is less about having “the right thing to say” and more about listening carefully and making it clear that they have been heard and that you understand, to the best of your ability, what they’re experiencing.

I also agree with all of the benefits that you listed, and I don’t think they should be understated. The quality of life in the field is generally outstanding, and if you’re the kind of person that wants to work a lot of hours then it can be quite lucrative. There are many, many ways to structure your practice, including a daily mix of inpatient work, outpatient medication management, and outpatient psychotherapy - whatever your fancy is. If you’re entrepreneurial, then psychiatry is the field for you. The field is also wanting for intelligent, well-trained folks. At least in my area, the field is filled with people that have no business being anywhere near patients and either don’t care enough or simply don’t have the ability to practice competent medicine. Thus, it’s not particularly difficult to rise to the top as long as you’re intellectually interested, have a strong work ethic, and can interact well with patients and their families.

I have no regrets about my career choice. I love my work and think it’s extremely interesting. I feel good about what I do the overwhelming majority of the time. I feel like I can make a substantive difference in most patients’ lives. I’m optimistic about the future and think I’m going to have an awesome career. Those are perhaps the greatest endorsements I can give about my experience.

Either way, you’ll be fine. Go with your gut. Good luck.

 

[Redpancreas]

I gotta figure this out soon, really appreciate any thoughts.

General considerations: Strong applicant scores-wise with H in both peds and psych rotations. Restricted by spouse's job to a city with ~5 psych residencies, and ~7 peds residencies. Of course will apply elsewhere but would suck big time not to match here. Want to have a couple kids, work life balance is important to me.

Peds
Pros:
-Loved my outpatient peds rotation, could really see myself as a gen pediatrician. My dream job would be working 4 days per week. Love kids. Don't mind parents (but maybe I got lucky so far). Love explaining medical information to parents and kids. Not a huge fan of inpatient medicine, but residency is only 3 years.
-Enjoy the pathology a lot, didn't mind studying peds stuff at all (unlike adult stuff like COPD/CHF which makes me so bored)
-Like the preventative aspect
Cons:
-Worried about the higher liability/responsibility. I'm a high stress person and the idea of missing something leading to bad outcome in a kid is terrifying.
-Not the hottest at the physical exam currently. Worried about getting good enough at murmurs/throat/ear exams/etc. Obviously this is what training is for, though. I enjoy small procedures like skin stuff but not sure how I'll do with larger procedures in residency eg LPs, lines.
-$$ (lack thereof).

Psych
Pros:
-Also enjoyed my psych rotation a lot, enjoy reading/learning about psych diseases and liked thinking about the whole person and social context.
-Lifestyle and $ are great. Diversity of job opportunities.
-Fewer emergencies, less liability
-No physical exam, get more time to talk with patients and form a relationship
-Have a ton of empathy for psych patients, got a lot of good feedback on my interview skills/ability to get relevant info from psych patients
-Field is changing rapidly, very interesting future
Cons:
-Giving up a lot of medicine I've learned would be sad. The stigma. Have never seen myself as a psychiatrist, but I think I could get over this if I committed to psych.
-Have some reservations about efficacy of current psych treatments. But I've seen sketchy/non evidence based medicine practiced in all specialties, so this isn't that specific to psych.
-Find the heavy conversations/finding the right words to say/interacting with the difficult personalities exhausting after a while.

Thanks for reading!!

I think either of these would be good. You seem to be more interested in Pediatrics in my opinion. Only real con there is the $. Psychiatry allows for a lighter schedule for more pay, but it seems like it is not something you’re super passionate about so it’s your job to decide the career vs. passion thing.,