psych and OB

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earthgirl101

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I am currently trying to decide between a career in psychiatry or OB/GYN (don't laugh, I see more overlap than most). I am posting this on both the psych and OB/GYN homes, but was wondering if anyone new anyone working on the intersection of these two fields or had any advice on which would be the better primary residency to manage the psychiatric needs of women throughout their pregnancy? (Obviously, if I want to do deliveries then OB-I have no interested in GYN-Surg.)
Thanks for you help!
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Definitely psych- if you went through OB, I think you would develop too many of your own psychiatric needs. Check out the "which clerkship is the worst thread" on the clinical rotations forum.
 
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Those were actually my final two residency options as well (though I'd be lying if I didn't say that psych had a substantial advantage throughout).

The answer probably depends on what you mean by "psychiatric needs." If you mean actively screening for mental illness, referring for psychotherapy, coordinating care, and in some instances prescribing medications when appropriate, the answer would be OBGYN. If you mean complex medication management for folks whose psychiatric needs fall out of the realm of the primary care physician's expertise, then the answer would be psychiatry. An OB isn't going to be adjusting someone's neuroleptics or delivering psychotherapy anymore than a psychiatrist is going to be performing a vacuum delivery with lac repair.

The good news is that you have a defined interest in an area in which immense need exists. Either route you take, you can be an excellent advocate for the mental health needs of your pregnant patients. Your role in the management of those needs, however, would be profoundly different. Neither less important, just very different.
 
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It was my experience on OB that OB/Gyns did not manage psychiatric medication in their patients very often. While most were not afraid to use antidepressants in truly depressed pregnant patients (especially in 2nd or 3rd trimesters) I never saw much more in depth psych management than that. It's not impossible, of course, but it isn't common.
 
I just switched from ob to psych and think that I will go into reproductive psychiatry. It's not so strange a dilemma. I agree with the above poster that ob/gyns are not very comfortable prescribing much more than an SSRI. Any other class or any polypharmacy and they try to send the patient to a psychiatrist. Unfortunately, most psychiatrists don't like to prescribe to pregnant patients. So you end up with a group of people with very poor access to health care at the time when they need it the most. If you want to help pregnant patients with their psychiatric needs, go into psych.

However, if you want to put your hands on your patients, you should go into ob, because you basically don't do that at all in psych. Look into what it is you like about each field and see if you'd like to be doing that for your career. If you hate gyn surgery (which I contend no student knows, you really have to perform surgery to rule it out), you can still do ob/gyn, just go into mfm (and take care of mentally ill pregnant women--there are mfms who do this), but you will still have to do c-sections and sometimes c-hysts and take care of non-psychiatric high risk pregnancies as well. As someone stated above, your focus will be different coming from those very different backgrounds. What you can offer the patient and how your relationship will be defined will also be very different. It really depends on how you want to relate to your patients.

Taking lifestyle into account is also a good idea. :) Good luck.
 
You could do an FM/psych double board residency.
 
am currently trying to decide between a career in psychiatry or OB/GYN (don't laugh, I see more overlap than most).
Click to expand...

Agree with you.

Which to decide is up to you. I'd narrow it down to the following 2 factors.

Lifestyle: In psyche you can have a life as a resident and after you graduate the hours are as demanding as you want them to be. Ob-gyn: several of the residencies have brutal hours, several programs violate the 80 hr cap. Even as an attending you'll have bad hours.

The field itself: which field seems to appeal to you more? (I hated delivering babies. Each time I felt as if I was defusing a bomb--one wrong move and zzzt!)

Reproductive psyche is a crossroads. NYU has Shari Lusskin, M.D., an authority on reproductive psychiatry and she's UpToDate's go to person for that. NYU also hosts a reproductive psychiatry lecture series. So if you want to go into that field, NYU is definitely a consideration for residency.
https://tools.med.nyu.edu/CMECOURSE...rse&TheCourseID=1661&CFID=154&CFTOKEN=4979161
 
I'm in a similar situation. But trying to choose between psych and anesthesia. It really sucks when you like two equally rewarding fields. I'm having a difficult time. My family keeps telling me they don't see me as a psychiatrist since I lack patience. But on my AI I see such a need and I like working with the mentally ill. Maybe because it runs in my family. Anyway, don't mean to hijact this thread. Good luck with your decision.
 
Thanks for the replies; I will definately look into the field of reproductive psychiatry. We don't have this field at my institution, and it was very helpful to get some leads on this:)
 
earthgirl101 said:
I am currently trying to decide between a career in psychiatry or OB/GYN (don't laugh, I see more overlap than most). I am posting this on both the psych and OB/GYN homes, but was wondering if anyone new anyone working on the intersection of these two fields or had any advice on which would be the better primary residency to manage the psychiatric needs of women throughout their pregnancy? (Obviously, if I want to do deliveries then OB-I have no interested in GYN-Surg.)
Thanks for you help!
Click to expand...

Hi, I know it's been a couple years but I was actually also thinking of doing something similar. I was just curious to see what you ended up deciding and if you found a way to incorporate both. Thanks so much!
 
siapr92 said:
Hi, I know it's been a couple years but I was actually also thinking of doing something similar. I was just curious to see what you ended up deciding and if you found a way to incorporate both. Thanks so much!
Click to expand...

Can't speak for the OP, but I've seen a number of people switch from OB to psych and have done well. Interestingly, none of them went into reproductive psych.

I've never seen the reverse, but its also much more palatable to start psych as a PGY-2 as opposed to OB as a PGY-1.
 
hypnosis for childbirth has been around for ever. you are not going to be doing any other kind of psychotherapy to women in active labor without receiving a well deserved punch in the face.
 
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OB was the worst, most malignant experience in med school. I'm a hard worker, but those residents really had it out for me and I wasn't the only one. My particular site has a history of being terrible and I was stupid enough to not choose a different site. I think it's sad, though, that those residents and attending enjoy torturing medical students. Do yourself a favor, be happy, and choose psych.
 
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splik said:
hypnosis for childbirth has been around for ever. you are not going to be doing any other kind of psychotherapy to women in active labor without receiving a well deserved punch in the face.
Click to expand...

Kick. Laboring women kick doctors. Ask me how I know.
 
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