Psych or IM

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EFesta77

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Hey guys,
So here is my dilemma. Third year of med school is rapidly coming to a close for me (in peds right now with only FM to go). Everyone told me just wait until 3rd year ends, and you'll have a better idea of what specialty you want to pursue. Well, I definitely discovered what I do NOT want to go into. However, I find myself stuck between psych and IM.
Little background: After undergrad I pursued my PhD in biological psychology and did a year of a post-doc before enrolling in med school. I basically entered med school in order to become a psychiatrist. But I do find I really like IM and all the knowledge that goes along with it. I especially enjoyed Heme/Onc because I observed quite an intense Dr-patient relationship (which is something I like about psych).
I thought a little about combined IM/psych programs, but I feel that you end up picking one or the other when all is said and done.
I think something that's making me reconsider psych is the quality of the department at my school. It is a really crappy department. The residents are of really low quality. It has totally turned me off. The problem is that I haven't had exposure to a high-quality psych department. The only reference I have is my experience at my school.

Any else go through (going through) something similar?
Thanks for listening.

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Hey guys,
So here is my dilemma. Third year of med school is rapidly coming to a close for me (in peds right now with only FM to go). Everyone told me just wait until 3rd year ends, and you'll have a better idea of what specialty you want to pursue. Well, I definitely discovered what I do NOT want to go into. However, I find myself stuck between psych and IM.
Little background: After undergrad I pursued my PhD in biological psychology and did a year of a post-doc before enrolling in med school. I basically entered med school in order to become a psychiatrist. But I do find I really like IM and all the knowledge that goes along with it. I especially enjoyed Heme/Onc because I observed quite an intense Dr-patient relationship (which is something I like about psych).
I thought a little about combined IM/psych programs, but I feel that you end up picking one or the other when all is said and done.
I think something that's making me reconsider psych is the quality of the department at my school. It is a really crappy department. The residents are of really low quality. It has totally turned me off. The problem is that I haven't had exposure to a high-quality psych department. The only reference I have is my experience at my school.

Any else go through (going through) something similar?
Thanks for listening.

I was in the exact same boat. I ended up applying to one IM program in addition to Psych programs.

I would encourage you to apply to both. There was something that happened when I interviewed that gave me a definite "no I don't want to do IM." Something about putting myself in a resident/doc's shoes that helped me deicde. Frankly, a lot of it came down to the workload. I'm older and I just don't have a residency + fellowship in me. I enjoy life outside of medicine too much. Also, I don't really enjoy to minutiae of IM that much. . . as for heme/onc - I like outpatient heme/onc and the overall idea of heme/onc. However, most of your patients die gruesome deaths. I strongly dislike inpatient heme/onc. I think that'd get to me after a while.

Maybe an away at a "good" department would help you decide? My home program isn't the greatest, and when I interviewed it was really energizing to see what a good dept looked like!

Good Luck!
 
The problem is that I haven't had exposure to a high-quality psych department.
Have you tried to set up an elective in psych somewhere else? That would probably help a lot. I do agree that many schools do a terrible job of giving students a positive exposure to psychiatry, which probably alienates people who would have liked the field if they had seen it at its best.

You do remind me of myself one year ago. I loved oncology, found the patient interaction in the specialty very rewarding, and was comfortable dealing with the terminal patients, so I really struggled with "Psych vs. Onc?" for months.
The reasons I picked psych instead included:
1) I felt that heme/onc is already a very popular field that everyone understands the need for, whereas the need for mental health services is often overlooked. Due to the aforementioned lack of positive recruitment of medical students, there is a shortage in qualified psychiatrists. For those reasons, I felt like my presence had the most potential for making a true difference in psychiatry.

2) Psychiatry does have several intersections in oncology since we have the option of pursuing Palliative Care fellowships or Psycho-oncology training. Here is one example of a psycho-oncology training opportunity: http://www.mskcc.org/mskcc/html/69092.cfm

3) Since getting a fellowship is never a certainty, I felt it was probably smart to go into the field whose bread and butter general cases I liked most.
I enjoy the bread and butter of psychiatry much more than I enjoyed bread and butter IM. I became bored with diabetes, HTN, COPD exacerbation, and chest pain...but yet I never got bored while talking to psychotic patients! Every psych patient had a different story that was often pretty interesting.

4) Psych residency is a lot more benign than IM residency usually is. While I don't think anyone should pick their field solely based on lifestyle concerns, I have met so many stressed and unhappy IM residents that it kind of did turn me off to wanting to be like them.

5) I will get exposure to IM from the resident perspective during my internship year (since all psych residents do several months of IM) so if I do come to realize I love it after all, I still have the option to look into switching at that point. However, right now I feel pretty good about my decision to go for psych. Good luck on making your decision!
 
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I thought a little about combined IM/psych programs, but I feel that you end up picking one or the other when all is said and done.
I think you have a pretty good grasp of your career goals and what you like about each patient population. Many people go through "specialty wars" throughout the fourth-year application and interview process. Applying for both would not be uncommon. As you interview for both specialties the pros and cons of each should be elucidated.

The problem is that I haven't had exposure to a high-quality psych department.
Obviously this is an easy fix. IM seems to be your #1 at this moment; psych your #2. I'd suggest a couple away rotations at solid psych departments early on in the year. If it doesn't live up to your current excitement about IM, then you've got your answer. If you're still conflicted after that...(I've got nothing :cool:)...that'd be something you'll have to work out on your own.
 
Thanks guys!... It's good to see some people were in similar situations. It's what I need to hear. My plan is exactly that... Do an away or two at some psych programs in nyc during the summer, and see if that helps push me in the right direction.
Maybe I'll end up applying to some programs from both specialties..

Also....even though we shouldn't judge the specialty by the residency, IM does look kind of miserable. So that is a definite con.
 
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