Psych PGY-1 Considering Re-Applying For Anes - Seeking Perspectives

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Hot_Sauce

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I'm a psych PGY-1 in my mid 30s at a mid-tier academic program. Not super competitive numbers wise, but I'm a USMD and think I would have a shot at my current institution, my med school institution, and hopefully other lower tier programs.

So far, I'm just not a fan of psychiatry. My job has been in a dank, dreary inpatient psych ward at a safety net hospital in an urban city center. I don't feel like a doctor: listening to these nonsensical, intoxicated/recovering, and/or truly mentally ill patients and basically looking to see what they were prescribed last time and re-starting it or making minor adjustments with the same few drugs isn't challenging or interesting. Some of the patients' pathology is truly interesting to observe but already the novelty is wearing off. There's no gratification or satisfaction in anything I've done so far. Most of all, I miss using my hands and doing procedures. I originally applied to EM and psych and ranked psych first because of interest in psychology, being entrepreneur minded and wanting to start my own business, and lifestyle (again mid 30s).

In med school my favorite experiences were suturing, cutting, injecting, and also the few times where I was able to make that intimate patient connection such as the mother of a patient whose baby I delivered thanking me, or a little girl in the child psych ward who was suicidal and by the end of her stay was happy and her parents addressed the family issues leading to her depression. But really, my satisfaction came from doing things. So far in psych, there's none of that.

I didn't get a chance to do a Sub-I, and I'm trying to line up some shadowing now, but I kinda just wanted to ask you all, if you were in my position, what kind of things I should consider, and if you were in my shoes what would you be doing/thinking? I'm just a month into residency, and by the time I finish Psych or Anes I would be about 40. I'd lose a year in Anes because I'd have to re-start as a PGY-1. Some of my Anes friends and even attendings said I should stick with psych 100% due to the lifestyle and owning your own patients; others have said it's a great, fun, satisfying gig with tons of vacation, high pay, and the ability to really save lives.

Just seeking some different perspectives here. Thanks.

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In med school my favorite experiences were suturing, cutting, injecting, and also the few times where I was able to make that intimate patient connection ... But really, my satisfaction came from doing things... others have said it's a great, fun, satisfying gig with tons of vacation, high pay, and the ability to really save lives.

Just seeking some different perspectives here. Thanks.

Unless you'll be going into CCM, you won't really have those same opportunities ever again to make that patient-physician connection. If that's important to you, I would say general anesthesiology is not for you. I get that to some extent in the cardiac ORs if the patients get multiple procedures, but it's not all that common under those circumstances either. Most of your patient interactions will be consenting them for anesthesia +/- procedures and answering their questions. I find some value in being able to walk into a room and make people laugh, smile, or feel at ease within the first few minutes, but it doesn't go beyond that for the majority of your career, IMO.

We "do" a lot in anesthesia, but during residency, you're "doing" those things for about 60-70 hours a week. Compare those hours to psych, plus the frequent in-house call (depending on the residency), plus dealing with all different types of personalities in the OR as well as outside of it, plus the acuity of the cases and the necessity for you to not only "do" but be able to think quickly and put those thoughts to action without necessarily all of the information at hand... this type of pace and energy is not usually required in psychiatry, and it's hard to appreciate until you become a resident.

Some jobs have good vacation (with concomitant pay decrease), but a lot of academic jobs have limited vacation/CME type stuff as well with lower pay as well. Overall, I would say the market is okay. All of the graduates I know in my class and the couple below us have had no issues (myself included).

We do save lives undoubtedly, as most physicians do in some way or another. I would think long and hard about a career in anesthesiology. It's definitely not for everybody.
 
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You are a month in. Stick it out. I often regret not sticking to my original plan of doing psych.

If you really feel that you must "work with your hands" to be happy, I recommend knitting, piano, card games, video games, basketball, or fishing. I am sure the list is endless.

Once you are established and are helping psych patients and see their turn around there will be plenty who thank you and remember you because you establish long term relationships. You don't have to work in addiction. I absolutely hated working with addicts.

As anesthesiologists, no one remembers us. We are constantly being rushed to "move the meat". There are threads here on how to "improve turnover times". You are at the beck and call of the surgeon. You will most likely have to work nights and weekends at least initially and of course throughout residency.

I will tell you right now the need for psychiatry is abundant. I mean have you seen what's going on with the world? You think people's mental health is the same as it was six months ago? Psychiatrists are needed now more than ever and demand is going through the roof. Pay is going up and wait times are insane. And I as a locus make the same as a psychiatry locums just FYI. And my job involves life and death more often than yours ever will (ICU work as well).

Just please don't be that psychiatrist who does "cash only" because most people who are really really struggling with serious psych issues can't afford those fees. I find psychiatrists who only treat the patients who can afford $200-300 an hour to be doing the psych community a disservice. Maybe do some kind of sliding scale or weekend work where you help out poorer inpatients or something or bill out of network if you feel the insurance company is screwing you or something.

Stick it out. You are only a month in. The freedom to have your own practice and make your own rules especially the way healthcare is going in this country is priceless.
 
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I'm a psych PGY-1 in my mid 30s at a mid-tier academic program. Not super competitive numbers wise, but I'm a USMD and think I would have a shot at my current institution, my med school institution, and hopefully other lower tier programs.

So far, I'm just not a fan of psychiatry. My job has been in a dank, dreary inpatient psych ward at a safety net hospital in an urban city center. I don't feel like a doctor: listening to these nonsensical, intoxicated/recovering, and/or truly mentally ill patients and basically looking to see what they were prescribed last time and re-starting it or making minor adjustments with the same few drugs isn't challenging or interesting. Some of the patients' pathology is truly interesting to observe but already the novelty is wearing off. There's no gratification or satisfaction in anything I've done so far. Most of all, I miss using my hands and doing procedures. I originally applied to EM and psych and ranked psych first because of interest in psychology, being entrepreneur minded and wanting to start my own business, and lifestyle (again mid 30s).

In med school my favorite experiences were suturing, cutting, injecting, and also the few times where I was able to make that intimate patient connection such as the mother of a patient whose baby I delivered thanking me, or a little girl in the child psych ward who was suicidal and by the end of her stay was happy and her parents addressed the family issues leading to her depression. But really, my satisfaction came from doing things. So far in psych, there's none of that.

I didn't get a chance to do a Sub-I, and I'm trying to line up some shadowing now, but I kinda just wanted to ask you all, if you were in my position, what kind of things I should consider, and if you were in my shoes what would you be doing/thinking? I'm just a month into residency, and by the time I finish Psych or Anes I would be about 40. I'd lose a year in Anes because I'd have to re-start as a PGY-1. Some of my Anes friends and even attendings said I should stick with psych 100% due to the lifestyle and owning your own patients; others have said it's a great, fun, satisfying gig with tons of vacation, high pay, and the ability to really save lives.

Just seeking some different perspectives here. Thanks.

Ill give a different perspective than the previous two posts..

Anesthesiology does in fact have the things you are looking for.

There is often a very meaningful patient-physician connection. Patients want to get to know the person who will be taking such important care of you during such a critical time in your life, even if you dont follow them, you certainly "own" them while they are unconscious at your hands for hours during surgery. Anesthesiologists should be looking to establish that connection in their brief time with patients, but some hide behind a drab personality and act more as a technician, which is not comforting to patients.... the guy whos taking care of me while im asleep, yeah he seems like a good trustworthy guy so i feel better about this whole procedure

Pay is good, most jobs start at 350-400k.

Vacation is good, most jobs start at 6-8 weeks.

Lifestyle is not bad but its definitely not psych hours. You will be up late in the OR, you will be on call overnight (not just answering pages from home or rounding in the mornings and then going home) You will see blood and guts. You will make mistakes and people will die at your hands, youd be going from the least intense field to the most (arguably)

What to do?

You should know that many new docs feel how you do about a new field. Psych will most likely grow on you. I would give it until Thanksgiving.

If by thanksgiving you are still wondering about anesthesia, start making plans to get into a PGY1 prelim program the next year.

Then at the end of the year you can decide to go to that prelim program or stick with psych.

Then when you are in the prelim program you need to open your mind to what you want to do so this doesnt happen again.

Decide between anesthesia and EM and never look back..
 
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Fer Christ's sake man you're one month into your residency and you're doing a crummy rotation. Give it AT LEAST 6 months and gain broader exposure to other aspects of psychiatry. Anesthesia is awful right now and will only be worse in the future. Stick it out or get it stuck in - sans lube.
 
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I think a lot of people look at anesthesia from the outside and thing: procedures, good pay/vaca, no notes/rounding. Sounds awesome!

I was chatting with a guy in the locker room on his last day of residency a few weeks ago. He'd been a hospitalist for a few years before deciding to go back and retrain in anesthesia. I asked him if it was everything he'd dreamed it'd be.

His answer: "It was way harder."

The grass isn't always greener dude/dudette.
 
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Slightly different perspective. Not telling you to become an anesthesiologist or psychiatrist but instead remember sunk cost fallacy. Quit frequently and early if you are unhappy...
 
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I switched in the other direction after PGY2 of anesthesia and am super happy that I did.

For me, anesthesia looked great as a med student but sucked as a resident. Psych looked kinda boring as a med student but is freaking awesome as a resident. A lot of my psych co-residents like to bitch but have no idea how much chiller this is than anesthesia.
 
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As anesthesiologists, no one remembers us. We are constantly being rushed to "move the meat". There are threads here on how to "improve turnover times". You are at the beck and call of the surgeon. You will most likely have to work nights and weekends at least initially and of course throughout residency.

This is jaded. Cases may get mundane from our side but having surgery is a very big deal to each and every patient. It is simply not true that they don’t remember you. How often do you hear “oh you’re the one I’ve been waiting to talk to!” Or “I’m really nervous.” Much like psych, how you talk to patients albeit in mostly brief encounters can make a real impact on their experience.

And yeah. Improving turnover time makes more money and gets everyone home earlier and happier.
 
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I switched in the other direction after PGY2 of anesthesia and am super happy that I did.

For me, anesthesia looked great as a med student but sucked as a resident. Psych looked kinda boring as a med student but is freaking awesome as a resident. A lot of my psych co-residents like to bitch but have no idea how much chiller this is than anesthesia.
This may be the only time I've ever heard of this happening...
 
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Unless you'll be going into CCM, you won't really have those same opportunities ever again to make that patient-physician connection. If that's important to you, I would say general anesthesiology is not for you. I get that to some extent in the cardiac ORs if the patients get multiple procedures, but it's not all that common under those circumstances either. Most of your patient interactions will be consenting them for anesthesia +/- procedures and answering their questions. I find some value in being able to walk into a room and make people laugh, smile, or feel at ease within the first few minutes, but it doesn't go beyond that for the majority of your career, IMO.

We "do" a lot in anesthesia, but during residency, you're "doing" those things for about 60-70 hours a week. Compare those hours to psych, plus the frequent in-house call (depending on the residency), plus dealing with all different types of personalities in the OR as well as outside of it, plus the acuity of the cases and the necessity for you to not only "do" but be able to think quickly and put those thoughts to action without necessarily all of the information at hand... this type of pace and energy is not usually required in psychiatry, and it's hard to appreciate until you become a resident.

Some jobs have good vacation (with concomitant pay decrease), but a lot of academic jobs have limited vacation/CME type stuff as well with lower pay as well. Overall, I would say the market is okay. All of the graduates I know in my class and the couple below us have had no issues (myself included).

We do save lives undoubtedly, as most physicians do in some way or another. I would think long and hard about a career in anesthesiology. It's definitely not for everybody.

I guess one thing that I'm struggling with is how much satisfaction I will get from the day-to-day of anesthesia. While I loved those few meaningful patient-physician connections I got in med school, I also really loved attempting and finally getting an US guided IV. It felt satisfying to get that IV in when the nurse couldn't. I felt like I had a real skillset that others couldn't do, whereas in psych everyone thinks they are doing your job better (nurses, psychologists, pharmacists). I get that some CRNAs think this way too though.

Also I am struggling with the 'do what you love' versus the 'be smart' mentality. On paper, psych is great in terms of lifestyle, potential to make money if that's what I really want, and also really save lives (as you alluded to, psychs also save lives by preventing suicides and homicides by keeping people in when others would let them loose).

In short, I miss the adrenaline of EM and surgery; and Anes seems to have that, a skillset, and cerebral aspect of problem-solving and pharmacology. But like psych, it also sounds good on paper. I've heard differing opinions on the phsyician-patient relationship, and that its kind of what you make of it -- if you want to be in-and-out you can do that, but if you want to make a meaningful connection it's also possible. Lastly so far in inpatient psych at least, the meaningful connections aren't really there as the patients are often psychotic or intoxicated and we are just stabilizing them.

Are you early, mid, or late career, would you do it again, and do you recommend it to current med students?

You are a month in. Stick it out. I often regret not sticking to my original plan of doing psych.

If you really feel that you must "work with your hands" to be happy, I recommend knitting, piano, card games, video games, basketball, or fishing. I am sure the list is endless.

Once you are established and are helping psych patients and see their turn around there will be plenty who thank you and remember you because you establish long term relationships. You don't have to work in addiction. I absolutely hated working with addicts.

As anesthesiologists, no one remembers us. We are constantly being rushed to "move the meat". There are threads here on how to "improve turnover times". You are at the beck and call of the surgeon. You will most likely have to work nights and weekends at least initially and of course throughout residency.

I will tell you right now the need for psychiatry is abundant. I mean have you seen what's going on with the world? You think people's mental health is the same as it was six months ago? Psychiatrists are needed now more than ever and demand is going through the roof. Pay is going up and wait times are insane. And I as a locus make the same as a psychiatry locums just FYI. And my job involves life and death more often than yours ever will (ICU work as well).

Just please don't be that psychiatrist who does "cash only" because most people who are really really struggling with serious psych issues can't afford those fees. I find psychiatrists who only treat the patients who can afford $200-300 an hour to be doing the psych community a disservice. Maybe do some kind of sliding scale or weekend work where you help out poorer inpatients or something or bill out of network if you feel the insurance company is screwing you or something.

Stick it out. You are only a month in. The freedom to have your own practice and make your own rules especially the way healthcare is going in this country is priceless.

I hear you, and I realize it's only been a month, but if I'm going to make a change, I need to hustle and start getting experience by shadowing, LORs, and talking to my PD since application season is right around the corner. Intellectually, I totally agree psych is great. It's just that, so far, psych is not what I imagined being a physician would be. There's so little medicine; my attendings consult for essentially normal ECGs with like an axis deviation; subclinical hypothyroidism; simple iron deficiency anemia. Our ITE exam is mostly Jungian personality types, ethics, Maslow's hierarchy, attachment styles. I've heard the boards are different and similar to Neuro boards, but so far it's just not stimulating to me. Unfortunately that higher calling to be on the front lines of psych since everyone is suffering just doesn't move me at the moment, because most of the people suffering need lifestyle modification (better diet, exercise, sunlight, working on themselves with journaling, reading, making new relationships) -- not pharmacological intervention. I know it sounds petty, but I wanted to be doing the 'doctor thing' -- wearing my white coat and greeting patients, in the hospital looking at imaging and hearing the monitors beeping and showing waveforms...not trying to obtain a history from a homeless meth addict at 2 am, get nearly assaulted by a schizophrenic homicidal pt telling me to get out and go fight the war against whitey, or figure out whether a psychotic patient is actually suicidal or just needs a place to stay for a couple days (its almost always the latter).

I totally agree about the being my own boss, and the way healthcare is going, I see that psych (and derm, etc) is the last bastion of freedom in medicine, but, dang, I have to like it first and foremost, right?

Ill give a different perspective than the previous two posts..

Anesthesiology does in fact have the things you are looking for.

There is often a very meaningful patient-physician connection. Patients want to get to know the person who will be taking such important care of you during such a critical time in your life, even if you dont follow them, you certainly "own" them while they are unconscious at your hands for hours during surgery. Anesthesiologists should be looking to establish that connection in their brief time with patients, but some hide behind a drab personality and act more as a technician, which is not comforting to patients.... the guy whos taking care of me while im asleep, yeah he seems like a good trustworthy guy so i feel better about this whole procedure

Pay is good, most jobs start at 350-400k.

Vacation is good, most jobs start at 6-8 weeks.

Lifestyle is not bad but its definitely not psych hours. You will be up late in the OR, you will be on call overnight (not just answering pages from home or rounding in the mornings and then going home) You will see blood and guts. You will make mistakes and people will die at your hands, youd be going from the least intense field to the most (arguably)

What to do?

You should know that many new docs feel how you do about a new field. Psych will most likely grow on you. I would give it until Thanksgiving.

If by thanksgiving you are still wondering about anesthesia, start making plans to get into a PGY1 prelim program the next year.

Then at the end of the year you can decide to go to that prelim program or stick with psych.

Then when you are in the prelim program you need to open your mind to what you want to do so this doesnt happen again.

Decide between anesthesia and EM and never look back..

Thanks for this rather practical advice, and I appreciate your assessment of anesthesia. Question, do you know if I decided to pursue Anes, whether I would have to apply for TY and Anes programs, and rank them both separately? Meaning, would I have to give up my psych spot and potentially match into a TY year but not any Anes programs? That would be the worst of all worlds. I really enjoyed EM, but I've decided that I won't take the hit to my circadian rhythms. I'm sure Anes has its hits too, but not the cyclical flipping that is so detrimental to health and happiness that EM has.

Also it sounds like you like it. Do you still like it, are you early, mid, or late career, and would you personally recommend it to med students contemplating it given the career outlook right now?
 
Fer Christ's sake man you're one month into your residency and you're doing a crummy rotation. Give it AT LEAST 6 months and gain broader exposure to other aspects of psychiatry. Anesthesia is awful right now and will only be worse in the future. Stick it out or get it stuck in - sans lube.

Yeah, I hear you. I just wanna hustle if need be since application season is right around the corner.

What do you mean Anesthesia is awful right and only worse in the future? From what I understand, the job market has been on fire lately (pre-covid), and will likely get better again once things calm down due to the huge backlog of elective procedures, and further aging of the population needing elective procedures? As far as the CRNA thing and VA, is that what your referring to? I'm torn about this argument since mid-level encroachment is happening everywhere including psych. The one big thing psych's got going for it is ability to open up shop fairly easily. And telepsych.


I think a lot of people look at anesthesia from the outside and thing: procedures, good pay/vaca, no notes/rounding. Sounds awesome!

I was chatting with a guy in the locker room on his last day of residency a few weeks ago. He'd been a hospitalist for a few years before deciding to go back and retrain in anesthesia. I asked him if it was everything he'd dreamed it'd be.

His answer: "It was way harder."

The grass isn't always greener dude/dudette.

Can you elaborate? When you mean its way harder, do you mean time-wise and losing more sleep? Harder because you have to deal with surgeons? Harder because as a hospitalist you basically quarterback and punt various issues to specialists whereas in Anes its up to you to resuscitate acutely or get the intubation or whatever?

I guess my question for that hospitalist would be, why he changed to Anes, is he glad he did it, and would he do it again.


Slightly different perspective. Not telling you to become an anesthesiologist or psychiatrist but instead remember sunk cost fallacy. Quit frequently and early if you are unhappy...

Yeah that's why I'm starting this now. One of my buddies is a CA-2 here at my program and I already had a meeting with the PD here whose gonna help me get some shadowing experiences in my off weekends. Gotta figure out if Anes would make me happy. One year from graduation and sunk cost is one thing, 2 or more becomes prohibitive. Money-wise, I guess it would probably even out since Anes has a higher income generally speaking.
 
I switched in the other direction after PGY2 of anesthesia and am super happy that I did.

For me, anesthesia looked great as a med student but sucked as a resident. Psych looked kinda boring as a med student but is freaking awesome as a resident. A lot of my psych co-residents like to bitch but have no idea how much chiller this is than anesthesia.

Gotta say @neverdone is an appropriate username for switching from Anes to psych! Though I'm sure you're not the only one.

Can I ask what you didn't like about it, and why you switched? Seems like your happy with the decision?

Do you miss procedures and working with your hands? Do you miss "medicine"?
 
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This is jaded. Cases may get mundane from our side but having surgery is a very big deal to each and every patient. It is simply not true that they don’t remember you. How often do you hear “oh you’re the one I’ve been waiting to talk to!” Or “I’m really nervous.” Much like psych, how you talk to patients albeit in mostly brief encounters can make a real impact on their experience.

And yeah. Improving turnover time makes more money and gets everyone home earlier and happier.

With my limited experience I tend to agree with you. Plus it seems like when **** hits the fan, everyone is very grateful for the anesthesiologist to be there. My cousin recently had a baby and the CRNA misplaced his wife's epidural. He asked for the Anes on call, and said there was a sigh of relief from everyone in the room when the Anes got there and 'saved the day.'
 
This is jaded. Cases may get mundane from our side but having surgery is a very big deal to each and every patient. It is simply not true that they don’t remember you. How often do you hear “oh you’re the one I’ve been waiting to talk to!” Or “I’m really nervous.” Much like psych, how you talk to patients albeit in mostly brief encounters can make a real impact on their experience.

And yeah. Improving turnover time makes more money and gets everyone home earlier and happier.
Ask your surgeon friends to ask these patients to state your name when they are there for their follow up.
Come on.
And yeah, turnover times can get people home earlier. But often times it can be extreme and patients are treated like cattle. You know, people bragging about their 15 minutes turnovers all the time like its some kind of competition.
 
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Do what you want, but in 10 years, when you’ve gotta listen to what hospital administrators think, and OR directors think, and surgeons think, and nurses think, and some idiot CMO of the private equity-owned AMC you work for thinks, and what some CRNA thinks....

You might look back and think that having to listen to a few psych patients, setting your own schedule, and calling the shots wasn’t such a bad gig after all...
 
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Ask your surgeon friends to ask these patients to state your name when they are there for their follow up.
Come on.
And yeah, turnover times can get people home earlier. But often times it can be extreme and patients are treated like cattle. You know, people bragging about their 15 minutes turnovers all the time like its some kind of competition.

This is not the reality I’m living in. Forgetting names is normal. Either way, this has no bearing on my job satisfaction. Do you know all your nurses names? Invariably when people find out I’m a doctor they mention whatever surgery they’ve had. If I ask who their surgeon was, more than half the time they don’t remember. Plus if anything, its definitely a benefit that i don’t have long term contact with patients and i also think it’s a benefit that people don’t always remember us.

This also neglects that pregnant women, L and D nurses, and block patients often treat us like heroes.

You’ve never had to turn down gifts or tips? One time as a resident a family legitimately tried to hand me straight cash.
 
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Ask your surgeon friends to ask these patients to state your name when they are there for their follow up.
Come on.
And yeah, turnover times can get people home earlier. But often times it can be extreme and patients are treated like cattle. You know, people bragging about their 15 minutes turnovers all the time like its some kind of competition.

I’m not denying that depending on the schedule and check in process, it can feel like herding cattle. Particularly, if nursing slows down check in or if the add on schedule is busy. This is one of the big reasons why I ultimately decided against cardiac. A rushed conversation in preop being the last conversation a patient has with their family members is pretty dark. No system is perfect. Rushed preops are a systems problem that can be worked on.
 
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Gotta say @neverdone is an appropriate username for switching from Anes to psych! Though I'm sure you're not the only one.

Can I ask what you didn't like about it, and why you switched? Seems like your happy with the decision?

Do you miss procedures and working with your hands? Do you miss "medicine"?

I probably shouldn’t have gone into medicine in the first place, so no I don’t miss anything like procedures or real “medicine”.

I had the realization during residency that I went into medicine to have a stable well paying job, not for adrenaline or glamour.

Once I realized that, I knew I’d be happier switching into a lower stress field, which being in psychiatry has definitely accomplished.

If I was in anesthesia, I’d be trying to save and retire early.
 
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Do you know all your nurses names?
I absolutely do. Additionally, I make it a point to know the names of the housekeeping staff, maintenance people, and cafeteria employees. Most other physicians ignore these important individuals but HOMIE DON'T PLAY THAT.
 
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Can you elaborate? When you mean its way harder, do you mean time-wise and losing more sleep? Harder because you have to deal with surgeons? Harder because as a hospitalist you basically quarterback and punt various issues to specialists whereas in Anes its up to you to resuscitate acutely or get the intubation or whatever?

I guess my question for that hospitalist would be, why he changed to Anes, is he glad he did it, and would he do it again.

He’s going into pain. Should tell you a lot.
 
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I'm a psych PGY-1 in my mid 30s at a mid-tier academic program. Not super competitive numbers wise, but I'm a USMD and think I would have a shot at my current institution, my med school institution, and hopefully other lower tier programs.

So far, I'm just not a fan of psychiatry. My job has been in a dank, dreary inpatient psych ward at a safety net hospital in an urban city center. I don't feel like a doctor: listening to these nonsensical, intoxicated/recovering, and/or truly mentally ill patients and basically looking to see what they were prescribed last time and re-starting it or making minor adjustments with the same few drugs isn't challenging or interesting. Some of the patients' pathology is truly interesting to observe but already the novelty is wearing off. There's no gratification or satisfaction in anything I've done so far. Most of all, I miss using my hands and doing procedures. I originally applied to EM and psych and ranked psych first because of interest in psychology, being entrepreneur minded and wanting to start my own business, and lifestyle (again mid 30s).

In med school my favorite experiences were suturing, cutting, injecting, and also the few times where I was able to make that intimate patient connection such as the mother of a patient whose baby I delivered thanking me, or a little girl in the child psych ward who was suicidal and by the end of her stay was happy and her parents addressed the family issues leading to her depression. But really, my satisfaction came from doing things. So far in psych, there's none of that.

I didn't get a chance to do a Sub-I, and I'm trying to line up some shadowing now, but I kinda just wanted to ask you all, if you were in my position, what kind of things I should consider, and if you were in my shoes what would you be doing/thinking? I'm just a month into residency, and by the time I finish Psych or Anes I would be about 40. I'd lose a year in Anes because I'd have to re-start as a PGY-1. Some of my Anes friends and even attendings said I should stick with psych 100% due to the lifestyle and owning your own patients; others have said it's a great, fun, satisfying gig with tons of vacation, high pay, and the ability to really save lives.

Just seeking some different perspectives here. Thanks.



i say stick it out. find some inside motivation and introspection why you applied and wanted to be in psych in the first place. then move to a fancy office in NYC and listen to rich people talk about why their husbands or wives keep cheating on them with some 20 year old and refill their zoloft and prozac as needed. you will be raking in so much money through referrals. wear a tweed suit and bow tie. lay people actually consider you more of a physician than they would an anesthesiologist. or do child psych....my buddy is an attending and loving it.
 
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I guess one thing that I'm struggling with is how much satisfaction I will get from the day-to-day of anesthesia. While I loved those few meaningful patient-physician connections I got in med school, I also really loved attempting and finally getting an US guided IV. It felt satisfying to get that IV in when the nurse couldn't. I felt like I had a real skillset that others couldn't do, whereas in psych everyone thinks they are doing your job better (nurses, psychologists, pharmacists). I get that some CRNAs think this way too though.

Also I am struggling with the 'do what you love' versus the 'be smart' mentality. On paper, psych is great in terms of lifestyle, potential to make money if that's what I really want, and also really save lives (as you alluded to, psychs also save lives by preventing suicides and homicides by keeping people in when others would let them loose).

In short, I miss the adrenaline of EM and surgery; and Anes seems to have that, a skillset, and cerebral aspect of problem-solving and pharmacology. But like psych, it also sounds good on paper. I've heard differing opinions on the phsyician-patient relationship, and that its kind of what you make of it -- if you want to be in-and-out you can do that, but if you want to make a meaningful connection it's also possible. Lastly so far in inpatient psych at least, the meaningful connections aren't really there as the patients are often psychotic or intoxicated and we are just stabilizing them.

Are you early, mid, or late career, would you do it again, and do you recommend it to current med students?



I hear you, and I realize it's only been a month, but if I'm going to make a change, I need to hustle and start getting experience by shadowing, LORs, and talking to my PD since application season is right around the corner. Intellectually, I totally agree psych is great. It's just that, so far, psych is not what I imagined being a physician would be. There's so little medicine; my attendings consult for essentially normal ECGs with like an axis deviation; subclinical hypothyroidism; simple iron deficiency anemia. Our ITE exam is mostly Jungian personality types, ethics, Maslow's hierarchy, attachment styles. I've heard the boards are different and similar to Neuro boards, but so far it's just not stimulating to me. Unfortunately that higher calling to be on the front lines of psych since everyone is suffering just doesn't move me at the moment, because most of the people suffering need lifestyle modification (better diet, exercise, sunlight, working on themselves with journaling, reading, making new relationships) -- not pharmacological intervention. I know it sounds petty, but I wanted to be doing the 'doctor thing' -- wearing my white coat and greeting patients, in the hospital looking at imaging and hearing the monitors beeping and showing waveforms...not trying to obtain a history from a homeless meth addict at 2 am, get nearly assaulted by a schizophrenic homicidal pt telling me to get out and go fight the war against whitey, or figure out whether a psychotic patient is actually suicidal or just needs a place to stay for a couple days (its almost always the latter).

I totally agree about the being my own boss, and the way healthcare is going, I see that psych (and derm, etc) is the last bastion of freedom in medicine, but, dang, I have to like it first and foremost, right?



Thanks for this rather practical advice, and I appreciate your assessment of anesthesia. Question, do you know if I decided to pursue Anes, whether I would have to apply for TY and Anes programs, and rank them both separately? Meaning, would I have to give up my psych spot and potentially match into a TY year but not any Anes programs? That would be the worst of all worlds. I really enjoyed EM, but I've decided that I won't take the hit to my circadian rhythms. I'm sure Anes has its hits too, but not the cyclical flipping that is so detrimental to health and happiness that EM has.

Also it sounds like you like it. Do you still like it, are you early, mid, or late career, and would you personally recommend it to med students contemplating it given the career outlook right now?

FWIW the length of your posts seems more fitting for psych.
 
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You are a month in. Stick it out. I often regret not sticking to my original plan of doing psych.

If you really feel that you must "work with your hands" to be happy, I recommend knitting, piano, card games, video games, basketball, or fishing. I am sure the list is endless.

Once you are established and are helping psych patients and see their turn around there will be plenty who thank you and remember you because you establish long term relationships. You don't have to work in addiction. I absolutely hated working with addicts.

As anesthesiologists, no one remembers us. We are constantly being rushed to "move the meat". There are threads here on how to "improve turnover times". You are at the beck and call of the surgeon. You will most likely have to work nights and weekends at least initially and of course throughout residency.

I will tell you right now the need for psychiatry is abundant. I mean have you seen what's going on with the world? You think people's mental health is the same as it was six months ago? Psychiatrists are needed now more than ever and demand is going through the roof. Pay is going up and wait times are insane. And I as a locus make the same as a psychiatry locums just FYI. And my job involves life and death more often than yours ever will (ICU work as well).

Just please don't be that psychiatrist who does "cash only" because most people who are really really struggling with serious psych issues can't afford those fees. I find psychiatrists who only treat the patients who can afford $200-300 an hour to be doing the psych community a disservice. Maybe do some kind of sliding scale or weekend work where you help out poorer inpatients or something or bill out of network if you feel the insurance company is screwing you or something.

Stick it out. You are only a month in. The freedom to have your own practice and make your own rules especially the way healthcare is going in this country is priceless.
arent all those benefits part of pain management? psych + needles essentially with roughly twice the pay. always shocked me when people recommended psyc when they are in anes and can do pain
 
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I switched from PM&R to anesthesia for roughly the same reasons as you described. I am very satisfied and happy with my choice so far. I’d bet that anesthesia is the most switched into specialty, there’s a reason behind that. FWIW I’ve spoken to many people who switched into anesthesia before I switched myself, and have never heard anyone regret it. If you’re really willing to go through the brutal process of switching specialties to do something, chances are you already know your answer.
 
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Consider pain medicine.
You’ll own the patients, form a relationship, and stick them with a bunch of needles. You can even go into pain fellowship straight from psych residency. Some fellowship like taking a few PMRs or psychs to even out the anesthesia batch.
 
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Fer Christ's sake man you're one month into your residency and you're doing a crummy rotation. Give it AT LEAST 6 months and gain broader exposure to other aspects of psychiatry. Anesthesia is awful right now and will only be worse in the future. Stick it out or get it stuck in - sans lube.

Could you elaborate on anesthesia being awful right now? Compared to a lot of specialities hours are good, no clinic(I guess some like clinic but its my nightmare), and a comp report I just saw on this site today had the average pay over 400k in every region in the country.
 
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Could you elaborate on anesthesia being awful right now? Compared to a lot of specialities hours are good, no clinic(I guess some like clinic but its my nightmare), and a comp report I just saw on this site today had the average pay over 400k in every region in the country.
DONT DO IT MAN JUST DONT. because some old bitter dude on here told you not too. anesthesiologists are heading to minimum wage salaries and have to service the surgeons in inappropriate ways according to sdn prophecies dating 10 years back.
 
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I switched from PM&R to anesthesia for roughly the same reasons as you described. I am very satisfied and happy with my choice so far. I’d bet that anesthesia is the most switched into specialty, there’s a reason behind that. FWIW I’ve spoken to many people who switched into anesthesia before I switched myself, and have never heard anyone regret it. If you’re really willing to go through the brutal process of switching specialties to do something, chances are you already know your answer.
I can understand the switch from psych to anesthesia but PM&R is much more hands on and implements more aspects of "hard medicine". There's a solid amount of hands on procedures physiatrist utilize. Plus if you do interventional pain or spine, you'd be even more procedural. However, Yes a general gas doc will do more procedures than general physiatrist. Was there more to the switch than just the amount of procedures? I'm asking this since I have a close friend deciding between the two.
 
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This is jaded. Cases may get mundane from our side but having surgery is a very big deal to each and every patient. It is simply not true that they don’t remember you. How often do you hear “oh you’re the one I’ve been waiting to talk to!” Or “I’m really nervous.” Much like psych, how you talk to patients albeit in mostly brief encounters can make a real impact on their experience.

And yeah. Improving turnover time makes more money and gets everyone home earlier and happier.

How often? Once every few months would be my guess. A bit longer now due to the whole covid situation.
 
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I guess one thing that I'm struggling with is how much satisfaction I will get from the day-to-day of anesthesia. While I loved those few meaningful patient-physician connections I got in med school, I also really loved attempting and finally getting an US guided IV. It felt satisfying to get that IV in when the nurse couldn't. I felt like I had a real skillset that others couldn't do, whereas in psych everyone thinks they are doing your job better (nurses, psychologists, pharmacists). I get that some CRNAs think this way too though.

Also I am struggling with the 'do what you love' versus the 'be smart' mentality. On paper, psych is great in terms of lifestyle, potential to make money if that's what I really want, and also really save lives (as you alluded to, psychs also save lives by preventing suicides and homicides by keeping people in when others would let them loose).

In short, I miss the adrenaline of EM and surgery; and Anes seems to have that, a skillset, and cerebral aspect of problem-solving and pharmacology. But like psych, it also sounds good on paper. I've heard differing opinions on the phsyician-patient relationship, and that its kind of what you make of it -- if you want to be in-and-out you can do that, but if you want to make a meaningful connection it's also possible. Lastly so far in inpatient psych at least, the meaningful connections aren't really there as the patients are often psychotic or intoxicated and we are just stabilizing them.

Are you early, mid, or late career, would you do it again, and do you recommend it to current med students?



I hear you, and I realize it's only been a month, but if I'm going to make a change, I need to hustle and start getting experience by shadowing, LORs, and talking to my PD since application season is right around the corner. Intellectually, I totally agree psych is great. It's just that, so far, psych is not what I imagined being a physician would be. There's so little medicine; my attendings consult for essentially normal ECGs with like an axis deviation; subclinical hypothyroidism; simple iron deficiency anemia. Our ITE exam is mostly Jungian personality types, ethics, Maslow's hierarchy, attachment styles. I've heard the boards are different and similar to Neuro boards, but so far it's just not stimulating to me. Unfortunately that higher calling to be on the front lines of psych since everyone is suffering just doesn't move me at the moment, because most of the people suffering need lifestyle modification (better diet, exercise, sunlight, working on themselves with journaling, reading, making new relationships) -- not pharmacological intervention. I know it sounds petty, but I wanted to be doing the 'doctor thing' -- wearing my white coat and greeting patients, in the hospital looking at imaging and hearing the monitors beeping and showing waveforms...not trying to obtain a history from a homeless meth addict at 2 am, get nearly assaulted by a schizophrenic homicidal pt telling me to get out and go fight the war against whitey, or figure out whether a psychotic patient is actually suicidal or just needs a place to stay for a couple days (its almost always the latter).

I totally agree about the being my own boss, and the way healthcare is going, I see that psych (and derm, etc) is the last bastion of freedom in medicine, but, dang, I have to like it first and foremost, right?



Thanks for this rather practical advice, and I appreciate your assessment of anesthesia. Question, do you know if I decided to pursue Anes, whether I would have to apply for TY and Anes programs, and rank them both separately? Meaning, would I have to give up my psych spot and potentially match into a TY year but not any Anes programs? That would be the worst of all worlds. I really enjoyed EM, but I've decided that I won't take the hit to my circadian rhythms. I'm sure Anes has its hits too, but not the cyclical flipping that is so detrimental to health and happiness that EM has.

Also it sounds like you like it. Do you still like it, are you early, mid, or late career, and would you personally recommend it to med students contemplating it given the career outlook right now?
The comment about your circadian rhythm made me laugh. I can tell you there is nothing normal about my circadian rhythm after usually working overnight 1-2 nights a week, occasional week of night float, getting called in at odd hours. Staying up late and getting up early. Anesthesia is likely not much if any more friendly to your circadian rhythm IME.

Also, you must remember that in 10-15 years no matter what you do, it will be a job and likely not much more. It will be routine and have annoying things and things you enjoy. Having flexibility in that job is likely priceless. Do you think accountants talk about how much they LOVE their spreadsheets and balancing the budget or doing the company's taxes? Heck no. But they likely consider it to be a steady and reliable job that they can be good at and that can support them financially. So the excitement of certain things can wear off and in the end you need a good job that pays the bills and supports you and your family's endeavors. This is just my thoughts.
 
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Could you elaborate on anesthesia being awful right now? Compared to a lot of specialities hours are good, no clinic(I guess some like clinic but its my nightmare), and a comp report I just saw on this site today had the average pay over 400k in every region in the country.

You should do a search on this forum. Your knowledge of the field is very lacking. Could easily tell when you stated " Compared to a lot of specialities hours are good". Got to AAMC.org which you should have access to as a med student, and look at the avg hours anesthesiologists work, and look at other fields and tell me how many specialties actually work more than we do on average. have fun

after that, look at reputable sources of salaries (MGMA is top, can look at medscape too if dont have others), and see how much anesthesia has slipped in the past 5 years compared to other fields. Then use the information from above on hours, and calculate how much you get paid per hour. Then look at how many of the other specialties actually deal with emergencies and frequent in house calls. good luck
 
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I really enjoyed EM, but I've decided that I won't take the hit to my circadian rhythms. I'm sure Anes has its hits too, but not the cyclical flipping that is so detrimental to health and happiness that EM has.

Also it sounds like you like it. Do you still like it, are you early, mid, or late career, and would you personally recommend it to med students contemplating it given the career outlook right now?

if you dont want to take a hit to your circadian rhythm, you need to run far far away from anesthesia. In terms of residency, anesthesia residents work just as many night shifts as ED residents, except your total hours will be more than EDs. When i was resident, there were months when I did 7 Overnight calls (either 7am to 7am 24 hour shifts, or 3pm to 7am shifts), in addition to 6 'late' calls, where you go from 7am to ~10-11pm. The remaining days were regular days (7am to 6pm)

As an attending it varies depending on your job, but that can be said for ED as well. You can easily work in a urgent center if you really want and have better hours. I'm working at a major academic center now and this month alone i worked ten overnight shifts, with the remaining days left being regular day shifts or late shifts (til 11pm or so). So i can safely say my circadian rhythm is shot
 
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I'm working at a major academic center now and this month alone i worked ten overnight shifts, with the remaining days left being regular day shifts or late shifts (til 11pm or so). So i can safely say my circadian rhythm is shot

Was that extra voluntary call for $$? I bet that has happened 0 times in the history of psych.
 
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Could you elaborate on anesthesia being awful right now? Compared to a lot of specialities hours are good, no clinic(I guess some like clinic but its my nightmare), and a comp report I just saw on this site today had the average pay over 400k in every region in the country.
Not applying to Anesthesia but I’m curious how many hours +/- calls/nights they usually work for that 400k.
Primary care docs make 250k+ working banker hours where I’m at. I can’t imagine it’d be that hard to get near that figure with few extra shifts.
 
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Not applying to Anesthesia but I’m curious how many hours +/- calls/nights they usually work for that 400k.
Primary care docs make 250k+ working banker hours where I’m at. I can’t imagine it’d be that hard to get near that figure with few extra shifts.

Hourly pay is similar.
 
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Not applying to Anesthesia but I’m curious how many hours +/- calls/nights they usually work for that 400k.
Primary care docs make 250k+ working banker hours where I’m at. I can’t imagine it’d be that hard to get near that figure with few extra shifts.

Yea I have no idea. I do know I'd rather be a garbage man for 250k if that job existed than be a primary care doc.
 
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if you dont want to take a hit to your circadian rhythm, you need to run far far away from anesthesia. In terms of residency, anesthesia residents work just as many night shifts as ED residents, except your total hours will be more than EDs. When i was resident, there were months when I did 7 Overnight calls (either 7am to 7am 24 hour shifts, or 3pm to 7am shifts), in addition to 6 'late' calls, where you go from 7am to ~10-11pm. The remaining days were regular days (7am to 6pm)

As an attending it varies depending on your job, but that can be said for ED as well. You can easily work in a urgent center if you really want and have better hours. I'm working at a major academic center now and this month alone i worked ten overnight shifts, with the remaining days left being regular day shifts or late shifts (til 11pm or so). So i can safely say my circadian rhythm is shot

Your job is incredibly awful.
 
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So far, I'm just not a fan of psychiatry. My job has been in a dank, dreary inpatient psych ward at a safety net hospital in an urban city center. I don't feel like a doctor: listening to these nonsensical, intoxicated/recovering, and/or truly mentally ill patients and basically looking to see what they were prescribed last time and re-starting it or making minor adjustments with the same few drugs isn't challenging or interesting. Some of the patients' pathology is truly interesting to observe but already the novelty is wearing off. There's no gratification or satisfaction in anything I've done so far.

Don't discount psych until you've done outpatient clinics. It can be immensely satisfying to see people thrive with the help of psychotherapy/psychopharmacology. You often don't see that side of psychiatry on an inpatient ward.

I was in a similar situation in Australia. In our training system, you spend a year or two as a house officer before getting onto a training programme as a registrar. I started off wanting to do psych and spent 6 months on a very busy inpatient psych ward. It was awful -- mainly for the same reason you mention: I didn't feel very accomplished. Progress measured in inches sorta thing.

Then I started clozapine clinic. I saw people who were quite functional and generally very grateful for my help. It was a similar vibe in the bipolar clinic too. The drugs often work, and you are "doing things," but it's your words and personality that do the heavy lifting. Very rewarding. 9-5 schedule too.

I ended up switching to a critical care pathway, and now I'm a fairly advanced ICU/ED dual trainee (with almost a year of anaesthesia under my belt). I work with my hands a lot, but procedures get pretty routine and even boring. I promise you the wow factor really dies down after your 100th central line. What keeps me going is the rush of a good resuscitation, which is often quite cerebral. It's like crack to me, just need another hit.

What doesn't get routine is shift work, being on call, missing holidays, and the stress of making life and death decisions. I love my job, but it really does suck. I'm not sure how I'm going to sustain this in my 50s and 60s. And that hurts to say because I've devoted my 20s and 30s to training for this job.
 
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Yeah, I hear you. I just wanna hustle if need be since application season is right around the corner.

What do you mean Anesthesia is awful right and only worse in the future? From what I understand, the job market has been on fire lately (pre-covid), and will likely get better again once things calm down due to the huge backlog of elective procedures, and further aging of the population needing elective procedures? As far as the CRNA thing and VA, is that what your referring to? I'm torn about this argument since mid-level encroachment is happening everywhere including psych. The one big thing psych's got going for it is ability to open up shop fairly easily. And telepsych.




Can you elaborate? When you mean its way harder, do you mean time-wise and losing more sleep? Harder because you have to deal with surgeons? Harder because as a hospitalist you basically quarterback and punt various issues to specialists whereas in Anes its up to you to resuscitate acutely or get the intubation or whatever?

I guess my question for that hospitalist would be, why he changed to Anes, is he glad he did it, and would he do it again.




Yeah that's why I'm starting this now. One of my buddies is a CA-2 here at my program and I already had a meeting with the PD here whose gonna help me get some shadowing experiences in my off weekends. Gotta figure out if Anes would make me happy. One year from graduation and sunk cost is one thing, 2 or more becomes prohibitive. Money-wise, I guess it would probably even out since Anes has a higher income generally speaking.
FYI, some of the docs who make a ton of money, are shrinks.
You can take call at five different hospitals and probably sleep all night.
 
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i say stick it out. find some inside motivation and introspection why you applied and wanted to be in psych in the first place. then move to a fancy office in NYC and listen to rich people talk about why their husbands or wives keep cheating on them with some 20 year old and refill their zoloft and prozac as needed. you will be raking in so much money through referrals. wear a tweed suit and bow tie. lay people actually consider you more of a physician than they would an anesthesiologist. or do child psych....my buddy is an attending and loving it.
Please don’t go into psych to just listen to some rich people in some overpopulated city like NYC.
This is total BS advice. But not surprising because it’s all about money in this country.
You could do a great service to bipolar, schizophrenic, abused, schizoaffective, psychotic, depressed, suicidal, catatonic patients who truly need help.
Not ones who just need talk therapy alone from a psychologist.
Come on. There’s more to life than taking care of “rich people”.
Poor people need help the most. And I am seeing adverts out there for $250 an hour for locums docs in psych. The pay is on par mostly these days with anesthesia IF you open up your own shop or do locums.
 
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This is not the reality I’m living in. Forgetting names is normal. Either way, this has no bearing on my job satisfaction. Do you know all your nurses names? Invariably when people find out I’m a doctor they mention whatever surgery they’ve had. If I ask who their surgeon was, more than half the time they don’t remember. Plus if anything, its definitely a benefit that i don’t have long term contact with patients and i also think it’s a benefit that people don’t always remember us.

This also neglects that pregnant women, L and D nurses, and block patients often treat us like heroes.

You’ve never had to turn down gifts or tips? One time as a resident a family legitimately tried to hand me straight cash.
In case you don’t know, I absolutely despise OB. And sure those pregnant screamers remember me for just a few minutes and then the post epidural lethargy slips in and they forget everything. And I get out of there ASAP.

I can’t tell you how many people have ever personally thanked me before. Sure. Briefly. But again they forget.

I get a lot more satisfaction in the ICU. The more and more time I spend in OR culture, the more I want out. I find it to be all about go, go, go, go and you aren’t moving fast enough etc. Not all locations for sure, but I would venture again to say, most locations.

And again, these patients are not cattle. But it’s all about the bottom line.
 
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With my limited experience I tend to agree with you. Plus it seems like when **** hits the fan, everyone is very grateful for the anesthesiologist to be there. My cousin recently had a baby and the CRNA misplaced his wife's epidural. He asked for the Anes on call, and said there was a sigh of relief from everyone in the room when the Anes got there and 'saved the day.'
There will be plenty more times where you will not be able “save the day”.
And there will be plenty of times where you aren’t called to help until it’s too late.
You are gonna have some deaths, plenty of folks knocking on deaths door that you may drop off “alive“ in the unit but technically they are already dead, a few bad outcomes that may lead to a comorbidity, etc.
It’s not always glory and saving the day when **** hits the fan.
Just the reality of our jobs.
 
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Please don’t go into psych to just listen to some rich people in some overpopulated city like NYC.
This is total BS advice. But not surprising because it’s all about money in this country.
You could do a great service to bipolar, schizophrenic, abused, schizoaffective, psychotic, depressed, suicidal, catatonic patients who truly need help.
Not ones who just need talk therapy alone from a psychologist.
Come on. There’s more to life than taking care of “rich people”.
Poor people need help the most. And I am seeing adverts out there for $250 an hour for locums docs in psych. The pay is on par mostly these days with anesthesia IF you open up your own shop or do locums.
A psychiatrist I worked with in med school would cover a community outpatient place 4 hours a week and got paid 2K a week to do it. Yes, $500 an hour from that one thing. Inpatient rounding in the morning for about an hour, then most mornings he went to his drug research clinic which paid him very well, then afternoons we went to something different each day. The guy had tons of variety, contracted at numerous community centers, covered a an addiction clinic a couple times a month. Great hours.
 
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FYI, some of the docs who make a ton of money, are shrinks.
You can take call at five different hospitals and probably sleep all night.
This is absolutely correct. If you work like a surgeon in Psych you can make a Surgeons income. And you still have the option of a 30 hour work week if you need less money.
 
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I feel like this bears repeating every year: specialty/subspecialty selection is not a multiple choice exam. There is no right (and wrong) answer. Depending on the day, your mind will naturally overstate the benefits of one field while minimizing the downsides, and vice versa. Then maybe the next week you flip the two. I think the reason people (including a younger me) struggle with this so much is they feel if they just talk to enough people and gather enough information, the correct choice will become clear. I can tell you the opposite was true for me, it only got more difficult the more I examined it.

That being said, I think if you truly can’t decide, bet on whatever is going to give you the best lifestyle. Eventually every procedure that seems cool now will get old, and sooner than you think, I promise. If you set yourself up for more time outside the hospital later in life, you can fill a greater proportion of your week with stuff that actually makes you happy/healthy/fufilled.
 
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I feel like this bears repeating every year: specialty/subspecialty selection is not a multiple choice exam. There is no right (and wrong) answer. Depending on the day, your mind will naturally overstate the benefits of one field while minimizing the downsides, and vice versa. Then maybe the next week you flip the two. I think the reason people (including a younger me) struggle with this so much is they feel if they just talk to enough people and gather enough information, the correct choice will become clear. I can tell you the opposite was true for me, it only got more difficult the more I examined it.

That being said, I think if you truly can’t decide, bet on whatever is going to give you the best lifestyle. Eventually every procedure that seems cool now will get old, and sooner than you think, I promise. If you set yourself up for more time outside the hospital later in life, you can fill a greater proportion of your week with stuff that actually makes you happy/healthy/fufilled.

I say that last bit as a guy who picked cardiothoracic anesthesia and ICU over pain fellowship. Some days man...
 
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