Psych vs. derm

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Psychoderm

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I decided to pursue medicine because of my interest in psychiatry. I've been always fascinated about the human mind, and thought that I would tremendously enjoy practicing psychiatry. I have always wanted to understand the nuerophysiology behind human mind and how neural network within the human brain ultimately manifests itself into various behaviors. With my tremendous interest in such ideas, I started medical school. I did very well in med school and received a very high board score. I dedicated few years into neuroscience research through a prestigious research fellowship, which ultimately culminated many publications; non related to psychiatry, but all in neuroscience. I did my 3rd year psych rotation in child psychiatry, and I did not enjoy it at all. I barely interacted with any of the kids, and all we did was meetings with parents, social workers, teachers, and changed their medicine and dosage. All those fantasies that I had about the human mind were non-existent through my experience during my rotation. I felt all we do in psychiatry is match up patient's behavior/characteristics to some already written protocol (DSM) in order to acquire a new name for the patient's behavior and then treat accordingly (again, based on very spelled out protocol). There was no creativity there for me, no intellectual stimulation, and left me with disappointment. I realize that I never got a good grasp of psychiatry and my rotation was probably not a good representation of the field. I maintained an open mind throughout my rotations, and have not truly found my calling. I did a month derm rotation, and I truly enjoyed it. I like the medicine behind derm, the patient interaction, especially that patients are healthy and I get to joke around and laugh with them. I liked the procedures, and the fact we treated many skin cancers everyday. But, there was still something missing, the intellectual stimulation that I get even thinking about the human brain and behavior. Now, I need to submit my residency application, and I am having a very difficult time making my final decision. I am very competitive for derm, and a lot of good programms for psych, but I don't know which rout I should take. I truly appreciate any comments you may have for me.
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It would not be the worst idea in the world to apply to derm with psych as your backup.
Derm isn't a guaranteed slam dunk for anyone, so everyone should have a backup plan.

If you have the time, I would definitely recommend doing another psych rotation at a place that has a reputation for being a good experience. I do think that many med students get bad exposure to the field and don't get to see it at its best. For example, you seem like the kind of person who might enjoy consult-liaison psych/psychosomatic medicine more than the typical inpatient psych ward.
 
Internal medicine/FP followed by addiction. Then a concierge service.

You can do botox/dermabrasion etc and see addicts with formication.
 
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Psychoderm said:
I am very competitive for derm, and a lot of good programms for psych, but I don't know which rout I should take. I truly appreciate any comments you may have for me.
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In your case, I would recommend psychiatry.

I too was a competitive applicant for any of the ROAD specialties but I chose psychiatry and is now enjoying going to work every day.
 
Psychoderm said:
I decided to pursue medicine because of my interest in psychiatry. I've been always fascinated about the human mind, and thought that I would tremendously enjoy practicing psychiatry. I have always wanted to understand the nuerophysiology behind human mind and how neural network within the human brain ultimately manifests itself into various behaviors. With my tremendous interest in such ideas, I started medical school. I did very well in med school and received a very high board score. I dedicated few years into neuroscience research through a prestigious research fellowship, which ultimately culminated many publications; non related to psychiatry, but all in neuroscience. I did my 3rd year psych rotation in child psychiatry, and I did not enjoy it at all. I barely interacted with any of the kids, and all we did was meetings with parents, social workers, teachers, and changed their medicine and dosage. All those fantasies that I had about the human mind were non-existent through my experience during my rotation. I felt all we do in psychiatry is match up patient's behavior/characteristics to some already written protocol (DSM) in order to acquire a new name for the patient's behavior and then treat accordingly (again, based on very spelled out protocol). There was no creativity there for me, no intellectual stimulation, and left me with disappointment. I realize that I never got a good grasp of psychiatry and my rotation was probably not a good representation of the field. I maintained an open mind throughout my rotations, and have not truly found my calling. I did a month derm rotation, and I truly enjoyed it. I like the medicine behind derm, the patient interaction, especially that patients are healthy and I get to joke around and laugh with them. I liked the procedures, and the fact we treated many skin cancers everyday. But, there was still something missing, the intellectual stimulation that I get even thinking about the human brain and behavior. Now, I need to submit my residency application, and I am having a very difficult time making my final decision. I am very competitive for derm, and a lot of good programms for psych, but I don't know which rout I should take. I truly appreciate any comments you may have for me.
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Why...not...neuro? It has a rep for being intellectual (give or take an MRI or two) and it seems to fit your CV. Also, I would argue that your past experience in psych, especially at big research powerhouse type programs, might not be representative (I would think Columbia, McLean etc?).

@ Peppy: I think you're on to something with the whole exposure to psych as a student not being the greatest...I had a similar experience as OP after an inpatient psych rotation...Lots of time spent on family meetings, social work, and struggling with/digging up collateral information/past psych records. Maybe it was the specific culture of the place where I was at, but stylistically it almost felt like a police academy (lots of confrontational interviewing, cynicism, doubting patients because they're psych patients...Even though some were parading the "skepticism w/o cynicism" route). Really turned me off, but every now and then an old time doc would conduct an amazing interview and it'd blow you away. At the end of the day, I think a C/L rotation would have given me better insight, so I still have hope.

I think the bottom line is you either accept the "intangibles" in psych or you can't.
 
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If you're not already doing this, I would recommend doing 4th year electives ASAP in both derm and psych to get a better gauge on what you want to do. In the meantime, prepare applications for both specialities. It is still very early in the process and you have time to decide. There is a difference between being intellectually interested in psychiatry and actually practicing it. If they combine, then great! However, if you don't think you're going to enjoy the actual practice, you're going to be miserable. Keep in mind, however, that you could always change specialities if it turns out that what you pick was not the right choice.

Good luck!
 
^Great advice.

I had a lot of difficulty making up my mind, but I did two electives in June and July, and the decision couldn't have been easier. My third year psych rotation wasn't a negative experience, but it didn't sell me on the field either. My June rotation (ROAD specialty) consisted of me looking at my watch and wondering when the day would be over. I never once felt compelled to read when I got home. On my psych elective, OTOH, the day would fly by and I found myself reading constantly in my free time.
 
I don't really like the ROAD acronym. Particularly because anesthesia is not necessarily an appealing lifestyle choice, especially once they start doing critical care etc.

On the other hand, psychiatry and pathology, as well as emergency medicine can be excellent for lifestyle. As can sleep

So I vote for PEDRO or PEDROS.
 
Hey, I'm an ophtho resident so my apologies for posting on the psych forum.

I tormented myself during 4th year trying to decide between ophtho and pscyh. At the end, I chose ophtho. In retrospect, both pscyh and ophtho are wonderful fields and I know I would have been happy in either specialty.

What I liked about psych is the potential for research. I really believe that Psychiatry is the last frontier of medicine and there will be many new and exciting discoveries over the next 10-20 years that will revolutionize the field. Also, I feel that psychiatrists (and to a slightly lesser extent ophthalmologists) help patients in a way that is not possible in any other field. If I ever become a millionaire, I plan on donating to pscyh research and psych services as much as I can. :D

At the end I chose ophthalmology because I find vision fascinating and to me there are few things in medicine worse than going blind. I also love surgery and it was very difficult for me to give that up.

I haven't done a dermatology rotation, but being in ophtho we do have a lot of interactions with derm and I can tell you that at least in an academic setting, they see a lot of interesting cases. Many systemic diseases have ocular and dermatologic manifestations. From a shy teenage whose self-esteem is affected due to their face being covered by acnea, to someone with melanoma, to severe skin manifesations of infections or some of the autoimmune diseases, dermatologists treat it all.

As far as the comments regarding derm being a ROAD specialty, I think psych could fall into that categorie too if you wanted to make it all about lifestyle. In fact, you can do that with any specialty.

I think both dermatology and psychiatry are wonderful fields and you will be happy in either field. If you see yourself as a big researcher in the future, you should definitely think very hard about psychiatry. On the other hand, if you were to change your mind later, it is always easier to switch from a derm residency into a psych residency than the other way around.
:luck:
 
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azzarah said:
Hey, I'm an ophtho resident so my apologies for posting on the psych forum.

I tormented myself during 4th year trying to decide between ophtho and pscyh. At the end, I chose ophtho. In retrospect, both pscyh and ophtho are wonderful fields and I know I would have been happy in either specialty.

What I liked about psych is the potential for research. I really believe that Psychiatry is the last frontier of medicine and there will be many new and exciting discoveries over the next 10-20 years that will revolutionize the field. Also, I feel that psychiatrists (and to a slightly lesser extent ophthalmologists) help patients in a way that is not possible in any other field. If I ever become a millionaire, I plan on donating to pscyh research and psych services as much as I can. :D

At the end I chose ophthalmology because I find vision fascinating and to me there are few things in medicine worse than going blind. I also love surgery and it was very difficult for me to give that up.

I haven't done a dermatology rotation, but being in ophtho we do have a lot of interactions with derm and I can tell you that at least in an academic setting, they see a lot of interesting cases. Many systemic diseases have ocular and dermatologic manifestations. From a shy teenage whose self-esteem is affected due to their face being covered by acnea, to someone with melanoma, to severe skin manifesations of infections or some of the autoimmune diseases, dermatologists treat it all.

As far as the comments regarding derm being a ROAD specialty, I think psych could fall into that categorie too if you wanted to make it all about lifestyle. In fact, you can do that with any specialty.

I think both dermatology and psychiatry are wonderful fields and you will be happy in either field. If you see yourself as a big researcher in the future, you should definitely think very hard about psychiatry. On the other hand, if you were to change your mind later, it is always easier to switch from a derm residency into a psych residency than the other way around.
:luck:
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Nice post. Glad to hear I'm not the only one that narrowed it to those two. I think my last post was a bit of a hyperbole. I was strongly considering ophtho...even did an additional year of research in the field. I really enjoyed the idea of working to restore/maintain visual function...it's certainly a highly valued organ, patients are generally very thankful for the services. The concreteness also made it more comfortable for me. But psych is something special, and at this point I have no doubt it's the right choice for me. That said, I'm sure I'll always wonder what would have been...

Of course, for you, if you ever decide to switch, the door will always be open.
 
OP, one of the things about psychiatry is that the practice (as well as intellectual curiosity of its practitioners) can vary tremendously depending where you are. As someone else mentioned, the climate in one of the research powerhouse schools will be quite different than your med school experience - you'll find that the psychiatry departments there are very interested in exactly the things you're interested in, and that the practice isn't just about stuffing people into DSM categories and doling out medications arbitrarily.

I strongly echo everyone else who's recommending you do a sub-I at one of these places.
 
VMSmith said:
I strongly echo everyone else who's recommending you do a sub-I at one of these places.
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And more rotations in Derm. I'm not sure what the OP's app looks like, but high board scores aren't adequate preparation for getting into a derm residency. The folks I've talked to going that route all have AOA, top notch scores, honors all around, and still have to scramble to get a couple derm rotations in and tried to do some longitudinal research.

I'd take a psych course to see if it actually appealed, but if you're still gunning for derm, there's going to be a lot of work involved. A 250 on Step I isn't going to impress the derm folks.
 
Manicsleep said:
So I vote for PEDRO or PEDROS.
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Yes, that is brillant! We should start a campaign!

Napolean%20vote%20of%20pedro.jpg
 
Not to hijack the thread but I'm curious if a 250 on step 1 will impress the top psych programs (like ucla & ucsf)? Obviously the whole application is taken into account, but does anyone know what's considered 'competitive' for these programs?
 
peppy said:
It would not be the worst idea in the world to apply to derm with psych as your backup.
Derm isn't a guaranteed slam dunk for anyone, so everyone should have a backup plan.
Click to expand...

I agree that applying to both for someone in this situation could be a good idea. However, how could someone use one application, even with two different personal statements, to apply to two so different fields. It seems to me that by looking at experiences and publications on the application, any derm program may be dissuaded because they would think the applicant may be more interested in psych, and any psych program would be dissuaded, even more so, because they would assume they were just the applicant's back up ... right?

Is there a way to get around this? I assume they don't let you use to completely different applications.
 
HappyGenome said:
I agree that applying to both for someone in this situation could be a good idea. However, how could someone use one application, even with two different personal statements, to apply to two so different fields. It seems to me that by looking at experiences and publications on the application, any derm program may be dissuaded because they would think the applicant may be more interested in psych, and any psych program would be dissuaded, even more so, because they would assume they were just the applicant's back up ... right?

Is there a way to get around this? I assume they don't let you use to completely different applications.
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You have the ability to individualize your application to every program. This comes out that a few people will make a specific personal statement for each top program to which they're applying, naming the program in the personal statement.
 
nitemagi said:
You have the ability to individualize your application to every program. This comes out that a few people will make a specific personal statement for each top program to which they're applying, naming the program in the personal statement.
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I was under the impression that only the personal statement can be made unique to each school - so you mean that even the sections in the application about publications and leadership/clinical volunteer activities can be made specific per school?

I assume this is what people would do if they are applying to two completely different fields, so each field would not know.
 
HappyGenome said:
I was under the impression that only the personal statement can be made unique to each school - so you mean that even the sections in the application about publications and leadership/clinical volunteer activities can be made specific per school?
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I think nitemagi was referring to the personal statement. You can not personalize your application to each program/specialty, but you can choose which personal statement you send.

You can also obviously send different letters to different programs. But when it comes to your application itself (the experiences, accomplishments, awards, etc.), you have one application.
 
Skinceutical said:
Thank god for psychiatrists.

Neurodermatoses and Morgellons are the bane of our existence in derm. Other than starting them on Orap and referring to you guys, there's really nothing we can do.
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Yeah. Pills and therapy looks like the cure. Right up our alley. And getting way off topic, I think Orap is the historical 'board answer' med for Morgellon's, or delusional parasitosis as I prefer, but I don't believe there is any RCT showing it to be more effective than another anti-psychotic.
 
heyjack70 said:
Yeah. Pills and therapy looks like the cure. Right up our alley. And getting way off topic, I think Orap is the historical 'board answer' med for Morgellon's, or delusional parasitosis as I prefer, but I don't believe there is any RCT showing it to be more effective than another anti-psychotic.
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Yeah, I don't know of any RCTs either, though I have seen a couple case series. Anecdotally, I've also seen some dermatologists who use Zyprexa too.

So in your opinion there's no real benefit to using any one particular anti-psychotic? Interesting.
 
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