psych vs family med

[tourocom2008]

Hello all,
fourth year medical student here trying to decide between the two specialties (I might apply both- warning very indecisive with these types of decisions lol).

Psych: I really liked hearing peoples stories and I am the type of person that tends to sympathize/listen to everyone despite their background and issues. This always came naturally to me. I also seem to have a knack at reading people. I also find that I am more interested in just talking to people than getting medical histories/doing medicine on medical rotations even such as ICU. I also don't really like having the pressure of making a quick diagnosis spot on. I also don't like having to know all different types of dermotologies, illnesses, and every this there and that about medicine (seems overwhelming, but maybe I could do it in residency?). I also liked working in the psych hospital (kind of like living on the edge to be honest). The cons are a concern about the future of psych (almost the whole field seems based around the prescription of say 3 groups of medications and seems that it can be subject to massive changes). questionable efficacy/safety about drugs. I understand that these drugs have benefited many people, but I am also worried about the harm they can do. There are many websites/posts on the internet about people never feeling the same afterwards/people feeling emotionally numb or loosing their spirituality/possible violent side effects of the drugs/the drugs not really working that well anyways/taking pills instead of just working through things/ and the environment effects of the drugs in the water supply. Also our society seems all about mental health now, but what if things swing back the other way? Do I still have a job?

Family med I like being able to be the first contact of patients, I like the extreme flexibility, I like the long term relationships, I like being the person who people in the community trust and the person that can help guide them through the complex medical system, and i am thinking working rural/remote or even military would be cool though overwhelming lol. I am worried about the hours (especially doing full spectrum), the vast array of knowledge (not sure if I can fit it all in my brain, and I don't want to be that doctor who has no idea what your rash is--I feel like that all the time on rotations), the algorhimicness of the practice- I feel like instead of using intuition you just commit memorize tidbits and use that memory (I prefer using intuition).
Anyone have any suggestions or similar debacles.

Thank you!

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[calvinhobbes]

If you do CL psych, you can still do “medicine” (be an FM or IM or Peds consultant as a Psychiatrist) while practicing psych, which is pretty awesome. As a psychiatrist, you’re considered a specialist, too, and yes you’ll always have a job especially as more research pours into epigenetics, and understanding how a patient responds differently to various medicines/therapies. FM is great but most don’t manage psych, and refer out. Both lifestyles are great, but you have more flexibility in psych. Good luck!

 

[Shufflin]

1. All kinds of meds are in the water supply. Docs overprescibed opiates for decades which are now found in the waters off the coasts of Oregon and Washington. Traces in shellfish, etc.

2. Psych is about the least algorithmic specialty out there which has its pros and cons

3. Psych is only strengthening in both it's demand and support. Govt and public figures see its need, reimbursements are increasing

4. Psych meds are not the only kind to potentially have negative effects on the mind. Many non-psych meds can cause depression, trigger mania, lead to psychosis even, meds that Fam Med docs might prescribe

 

[Jenghiz_Khaan]

IMO family medicine might seem to require a vast array of knowledge, but it never goes deep enough. Anytime anything gets serious enough to require a specialist, it gets referred automatically. Don’t know about you but it would make me feel “incomplete” as a physician to be a jack of all trades, master of none type. Specialization allows you to tackle real problems head-on, as well as make breakthroughs in that specific field. Just seems more fulfilling.

Psychiatry is a whole ‘nother domain. I definitely feel you need a certain kind of personality to provide effective mental health treatment. If you are skilled you can make a very good living. Most practitioners have turned to pushing prescriptions to increase income, which is of course a moral dilemma in itself. Another disappointment is that it truly diverges from traditional medicine in the way it’s designed. The fact that certain disorders can be treated by drugs seems to be the only thing that allows them to be classified as “medical”. Very fuzzy line between neurology and psychology as a result.

Comparing the two, this is more of a debate between specialist versus generalist. Both provide extensive patient relationships but in very different ways. It’s true that FM has begun to treat so many psychiatric illnesses by virtue of being the gatekeeper physicians, and that both specialties have exceptionally lax lifestyles. Either or has a unique approach to patient satisfaction.

 

[AD04]

If you are skilled you can make a very good loving.

Try not to get in trouble when you make good loving. Namely, not with current or former patients.

 

[Psychresy]

Women, money, power vs. shame, regret, no chill.

You decide.

 

[tourocom2008]

Women, money, power vs. shame, regret, no chill.

You decide.

Which one is which

 

[Psychresy]

It's psych brah. Kings of the hospital.

 

[MisterKitty]

It's psych brah. Kings of the hospital.

I get so much tail now that I’m a psych resident

 

[nexus73]

The psych groupies are not what i was promised.

 

[Psychresy]

The psych groupies are not what i was promised.

They can be a little clingy.

 

[Attending1985]

your concerns about psychiatry are certainly valid and not likely to go away. Your concern about master in family medicine is not valid. You will do fine and master the knowledge you need to go a good gp. Primary care is also a relationship based specialty and you will certainly flex those skills as a good gp and this will remove the algorithmic feel.

 

[Sushirolls]

If you can like FM or IM, then go do that. The ability to also open up your own practice and make it what you want is better in my opinion than Psychiatry. You can truly just have a 2 room office, waiting room and that for the doctor - no MA, no front desk, just you, doing cash/DPC style FM/IM. You'll be able to build the quality patient relationships over time that are mirrored in Psychiatry, plus you'll have greater diversity of conditions to treat - including psychiatric.

One doesn't have to practice IM/FM in the Big Box style that every one gets exposed to, you can make it what you want.

 

[Jenghiz_Khaan]

Try not to get in trouble when you make good loving. Namely, not with current or former patients.

Don't patronize me.