Psychiatrist vs. Psych NP?

[digitlnoize]

Sounds more like a philosophy class than psychology to me. Psychology is a science.

Not the way this guy taught it. Terrible class.

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[whopper]

I recall several times in college where a professor or TA said something that was completely wrong or didn't know an answer to a question. If you pointed it out not because you were trying to be a smart-ass but because you wanted to learn, they became red-faced and couldn't own up to it. Same happened in medical school and residency.

My PD in fellowship, and my former PD in residency were two of the best doctors I ever had as teachers. The first is ranked one of the top 100 doctors in the country, and the latter was ranked one of the top doctors in the state of NJ. Both of them fully acknowledged when they didn't know something, and would own up to it and ask me to look into it (and they did too) if we encountered something we did not know, but seemed relevant.

 

[Ibid]

You never worked an 80 hour week, never did CPR on somebody at 3AM who died right in front of you, and you never had to work a 30 hour shift q4. There is.. No comparison.

we're never going to think you worked as hard as we did, because you didn't. . Nobody should have to work as hard as we do.

Rough translation.... "You don't know man... you weren't there..." Billy loves the smell of thorazine in the morning.....so never get out of the boat. Absolutely goddamn right! Unless you were goin' all the way... get out of the boat and you split from the whole ****in' program.

Just remember his mind is clear but his soul is insane.
[YOUTUBE]http://www.youtube.com/watch?v=sBksHaTQCbU[/YOUTUBE]

 

[billypilgrim37]

Rough translation.... "You don't know man... you weren't there..." Billy loves the smell of thorazine in the morning.....

Abilify in the morning, Thorazine at night...

The Horror, The Horror...

 

[JaggerPlate]

It's funny. I actually found my undergrad Psychology classes MUCH harder than Organic Chemistry or Physics because the grading was so subjective.

Really?? I took some upper division psych classes with psych majors during undergrad and it was a universe apart from O-Chem with regard to difficulty. In fact, majoring in psych had a less than stellar rep at my college. It was the 'drank too hard for three years and now the easiest thing to morph my myriad of classes into is a psych major,' major.

 

[digitlnoize]

Really?? I took some upper division psych classes with psych majors during undergrad and it was a universe apart from O-Chem with regard to difficulty. In fact, majoring in psych had a less than stellar rep at my college. It was the 'drank too hard for three years and now the easiest thing to morph my myriad of classes into is a psych major,' major.

I mean, I only took 2 relatively lower level classes (and I know psych is usually more scientific), but these weren't. We had things like "interpret this dream" or "what was this person's motivation" essays.

The worst one was my ethics class (which WAS philosophy), where we got questions like, "argue for or against the legalization of marijuana." The teacher was a raging liberal and if you didn't take his side you failed. I threw all of my scruples down the drain, said what he wanted to hear, and got an A. Some of my friends couldn't do it and had to drop it after failing 2 tests badly, despite well argued perspectives...they just didn't argue the side he wanted.

I feel the same way about English majors. "Interpret the meaning of 'Chrysanthemums'" and crap. It's all very subjective based on the grader.

I was a music major in my old life. You write a piece that your teacher likes, you get an A. You write a piece that they don't like (but is still "good") you get a C. Sooooo subjective, and a huge reason that I decided NOT to major in music when I went back to school to go to med school, despite advice that med schools were looking for "well rounded" applicants. I knew it'd be easier to get a higher GPA from objective science classes. F=ma, always, ya know?

 

[Chimed]

I mean, I only took 2 relatively lower level classes (and I know psych is usually more scientific), but these weren't. We had things like "interpret this dream" or "what was this person's motivation" essays.

I think it must really depend on where one did their undergrad. The psych department at my undergrad was very biologically based. Although O-chem and the bio courses were tougher, the psych courses and major were also no walk in the park and the major was certainly not a fall back. In my intro psych course, we were tested on neurotransmission and various aspects of brain function.

 

[whopper]

O-Chem where I took it was horrendously difficult, same with Chemistry. I recall the chemistry lab exam, that was only a 2 credit class, but actually 6 hours in the lab per week, had an exam final average grade on the order of about 35%.

In fact, when I was taking the class, I came to the realization that if I studied till I dropped, my grade was no better than it was if I didn't study for it. An average of 35% highly suggests the exam grade had no correlation with what the person was actually learning. So during finals week, I decided to pretty much just not study for it at all.

While one might think that might make the class easy...no way. It definitely strikes you back in the butt when you take the MCAT.

In fact so many of my classes I felt in college were in this category because the professors were research types that didn't seem to care about teaching.

 

[Chimed]

O-Chem where I took it was horrendously difficult, same with Chemistry. I recall the chemistry lab exam, that was only a 2 credit class, but actually 6 hours in the lab per week, had an exam final average grade on the order of about 35%.

Thanks, whopper, for reminding me of the horror of my own O-chem lab. Now the nightmares are going to return....

 

[digitlnoize]

O-Chem where I took it was horrendously difficult, same with Chemistry. I recall the chemistry lab exam, that was only a 2 credit class, but actually 6 hours in the lab per week, had an exam final average grade on the order of about 35%.

In fact, when I was taking the class, I came to the realization that if I studied till I dropped, my grade was no better than it was if I didn't study for it. An average of 35% highly suggests the exam grade had no correlation with what the person was actually learning. So during finals week, I decided to pretty much just not study for it at all.

While one might think that might make the class easy...no way. It definitely strikes you back in the butt when you take the MCAT.

In fact so many of my classes I felt in college were in this category because the professors were research types that didn't seem to care about teaching.

I had a physics class that was exactly the same way. Although the professor had the most inventive curve system: Say you got a 49 on the exam. She'd take the square root of that and multiply it by 10, so you'd get a 70. Then she'd do the same with your average. So if you got a "49" on each test, you'd wind up with a...79-ish, probably rounded to 80. Guess what my worst MCAT score was?

My O-chem class was ridiculously hard. I think what made it a good class was my EXCELLENT teacher. She was spectacular, and had a really innovative "guided PBL" teaching method, that worked wonders for O-chem. Small groups working through mechanisms, punctuated by short lectures between problems sets. UVa (not where I went) is embarking on a similar curriculum for their medical school now.

I think entirely too many of my teachers were pure researchers that had no business in a classroom. I took a "neuroanatomy" class that wound up being only lectures on this guy's research on the mating noises of toadfish and his friend's research on horny chickens (did you know that if you breed chickens, and select for the "horniness" you will, after a few generations, get chickens who are so horny that their hearts explode? I didn't, but thanks to this class, now I do.) He's only on faculty because he was one of the few bio faculty who had been published (in Nature, or some big journal), even after he spanked a student (yes, there was evidence, it went to court, and the school settled for 100-200k). No business teaching.

 

[loveoforganic]

Chem/psych major at a big state u. Psych major was much easier until senior year, then it was comparable/maybe a little harder or at least more time intensive. Between my two senior psych seminars, I probably read 1500+ pages of academic lit and 1300ish pages of textbook. The psych stuff was more self-motivated than the chem though.

 

[billypilgrim37]

My hardest class in all of undergrad was James Joyce's Ulysses second semester of my freshmen year. Made PChem seem like a monday sudoku puzzle.

 

[notdeadyet]

My hardest class in all of undergrad was James Joyce's Ulysses second semester of my freshmen year. Made PChem seem like a monday sudoku puzzle.

Boy, ditto this, though at least I was wise enough to wait until sophomore year.

Most of the challenge of the med school science pre-requisites seems to be at schools in which the use it as hazing to cut down on the number of pre-meds who end up applying to medical school.

At the end of the day, biology, chemistry and organic chemistry is just not that hard to conceptualize and understand at the 100-level (you could make a pretty good case that physics is, especially if taught with the assumption that you speak calculus). I think liberal art courses can potentially much more challenging conceptually, at least at the beginner levels.

 

[whopper]

Many classes really depend on the quality of the teacher. At Rutgers College, most of the science classes were poorly taught by research people who didn't care about teaching. Some of them even broadcasted it out loud to the students.

If a guy who really cared about O Chem taught it, I think it could be a good class. Such was not the case at Rutgers, and I felt pretty insulted that the "honors program" was basically the type of thing where if you just showed up to class you got an A (at least when I was there). Here I was, dying in a class like O-Chem, and a friend of mine is in the honors program doing nothing and getting an A.

The bad thing about RU was that I had to change my mindset from one who actually wanted to learn for real to someone who had to figure out how to at least pull a B in the class, and that did not involve learning it. It meant doing things like asking students what the of grades they got, finding where to get old exams and rote memorizing the answers even though they didn't make sense, and learning to keep my mouth shut even when I thought the professor was way off.

And the not surprisingly, all the classes I took at SU, where they actually taught for real, my MCAT performance was way better than RU.

I had a physics class that was exactly the same way. Although the professor had the most inventive curve system: Say you got a 49 on the exam. She'd take the square root of that and multiply it by 10, so you'd get a 70. Then she'd do the same with your average. So if you got a "49" on each test, you'd wind up with a...79-ish, probably rounded to 80. Guess what my worst MCAT score was?

All these classes where professors make these interesting curves, yet the question is hardly asked, is the grade actually valid to what the person truly knew? I never heard that being asked.

 

[digitlnoize]

All these classes where professors make these interesting curves, yet the question is hardly asked, is the grade actually valid to what the person truly knew? I never heard that being asked.

No one cares. Do our board exams judge any better. Ok, so they prove I can distinguish between Prader-Willi and Angelman's, or that I can (or can't) take a multiple choice test, but do they actually tell who is a good doctor and who is not? The only data I've ever seen is that they can kinda predict who is going to pass the next test. The MCAT is a so-so predictor of who will pass Step 1, which is a good predictor of who will pass Step 2, and so on. No one ever actually stops to ask if these things we're passing actually mean anything.

Ok, sorry...I'm on week umpteen of studying for Step 2 and a little peeved and all the stupid zebras. I think my Step 1 had a zillion questions on zebras and not a single one on freaking DIABETES! Grrrr.

 

[billypilgrim37]

Ok, sorry...I'm on week umpteen of studying for Step 2 and a little peeved and all the stupid zebras. I think my Step 1 had a zillion questions on zebras and not a single one on freaking DIABETES! Grrrr.

I had 8 different questions on Step 1 about gonococcal arthritis.

 

[whopper]

In the spirit of the above post, on my psychiatry written board exam, I had several, forgot the exact amount, but around maybe 6 or 7 questions all on the OTL thingee with benzos and the liver. They all pretty much were asking the same thing. Guy with a liver problem, the guy needs a benzo, what do you give him. Answer? The benzo that starts with an O, a T, or an L.

I'm of the opinion that to do well in medschool (not as a doctor or in residency), you need to be a good scorer on multiple choice tests. One of the most brilliant medstudents I ever met (now an attending) correctly diagnosed a patient with POEMS syndrome even though some of the best doctors in the country couldn't get it. He was only able to score Bs at best in all his medschool classes. The guy studied to learn it, not to ace the exam, and as we all know, there's a difference. The guy looking to ace the exam gets a whole bunch of old exams and does thousands of questions. The guy looking to learn it will read about it, and start going into journal articles, but hardly spends any time rote-memorizing questions.

To be a good doctor, IMHO its hard work, you have to give a damn, you have to constantly be reading up on journals, you have to listen to patients, you have to like what you're doing, you got to always think "what could've I have done that would've made my performance better?," and when you just don't know WTF is going on you have to admit to yourself your limitations that you're going to have to consult with your colleagues or spend a few hours doing lit-searches to see if there's anything you're missing. This is something multiple choice tests don't measure.

 

[priorities2]

Could anyone comment a bit more on the actual differences in career options and job duties between Psych NPs and Psychiatrists? This thread gave some good info but it got off-course before really getting into those differences. As in, how do these two professionals typically spend their day differently, and is there a substantially different career trajectory with different paths available? Thank you.

 

[PikminOC]

In my state, the APNP needs a physician "collaborator" and someone to agree to this. So, the APNP does not practice completely on her own bc the collaborator is responsible for the NP's mistakes.

The APNP I worked with knew more psychotherapy than me (an MD) bc she had extensive psychology training far beyond the NP level.

 

[PikminOC]

You don't know what you don't know.

As I am learning from my oral board prep!

Also, not everyone wants to do psychotherapy, just like not everyone wants to prescribe medications.

 

[zenman]

Could anyone comment a bit more on the actual differences in career options and job duties between Psych NPs and Psychiatrists? This thread gave some good info but it got off-course before really getting into those differences. As in, how do these two professionals typically spend their day differently, and is there a substantially different career trajectory with different paths available? Thank you.

It varies with the position. I've worked in corrections and in a community mental health center. Now, I'm in a hospital setting and do inpatient, outpatient, CL consults, and bariatric surgery consults. I could do all four in one day. My med director likes inpatients so she is on the unit most of the day, plus attending those damn management meetings. I cover the inpatient unit when I'm on weekend call, otherwise I may admit one of my own outpatients if needed or admit a patient I've done a CL consult on when they are medically cleared. Obviously I'll never be the med director nor do I want that spot. I could also go into private practice if I wanted. This answer any of your questions?

 

[priorities2]

That's very helpful.

So are Psych NPs more likely to lead support groups in hospital outpatient settings than Psychiatrists?

 

[zenman]

That's very helpful.

So are Psych NPs more likely to lead support groups in hospital outpatient settings than Psychiatrists?

Our hospital doesn't provide any outpatient groups, only med management outpatient services. We're getting some counselors credentialed to do outpatient therapy but I don't know if there will be groups. We have a new behavioral health management firm taking over so we'll see.

 

[Therapist4Chnge]

That's very helpful.

So are Psych NPs more likely to lead support groups in hospital outpatient settings than Psychiatrists?

Probably neither. The vast majority of places that hire NPs (or psychiatrists) on an out-pt basis are doing so because they need a prescriber....not someone to run groups, provide therapy, etc.

 

[nitemagi]

Probably neither. The vast majority of places that hire NPs (or psychiatrists) on an out-pt basis are doing so because they need a prescriber....not someone to run groups, provide therapy, etc.

Agree partially, though this is a self-perpetuating and self-fulfilling belief. I've gone to job interview after job interview (before settling down with my current 3 jobs), all of which are for prescribing. When I mention I like doing therapy they all offered to come up with ways to integrate that into the position-- just that they never expected a psychiatrist to WANT to do that.

 

[AnnoyedByFreud]

Agree partially, though this is a self-perpetuating and self-fulfilling belief. I've gone to job interview after job interview (before settling down with my current 3 jobs), all of which are for prescribing. When I mention I like doing therapy they all offered to come up with ways to integrate that into the position-- just that they never expected a psychiatrist to WANT to do that.

This is very interesting. I'm in a psych NP program and really want to include therapy in my practice at some point.

 

[nitemagi]

This is very interesting. I'm in a psych NP program and really want to include therapy in my practice at some point.

Start by asking for it on every rotation and every worksite. My first psych rotation back in med school was on an adolescent unit and there was a psych NP doing therapy there on a daily basis. It's out there. Seek it out.

 

[Wilf]

Medical doctors certainly do have more training, but the quality of the person treating the patient is highly variable, and I've seen NPs I'd rather have vs. medical doctors.

A medical doctor is certainly capable of more, all things being equal, though I've also seen several (actually a frightening large percentage, around 1/2) of medical doctors flubbing on cases to the degree where if someone with the training of a NP wanted to do a better job on the specific case they could, simply because they cared.

Bottom line, I'd rather judge the medical professional on the quality of their work rather than the title. I would expect more from an M.D. based on the extra training, but so many M.D.s IMHO fail to live up to the expectation.

Hey Whopper, I've always been curious as a lurker of the psychiatry boards, why is it that you seem to have such antipathy towards MDs? My experience has been that the vast majority of MDs are quite competent in their jobs and couldn't do much better of a job realistically. I've seen you mention on here before that doctors tend to be arrogant. That might be true but the same generalization could be made for CEOs, lawyers, and professional athletes. The top tend to be a little arrogant by human nature. I don't mean this to be a confrontational post at all. I'm just interested in the source of some of your feelings towards your colleagues.

 

[splik]

My experience has been that the vast majority of MDs are quite competent in their jobs and couldn't do much better of a job realistically.

sadly it just shows how little experience you have!

 

[AnnoyedByFreud]

Hey Whopper, I've always been curious as a lurker of the psychiatry boards, why is it that you seem to have such antipathy towards MDs? My experience has been that the vast majority of MDs are quite competent in their jobs and couldn't do much better of a job realistically. I've seen you mention on here before that doctors tend to be arrogant. That might be true but the same generalization could be made for CEOs, lawyers, and professional athletes. The top tend to be a little arrogant by human nature. I don't mean this to be a confrontational post at all. I'm just interested in the source of some of your feelings towards your colleagues.

I don't think Whopper dislikes docs, but just acknowledges the reality that the individual provider can be more important than the initials behind their name. As a rule, physicians clearly receive the most training. However, does that mean that every single MD/DO is going to automatically be better than a NP or PA due to the superior training? Not by a long shot. It comes down to individuals. At least, that's how I read Whopper's comments.

 

[nitemagi]

Psychiatry is also a constantly advancing field. 20 years ago benzo use was pretty common. Today it's almost a faux pas to the recently trained psychiatrist. Board certification also used to be lifetime, which means older psychiatrists didn't really have to keep up on changes in the field, leading to generation gaps. There's also regional differences, and the truth that residency is still very much built on the apprenticeship model, which means that if your mentor is behind the times or a bad teacher and that's all you have available, you might turn out to be bad too. And finally there's the risk of the "Trendy" doctor that likes to prescribe everything off label, might buy every line of rationale that the drug company feeds, and/or misses the forest for the trees (chasing every little symptom with a different med but missing the whole clinical picture).

 

[vistaril]

Hey Whopper, I've always been curious as a lurker of the psychiatry boards, why is it that you seem to have such antipathy towards MDs? My experience has been that the vast majority of MDs are quite competent in their jobs and couldn't do much better of a job realistically. I've seen you mention on here before that doctors tend to be arrogant. That might be true but the same generalization could be made for CEOs, lawyers, and professional athletes. The top tend to be a little arrogant by human nature. I don't mean this to be a confrontational post at all. I'm just interested in the source of some of your feelings towards your colleagues.

it seems to me that a large % of psychiatrists are, quite frankly, subpar.....at least compared to other fields in medicine. I think the reasons for this are as follows:

1) since the amount of hard ebm in psychiatry is far less than in anything else, people who are not practicing ebm in any way stand out less.

2) entrance standards in psychiatry are generally a good bit lower than other specialties. any american grad, no matter how they did in med school, will be able to find a residency somewhere in psychiatry. the bottom 5-10% of their med school class is likely to struggle to find a spot in moderately competitive fields like gen surgery, em, anesthesia, etc.....

3) let's be honest, if you're lazy(and some people are), psychiatry is a good fit. You can probably "get by" doing less in psychiatry than any other field.

4) If you're grossly incompetent, it's probably easier to "hide it" in psychiatry than any other field. A grossly incompetent surgeon's skills would be apparent to all in the OR. A grossly incompetent hospitalist would have pts decompensating much more frequently than other docs and be sending an abnormal number of pts to the micu. But even if a psychiatrist has no clue really what is going on, usually their med regimens might still overlap mostly with what a good psychiatrist would pick. It doesn't take a brain surgeon to figure out that most agitated agressive pts being admitted are on depakote and an antipsychotic....just pick one and you're not really going to stand out that much.

that sounds a little cruel, but thats how most people in medicine view it.

 

[Leo Aquarius]

it seems to me that a large % of psychiatrists are, quite frankly, subpar.....at least compared to other fields in medicine. I think the reasons for this are as follows:

1) since the amount of hard ebm in psychiatry is far less than in anything else, people who are not practicing ebm in any way stand out less.

2) entrance standards in psychiatry are generally a good bit lower than other specialties. any american grad, no matter how they did in med school, will be able to find a residency somewhere in psychiatry. the bottom 5-10% of their med school class is likely to struggle to find a spot in moderately competitive fields like gen surgery, em, anesthesia, etc.....

3) let's be honest, if you're lazy(and some people are), psychiatry is a good fit. You can probably "get by" doing less in psychiatry than any other field.

4) If you're grossly incompetent, it's probably easier to "hide it" in psychiatry than any other field. A grossly incompetent surgeon's skills would be apparent to all in the OR. A grossly incompetent hospitalist would have pts decompensating much more frequently than other docs and be sending an abnormal number of pts to the micu. But even if a psychiatrist has no clue really what is going on, usually their med regimens might still overlap mostly with what a good psychiatrist would pick. It doesn't take a brain surgeon to figure out that most agitated agressive pts being admitted are on depakote and an antipsychotic....just pick one and you're not really going to stand out that much.

that sounds a little cruel, but thats how most people in medicine view it.

Psychiatrists rule at treating what they are trained to treat - psychiatric disorders. Neurosurgeons are subpar at treating psych patients, just as psychiatrists are subpar at removing tumors.

Thus, your comment that psychiatrists are subpar makes no sense. Frankly, none of the other doctors want to touch psych patients.

I do not follow your logic. Non-competitive specialty => attracts bottom 5% medical students => subpar doctors. It just doesn't happen this way. Top students from my class and many others applied for psych residencies. According to your logic, then PM&R docs, pathologists, fam medicine docs, and psychiatrists must be subpar. This just isn't reality.

Lastly, remember that half of being a good psychiatrist depends on maturity and interpersonal skills. In my graduating class, only 10% to 20% had the high social skills that's needed to be a good psychiatrist.

You're looking at it all wrong my friend.

 

[BS81]

I think you're giving hospitalists too much credit here. Anyone from a US med school can find a community IM program somewhere. And after you graduate you just run through those CHF, COPD exacerbation, etc. algorithms over and over. There is nothing you couldn't handle without just looking in to the MGH handbook. If anything else is more complex than that you just send out for a consult. But other than that, sure, I can see your points, but I don't think they're exclusive to psych.

 

[zenman]

Abilify in the morning, Thorazine at night...

The Horror, The Horror...

Anyone ever say anything good about Abilify??

 

[vistaril]

Psychiatrists rule at treating what they are trained to treat - psychiatric disorders. Neurosurgeons are subpar at treating psych patients, just as psychiatrists are subpar at removing tumors.

Thus, your comment that psychiatrists are subpar makes no sense. Frankly, none of the other doctors want to touch psych patients.

I do not follow your logic. Non-competitive specialty => attracts bottom 5% medical students => subpar doctors. It just doesn't happen this way. Top students from my class and many others applied for psych residencies. According to your logic, then PM&R docs, pathologists, fam medicine docs, and psychiatrists must be subpar. This just isn't reality.

Lastly, remember that half of being a good psychiatrist depends on maturity and interpersonal skills. In my graduating class, only 10% to 20% had the high social skills that's needed to be a good psychiatrist.

You're looking at it all wrong my friend.

the point being it is a *lot* harder and more difficult to practice neurosurgery than psychiatry. Any psychiatrist who doesn't feel that way is delusional frankly.

and of course there are some people in psychiatry who were top students in med school. Just not as many as in most other fields. And yes, there are a lot of sketchy pathologists too.

Additionally, I seriously doubt only 10-20% of your class had the high social skills needed to be a psychiatrist. This is a specialty which is ~30% or so(havent checked the last numbers) non-american fmgs, many of whom speak poor english. Additionally, many fmg's(especially those from india) are really not good at displaying empathy....which you would think would be an important quality for a psychiatrist.

 

[vistaril]

I think you're giving hospitalists too much credit here. Anyone from a US med school can find a community IM program somewhere. And after you graduate you just run through those CHF, COPD exacerbation, etc. algorithms over and over. There is nothing you couldn't handle without just looking in to the MGH handbook. If anything else is more complex than that you just send out for a consult. But other than that, sure, I can see your points, but I don't think they're exclusive to psych.

yes, but the algorithm because more complicated(and some thought is required) when the pt has COPD, CHF, and renal failure for example....and you're trying to blanace all those.

Also, it's not really fair to compare community IM programs to university psych programs. If you're going to compare residents, compare medicine residents at...say....University of Virginia with psych residents at the same institution(just made a program up there is nothing exclusive about it)

 

[snarfer]

it seems to me that a large % of psychiatrists are, quite frankly, subpar.....at least compared to other fields in medicine. I think the reasons for this are as follows:

1) since the amount of hard ebm in psychiatry is far less than in anything else, people who are not practicing ebm in any way stand out less.

2) entrance standards in psychiatry are generally a good bit lower than other specialties. any american grad, no matter how they did in med school, will be able to find a residency somewhere in psychiatry. the bottom 5-10% of their med school class is likely to struggle to find a spot in moderately competitive fields like gen surgery, em, anesthesia, etc.....

3) let's be honest, if you're lazy(and some people are), psychiatry is a good fit. You can probably "get by" doing less in psychiatry than any other field.

4) If you're grossly incompetent, it's probably easier to "hide it" in psychiatry than any other field. A grossly incompetent surgeon's skills would be apparent to all in the OR. A grossly incompetent hospitalist would have pts decompensating much more frequently than other docs and be sending an abnormal number of pts to the micu. But even if a psychiatrist has no clue really what is going on, usually their med regimens might still overlap mostly with what a good psychiatrist would pick. It doesn't take a brain surgeon to figure out that most agitated agressive pts being admitted are on depakote and an antipsychotic....just pick one and you're not really going to stand out that much.

that sounds a little cruel, but thats how most people in medicine view it.

Psychiatry, like pediatric and surgery, is more of a calling IMHO. In my medical school class, the people who went in to psychiatry were often in the top 1/3. Yes, maybe 1/3 of my classmates in residency could be considered "lazy" but this is subjective. They were certainly bright nevertheless.

In general, I find psychiatrists tend to devalue their peers and perhaps themselves more than the other medical specialties. Perhaps a misperception or projective identification or low self esteem? I don't really know. At my hospital where I did my training, the morbidity and mortality rate b/w catagorical/transitional medicine residents and psychiatry residents (while on IM rotationss) were similar. This hospital, including the psychiatry department, has a good reputation.

 

[vistaril]

Psychiatry, like pediatric and surgery, is more of a calling IMHO. In my medical school class, the people who went in to psychiatry were often in the top 1/3. Yes, maybe 1/3 of my classmates in residency could be considered "lazy" but this is subjective. They were certainly bright nevertheless.

In general, I find psychiatrists tend to devalue their peers and perhaps themselves more than the other medical specialties. Perhaps a misperception or projective identification or low self esteem? I don't really know. At my hospital where I did my training, the morbidity and mortality rate b/w catagorical/transitional medicine residents and psychiatry residents (while on IM rotationss) were similar. This hospital, including the psychiatry department, has a good reputation.

trying to calculate a morbidity/mortality rate for psychiatry *interns* on a medicine service is useless. Interns on a medicine service in general arent given much responsiblity.....they arent the ones calling the shots. Psych interns on medicine services are given even less.

I also note that psychiatrists tend to devalue their peers more than other medical specialties......instead of searching for psychologically minded reasons as to why this is, perhaps just look for the easy answer- a psychiatry residency is not as difficult as most others. I mean the fact is surgery and other fields are generally "harder" than psychiatry. Sorry if that is cruel, but it's true.....and it's how 97% or more of how all non-psych people in medicine feel......

 

[digitlnoize]

yes, but the algorithm because more complicated(and some thought is required) when the pt has COPD, CHF, and renal failure for example....and you're trying to blanace all those.

Also, it's not really fair to compare community IM programs to university psych programs. If you're going to compare residents, compare medicine residents at...say....University of Virginia with psych residents at the same institution(just made a program up there is nothing exclusive about it)

Hahaha. I'll bite. As a new psych intern at a university program who started on a medicine rotation, I must say that although I was scared my medicine would be rusty, that I'm pretty on par with my medicine colleagues. Granted, we're comparing Day 5 interns with each other, but hey. Obviously, the Year 2-3 medicine residents are infinitely more advanced in their MEDICAL treatment than I am. But, the PGY 2-4 psych residents are on that level in psych too...so...hard to compare.

trying to calculate a morbidity/mortality rate for psychiatry *interns* on a medicine service is useless. Interns on a medicine service in general arent given much responsiblity.....they arent the ones calling the shots. Psych interns on medicine services are given even less.

I would agree that interns aren't given very much responsibility...especially not week 1. I would disagree that psych interns are treated differently. I have not been coddled in any special way relative to my medicine intern colleagues.

I mean the fact is surgery and other fields are generally "harder" than psychiatry. Sorry if that is cruel, but it's true.....and it's how 97% or more of how all non-psych people in medicine feel......

I would disagree. I think they can both be challenging, but there are too many variables to consider. Psych residents work pretty hard at my institution. Less hard at others. Surgery residents tend to work very hard everywhere, but some programs are easier than others.

More importantly, what's more important is each person's perception of difficulty. I would argue that your typical surgery resident would find psych extremely difficult, and vice versa.

 

[F0nzie]

More importantly, what's more important is each person's perception of difficulty. I would argue that your typical surgery resident would find psych extremely difficult, and vice versa.

Agree. Prior to 3rd year all I was interested was in pharmacologic management and I figured it would be easy. Psychotherapy really threw me for a spin. For the first 6 months of psychotherapy, I was going home feeling completely wiped out and depleted. Now my energy is back and I'm starting to feel more resilient.

I feel psychotherapy is a lot of work if you're interested in it. I try to review my notes and have good recall to avoid empathic failures in subsequent sessions. Occasionally I'll randomly think about these patients over my weekends "what could I have said differently?", "how should I reframe that?". Then I start making formulations and wonder how I would test out my hypothesis in the next session.

For those that are not interested in psychotherapy, it's a lot easier, simply nod and say "that's too bad" and "how does that feel" the whole time and give the same advice one would expect from a good friend.

 

[snarfer]

trying to calculate a morbidity/mortality rate for psychiatry *interns* on a medicine service is useless. Interns on a medicine service in general arent given much responsiblity.....they arent the ones calling the shots. Psych interns on medicine services are given even less.

.

PGY 1-3 were plenty difficult where I trained. PGY4 was less busy but def not 9-5 type of work. Like I wrote before, I did the same thing as all the catagorical/transitional interns on my medicine rotations. Your institution maybe different in this regard.
Psychiatry is 'harder' as it saps you mentally. The same can't be said for the other specialties.

 

[snarfer]

Agree. Prior to 3rd year all I was interested was in pharmacologic management and I figured it would be easy. Psychotherapy really threw me for a spin. For the first 6 months of psychotherapy, I was going home feeling completely wiped out and depleted. Now my energy is back and I'm starting to feel more resilient.

I feel psychotherapy is a lot of work if you're interested in it. I try to review my notes and have good recall to avoid empathic failures in subsequent sessions. Occasionally I'll randomly think about these patients over my weekends "what could I have said differently?", "how should I reframe that?". Then I start making formulations and wonder how I would test out my hypothesis in the next session.

For those that are not interested in psychotherapy, it's a lot easier, simply nod and say "that's too bad" and "how does that feel" the whole time and give the same advice one would expect from a good friend.

I agree. psychotherapy also wipes me out by 4 in the afternoon. It is also very rewarding when it works. when I initially started doing therapy as a PGY, I prepared as much as I prepared to assist in a lap chole. in med school.

 

[aphenomenon]

I don't think Whopper dislikes docs, but just acknowledges the reality that the individual provider can be more important than the initials behind their name. As a rule, physicians clearly receive the most training. However, does that mean that every single MD/DO is going to automatically be better than a NP or PA due to the superior training? Not by a long shot. It comes down to individuals. At least, that's how I read Whopper's comments.

Agreed.

 

[vistaril]

I would agree that interns aren't given very much responsibility...especially not week 1. I would disagree that psych interns are treated differently. I have not been coddled in any special way relative to my medicine intern colleagues.



I would disagree. I think they can both be challenging, but there are too many variables to consider. Psych residents work pretty hard at my institution. Less hard at others. Surgery residents tend to work very hard everywhere, but some programs are easier than others.

More importantly, what's more important is each person's perception of difficulty. I would argue that your typical surgery resident would find psych extremely difficult, and vice versa.

hahaha.....first, why is that 90% of all psych residents say "when I was an intern on medicine, I was treated just like the categorical interns?"........either people are lying, or they are delusional. The real test would be to go over in the medicine forums and ask the medicine residents there- when you have a psych intern, do you treat them the same as a categorical? 9/10+ would say hell no, and 8/10 would find the question laughable....

as for surgery residents finding psych difficult....not really. Not very interesting? Sure. Of questionable value in some cases? probably. Hard? no......

I love psych and I wouldnt want to do anything else in medicine. But if you as a psychiatry, be it an intern or an attending, feel that other specialties *really* view you on par with them......you're delusional.






//

 

[digitlnoize]

hahaha.....first, why is that 90% of all psych residents say "when I was an intern on medicine, I was treated just like the categorical interns?"........either people are lying, or they are delusional. The real test would be to go over in the medicine forums and ask the medicine residents there- when you have a psych intern, do you treat them the same as a categorical? 9/10+ would say hell no, and 8/10 would find the question laughable....

Well, on my medicine rotation, each of us interns are given new patients in a rotation. So I'm not getting any "easy" patients. Whoever is up next gets the patient. Doesn't matter if you're med or psych.

I love psych and I wouldnt want to do anything else in medicine. But if you as a psychiatry, be it an intern or an attending, feel that other specialties *really* view you on par with them......you're delusional.

Wait a minute. Earlier, you were saying that psych was objectively easier than surgery. Now you're saying that surgeons just *think* it's easier?

I don't really care how they feel. They'll come crying to us just like everyone else when they need to cut a schizophrenic.

 

[vistaril]

Well, on my medicine rotation, each of us interns are given new patients in a rotation. So I'm not getting any "easy" patients. Whoever is up next gets the patient. Doesn't matter if you're med or psych.



Wait a minute. Earlier, you were saying that psych was objectively easier than surgery. Now you're saying that surgeons just *think* it's easier?

I don't really care how they feel. They'll come crying to us just like everyone else when they need to cut a schizophrenic.

there is no reason it cant be both. Psychiatry is much easier to practice than surgery. Surgeons do feel that being a surgeon is much harder than being a psychiatrist.

As for cutting schizophrenics, Im not sure what you mean by "come crying"? They may do a capacity consult if warranted. Or they may ask for med recs if she is going to be in the hospital awhile and is unstable from a mh perspective. But I hardly see how thart equates to come crying....

 

[vistaril]

PGY 1-3 were plenty difficult where I trained. PGY4 was less busy but def not 9-5 type of work. Like I wrote before, I did the same thing as all the catagorical/transitional interns on my medicine rotations. Your institution maybe different in this regard.
Psychiatry is 'harder' as it saps you mentally. The same can't be said for the other specialties.

ummm.I agree pgy4 at a lot of psych programs is def not 9-5 type work. It's more like 845am-1045am type of work......


many psych programs have lots of "electives" built in to 4th year....as many as 9-10 months in some cases.....

as for "saps you mentally", I'm not sure what that means objectively

Also, on paper everywhere does the same thing on medicine rotations....the reality is different.

 

[aphenomenon]

Well, on my medicine rotation, each of us interns are given new patients in a rotation. So I'm not getting any "easy" patients. Whoever is up next gets the patient. Doesn't matter if you're med or psych.

exactly. Vistaril is just being contrarian. How could that system have it that psych interns were treated any differently? The people booking beds to your service dont know youre a psych intern. And to tell you the truth, attendings often dont know for much of the two weeks youre working with them either. And...night float!

 

[digitlnoize]

Im not sure what you mean by "come crying"?

It's a figure of speech. It means they will ask us for help when they have an unstable psych patient on their service. And they will thank us deeply when we fix it.

I guess I just don't like how you're always dealing in absolutes. I still don't see why it matters if surgeons think psych is easier or harder than surgery.

Anyways, it really doesn't matter...can we get back on topic?