Psychiatry Anyone?

[John90210]

What are some good programs? I know the job market is red hot and has been for years. This year interest also has picked up? What do you guys think of psychiatry?

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[Mindy]

Nobody on this forum ever seems to reply to psych posts... It is my only hold-out before I enter pathology...
Thoughts anyone?

Mindy

 

[Magree]

Hi:

Perhaps you need to be more specific with your questions. Which are "good" programs depends a lot on what you want to do - are you interested in psychotherapy as well as psychopharmacology? Some programs offer very little psychtherapy training let alone psychoanalysis? Do you want a lot of medicine along with psych? Places like Columbia are known for a strong medical internship prior to any specialization. Like all other specialties if you want to teach or subspecialize, most would recommend going to a university program.

I think its a great field and that there is a lot of possibilities to help people. However, its difficult enough with enlightened, knowledgeable politcians to get funding for mental health - so who knows what monies will be available for expansion of programs or research. Just the same, like neurology, I think psych as a field will expand tremendously in the next 10 - 20 years. But that's just my impression. Hope this helps.

cheers,

M-

 

[Rhubarb]

Hello John90210, Mindy, and Magree,

I'm a fellow psych enthusiast. From surveying the posts, seems like we're a rare breed (in so many ways). John, your description of the psych job market as "red hot" struck me. Never have I heard so sexy a term associated with it. Could you please expand. I'm a third-year med student trying to generate a healthy knowledge of psychiatry as a potential career.

Thanks,
Rhubarb

 

[John90210]

Hi Rhubarb,

As you probably know, Psych is not the most sought after field. In fact, it is one of the easiest to match in. Over the past 10 yrs great advances in neurology and neurochemistry have expanded the understanding of mental disorders as well as the search for treatments. More importantly, mental health has gotten more attention from society at large and payees in general. What is more important is the demand for psychiatric services which has been increasing rapidilly due to better treamtment and public education, etc. Dedicated, smart AMGs have not sought psychiatry and therefore there is a demand for these individuals. There are no shortages of jobs in any part of the country. Just ask any pscychiatrist, recent grads, and check out classifieds in journal, internet. More importantly, program directors are flooded with request for caring, intelligent residents. With an aging population, great scientific advances and a recognition that mental health is just as important as physical health demand for these services will increase. I persoanlly know everyone who graduated from my school;s residency program got great jobs all over the country and are very happy. The lowest starting pay was about 140K for a 40 hour 9-5 position. Keep your mind open to everything, but follow what you truly enjoy. Good luck.

 

[Mindy]

Like Rhubarb, I am a third year trying to get a feel of a psych career. Any thoughts on how attendings feel about their job? I have minimal experience since I have yet to rotate through.

Magree, have you noticed a trend of people interested in both psych and path? There seems to be a personality type that is interested in pursuing one or the other of these fields (i have been informally surveying people )

Mindy

 

[Kluver Bucy]

•••quote:•••Originally posted by Mindy:
•Magree, have you noticed a trend of people interested in both psych and path? There seems to be a personality type that is interested in pursuing one or the other of these fields (i have been informally surveying people )

Mindy•••••That's interesting. Quite a while ago, a Myers-Briggs Type Indicator showed one of the types self-selecting psychiatry and pathology among their top 3 specialties.

Personally, I think a choice of specialty can be chosen based on the party test:

When attending a party, I enjoy:
A. Meeting new people, maintaining and fostering relationships with people I already know, listening to them and, when appropriate, offering my experience and expertise to help them to solve problems in order to lead fulfilling lives.
B. Having the guests assume awkward positions while manually probing their bodily orifices.
C. Administering chemicals to the guests until they lose consciousness
D. Skipping the party altogether, and viewing radiographic images or disembodied necrosed tissue of the guests.
E. Using sharp instruments to remove vital organs from fellow partygoers.

 

[neilc]

that looks like a test designed by a psychiatrist seeking new patients...just reading the answers and reviewing at my aspiration of becoming a surgeon makes me wonder if that means i should seek help!!

 

[Magree]

Hi Mindy and KB:

Well.... I was an I N T/F J :wink: ( I was right on the cusp of T and F ). Don't know if this is the type KB was talking about or not. There are LOTS of areas of medicine that attract me I think both psych and path have a lot of interesting problem solving - mind you I also considered IM, anesthetics, and FP. There was short periods of interest in neurology and surgery :wink: .

I haven't really spoken to many practicing psychiatrists. A friend is a LCSW and she said that it was impossible to get people into the psych docs in her area (West Coast). They were totally in-demand. But also that it was tough for them because of the whole managed care / capitation / referral stuff. Would be interesting to from some psych residents. Hope this helps.

M-

 

[doc2003]

I love psychiatry too for many reasons such as:
1. the hours
2. no rectals
3. long-term relationships with patients
4. it can be very interesting (makes me think)

However, you must realize there are downsides:
1. if you make 100-160k when the field is red hot, what if it ever turns cold?
2. the psychiatrists during my rotation said they all thought that psychologists would eventually get prescribing privileges for anti-depressants and some other psychoactive substances... I tended to disagree, but a scary notion nonetheless
3. longer residency than FP, IM, Peds with very little salary difference
4. I have never spent 40 hours a week listening to people's problems but some psychiatrists say they would never do it again because of that
5. Nothing is quick, treatments help but patients often relapse, nothing is curative

It's a difficult choice and as you can see, I haven't decided yet.

 

[brownman]

psyche,

Well...in my own world; I'm the kind of psychoanalysis. Before I chose to come back to medicine, I really thought...long...and hard...about psyche. No joke...it was very difficult to chose not to do it. So much so, that in one of my interviews after reading my essay, the interviewee asked me, "so..why don't you go into psyche? You'd be great at it".

Simple...psychiatrists don't do psychoanalysis any more. It is a very difficult niche of psychiatry to carve out. Granted, it's the most lucrative part of psyche (with the right clientele) and the most rewarding I believe, but it is becoming fewer and further in between. Reasons are multi factorial as to why; part of it is managed care, which reimburses for medicine not time (sound familiar?). But, the biggest reason is, PSYCHIATRY PROGRAMS WANT YOU TO PRESCRIBE MEDICATION. They in fact, want that to be the future. Which is detrimental I believe, to the curative nature of psychiatry. It does need to serve as a compliment, but psychotherapy is what the field is built on. And that's what the field should grow with...but this isn't medicine of the past. I had a friend who tried to match into psyche...in one of his interviews, he told the attending physician that giving pills for cure is idiotic...that you should provide the person with real therapy. They called him later...and told him that they weren't going to rank him highly because of it. I mean..this guy is a stellar candidate..and this wasn't an amazing program...just one in his hometown. In the end, he matched somewhere else...and told them to go screw themselves. So goes life....

Go into psyche if you love it....realize it's a very medical field..and pills rule now. Good luck...and hopefully you can find a program that focuses on psychotherapy far more than anti-psychotic medication.

 

[Rhubarb]

Brownman,

I agree that pills rule the current psychitry scene. And, yes, it is a shame. Psychotherapy, however, remains an important component of mental health counseling, it's just not administered by psychitrists. Here's where the psychologist steps in. Psychiatrists (at least autonomous ones) could do psychotherapy all day long if they chose. But the big boys at the HMO won't give them any Benjamins for that. Perhaps that's why psychologists are foaming at the mouth to start prescribing.
Psychiatrists struggle in the health care paradigm that rewards doing (i.e., cutting out an appendix) over thinking/talking (psychotherapy). Alas, here's where the monolith of evidence-based medicine crumbles: "soft" data becomes its wretched step-child. You can draw reams of beautiful, "hard," reproducible data from some appendectomy study, but similarly desirable data are difficult to extract from a psychotherapy trial. Does that translate to psychotherapy being some sort of quackery? Of course not.
Pills? Ah, now there's something that can be measured. Success suddenly becomes so evident when X mg of X drug are prescribed. That's orgasmic for the HMOs because now they can easily measure success, efficacy, and, ultimately, the almighty bottom line. As society becomes enlightened (gulp), cognition may someday be appropriately recognized and compensated.

Rhubarb

 

[Mindy]

Kluver, that truly was one of the funniest darned things I ever read

mindy

 

[Kluver Bucy]

Thanks, Mindy!

•••quote:•••Originally posted by Mindy:
•Kluver, that truly was one of the funniest darned things I ever read

mindy•••••

 

[doc2003]

No sooner did I mention it, and I receive this:

3. N.M. PSYCHOLOGISTS MAY GAIN PRESCRIBING PRIVILEGES
The New Mexico AFP needs your help to convince Gov. Gary
Johnson to veto a state bill passed last week that will
allow psychologists with Ph.D.s to prescribe psychotropic
drugs. A letter posted on Speak Out: AAFP's
Legislative Action Center
( <a href="http://capitol.aafp.org/aafp/issues/alert/?alertid=101519" target="_blank">http://capitol.aafp.org/aafp/issues/alert/?alertid=101519</a> )
calls House Bill 170 -- the first of its kind -- a
"dangerous precedent" that could jeopardize the quality of
care mental health patients receive. Select "NM" as the
state and e-mail the letter to Gov. Johnson.

 

[ckent]

•••quote:•••Originally posted by doc2003:
•No sooner did I mention it, and I receive this:

3. N.M. PSYCHOLOGISTS MAY GAIN PRESCRIBING PRIVILEGES
The New Mexico AFP needs your help to convince Gov. Gary
Johnson to veto a state bill passed last week that will
allow psychologists with Ph.D.s to prescribe psychotropic
drugs. A letter posted on Speak Out: AAFP's
Legislative Action Center
( <a href="http://capitol.aafp.org/aafp/issues/alert/?alertid=101519" target="_blank">http://capitol.aafp.org/aafp/issues/alert/?alertid=101519</a> )
calls House Bill 170 -- the first of its kind -- a
"dangerous precedent" that could jeopardize the quality of
care mental health patients receive. Select "NM" as the
state and e-mail the letter to Gov. Johnson.•••••I personally think that psychologist can and should be able to prescribe many different types of anti-depressants. Many of them are benign medications, with no real monitoring necessary for patients who are taking them. There are too many psychiatrists out there who are pill-pushers, they meet with patients for 30 minute meetings, and then offer them drugs right away before asking any real questions to find out why or if the person really wants drugs. And then, they follow up with the patient once every several months just to see if the dosage is correct. Psychologists, and anyone off the street for that matter, are very capable of doing the same thing. And before anyone starts going on about how psychiatrist might be able to tell if something is "physically" wrong with the patient (eg hypothyroidism, cushings, etc), they don't do any tests to check for anything when they have initial interviews. And the number of physical diseases that cause psychiatric manifestations that would present first to a psychiatrist before being screened by a primary care doc is so low that it probably will never happen, if someone doesn't think they need a shrink, they won't go see one, they will go or their family members will want them to go to their primary care doc first. Just my 2 cents. In case you cannot tell, I happen to think that the whole field of psychiatry should be disbanded from medical school. I think that it's important for physicians to understand psychiatric illness and know how to treat them, but to have a whole specialty of it seems like a waste to me. Not only that, most psychiatrist are mentally ill themselves anyways, and if they aren't mentally ill, many are incompetent.

 

[Magree]

Hi:

I agree that there are many non-MDs who could safely prescribe a few anti-depressants. However, my impression of non-MD health providers is that the rigor of their approach and training varies greatly, and I think your statements about totally disbanding psychiatry training is more reactionary than realistic.

Also, it is true that there are many people in psych who have not "done their own work" so to speak (and I've met a few :wink: ). But so have I met any number of them in other specialties for that matter. They tend to stand out more pronouncedly and people remember them - forming prejudiced views. The compassionate, competent folks just do their jobs and go largely unnoticed or discussed.

M-

 

[Adrian1]

I agree with Magree, I was quite surprised at the level of concern that the 3 psychiatrists I rotated with placed on medications, scripts, side effects and proper monitoring. Furthermore, the complexity of having patients on multiple drugs ( I think I saw more people taking 3 or more psych meds than just "one anti-depressant") can make the Tx quite complicated. How many psychologists know the effect of ramping up CYP450s and the drug levels associated with other meds the pt might be taking? Perhaps there are a few, or even many, psychs who prescribe without regard, but that was not my experience, and those phsyicians that do will eventually encounter their problems.

A

 

[doc2003]

I really don't have a problem with psychologists prescribing if they do a training program (2-3 years) teaching them how to prescribe and what to watch for (psychopharmacology etc.). I have two friends in their last year of their psychology doctorate and I asked them their opinion. They said: "we are not trained to do it." Also, there are some interesting questions such as: Paxil can cause sexual dysfunction but is not contraindicated with Viagra -- so many docs give both at the same time. Should the psychologist be able to prescribe viagra... I don't think so.

The truth is that MOST medicines side-effects are rather benign but you have the far reaching effects of the medicine. As physicians we train for the 1% of when things go wrong. If psychologists prescribe they should be as good at recognizing these problems as psychiatrists.

 

[Ponyboy]

I do not think that psychologist should be given the rights to prescribe medications. The only relatively safe anti-depressants are the SSRI's and even then you must still be wary of serotonin syndrome. Every other type of antidepressant has serious side effects that you must watch out for (not to mention the multitude of other meds that are used in psychiatric practice). You need the medical training and the clinical skills to identify myoclonus, EPS, etc. not to mention clinical syndromes of psychotropic toxicity. Sure, it's easily identifiable on an exam but unless you actually have seen it, and know what it looks like, you will have a hard time identifying it in your patients.

Secondly, what would psychologists be allowed to prescribe? SSRI's? Lithium? Anticonvulsants? Antipsychotics? If I were a family doc treating someone with depression that was resistant to monotherapy antidepressants, I would be very hesitant to try the combination of meds that I see psychiatrists using. Simply because there are too many side effects and interactions to juggle between psychotropic meds (not to mention medications for a variety of other medical conditions). I don't see how psychologists could fare much better. If psychologists were allowed to prescribe simple monotherapy for psychiatric illnesses, I can't really see what benefit they could possibly offer over a primary care doc.

Thirdly, it's a gross mistake to think that psychiatrist simply treat people who are feeling down with antidepressants. A large part of the psychiatric population are the patients who are resistant to treatment, who have strong biological and complex diseases that cannot be remedied with talk therapy. You're kidding yourself if you think that you can simply talk a schizo out of their delusions. The simple psychiatric illnesses are taken care of by primary care docs. It's the complex, resistant illnesses that psychiatrists alone can treat.

Finally, there is an old principle in medicine that states you should not treat something if you can't handle the adverse effects. If you can't medically treat your patients when they OD or get EPS, you shouldn't be treating them in the first place.

As an aside, I found my psych rotation to be very interesting. It's very different from every other specialty because you really get to know your patients as a person. The problems are not like the hyponatremia, the HTN and other problems that you see in medicine. They're real life problems that everyone faces.

 

[Kluver Bucy]

I think that all mental health professionals should be able to prescribe psychotropic meds if they receive the proper training. That training should consist of four years of medical school followed by a residency.