Psychiatry & Geographic Flexibility

[PavlovsBell]

A little bit of background: I was accepted into a Clinical PhD Program of Psychology. I accepted an offer that would maximize opportunities for my husband and I had every intention of moving to another state, until a few days ago when my husband received a job at a NYC hedge fund that is just way too good to turn down. I have been wanting to be a Psychologist or Psychiatrist since I was in middle school, but I went to a very intense high school that intimidated me away from science, so I just went with Psychology. I am not sure if I want to do research on practice, but I want the option to do both early on. However, after applications and learning more about the field, I have realized there is very little geographic flexibility. Which is a huge issue because my husband's career will not allow for move after move (for grad school, then internship, then postdoc, then Tenure-Track positions).

So I guess my question are.

1. How geographically flexible is Psychiatry. Would it be doable to do Medical School and Residency and Jobs in NYC/Boston/San Francisco/LA/Chicago only?
2. Is it a crazy idea to start over with a post-bac to do Psychiatry? I read many of the Psychiatry vs. Psychology threads and understand the differences, and I do think in my case Psychology might be more of a fit than Psychiatry (but pursuing a Psych PhD will really harm my husbands career...) If I know that I would be very happy as a Psychologist, do you think it is likely that I will be happy as a Psychiatrist?
3. How do I know that I will be smart enough to make it to and through medical school, starting with biology/chemistry/physics and then anatomy and surgical rotations? And that I will be interested in being a doctor too , not just a Psychiatrist?

My other alternative is to stay in investment banking, continuing working crazy hours, and having no purpose to what I do. But at least there is less risk and the work itself is somewhat enjoyable..

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[Nasrudin]

A little bit of background: I was accepted into a Clinical PhD Program of Psychology. I accepted an offer that would maximize opportunities for my husband and I had every intention of moving to another state, until a few days ago when my husband received a job at a NYC hedge fund that is just way too good to turn down. I have been wanting to be a Psychologist or Psychiatrist since I was in middle school, but I went to a very intense high school that intimidated me away from science, so I just went with Psychology. I am not sure if I want to do research on practice, but I want the option to do both early on. However, after applications and learning more about the field, I have realized there is very little geographic flexibility. Which is a huge issue because my husband's career will not allow for move after move (for grad school, then internship, then postdoc, then Tenure-Track positions).

So I guess my question are.

1. How geographically flexible is Psychiatry. Would it be doable to do Medical School and Residency and Jobs in NYC/Boston/San Francisco/LA/Chicago only?
2. Is it a crazy idea to start over with a post-bac to do Psychiatry? I read many of the Psychiatry vs. Psychology threads and understand the differences, and I do think in my case Psychology might be more of a fit than Psychiatry (but pursuing a Psych PhD will really harm my husbands career...) If I know that I would be very happy as a Psychologist, do you think it is likely that I will be happy as a Psychiatrist?
3. How do I know that I will be smart enough to make it to and through medical school, starting with biology/chemistry/physics and then anatomy and surgical rotations? And that I will be interested in being a doctor too , not just a Psychiatrist?

My other alternative is to stay in investment banking, continuing working crazy hours, and having no purpose to what I do. But at least there is less risk and the work itself is somewhat enjoyable..

This is a very interesting set of propositions.

I will only speak to one with some degree of certainty: geographic flexibility. Like you, only certain locations are suitable for me. And psychiatry offers one of the best opportunities in medicine to control the probability of your opportunities. It's not a certainty and will depend on how well you do. But it's among the best for being able to pick your location at all levels of your training. Except medical school. That would be the hardest part I think. But if you have good grades so far NYC is probably one of the best situations you could be in as a premed given the number of schools and preference for state citizens.

I don't think there's any problem with knowing you want to do psych before going to medical school. Plenty here have done just that. But you should definitely know that you want to be a physician. As most of our training is clinical medicine and the preparation for it until half of intern year is over. We don't learn to be psychiatrists until the 2nd, 3rd, and 4th years of residency. That's one hell of a long haul from being a premed.

Good luck.

 

[Nasrudin]

Additionally, you seem to be under the wrong impression about the nature of our coursework. It does not require a high degree of intellect but rather the tenacity and discipline to see the work through. So that with enough motivation most could do it.

 

[shan564]

I agree with the advice above, but I'll give my own spin on it.

First off, I think that you already know what you want to do. I'm not good enough at reading minds to tell which option you want to pursue, but whichever it is, I think that deep down, you're really just looking for confirmation from us. After you spend a couple of months thinking about this decision, I think that you'll come up with an answer on your own, regardless of what we tell you. But I'll answer your questions anyway, just in case I'm wrong.

Second - and I should preface this by saying that this is purely conjecture and based on very little knowledge - but I'm not sure why you think there's very little geographic flexibility for a PhD-level clinical psychologist. If your husband has a "way too good to turn down" job at a hedge fund, I'm guessing that finances aren't a big issue for you. And if you're willing to work for a bit less money, I'm sure that somebody will hire you. We most certainly have a massive shortage of affordable psychotherapists everywhere in the universe. Not to mention the fact that there are plenty of people doing telepsychology right now.
I'm guessing the issue is that you got into a PhD program in a particular locale and you're not sure if you'll be able to get into a school in NYC. I can't offer too much specific advice on that, but if you don't think that you can get into a PhD program in a particular locale, then it'll only be harder to get into med school.

1. How geographically flexible is Psychiatry. Would it be doable to do Medical School and Residency and Jobs in NYC/Boston/San Francisco/LA/Chicago only?

As mentioned earlier, the bottleneck will be at the stage of med school. And the answer to that question will depend on how good of an applicant you are. If you have a good GPA and you think you can do well on the MCAT, you'll probably be able to get into SUNY-Downstate. Once you get through med school, you'll be able to go wherever you want.

2. Is it a crazy idea to start over with a post-bac to do Psychiatry? I read many of the Psychiatry vs. Psychology threads and understand the differences, and I do think in my case Psychology might be more of a fit than Psychiatry (but pursuing a Psych PhD will really harm my husbands career...) If I know that I would be very happy as a Psychologist, do you think it is likely that I will be happy as a Psychiatrist?

There are actually two unrelated questions here, and I'll start with the second one.
If you "know" that you'll be happy as a psychologist, then you'll probably be happy as a psychiatrist. The reason is because psychiatrists have the flexibility to practice purely psychotherapy if you so choose, so in case you find yourself unhappy doing the things that are unique to psychiatry, you could always be a psychiatrist whose practice is structured similarly to that of a psychologist.

As for whether it's a crazy idea to start over - that's dependent entirely on your life situation, and is not something that our expertise can help to answer, since it's really a question of whether you want to invest the time. If I were in your place at the age of 24, I would probably do it. If I were in your place at the age of 44, I probably wouldn't. But you should recognize that a post-bac only works if you're certain that you can get a high GPA. And if you had a high GPA in undergrad, then you wouldn't need a post-bac... so the fact that you're asking the question suggests that either you didn't have a high GPA in undergrad or that you're not familiar with med school admissions. If it's the former, then the question you need to ask yourself is how you'll ensure that your post-bac GPA will be higher than your undergrad GPA. If it's the latter, then you should probably do a bit more research on med school admissions.

3. How do I know that I will be smart enough to make it to and through medical school, starting with biology/chemistry/physics and then anatomy and surgical rotations? And that I will be interested in being a doctor too , not just a Psychiatrist?

As has been mentioned above, getting through med school doesn't require a great deal of intellect. If you're an investment banker, then you're probably smart enough.
Of course, being smarter does help. The question about getting "through" med school isn't as important as the question of getting "to" med school - the med school admissions process does a good job of selecting for people who are highly likely to be able to get through.
As far as getting "to" med school - if you had a good undergrad GPA, you're probably hard-working and focused enough. If you did well on the SAT and/or the GRE, you're likely to do well on the MCAT. Those are the two most important factors.
As far as being interested in being a doctor - I don't think there's any good way to predict that. The only way to learn whether you like being a doctor is to be a doctor. As undergrads, they used to tell us that shadowing a doctor or working in healthcare can help, but I hated shadowing and I love being a doctor. I thought I'd hate being a doctor and I resented my family for strongly encouraging me to do it, but it turns out that they knew me better than I knew myself... they were right, I was wrong, and I am eternally indebted.
For what it's worth, I don't know many people who don't like being a doctor. The reason for that is because there are so many things you can do in medicine that there's something for everybody.
In my case, I really didn't even like med school. That made me think that I wouldn't like being a doctor, but there's a HUGE difference between then and now. I think the shift started sometime in my 4th year of medical school, when I felt like I'd finally learned enough to have some idea of what was going on around me.
Also in my case, med school got a lot better when I did my psych rotation and learned that I wanted to be a psychiatrist. Until then, a major reason why I didn't like med school is because I felt like I wasn't finding the specialty that was right for me. You probably won't have the same problem.

 

[Nasrudin]

Also in my case, med school got a lot better when I did my psych rotation and learned that I wanted to be a psychiatrist. Until then, a major reason why I didn't like med school is because I felt like I wasn't finding the specialty that was right for me. You probably won't have the same problem.

Same here! I thought I made a mistake going to medical school until I found Psychiatry. Maybe we're born and not made. The half of us who knew we were going to be psychs and the half that didn't alike.

 

[PavlovsBell]

Thank you for all your insight! Nasrudin -it is very helpful to know that there is geographic flexibility - this is one of my biggest issues with Psychology PhDs (everyone in the Psychology forums and the few Psychologists I know always talk about this issue, particularly early on in the training), and it is good to know that it is likely I won't run into the same issue after I get into medical school.

shan564, thank you so much for a very informative post! It is very helpful.

First off, I think that you already know what you want to do

To be completely honest, I don't. I am very torn - and it is hard because I don't have that much time if I wan't to take the PhD offer I have in hand (my husband has to accept or decline his offer by Monday AM). I am open to both ideas at this time, and they each have a different set of pros and cons. I think my biggest issue with pursuing Psychiatry is that I have to start over, taking Biology and Chemistry and Physics with 18 year olds, with no guarantee that I will do well and get into medical school. I think if I had an MD and PhD admission in hand, I would take the MD admission. But I don't know if I have enough faith in myself that I will get into Medical School.

As mentioned earlier, the bottleneck will be at the stage of med school. And the answer to that question will depend on how good of an applicant you are. If you have a good GPA and you think you can do well on the MCAT, you'll probably be able to get into SUNY-Downstate. Once you get through med school, you'll be able to go wherever you want.

I had a 3.8 GPA at a top 25 undergrad, but I had very easy majors (Psychology and Business). I am not sure what kind of GPA I can get if I redo all my science pre-reqs - I haven't taken a science class since high school. My SAT was a 2230/2400... I don't know if I can expect a low 30s MCAT if I try hard enough, but I think that's what I need for a SUNY-Downstate admission.

As for whether it's a crazy idea to start over - that's dependent entirely on your life situation, and is not something that our expertise can help to answer, since it's really a question of whether you want to invest the time. If I were in your place at the age of 24, I would probably do it. If I were in your place at the age of 44, I probably wouldn't. But you should recognize that a post-bac only works if you're certain that you can get a high GPA. And if you had a high GPA in undergrad, then you wouldn't need a post-bac... so the fact that you're asking the question suggests that either you didn't have a high GPA in undergrad or that you're not familiar with med school admissions. If it's the former, then the question you need to ask yourself is how you'll ensure that your post-bac GPA will be higher than your undergrad GPA. If it's the latter, then you should probably do a bit more research on med school admissions.

I am actually 24. I had a high GPA (but that was because I had very easy majors) in undergrad and I need a post-bac to get all my pre-med requirements (ei Chem I, Bio I, Physics I) since I didn't take them in undergrad. But yes, if I pursue this path I need to start researching med school admissions hardcore so that I can give myself the best chance to get accepted into SUNY-Downstate or another NYC school. And I need to know that I will get in - if I don't get in, this will be a huge mistake. But I think if I get in and graduate, then this will make the most sense for my particular situation. I am just not sure if I want to take the risk, or go with the PhD offer and a different kind of career opportunity for my husband.

 

[AcronymAllergy]

How far is the grad program from where your husband would be working? It's not ideal, but I know of folks who went the long distance route for some or all of grad school. Might not be an option for you, though.

Somewhat unrelated, but even with psych, I'm surprised you were able to get through without having to take any science classes in college. I took many more than was necessary, but even the bare minimum at the various schools I attended included bio, chem, or physics. Also, you won't really be escaping science by going the psychology route, of course; quite the opposite, actually. There likely will be less emphasis on biology, chemistry, and the like, though, depending on your research and clinical interests.

 

[fallen625]

Acronym, thank you for the insight. We are certainly considering long distance as well. As a Psychologist, would you say that the lack of geographic flexibility continues after PhD admissions? My husband can take a step down in his career now, but I wouldn't want to ask him to keep doing it over and over again.

 

[AcronymAllergy]

Acronym, thank you for the insight. We are certainly considering long distance as well. As a Psychologist, would you say that the lack of geographic flexibility continues after PhD admissions? My husband can take a step down in his career now, but I wouldn't want to ask him to keep doing it over and over again.

There's likely going to be less overall geographic flexibility with psychology than psychiatry as a whole, yes, although there are caveats. However, like you mentioned above, internship is pretty much a crapshoot, and you're at the mercy of the match for that. Post-doc is typically less restrictive in that sense; I personally don't know of anyone who wasn't able to end up in at least the region they were hoping for initially, if not the specific state/city. Same goes for jobs, although when it comes to employment, another forum member posted something with which I agree and which I'll shamelessly attempt to paraphrase: 1) location 2) pay 3) type of work; you can likely have two of the three, but be prepared to compromise on the third. Academia in particular can be rough, but that's not unique to psychology, and most would probably say we have it better than other academic disciplines due to our ability to practice clinically if we so choose. Then again, while my sample size is limited, of the folks I know from my grad program who were interested in tenure-track university positions, everyone who applied found one. They were, however, geographically flexible.

Me personally, I've been pretty much open throughout my training, which has definitely helped. I didn't have problems securing an internship, postdoc, or (theoretically, unless they somehow yank it away) job. I've been able to do so while staying in the geographic region I prefer, but I haven't always had a full say when it came to the state in which I ended up.

 

[shan564]

To be completely honest, I don't.

That's because you haven't yet figured out how to figure out what you really want. I think you will end up doing that.

I am very torn - and it is hard because I don't have that much time if I wan't to take the PhD offer I have in hand (my husband has to accept or decline his offer by Monday AM). I am open to both ideas at this time, and they each have a different set of pros and cons. I think my biggest issue with pursuing Psychiatry is that I have to start over, taking Biology and Chemistry and Physics with 18 year olds, with no guarantee that I will do well and get into medical school. I think if I had an MD and PhD admission in hand, I would take the MD admission. But I don't know if I have enough faith in myself that I will get into Medical School.

There's not as big of a difference between 18 and 24 as you might think when you're 24. Also, it's not just 18-year-olds, it's mostly 18-22 year-olds.

I had a 3.8 GPA at a top 25 undergrad, but I had very easy majors (Psychology and Business). I am not sure what kind of GPA I can get if I redo all my science pre-reqs - I haven't taken a science class since high school. My SAT was a 2230/2400... I don't know if I can expect a low 30s MCAT if I try hard enough, but I think that's what I need for a SUNY-Downstate admission.

Your GPA will be more meaningful than your major. Med schools like to pad their stats with high GPAs. I made the mistake of majoring in chemistry with minors in medical physics, radioenvironmental sciences, and biology... I made my own life more difficult by doing that. I have a friend who majored in sociology and then did better than I did in med school.

If you got a 2230 on the SAT, you must have gotten at least a 630 on the math section (probably higher). That tells me that you'll probably do fine in chemistry and physics unless you're unable to buckle down and focus/work hard in the class. And I think that difficulty with buckling down is unlikely considering your GPA.

I am actually 24. I had a high GPA (but that was because I had very easy majors) in undergrad and I need a post-bac to get all my pre-med requirements (ei Chem I, Bio I, Physics I) since I didn't take them in undergrad. But yes, if I pursue this path I need to start researching med school admissions hardcore so that I can give myself the best chance to get accepted into SUNY-Downstate or another NYC school. And I need to know that I will get in - if I don't get in, this will be a huge mistake. But I think if I get in and graduate, then this will make the most sense for my particular situation. I am just not sure if I want to take the risk, or go with the PhD offer and a different kind of career opportunity for my husband.

You don't need a post-bac to get all of those requirements. You can take them as a non-degree-seeking student too. It sounds like you've identified the fact that your biggest issue is with bio/chem/physics, so maybe you should just start as a non-degree-seeking student somewhere (even at a community college) and just take some classes. Or even take one online, just to see if you can do it. I'll bet you'll surprise yourself.

By the way, don't you have to take some science classes to graduate with a psychology degree? They sure as hell made me take a lot of classes that were completely unrelated to my degree, and biology is actually pretty strongly related to psychology.[/quote][/QUOTE]