Psychiatry Subspecialties

[tubadown]

I'm just entering college and i am very interested in the psychiatric field. I'm just looking for some information on whether you can do personality disorders as a subspecialty or if it is covered in one already established? I'm very new to this so really any info in the specialty area's of psychiatry would be appreciated.

---

Members don't see this ad.

 

[The Everglow]

I'm just entering college and i am very interested in the psychiatric field. I'm just looking for some information on whether you can do personality disorders as a subspecialty or if it is covered in one already established? I'm very new to this so really any info in the specialty area's of psychiatry would be appreciated.

Hey there Tubadown! I do not believe there are any fellowships (subspecialty of psychiatry) that focus on personality disorders, however I could be wrong! Check the sticky at the top of the psychiatry forum, 4th from the top. It goes over the currently offered psychiatry fellowships.

Good luck with college, and all the best!

 

[tubadown]

So this is going to sound like a dumb question I'm sure. But are fellowships sort of like a workshop? You go just to get extra training in that area but still practice general psychiatry with a specialty in that field? Or are they more of another stepping stone in your education and you branch of in that direction specifically? I guess what I'm trying to say is I'd like to do more counseling of adults with problems and none of the fellowships really entail what I'm looking for. Geriatric is the elderly and Child psych is obviously dealing with children/adolescents. Is there some sort of middle-ground?

 

[sunlioness]

You could do that with general psychiatry, though you would probably want to seek out additional psychotherapeutic training on your own. Also consider if you really need to be a physician to do what you want to do and consider grad school for psychology.

 

[tubadown]

Forensic Psychiatry looks interesting however. Do you have any information about that?

 

[cleareyedguy]

Don't worry about fellowships. Focus on school and what interests you. Many people focus on something like personality disorders early in their career because they want to work out their own issues or those of their family or because the patients present with their issues right out there or because they find something in the behavior evocative. For some, the curiosity persists for decades. For others, it fades, and they pursue something else. The most important factor in determining the specifics of your career will be you, and you should try to challenge yourself in multiple ways for a few years before you worry about subspecialization.

 

[peppy]

If you are JUST interested in psychotherapy/counseling and not really interested in medicine, then psychiatry might not be the best route. You may want to consider social work or grad school in psychology instead.
But if you do think mental illness is interesting from a medical perspective, your interest in personality disorders and psychotherapy would definitely be welcome in psychiatry. You will see PLENTY of personality disorder patients in general psychiatry without needing to do a fellowship, especially if you do outpatient therapy. Plenty, trust me.

 

[nitemagi]

I agree, decide on medicine vs. not first.

If you're interested in personality disorders, there's many psychotherapy pathways, including DBT and psychoanalysis.

 

[masterofmonkeys]

agreed if your primary interest is personality disorders, I'd say therapy-heavy MSW program (Univ of Denver as an example) or psychology program then psychoanalytic training would probably be the direction to take.

 

[psychgeek1]

I'm the same too. I'm in college and interested in psych. What specialty would you recommend

 

[masterofmonkeys]

I'm the same too. I'm in college and interested in psych. What specialty would you recommend

Depends on your specific interest. Personality disorders get minimal benefit from medications but DBT (for borderlines) and psychodynamic psychotherapy (for all) are the only things with any evidence for efficacy. As those are both psychotherapies, it doesn't make a lot of sense to go the MD route if you can get the psychotherapy training in A) a shorter amount of time and B) more time actually spent training in therapy.

I'm also interested in psychotherapy as a primary modality, but my interest is in the treatment of children with major medical (non-psychiatric) conditions. As such, I want to understand intimately the disorders themselves, the biological and psychological aspects of their medical treatment, and work with the medical teams in guiding that process. That and I think meds are an important piece of treatment (but only wen they're a piece). So it made a hell of a lot more sense to me to get an MD.

In other words, 'I'm interested in psych' is a bit too broad...

 

[digitlnoize]

I'm the same too. I'm in college and interested in psych. What specialty would you recommend

What he said.

I know you guys are pre-meds, and I applaud your broad reading of SDN...but at this point, here's what I would do.

1. If you think you want to do psych, decide now if you want to do MEDICINE or Not-Medicine (Psychology or Social Work/Counseling).

2. If you want to do Medicine, the most important thing is to concentrate on your grades (GPA as high as possible, preferably > 3.75) and MCAT (preferably >30 total).

3. For med school, they like to see both medical experience (shadowing, volunteering, working) and non-medical volunteer experience. Doing this in a mental health area may help identify areas of interest. For example, volunteering for a month at an addiction place might help you realize that you love or hate addiction medicine.

4. If your grades are fine, and you still want to do medicine, then think about what field you want to do, with the caveat that most med students change their mind before med school is over.

5. If you're convinced you're going to do psychiatry either way, then you can start perusing the field a bit. Start with general adult psychiatry, since that's what you'll be, first and foremost. Once you have a bit of a handle on that, then you can start looking at the various subspecialties, but as you go through the process, your interests will present themselves.

When I went to med school, I was convinced I wanted to do radiology, because I like computers and they make bank. Later, I realized that I despise anatomy, I actually enjoy human contact and sunlight, and that the lifestyle of a radiologist isn't always what it's cracked up to be. Then I did my 3rd year psych rotation (and some others) and LOVED it. In retrospect, it should have been obvious to me from like, age 14, that this is what I should be doing, and it fits me like a glove. You may have a similar changing experience.

Other things that I like (but not nearly as much as psych) that were surprising: - I enjoyed OBGYN much more than I thought I would.
- I could have seen myself doing an IM subspecialty, like cardio or endocrine as a backup.
- I love child psych but I loathe pediatrics. There's a difference between a mentally ill kid and a physically ill baby.

Anyways, enjoy your life and don't stress too much about the details just yet. There are a TON of fields in psych and you don't have to lock yourself into any one of them for a long time. If you really want more info, you can find some good stuff on places like the APA website and by google-ing psychiatry.

 

[wskhunky]

So I know the title of this conversation is a bit different from where it's leading to, but I was wondering if anyone had any suggestions as to how to decide between counseling and med school for psychiatry?

I am considering doing a full-calendar year master's program in mental health counseling (would get a M.S.Ed, but not a license unless if I do a second year) before applying to medical school. Have already taken the MCATs (32R) and have an okay-GPA from a double-major engineering degree (3.68c, 3.72s). Have a decent amount of experience volunteer/clinical/research-wise. Am taking two years off after undergrad-- my first year is currently working as a research tech at a children's hospital. If I were to do the masters program for my second year off, I would be ending my research tech position a year early (and eliminating the chance of a publication).

If I were to do the master's program, the cons would be 30K in debt + no research publication. The pros would be that i'd have real exposure to the counseling field and would (possibly?) decide if i want to do med school/counseling. I was wondering if there's another way to figure this out, without becoming in debt?

I'm interested in the counseling field because I want to do therapy in the future. How much do psychiatrists get trained in therapy? How much of it do they do?

 

[nitemagi]

So I know the title of this conversation is a bit different from where it's leading to, but I was wondering if anyone had any suggestions as to how to decide between counseling and med school for psychiatry?

I am considering doing a full-calendar year master's program in mental health counseling (would get a M.S.Ed, but not a license unless if I do a second year) before applying to medical school. Have already taken the MCATs (32R) and have an okay-GPA from a double-major engineering degree (3.68c, 3.72s). Have a decent amount of experience volunteer/clinical/research-wise. Am taking two years off after undergrad-- my first year is currently working as a research tech at a children's hospital. If I were to do the masters program for my second year off, I would be ending my research tech position a year early (and eliminating the chance of a publication).

If I were to do the master's program, the cons would be 30K in debt + no research publication. The pros would be that i'd have real exposure to the counseling field and would (possibly?) decide if i want to do med school/counseling. I was wondering if there's another way to figure this out, without becoming in debt?

I'm interested in the counseling field because I want to do therapy in the future. How much do psychiatrists get trained in therapy? How much of it do they do?

Go do some hospital shadowing. Many psychiatrists do little to no therapy. Some do a lot (my private practice is almost all psychotherapy with med management). Figure out if you want to be a Physician first.

 

[wskhunky]

Go do some hospital shadowing. Many psychiatrists do little to no therapy. Some do a lot (my private practice is almost all psychotherapy with med management). Figure out if you want to be a Physician first.

Thanks for your advice! I shadowed a psychiatry attending, and yeahh I realized that he did "therapy" through his day-to-day interactions with patients, while managing their medications, talking about how long they'd be in the hospital for, reminding them about "reality" for schizophrenic patients. He told me (among others) that psychiatrists rarely do therapy, and due to medschool debts & etc, could only see patients who are well off/ willing and able to pay decent money-- which are the exact reasons why I am considering counseling rather than med school. I would like to do therapy every day.

But I am attracted to the aspect of having lots of options and different career paths that I can choose (and the opportunity to travel abroad) if I were to do medical school... any thoughts?

 

[st2205]

Thanks for your advice! I shadowed a psychiatry attending, and yeahh I realized that he did "therapy" through his day-to-day interactions with patients, while managing their medications, talking about how long they'd be in the hospital for, reminding them about "reality" for schizophrenic patients. He told me (among others) that psychiatrists rarely do therapy, and due to medschool debts & etc, could only see patients who are well off/ willing and able to pay decent money-- which are the exact reasons why I am considering counseling rather than med school. I would like to do therapy every day.

But I am attracted to the aspect of having lots of options and different career paths that I can choose (and the opportunity to travel abroad) if I were to do medical school... any thoughts?

My thoughts are do whichever one you want to do, but when you're comparing the two financially understand that because therapy isn't lucrative in psychiatry doesn't mean that 35k yearly with a masters is better.

 

[nitemagi]

Therapy can be quite lucrative in psychiatry, if you're good at it and have a cash practice. In big cities, charging $2-300/hr is quite routine. But you have to actually practice it to get good at it. And you have to be a little entrepreneurial too.

 

[wskhunky]

Therapy can be quite lucrative in psychiatry, if you're good at it and have a cash practice. In big cities, charging $2-300/hr is quite routine. But you have to actually practice it to get good at it. And you have to be a little entrepreneurial too.

Do you think getting a counseling degree (224 hours practicum) before med school would help? Or is it better to do workshops/get training in residency/post-medschool?

 

[nitemagi]

Do you think getting a counseling degree (224 hours practicum) before med school would help? Or is it better to do workshops/get training in residency/post-medschool?

Better to get training after. Not only will you have a much broader knowledge base to draw from (book learning and patient exposure), but you'll be in a better financial situation to do it.

 

[whopper]

Only because it's been asked...

Forensic psychiatry is where the law interfaces with psychiatry. Where this usually happens is where someone is in a legal situation (e.g. a criminal case, lawsuit, involuntary commitment).

Evaluations for competency to stand trial, sanity evaluations (for a not guilty by reason of insanity defense), mitigation (where someone's already been found guilty but the defense attorney argues factors to give a lesser sentence), workplace evaluations, etc.

Some factors I believe may make a psychiatric resident want to go into the field....

• An interest in finding out a true diagnosis, to the degree where you're willing to take someone off of meds to see how they do for real, not just slapping a diagnosis for billing purposes.
• Being peeved by patient that you believe are malingering but not being taught about it in a manner that satisfied your curiosity
• Educating: while testifying, you need to be able to teach the judge and jury what is going on in a language they can understand. Kinda like being a psychiatric equivalent of Bill Nye.
• A morbid fascination with crime and criminals.

And most importantly....

• A strong desire to help the innocent but want to see the law throw the book at the guilty.

 

[surftheiop]

Just to throw in a plug for non-medical routes- my wife is in an MSW program and in her first semester took a class that taught more about addictions than most medstudents will learn in medschool (and more than non-psych would pick up in residency). Im sure once she starts psychotherapy classes it will be well beyond anything I get in medschool.

If you know therapy is your only (primary) interest, then I can assure you your going to be pulling you hair out after the first semester of medschool wondering why you aren't finishing up your MSW instead of still being 8+ years away from being able to focus entirely on doing therapy (if you choose).

 

[whopper]

A problem with going into psychiatry if you want to go into mental health treatment before medschool...

You're going to be thrust into a tough curriculum that only indirectly at best touches upon mental health for years.

Having to shove your finger up a guy's hairy brown rectum, memorize the histological layout of a hair follicle, cutting up a human body for hours in a room that stinks as if a can of Lysol was sprayed in your face......

After years of this while studying 12+ hours a day for years and very little of it is based on mental health.....

 

[nitemagi]

A problem with going into psychiatry if you want to go into mental health treatment before medschool...

You're going to be thrust into a tough curriculum that only indirectly at best touches upon mental health for years.

Having to shove your finger up a guy's hairy brown rectum, memorize the histological layout of a hair follicle, cutting up a human body for hours in a room that stinks as if a can of Lysol was sprayed in your face......

After years of this while studying 12+ hours a day for years and very little of it is based on mental health.....

True. Though something that the RxP psychologists just don't understand is that a lot more than you realize ends up becoming relevant to being a good psychiatrist. Starting with the intensive basic science, to recognizing signs of various medical illnesses, to the various effects of a psychotropic on the different organ systems of the body (not just the brain). It's all relevant.

If your only goal is to do psychotherapy, going through medical school may not be the path for you. If you want to have the possibility of mastery of both psychopharmacology and psychotherapy, then IMO you have to be a psychiatrist and thus a physician. Anything else is half-measures and quite possibly dangerous.

I'd also add re: Whopper's comments about forensics, that civil law is also an area relevant for forensic psychiatry, which he can comment on more than me.

 

[wskhunky]

Thank you all so much for your responses. Seems like... the conclusion is (and in some ways, it's so obvious!) if I want to do therapy, doing a masters is much more worthwhile than going to medical school, which focuses primarily on psychopharmacology.

Just wondering, though-- if I am still undecided between either profession, is it best to just get a master's first (would be +30K in debt, and miss out on a publication)? and if i like it, i could do the second year and pursue licensure, and if i don't, then go to med school?

Or would it be better to go to medical school, decide i actually (and with more certainty) want to do psychiatry/psychology-related work, and then pursue a masters/ do workshops to be able to focus on therapy & improve skills in thearpy, so i can do therapy+ med management?

 

[nitemagi]

Thank you all so much for your responses. Seems like... the conclusion is (and in some ways, it's so obvious!) if I want to do therapy, doing a masters is much more worthwhile than going to medical school, which focuses primarily on psychopharmacology.

Just wondering, though-- if I am still undecided between either profession, is it best to just get a master's first (would be +30K in debt, and miss out on a publication)? and if i like it, i could do the second year and pursue licensure, and if i don't, then go to med school?

Or would it be better to go to medical school, decide i actually (and with more certainty) want to do psychiatry/psychology-related work, and then pursue a masters/ do workshops to be able to focus on therapy & improve skills in thearpy, so i can do therapy+ med management?

If you're undecided on which profession, decide if you want to go through medical school or not. That's your first decision point. You know you want to do therapy. It's a long road to the end of residency. Don't waste 8 years if you don't have to. In that same regard, don't waste 1-year on a masters that you won't need/want later.

I was mentored as an undergrad by a terrific MSW when I was an undergrad. She introduced me to counseling and therapy, and for about a week I thought about getting an MSW. Having gone through the process and knowing a lot of MSW's, it would have been a waste of time. Everything I could have gotten [that I wanted] from an MSW training I got during med school and residency. Why turn 8 yrs into 9+? The difference is that I knew I wanted to go to medical school, and I was only 85% sure I wanted to do psychiatry at that point. Medical school and an MD gives you a lot of options. But it's a big commitment to get those options.

Residency requires you to learn some therapy. But you'll probably only get basic counseling skills in med school, unless you seek out a mentor and try to get additional training along the way (which is very uncommon, but feasible).

 

[NoNoNoNo]

My thoughts are do whichever one you want to do, but when you're comparing the two financially understand that because therapy isn't lucrative in psychiatry doesn't mean that 35k yearly with a masters is better.

This.

 

[surftheiop]

Thank you all so much for your responses. Seems like... the conclusion is (and in some ways, it's so obvious!) if I want to do therapy, doing a masters is much more worthwhile than going to medical school, which focuses primarily on psychopharmacology.

Just wondering, though-- if I am still undecided between either profession, is it best to just get a master's first (would be +30K in debt, and miss out on a publication)? and if i like it, i could do the second year and pursue licensure, and if i don't, then go to med school?

Or would it be better to go to medical school, decide i actually (and with more certainty) want to do psychiatry/psychology-related work, and then pursue a masters/ do workshops to be able to focus on therapy & improve skills in thearpy, so i can do therapy+ med management?

I'm sure you know this, but just to clarify if you have a misunderstanding. Med school doesn't "focus" on psychopharmacology either, medschool focuses on teaching you to be a physician as a whole, and psychopharm (or anything directly related to psych) is only going to be a tiny part of it.

 

[digitlnoize]

I'm sure you know this, but just to clarify if you have a misunderstanding. Med school doesn't "focus" on psychopharmacology either, medschool focuses on teaching you to be a physician as a whole, and psychopharm (or anything directly related to psych) is only going to be a tiny part of it.

An annoyingly small part of it at most schools. Considering how much psychopathology the average doctor encounters daily, we should do way more psych training in medical school.

Part of the problem is that, historically, we haven't known many of the mechanisms for how this stuff has worked. Now, some things are finally starting to become hazily clearer, and there's no reason we can't teach basic psychopharm in more depth, or even basic DSM diagnoses.

 

[notdeadyet]

Part of the problem is that, historically, we haven't known many of the mechanisms for how this stuff has worked. Now, some things are finally starting to become hazily clearer, and there's no reason we can't teach basic psychopharm in more depth, or even basic DSM diagnoses.

I'm curious what med school doesn't teach basic DSM diagnoses as part of the curriculum?

At most medical schools I know of, psychiatry is 1-2 months. Which makes it 8-17% of the clinical curriculum. Given how much there is to medicine, that seems about right.

I think the bigger problem is how seriously medical students treat psychiatry, not the amount of time allocated to it.

 

[digitlnoize]

I think you are correct. We had 1 month of psych 3rd year and a joke Behavioral Medicine class 2nd year.

I feel like its largely skipped during basic science years though, at least at my school, and in our (widely used) basic pharm text book...

 

[surftheiop]

My medschool actually has a surprisingly big component of psych related things, even in our first year. Its part of our fundamentals of medicine type class where you learn how to interview patients. We have already done mock interviews related to smoking cessation, anxiety, depression, substance use, domestic violence, etc. Before doing those interviews we always have a really brief introductory lecture that quickly outlines the DSM criteria for the condition and some some general screening guidelines. I've actually been really impressed with the exposure so far. It kind of makes sense, seeing as psych is the specialty where the interview is most critical so its a good way to practice challenging interview topics (ex. substance use) that will carry over to all fields.

 

[wskhunky]

surf, what medical school do you attend?