Starting 4th year. Gotta pick one for match soon. Both have my interest and I keep oscillating between the two.
Thoughts?
Thoughts?
Starting 4th year. Gotta pick one for match soon. Both have my interest and I keep oscillating between the two.
Thoughts?
The other exercise I really like is to imagine yourself with 2 (or more) exam rooms waiting for you. Would you rather see the hypertensive diabetic, or the depressed patient whose SSRI has stopped working for them.
I'll start. First of all, you can apply to both in the match. Just a matter of ranking.
Actually the difference is the hypertensive diabetic depressed patient whose SSRI stopped working who you need to deal with all of their problems, or the hypertensive diabetic depressed patient whose SSRI stopped working who you just focus on the depression. Although depression worsens cardiovascular disease outcomes there is no convincing evidence that our current treatments make any difference to these outcomes...
Thank you all for replies.
Two patients waiting, the depressed one sounds more interesting.
What are everyone's thoughts on the differences in lifestyle between the two specialties?
Thank you all for replies.
Two patients waiting, the depressed one sounds more interesting.
What are everyone's thoughts on the differences in lifestyle between the two specialties?
Put yourself in the PCPs shoes. How would you react to having your patient come in and finding all the htn and dm meds you had put them on (possibly after trailing others or chosen based on part of a larger health plan) were all changed by someone who has had little exposure to the patient and, let's face it, a few months of experience on medicine rotations as an intern in terms of experience in this.So the diabetic hypertensive depressed patient comes to your psych clinic what do you do? Do you treat the depression and the HTN and DM even though the latter are not your domain? Refer them to their PCP? What do psychiatrists do?
Starting 4th year. Gotta pick one for match soon. Both have my interest and I keep oscillating between the two.
Thoughts?
I personaly do not see much relationship between the two specialties. It is pretty clear cut, and there is a very clear difference between the two.
Family Medicine:
-You are the PCP, meaning you WANT to and ENJOY to take responsibility and control over the ENTIRE patient's health.
-You ENJOY managing MANY medical conditions spanning different feilds.
-You ENJOY doing minor PROCEDURES.
-You are CONFORTABLE with knowing little about too many things - NOTE: This can be a very uncomfortable feeling, as I came to find out. You might always feel like you do not know much about anything, but you do know about a lot of many different things.
-As a PCP, patients EXPECT a more "personalized" care from you, since you are the only doc who is untimately responsible for their entire health.
To me, practicing FM is like being in (and enjoying) a state of "mania", were one rapidly shifts from one thought process to another. It can drive some crazy!
Psychiatry
-You are FOCUSED on ONE thing: Mental Health
-You are responsible for ONE aspect of the patient's health: Mental Health
-You know one thing very well: Mental Health
-You do not want to bother with (and do not like) managing any other medical condition that is not related to mental health.
-You need to have a "tough skin", because some patient encounters can be very stressfull.
Good Luck.
Maybe the most simple way to look at it is:
FP- Jack of all trades, experts at none (so to speak)
Psych- Expert at one small niche
Personally I prefer knowing everything about something rather than something about everything. Its hard enough to know everything well in psychiatry. I can't imagine FP because you need to know all of medicine, peds and psychiatry to boot since you will be seeing 75 percent of psychiatric patients anyway.
Thank you all for replies.
Two patients waiting, the depressed one sounds more interesting.
What are everyone's thoughts on the differences in lifestyle between the two specialties?
psych sucks, do FM
I have no problem keeping our numbers small
Actually, all we try to do in these forums is inform based on the resources available to us. Ultimately do what makes you happy.
This is my 100th post !
Pay:
Family Medicine
- $158,000 - $167,000 per year mean income (Medscape and WUSTL sites)
- You bill Medicare $100 and you only get paid $60, so insurance companies don't even cover your expenses.
Psychiatry
- You bill $300 per hour to your patient and he pays you directly in cash. You can chose to accept insurance if you like, but psych is one of the last specialties where you can have a cash-only practice.
- Psychiatry has a higher average salary for fewer working hours than fam med.
Taking income and working hours data from the WUSTL, Medscape, and ACEP sites and coming up with a dollars per hour value for each specialty, I ranked the non-surgical specialties from highest earners to lowest at bottom:
Non-Surgical Specialties, Income Per Hour Rank
Radiology
Dermatology
Anesthesiology
Psychiatry - when combining employee and private practice rates
Emergency Medicine
Neurology
Internal Medicine
Pediatrics
Family Practice
sources*: http://residency.wustl.edu/medadmin/resweb.nsf/, http://www.acep.org/content.aspx?id=45806, http://www.medscape.com/sites/public/physician-comp/2011
Keep in mind that the average income in psychiatry is not astronomical because it has one of the highest percentage of doctors working less than 30 hrs per week. So if you wanted to bring in lots of money in this specialty you could, just work 40 or more hrs.
I think you're painting a very unrealistic pro-psychiatry picture of things in terms of lifestyle/pay....I'd like to know the % of psychiatrists out there working who recieve $300/hr compensation in cash money from patients. I bet it's less than 5%.
And emergency medicine docs make more than psychiatrists per hour.....if you went over to the em boards and posted this they would laugh. Keep in mind that emergency medicine docs typically work a clinical hrs year of less than 1800 hrs in many cases.....Salaried EM positions typically pay 150-175+ per hour. Inpatient or outpt psychiatry positions do not end up paying that much.
Psychiatry is one of the lower paying specialties in medicine. Yes, there are exceptions, but those exceptions exist in every field. If you're a family med doc and you work in a high volume doc in a box walk in clinic you can see 70 pts a day in cold season.....
The $300/hr cash is indeed a minority of psychiatry, and not representative of how most psychiatrists practice. Nevertheless, I can promise you that the average 40-50 hr week starting salaries in psych are well above the $158-167K mentioned for FP above.
a more honest comparison is this: what is the average STARTING salary in psych for a full time outpt position(at like a CMHC) vs the same(outpt m-f 830-5) in family med?
psych sucks, do FM
I know you won't get as much money...
Actually, the average psych salary is higher than the average FM salary in most salary surveys. When you then take into account the various factors pulling down our average (low # of hours worked per week, high percent of >55yo docs working part time, etc), it's substantially higher, especially in some subspecialties like C&A, and if calculated per hour.
people dont go into psych with a certain ideal wrt how they are going to practice. people DO go into family with this concept.
If a family med doc wante to maximize their income in the same way psychs do, they could.
I think you're painting a very unrealistic pro-psychiatry picture of things in terms of lifestyle/pay....I'd like to know the % of psychiatrists out there working who recieve $300/hr compensation in cash money from patients. I bet it's less than 5%.
QUOTE]
$300/hr is fairly typical in a cash practice- however this is revenue and not take-home pay.
However, if i do just my fm residency...and want to practice psych...can't i open up a psych practice for med. managment and only do c.o.d if reimbursiment is an issue b/c i wont be a trained psychiatrist but an fp doing just psych??
Can anyone elaborate on this?
Except in my case: Do IM then do a year or two of additional training (my interests is with chronic pain and addiction stuff), kinda play that Dr. Drew Pinsky style medicine?
I don't want flames. I just have to ask about this route?
Can anyone elaborate on this?
Except in my case: Do IM then do a year or two of additional training (my interests is with chronic pain and addiction stuff), kinda play that Dr. Drew Pinsky style medicine?
I don't want flames. I just have to ask about this route?
if you want to do addiction medicine then doing an IM residency and then a 12 month addiction fellowship would be perfect.
Im a psychiatrist and am not complaining and as a pgy-4 have job offers I am sorting out, but it is one of the lowest paying specialties out there. The idea that it's not is silly. Someone earlier(a freaking med student?) posted that psych makes more than emergency med per hour....that is not remotely true. The em board would laugh at that concept to no end.....
average clinical per hour salaries for emergency medicine physicians on staff(not in a group that bills separately to patients) are ~200/hr. For psych the equivalent is maybe 120/hr.
Yes you can get ~$200/hr in a small rural ER working single coverage. But the big groups that employ EM physicians around civilization start at $125 (at least around my midwest metro). They do get benefits though on top of it, which most psychiatrists don't get with an hourly rate. But of course the ceiling is higher, and they can make $200+/hr if they find an honest group that won't exploit them and won't fire them right before they're eligible for partner status.
If you want to be an employee, then yes, EM pays more than psych. That being said, it's very difficult (if not impossible) to do own your own EM practice and make the big money...you might one day make partner, but often that's just a dangling carrot.
However, in psych private practice, if you own your own place, the ceiling is MUCH higher than in EM. You can fairly easily clear $200/hour after expenses in most psych practices...MUCH more if you're frugal, in the right area, in child, and/or unethical.
Plus, our hours are so much better. And, no rectals, pelvics, infectious diseases, or blood and guts. Psych FTW...at least for me. Everyone is entitled to their own opinion!
people do their own EM practices all the time....most EM practices in suburban ER's are just groups of EM physicians coming together. The pt's insurance company gets billed for services by the EM group. The EM physicians in the group divide the pot up based on billings/collections. Most people in such practices get to be partner fairly easily since there isn't a large investment in real estate or equipment required.
Most psychiatrists make between 170k and 220k a year. Thats where most of them fall outside academia. Most EM physicians fall a good bit above that. An EM physician in the 30th salary percentile for EM makes about as much as a psychiatrist in the 75th percent for psych. EM physicians also tend to work fewer clinical hours than psychiatrists.
There is always a lot of stuff about what a psychiatrist "can" make under conditions x.y,z if things are done this way or that. Well if those games can be played, I know a family medicine physician who makes >450k.....it's best to just look at what the numbers actually say, and the numbers say psychiatry is one of the lower paying specialties.
wow vistaril,
You're a downer bro! I just graduated residency and making well over your high end of range >220,
Like I said, individual reports are not particularly useful. I know a guy in family medicine who makes 500k a year and I also know of a guy in urology who only makes about 230k. What do you make of that? Nothing....except hopefully that there are people in every field well above and sometimes below salary norms.....
The averages and the 25th-75th numbers make it clear that psychiatry is one of the lower paying specialties. That doesnt mean you can't do better(or worse) than these averages.
I actually (surprise) completely disagree. Although individual reports lack the statistical power, they are very important, at least in situations like this, for letting you know what is POSSIBLE.
The fact that it's possible to have kumar28's gig in psychiatry makes it destroy every other specialty, at least for me. Others may feel differently.
Regardless, I do think it's important to not only look at the pure statistical data, but to look at individual stories so you can learn what others are doing and what is possible. .
there are bunches of "individual stories" of physicians/residents in all these forums....go over to anesthesia and you'll learn it's very doable to make 7 figures if you hustle. go over to cardiology and you'll hear stories about how if your not doing 7 figures by your third year out of an interventional fellowship you're office manager is probably stealing from you. go over to neurology and there are stories of the many salaried inpatient gheneral neuro/stroke positions being offered at 400k+.
There is always going to be a bunch of individual stories in every specialty that seem more appealing than what the norms are.
Sorry, but Harvard and Hopkins have the most name brand recognition in all of medicine. Don't pretend like UPenn is on that same name recognition level. If you invoke UPenn, then you have to invoke Stanford, UCLA, UCSF and probably Yale. That's just domestically. On an international level UPenn is nothing compared to name recognition of, say, UCLA. People overseas know UCLA. You say UPenn or Perelman and they won't hear what you are saying.