Psychiatry vs Family Medicine

[notdeadyet]

That argument came out of nowhere. Maybe it's a west coast east coast thing, but people would probably hold UPenn over UCLA around here.

And 99.9% of the population, including about 99% of us in the field, literally, could give a $hit either way.

If folks are still obsessing about ranking/prestige by the time they hit residency, they should probably surrender that they run to a type.

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[nancysinatra]

And 99.9% of the population, including about 99% of us in the field, literally, could give a $hit either way.

If folks are still obsessing about ranking/prestige by the time they hit residency, they should probably surrender that they run to a type.

I care. I care very much about knowing which orthopedic program is most highly ranked, and isn't it actually HSS?

Do we have an equivalent in psychiatry? If not, why not? What's wrong with us?

 

[DOC PENGUIN]

I care. I care very much about knowing which orthopedic program is most highly ranked, and isn't it actually HSS?

Do we have an equivalent in psychiatry? If not, why not? What's wrong with us?

MGH/McLean and Hopkins i heard were good. I also heard that NYU and Columbia are very good.

 

[notdeadyet]

I care. I care very much about knowing which orthopedic program is most highly ranked, and isn't it actually HSS?

Do we have an equivalent in psychiatry? If not, why not? What's wrong with us?

Apples and oranges. A bone is a bone is a bone. It doesn't matter whether or not it comes from a homeless patient or an aristocrat, gay or straight patient, white or Latino, urban or rural. It's surgery, so it's not like there are distinctions between inpatient and outpatient. There are different procedures, but all are variations of the same theme, so you don't have dozens of radically different modalities to deal with.

Surgery is easy to quantify and put in boxes. Psych isn't. Asking the best psych program is akin to asking the best color.

 

[nancysinatra]

Surgery is easy to quantify and put in boxes. Psych isn't. Asking the best psych program is akin to asking the best color.

Surely we would agree that there must be a worst psych program, no?

 

[notdeadyet]

Surely we would agree that there must be a worst psych program, no?

While it's hard to make a case for one program being all things for all people, I think you're right that you could make a case for some programs being no good for everyone.

 

[digitlnoize]

MGH/McLean and Hopkins i heard were good. I also heard that NYU and Columbia are very good.

I hate these "best places" lists. The choice of residency is so individualized that I feel it's nearly impossible to make a list of best places.

For me, all of those programs were so far down my list that I didn't even bother applying. I had ZERO desire to live in Boston, Baltimore, or NYC. Period. ZERO. I want to live in the opposite of those places. Thus, every one of those programs is the worst place for me.

Granted, I'm a non-trad with a family, so I'm a bit unique, but the same applies if you're a west coaster looking to stay near your family, or someone who loves mountains, or someone who hates the cold, or...etc.

If your only criteria for a "best place" is "competitiveness" and "prestige", then sure, those places are great. But, you couldn't pay me enough to do residency at any of them. Between the expense of living in those cities, the crime, the traffic, the health risks, and all the other big city life problems that I personally hate, and the rampant narcissism you're likely to encounter at those places...no way.

Don't be Lemmings. [YOUTUBE]http://www.youtube.com/watch?v=LQqq3e03EBQ[/YOUTUBE]

 

[carlosc1dbz]

Doctors dont get rich unless they are something other than doctors. ex. business owners. Also my understanding is that most salaries at these big name academic places are usually lower.

 

[vistaril]

Doctors dont get rich unless they are something other than doctors. ex. business owners. Also my understanding is that most salaries at these big name academic places are usually lower.

a lot of specialties can get rich by simply practicing medicine....

 

[DD214_DOC]

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.

I call the, "only knowing mental health" thing BS.

Yes, we know mental health very well. But some of us also know enough medicine to give the family docs a run for their money, particularly highlighted by getting a referral for facticious disorder or malingering and ending up sending them to get a direct laryngoscopy to diagnose VCD. (which was positive). Needless to say, the PCM had egg on his face.

I'm also willing to bet I know more neurology than most family doctors, especially since it's part of our board exams.

 

[PikminOC]

I call the, "only knowing mental health" thing BS.

Yes, we know mental health very well. But some of us also know enough medicine to give the family docs a run for their money, particularly highlighted by getting a referral for facticious disorder or malingering and ending up sending them to get a direct laryngoscopy to diagnose VCD. (which was positive). Needless to say, the PCM had egg on his face.

I'm also willing to bet I know more neurology than most family doctors, especially since it's part of our board exams.

I actually completed a preliminary medicine year for internship with 2 months in the ICU prior to my psychiatry training for PGY2-4.

Recently, I was consulted for anxiety on a CHF and COPD'er who was imminently ill and needed ICU placement, not more benzos or a psychiatry consult. I tried to tell the primary doc, who was not answering his pages. So I called the pulmonary doc on the case who finally admitted the patient to the ICU due to tachycardia and hypoxia, where she passed away less than 24 hours later. The patient's discomfort was not suddden onset, but the primary doc labelled it as 'anxiety' when immediate medical care was needed.

And we focus on the "whole" patient with a biopsychosocial model, not just the 'mental' part.

I am surprised Leukocyte wrote what he wrote on here.

And 'rich' depends on your lifestyle, your dependents, and your loans so it is a very relative term.

 

[nancysinatra]

Well I call BS about people saying that psychiatrists are well rounded general doctors who can do anything equally well as specialists in those areas. Sure there are examples of where an internist missed something and called a psych consult only to have the psychiatrist discover the underlying medical problem. Everyone who's been to residency has some examples like that.

Nonetheless, I would not go to a psychiatrist to get my appendix removed or to have an echocardiogram read or even to have my high blood pressure treated. I wouldn't go to a psychiatrist if I had a stroke either, despite those 2 infinitely useful months of neurology. If I had ARDS and needed to be on a ventilator, guess what? I wouldn't call a psychiatrist. And despite the fact that we occasionally sedate patients using our arsenal of PO meds, I wouldn't trust a psychiatrist to administer anesthesia! Or for that matter, I don't want a psychiatrist reading biopsies or interpreting abdominal CTs.

So I disagree, we do not focus on the "whole patient." That's a bunch of bunk our field uses to distinguish itself from other fields that just look at "the disease."

Seriously, do people really disagree that the main focus of psychiatry is mental health?

I'm not saying we aren't doctors but I'm just saying our training is rather specialized. I'm not saying that's always good either, but at least that's been my experience.

Oh, and while I "know" lots of neurology because it's on the PRITE, it's not like I'm some kind of ace when it comes to actually implementing it. Ordering a B12 here and there or recommending an LP for a difficult delirium case, and knowing a bit about parkinson's meds does not make me "good" at neurology!

 

[PikminOC]

Wait until you are an attending and your name is on the chart so you can be named in a lawsuit if the patient is not managed properly from all sides. Then, you will be very interested in the "whole" pt.

I don't think I am as qualified as a fully trained IM doc, but I do think it is important that we do catch medical discrepancies in spite of only being in chg of "mental health".

I don't want an anesthesiologist managing my patients mental illness.

 

[nancysinatra]

Wait until you are an attending and your name is on the chart so you can be named in a lawsuit if the patient is not managed properly from all sides. Then, you will be very interested in the "whole" pt.

I don't think I am as qualified as a fully trained IM doc, but I do think it is important that we do catch medical discrepancies in spite of only being in chg of "mental health".

I don't want an anesthesiologist managing my patients mental illness.

I agree with you, but wasn't the point of this thread to discuss the differences between psych and family medicine, for the sake of someone who is trying to choose between the two?

If you choose psych you're not going to be "focusing on the whole patient" as the major emphasis of your job. If you DO focus on the "whole patient" with every patient you see then good luck managing your time and getting properly paid for all those workups and physical exams.

Of course no one wants to miss anything, whether medical or psychiatric. But that should be true in all specialties.

All I'm saying is there is a difference between the fields. Really I'm only pointing this out because every time this question comes up on the psych forum, people rush to say the same pro-psychiatry platitudes, like "psychiatry is about the whole patient," or "in psychiatry you can't afford to not know your medicine." Yet the person asking the question is facing a major decision between two very different fields! How does it help to minimize the differences? The person might still choose psychiatry, even if the differences are discussed openly.

When I was trying to decide between psychiatry and surgery, I couldn't even count the number of people in both fields who told me that the two fields have "a lot of overlap" in terms of who goes into them. I even heard people say that they have some "similarities."

Now I know that at least the latter claim is just bunk. There is not a single procedure in psychiatry and we do not operate, ever. My day to day job bears no resemblance to that of a surgeon's. Similarly surgeons do not get to know the patients in the same way we do. They do not deal with the same issues. I might have made the same choice without those comments, but I'm just saying that given the position I was in I don't think they helped much.

 

[OldPsychDoc]

The hardest thing from my end in this whole application process is trying to figure out from those personal statements and LORs who really has a heart for caring for the mentally ill. I don't mind a little ambivalence, or serious consideration of other disciplines--but it sure make my job easier when that quality jumps off the page.

Nancy makes good points--at the same time, as committed as I was to psych going into MS3, I might have changed my mind if I hadn't seen that there was "enough" medicine to keep me interested. But psych and FP are indeed very different in day to day lifestyle, and I can honestly say I would've lost my mind in primary care.

Bottom line: when it comes to these types of threads, nothing we will say is going to matter if you don't KNOW YOURSELVES. (Which is not to say that the occasional platitude or observation from another person can't help strike a relevant chord in that process for you.)

 

[vistaril]

When I was trying to decide between psychiatry and surgery, I couldn't even count the number of people in both fields who told me that the two fields have "a lot of overlap" in terms of who goes into them. I even heard people say that they have some "similarities."

Now I know that at least the latter claim is just bunk. There is not a single procedure in psychiatry and we do not operate, ever. My day to day job bears no resemblance to that of a surgeon's. .

ummm, I like you nancy, but did you not know this going in? did you see psychiatrists during your med school rotation doing procedures and making complex medical/surgical decisions? Of course not....

anyone who is going to "miss the medicine" (or however you want to phrase it) should know they shouldn't do psychiatry. That is very different than not missing the medicine and then still telling people you do, or not missing the medicine and still telling people you do still use your "medical knowledge" on psychiatry

 

[nancysinatra]

ummm, I like you nancy, but did you not know this going in? did you see psychiatrists during your med school rotation doing procedures and making complex medical/surgical decisions? Of course not....

At my med school, the psychiatrists did lobotomies.

 

[BlueLotus]

Great topic as I like FM and Psych, too.

My heart is in psych, but I will do a transitional year first to test that theory : )
Glad to hear it's OK to apply to both fields.

Also, I think that if one likes both fields, and one does not get a psych residency or if the residency offered appears to have noticeable structural and internal problems, then it may be wisest to choose FM for an environment that may be healthier.

For me, the extra time is to discover if I am only interested in psych; If so, the prior statement no longer applies. Then, I think, when a person is only interested in psych (can't breathe without it), then, go for any program available : )

Wish I knew about this site earlier!

New to forums: Here goes my 1st public reply.

 

[vistaril]

Great topic as I like FM and Psych, too.

My heart is in psych, but I will do a transitional year first to test that theory : )
Glad to hear it's OK to apply to both fields.

Also, I think that if one likes both fields, and one does not get a psych residency or if the residency offered appears to have noticeable structural and internal problems, then it may be wisest to choose FM for an environment that may be healthier.

For me, the extra time is to discover if I am only interested in psych; If so, the prior statement no longer applies. Then, I think, when a person is only interested in psych (can't breathe without it), then, go for any program available : )

Wish I knew about this site earlier!

New to forums: Here goes my 1st public reply.

I'm confused by a lot of the above....

for starters, if your heart is in psych why do you need a transitional year to 'test that theory'? Could you not have tested that theory during the last couple years or med school?

second, if one 'does not get a psych residency' and applied broadly, there are serious issues. And that person may not get any residency. There are some applicants who probably have a better chance to match fm than psych if they are just looking to match somewhere. There are other applicants who probably have a better chance to match psych than fm. For example, an american osteopathic grad with one comlex failure, poor to mediocre IM/surgery/fm rotation scores, but seems like a decent enough communicator, did a number of psych electives and got some decent psych letters is going to have a lot easier time trying to get in some psych program somewhere than a family medicine program. And there are other types of candidates who can probably slide into some famly medicine program a little easier than some psych programs. They are both two of the least competitive fields, but depending on the strengths of ones application it may be a little easier to match in one vs the other.

 

[heyjack70]

For outpatient:

Family Medicine:
-practicing a broad range of medicine
-being the hub for all referrals, specialist reports, and test results
-specialists know you make much less than them, and are cramming pt's into 10 minute visits, but will still tell patients to have you fill out work forms even if it is in the area of their specialty.
-getting less $ and doing more work
---make a bit less than psych, but only 3 years of residency


Psychiatry:
-focusing on mental health
-keeping track of labs/tests that you order
-deferring/referring primary care issues to PCP.
-much less in your inbox
-make a bit more the family medicine
---but 4 years of residency.

 

[vistaril]

For outpatient:

Family Medicine:
-practicing a broad range of medicine
-being the hub for all referrals, specialist reports, and test results
-specialists know you make much less than them, and are cramming pt's into 10 minute visits, but will still tell patients to have you fill out work forms even if it is in the area of their specialty.
-getting less $ and doing more work
---make a bit less than psych, but only 3 years of residency


Psychiatry:
-focusing on mental health
-keeping track of labs/tests that you order
-deferring/referring primary care issues to PCP.
-much less in your inbox
-make a bit more the family medicine
---but 4 years of residency.

as for FM salary vs psych salary, I think it depends on where you are looking and how it is being reported(more psychs are on salary and psych's have easier to identify income).....

that said, the income potential in family med is a lot higher. I could go out and make more money over the next few years in family med than psych. That's just speaking for me. Family med has the potential for ancillary income and other revenue sources within the practice. Family medicine also has more private practice possibilities imo. And if you go over to the family medicine forums on this site(small sample I know), you'll see that one guy is making > 600k and several others are doing 350-450k....that's not common, but it's much more possible to do that in fm than psych.

In both family medicine and psych, the lowest salaried positions(like at VAs for outpt work) are generally going to be in the 155-160ish area.

 

[Leo Aquarius]

as for FM salary vs psych salary, I think it depends on where you are looking and how it is being reported(more psychs are on salary and psych's have easier to identify income).....

that said, the income potential in family med is a lot higher. I could go out and make more money over the next few years in family med than psych. That's just speaking for me. Family med has the potential for ancillary income and other revenue sources within the practice. Family medicine also has more private practice possibilities imo. And if you go over to the family medicine forums on this site(small sample I know), you'll see that one guy is making > 600k and several others are doing 350-450k....that's not common, but it's much more possible to do that in fm than psych.

In both family medicine and psych, the lowest salaried positions(like at VAs for outpt work) are generally going to be in the 155-160ish area.

This is silly. Psychiatrist potential can go as far as he or she wants, just as in Fam med. You can't say potential is a lot higher, because large revenue streams are possible in both fields. It's completely dependent on the individual. How much you can make depends on your drive, opportunities, and creativity. Have you heard of a psychiatrist making more than a brain surgeon? I have. Around here brain surgeons make $500,000. I know two psychiatrists who are directors of hospitals, and they make huge sums, over $700,000. (Surgeons are too busy to direct hospitals imho.) I know of another who runs a multigroup practice, again big money. I know another who does work for a pharmaceutical company. You make as much as you want. You can slice the loaf any number of ways. Psychiatry is a great field, and it gives you the flexibility and time to take on leadership and managerial roles. Stop being scared about it, go out there, and do it!

Start looking at the majority of family med docs, instead of the highest paid which are outliers. The vast majority are pressured to see dozens of patients a day only to be reimbursed at a fraction of what they bill insurance, and these reimbursement rates are being cut by Congress. I'd hate to be doing that day-in-and-day-out. Many have to close shop or move states. We have it much better from this standpoint, I don't care what the "potential" is. If you want to make big money as a family med doc, go rural and do deliveries all day. Again, the vast majority of family med docs don't do this and face a much different reality. I'm very happy to be in psychiatry, and plan on making lots of money but it's not my obsession.

Vistaril, you're so hung up on money it's ridiculous. And your logic and analysis of it is on the level of high school reasoning. Forget these message boards man. Rich successful doctors don't hang out on message boards.

 

[dl2dp2]

wow vistaril,
You're a downer bro! I just graduated residency and making well over your high end of range >220, with benefits, work about 6 hours per day and with way less stress than an ER physician. dont have to work nights. I love my job, its interesting, in a private psych hospital. Also doing alot of addictions. I am also a medical director of one CD program. On call every 4th weekend. Im about 20 min away from a major city. this is also to start, my salary will go way up if I elect to stay here.

There are so many jobs like this. We can go anywhere we want as well.

My ER buddies are making about the same as me however they are fluctuating with days and nights. I would hate that lifestyle. Screws up family life, cant see your kids daily etc...Not to mention by fluctuating your circadian cycle you pose a higher risk for cancer...this just came out recently

I am super happy with my decision with psych. Vistaril....are you depressed. Maybe you should get some therapy, an antidepressant maybe?? You're a pgy4...go out and make stuff happen rather than just complain. The opportunities with psych are endless

LOL.

This is basically where the money is at with psych, IMHO: 220k. 6 hours a day. TO START. interesting cases. BLISS.

And it's not just "possible", it's the AVERAGE. This is like the Kaiser-Permenante arrangement. Big HMO rates. And not some random rural place. Suburb of major city. Sure this isn't ortho. We top out at 250-300 at the end of the career. We don't make millions. So what?

This is also why i'm super happy with my decision with psych. I think Vistaril might very well be depressed... but I think maybe he needs 3x/week on the couch.

 

[F0nzie]

Why is everyone so hard on Vistaril. He just want to learn how to make some cheddar.

 

[BlueLotus]

Psychiatry is a great field, and it gives you the flexibility and time to take on leadership and managerial roles. Stop being scared about it, go out there, and do it!

Thanks for the clarification from an earlier responder + from the encouragement here. It's Great!

I went to school thinking IM, PEDs, or FM. In my school, much of the training is in general medicine; there were relatively few rotations that I could devote to psych. Psych never crossed my mind until my 1st rotation. It was a great experience!

Income potential, status, or stigma of a field are not my concerns. I certainly want enjoy what I am doing each day, but I have entered medicine as a vocation rather than a job. That is, I want to provide a useful service for others which I believe is easiest to do when we enter a field that best matches our interests and temperament.

I believe that it is good to take the time needed to seek the truth for a person when there is still uncertainty surrounding a big decision. Although I am nervous, I am embracing the opportunity to do a transitional year.

 

[vistaril]

LOL.

This is basically where the money is at with psych, IMHO: 220k. 6 hours a day. TO START. interesting cases. BLISS.

And it's not just "possible", it's the AVERAGE. .

It is definately not average to start out working 6 hours a day making 220k. And especially not seeing interesting cases.

 

[vistaril]

This is silly. Psychiatrist potential can go as far as he or she wants, just as in Fam med. You can't say potential is a lot higher, because large revenue streams are possible in both fields. It's completely dependent on the individual. How much you can make depends on your drive, opportunities, and creativity. Have you heard of a psychiatrist making more than a brain surgeon? I have. Around here brain surgeons make $500,000. I know two psychiatrists who are directors of hospitals, and they make huge sums, over $700,000. (Surgeons are too busy to direct hospitals imho.) I know of another who runs a multigroup practice, again big money. I know another who does work for a pharmaceutical company. You make as much as you want. You can slice the loaf any number of ways. Psychiatry is a great field, and it gives you the flexibility and time to take on leadership and managerial roles. Stop being scared about it, go out there, and do it!

Start looking at the majority of family med docs, instead of the highest paid which are outliers.

the problem is most psychiatrists do not work for pharm companies or direct hospitals.....just like most FMs don't. The difference between the two is that once you get past these outliers in both fields, family medicine has a lot more potential for routine extra revenue sources within the scope of their practice. Labs, imaging, home health nursing, etc...a lot of family med and urgent care places have a pharmacy within the urgent care place for example that they own. things like that. You can't do that in psych. I've been racking my brain thinking of ways to generate such extra revenue and can't think of anything.

 

[F0nzie]

the problem is most psychiatrists do not work for pharm companies or direct hospitals.....just like most fms don't. The difference between the two is that once you get past these outliers in both fields, family medicine has a lot more potential for routine extra revenue sources within the scope of their practice. Labs, imaging, home health nursing, etc...a lot of family med and urgent care places have a pharmacy within the urgent care place for example that they own. Things like that. You can't do that in psych. i've been racking my brain thinking of ways to generate such extra revenue and can't think of anything.

ch-ch-ch-cheddar

 

[vistaril]

ch-ch-ch-cheddar

Haven't really brought this up in the revenue source thread, but suboxone is something I am looking into.....but that's not really an extra revenue source within the scope of what you're already doing. You still have to see new patients to generate the $. But it may be extra in the sense that the per pt reimbursement is higher than a medmgt pt or the per minute reimbursement is higher...depending on how you run it of course. But family med can do suboxone as well.

What's the suboxone situation like in your area? Possibility of high volume(or at least pushing the 100 pt max)cash side business or is it tough to attract these pts for suboxone in your area?

 

[Armadillos]

Maybe the family med market is just tough where I am in comparison to the relatively expensive rent prices, but I think a family med doc around here might literally punch you in the face if you said anything related to family med currently having a good financial situation.

 

[vistaril]

Maybe the family med market is just tough where I am in comparison to the relatively expensive rent prices, but I think a family med doc around here might literally punch you in the face if you said anything related to family med currently having a good financial situation.

it doesn't for some people. You can't put no effort into it, and if you start your own place there is some risk and some possibility for failure as well. But there is no question that if done right there are a lot of different revenue sources which you can incorporate into practice....much easier than in psych.

 

[F0nzie]

I have no idea what the suboxone situation is like in my area... not even sure the best way to get referrals for opiate addition treatment...

 

[OldPsychDoc]

I have no idea what the suboxone situation is like in my area... not even sure the best way to get referrals for opiate addition treatment...

Just buy an ad in your local "free" paper--you'll be at the 30 pt limit before your check clears....

 

[steph curreus]

Hey everyone! Thanks for all the great info on this thread! I'm a third year student and I'm kinda in the same boat now deciding between the two. I was always was thinking FM as my top choice but now that I'm in an out patient FM rotation the field doesn't seem to be as appealing as I thought, so I'm really considering psych cause I really enjoyed that rotation.

Can anyone speak to what these two specialties are like in the military? I'm an HPSP student so I will owe the first few years of practice to the army. Just wondering if there are significant differences in these fields between the civilian and military practices. Thanks!