psychiatry vs IM

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Hello,

For those of you who have finished the first year of psych residency or more, can you please tell me which is more challenging, psych or IM? I am referring to the number of hours worked, emotional drain, ability to make a difference in patient's lives, etc.

Also, in which field are future working opportunities the best in terms of work hours and flexibility in locating a job?

Thank you in advance.
Tartufe

 

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bump please

 

[peppy]

I am not a resident yet, but from everything I've heard, psychiatry tends to have shorter, regular working hours and more flexibility than IM does. I can't comment on the other issues, which seem more subjective...hopefully someone else will answer that stuff. Good luck with making your decision.

 

[alina_s]

I think that the difference in stress levels varies wildly from program to program. Keep in mind that medicine residencies are usually much, much bigger than psychiatry, so even though they have far more beds, they can also "afford" some things that psychiatry can't. At my medical school, medicine rotations were far worse than psychiatry but in my residency, although the hours are still longer on medicine, they are a lot more predictable too. I worked just under the 80 hour limit on medicine, but on post-call days, I was always out by 2 (sometimes 11) and on non-call days, I never had to stay past 5:30, usually more like 3. Contrary to popular belief, psychiatry hours aren't cush by outside-of-medicine standards; I've been working about 65 hours, but the unpredictability makes it feel like more. There also aren't enough interns in my psych program to have assigned admission days, so on any day, we can get an admission at 4:55. On inpatient psych, there aren't enough residents for there to be a team with interns and a senior, so there isn't anybody to help us get out post call. Call is taken solo on psych, never two interns and a senior/night float. On psych, we have to cover the ER and the ward, so that we have to decide whether to admit patients and arrange for disposition if not (on medicine, the night float took care of admission decisions, interns just took care of orders afterwards). Maybe bigger programs have more comfortable coverage but I assume that they're busier too.

 

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bump

 

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250 views and so few responses. Please respond!

 

[Anasazi23]

Hello,

For those of you who have finished the first year of psych residency or more, can you please tell me which is more challenging, psych or IM? I am referring to the number of hours worked, emotional drain, ability to make a difference in patient's lives, etc.

Also, in which field are future working opportunities the best in terms of work hours and flexibility in locating a job?

Thank you in advance.
Tartufe

More challenging?

That completely depends on your personal skills, strengths, and interests. I've done both medicine and psychiatry in residency thus far. Both have their difficult moments. Medicine is, in my opinion, more tedious, repetitive, and less open-ended. It is also more grueling in terms of hours, demands, and stress (constant complaints of SOB, CP, etc, etc, etc.)

I've had brilliant medicine docs ask me how I have the strength to deal in psychiatry...that they usually enjoy it themselves, but didn't feel they had the patience or emotional strength to deal with it themselves.

As far as making a difference in peoples' lives - they both obviously do quite a lot, again in differing ways. Personally, I got tired of the 85 year old ladies with DM, HTN, dyslipidemia, lung nodules on CT, cellulitis, urinary incontinence complaining of chest tightness and struggling to get IVs in them all day. You stabilize them, and they leave. ...then come back again...rinse...repeat.

Psychiatry also has it's very aggravating revolving door...stabilized on antipsychotics...discharge...doesn't attend followup....uses cocaine and/or heroin...returns to ER at 3am complaining of hearing voices and "thinking of jumping in front of the subway train."

Both sets of patients (medicine vs. psych) have outpatient clinics and private practice, which can be much more rewarding from what I've seen...patients are more self-motivated, and both they and their families are infininetly grateful for helping them or their family members return to normal life.

Work hours and flexibility in finding a job?
Psych is better hands down. Psychiatrists are in demand in every state, even in the more saturated areas, such as New York City. Call is less, average pay (according to some salaries) is higher at both base and upper limit, malpractice is lower, lifestyle is better, occupational exposure is less, etc.

Hope that helps.

 

[OldPsychDoc]

More challenging?
...Hope that helps.

Agree with basically everything Anasazi said. For me the final clincher was looking at the lifestyle of senior residents. In IM you're still on call q 4, having responsibility for a team, and trying to fit in clinic. In psych you will find programs where call occurs once a month or less, and by third year you're pretty much focused on clinics.

 

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thanks to you guys for replying..i was actually waiting for your 2 cents!

How are psych calls, time wise vs IM calls??