as a c-/l psychiatrist, it drives me nuts when everyone suggests consults for people who want to do physical medicine. Consults is absolutely the worst possible field of psychiatry if you want to be managing people's medical problems because you are going to have to see everyone else doing that and you have the least opportunity to manage patient's medical problems compared with other areas of psychiatry. you are being explicitly consulted to address psychological aspects of care or answer psychiatric, ethical or medico-legal questions, and not medical ones. We are dealing with demoralization, somatization, functional neurological symptoms, adjustment reactions, grief, acute stress disorders, personality disorders, poor coping, poor adherence, behavior interfering with care, depression and anxiety in the medical setting, with lots of delirium and dementia thrown in for good measure.
inpatient, addictions, geriatrics, and community mental health all provide much more scope and opportunity to be managing medical problems depending on the set up. but there are inpatient units where psychiatrists do the admission physicals (at others it's an NP or internist), and routinely manage bread and butter medical issues that come up on the ward. In state hospital systems (even though there are often internists and specialists), psychiatrists often have to take a major role in managing medical problems. inpatient geropsych units have patients with lots of comorbidities which you will typically be co-managing with a geriatrician. In some community mental health settings, the psychiatrist may be the only physician the patient ever sees, and some spaces are set up where the psychiatrist is managing basic things likes hypertension, diabetes, cholesterol, hypothyroidism etc etc. there is a lot of medicine overlay in addictions and geriatrics (and eating disorders too, but this is a niche area, and typically an adolescent medicine doc is managing alot of the "medical stuff")
Listen OP, you are a first yr med student so its great you are interested in practicing medicine and you're gonna spend the next 5 years mastering the basics of the clinical skills necessary for the practice of medicine. It is normal for those destined for psychiatry, having invested so much to get those hard-one medical skills, and being completely unskilled in the dark arts of psychiatry, but fear losing that identity and not using those skills. But psychiatry is a branch of medicine and those skills and that knowledge you gain will provide a basic foundation you will use everyday in managing psychiatric problems, recognizing when a neurological or other medical issue is causing a patient's symptoms, monitoring labs and side-effects from medications, treating psychiatric issues in patients with heart/liver/kidney disease and pregnancy and breastfeeding, treating patients with somatoform disorders, factitious disorders and other abnormal illness behaviors, and the art of observation which forms the basis for our physical exam - the mental state exam. In psychiatry you will eventually learn a new set of skills and jedi mind tricks which build on those foundational skills in med school and mini-internship as well as undoing the harmful parts of medical training that rob you of empathy, humanity, and separate you from patients. While you can certainly try to be a one-stop shop for patients and manage all of their problems, you would have do a substandard job of it. We only have so much time to spend with patients, and the more time you spend treating patient's other medical issues, the less time to have to focus on the issues that bring them to see you in the first place.
