Psychiatry with low COMLEX

[Snafuiil]

So I'm applying in the upcoming match and wanted to know if I even have a shot at psychiatry at all.
My COMLEX is a 418 level 1 and I still have to take Level 2 coming up but I have been studying well and think I can get a solid score on it.
I also have 2 letters from psychiatrists and a 3 more letters in different specialties.
Should I try to take USMLE for psych will it make a difference?

Any insight will help!

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[Giovanotto]

Oh boy, it doesn't look good. You definitely need to take USMLE for psych these days.

 

[BorderlineQueen]

Based on match data with that low of a complex score you have around a 70 percent chance of matching . Only take step one if you know you can pass on your first attempt. Because if you fail that failure will look bad . Tableau Public

 

[BorntobeDO?]

I am not one who believes USMLE is necessary for psych. But at the same time, that 418 is a real issue. If I were you, I would be looking at away rotations and picking a favorite backup.

 

[Dr. Rafiki]

Psychiatry, based on the most recent charting outcomes, is one of the two specialties where ranking 2 specialties (as opposed to only applying psych) does not severely hurt your chances in matching. Family Med is the other.

My advice: apply to and rank as many psych AND as many Family Med programs as you can; you'll likely deal with mental health issues frequently in primary care and thus can still pursue your passion. This way, you mitigate the chance of not matching.

 

[hallowmann]

Agree with above. I'd still apply psych, but have sufficient FM programs as a backup. Be sure to cater your apps to each though (different personal statement, LORs, etc.).

 

[samac]

So I’m on the psych train right now with a board failure. What I’m learning is that with PDs who have been around for a while board scores aren’t as important (yet). They want a person that gets along well with others.

Look at programs that were DO and do as many aways as possible. Good luck.

 

[DO2015CA]

So I’m on the psych train right now with a board failure. What I’m learning is that with PDs who have been around for a while board scores aren’t as important (yet). They want a person that gets along well with others.

Look at programs that were DO and do as many aways as possible. Good luck.

Man, I thought I remembered at some point you were FM. Wish the best of luck.

Others should take this as a reason to have the best possible applications because rotations change things

 

[DennisReynolds]

You need step 1 and step 2 and crap ton of auditions pretty much.

My buddy matched into a new psych program after doing 6 aways.

Had a 215ish step 1 and 230+ step 2. Applied to 80+ programs and got 12ish interviews.

6 of them were from aways.

So... yeah... not really lookin' too good man.

 

[BorntobeDO?]

For back up FM applications, do you think it will hurt if I dont have a LOR from a FM physician? I was able to get one tailored toward FM, but its from a primary care IM doc..

You need to fix that. Nothing screams backup like not even having a FM letter.

 

[ciestar]

For back up FM applications, do you think it will hurt if I dont have a LOR from a FM physician? I was able to get one tailored toward FM, but its from a primary care IM doc..

Yes.
Programs don’t want to know they’re the back-up.

 

[Roxas]

So I’m on the psych train right now with a board failure. What I’m learning is that with PDs who have been around for a while board scores aren’t as important (yet). They want a person that gets along well with others.

Look at programs that were DO and do as many aways as possible. Good luck.

Yeah that's what I was banking on too. Didn't match. What's worse is I thought my aways and interviews went very well. I wouldn't rely on this anymore, it's antiquated advice. Anyone without step and a below average comlex needs to apply to a backup.

Contrary to what I had hoped, a lot of people "get along well with others," or can at least pretend to long enough to get through an away month or an interview day. They still need a way to stratify their applicants, so many of them will still look at scores.

 

[samac]

Yeah that's what I was banking on too. Didn't match. What's worse is I thought my aways and interviews went very well. I wouldn't rely on this anymore, it's antiquated advice. Anyone without step and a below average comlex needs to apply to a backup.

Contrary to what I had hoped, a lot of people "get along well with others," or can at least pretend to long enough to get through an away month or an interview day. They still need a way to stratify their applicants, so many of them will still look at scores.

Sorry to hear that Roxas. It’s good to know. It’s flat out what I’ve heard from a few different PD’s, so it’s good to know they could just be blowing steam.

 

[BorntobeDO?]

Sorry to hear that Roxas. It’s good to know. It’s flat out what I’ve heard from a few different PD’s, so it’s good to know they could just be blowing steam.

Matches talk and BS walks. I like to hear good things, but I always remind myself that talk is cheap. And PD's love to talk. I don't even think its intentional, they just don't want to say bad things about you because they probably feel bad as they remember being a 'try hard' in medical school.

 

[Drrrrrr. Celty]

Sorry to hear that Roxas. It’s good to know. It’s flat out what I’ve heard from a few different PD’s, so it’s good to know they could just be blowing steam.

I'm not going to lie here. Unless you know people or you interview alot at programs that exclusively base rank order lists off of whether you play nice with the residents you're going to struggle matching Psych.

I would say if you like Psych still apply for it, but look into primary care oriented IM and Family medicine programs where you can still do a lot of Psych. Like I would say that I still handle a lot of psych in clinic and on in patient.

 

[Postictal Raiden]

Yeah that's what I was banking on too. Didn't match. What's worse is I thought my aways and interviews went very well. I wouldn't rely on this anymore, it's antiquated advice. Anyone without step and a below average comlex needs to apply to a backup.

Contrary to what I had hoped, a lot of people "get along well with others," or can at least pretend to long enough to get through an away month or an interview day. They still need a way to stratify their applicants, so many of them will still look at scores.

Bbbbut data show that even without USMLE and COMLEX blow 500 would still put your chances at 70%+!!!

That's what I hate about this interactive charting crap. Doesn't tell you the whole story. One guy from my school matched ortho (AOA) with <450 and no USMLE. One guy from my class matched derm at a very reputable ACGME institution with very average scores.

I've grown tired discussing this with people who come here and tell neurology, or psychiatry, hopefuls that they are shoe in for matching with subpar scores and cite this chart. Looking at these numbers in isolation is very misleading. Never underestimate the influence of networking, letters, and auditions.

My advise for anyone with below average stats is to improve the other aspects of their applications. There are no free lunches, you either earn your spot by having solid board scores or by demonstrating your work ethics. Ofc having both is ideal.

To the OP, solely based on your numbers, your chances of matching are very low. However you shouldn't give up. Go audition and prove to them your worth. Last year, my program ranked an applicant with no USMLE and barely passing board scores higher than several others with 230+.

 

[DennisReynolds]

Bbbbut data show that even without USMLE and COMLEX blow 500 would still put your chances at 70%+!!!

That's what I hate about this interactive charting crap. Doesn't tell you the whole story. One guy from my school matched ortho (AOA) with <450 and no USMLE. One guy from my class matched derm at a very reputable ACGME institution with very average scores.

I've grown tired discussing this with people who come here and tell neurology, or psychiatry, hopefuls that they are shoe in for matching with subpar scores and cite this chart. Looking at these numbers in isolation is very misleading. Never underestimate the influence of networking, letters, and auditions.

My advise for anyone with below average stats is to improve the other aspects of their applications. There are no free lunches, you either earn your spot by having solid board scores or by demonstrating your work ethics. Ofc having both is ideal.

To the OP, solely based on your numbers, your chances of matching are very low. However you shouldn't give up. Go audition and prove to them your worth. Last year, my program ranked an applicant with no USMLE and barely passing board scores higher than several others with 230+.

You've always been the GOAT on these forums and have always kept it real IBN.

Sincerely hope residency is treating you well. You're gonna make a badass neurologist dude. Thank you for all of the wise words and messages you share on here.

Peace and love broda.

 

[samac]

I'm not going to lie here. Unless you know people or you interview alot at programs that exclusively base rank order lists off of whether you play nice with the residents you're going to struggle matching Psych.

I would say if you like Psych still apply for it, but look into primary care oriented IM and Family medicine programs where you can still do a lot of Psych. Like I would say that I still handle a lot of psych in clinic and on in patient.

I know it’s a struggle, but I can at least say I’m going into it as prepared as I can be.
100 program list, 4 auditions at programs with ties to my school.

I’m going all in, since I'm not particular about location if I would have to scramble. I would also tell people in my shoes to have a back up, I'm just living dangerously.

 

[Roxas]

I know it’s a struggle, but I can at least say I’m going into it as prepared as I can be.
100 program list, 4 auditions at programs with ties to my school.

I’m going all in, since I'm not particular about location if I would have to scramble. I would also tell people in my shoes to have a back up, I'm just living dangerously.

Psych in the SOAP is next to impossible (17 or something positions last year? lol). In the scramble, it's nonexistent. Feel free to disregard, but I'm telling you as someone who had to go though it, the SOAP process is truly awful. I would much prefer to spend the 5 days between Monday and Friday worrying about if I matched psych vs FM than wonder if I was going to end up with a position at all. What's worse is trying to decide what place to spend the next 3 years with having essentially no info to work with besides a 15 minute phone interview and the program's website. It sucks.

I understand the appeal of going "all in" because it seems like you're giving up before the end otherwise, and you want to say that you gave it everything you had. I'm just trying to share as someone who took a similar tactic, what I wish I would have done differently. And maybe all of this is moot because you'll match psych and skip off into the sunset. I sincerely hope you do. But for a lot of people last cycle it didn't work out like we thought.

 

[samac]

Psych in the SOAP is next to impossible (17 or something positions last year? lol). In the scramble, it's nonexistent. Feel free to disregard, but I'm telling you as someone who had to go though it, the SOAP process is truly awful. I would much prefer to spend the 5 days between Monday and Friday worrying about if I matched psych vs FM than wonder if I was going to end up with a position at all. What's worse is trying to decide what place to spend the next 3 years with having essentially no info to work with besides a 15 minute phone interview and the program's website. It sucks.

I understand the appeal of going "all in" because it seems like you're giving up before the end otherwise, and you want to say that you gave it everything you had. I'm just trying to share as someone who took a similar tactic, what I wish I would have done differently. And maybe all of this is moot because you'll match psych and skip off into the sunset. I sincerely hope you do. But for a lot of people last cycle it didn't work out like we thought.

Thanks for the info. I did mean SOAP into family rather than psych.
It’s difficult from my perspective too. I know some people without any red flags who didn’t match psych at all. While I know a couple others in my shoes who matched to their top choice with >5 interviews. It seems like it’s a partial crap shoot right now.

I’ll look into applying family, thanks for the honest insight.

 

[Drrrrrr. Celty]

Thanks for the info. I did mean SOAP into family rather than psych.
It’s difficult from my perspective too. I know some people without any red flags who didn’t match psych at all. While I know a couple others in my shoes who matched to their top choice with >5 interviews. It seems like it’s a partial crap shoot right now.

I’ll look into applying family, thanks for the honest insight.

As someone who soaped into IM and into a pretty alright program. I think if I could go back I would have applied to FM and IM and been able to be selective about where I went.

Secondly if you don't match you're going to in the majority of cases end up in a TRI. Which is a year wasted unless you decide to do a pgy-2 specialty, which if you failed to match your first year probably isn't happening.

You do whatever you want. But I had great stats and I still didn't match. Now whether or not that was a good thing however since I ended up absolutely hating psychiatry by the end of November is a different story.

I think that looking back I wish I had realized how much of a fool I was for dismissing FM just because I had an awful experience. If I had been more open to mentoring I probably would have applied for it and realized that I could have done 100% of the psychiatry I actually enjoy ex. depression, anxiety, bipolar, and some supportive psychotherapy.

 

[BorderlineQueen]

Thanks for the info. I did mean SOAP into family rather than psych.
It’s difficult from my perspective too. I know some people without any red flags who didn’t match psych at all. While I know a couple others in my shoes who matched to their top choice with >5 interviews. It seems like it’s a partial crap shoot right now.

I’ll look into applying family, thanks for the honest insight.

Just some perspective IM and FM is mostly psych they prescribe 70-85% of all psych meds. You’ll be seeing depression, anxiety, eating disorders as an FM/IM doc. In psych you’ll be dealing with chronically suicidal borderlines who call you at least once a day . You refer them to dbt yet they don’t go . You’ll also be dealing with Bipolar and schizophrenia.

 

[samac]

Just some perspective IM and FM is mostly psych they prescribe 70-85% of all psych meds. You’ll be seeing depression, anxiety, eating disorders as an FM/IM doc. In psych you’ll be dealing with chronically suicidal borderlines who call you at least once a day . You refer them to dbt yet they don’t go . You’ll also be dealing with Bipolar and schizophrenia.

Borderlines aren’t my favorite, but I like dealing with patients with more acute issues, those with bipolar, schizophrenia, extreme depression/anxiety, etc.
if I end up in family medicine I’ll survive, but it’s just not the goal as low acuity psych stuff is fine, it just isn’t my favorite thing.
Thanks for the positive vibes on if I have to take the family route guys. I appreciate it.

 

[BorderlineQueen]

Borderlines aren’t my favorite, but I like dealing with patients with more acute issues, those with bipolar, schizophrenia, extreme depression/anxiety, etc.
if I end up in family medicine I’ll survive, but it’s just not the goal as low acuity psych stuff is fine, it just isn’t my favorite thing.
Thanks for the positive vibes on if I have to take the family route guys. I appreciate it.

As a Fm/Im doc you can definitely manage the harder conditions. I know some FM/Im docs who are using lithium to treat bipolar . So it’s possible to do high acuity stuff in FM/IM.

 

[Drrrrrr. Celty]

As a Fm/Im doc you can definitely manage the harder conditions. I know some FM/Im docs who are using lithium to treat bipolar . So it’s possible to do high acuity stuff in FM/IM.

If you're outside of a major city then the primary care doctor = psychiatrist. Hell, even in major cities the waitlist is 6mo.

 

[Drrrrrr. Celty]

Borderlines aren’t my favorite, but I like dealing with patients with more acute issues, those with bipolar, schizophrenia, extreme depression/anxiety, etc.
if I end up in family medicine I’ll survive, but it’s just not the goal as low acuity psych stuff is fine, it just isn’t my favorite thing.
Thanks for the positive vibes on if I have to take the family route guys. I appreciate it.

You'll see acute psychotic breaks in primary care. Obviously you won't manage them. But then again unless your goal is inpatient psychiatry you won't manage them either.

 

[EmilKraepelin55]

As a Fm/Im doc you can definitely manage the harder conditions. I know some FM/Im docs who are using lithium to treat bipolar . So it’s possible to do high acuity stuff in FM/IM.

Perhaps I just don’t understand the practice of psychiatry enough since I am just an OMSII, but from what I think I understand psychiatry is more about the personal relationship built over time to understand the etiology of the patient’s condition and the subtleties of that individuals’s personality which can alter their experience of said condition which may either require a drug, talk therapy, or both for treatment. So in that sense, why would I choose FM/IM other than necessity based on competition to get to practice psych? If it’s purely medication management, then I don’t really think that’s all that fulfilling from a practice stance in my opinion. But again, I am just spit balling based on my personal experiences. Correct me if I am wrong.

 

[BorderlineQueen]

Perhaps I just don’t understand the practice of psychiatry enough since I am just an OMSII, but from what I think I understand psychiatry is more about the personal relationship built over time to understand the etiology of the patient’s condition and the subtleties of that individuals’s personality which can alter their experience of said condition which may either require a drug, talk therapy, or both for treatment. So in that sense, why would I choose FM/IM other than necessity based on competition to get to practice psych? If it’s purely medication management, then I don’t really think that’s all that fulfilling from a practice stance in my opinion. But again, I am just spit balling based on my personal experiences. Correct me if I am wrong.

What you describe above is what a clinical psychologist does . It if possible to do therapy as a psychiatrist if you’re willing to take a pay cut or do cash pay private practice. But most psychiatrists do medication management and supportive therapy in a 15 minute appointment. In my experience the best psychiatrists spend time with you 30-50 minutes . I’ve had only one psychiatrist like this and we have also had numerous family sessions that were like an hour and a half. She works hard though and frequently stays late. But most psychiatrists are like how are the meds working ? Any side effects ? Are you suicidal ? If no see you in three months . I’m not a med student I was considering med school because of my interest in psychiatry . But then I realized I don’t want to push drugs all day on people with out adequate coping skills . Which is why I decided on clinical psychology.

 

[DO2015CA]

Perhaps I just don’t understand the practice of psychiatry enough since I am just an OMSII, but from what I think I understand psychiatry is more about the personal relationship built over time to understand the etiology of the patient’s condition and the subtleties of that individuals’s personality which can alter their experience of said condition which may either require a drug, talk therapy, or both for treatment. So in that sense, why would I choose FM/IM other than necessity based on competition to get to practice psych? If it’s purely medication management, then I don’t really think that’s all that fulfilling from a practice stance in my opinion. But again, I am just spit balling based on my personal experiences. Correct me if I am wrong.

What you describe above is what a clinical psychologist does . It if possible to do therapy as a psychiatrist if you’re willing to take a pay cut or do cash pay private practice. But most psychiatrists do medication management and supportive therapy in a 15 minute appointment. In my experience the best psychiatrists spend time with you 30-50 minutes . I’ve had only one psychiatrist like this and we have also had numerous family sessions that were like an hour and a half. She works hard though and frequently stays late. But most psychiatrists are like how are the meds working ? Any side effects ? Are you suicidal ? If no see you in three months . I’m not a med student I was considering med school because of my interest in psychiatry . But then I realized I don’t want to push drugs all day on people with out adequate coping skills . Which is why I decided on clinical psychology.

Bingo. Today’s system doesn’t allow for psychiatrists to do everything they are trained in because there aren’t enough psychiatrists. Also, mental health can and should be a team strategy. The physicians time can’t be taken up doing the more time required activities when another cheaper person is available. The psychiatrists are functioning to do what the other people cannot. An IM doctor can take temperatures and BPs but they have MAs because the doc needs to be practicing at the top of their license.

 

[BorderlineQueen]

Bingo. Today’s system doesn’t allow for psychiatrists to do everything they are trained in because there aren’t enough psychiatrists. Also, mental health can and should be a team strategy. The physicians time can’t be taken up doing the more time required activities when another cheaper person is available. The psychiatrists are functioning to do what the other people cannot. An IM doctor can take temperatures and BPs but they have MAs because the doc needs to be practicing at the top of their license.

I know a lot of psychiatrists who do want to do therapy . But prescribing meds = more $$$.

 

[Drrrrrr. Celty]

Bingo. Today’s system doesn’t allow for psychiatrists to do everything they are trained in because there aren’t enough psychiatrists. Also, mental health can and should be a team strategy. The physicians time can’t be taken up doing the more time required activities when another cheaper person is available. The psychiatrists are functioning to do what the other people cannot. An IM doctor can take temperatures and BPs but they have MAs because the doc needs to be practicing at the top of their license.

Doesn't allow them? Uh, lets talk about a profession that almost exclusively runs cash practices.

 

[BorderlineQueen]

Doesn't allow them? Uh, lets talk about a profession that almost exclusively runs cash practices.

Yep 55% of psychiatrists take insurance compared to other doctors its 86%.

 

[Sardonix]

Psychiatrist I rotated with was really trying to fight the good fight.

45-60min appts. Trying to get people off their benzos left and right. Unfortunately the doc he had inherited the patients from had basically trained them that it was medicine or the highway, so they actually get angry when he asks them to discontinue their completely unnecessary Ativan scripts. It's really sad. He's burnt out and very disillusioned despite pushing on.

 

[BorderlineQueen]

Psychiatrist I rotated with was really trying to fight the good fight.

45-60min appts. Trying to get people off their benzos left and right. Unfortunately the doc he had inherited the patients from had basically trained them that it was medicine or the highway, so they actually get angry when he asks them to discontinue their completely unnecessary Ativan scripts. It's really sad. He's burnt out and very disillusioned despite pushing on.

This is why I hate psychiatry as I mentioned above. People with inadequate coping skills demanding meds that they don't need. Psych patients who actually need meds don't take them and the ones who take the meds don't need them. You can't just throw pills at a problem and expect to fix the problem. You can Rx for prozac all-day long but it's not going to give the patients coping skills or improve a crappy life situation.

 

[DO2015CA]

This is why I hate psychiatry as I mentioned above. People with inadequate coping skills demanding meds that they don't need. Psych patients who actually need meds don't take them and the ones who take the meds don't need them. You can't just throw pills at a problem and expect to fix the problem. You can Rx for prozac all-day long but it's not going to give the patients coping skills or improve a crappy life situation.

Are you a little borderline lol, not all psychiatrists are bad.

 

[BorderlineQueen]

Are you a little borderline lol, not all psychiatrists are bad.

I never said I hated all psychiatrists but the current affair of psychiatry is a sad affair. Most psychiatrists are competent individuals who try there best. My problem is patients have high expectations.

 

[allantois]

I never said I hated all psychiatrists but the current affair of psychiatry is a sad affair. Most psychiatrists are competent individuals who try there best. My problem is patients have high expectations.

I would just like to chime in that the quality of therapy is extremely variable. There’s a ton of crappy therapists where their patients don’t really ever get better either. Studies generally show that both meds and therapy are equally effective for things like depression. At least with meds there’s less variability and patients don’t need to see you 2 times a week for indefinite period of time.

 

[BorderlineQueen]

I would just like to chime in that the quality of therapy is extremely variable. There’s a ton of crappy therapists where their patients don’t really ever get better either. Studies generally show that both meds and therapy are equally effective for things like depression. At least with meds there’s less variability and patients don’t need to see you 2 times a week for indefinite period of time.

With CBT to treat depression you do 6-20 sessions . So it’s not an indefinite period of time it’s a short limited time . While I agree the quality of therapists. That’s why I would only see a psychiatrist or psychologist for therapy and not a mid-level.

 

[Candidate2017]

Just some perspective IM and FM is mostly psych they prescribe 70-85% of all psych meds. You’ll be seeing depression, anxiety, eating disorders as an FM/IM doc. In psych you’ll be dealing with chronically suicidal borderlines who call you at least once a day . You refer them to dbt yet they don’t go . You’ll also be dealing with Bipolar and schizophrenia.

I prescribe abx, insulin, HTN meds etc on the psych ward, but that doesn't make me an IM doc. Prescribing psych meds in a 8-12 minute primary care visit =/= practicing psychiatry. The breadth and depth of consideration and potential differentials in a 60-90 minute initial eval is a big part of psychiatry, along with building a therapeutic relationship over time. There's a joke that says primary care doctors start psychotropics but psychiatrists stop psychotropics.

And no, my borderlines do not call me everyday.

 

[Candidate2017]

Psychiatrist I rotated with was really trying to fight the good fight.

45-60min appts. Trying to get people off their benzos left and right. Unfortunately the doc he had inherited the patients from had basically trained them that it was medicine or the highway, so they actually get angry when he asks them to discontinue their completely unnecessary Ativan scripts. It's really sad. He's burnt out and very disillusioned despite pushing on.

Why would he ask a pt to DC their scripts? It's his job to NOT write the scripts. This is not a psychiatry issue but an issue related to physicians giving in to "customer satisfaction". I tell new BZD pts their old doc practices bad medicine, state the reasons why I cannot continue their BZDs, I will taper their BZDs or they can go elsewhere.

 

[Candidate2017]

This is why I hate psychiatry as I mentioned above. People with inadequate coping skills demanding meds that they don't need. Psych patients who actually need meds don't take them and the ones who take the meds don't need them. You can't just throw pills at a problem and expect to fix the problem. You can Rx for prozac all-day long but it's not going to give the patients coping skills or improve a crappy life situation.

Lots of misinformation about psychiatry here. You are not describing psychiatry. Rather, you are describing primary care and giving reasons why patients need psychiatrists.

The 15 min med checks you refer to are for long-term, stable pts and/or pts that do not want to engage therapeutically.

 

[BorderlineQueen]

I prescribe abx, insulin, HTN meds etc on the psych ward, but that doesn't make me an IM doc. Prescribing psych meds in a 8-12 minute primary care visit =/= practicing psychiatry. The breadth and depth of consideration and potential differentials in a 60-90 minute initial eval is a big part of psychiatry, along with building a therapeutic relationship over time. There's a joke that says primary care doctors start psychotropics but psychiatrists stop psychotropics.

And no, my borderlines do not call me everyday.

I prescribe abx, insulin, HTN meds etc on the psych ward, but that doesn't make me an IM doc. Prescribing psych meds in a 8-12 minute primary care visit =/= practicing psychiatry. The breadth and depth of consideration and potential differentials in a 60-90 minute initial eval is a big part of psychiatry, along with building a therapeutic relationship over time. There's a joke that says primary care doctors start psychotropics but psychiatrists stop psychotropics.

And no, my borderlines do not call me everyday.

I never said that a primary care doctor prescribing psych meds is practicing psychiatry. I’m just saying that and it’s a well known fact that most pcps prescribe the majority of all psych meds. I’m trying to comfort the op and posters that they still can do some parts of managing mental illness in Fm/IM . Op is worried about not matching psych and you come in here and type a very condescending post. You degrade the work of pcps who manage mental illness . Pcps are perfectly capable of managing mild mental illness .

 

[Drrrrrr. Celty]

I prescribe abx, insulin, HTN meds etc on the psych ward, but that doesn't make me an IM doc. Prescribing psych meds in a 8-12 minute primary care visit =/= practicing psychiatry. The breadth and depth of consideration and potential differentials in a 60-90 minute initial eval is a big part of psychiatry, along with building a therapeutic relationship over time. There's a joke that says primary care doctors start psychotropics but psychiatrists stop psychotropics.

And no, my borderlines do not call me everyday.

You restart those medications and you occasional prescribe metformin. For anything that remotely looks medical you're forced to call medical staff or transfer your patients because you don't want to deal with it. I think it's one of the biggest jokes I found while I did Psych rotations in that medical ineptitude was exceptionally prominent even in residents due to their medicine and neuro rotations being more shadowing experiences half of the time.

I mean, just saying but when I have a depressed patient, I follow guidelines for depression. Try to dig through whats causing it and offer therapy and if it's moderate to severe start an SSRI. This not to mention that most therapist will accept insurance... and their waits are not 6 months long.

Look. I think the notion that Psychiatry has a monopoly on good psychosocial interaction with patients and the rest of medicine somehow is dominated by personalities who are stunted and disinterested persons is simply not true. Should there be better or more training within the primary care model to approach these issues? Sure.

 

[Sardonix]

Why would he ask a pt to DC their scripts? It's his job to NOT write the scripts. This is not a psychiatry issue but an issue related to physicians giving in to "customer satisfaction". I tell new BZD pts their old doc practices bad medicine, state the reasons why I cannot continue their BZDs, I will taper their BZDs or they can go elsewhere.

Because of the reason you stated. They will raise hell otherwise or simply never return to the practice if he discontinues their benzos without convincing them first.