Rads vs. Psych (yeah, another one of these)

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Croman

Croman

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Hey guys,

I'm a third year medical student in a conundrum about specialty. Some background on me: I originally wanted to be a psychiatrist going into medical school and really since I was 15. I minored in neuroscience in undergrad and did behavioral research in spiders. Did well in preclinical years and Step 1 (top 20-40 quintile, 257 step 1) but I consider myself very Type B. Definite introvert but feel comfortable in one-on-one interaction, study best on my own. I enjoyed basically all of my preclinical studies to a degree.

Come third year, I took a radiology elective and was surprised how much I enjoyed it. I really loved the work flow and the problem solving, and it avoided some of the crap I've hated third year thus far (i.e. endless documentation). I felt like I had a knack for it as well, as I was pretty quick on picking up abnormalities and got some very positive feedback from attendings. As much fun as it was, I had some qualms about my ability to succeed in the field. I did well in anatomy, but it wasn't my strongest subject overall. Additionally, I'm not a very technically-oriented person and some of the technology around it is a bit of a black box for me. My final two rotations are IM and surgery, so I would have to perform well here particularly for LORs.

I also loved my psych rotation third year as I'm very interested in the content and found it meshed well with my "big picture" mentality when it comes to approaching problems. However, I disliked my neuro rotation because of feelings of futility in treating patients and have some worries that I could fall into the same situation doing psych. Additionally, it's a lot more narrow in scope than rads and I might miss some of the variety. Finally, I did my rotation at a center with a lot of voluntary admissions, so I'm not sure I got the best perspective on the field going there.

As far as other factors, prestige and money matter for me (the latter much less so). Family, fiance and friends seem to be somewhat pushing for radiology, as I would be more likely to go to my home institution, and have said I would get "bored or depressed" doing psych and "my talents would be wasted" there. I have a lot of hobbies and interests outside of medicine (weightlifting, hiking, firearms, video games). Essentially, I think my heart is with psych to a degree and my brain is with rads. I also think that having had a long-term goal of doing psych has made it difficult to consider a jump to another specialty.

Sorry for the long read. If there is a better place to post this, let me know!
 
To summarize, as compared to psychiatry, the only down sides you see of radiology are the anatomy and the technology, right?

Regarding anatomy, do what you enjoy and not what you're good at. I'd be miserable as a mathematician right now if I hadn't followed that advise.

Regarding radiology's technology, students tend to think too much of the physics involved. You have to learn it for your boards, and then just think of it as magic for the next 30 years.
 
Not sure why you think the scope of psych is so narrow. Different conditions can present in many different ways and I never get tired of some of the crazy s*** the patients with acute psychosis come up with. Plus it's one of the fields with the greatest research potential left in medicine, so in terms of creativity and variety the sky is the limit.

As to your original question, it sounds like you'd be fine with either field for now. What you should be asking yourself is which field can you see yourself in 30-40 years from now? Which field has common cases that you enjoy? How much do you value your free time/how much longer do you want to train before you finish residency? I'll also add you should do what you want and not what your family wants to push you into or "where your talents will be best utilized". Do what you think is going to make you happy in the long run, as both fields can pull in serious bank if you're willing to put in the hours.

Also, is there really less documentation in rads than in other fields? Just curious as the docs I encountered during my short time in a rads department seemed to spend just as much time in front of a computer as anyone else I've worked with.
 
Talk to your mentors and supervisors. Tell them what you like about each specialty. Ask them about what their practices are life, and their work-life satisfaction. What do they like about their jobs, what they don't like. Are the likes and dislikes amenable to any control (you're going to spend a lot of time in the dark staring at screens no matter what as a radiologist, but you can do Interventional if you like procedures)? Have you struggled with mental illness yourself? If so, you might want to stay away from psychiatry. On the flipside, do you mind monotony? Remember, radiologists all have their days churning through hundreds of routine x-rays.
 
Stagg737 said:
Also, is there really less documentation in rads than in other fields? Just curious as the docs I encountered during my short time in a rads department seemed to spend just as much time in front of a computer as anyone else I've worked with.
Click to expand...

I think this depends. Radiologists are always consultants. With psych, depending on what you do you are either a consultant or a primary acting in a specialist capacity. Primary work, even with psych, brings with it more paperwork nonsense than consultant work, and more of the paperwork is not directly related to your clinical work with the patient.
 
Regarding psych, you shouldn't let your neuro rotation factor into this decision as the two fields are really very different and attract different personalities. Plus, for residency most programs only have 2 months of neuro, frequently in consult or outpatient as part of that. I hated neuro and loathed the futility of treatments like you said.
Only you can decide what you want but you should make that decision, not your family who won't have to go through residency. I would advise you not to worry about the prestige of the field as that really won't determine what will make you happy. Ask yourself which rotation you were happiest on, which did you not mind staying late or coming early into. Psychiatry is the most diverse specialty. You can do outpatient, inpatient, kids, adults, work in the court system, do research, do therapy, etc etc. There is a big difference between working on a unit with only voluntary patients. I was on a unit with involuntary patients who were acutely psychotic and let me tell you, it was very different from the voluntary one. Yes, psych has paperwork, but you will find that psychiatrists (at least the ones I've seen) have some of the best support in terms of social work and nurses. So in conclusion, make the decision based on what you want and what will make you happy.
 
chopes31 said:
Do you enjoy interviewing patients at length? Are you okay with minimal patient interaction?


Sent from my iPhone using SDN mobile app
Click to expand...

I enjoy patient interaction but it isn't a necessity for me. I could live without it if I was really passionate about the content and I don't think I'd miss it long term by going into rads.
 
I vote psych. The future of radiology is so uncertain with tele-radiology beaming x-rays halfway around the world to radiologists in India and image recognition programs improving daily. On the other hand, I can't imagine a good substitute for an MD psychiatrist doing an in-person eval of a manic or psychotic patient coming about in the foreseeable future.
 
Croman said:
Thanks a ton everyone!



Could you clarify this?
Click to expand...

The honest truth is that any work with mental illness takes a lot out of the MD if it's to be done well. Many of the patients don't get better, and suicide or death by overdose is a shockingly common outcome, even when everything seems to be going fine with the patient. Many psychiatrists cope very well (or are oddballs themselves), but maladaptive behaviors are also tragically common, including unintended intimate relationships with patients and substance abuse. Psychiatrists are either the #1 or #2 specialty for substance problems and suicide themselves (Anesthesia is up there as well). Doctors with a history of mental illness are at a significantly higher risk of burnout and depression regardless of the field they work in, but psychiatry can be a very difficult field. It ain't Frasier or even The Sopranos.

That's what ultimately left me a wreck. My last 5 years of practice was at a Community Health Centre. The majority of the patients had mental health and addiction problems, and I functioned most days as a de facto psychiatrist.

Don't get me wrong. It's a vital area of medicine that's criminally understaffed. You'll have the potential to help and even save many, many lives as a psychiatrist. But the bad days are very bad.
 
Levo said:
I vote psych. The future of radiology is so uncertain with tele-radiology beaming x-rays halfway around the world to radiologists in India and image recognition programs improving daily. On the other hand, I can't imagine a good substitute for an MD psychiatrist doing an in-person eval of a manic or psychotic patient coming about in the foreseeable future.
Click to expand...

How can we just outsource to someone who is unlicensed to practice medicine in america? We don't allow foreign docs to just waltz into the country and start diagnosing patients, so why would we change the rules for radiology?
 
LouSkuntzMD said:
How can we just outsource to someone who is unlicensed to practice medicine in america? We don't allow foreign docs to just waltz into the country and start diagnosing patients, so why would we change the rules for radiology?
Click to expand...

We can't, we don't, and we won't. The teleradiology from India thing was a red herring over a decade ago when I was considering radiology, and it still is today.
 
Levo said:
I vote psych. The future of radiology is so uncertain with tele-radiology beaming x-rays halfway around the world to radiologists in India and image recognition programs improving daily. On the other hand, I can't imagine a good substitute for an MD psychiatrist doing an in-person eval of a manic or psychotic patient coming about in the foreseeable future.
Click to expand...

Yeah no this isn't happening. The liability alone makes it doa
 
sloop said:
I think this depends. Radiologists are always consultants. With psych, depending on what you do you are either a consultant or a primary acting in a specialist capacity. Primary work, even with psych, brings with it more paperwork nonsense than consultant work, and more of the paperwork is not directly related to your clinical work with the patient.
Click to expand...

I didn't mean rads compared to psych, I know psych is one of the more documentation-heavy fields (aka history is everything...). I meants rads in general compared to every other field. OP made radiology sound like it does a lot less documentation than most other fields, I was asking if that's actually true or if rads does just as much documentation as most other fields.
 
W19 said:
The job market for rad is not that good; something OP should also consider...
Click to expand...

I disagree. The job market was bad for several years, but it has rebounded nicely. As a surrogate indicator, the ACR job website currently lists over 600 jobs. Not too long ago that number was in double digits. Keep in mind, these are only the advertised positions, which is important because most practices will only advertise if they cannot fill a position through word of mouth.

Also, unless there is a sea change in how medicine is practiced, judging the job market 7 years ahead of time is rife with problems. Radiology has not undergone such a sea change, so I think it's folly for someone high on radiology to avoid it because of what might be going on with the job market in 2024 and beyond. My class applied when radiology was near its peak popularity, only to enter the job market at its nader. People leaving training now are finding the opposite.
 
Regarding documentation/paperwork, do people generally consider radiology reports to be paperwork? These are typically dictated in real-time with voice-recognition software, and 99/100 are never thought about or seen again after the "finalize" button is pressed minutes later. I consider that a far cry from a note or H&P, much less some sort of ancillary insurance paperwork, but I never know where all of these documentation-avoiding people draw the line.
 
rad work is documentation heavy. often one page paper per ct read. im not a rad, but as an ED doc, reading their reports 10+ times a shift. they can be overwhelming. Ive read my fair share of psych notes as well and they are very detailed but their case load is much less. id bargain that rads does more words per hour of work than psych.

Sent from my Pixel using Tapatalk
 
Psai said:
Yeaaahhh can you stop talking about anything other than medical school that'd be greaattt
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That's the only thing I marginally know anything about...🙄

Good luck dealing with d***head surgeons and CRNA for the rest of you life.
 
Damn.. hate to see two of my day ones W19 and Psai go at it bruh.

This hurts. 🙁
 
DetectiveAlonzo said:
Damn.. hate to see two of my day ones W19 and Psai go at it bruh.

This hurts. 🙁
Click to expand...
It's well known that the rad market is not as hot as it was in the early 2000s and CRNA and AMC are taking over anesthesia, so I don't know what was so inaccurate about my post. Besides, the particular poster that is attacking me thinks he/she is the alpha and omega of everything about medicine and has been hostile to many posters in this forum. He has been banned multiple times temporarily... He/she has gotten away with many BS in SDN because of favoritism among the moderators--and we all know it.
 
W19 said:
It's well known that the rad market is not as hot as it was in the early 2000s and CRNA and AMC are taking over anesthesia, so I don't know what was so inaccurate about my post. Besides, the particular poster that is attacking me thinks he/she is the alpha and omega of everything about medicine and has been hostile to many posters in this forum. He has been banned multiple times temporarily... He/she has gotten away with many BS in SDN because of favoritism among the moderators--and we all know it.
Click to expand...

Weird. Even the title reads "account on hold" like its some joke.

I don't get it.
 
W19 said:
It's well known that the rad market is not as hot as it was in the early 2000s
Click to expand...

If that is the standard by which anyone judges a job market, then he/she will be disappointed in perpetuity. The boom during that period was caused by the simultaneous proliferation of MDCT and PACS, which made throughput much more efficient, all while predating the DRAs that slashed reimbursement. I remember meeting R3s who had contracts with huge signing bonuses for start dates nearly three years in the future. I'd be floored if we ever see that sort of market again. Ever.
 
W19 said:
Besides, the particular poster that is attacking me thinks he/she is the alpha and omega of everything about medicine and has been hostile to many posters in this forum. He has been banned multiple times temporarily... He/she has gotten away with many BS in SDN because of favoritism among the moderators--and we all know it.
Click to expand...

There's no such thing as a "temporary" ban.




Sent from my iPhone using SDN mobile
 
W19 said:
It's well known that the rad market is not as hot as it was in the early 2000s and CRNA and AMC are taking over anesthesia, so I don't know what was so inaccurate about my post. Besides, the particular poster that is attacking me thinks he/she is the alpha and omega of everything about medicine and has been hostile to many posters in this forum. He has been banned multiple times temporarily... He/she has gotten away with many BS in SDN because of favoritism among the moderators--and we all know it.
Click to expand...

"It's well known"?

Let me know the next time you're in the market for a rads job, then maybe we'll talk.

By the way, when was the last time you've made a positive contribution to this website? Because all I see from you is nonsense about fields you haven't even rotated in. "primary care can be done by midlevels blah blah blah" -guy who hasn't even taken step 1 yet
 
Last edited:
Psai said:
"It's well known"?

Let me know the next time you're in the market for a rads job, then maybe we'll talk.

By the way, when was the last time you've made a positive contribution to this website? Because all I see from you is nonsense about fields you haven't even rotated in. "primary care can be done by midlevels blah blah blah" -guy who hasn't even taken step 1 yet
Click to expand...
He/she has taken step 1. And ironically even with a decent step 1 score they are acting like the sky is falling and psych is too competitive for them which couldn't be further from the truth.

This reminds me of the issues that a lot of people see with the current Democratic Party. W19 will continue to make horrible post after horrible post. Factually incorrect, naive, appealing to authority, whatever. Other posters will make a post that is 100% spot on but happens to have an offensive term and tone and they are reprimanded. Now I understand the desire to achieve civility as it helps the universal cause and how some policing of etiquette is needed. I admit that I am often guilty of what I just described myself. However, at some point we need to acknowledge that posting garbage that happens to be in a meek, politically correct manner is still garbage. When did we start valuing political correctness over facts? Would it be that unreasonable to try and discourage posters who are clueless from acting like authorities on topics they don't know?

If a rads resident or attending wants to comment on the job market, I'm all for it. If any poster wants to bring it up as a possible issue and ask for corroboration, I'm all for it. If a third year who admittedly has been struggling with every single step of medical school is going to deem the market poor, I think we need to draw the line.
 
chopes31 said:
Do you enjoy interviewing patients at length? Are you okay with minimal patient interaction?


Sent from my iPhone using SDN mobile app
Click to expand...

Sidebar argument aside... this. You're considering specialties that are essentially opposites in terms of what you do day-to-day. What do you actually see yourself being content doing?
 
After reading your original post, I wonder what was the reason that you always wanted to be a psychiatrist?

Being a fourth-year psychiatry resident, I can give you some input. I think the field of psychiatry is expanding really fast. It is fascinating and challenging at the same time. Every patient is a mystery in itself which requires not only just your clinical skills but also your inquisitive nature . Paperwork is manageable with the EMR's and most of the places these days have Dragon or Dictation options. If someone likes research, there are ample opportunities. The field is really expanding, there are multiple fellowship options, including forensics, addiction, geriatrics, sleep, pain, child, neuropsychiatry, perinatal psychiatry. There are other options like Post-doc fellowships in psychotic disorders, mood disorders, eating disorders, interventional psychiatry - ECT, RTMS, VNS, DBS...
On top of all this, there are ample job opportunities in both inpatient, outpatient, tele-psychiatry, mixed, part-time, full-time whatever you like.

In a nut-shell, you know the answer deep inside your heart, you just need to find it out...
 
So I'm a radiologist in my spare time. I didn't have the attention span to fully read your post, so I am just going to respond to what I think you said rather than what you actually said.

Both are great lifestyles, but there are limitations. In Psych you have to talk to people. How much you make is based on the people themselves.

Contrary to what has been posted multiple times by an uninformed person above, the job market in Radiology is pretty good right now. When I came out of residency it was much worse. But you can get a job making $300k which is probably higher than you will ever make in Psych. And You have a muuuuuuuuuch higher ceiling than psych.
 
W19 said:
The job market for rad is not that good; something OP should also consider...
Click to expand...
You have no idea what you are talking about.
 
Resources for step 1?
 
colbgw02 said:
To summarize, as compared to psychiatry, the only down sides you see of radiology are the anatomy and the technology, right?

Regarding anatomy, do what you enjoy and not what you're good at. I'd be miserable as a mathematician right now if I hadn't followed that advise.

Regarding radiology's technology, students tend to think too much of the physics involved. You have to learn it for your boards, and then just think of it as magic for the next 30 years.
Click to expand...
I truly enjoyed my rads rotation. Loved how intellectual it is. Every case felt like doing a UWorld question. However, anatomy is one of my weakest subjects and I felt that would be a big obstacle for me to succeed as a radiologist. Reading your post makes me reconsider things.
 
Feels like another example of a successful implementation of the 'hidden curriculum' :/
 
In 2016 Radiologists averaged $375k. Psychiatrists averaged $226k.

It kills me when people pull out exceptions to the rule and try to say that the rule therefor is not valid.

michaelrack said:
I know a lot of psychiatrists who make more than 300k.
Click to expand...
 

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