Really interested in PSYCH all of a sudden

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JMC_MarineCorps

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Hi, I was bit by the psychiatry bug last month on my psych clerkship...got all the way through 2 1/2 yrs of medical school thinking I was definitely bound for EM, but now I would like to gain as much knowledge about this newfound interest as possible.

I've been searching this forum and I've found nothing wrt D.O.'s applying to California psych programs...can anyone on here speak to this oddity. Is it an oddity? What sort of hours do psychiatrists work? Call schedule? Where are the majority of psychiatrists these days? Private practice? What is a decent salary for psychiatrists in CA? Does it pay more in the midwest like most things do? I know its gonna take time to collect all this info, but I've had blinders on for quite a while.

Looks like my 4th year will be split b/w EM and psych trying to figure out where I belong.

Thanks for taking the time,

JMC
 
well u can always work as a psychiatrist in either a regular ER or psych ER. that way get both.
 
I have just got back from the interview trail and I am sorry to report I do not recall there being one single DO on any interviews or at any of the main Cali schools residents lists-who list all their residents-all of the UCLA, UCSD, UCI, UCSF, Stanf-I am not sure about USC and all the other communicty/univ-affilitated programs in CA but those big 5 I am sure do not accept DO students unfortunately-have no clue why but seems the case.
 
If you do inpatient psychiatry, you will still often utilize the medical aspects of your education.

Several people in inpatient psychiatry do have medical problems such as diabetes, asthma, hypertension, etc.

If you order a med consult, they often do not show up in a timely manner, and if you were to treat the simple stuff on your own, the med consultant will love you for not bothering them.

If you do Crisis Psychiatry, you do have to have some knowledge of E. medicine because the ER doctor often times medically clears patients onto the crisis psyche without giving them a real evaluation. Often times you have to pick up on the patient's medical problem that the ER doctor missed and ship them back to the ER, and be able to defend why.

E.g. "Excuse me doctor, you medically cleared a patient onto me that IMHO had hepatic encephalopathy that you did not evaluate. I ordered a serum ammonia and its over 150. The patient has clear asterexis, and the psychosis you pointed out does not appear to be psychosis, but is more consistent with delirium 2ndary to hepatic encephalopathy".

"I request that you take this patient back to the ER and transfer him to the medical floor. If you do not, I will document this discussion and my findings".

In the crisis center of my hospital, about once a week I got to have a sometimes stern talk with the ER doc like this. About 25% of the time the ER doctor is very upset that you challenged them and a debate will start. If you don't know your medicine you won't be able to stand up to them, and lots of my attendings completely forgot their medicine and accept any medically unstable cases the ER docs throw at them. It bugs the heck out of me when the guy who's supposed to be teaching me seems to know less in that area.

Of the times I stood my ground and refused to accept the ER doc's "turf dump", I was right about 80-90% of the time. I blocked an M.I. a hepatic encephalopathy, a broken leg, confusion 2ndary to overmedication, acute abdominal pain (which is a surgical emergency until ruled out), shock (the Hgb was less than 7), hyperparathyroidism causing confusion, among a few others.

The one time I was wrong--I still think I was justified. The patient was unconscious for over 12 hrs in the psyche unit and developed a cyanotic right arm that became cool to touch for several hours. She was also on lovenox for unknown reasons. IMHO that's enough reason to fear a thrombus. She was taken to the med floor and upon IV fluid administration woke up and was fine. Still considering the circumstances I felt justified and I had to have a bad shoot out with a med attending.

Consult Liason and Geriatric Psychiatry are also 2 other fields in psyche where good knowledge in medicine is a very good thing to have and will often be used.
 
I have just got back from the interview trail and I am sorry to report I do not recall there being one single DO on any interviews or at any of the main Cali schools residents lists-who list all their residents-all of the UCLA, UCSD, UCI, UCSF, Stanf-I am not sure about USC and all the other communicty/univ-affilitated programs in CA but those big 5 I am sure do not accept DO students unfortunately-have no clue why but seems the case.

Thanks chinnychin...I firgured it'd be tough.
 
If you do inpatient psychiatry, you will still often utilize the medical aspects of your education.

Several people in inpatient psychiatry do have medical problems such as diabetes, asthma, hypertension, etc.

If you order a med consult, they often do not show up in a timely manner, and if you were to treat the simple stuff on your own, the med consultant will love you for not bothering them.

If you do Crisis Psychiatry, you do have to have some knowledge of E. medicine because the ER doctor often times medically clears patients onto the crisis psyche without giving them a real evaluation. Often times you have to pick up on the patient's medical problem that the ER doctor missed and ship them back to the ER, and be able to defend why.

E.g. "Excuse me doctor, you medically cleared a patient onto me that IMHO had hepatic encephalopathy that you did not evaluate. I ordered a serum ammonia and its over 150. The patient has clear asterexis, and the psychosis you pointed out does not appear to be psychosis, but is more consistent with delirium 2ndary to hepatic encephalopathy".

"I request that you take this patient back to the ER and transfer him to the medical floor. If you do not, I will document this discussion and my findings".

In the crisis center of my hospital, about once a week I got to have a sometimes stern talk with the ER doc like this. About 25% of the time the ER doctor is very upset that you challenged them and a debate will start. If you don't know your medicine you won't be able to stand up to them, and lots of my attendings completely forgot their medicine and accept any medically unstable cases the ER docs throw at them. It bugs the heck out of me when the guy who's supposed to be teaching me seems to know less in that area.

Of the times I stood my ground and refused to accept the ER doc's "turf dump", I was right about 80-90% of the time. I blocked an M.I. a hepatic encephalopathy, a broken leg, confusion 2ndary to overmedication, acute abdominal pain (which is a surgical emergency until ruled out), shock (the Hgb was less than 7), hyperparathyroidism causing confusion, among a few others.

The one time I was wrong--I still think I was justified. The patient was unconscious for over 12 hrs in the psyche unit and developed a cyanotic right arm that became cool to touch for several hours. She was also on lovenox for unknown reasons. IMHO that's enough reason to fear a thrombus. She was taken to the med floor and upon IV fluid administration woke up and was fine. Still considering the circumstances I felt justified and I had to have a bad shoot out with a med attending.

Consult Liason and Geriatric Psychiatry are also 2 other fields in psyche where good knowledge in medicine is a very good thing to have and will often be used.

Appreciate the response whopper...I guess my post sounded like I would be interested in doing both, but I think it would be one or the other...certainly not both. Liason psych, crisis psych, geriatric psych...oh my. Guess there's quite a bit of diversity within the field.

Some of the advantages I like about EM: no call, shift work, when you're off - you're off, attractive pay, acute crisis management and you're on your way.

What are some of the benefits that you all enjoy or perceive that you will enjoy in the future.

Thanks!
 
I just got back from many interviews in CA and I can say that, according to one LA-based Program Director, "the L.A. psych spots never fill up completely. There are always a couple spots left over that aren't filled. We are all competing for a pretty small group of applicants."

(This wasn't from UCLA-NPI or Cedars).

So I think your prospects are VERY good of matching in Cali, if you just apply BROADLY enough (i.e. Bakersfield, Loma Linda--just apply to ALL Cali ones and you should be cool).

On the subject of lifestyle/wages, my experience talking to my working friends is that psychiatrists who do med checks (around 20-30 mins per pt) get around $100-140 per pt (my friend in SF gets 150-170 per med check in a 20 minute meeting!!). Psychotherapy is less, usu around 150-200/hr (including meds). So you end up making between $2-300 k/year if you hustle--and even more if you really want.

Most of my psych friends in Cali work around 40 hours per week (normal business hours) and really enjoy their lives. A lot start out working in Jails and ED's as psychiatrists until they get their private practice up and running. Addiction is supposed to be a real 'cash cow' in the city of Angels...hmmm wonder why?

Dude, I was between ER and psych my third year--but just fell in love with the kind of CONTACT you can have with people in psych that ER just doesn't provide. Plus--I'm kind of corny--but I think that if you really take psychiatry seriously, as a vocation and not a job, it will call on you to become an extraordinary person.

I love psych--I feel so privileged to be entering this field. Good luck and I hope you choose it! Cheers👍
 
NPI does have a DO, who matched into a PGY-2 position. He's a great guy (I worked with him on a rotation), but he's definitely an exception to the rule. By and large in competitive programs DO's have difficulty getting in. This guy has an interesting history that got him in the door.
 
I have just got back from the interview trail and I am sorry to report I do not recall there being one single DO on any interviews or at any of the main Cali schools residents lists-who list all their residents-all of the UCLA, UCSD, UCI, UCSF, Stanf-I am not sure about USC and all the other communicty/univ-affilitated programs in CA but those big 5 I am sure do not accept DO students unfortunately-have no clue why but seems the case.

There is a FMG in the intern class at UCSF.

-AT.
 
I just got back from many interviews in CA and I can say that, according to one LA-based Program Director, "the L.A. psych spots never fill up completely. There are always a couple spots left over that aren't filled. We are all competing for a pretty small group of applicants."

(This wasn't from UCLA-NPI or Cedars).

So I think your prospects are VERY good of matching in Cali, if you just apply BROADLY enough (i.e. Bakersfield, Loma Linda--just apply to ALL Cali ones and you should be cool).

On the subject of lifestyle/wages, my experience talking to my working friends is that psychiatrists who do med checks (around 20-30 mins per pt) get around $100-140 per pt (my friend in SF gets 150-170 per med check in a 20 minute meeting!!). Psychotherapy is less, usu around 150-200/hr (including meds). So you end up making between $2-300 k/year if you hustle--and even more if you really want.

Most of my psych friends in Cali work around 40 hours per week (normal business hours) and really enjoy their lives. A lot start out working in Jails and ED's as psychiatrists until they get their private practice up and running. Addiction is supposed to be a real 'cash cow' in the city of Angels...hmmm wonder why?

Dude, I was between ER and psych my third year--but just fell in love with the kind of CONTACT you can have with people in psych that ER just doesn't provide. Plus--I'm kind of corny--but I think that if you really take psychiatry seriously, as a vocation and not a job, it will call on you to become an extraordinary person.

I love psych--I feel so privileged to be entering this field. Good luck and I hope you choose it! Cheers👍

Great reply...I appreciate that...really helps put things in perspective. Addiction med is actually one of my interests. My father has been a transient for the past 15 years or so 2ary to alcohol. I just got in touch with him after my psych rotation. Lives in a 1/2 way house up in Cleveland. It really is a nasty disease.

I guess if there is good money to be made in it too, wow, even better.

How I would love to stay in CA too. Man, that would be cool.

JMC
 
Make sure you check out Bakersfield's residency then--it is a new residency (only in its 3rd year) and they have some really cool attendings there.

Plus they say that working in the Central Valley is incredible--there is an overwhelming need for psychiatrists there and one of the attendings told me, straight up, "You'll be making 250-300 your first year--there just aren't any psychiatrists here. It's virgin territory." I think there is something to be said for working in underserved areas--you see the need for good physicians so clearly.

Good luck about your choice, and if you want to talk further, just send me a private message--I'll be happy to have a chat!

Cheers!
 
Make sure you check out Bakersfield's residency then--it is a new residency (only in its 3rd year) and they have some really cool attendings there.

Plus they say that working in the Central Valley is incredible--there is an overwhelming need for psychiatrists there and one of the attendings told me, straight up, "You'll be making 250-300 your first year--there just aren't any psychiatrists here. It's virgin territory." I think there is something to be said for working in underserved areas--you see the need for good physicians so clearly.

Good luck about your choice, and if you want to talk further, just send me a private message--I'll be happy to have a chat!

Cheers!

Thanks, I might do that.

I just found this article and thought I would post it in my own thread, since I brought up the CA salary thing. You can scroll to the bottom for the 'bottom-line.' This, of course, does not speak to the amount of hours they work, but its a good start I guess. Wow, who knew?

http://www.pe.com/breakingnews/local/stories/PE_News_Local_R_patton30.dd7482.html

Officials fear losing staff from state mental hospitals

05:07 PM PST on Monday, January 29, 2007

Gregor McgAvin The Press-Enterprise

Officials at Patton State Hospital in San Bernardino fear the hefty pay raises for medical staff in California's prisons could lure doctors and nurses from lower-paying jobs in the state's mental hospitals.

The court-ordered increases -- which take effect in March -- would nearly double the salary earned by psychiatrists, psychologists and other staff members at the state's nine mental hospitals.

"The reality is, if those salaries are not matched" medical personnel will leave the mental hospital system for greater pay, said Octavio Luna, director of Patton State Hospital. "We have had people indicate they are interested."

The prison raises were ordered by a federal official overseeing reform of the state's overcrowded prison system. The increases were designed to draw highly qualified medical professionals to the California Department of Corrections and Rehabilitation's $1.5-billion medical system.

Luna said could not say how many staff members are looking to jump ship. But the issue comes at a particularly bad time for officials at mental hospitals, who are already struggling to recruit and retain enough personnel to comply with federal standards to treat the roughly 5,000 patients in the state's mental hospital system.

A staff psychiatrist now earning $11,955 a month for the Department of Mental Health would stand to make $21,031 a month working for the prison system. The top salary for psychologists at mental hospitals is $5,201 monthly, compard to $7,125 a month in the prisons.

Patton already needs to hire about 40 staff psychiatrists to meet the total of 106 that federal officials said the hospital must have to serve its roughly 1,500 patients.

That roughly 38 percent vacancy rate is nothing compared to Atascadero State Hospital, the most understaffed mental hospital in California, where 70 percent of the psychiatrist positions are unfilled.

The U.S. Department of Justice in March 2006 reached a settlement with the state mental hospital system which gave the hospitals three years to correct serious violations of patient safety and civil rights.

In September 2005, two Patton patients were arrested in connection with the death of their 50-year-old roommate. Three months later, a Patton patient died after a fellow patient attacked him, police said.

If medical personnel flee the mental health department in large numbers, Luna said, that could make it impossible for mental hospitals to make the changes ordered by federal investigators.

That could in turn lead to the appointment of a federal receiver to oversee the system -- as happened to the prison system.

"That's the worst of all scenarios, because then you no longer have any control of what goes on locally," Luna said.

He and other officials said they hope the high salaries will draw job candidates from the private sector.

"They can take the cream of the crop," said Cindy Barrett, a Patton spokeswoman.

Luna said mental health department officials plan to lobby Gov. Arnold Schwarzenegger and the state legislature to raise salaries in the state's mental hospitals to keep pace with the prisons.

Reach Gregor McGavin at 951-368-9549 or [email protected].

HIGHER PAY

A staff psychiatrist at one of California's state mental hospitals earns $11,955 per month.

The same job in the state prison system now pays $21,031 a month.

A psychologist with the state mental health department makes $5,201 a month, compared to $7,125 a month in the prisons.

Source: California Department of Corrections and Rehabilitation, California Department of Mental Health.
 
I am starting as a DO in the AOA approved residency at Arrowhead Regional Medical Center. It is a great program run by great attendings. We are following the new call format. I am starting as an R-2 b/c I have had previous internship and a CA license.

If you are a DO, I would consider Arrowhead.

cheers.
 
This thread is four years old. The individual is finishing his or her residency right about now.
 
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