Really thinking psych, but now that it’s application season, concerned about not working with my hands.

[ladysmanfelpz]

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I’ve always been interested in psychiatry. I like the fact your are a specialist and that you mainly work with healthy (of body anyway) people. I really don’t like working with old dying people or people that won’t take care of themselves which is so common throughout most specialties. The thing is is I feel I’m pretty detail oriented and fairly coordinated with my hands. Never really wanted to be a surgeon, but appreciate the instant gratification of a simple procedure like IV or suture. In fact one of my favorite jobs premed was a phlebotomist where I would routinely get difficult sticks the other phlebotomists couldn’t.

So is there anything, or anyway a psychiatrist can get work with their hands? I’ve heard psych is one of the few specialties that can go into pain management. Is this true? And if so, any chance at injections/nerve blocks, or is this all anesthesia and psych gets to deal with suboxone/methadone? Could you even do it slightly outside your scope, like botox injections at a cosmetics clinic if your really wanted to ha?

Just kinda curious as its pretty scary applying for something you will spend the rest of your life in. Thanks for the help.

 

[liquidshadow22]

For the most part, avoid psychiatry like the plague if you like procedures. Sure you might have a small chance of matching a pain fellowship but I wouldn't count on it.

Surgery keeps you in the moment unlike other areas of nonsurgical medicine that force you to be attached to a computer screen typing and clicking your life away.

 

[jbomba]

On the other side you can make a very decent living working very few hours in psych that you could pursue hobbies that allow you to work with your hands. Something to consider.

 

[Bartelby]

You can choose to try to work with physically healthy people, but the mentally ill population tends to have medical comorbidities so especially if you are planning to work with seriously mentally ill individuals don't count on them being physically healthy.

You also mention "I really don’t like working with old dying people or people that won’t take care of themselves which is so common throughout most specialties." I hate to break it to you but psychiatry has more than its fair share of people who will not take care of themselves!

But in answer to your question I echo the above that you will be unlikely to do procedures in psychiatry. If working with your hands is a must you may want to reconsider, but keep in mind many people worry about things like this beforehand (myself included) but end up not missing it at all.

 

[TankTuck]

Go home and work on your truck. It is amazing doing minimal physical exams and not touching patients.

 

[Ironspy]

I do all sorts of simple work with my hands (painting, plaster, drywall, tile) at home in my spare time. I loved surgery and sometimes I’m wistful about leaving much of medicine behind but I’m happier and better rested than my friends from med school who matched in other specialties. Psych does not do procedures in any meaningful way. I do ECT/TMS but these aren’t really procedures.

 

[Crayola227]

Agreed. Working with your hands for a *living* as opposed to in a way that you can totally control - way overrated, especially as you age and your body starts to go.

The practice of psych is a lot more physical-disability/arthritis-proof than a lot of specialties. And everyone starts to get osteo if nothing else if they live long enough.

 

[kopftonmd]

All this said, you can also pursue other specialty pathways (FM, EM come to mind) that involve hands-on stuff where you also have to handle mental health. Or you could do a combined residency!

 

[Sushirolls]

I’ve always been interested in psychiatry. I like the fact your are a specialist and that you mainly work with healthy (of body anyway) people. I really don’t like working with old dying people or people that won’t take care of themselves which is so common throughout most specialties. The thing is is I feel I’m pretty detail oriented and fairly coordinated with my hands. Never really wanted to be a surgeon, but appreciate the instant gratification of a simple procedure like IV or suture. In fact one of my favorite jobs premed was a phlebotomist where I would routinely get difficult sticks the other phlebotomists couldn’t.

So is there anything, or anyway a psychiatrist can get work with their hands? I’ve heard psych is one of the few specialties that can go into pain management. Is this true? And if so, any chance at injections/nerve blocks, or is this all anesthesia and psych gets to deal with suboxone/methadone? Could you even do it slightly outside your scope, like botox injections at a cosmetics clinic if your really wanted to ha?

Just kinda curious as its pretty scary applying for something you will spend the rest of your life in. Thanks for the help.

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Apply tractor to the land. You will be busy with your hands, and with Psych should have time to apply said tractor to the land. Bonus points if you raise livestock or crops.

 

[Shufflin]

I’ve always been interested in psychiatry. I like the fact your are a specialist and that you mainly work with healthy (of body anyway) people. I really don’t like working with old dying people or people that won’t take care of themselves which is so common throughout most specialties. The thing is is I feel I’m pretty detail oriented and fairly coordinated with my hands. Never really wanted to be a surgeon, but appreciate the instant gratification of a simple procedure like IV or suture. In fact one of my favorite jobs premed was a phlebotomist where I would routinely get difficult sticks the other phlebotomists couldn’t.

So is there anything, or anyway a psychiatrist can get work with their hands? I’ve heard psych is one of the few specialties that can go into pain management. Is this true? And if so, any chance at injections/nerve blocks, or is this all anesthesia and psych gets to deal with suboxone/methadone? Could you even do it slightly outside your scope, like botox injections at a cosmetics clinic if your really wanted to ha?

Just kinda curious as its pretty scary applying for something you will spend the rest of your life in. Thanks for the help.

Once in a blue moon, psych goes into pain medicine. This rare individual is trained to do all the pain procedures a pain doc would expect to do. Epidurals and all.

Don't make the mistake of going into psych to segue into pain though. Blue moons are rare and you may get stuck in psych.

 

[Liquid8]

In fact one of my favorite jobs premed was a phlebotomist where I would routinely get difficult sticks the other phlebotomists couldn’t.

I was this guy as an intern – always doing IVs and helping out others when they missed. Did quite a bit of work in theatre learning intubation on one rotation, but was swayed against anaesthetics due to the perceived lack of autonomy (as well as having to work surgeon hours).

I echo the view that if you want procedures you won’t find that in psychiatry, but one can always fill that gap with a suitable hobby. For me that was learning to play the guitar and building model kits among other things. Have found that having a broad interest outside of medicine certainly assists with building rapport with patients as well as adds variety to what would otherwise be a routine interaction.

I think you will get physically sick patients in psychiatry, but the difference is you are able to give them the time to sit and explore these issues without necessarily having to do anything. The same can’t really be said for non-psychiatrists specialists exploring psychiatric problems with their patients

 

[swamzi]

Looks like you want to do a surgical speciality. Sit down with a psych attending who you trust and talk it out.

 

[dl2dp2]

I do a decent amount of depot injections in addiction medicine. My office colleague treats schizophrenia in office and does depot antipsychotics. There's always ketamine and TMS. It's not much but it's not nothing. Something to think about.

 

[TheGift]

sounds like you may like anesthesia from what you are saying. Give it some though and be honest with yourself about what it is that you want.

 

[adiradirim]

I was in your shoes. In med school, I wanted to do a procedural specialty (gas/surg) but hated the hours, lifestyle, and personalities of surgery. I loved psych for the interactions, long term relationships, helping improve functioning, etc. I decided on psychiatry but really missed doing procedures. I never felt that psych "procedures" were all that satisfying. I learned about pain medicine in residency and decided I loved it. Procedures are quick and effective. I put in a lot of work and had a few excellent and rare opportunities that opened doors for me and allowed me to get accepted for a spot in a pain fellowship. I think pain is an awesome balance between psychiatry and procedural specialties. However, I would never recommend anyone goes into psych with the intent of doing pain. Less than 5 psychiatrists do it each year probably and it is an uphill battle.

Consider anesthesia or PMR if you want to do pain. Do psych if you wanna do psych. Get your hands dirty outside of work!
Feel free to DM me

 

[MisterKitty]

Do surgery. Psychiatry is being replaced by social workers, nurse practitioners, and therapists.

 

[NontradCA]

Do surgery. Psychiatry is being replaced by social workers, nurse practitioners, and therapists.

I feel luck to have social workers and therapists doing the jobs they do with my patients. In my experience the NPs add business because of turn around, asking for help all the time. Yea the bar is low as to the level of basic human value that is placed on our patients by society, but I don't see psychiatrists going anywhere.

 

[Sushirolls]

Do surgery. Psychiatry is being replaced by social workers, nurse practitioners, and therapists.

Surgery will likely keep one in the hospital, which means politics, which means bureaucracy, which means employment by Big Box Shops.

Only a handful of states are not "certificate of need" and can permit an ease of opening up a surgery center to escape such environments.

 

[hebel]

After actually training in it, I found doing therapy to be sort of procedural/interventional in a sense.

Probably not what you mean though. If it's just about doing stuff with your hands, you can probably scratch that itch with your ample free time.

 

[liquidshadow22]

Surgery will likely keep one in the hospital, which means politics, which means bureaucracy, which means employment by Big Box Shops.

Only a handful of states are not "certificate of need" and can permit an ease of opening up a surgery center to escape such environments.

Sure but certain procedural fields (spine surg, ent, urology etc) will get paid 600k to 1 million per year by some hospital systems. Agree that the hospital owns you but I'd give up my autonomy to make that and get to do procedures all day. Very difficult to make that kind of money in psych.

 

[Shufflin]

Also consider that the value proposition, in some instances, can be as good or better in Psych than in Pain Medicine. The reimbursement landscape in pain is not improving. You can make as much in Psych if you set it up carefully.

Also, in Pain the places hiring new grads have steep expectations for productivity. You're on your feet all day in lead meeting rVU targets. You have to be ok with that. You can find a moderate pace in Psych, not really in Pain. Another important point to consider.

 

[TheGift]

Sure but certain procedural fields (spine surg, ent, urology etc) will get paid 600k to 1 million per year by some hospital systems. Agree that the hospital owns you but I'd give up my autonomy to make that and get to do procedures all day. Very difficult to make that kind of money in psych.

It is a known fact that the money in medicine is in procedures so if one is looking to maximize their income this is definitely not the field.

 

[psychacad]

On the other side you can make a very decent living working very few hours in psych that you could pursue hobbies that allow you to work with your hands. Something to consider.

This. Now that I'm on the other side (i.e done with residency), all the practical positive aspects that drew me to psych were real. I make a very decent living (~200k) working part time in a relatively low stress environment. That leaves me ample time to pursue all the things that I wanted to pursue. It is a great choice.

 

[liquidshadow22]

This. Now that I'm on the other side (i.e done with residency), all the practical positive aspects that drew me to psych were real. I make a very decent living (~200k) working part time in a relatively low stress environment. That leaves me ample time to pursue all the things that I wanted to pursue. It is a great choice.

How many hours do you work for 200k?

 

[psychacad]

How many hours do you work for 200k?

It averages out 24/week, but in reality even less, since most of this is weekend/overnight coverage, where I can get decent sleeping time.

 

[liquidshadow22]

It averages out 24/week, but in reality even less, since most of this is weekend/overnight coverage, where I can get decent sleeping time.

Sounds pretty good, what kind of a job is this?do you get full benefits?

 

[psychacad]

Sounds pretty good, what kind of a job is this?do you get full benefits?

I don't get full benefits; however, this could be easily done if I chose to work a bit more. It's essentially ER/Inpatient coverage.

There are plenty of gems in psych; mine is probably not that special. Something similar can be done with outpatient private practice. There are also places that really value quality of life and good practice. You just have to be smart in what you pick and run away from the factory mills. I find that in general full time salaried places are not really a great choice.

 

[Shufflin]

Sure but certain procedural fields (spine surg, ent, urology etc) will get paid 600k to 1 million per year by some hospital systems. Agree that the hospital owns you but I'd give up my autonomy to make that and get to do procedures all day. Very difficult to make that kind of money in psych.

I'm in that range you mention. I'm not a surgeon, I'm not salaried, I have autonomy. Just as Psychacad said, there are gems in Psych.

 

[jbomba]

Sure but certain procedural fields (spine surg, ent, urology etc) will get paid 600k to 1 million per year by some hospital systems. Agree that the hospital owns you but I'd give up my autonomy to make that and get to do procedures all day. Very difficult to make that kind of money in psych.

There are numerous locums jobs one can look at right now offering 220-300 an hour. Might be corrections or another less desirable setting, but do the math... You can make the same money in psych and not be owned. And also not be on call unless you want to be.

 

[liquidshadow22]

I'm in that range you mention. I'm not a surgeon, I'm not salaried, I have autonomy. Just as Psychacad said, there are gems in Psych.

On a per hour basis, it is difficult to find jobs through job listings that pay greater than $200 an hour. how do you find the gems?How many jobs do you have? Are you located in a rural area? Do you have full benefits?

It's not rare to see a specialized surgeon making 1 million, it definitely is rare to see a psychiatrist do that. Not saying it's impossible in psych, I just don't think everyone can get into this kind of setup to hit these numbers.

 

[liquidshadow22]

There are numerous locums jobs one can look at right now offering 220-300 an hour. Might be corrections or another less desirable setting, but do the math... You can make the same money in psych and not be owned. And also not be on call unless you want to be.

Those rates are not common. They will be in the middle of no where most likely and you will get no benefits and locums is not guaranteed

 

[jbomba]

Those rates are not common. They will be in the middle of no where most likely and you will get no benefits and locums is not guaranteed

These rates are all within southern california where I hope to be practicing in a couple of years. None is more than 45 minutes from a downtown area of a major socal city. Looking in other parts of the country, there are inpatient rates which hover around $2-225/hour. See the "is 200 the new minimum in psych?" thread. You are misinformed if you think these rates are only available in middle of nowhere locations.

I didn't say they came with benefits. The locums I've seen (at least in socal where I've done the most digging) are usually temp to hire. I've spoken to a couple recruiters so feel like I've got a slightly decent idea what I'm talking about here.

If you don't like the idea of locums, do the math on CPT codes and you'll see you can make at least $280/hr with a busy clinic taking insurance. Work surgical hours and you'll pull surgical numbers, but have the added bonus of no nights/weekends/call/hospital admin.

 

[liquidshadow22]

These rates are all within southern california where I hope to be practicing in a couple of years. None is more than 45 minutes from a downtown area of a major socal city. Looking in other parts of the country, there are inpatient rates which hover around $2-225/hour. See the "is 200 the new minimum in psych?" thread. You are misinformed if you think these rates are only available in middle of nowhere locations.

I didn't say they came with benefits. The locums I've seen (at least in socal where I've done the most digging) are usually temp to hire. I've spoken to a couple recruiters so feel like I've got a slightly decent idea what I'm talking about here.

If you don't like the idea of locums, do the math on CPT codes and you'll see you can make at least $280/hr with a busy clinic taking insurance. Work surgical hours and you'll pull surgical numbers, but have the added bonus of no nights/weekends/call/hospital admin.

Cali is probably the highest paid state in the country. But you also pay 12% state income tax. You will not see rates like this commonly on the east coast.

Agree with your insurance based pp numbers, that should be doable.

 

[jbomba]

Cali is probably the highest paid state in the country. But you also pay 12% state income tax. You will not see rates like this commonly on the east coast.

Agree with your insurance based pp numbers, that should be doable.

I actually didn't know that about California rates. But yes our state income tax rate is brutal.

 

[Laradd]

Wish you luck!!

 

[Attending1985]

Don’t do psych if you want to work with healthy people who take care of themselves. Ob/gyn peds or sports medicine will bring healthy populations

 

[liquidshadow22]

Don’t do psych if you want to work with healthy people who take care of themselves. Ob/gyn peds or sports medicine will bring healthy populations

Private practice psych is mostly healthy people who can take care of themselves

 

[Dalemane]

lucrative private practices aren't some shady pill mill types giving out controlled substances like candy, right?

 

[Psychresy]

lucrative private practices aren't some shady pill mill types giving out controlled substances like candy, right?

As has been mentioned. Just look at CPT codes and do the math. You can make big money if you work slightly more than the average number of hours. Low overhead, low malpractice...pp psych is prime for a good income.