Reservations

[TheReluctantShrink]

---

Members don't see this ad.

I'm finally looking for a catharsis in an environment that will (hopefully) be more supportive because I'm coming out: I love psychiatry. But, as the title says, I have so many reservations before I can feel comfortable committing and only apply to psych residencies. Silly things that my ego is holding onto like prestige, pay, laying down my stethoscope, and other things that my spouse is holding onto like safety, job satisfaction, and paying back my soul-crushing loans.

When I admit interest in the field, I am unanimously met with statements along the lines of "That would be such a shame - you'd be letting your talents go to waste" and "you know people only go into psychiatry because they have low board scores". (I should note that up to this point, I was planning on applying to anesthesia primarily but also some psych programs.) While I hope I could eventual be at peace with these shallow views of the field, I find this sentiment, which is voiced very frequently to me, to be incredibly frustrating.

I'm an off-cycle 4th year who will be finished with rotations soon, and at this point, I can confidently say that my psych rotations have been the only ones I've really enjoyed - I don't dread going in the morning and am actually sad when they end. I enjoy the patients, the pathology, and most of the other professionals in the field. That said, I also do enjoy working with my hands -- doing procedures -- so that along with my ego and the stigma are the only things holding me back.

Did you have these same internal conflicts about finally committing to the field? Are you happy in residency and beyond? I'm not sure if I'm looking for permission to love the field or if I just have a desire to hear others say that yeah, all the stigma sucks, but you get over it.

 

[Psychotic]

If there is another medical field you feel drawn to, pursue it. Most people I know in psychiatry are here because they couldn't see themselves anywhere else...that is how I felt, and most of my colleagues tell a similar story.

You mention anesthesiology (not anesthesia, btw). Why are you not pulling the trigger on it? Just curious - what are these "special talents" that would go to waste in psychiatry that you would use elsewhere?

 

[Bartelby]

I did. I really enjoyed non-psychiatric parts of medicine (primarily EM and family medicine) and worried about giving up more generalist skills. My board scores were higher than the average matched ophthalmologist's (for instance) for my year. I had good clinical evaluations, research, and some interesting extracurriculars coming from a top-25 school. I also got some incredulous looks and "why would you go into psych" or "so you're giving up on real medicine?" I went into psychiatry anyway.

I don't regret it! For me it was the exact same feeling you've described above. Day after day I actually looked forward to going into work when I was on my psychiatry rotations. I realized that what mattered far more than impressing people with what an important job I have was my day-to-day state of mind. I'm about to graduate and I still find myself listening to mental-health related audiobooks for fun, challenging myself with new approaches to psychotherapy, and feeling honored that I get to help people who are often suffering immensely. Also re: job security, I get so many unsolicited invitations to apply for jobs (typically at least one most weekdays) that I have stopped even reading them. No one in my residency class had even the slightest trouble finding a good job and if you ask around this forum (aside from one particular poster who is well known for his pessimism) most will confirm that finding a secure job earning in the ranges expected for a physician is no problem.

I'm so glad I didn't cave to external expectations. If you're convinced that psychiatry is right for you then I would say go for it.

 

[lymphocyte]

I'm finally looking for a catharsis in an environment that will (hopefully) be more supportive because I'm coming out: I love psychiatry. But, as the title says, I have so many reservations before I can feel comfortable committing and only apply to psych residencies. Silly things that my ego is holding onto like prestige, pay, laying down my stethoscope, and other things that my spouse is holding onto like safety, job satisfaction, and paying back my soul-crushing loans.

I'm an off-cycle 4th year who will be finished with rotations soon, and at this point, I can confidently say that my psych rotations have been the only ones I've really enjoyed - I don't dread going in the morning and am actually sad when they end. I enjoy the patients, the pathology, and most of the other professionals in the field. That said, I also do enjoy working with my hands -- doing procedures -- so that along with my ego and the stigma are the only things holding me back.

Did you have these same internal conflicts about finally committing to the field? Are you happy in residency and beyond? I'm not sure if I'm looking for permission to love the field or if I just have a desire to hear others say that yeah, all the stigma sucks, but you get over it.

Prestige is earned. Pay is good. All psychiatrists are doctors first. Most psychiatrists are satisfied. Most psychiatrists are safe. Family comes first. Nobody claps for you when you're 40. Plan accordingly.

Oh, and anesthesia isn't doing that great. Nurse anesthetists are crowding out the ASA 1-2 cases. Maybe that will change. Probably not. The point is, you can't predict the future. (Radiology is another good example.) Focus on what might make you the happiest regardless. If happiness is satisfying the expectations of others, then you're setting yourself up for misery.

I wish you the very best in whatever you decide.

 

[PikminOC]

Most psychiatrists are safe. Family comes first. Nobody claps for you when you're 40. Plan accordingly.
...
What does this mean

 

[lymphocyte]

Most psychiatrists are safe. Family comes first. Nobody claps for you when you're 40. Plan accordingly.
...
What does this mean

Jeez, @GroverPsychMD can't I just regurgitate fortune-cookie aphorisms?

It was a point-by-point response to the poster's concerns.

Most psychiatrists are safe, and true harm is relatively rare (but safety is a fair concern--violence, broadly defined, is at 4 x the baseline rate for all physicians in the US, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074201/).

If his or her spouse is adamant against the profession, I would take that seriously.

Narcissistic supply dries up fast when you leave academics, or so I've heard. If ego and stigma are the only things holding you back from pursuing what you love, then just remember that 40-year-old-you is not 28-year-old-you. At 40, those people who said "you'd be letting your talents go to waste" will very likely be long gone and all you'll be left with is professional satisfaction in applying your talents to a job well done.

My observation of most middle-aged doctors (some of whom are close mentors) is that nobody cares anymore, except you, your family (if you're not a jerk), your closest friends, and some of your patients. And the medical board if you really stuff up. The ones who can't deal with that tend to be the most miserable.

 

[birchswing]

Jeez, @GroverPsychMD can't I just regurgitate fortune-cookie aphorisms?

It was a point-by-point response to the poster's concerns (as I bolded).

Most psychiatrists are safe, and true harm is relatively rare (but safety is a fair concern--violence, broadly defined, is at 4 x the baseline rate for all physicians in the US, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074201/).

If his or her spouse is adamant against the profession, I would take that seriously. I'm (amicably) divorced x 1.

Narcissistic supply dries up fast when you leave academics, or so I've heard. If ego and stigma are the only things holding you back from pursuing what you love, then just remember that 40-year-old-you is not 28-year-old-you. At 40, those people who said "you'd be letting your talents go to waste" will very likely be long gone and all you'll be left with is professional satisfaction in applying your talents to do a job well done.

My observation of most middle-aged doctors (some of whom are close mentors) is that nobody cares anymore, except you and some of your patients. And the medical board if you really stuff up.

Reminds me of "imaginary audiences" I learned about in developmental psychology:

https://en.wikipedia.org/wiki/Imaginary_audience

I think it's what keeps Facebook running (of course there is an actual audience, but the most vital part is the feeling of being watched—and you have an audience of people who are there for the same reason for themselves).

 

[lymphocyte]

.

 

[TheReluctantShrink]

If there is another medical field you feel drawn to, pursue it. Most people I know in psychiatry are here because they couldn't see themselves anywhere else...that is how I felt, and most of my colleagues tell a similar story.

You mention anesthesiology (not anesthesia, btw). Why are you not pulling the trigger on it? Just curious - what are these "special talents" that would go to waste in psychiatry that you would use elsewhere?

Thanks for the replies!! I never said I had any "special talents" - that statement is feedback I've gotten from attendings that felt I did very well on their rotation - they cited the usual "throwing away your medicine". I actually had one attending offer to write me a LOR with the caveat that he'd only do it if I wasn't applying to psych as he said it would be "a big waste of his time". Re "anesthesia", I'm not going to argue semantics, but suffice it to say that I'm finishing my third anesthesia rotation now and I've only heard maybe one or two people call it "anesthesiology". I'm not pulling the trigger because there are very big ticket items that I don't like about the field (deal-breakers, if you will): being in the OR all day, very brief patient interactions, working with unpleasant, egomaniac surgeons all day every day, early hours, lots of call, increasing autonomy of CRNAs means dwindling jobs for anesthesiologists, repetitive nature of the work, super detailed knowledge of pharm that I find uninteresting, lots of radiation exposure, and the list goes on. What do I like? Being an intensivist in the OR, getting to see the direct effects of interventions, the procedures. People see these lists and are then quick to suggest EM, but I worked in that field prior to starting medical school, so I know I'm not interested in it. I've met a few psychiatrists along the way who were between two very different fields - OB and general surgery to name two of them, so I do not think I'm a rarity.

I like some aspects of other fields, but I just really seem drawn to and enjoy psych. As Bartelby mentioned, I enjoy reading about psychiatry, staying a later to finish things up, etc. I haven't found this with any other field. I have especially enjoyed CL psychiatry. Bartelby, I'm very happy to hear that you had similar feelings as mine and are happy in your decision!

Yes, the ego factor needs to just be let go of. My spouse is supportive of whatever I ultimately choose, but just worries there's going to be some psychotic patient who might try to track me down - I've explained that all fields deal with "psych patients", and there's always the potential in any field that you could piss someone off to the point of seeking retribution. Bottom line is that I'm looking for satisfaction in what I do. I already have kids, so being able to spend time with them is also a huge priority. To me at least, this seems possible with psychiatry. As an unrelated aside, I have only met a handful of anesthesiologists who say they'd choose the field again (the chair at the program I'm at now encouraged me to apply to a different field), whereas the overwhelming majority (I know, N=20 or something) of psychiatrists I have met/worked with report they are very happy in their decision and would choose the field again. The survey data seems to back up this sentiment.

 

[lymphocyte]

Thanks for the replies!! I never said I had any "special talents" - that statement is feedback I've gotten from attendings that felt I did very well on their rotation - they cited the usual "throwing away your medicine". I actually had one attending offer to write me a LOR with the caveat that he'd only do it if I wasn't applying to psych as he said it would be "a big waste of his time". Re "anesthesia", I'm not going to argue semantics, but suffice it to say that I'm finishing my third anesthesia rotation now and I've only heard maybe one or two people call it "anesthesiology". I'm not pulling the trigger because there are very big ticket items that I don't like about the field (deal-breakers, if you will): being in the OR all day, very brief patient interactions, working with unpleasant, egomaniac surgeons all day every day, early hours, lots of call, increasing autonomy of CRNAs means dwindling jobs for anesthesiologists, repetitive nature of the work, super detailed knowledge of pharm that I find uninteresting, lots of radiation exposure, and the list goes on. What do I like? Being an intensivist in the OR, getting to see the direct effects of interventions, the procedures. People see these lists and are then quick to suggest EM, but I worked in that field prior to starting medical school, so I know I'm not interested in it. I've met a few psychiatrists along the way who were between two very different fields - OB and general surgery to name two of them, so I do not think I'm a rarity.

I like some aspects of other fields, but I just really seem drawn to and enjoy psych. As Bartelby mentioned, I enjoy reading about psychiatry, staying a later to finish things up, etc. I haven't found this with any other field. I have especially enjoyed CL psychiatry. Bartelby, I'm very happy to hear that you had similar feelings as mine and are happy in your decision!

Yes, the ego factor needs to just be let go of. My spouse is supportive of whatever I ultimately choose, but just worries there's going to be some psychotic patient who might try to track me down - I've explained that all fields deal with "psych patients", and there's always the potential in any field that you could piss someone off to the point of seeking retribution. Bottom line is that I'm looking for satisfaction in what I do. I already have kids, so being able to spend time with them is also a huge priority. To me at least, this seems possible with psychiatry. As an unrelated aside, I have only met a handful of anesthesiologists who say they'd choose the field again (the chair at the program I'm at now encouraged me to apply to a different field), whereas the overwhelming majority (I know, N=20 or something) of psychiatrists I have met/worked with report they are very happy in their decision and would choose the field again. The survey data seems to back up this sentiment.

Sounds like you're putting a lot of thought into this, which is great no matter what you decide. I really do wish you well. ~

 

[OldPsychDoc]

...Silly things that my ego is holding onto like prestige, pay, laying down my stethoscope,

You're right--they're silly. And just read the posts from those who want to switch.

and other things that my spouse is holding onto like safety, job satisfaction, and paying back my soul-crushing loans.

Mrs. PsychDoc was worried too. It's not been an issue. No stalkers, the loans are paid back, and most importantly I'm not working soul crushing hours and coming home exhausted. Go into psych and you may find that you actually have the time and energy to have a life and a marriage, and to enjoy it.

... at this point, I can confidently say that my psych rotations have been the only ones I've really enjoyed - I don't dread going in the morning and am actually sad when they end.....

This. This is the only reason you need. And this is the reason that will get you through residency and will be most meaningful 10-20 years from now. Face it--work is a drag. Is always a drag. It's been a drag since Genesis 3. But those of us who have a reason to get up in the morning are the lucky ones.

 

[lymphocyte]

This is the only reason you need. And this is the reason that will get you through residency and will be most meaningful 10-20 years from now.Face it--work is a drag. Is always a drag. It's been a drag since Genesis 3. But those of us who have a reason to get up in the morning are the lucky ones .

Annnnnnnnnd... that's my new signature.

 

[thoffen]

It's a shame that your peers are saying these things about psychiatry. They are uncalled for.

The largest truth about psychiatry is that it is very heterogeneous, in practice and in training environment. There is ample opportunity to make large sums of money and practice a lot of medicine if you so desire. Exploring the mind has been the most challenging and rewarding thing I have ever embarked on. And I'm just getting started. I don't think I'd remotely be the person who I am today had I picked a different specialty.

 

[MacDonaldTriad]

Since when did everyone else become such an expert on what psychiatry is like? You don't hear psychiatrists speak disparagingly about psychiatry. Trust me the water is fine and most of us are happy. How did someone put it? "I don't miss butt puss at all". Unless you do of course, in which case your decision is clear.

 

[DD214_DOC]

The novelty of being a physician wears off pretty quickly, and your priorities shift towards free time, family, friends, and enjoying life. I like psychiatry. I don't love psychiatry, because I don't love working. If I suddenly found myself financially independent, I would leave in a heartbeat. Not because I abhor psychiatry, but because not working is always better than working. Psychiatry is interesting and enjoyable enough to be likeable and meaningful during the day, but not demanding enough to be unable to leave it all in the office when I go home. In fact, outside of work, I genuinely rarely even think about being a physician. I like that.

There's a reason studies show that the happiest phase of someone's life is retirement.

 

[milesed]

I was very interested in other fields in med school too, but psyc stood high above the others. I loved surgery and OB/Gyn but knew the schedule would kill me, Derm was fun but I was bored after doing just a 4 week elective in my 4th year. Pediatrics was my first choice going in, but at my med school it was brutal and no one seemed happy (residents and attendings).

I loved the psychiatric patients, residents and attendings. The pathology was the most interesting of all I saw in med school.

I've practiced as a child/adol psychiatrist for 16 years now and had no issues with being respected, prestige, etc. If anything, I'm more respected than most other specialists since there are very few psychiatrists where I live and I'm the only child psyc. My only issue is the pay when compared the those who perform procedures. Still, I'd never change the choice I made. I'm seeing lots of burnout in my Dr. friends who chose higher paying specialties and I am certain I will even continue to work during my retirement (part time) as I enjoy working. Many in other fields are counting the days until their retirement so they can stop completely.

 

[PikminOC]

Why only since genesis 3?

 

[lymphocyte]

Why only since genesis 3?

The Fall. Before that?

 

[OldPsychDoc]

Why only since genesis 3?

There probably are members of this board <cough>vistaril<cough> who would have found ways to be miserable in Eden...but for most of us, that's when the whole "sweat of the brow" thing set in.

 

[Ceke2002]

If there's one thing I simply don't understand it's the notion that a Psychiatrist is somehow not a 'real' Doctor, like you become a Psychiatrist and *poof* you just suddenly lose however many years of medical training you've previously gone through. Granted my Psychiatrist works in more of a Psychotherapeutic mode (most of the time at least), but speaking just for myself he's still been able to assess past reactions to medications and work out suitable alternatives based on (neuro) biological and pharmacological knowledge, he's also been able to correctly assess and identify a medication induced heart arrhythmia which lead to a change in medication that I tolerated a lot better, and then there's the blood tests he's requested, the brain scans and other tests he's check listed through to rule out physiological causes of visual hallucinations, monitoring my breathing rate, pallor, and pupillary response during a presyncope episode, and he's currently monitoring me from a medical point of view for hypermetabolic syndrome caused by refeeding (yeah I kinda had a tad bit of a relapse with some stuff, getting it under control now though). So all of that and because he's a Psychiatrist he's suddenly not a 'real' Doctor?

Baulderdash!

(and that goes for all other Psychiatrists as well)

 

[thoffen]

I think we have to understand psychiatry's checkered past and prior lack of foundation in biological framework and evidence-based medicine. Lots of your supervisors are going to have experience from that era or otherwise interactions with psychiatrists who are from that era. Add to it the need to split off any discomfort around your own mental inadequacy or inadequacy working with your patients' mental health, and you'll get a lot of psychiatry bashing.

Sadly, there are those that overreact to their own feelings about not being "real doctors" and are trying to make considering disorders of the mind like considering disorders of the heart. There is desperate need for new biological frameworks and evidence and categorical diagnoses, but clearly on an individual level a symptom checklist cannot be considered clinically useful in the same way an echocardiogram is.

But that's where psychiatry is fun if you can tolerate a lot of uncertainty.

 

[hebel]

I don't post here often, but I wanted to write a reply because you sound so much like me around this exact time last summer. I was a little different because I was actually set on EM, but after two audition rotations realized I just simply didn't enjoy it like I thought I would. I quickly switched my next EM rotation to an anesthesia one. Fast forward a little later and to make a long story short, I was agonizing between choosing to apply to anesthesia or psychiatry residencies. Your reservations in regards to pay, scope of medical practice, and especially prestige bothered me too. Its been a year since then, and it took months to gradually see the reality of some of my concerns, but ultimately I'm SO glad I went with my gut and chose psychiatry.

Here's a bit of a long winded story (sorry):
One of the first things that slowly eroded away my longing for prestige was last summer at a cookout. During my audition rotation last summer the relatives I was staying with had a cookout. Most people there were young couples around my age (mid to late twenties). At the table the typical topics like “what do you do? ” came up, and most people were things like accountants or something involving business, sales, etc. At the time I could say I was auditioning for an Emergency Medicine residency, and was planning on doing EM. EM is a sexy specialty, so I got a bunch of oohhs and ahhhhs at the table, and I admit that felt good for those few minutes. But about 30 minutes later it was going on 6:30pm, and I had to leave the cookout early to do an overnight shift in the ED. So minutes later, there I was driving to do an overnight shift that I personally did not enjoy at all. EM had that wow factor, but it personally made me miserable. At the time I would have gladly traded places with those other cookout guests who’s jobs some would consider “boring.” It made me realize that those few seconds of admiration by strangers or others was not worth it, if I didn't enjoy what made up the large majority of the rest of day.

 

[smalltownpsych]

If I really wanted to impress people who don't know me, I would just tell them that I was a neurosurgeon. That sounds pretty impressive to me. 😎 When it comes to the people that do know me, they aren't really that impressed with me regardless of what I do for a living.

 

[vistaril]

It's clear you have already made up your mind and are just looking for people to tell you what you want to hear, so here goes: psychiatrists are 'real doctors'. Hell I practice more 'general medicine' than most internists. Just last week I was doing a psych consult for a patient on the renal service and in trending the gfr with the patients fluid status felt that a rare form of nephrotic syndrome may be at work and alerted the nephrologist to this catch of mine. He said "are you serious? Really?". I said serious as a heart attack. Unfortunately it turns out that in this great work that saved the patients kidneys I didn't get a chance to get around to why I was consulted in the first place(apparently the pt made a Statement to a nurse about there being no point to life if he was going to be on dialysis and I was supposed to screen for suicide risk), but I felt that this was far too limiting for what I could bring to this case. Then the week before that I made a diagnosis of autoimmune B cell mediated wachakowi syndrome related atypical psychosis on consults. That's what is so great about c-l.....the exposure to fascinating medical cases never stops. As for prestige and standing in the community, I have never had a single person ask me questions like "so what's the difference between a psychiatrist and psychologist" or "wait, you mean you went to medical school?". Not a single one. In fact my neighbor is a general surgeon and he tells me that people get his role in healthcare and training confused all the time....glad I never had to worry about such things. As for pay, well...I wasn't a math major, but it only makes sense that if you are seeing maybe 2 patients in your office per hour and another provider is seeing maybe 5 patients per hour then you are going to make more money than the person seeing 5 per hour right? Oh and non-procedural specialties always pay more too.....a lot of people don't know this but it's much more lucrative to spend 35 minutes talking about a patients mood symptoms a
Than it is to do 6 occipital nerve injections over that same time period.

 

[psychhopefull2016]

It's clear you have already made up your mind and are just looking for people to tell you what you want to hear, so here goes: psychiatrists are 'real doctors'. Hell I practice more 'general medicine' than most internists. Just last week I was doing a psych consult for a patient on the renal service and in trending the gfr with the patients fluid status felt that a rare form of nephrotic syndrome may be at work and alerted the nephrologist to this catch of mine. He said "are you serious? Really?". I said serious as a heart attack. Unfortunately it turns out that in this great work that saved the patients kidneys I didn't get a chance to get around to why I was consulted in the first place(apparently the pt made a Statement to a nurse about there being no point to life if he was going to be on dialysis and I was supposed to screen for suicide risk), but I felt that this was far too limiting for what I could bring to this case. Then the week before that I made a diagnosis of autoimmune B cell mediated wachakowi syndrome related atypical psychosis on consults. That's what is so great about c-l.....the exposure to fascinating medical cases never stops. As for prestige and standing in the community, I have never had a single person ask me questions like "so what's the difference between a psychiatrist and psychologist" or "wait, you mean you went to medical school?". Not a single one. In fact my neighbor is a general surgeon and he tells me that people get his role in healthcare and training confused all the time....glad I never had to worry about such things. As for pay, well...I wasn't a math major, but it only makes sense that if you are seeing maybe 2 patients in your office per hour and another provider is seeing maybe 5 patients per hour then you are going to make more money than the person seeing 5 per hour right? Oh and non-procedural specialties always pay more too.....a lot of people don't know this but it's much more lucrative to spend 35 minutes talking about a patients mood symptoms a
Than it is to do 6 occipital nerve injections over that same time period.

I've gotten "whats the difference between a psychiatrist and a psychologist" and "this is my granddaughter she wants to be a psychologist" and such things all the time but I don't think that is an insult. Psychologists also work hard for mental health and getting a phd takes just as long. I think a lot of people honestly just have no idea what the difference is or say the wrong similar sounding word

 

[lymphocyte]

Oh and non-procedural specialties always pay more too.....a lot of people don't know this but it's much more lucrative to spend 35 minutes talking about a patients mood symptoms a
Than it is to do 6 occipital nerve injections over that same time period.

Sometimes I wonder if you're the most subtle troll ever.

 

[smalltownpsych]

I'm thinking that V was being just a tad sarcastic with the part about questions and pay. 😛

 

[lymphocyte]

I'm thinking that V was being just a tad sarcastic with the part about questions and pay. 😛

On reflection, I actually think the whole post was a masterpiece of sarcasm.

 

[hamstergang]

On reflection, I actually think the whole post was a masterpiece of sarcasm.

Yes, it's quite clearly all sarcasm. I only have issue with one part:

As for pay, well...I wasn't a math major, but it only makes sense that if you are seeing maybe 2 patients in your office per hour and another provider is seeing maybe 5 patients per hour then you are going to make more money than the person seeing 5 per hour right?

You say this (in different words) often, but it's still too simplistic to be true. Don't psychiatrists make more than primary care doctors, especially with the pediatrician population?

 

[vistaril]

Yes, it's quite clearly all sarcasm. I only have issue with one part:


You say this (in different words) often, but it's still too simplistic to be true. Don't psychiatrists make more than primary care doctors, especially with the pediatrician population?

Psychiatrists most certainly don't make more money than internists....it's not even close really. I could make 450-550k here if I was an internist. I'll admit to not knowing a lot about outpt peds reimbursement....but an outpt peds doc can see a lot more patients per hour than an outpt child psych(unless the child psych is just seeing kids for 5 mins apiece.....and then is that really practicing psychiatry though?)

 

[hamstergang]

Psychiatrists most certainly don't make more money than internists....it's not even close really.

Most salary surveys I've seen show psychiatrists making more than internists, so even if that's wrong it's likely close. Pediatricians make less than internists, but child psychiatrists make more than adult psychiatrists. Child psychiatrists see fewer patients per hour than pediatricians but make more than pediatrucians. That's my point that you don't seem to ever accept.

 

[st2205]

Most salary surveys I've seen show psychiatrists making more than internists, so even if that's wrong it's likely close. Pediatricians make less than internists, but child psychiatrists make more than adult psychiatrists. Child psychiatrists see fewer patients per hour than pediatricians but make more than pediatrucians. That's my point that you don't seem to ever accept.

Vistaril has implied heavily that he believes the only determinate of salary is a directly correlated relationship with CPT codes and doesn't see the other multitude of factors and variables that may influence a salary. Acceptance of this view works great for hospital administrators and, if his job prospects are any indicator, his can't-win attitude and persistent and pervasive traits likely leave him a rather neutered negotiator.

 

[Bartelby]

Psychiatrists most certainly don't make more money than internists....it's not even close really. I could make 450-550k here if I was an internist.

For those who are wondering how seriously to take vistaril's opinion, ask yourself how many of your internist colleagues have taken positions earning half a million dollars. Also take a look at the 2016 Medscape compensation report (http://www.medscape.com/features/slideshow/compensation/2016/public/overview#page=2) and compare.

 

[takeeacy]

I think there are a lot of psychiatrists who have had interests in surgical and procedural specialties - you are not alone. I know for a fact that at least at 2-3 of the "top 5ish residencies" (classmates/starting PGY-1s and residents I know) who had made late switches from fields such as ob/gyn, urology, gen surg and etc. I think it can be hard to compare psychiatry against procedural fields because you're comparing two very different practices with different appeals (apples to oranges) unlike say ortho to gen surg. It's valid to like both things since there is not a whole lot of overlap.

One thing that always bothered me was how people would tell me that I could practice "psychiatry" in their field. That drew me in quite often, but this generally meant unrigorously dealing with a difficult patient/cluster B individual. Such efforts were usually frustrating and not often fruitful. In the end, either psych would be consulted or the patient would be dismissed into the wastebasket dx of "crazy." So practicing and meeting "psych patients" in other fields often meant poor management of SSRIs or untrained attempts to provide "therapy." I think if you really enjoy either of those things, you could enjoy pursuing a field where you can really study how to practice those modalities better. (I found general surgery to be incredibly fun but I realized that I didn't care as much to learn the various suturing or laparoscopic techniques/approaches as much as the visceral enjoyment of opening up someone's abdomen and poking around and closing back up)

 

[Shikima]

I think there are a lot of psychiatrists who have had interests in surgical and procedural specialties - you are not alone. I know for a fact that at least at 2-3 of the "top 5ish residencies" (classmates/starting PGY-1s and residents I know) who had made late switches from fields such as ob/gyn, urology, gen surg and etc. I think it can be hard to compare psychiatry against procedural fields because you're comparing two very different practices with different appeals (apples to oranges) unlike say ortho to gen surg. It's valid to like both things since there is not a whole lot of overlap.

One thing that always bothered me was how people would tell me that I could practice "psychiatry" in their field. That drew me in quite often, but this generally meant unrigorously dealing with a difficult patient/cluster B individual. Such efforts were usually frustrating and not often fruitful. In the end, either psych would be consulted or the patient would be dismissed into the wastebasket dx of "crazy." So practicing and meeting "psych patients" in other fields often meant poor management of SSRIs or untrained attempts to provide "therapy." I think if you really enjoy either of those things, you could enjoy pursuing a field where you can really study how to practice those modalities better. (I found general surgery to be incredibly fun but I realized that I didn't care as much to learn the various suturing or laparoscopic techniques/approaches as much as the visceral enjoyment of opening up someone's abdomen and poking around and closing back up)

I thought of surgery for a long time until I realized, I needed to sleep. Nothing was more apparent when I was doing Q3-4 call back in the days of 30-36 hours straight without any sleep as an Intern. I needed to make a change for me to have a better quality of life.

 

[lymphocyte]

I think there are a lot of psychiatrists who have had interests in surgical and procedural specialties - you are not alone. I know for a fact that at least at 2-3 of the "top 5ish residencies" (classmates/starting PGY-1s and residents I know) who had made late switches from fields such as ob/gyn, urology, gen surg and etc. I think it can be hard to compare psychiatry against procedural fields because you're comparing two very different practices with different appeals (apples to oranges) unlike say ortho to gen surg. It's valid to like both things since there is not a whole lot of overlap.

I've noticed this too. Lots of psychiatrists who might have become surgeons, anatomic pathologists, or some other kind of proceduralists. Usually they pick psychiatry for 1) lifestyle reasons and 2) they actually enjoy spending time with patients.