seems like a lot of heavy SDN posters are going into psych. is it really that great?

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weasel23

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I lurk around several specialty forums because I've had a really tough time deciding what I want to do with my life (currently an M3). anyway, it seems like a lot of heavy SDN posters are going the psych route. maybe it's just a few cases, but regardless this forum is very active and everyone has great things to say about psych.

so is psychiatry really that much of a :hidden gem" in medicine? the way people talk on this forum you'd be crazy to pass up on the lifestyle/$ that psych apparently affords. this opinion hasn't been my impression talking to attendings in other specialties, though.

I keep changing my mind on specialty choice, but every time I stumble back on the psych forum, I ask myself why I shouldn't choose this field? Any thoughts?

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No, you shouldn't go into psych. I hear they work super hard, get paid ****, and patients are dangerous. It's a last resort for me personally
 
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I lurk around several specialty forums because I've had a really tough time deciding what I want to do with my life (currently an M3). anyway, it seems like a lot of heavy SDN posters are going the psych route. maybe it's just a few cases, but regardless this forum is very active and everyone has great things to say about psych.

so is psychiatry really that much of a :hidden gem" in medicine? the way people talk on this forum you'd be crazy to pass up on the lifestyle/$ that psych apparently affords. this opinion hasn't been my impression talking to attendings in other specialties, though.

I keep changing my mind on specialty choice, but every time I stumble back on the psych forum, I ask myself why I shouldn't choose this field? Any thoughts?
From what I've learned from my clinical experience and also what I've learned about the question of choosing psychiatry from my psychiatry attendings and residents, one thing seems clear:

If you are attracted to psych initially because of the "lifestyle/$", instead of being drawn to psych because you're genuinely fascinated by your patients who present with psychiatric illnesses (on your psych rotations AND other rotations), it is probably not a good idea for you to go into psych. Only you can answer this.

Lifestyle, $, encroachment, competitiveness, and practice environment (to an extent) is all potentially subject to change for any specialty. Pick your specialty based on 2 things: 1) do you like the patients and 2) are you fascinated by the pathology - these will remain constant.
 
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it's not a "hidden gem" - other doctors typically are aware of what you say

it's just, it's great, it's all the things people say it is,
*if you like psych*

If take the FM doc and I make them an IM doc outpt, well, is that so different??
If I take the general surgeon, and make them a CT surgeon, well, are they gonna blow their brains out?

but if I take the surgeon, and drop them in peds clinic for the rest of their life......
If I take me, and drop me in surgery.... I wouldn't have "a rest of my life".....

If you talk to any doc, they'll typically be able to list at least 1 or 2 other specialties they could have done, and often they're somewhat similar, in some fashion.
IM/EM --> wait a minute! both like being "generalists" and working in the hospital, and are part of the admissions process. They prefer sick >>> well.

Typically, you have "cutters" and "thinkers." Surgeons and non-surgeons typically aren't keen to swap shoes.

Psych is unlike all the other fields in *so* many ways. Even amongst the "thinkers," there's not many that can stomach it.

I can think of a lot of reasons why you might see a psych-bound bias to the posters on SDN.
 
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No, you shouldn't go into psych. I hear they work super hard, get paid ****, and patients are dangerous. It's a last resort for me personally

I can't speak for your feelings.

I can say the rest of what you said is total crap.
 
From what I've learned from my clinical experience and also what I've learned about the question of choosing psychiatry from my psychiatry attendings and residents, one thing seems clear:

If you are attracted to psych initially because of the "lifestyle/$", instead of being drawn to psych because you're genuinely fascinated by your patients who present with psychiatric illnesses (on your psych rotations AND other rotations), it is probably not a good idea for you to go into psych. Only you can answer this.

Lifestyle, $, encroachment, competitiveness, and practice environment (to an extent) is all potentially subject to change for any specialty. Pick your specialty based on 2 things: 1) do you like the patients and 2) are you fascinated by the pathology - these will remain constant.

for sure, i agree. i did enjoy my psych rotation, but through all of them so far I haven't found anything I absolutely love. i don't want to base my life decision on lifestyle/$, but it's really difficult to forecast a 40 year career with the limited exposure we get in medical school
 
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for sure, i agree. i did enjoy my psych rotation, but through all of them so far I haven't found anything I absolutely love. i don't want to base my life decision on lifestyle/$, but it's really difficult to forecast a 40 year career with the limited exposure we get in medical school
I feel your pain! What I'd suggest going forward would be to reflect on your rotations already completed and try and remember the patients and pathology that you really got excited about (and keep note of that going forward).

Using psych as an example, if your favorite thing during your surgery rotation was talking to the anxious pre-op patient (and then getting yelled at for it lol), your most memorable internal medicine patient was struggling with depression, and your favorite OB delivery was a schizophrenic patient, AND you "enjoyed" your psych rotation, psych might be for you.
Or, another example, if you love talking about preventative medicine and health behaviors with your surgery, IM, and peds patients and "enjoyed" FM then maybe FM or preventative medicine is for you.

Try to find the common thread in terms of patients and pathology, and remember that there's overlap in pathology between specialties at times which you may be able to tease out by reflecting on what youve done and being mindful of these things as you complete the rest of rotations. best of luck!
 
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it's not a "hidden gem" - other doctors typically are aware of what you say

it's just, it's great, it's all the things people say it is,
*if you like psych*

If take the FM doc and I make them an IM doc outpt, well, is that so different??
If I take the general surgeon, and make them a CT surgeon, well, are they gonna blow their brains out?

but if I take the surgeon, and drop them in peds clinic for the rest of their life......
If I take me, and drop me in surgery.... I wouldn't have "a rest of my life".....

If you talk to any doc, they'll typically be able to list at least 1 or 2 other specialties they could have done, and often they're somewhat similar, in some fashion.
IM/EM --> wait a minute! both like being "generalists" and working in the hospital, and are part of the admissions process. They prefer sick >>> well.

Typically, you have "cutters" and "thinkers." Surgeons and non-surgeons typically aren't keen to swap shoes.

Psych is unlike all the other fields in *so* many ways. Even amongst the "thinkers," there's not many that can stomach it.

I can think of a lot of reasons why you might see a psych-bound bias to the posters on SDN.


thanks for the post, great points and very helpful. i guess my thought is i absolutely could stomach it, i do enjoy the field. would I be miserable in another field of medicine? no, i think I could be happy in several fields. i just never envisioned myself in psychiatry before starting medical school, so I think that's biasing me against it. like you said, "psych is unlike all other fields in *so* many ways"
 
it's not a "hidden gem" - other doctors typically are aware of what you say

it's just, it's great, it's all the things people say it is,
*if you like psych*

If take the FM doc and I make them an IM doc outpt, well, is that so different??
If I take the general surgeon, and make them a CT surgeon, well, are they gonna blow their brains out?

but if I take the surgeon, and drop them in peds clinic for the rest of their life......
If I take me, and drop me in surgery.... I wouldn't have "a rest of my life".....

If you talk to any doc, they'll typically be able to list at least 1 or 2 other specialties they could have done, and often they're somewhat similar, in some fashion.
IM/EM --> wait a minute! both like being "generalists" and working in the hospital, and are part of the admissions process. They prefer sick >>> well.

Typically, you have "cutters" and "thinkers." Surgeons and non-surgeons typically aren't keen to swap shoes.

Psych is unlike all the other fields in *so* many ways. Even amongst the "thinkers," there's not many that can stomach it.

I can think of a lot of reasons why you might see a psych-bound bias to the posters on SDN.
Great points! I think a lot of this has to do with whether you are comfortable with using the DSM as your guide - I certainly respect it, but the way psychiatrists need to digest that information within the context of their clinical experience and for their clinical decision making is somewhat different than say an IM doc using the info in Harrisons or an EM doc using the info in Tintinali's in their clinical experience and decision making... I'd assume in psych, being comfortable with uncertainty is super important too...
 
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One thing that is not overblown is how much better the work-life balance is during residency compared to other fields. I'm at what is an above average workload psych program and basically live a completely "normal" life. All my friends in other fields seem to have lost some piece of their soul during residency.
 
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From what I've learned from my clinical experience and also what I've learned about the question of choosing psychiatry from my psychiatry attendings and residents, one thing seems clear:

If you are attracted to psych initially because of the "lifestyle/$", instead of being drawn to psych because you're genuinely fascinated by your patients who present with psychiatric illnesses (on your psych rotations AND other rotations), it is probably not a good idea for you to go into psych. Only you can answer this.

Lifestyle, $, encroachment, competitiveness, and practice environment (to an extent) is all potentially subject to change for any specialty. Pick your specialty based on 2 things: 1) do you like the patients and 2) are you fascinated by the pathology - these will remain constant.

"Lifestyle, $, encroachment, competitiveness, and practice environment (to an extent) is all potentially subject to change for any specialty. Pick your specialty based on 2 things: 1) do you like the patients and 2) are you fascinated by the pathology - these will remain constant."

In the ideal world you are correct. But the reality is, many medical students choose fields based on those factors. I'm not slamming any specialty, but purely from an objective point of view, why do you think derm and ophtho are top of the cake in competitiveness? Do you think if Dermatologists were being paid 180K and had q4 call as an attending, it would be #1? Doubtful. Its the same reason why Radiology has been crashing last 5 years, terrible job market. Of course these factors can change in 10-20 years, but overall they are relatively consistent.

So yes, obviously choose something you are interested, but I strongly suggest to consider other factors as well, such as job market, reimbursement trends, malpractice premiums (eg. OBGYN pays 100K minimum), overhead costs. These are things that nobody teaches you in medical school, and you can only rely on sources like SDN for this type of "external info".

As for Psychiatry being a hidden gem. Definitely true up until 2015. Past 3 years there has been a 10% increase in applicants in each year, highest among any specialty.

https://www.aamc.org/services/eras/stats/359278/stats.html


Obviously, its no ROAD speciality, but its no longer a bottom feeder either. Which goes back to my original point, is this new jump in applications because medical students are all of a sudden in awe of depression and schizophrenia, or is it because they want to go into a specialty that has rising reimbursement rates and good lifestyle? Think about it.
 
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it's not a "hidden gem" - other doctors typically are aware of what you say

it's just, it's great, it's all the things people say it is,
*if you like psych*

If take the FM doc and I make them an IM doc outpt, well, is that so different??
If I take the general surgeon, and make them a CT surgeon, well, are they gonna blow their brains out?

but if I take the surgeon, and drop them in peds clinic for the rest of their life......
If I take me, and drop me in surgery.... I wouldn't have "a rest of my life".....

If you talk to any doc, they'll typically be able to list at least 1 or 2 other specialties they could have done, and often they're somewhat similar, in some fashion.
IM/EM --> wait a minute! both like being "generalists" and working in the hospital, and are part of the admissions process. They prefer sick >>> well.

Typically, you have "cutters" and "thinkers." Surgeons and non-surgeons typically aren't keen to swap shoes.

Psych is unlike all the other fields in *so* many ways. Even amongst the "thinkers," there's not many that can stomach it.

I can think of a lot of reasons why you might see a psych-bound bias to the posters on SDN.

"Psych is unlike all the other fields in *so* many ways. Even amongst the "thinkers," there's not many that can stomach it."

Agreed, this is why I went into psych. Its the most diverse field in medicine. You can spend one day doing psychodynamic psychotherapy, the next day in a suboxone clinic, the day after doing epidural injections, and the day after doing ECT....you get my point.

Medical school in the U.S has it all wrong. Most schools' psych rotation involves 4 weeks in an inpatient unit....even though inpatient units are downsizing over the next decade or so....and medical students have almost 0 exposure to general outpatient psych, psychodynamic psychotherapy, addiction, forensics, CBT/DBT, sleep medicine (Sleep lab), interventional pain, neuropsychiatry/brain stimulation (ECT), child psych, CL, etc. I mean, there are a lot of psychiatry residents that don't even get exposure to a lot of this stuff, let alone med students! Thats how diverse this field is.

So obviously its a "hidden gem", because it truly is "hidden".
 
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Psychiatry in general is a good field at this point, and I have not regretted going into it. The personality type in psychiatry is sometimes a little tough to put up with; the people who say they "couldn't have gone into any other field, only psychiatry" tend to be the worst. And psychiatry also tends to get a lot of the students who did not do well in medical school which is unfortunate for our field (something I agree with splik about.) Psychiatrists also tend to let other specialties "walk all over us" and don't seem to mind when other specialties disrespect us.
The chair of neurosurgery at my medical school said he was set on psychiatry and then did his 3rd year rotation and decided he would not like his future colleagues and went to NS instead. I sort of understand where he was coming from, but I obviously did not find them to be that objectionable, and I should add that some are great people and fun to be around.
 
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"Lifestyle, $, encroachment, competitiveness, and practice environment (to an extent) is all potentially subject to change for any specialty. Pick your specialty based on 2 things: 1) do you like the patients and 2) are you fascinated by the pathology - these will remain constant."

In the ideal world you are correct. But the reality is, many medical students choose fields based on those factors. I'm not slamming any specialty, but purely from an objective point of view, why do you think derm and ophtho are top of the cake in competitiveness? Do you think if Dermatologists were being paid 180K and had q4 call as an attending, it would be #1? Doubtful. Its the same reason why Radiology has been crashing last 5 years, terrible job market. Of course these factors can change in 10-20 years, but overall they are relatively consistent.

So yes, obviously choose something you are interested, but I strongly suggest to consider other factors as well, such as job market, reimbursement trends, malpractice premiums (eg. OBGYN pays 100K minimum), overhead costs. These are things that nobody teaches you in medical school, and you can only rely on sources like SDN for this type of "external info".

As for Psychiatry being a hidden gem. Definitely true up until 2015. Past 3 years there has been a 10% increase in applicants in each year, highest among any specialty.

https://www.aamc.org/services/eras/stats/359278/stats.html


Obviously, its no ROAD speciality, but its no longer a bottom feeder either. Which goes back to my original point, is this new jump in applications because medical students are all of a sudden in awe of depression and schizophrenia, or is it because they want to go into a specialty that has rising reimbursement rates and good lifestyle? Think about it.

You're absolutely right about still considering compensation, job market, malpractice, etc. I'm just saying its more dangerous to use these things as your first decision point.

The problem with this in psychiatry SPECIFICALLY is that people who go into psych who do not love psych are more likely to be terrible psychiatrists. It is harder to fake being interested in a patient's psych issue than it is to fake (for example in rads) interest in what pathology you see on a scan or fake (for example in derm) interest in what that skin lesion is. Obviously, in all fields the physicians who are most interested in what they are doing are more likely to be better at it. The problem is with psych is that if you are a psychiatrist who is NOT really in love with psych I think your patients (and your own mental health) would be harmed to a larger degree vs. if you faked interest in any other specialty (in general)...

Also that is not to say you can't love other stuff too but choose to do psych because you really love it too, this is likely a good problem to have vs the opposite.
 
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It is pretty great. I struggled between family medicine, ER, and psychiatry. I am very happy with my choice.
 
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Psychiatry in general is a good field at this point, and I have not regretted going into it. The personality type in psychiatry is sometimes a little tough to put up with; the people who say they "couldn't have gone into any other field, only psychiatry" tend to be the worst. And psychiatry also tends to get a lot of the students who did not do well in medical school which is unfortunate for our field (something I agree with splik about.) Psychiatrists also tend to let other specialties "walk all over us" and don't seem to mind when other specialties disrespect us.
The chair of neurosurgery at my medical school said he was set on psychiatry and then did his 3rd year rotation and decided he would not like his future colleagues and went to NS instead. I sort of understand where he was coming from, but I obviously did not find them to be that objectionable, and I should add that some are great people and fun to be around.


Sure, this is historically true. Even main stream articles talk about psych being "low paid, high IMG":

http://fivethirtyeight.com/features...arder-to-find-a-psychiatrist-or-pediatrician/

"For example, 27.6 percent of all psychiatrists and 26.4 percent of physicians specializing in internal medicine graduated from foreign medical schools, compared with just 12.4 percent of doctors practicing radiology and 9.8 percent of those in the surgical subspecialties — fields that are better compensatedand attract plenty of domestically trained physicians."

But again, gears are shifting last few years, and the medscape compensation reports are inaccurate, because psychiatrists, over 70% of them, work less than 40 hrs/week. So of course psychiatrists are "poorly compensated". I'm sure if 70% of general surgeons worked less than 40 hours/week, they would also be "poorly compensated".
 
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I think I could have been happy in several other specialties - I genuinely liked IM and emergency medicine. Lifestyle and flexibility were factors in why I ultimately chose Psych.
My job right now, working for corporate medicine, is kind of stressful , but for now it feels worth it since it pays me well. However, if I ever do get fed up with my current job, it is nice to know that I have a lot of different options for how I want my next job to look. I am planning that most likely I will cut back on how many hours I work when I switch jobs in the future.

Honestly, I think the current generation of doctors tends to have more of a "work to live" than "live to work" attitude compared to older docs. That's how I feel, at least. Quite frankly, I feel like with the way society views doctors now, plus the likelihood that we will continue down the road of decreased respect, lower pay, and encroachment of NPs, I would not want to be in a specialty where I would have no choice but to keep killing myself working long hours.It doesn't feel like it's worth it these days, even though I think other specialties definitely have their positive aspects and can be very interesting/rewarding.

Personally, my #1 goal after graduating residency has been to pay off all my debt as soon as I can so that if things get really bad in medicine it is easy for me to walk away from the whole thing. Fortunately, I should be debt-free within another year and a half. :)
 
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I think I could have been happy in several other specialties - I genuinely liked IM and emergency medicine. Lifestyle and flexibility were factors in why I ultimately chose Psych.
My job right now, working for corporate medicine, is kind of stressful , but for now it feels worth it since it pays me well. However, if I ever do get fed up with my current job, it is nice to know that I have a lot of different options for how I want my next job to look. I am planning that most likely I will cut back on how many hours I work when I switch jobs in the future.

Honestly, I think the current generation of doctors tends to have more of a "work to live" than "live to work" attitude compared to older docs. Quite frankly, I feel like with the way society views doctors now, the likelihood that we will continue down the road of decreased respect, lower pay, and encroachment of NPs, I would not want to be in a specialty where I would have to keep killing myself working long hours to make a decent living. It doesn't feel like it's worth it these days, even though I think other specialties definitely have their positive aspects and can be very interesting/rewarding.


Yep. But medical students should also realize that there are psychiatrists that work 60-65 hours/week, start at 6:30am (ECT) and work until 8pm, as well as some private practice on weekends. Just like there are general surgeons who go into endocrine or breast surgery, and do 40 hours a week (8am to 4pm), with relatively minimal call. I personally know a few general surgeons that choose to only do elective hernias. I'm sure this is a tough gig to get, but it is possible to have a decent lifestyle as a general surgeon. Not every single gen surgeon is doing explorative laparotomies at 3am q3.

So yes, obviously for the majority in each field, psych has a better lifestyle than general surgery. But I'm also a firm believer that "lifestyle" is very overrated. I personally would rather do 70 hours a week as a general surgeon than 40 hours a week as a family doc. No point in being unhappy with a good lifestyle in my opinion.
 
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Yep. But medical students should also realize that there are psychiatrists that work 60-65 hours/week, start at 6:30am (ECT) and work until 8pm, as well as some private practice on weekends. Just like there are general surgeons who go into endocrine or breast surgery, and do 40 hours a week (8am to 4pm).

So yes, obviously for the majority in each field, psych has a better lifestyle than general surgery. But I'm also a firm believer that "lifestyle" is very overrated. I personally would rather do 70 hours a week as a general surgeon than 40 hours a week as a family doc. No point in being unhappy with a good lifestyle in my opinion.

Funny you mention this, I recently had a conversation with a community psychiatrist who was almost 80 yo and still practicing, and I asked how the hours had helped him prolong his career. He replied that most of his career he worked 70-80 hours a week with a busy practice as well as a whole bunch of other work that filled his time, and only recently dialed it back. Just goes to show if you're happy in your specialty then the hours probably matter less...
 
Funny you mention this, I recently had a conversation with a community psychiatrist who was almost 80 yo and still practicing, and I asked how the hours had helped him prolong his career. He replied that most of his career he worked 70-80 hours a week with a busy practice as well as a whole bunch of other work that filled his time, and only recently dialed it back. Just goes to show if you're happy in your specialty then the hours probably matter less...

Yea I think it was the learning channel or somewhere on tv, I was watching a documentary about longevity in humans. They interviewed a cardiac surgeon, who worked crazy, stressful hours during his career, but was still mentally sharp and physically healthy at age 95. The conclusion they came to of why he was able to live such a long and healthy life was because he loved what he did.....
 
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Just goes to show if you're happy in your specialty then the hours probably matter less...

To some extent, but as much as I love psychiatry I also want time for myself. This is even more true if you start a family. If 80 hour weeks were the norm in psychiatry that probably would have been a sufficient deterrent to entering the field in the first place.
 
To some extent, but as much as I love psychiatry I also want time for myself. This is even more true if you start a family. If 80 hour weeks were the norm in psychiatry that probably would have been a sufficient deterrent to entering the field in the first place.

But this also becomes subjective. Some people might be happier being miserable for 40 hrs/week but able to do other things or happier working 70 hours/week but unable to do as much outside of work. The key is to find a balance on the seesaw that is geared to your personal and professional goals.

Like I personally do not see myself working less than 60-65 hours/week.
 
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So yes, obviously for the majority in each field, psych has a better lifestyle than general surgery. But I'm also a firm believer that "lifestyle" is very overrated. I personally would rather do 70 hours a week as a general surgeon than 40 hours a week as a family doc. No point in being unhappy with a good lifestyle in my opinion.

Yes, if you love surgery and hate psych, I wouldn't go into psych just for the hours. Putting up with a job you hate, even if it is only for 20 hours a week, isn't any way to live, and if you are following a calling for something you feel truly passionate about, then the sacrifice of working long hours won't seem as bad.

However, if you do at least *like* psych, and have some interest but not necessarily a passion for another specialty that has worse hours, then I don't think it is unreasonable to make the lifestyle issue a factor that tips the balance in favor of psych. Yes, there are some psychiatrists who work like dogs - but that's because they've chosen to do that than because they have to do it.

I think that the lifestyle specialties will always have the advantage that, even if you end up not loving your job, at least you have free time to use to pursue the things you do truly care about in life. For me, spending time with my family and pursuing hobbies has ended up being a lot more rewarding to me than anything I do at work, even though I am fortunate that my job does give me moments of fun and satisfaction sometimes. Psych can be interesting, and as jobs go it really isn't a bad gig. I am glad I don't have to dig ditches or clean bathrooms in my daily work. Most days, though, it is still just a job - and most jobs are stuff that people wouldn't do if they weren't getting paid to do it. :)
 
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Obviously no one can ever tell you what field will be right for you. However, something that can be helpful is to consider which types of doctors you have most liked being around. After all, you're going to be spending the rest of your career around these people. I already pretty much knew that I was going to go into psychiatry even before I started medical school, but it gave me greater confidence in my decision when I found psychiatrists to be the most interesting and humorous bunch in all of medicine. What I liked most about psychiatrists is that they were the doctors who were most likely to talk about something other than medicine from time to time. Which doctors do you find funny? Which doctors d0 you find interesting? Which doctors are actually nice to you? Only you can decide. The company you keep makes a huge difference in terms of your quality of life. It's something to think about.
 
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I think that the lifestyle specialties will always have the advantage that, even if you end up not loving your job, at least you have free time to use to pursue the things you do truly care about in life
^Good point, can't argue with that

Most days, though, it is still just a job - and most jobs are stuff that people wouldn't do if they weren't getting paid to do it
I know that is technically true, but (as a still not yet jaded med student) isn't it more than "just a job"? Isn't that the whole point? Maybe I'm too optimistic - I've had probably 15 or so real jobs in my life (usually worked more than one at a time for lots of hours a week), and I can only think of 3 or 4 that I would NOT have done for free. I've been lucky to be able to pursue the things I enjoy in life so far (and jobs in those areas), and it was nice to make some money along the way, but that was never my driving force (been very blessed to have family support if I needed it, but haven't so far) and I was hoping that practicing as a physician in whatever specialty I found most interesting would be a similar experience. I'm also that kid who liked all my rotations and got there early and stayed late cuz it was fun.
Sounds more and more like it will eventually turn into "just a job" most days, which is a bummer but like you said at least it leaves time for other things in life...
It was interesting and helpful to hear your perspective as an attending, thanks!
 
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Medical school in the U.S has it all wrong. Most schools' psych rotation involves 4 weeks in an inpatient unit....even though inpatient units are downsizing over the next decade or so....and medical students have almost 0 exposure to general outpatient psych, psychodynamic psychotherapy, addiction, forensics, CBT/DBT, sleep medicine (Sleep lab), interventional pain, neuropsychiatry/brain stimulation (ECT), child psych, CL, etc. I mean, there are a lot of psychiatry residents that don't even get exposure to a lot of this stuff, let alone med students! Thats how diverse this field is.

So obviously its a "hidden gem", because it truly is "hidden".

I cannot overstate this enough. I don't think the psych rotation is a reliable measure of whether you'll like psychiatry or not, especially when medical schools stick medical students with high acuity patients who are not gratifying to work with. I also don't think that the people you work with should be a reliable marker of why you went into that specialty too - I've worked with great people in every specialty that inspired me to almost pick their specialty and extremely terrible people that made me not want to consider that same specialty.

Unfortunately, medical students will make their decision based on the personalities of people they worked with, which I think comes down to luck with who you're paired with, or based on the patient population, which in psych rotations isn't representative of how psychiatry is mainly practiced in the US.

However, I think that you should consider definitely lifestyle factors such as income and work hours when picking a specialty. The practical matter is that your job allows you to make a living. There's nothing wrong with that motivation. The question becomes: how much does that motivation matter to you? Some medical students have different pressures on them to choose a field that makes more money, or have more time off, or obtain that prestige regardless of length of training, or a million other things. It matters to reflect on what motivations matter in your life, and no one can tell you what those are even though they'll try to.

If your main purpose in life is to work to make a living, then you should know this and don't put too much effort in worrying about the work. Be an average psychiatrist if you want and choose to focus on what matters to you, whether it's your marriage, your family, your children, your cat, your rock garden, whatever you want. People may criticize you for that, but I don't think it's practical that everyone necessarily can or wants to be above average in their work.

so is psychiatry really that much of a :hidden gem" in medicine? the way people talk on this forum you'd be crazy to pass up on the lifestyle/$ that psych apparently affords. this opinion hasn't been my impression talking to attendings in other specialties, though.

I wouldn't put too much stock what other attendings think of psychiatry or any specialties other than their own for that matter, and even then I wouldn't hold a candle to it. There's going to be pros and cons to each specialty and you'll have to determine which ones are favorable or dealbreakers for you. Physicians, especially older ones, probably don't have a good grasp of the lifestyle/salary in fields other than their own though. I don't think any of them can tell you that less than 75% of psychiatrists work under 45 hours a week.
 
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I cannot overstate this enough. I don't think the psych rotation is a reliable measure of whether you'll like psychiatry or not, especially when medical schools stick medical students with high acuity patients who are not gratifying to work with. I also don't think that the people you work with should be a reliable marker of why you went into that specialty too - I've worked with great people in every specialty that inspired me to almost pick their specialty and extremely terrible people that made me not want to consider that same specialty.

Unfortunately, medical students will make their decision based on the personalities of people they worked with, which I think comes down to luck with who you're paired with, or based on the patient population, which in psych rotations isn't representative of how psychiatry is mainly practiced in the US.

However, I think that you should consider definitely lifestyle factors such as income and work hours when picking a specialty. The practical matter is that your job allows you to make a living. There's nothing wrong with that motivation. The question becomes: how much does that motivation matter to you? Some medical students have different pressures on them to choose a field that makes more money, or have more time off, or obtain that prestige regardless of length of training, or a million other things. It matters to reflect on what motivations matter in your life, and no one can tell you what those are even though they'll try to.

If your main purpose in life is to work to make a living, then you should know this and don't put too much effort in worrying about the work. Be an average psychiatrist if you want and choose to focus on what matters to you, whether it's your marriage, your family, your children, your cat, your rock garden, whatever you want. People may criticize you for that, but I don't think it's practical that everyone necessarily can or wants to be above average in their work.



I wouldn't put too much stock what other attendings think of psychiatry or any specialties other than their own for that matter, and even then I wouldn't hold a candle to it. There's going to be pros and cons to each specialty and you'll have to determine which ones are favorable or dealbreakers for you. Physicians, especially older ones, probably don't have a good grasp of the lifestyle/salary in fields other than their own though. I don't think any of them can tell you that less than 75% of psychiatrists work under 45 hours a week.


Some interesting stats, with regards to Psychiatrists working less than 45 hours a week (75%)


General Surgery - 55% work less than 45 hours/week
http://www.medscape.com/features/slideshow/compensation/2016/generalsurgery#page=20

Cardiology - 37% work less than 45 hours/week
http://www.medscape.com/features/slideshow/compensation/2016/cardiology#page=20

Ophthalmology - 75% work less than 45 hours/week
http://www.medscape.com/features/slideshow/compensation/2016/ophthalmology#page=20


Dermatology - 88% work less than 45 hours/week
http://www.medscape.com/features/slideshow/compensation/2016/dermatology#page=20

I'm actually shocked that over half of general surgeons don't crack 45 hour weeks....perhaps gen surg is also changing?

And also Derm..88%!? I know it is a lifestyle specialty, but wow!
 
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Some interesting stats, with regards to Psychiatrists working less than 45 hours a week (75%)


General Surgery - 55% work less than 45 hours/week
http://www.medscape.com/features/slideshow/compensation/2016/generalsurgery#page=20

Cardiology - 37% work less than 45 hours/week
http://www.medscape.com/features/slideshow/compensation/2016/cardiology#page=20

I'm actually shocked that over half of general surgeons don't crack 45 hour weeks....perhaps gen surg is also changing?

Interesting. That's how much time they spend "seeing" patients. This is a survey so the language may be up to interpretation of the responder since I don't know if general surgeons would consider operating "seeing" the patient, and they may consider rounding + clinic in that category whereas psych doesn't have that variety of patient encounters - we just have seeing the patient and admin work.

Or it might just be that the people who have the time to respond to these surveys are working less and can afford to use their time to answer these questions instead of seeing patients haha.
 
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Interesting. That's how much time they spend "seeing" patients. This is a survey so the language may be up to interpretation of the responder since I don't know if general surgeons would consider operating "seeing" the patient, and they may consider rounding + clinic in that category whereas psych doesn't have that variety of patient encounters - we just have seeing the patient and admin work.

Or it might just be that the people who have the time to respond to these surveys are working less and can afford to use their time to answer these questions instead of seeing patients haha.

I'm pretty sure "seeing" patients for surgeons includes operating time....11% of General Surgeons report seeing patients for more than 65 hours a week. There's no way there is operating time on top of 65 hours/week! There is no general surgeon that spends 65 hours rounding and in clinic, lol.
 
I'm pretty sure "seeing" patients for surgeons includes operating time....11% of General Surgeons report seeing patients for more than 65 hours a week. There's no way there is operating time on top of 65 hours/week! There is no general surgeon that spends 65 hours rounding and in clinic, lol.

Maybe those people interpreted the question different and included operating time. Not sure, but perhaps General Surgery is improving in terms of their lifestyle! It does say in the paragraph below the chart that younger surgeons are more likely to work less hours since there's been an increase in women in these age groups that are more likely to work part time.
 
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Maybe those people interpreted the question different and included operating time. Not sure, but perhaps General Surgery is improving in terms of their lifestyle! It does say in the caption that younger surgeons are more likely to work less hours since there's been an increase in women in these age groups that are more likely to work part time.

Yep. I suspect that gen surgeons are opting for jobs that = a lot of elective procedures (lap choleys, hernias, ingrown nails) and less call I guess.

General Surgery residency is obviously brutal, but once you get past the 5 years, I think you have opportunity to mold yourself a decent lifestyle (such as going into breast or endocrine) if that is your top priority.

I'm not suprised at all with cardiology.......STEMIs and q4....
 
Medical school in the U.S has it all wrong. Most schools' psych rotation involves 4 weeks in an inpatient unit....even though inpatient units are downsizing over the next decade or so....and medical students have almost 0 exposure to general outpatient psych, psychodynamic psychotherapy, addiction, forensics, CBT/DBT, sleep medicine (Sleep lab), interventional pain, neuropsychiatry/brain stimulation (ECT), child psych, CL, etc. I mean, there are a lot of psychiatry residents that don't even get exposure to a lot of this stuff, let alone med students! Thats how diverse this field is.

I figured that it might be like this, as we also have similar situation in Australia. Most medical students are only exposed to adult inpatient psychiatry which I think is the most difficult and confronting kind of work and probably a factor in many of them excluding psychiatry as a career option early on. When I was a student, we had 5 weeks of inpatient and a single week in community which also included a day on the CL and crisis teams and another day to observe ECT. These days things seem to have changed, with the students who rotate through having a more varied experience which may alter perceptions somewhat. Now the term is 9 weeks, including a week of lectures, 4 weeks of adult psychiatry but it’s 2 weeks in the adult ward, 2 weeks in the community clinic. The rest of the time is divided over other sub-specialities like child, aged, CL plus a week in private.

The same applies to any of our junior doctors interested in the field, as they will also get placed in public adult inpatient units to start with. I understand that the rationale for this is that this environment is the most supportive due to having more doctors around and they lack the experience to work more autonomously in the outpatient setting. However, it’s very frustrating as you see patients in their most unwell states. The case mix is often limited to severe, treatment resistant schizophrenia/ bipolar with psychosis, or drug users, BPD in crisis or other high acuity presentations, and due to length-of-stay KPIs they are quickly discharged after getting a “little” better to the community setting, and the cycle repeats again with a new patient. Then there’s also the additional challenge of involuntary patients and the accompanying paperwork/legal presentations just to get treatment started which other fields don’t have to contend with.

I think if you can tolerate the adult inpatient setting and enjoy the work, the rest is comparatively easy. I remember after completing an unaccredited residency year in the inpatient unit, one of the seniors who knew I was applying for the next year had told me, “If you like this, just wait until you do community,” and he wouldn’t he wouldn’t say anymore except that, “You’ll know when you get there.” About six months later when I started my first community job, it all became apparent.
 
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really great responses from everyone, thanks! going to have some tough decisions to make soon, but the advice you all gave, particularly the attendings, is really helpful. i'm going to try and get some more psych exposure soon, mainly outside the hospital
 
One reason I've heard people say is that psych and EM are the only two fields where having a patient physically attack you is a real possibility and something you have to be conscious of. I've talked to several physicians, including my 2nd year professor and attending, who have been attacked by patients multiple times during their career. I've talked to a few med students who enjoyed psych, but didn't want to enter the field because they didn't want to deal with aggressive patients. I'm not saying that every patient will be threatening or even that it's a common occurrence, but the fact is there are some patients that are prone to becoming violent. That is something that some physicians, understandably, aren't willing to deal with.
 
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As a third year/fourth year med student I struggled between radiology and psychiatry, and actually interviewed at both and ranked both, and let the match gods decide. I'm pretty happy that I ended up in psych. It's a fascinating fieled, great job opportunities and I'll end up making a similar (or maybe a bit less) amount to radiologists once I'm in PP with a much better lifestyle.
 
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One reason I've heard people say is that psych and EM are the only two fields where having a patient physically attack you is a real possibility and something you have to be conscious of. I've talked to several physicians, including my 2nd year professor and attending, who have been attacked by patients multiple times during their career. I've talked to a few med students who enjoyed psych, but didn't want to enter the field because they didn't want to deal with aggressive patients. I'm not saying that every patient will be threatening or even that it's a common occurrence, but the fact is there are some patients that are prone to becoming violent. That is something that some physicians, understandably, aren't willing to deal with.

Get through the residency, then do outpatient in a larger practice if you so desire...less likely to be attacked. Or lift bro, then their attacks will bounce off of your amazing pects. It's what I am planning on doing. Less likely to cause damage if you are super strong.
 
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Psych is a unique specialty. So, I think if you are truly into it, then you know. Once you start trying to do pro v con of all the specialties then you probably would be better doing something more straight up medicine. I personally advise students to pick what they enjoy. What you can see yourself doing. Money and lifestyle can be worked out in all specialties. I do not think any of us will starve. But getting up and doing this for 30+ yrs in a field you do not like is something else.............
 
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Psych is a unique specialty. So, I think if you are truly into it, then you know. Once you start trying to do pro v con of all the specialties then you probably would be better doing something more straight up medicine. I personally advise students to pick what they enjoy. What you can see yourself doing. Money and lifestyle can be worked out in all specialties. I do not think any of us will starve. But getting up and doing this for 30+ yrs in a field you do not like is something else.............

It's a great field to be in: flexibility, fewer hours in residency and practice, ability to open own practice, *if have right mindset* you are going into work helping people establish mental health, not as competitive as other lifestyle specialties, longevity in practice, the rounding is a lot more fun as you discuss each unique individual, fun neuroscience, personalities that are not considered very malignant, time to pursue hobbies...I could go on.
 
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As a third year/fourth year med student I struggled between radiology and psychiatry, and actually interviewed at both and ranked both, and let the match gods decide. I'm pretty happy that I ended up in psych. It's a fascinating fieled, great job opportunities and I'll end up making a similar (or maybe a bit less) amount to radiologists once I'm in PP with a much better lifestyle.

that's actually probably the two I am most between at this point as well. I think i've realized I really don't want to do the traditional IM or surgery and need something a bit separated from that. Psych and rads seem a lot different but I think they are alike in that regard. any more insight since you seemed to have thought similar to myself?
 
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that's actually probably the two I am most between at this point as well. I think i've realized I really don't want to do the traditional IM or surgery and need something a bit separated from that. Psych and rads seem a lot different but I think they are alike in that regard. any more insight since you seemed to have thought similar to myself?

If I didn't do psych I woulda done rads, specifically IR. I love radiology, which is why I love neuropsychiatry (lots of neuroimaging).

My issue with Rads is (and this is just my personal opinion) is the poor job market, declining reimbursement rates, lifestyle is not what it used to be ("ROAD") and the extreme competitiveness of IR fellowships...

But of course this could all be the exact opposite in 5-10 years.

You should obviously consult people on the radiology forum. I am hearing through the grapevine that the job situation is starting to slightly improve last couple years...but it will never be as ripe as Psych, where we can literally cherry pick what job we want. Thats a big factor for me, location, location, location.
 
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I lurk around several specialty forums because I've had a really tough time deciding what I want to do with my life (currently an M3). anyway, it seems like a lot of heavy SDN posters are going the psych route. maybe it's just a few cases, but regardless this forum is very active and everyone has great things to say about psych.

so is psychiatry really that much of a :hidden gem" in medicine? the way people talk on this forum you'd be crazy to pass up on the lifestyle/$ that psych apparently affords. this opinion hasn't been my impression talking to attendings in other specialties, though.

I keep changing my mind on specialty choice, but every time I stumble back on the psych forum, I ask myself why I shouldn't choose this field? Any thoughts?

I don't consider psychiatry to be a lifestyle field because I've encountered many psychiatry residencies that work their residents harder than rads or derm residents, who will earn twice as much psychiatrists.
 
"Psych is unlike all the other fields in *so* many ways. Even amongst the "thinkers," there's not many that can stomach it."

Agreed, this is why I went into psych. Its the most diverse field in medicine. You can spend one day doing psychodynamic psychotherapy, the next day in a suboxone clinic, the day after doing epidural injections, and the day after doing ECT....you get my point.

Medical school in the U.S has it all wrong. Most schools' psych rotation involves 4 weeks in an inpatient unit....even though inpatient units are downsizing over the next decade or so....and medical students have almost 0 exposure to general outpatient psych, psychodynamic psychotherapy, addiction, forensics, CBT/DBT, sleep medicine (Sleep lab), interventional pain, neuropsychiatry/brain stimulation (ECT), child psych, CL, etc. I mean, there are a lot of psychiatry residents that don't even get exposure to a lot of this stuff, let alone med students! Thats how diverse this field is.

So obviously its a "hidden gem", because it truly is "hidden".

Student psychiatry rotations should be largely inpatient and high acuity like other third year rotations like IM, surgery, peds or OB. Medicine is best learned by taking care of the sickest. Psychiatry practice would be elevated if psychiatry fell in line with other non-IM, nonsurgical residencies (derm, rads and anesthesia) that require a prelim IM or transitional year.

Psychiatry is not a hidden gem. People have valid reasons for choosing or not choosing psychiatry.
 
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The lesson to learn from rads is that a specialty can be blindsided and badly injured by forces outside its control.

It's inconceivable that the ground will shift until it does.

Fwiw, with the exception that one sits most of the day, rads and psych are nothing alike.
 
If you are interested in mental health then pursue psych.

That's why FIT is actually way important in psych.
 
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One reason I've heard people say is that psych and EM are the only two fields where having a patient physically attack you is a real possibility and something you have to be conscious of. I've talked to several physicians, including my 2nd year professor and attending, who have been attacked by patients multiple times during their career. I've talked to a few med students who enjoyed psych, but didn't want to enter the field because they didn't want to deal with aggressive patients. I'm not saying that every patient will be threatening or even that it's a common occurrence, but the fact is there are some patients that are prone to becoming violent. That is something that some physicians, understandably, aren't willing to deal with.

I've seen a psych nurse get tossed like a ragdoll.

Hell, my buddy was cornered by one of his patients in a recent rotation.
 
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One reason I've heard people say is that psych and EM are the only two fields where having a patient physically attack you is a real possibility and something you have to be conscious of. I've talked to several physicians, including my 2nd year professor and attending, who have been attacked by patients multiple times during their career. I've talked to a few med students who enjoyed psych, but didn't want to enter the field because they didn't want to deal with aggressive patients. I'm not saying that every patient will be threatening or even that it's a common occurrence, but the fact is there are some patients that are prone to becoming violent. That is something that some physicians, understandably, aren't willing to deal with.

Except that all of those patients go to other doctors as well... and they can be even more susceptible because they aren't used to looking for signs of agitation/potential aggression and certainly aren' trained in any type of de-escalation. I know at least two cases where urologists (one in New Orleans and one in Newport Beach) were shot by patients in the last several years...
 
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Student psychiatry rotations should be largely inpatient and high acuity like other third year rotations like IM, surgery, peds or OB. Medicine is best learned by taking care of the sickest. Psychiatry practice would be elevated if psychiatry fell in line with other non-IM, nonsurgical residencies (derm, rads and anesthesia) that require a prelim IM or transitional year.

Psychiatry is not a hidden gem. People have valid reasons for choosing or not choosing psychiatry.

But psychiatry residency is different from IM/GSurg/OBGYN/Peds...and there is nothing wrong with that.

ACGME has minimum requirement of 6 months inpatient for Psychiatry residency. So 6/48. For argument's sake, I'll be conservative and say all psych residencies have an average of 12/48 of inpatient. Even if this is true (which its probably not), thats still only 25% of your residency on inpatient unit. Whereas for a large majority of medical students, 100% of your exposure to psychiatry is inpatient. 100% exposure to 25% actuality. Inaccurate depiction, and therefore "hides" what psychiatry truly is.

Other specialties like IM and Peds have far more inpatient work during their residencies (probably 75%?, when including ICU rotations, etc), all the way though residency (PGY1-3). In Psych, its rare (yes, I'm sure there are some residencies, but I'm going to generalize) for PGY3s and PGY4s to spend anytime rotating through inpatient service.
 
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The job market in Psych is good but the trick to job hunting is finding an organization that works well with patients who have chronic psychiatric disorders. There are a lot of job options out there if you don't mind getting hit by a land mine or two. These poor work settings exist for a number of reasons. The lack of money is the most obvious reason. Profit margins in many settings are too low to invest in quality leadership, Human Resources, and operations management. The consequence of this major shortcut in our industry is catastrophic and often leads to failure to meet the needs of and standard of care for our patients. IMO this mismanagement will likely go on for decades. Psychiatrists will continue to scatter, work 5-10 hours here and there, and put in less hours. The byproduct of this and other factors is everyone gets additional job security.


Sent from my iPhone using SDN mobile app
 
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