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

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I think you have to find something about "difficult" patients interesting/engaging, if you're going to go into psychiatry. When I say "difficult" I'm referring to what most other physicians will be saying about our patients. Whether that's personality, adjustment, language/culture, or primary mood/thought disorder, most other physicians don't like or want to engage with "abnormal" persons, they just want a "reliable" historian who spits out textbook histories and adheres to the treatment plan. That's why I like CL, I can help bridge that gap between the medical team and the patient.

Wilf said:
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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I have to say I was a little surprised that so many of my cohort were so "psych only." Other generations of this residency program seemed more broadly interested. I've had people in my cohort tell me that I don't have a psychiatrist personality, but mostly because I'm logical/analytical... wtf?

Stagg737 said:
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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Honestly, if you're doing emergency department evals, you will interact with angry and potentially violent patients (and potentially their family members) on a regular basis.
 
Blitz2006 said:
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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While there job market is clearly excellent in psychiatry insofar as there are lots of jobs, it is a myth that one can "literally cherry pick" what job you want. I know several people (child psychiatrists no less) who did not get offered jobs they wanted (and they were excellent people from a strong training background and these were not desirable jobs). In my own job search I have applied to many, many jobs just to play anthropologist and you can't just parachute into an amazing job. From my perspective, most of the jobs out there suck. The remuneration increase for psychiatrists is currently unsustainable (particularly for government jobs).

If you're not terribly picky (I guess I am but there's no way in hell i'm doing general adult psychiatry) then yes you will find a job in most locals. for now anyway.
 
splik said:
While there job market is clearly excellent in psychiatry insofar as there are lots of jobs, it is a myth that one can "literally cherry pick" what job you want. I know several people (child psychiatrists no less) who did not get offered jobs they wanted (and they were excellent people from a strong training background and these were not desirable jobs). In my own job search I have applied to many, many jobs just to play anthropologist and you can't just parachute into an amazing job. From my perspective, most of the jobs out there suck. The remuneration increase for psychiatrists is currently unsustainable (particularly for government jobs).

If you're not terribly picky (I guess I am but there's no way in hell i'm doing general adult psychiatry) then yes you will find a job in most locals. for now anyway.
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Its relative cherry-picking compared to most other fields. My friend is a PGY4 Radiology resident, she told me she has slim chance of staying in the NYC area, let alone finding a a good job. She is going to Indiana next week for a job interview.... People focus on Rads/Path/Nephro as terrible job markets, but there are many other specialties that are tight, including ophtho and cards. In these fields people are just happy to be in a 50 mile radius from a major city.

Psychiatry I have no worries if I want to live in downtown LA or SF or NYC, its just a matter of the kind of job I want.
 
PistolPete said:
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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weasel23 said:
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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Blitz2006 said:
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 was also considering between radiology and psychiatry. Didn't realize there were so many others who were struggling with the same decision.
 
DetectiveAlonzo said:
Rads hands down if you have the scores.
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I would have agreed with this statement 10 years ago. Not at present, and not the way psych has been heating up over the past few years, I don't see it slowing down either.
 
DetectiveAlonzo said:
Rads hands down if you have the scores.
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I disagree. I have the scores, the publications, the letters, and opportunity to have been extremely competitive in radiology but chose psychiatry because it was slightly more interesting and a much better fit for me.


Sent from my iPhone using SDN mobile
 
clozareal said:
I was also considering between radiology and psychiatry. Didn't realize there were so many others who were struggling with the same decision.
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For me, I really wanted to like radiology, but as an MS4, coming home after my audition rotation, I realized I really didn't wanna spend my evening reading about radiology, although it is a cool, sexy field.

I ended up ranking psychiatry #1 and glad I did. In a cash PP, I can make 350-400k, working 30 hours per week. No nights, weekends, holidays or call unless I want it. I can find a job anywhere in the country.

These days, radiology is much more of a grind. Average salary is 400-450k but you're working 40-50 hours per week, often eating lunch at the workstation, and I'd guess having to work a certain number of weekends/nights. Plus finding a job in a large metro is harder than in psych.

I'll take the much better lifestyle for slightly less pay and less liability than radiology has.

Just my $0.02.
 
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Yeah... location location location is all I can say.

Have a family friend who is a radiologist based out of the east coast but lives on the West Coast.

Works at home.

His first contract out of residency was 500K.... he said he makes ALMOST ~800K right now.

Doesn't have to see a single patient in person lol

It just comes over time. Any field in medicine is gonna make you bank if you enjoy it and if you grind.

If you do what you love, the money will follow.
 
DetectiveAlonzo said:
Yeah... location location location is all I can say.

Have a family friend who is a radiologist based out of the east coast but lives on the West Coast.

Works at home.

His first contract out of residency was 500K.... he said he makes ALMOST ~800K right now.

Doesn't have to see a single patient in person lol

It just comes over time. Any field in medicine is gonna make you bank if you enjoy it and if you grind.

If you do what you love, the money will follow.
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Sounds like a sweet gig. I wonder how many hours a week he works?
 
PistolPete said:
Sounds like a sweet gig. I wonder how many hours a week he works?
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I would say ~50 give or take with call like once/twice a month. But SUPER productive. Last time I shadowed him, he was in the ZONE. He runs through films and consults like no other.

There are some people saying anesthesia is going down the drain, that EM is going more towards patient satisfaction, that FM and IM is garbage...

This just goes to say that do not be fooled by SDN numbers.

Do what you LIKE and see yourself practicing for 30+ years.
 
Here in the NYC area, the average starting salary for hospital radiology is 275k +/- 25K. You can top out at around 350k-375k after a few years of experience.
 
DetectiveAlonzo said:
Yeah... location location location is all I can say.

Have a family friend who is a radiologist based out of the east coast but lives on the West Coast.

Works at home.

His first contract out of residency was 500K.... he said he makes ALMOST ~800K right now.

Doesn't have to see a single patient in person lol

It just comes over time. Any field in medicine is gonna make you bank if you enjoy it and if you grind.

If you do what you love, the money will follow.
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Is he DR or IR?

If DR I'm very impressed.
 
Blitz2006 said:
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.
Click to expand...

Radiology market was horrendous when I graduated from fellowship 2013 but has improved somewhat (still not great), back then I had an awful job, actually forced me into a 2nd fellowship...now quite happy with my private practice job, lifestyle is great (on average work 3-4 days/week), make good money, stress level fairly low, actually currently looking into per-diem jobs given all my free time. Disclaimer is that I don't think my job is average/norm when it comes down to quality...declining reimbursements were disproportionately targeted at technical fees, we don't own equipment so this did not affect our bottom line...I actually considered psych, think its a pretty good field...
 
psychiatrists risk being victims of their own avarice. If you outprice yourself then you will be of no use and the market will find other ways to deal with the situation. If everyone goes cash only, the insurance companies will make it so they won't fill prescriptions from drugs not on their panels. That alone will deter most patients who need more expensive drugs and cannot afford to pay the ridiculous sticker price for their drugs. The rise of collaborative care also means that thousands of patients can be served without ever being seen by a psychiatrist and the outcomes are as good and probably better than the average psychiatrist seeing the patient in person. The next phase of telepsychiatry is basically patients logging in on an app from the comfort of their own home to check in with their psychiatrist. This is for healthier and wealthier customers, but there are already a larger number of these tech companies cornering the behavioral health market than anyone would have expected. Finally, there are all the government jobs. There is a point when someone will decide that the price of a psychiatrist is too much to afford and the value too little. And this is not mention the NPs and RxPs licking their lips waiting to fill the void that psychiatrists themselves have created.

Things are pretty good right now, but psychiatrists may be authoring their own suicide note.
 
Mr. Bub said:
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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True, but when they're in acute psychosis they're not going to see their FP or uro, they're coming to see the psych. Of course any physician in contact with a patient prone to violence is at risk, but as a psychiatrist one is putting themselves directly in the line of fire of those patients (sometimes literally). I've known/met a couple hundred physicians in person so far, and the only ones who have

FlowRate said:
Honestly, if you're doing emergency department evals, you will interact with angry and potentially violent patients (and potentially their family members) on a regular basis.
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True, which is why I included psychs and EM docs in the small group of physicians who may regularly have to deal with aggressive and potentially violent patients.
 
Crayola227 said:
don't be fooled by anything

medicine is mostly going in the ****ter
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My mentors insisted this was happening 35 years ago. I'm sure this time it really is going to happen, but you won't see me holding my breath. Some things are worse, and some things are better, but we are still here making good money with great demand.
 
clozareal said:
I disagree. I have the scores, the publications, the letters, and opportunity to have been extremely competitive in radiology but chose psychiatry because it was slightly more interesting and a much better fit for me.


Sent from my iPhone using SDN mobile
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and your profile name lol
 
Curious: What prevents radiology from being totally outsourced? When I had my appendectomy, my film was read in a different country. Not sure which one, but they mentioned it was not the US.
 
weasel23 said:
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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A lot of heavy SDN posters are the lounging intellectual type on the one hand and hard gunners on the other hand. That's why there is an abundance of psych/IM types on the one hand and competitive specialist/subspecialists on the other. It's a site that self-selects for certain personalities, and not a reflection of the field in general.

If you hate psych and don't like psychiatric disease, or really want to be a hero that practices "real" medicine, psych isn't going to be fulfilling. And, on average, the pay isn't really that good- it's on the lower end of specialties in general, check out Medscape or MGMA. But if you like (or are) crazy, and you can deal with the nebulous nature of the human mind and give up 95% of what doctoring you learn in med school, and you don't give a **** about prestige, it's a pretty sweet field.
 
birchswing said:
Curious: What prevents radiology from being totally outsourced? When I had my appendectomy, my film was read in a different country. Not sure which one, but they mentioned it was not the US.
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Liability. While it can be read out of country initially, a US-trained doctor must do the final read.
 
Mad Jack said:
A lot of heavy SDN posters are the lounging intellectual type on the one hand and hard gunners on the other hand. That's why there is an abundance of psych/IM types on the one hand and competitive specialist/subspecialists on the other. It's a site that self-selects for certain personalities, and not a reflection of the field in general.

If you hate psych and don't like psychiatric disease, or really want to be a hero that practices "real" medicine, psych isn't going to be fulfilling. And, on average, the pay isn't really that good- it's on the lower end of specialties in general, check out Medscape or MGMA. But if you like (or are) crazy, and you can deal with the nebulous nature of the human mind and give up 95% of what doctoring you learn in med school, and you don't give a **** about prestige, it's a pretty sweet field.
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Be careful Jack.

Now you're gonna have so and so come in and tell you how he/she makes $500K working 20 hours a week with no call and no emergencies.

LOL

I agree with you that it's really not a great paying field.

It's like any other field where the more time you put in, the more you can make.

When it comes to the specialty that runs it in terms of $/hr.... it's EM.
 
MacDonaldTriad said:
We had and EM to psych person on these boards. When he/she was asked about the switch, the two word answer was "butt puss", so there is that.
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Right. There are also psych to EM folks that I have contacted via reddit.

They absolutely loved the switch.

Psych is not for everybody.
 
birchswing said:
Curious: What prevents radiology from being totally outsourced? When I had my appendectomy, my film was read in a different country. Not sure which one, but they mentioned it was not the US.
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Because you need to have a US medical license and be board certified in radiology to report on radiographs in the US. Otherwise it's illegal. Even US residents who don't have their reports reviewed with supervision get in trouble. Lawyers love suing so those hospitals and doctors will quickly find themselves underwater.


Sent from my iPhone using SDN mobile
 
splik said:
I love lancing abscesses! very satisfying and instantaneous results!
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I think the one thing I'd really like, and perhaps we should integrate into standard psychiatric practice, would be a cryogun. It may even be helpful to punctuate encounters by pouring a large amount of liquid nitrogen into the floor and disappear into the fog. It would also help with ending encounters with patients that tend to drag on.
 
Blitz2006 said:
"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.

ERAS Statistics - ERAS - Services - AAMC


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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IDK if good pay would be enough to bring me into a field, but bad pay would is enough to keep me out. I really enjoyed psych but wasn't going to go into it bc I thought the salaries were significantly lower and my student loans burden is fairly intense. I was bummed out, but I had a few psychiatrists talk to me about how you can make the job more lucrative. At this point, I believe you can make good money in almost any specialty as a physician if you are willing to be creative. Some of the family medicine doctors running "Medical Spas" make enough money to burn a wet mule.
 
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Honestly I get the impression this cycle is going to be popular and probably painful.
 
Crayola227 said:
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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Oh eff me.

All of medicine can be reduced to borderline's and sociopaths apparently.

We're doomed.
 
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