Should I go into psychiatry?

[Twilque]

Hi there! I'm hoping to get some thoughts on if psychiatry seems like a good career path for me. I'm currently a junior in college studying Biology.



Reasons it could be:

- I've always been genuinely curious about people's thoughts, feelings, and behavior. I also like to learn biology, and while it's not as interesting as psychology, I do enjoy both and it seems like a good mix of the two.

- I like to be supportive through emotional issues, and people often tell me things they wouldn't normally talk about to others.

- I'd like to do something that isn't the same thing each day and has a certain element of exploration. I believe that psychiatry would be good for this, as each person comes from a different situation and has a story.

- It provides job security and financial security, and it has decent flexibility in number of hours (these are important because I want to eventually raise a family).

- I believe can get through med school with a lot of hard work, aka I'm a "good student".



Reasons it may not be:

- I'm concerned about making people reliant on pills if they don't need it and/or if a psychological method would be better (However, being a psychologist seems too intense/draining... I'm better at listening and being supportive than getting deeply involved in and guiding someone's mind constantly).

- The other specialties in medicine aren't appealing (mainly because they are more black and white, and more repetitive/less explorational), so I wouldn't have a good backup if psychiatry doesn't pan out and I would've gone to med school for nothing.

- I have my own issues, and I don't want to be someone who goes into the field for themself. I'm not completely sure how much of my interest in mental health is influenced by wanting to help others vs. understand myself (probably both). Given this, I also don't feel completely qualified to help other people with their brains, which is why I had previously rejected the idea of being a therapist.

- I originally got the idea to go into psychiatry from a friend who's doing that, and I'm not sure if I'm being influenced by that? But to be fair, I was already doing mental health-related activities.

- It has been challenging to choose a career path, and it feels like I'm running out of time, but I don't want to rush into this just because it seems attractive right now.



Any insight would be greatly appreciated. Thanks!

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[TexasPhysician]

I generally tell people that psychiatrists are physicians first. If you aren’t set on being a physician, I wouldn’t recommend it. 4 years of grueling work and test scores needed to apply for psychiatry. The majority of those 4 years are unrelated to mental health.

 

[Psychresy]

You should take 5 years off after college and do something cool. This is the best piece of advice I have for you at this juncture.

 

[Ole_Toe]

Also try to resist the urge to feel that you’re running out of time to pick a career. You’re running out of time to enjoy your 20s, travel, get to know yourself. But there’s no rush to pick a career imo. I started a post bac at 29 and med school at 31. Very grateful for the time I had in my 20s.

 

[dl2dp2]

Reasons it may not be:

- I'm concerned about making people reliant on pills if they don't need it and/or if a psychological method would be better (However, being a psychologist seems too intense/draining... I'm better at listening and being supportive than getting deeply involved in and guiding someone's mind constantly).

This is very rare in psychiatry and restricted to outpatient psychodynamic treatment for the lowest acuity patients. Generally, patients you would see will need medication to properly function. I have patients I have successfully tapered off all meds, and I only see them rarely (or I refer them back out.) Inpatient treatment obviously generally require medications except in very specialized settings (eating disorders, DBT residential, etc.)

I would say the more common community scenario by far is people who need meds but don't get it for lack of access of care. This clinical observation is also verified by epidemiological findings.

- The other specialties in medicine aren't appealing (mainly because they are more black and white, and more repetitive/less explorational), so I wouldn't have a good backup if psychiatry doesn't pan out and I would've gone to med school for nothing.

Actually, nothing in medicine is black and white. But I agree with @TexasPhysician psychiatrists are physicians are trained to think like physicians. Some psychiatrists eventually decide to do only psychodynamic psychotherapy on low acuity patients, but this is a very small minority. Most of the practicing psychiatrists are expected to handle the most acute mental health issues. If I hire a board-certified psychiatrist to staff a facility I better know that this person can deal with bipolar mania, suicidality, borderline crises, severe transference-related issues, alcohol withdrawal, active psychosis, cognitive decline, etc. These are common outpatient issues. If you can't see yourself enjoy managing these issues, at least semi-frequently, for your career, then this is not a great career for you.

Psychiatry as a field is also very much on a continual path in becoming more and more biological and less and less "explorational", for a variety of reasons. Being a psychiatrist carries the same privilege and responsibility of being a physician first and foremost.

That said, if you can see yourself enjoy the idea of being a doctor, this field is one of the best in medicine for a "good student", IMO and a very good field overall amongst all careers.

 

[comp1]

You're so early on, I think it's hard to put ourselves in your mindset. I definitely concur with the people saying that it's about becoming a physician first and specialist second. The reason for this is that you honestly have no idea at all about what medical specialties will interest you. You haven't really seen them from the practitioner's point of view. You could very well fall in love with orthopedic surgery. All of that said, if you don't want to become a physician, then there are LOTS of other graduate programs that could meet your goals.

 

[Monocles]

- The other specialties in medicine aren't appealing (mainly because they are more black and white, and more repetitive/less explorational), so I wouldn't have a good backup if psychiatry doesn't pan out and I would've gone to med school for nothing.

I would recommend no purely for this concern here.

As a med student (forced into medicine by immigrant parents, long story blah blah) I really did not like anything in medicine EXCEPT psychiatry, and would have been majorly screwed had I been a couple of years later now where psychiatry is more competitive. I can't imagine having to be forced to do anything else aside from psych! (or god forbid, having to learn about organ physiology or touch a stethoscope, yuck 😉)

I generally tell people that psychiatrists are physicians first. If you aren’t set on being a physician, I wouldn’t recommend it. 4 years of grueling work and test scores needed to apply for psychiatry. The majority of those 4 years are unrelated to mental health.

Agreed!

 

[FlowRate]

Go lurk on reddit /medicalschool and /residency for a bit (SDN's subforums for those are less day-in-the-life, especially for residency.) People have very mixed experiences but overall it's a very stressful and busy 8 years of your life that most of your peers spend working decent jobs and having ample free time. If you haven't yet, shadow some docs, especially residents, if possible. You have to know that you REALLY want to be a doctor before going to med school.

Even still, I think it's very hard for anyone to know what it's like to actually be in a certain career until you get to the point that you're doing the work. That's why shadowing and healthcare adjacent work is emphasized--at least trying to get the best idea you can about the job.

 

[deleted1100659]

I generally tell people that psychiatrists are physicians first. If you aren’t set on being a physician, I wouldn’t recommend it. 4 years of grueling work and test scores needed to apply for psychiatry. The majority of those 4 years are unrelated to mental health.

This is gold advice. Don't go to medical school because you want to be a psychiatrist; go because you want to be a doctor. When you're in medical school, you don't know what you will end up doing because a lot can happen in those years. You have to have a passion for medicine to get through it with your sanity intact. Plus the early years of psych residency you will do various non psych rotations. Same with clinicals in med school.

Also prozac is often more affordable than therapy, not everyone has the ability to go out and get a good psychologist to do CBT with. As far as reliant on pills...would you view it the same if someone with hypertension took daily medication to control their blood pressure?

 

[Twilque]

I generally tell people that psychiatrists are physicians first. If you aren’t set on being a physician, I wouldn’t recommend it. 4 years of grueling work and test scores needed to apply for psychiatry. The majority of those 4 years are unrelated to mental health.

What is meant by "being a physician" isn't completely clear to me. It seems like an emergency room surgeon's role, a dermatologist's role, and a radiologist's role are very different in day-to-day life and in sentiment. I know they are all united by being doctors, but I'm confused on what that means in and of itself...

This is very rare in psychiatry and restricted to outpatient psychodynamic treatment for the lowest acuity patients. Generally, patients you would see will need medication to properly function. I have patients I have successfully tapered off all meds, and I only see them rarely (or I refer them back out.) Inpatient treatment obviously generally require medications except in very specialized settings (eating disorders, DBT residential, etc.)

I would say the more common community scenario by far is people who need meds but don't get it for lack of access of care. This clinical observation is also verified by epidemiological findings.

Yeah, I was mainly thinking of less severe mental illnesses. I see the clear need for medicine in inpatient treatment and/or in more extreme circumstances. I guess I'm concerned about a case in which a person uses a medicine without fixing the underlying issue (if it can be helped with therapy), or if they are given more dosages of medicine than they need.

Actually, nothing in medicine is black and white. But I agree with @TexasPhysician psychiatrists are physicians are trained to think like physicians. Some psychiatrists eventually decide to do only psychodynamic psychotherapy on low acuity patients, but this is a very small minority. Most of the practicing psychiatrists are expected to handle the most acute mental health issues. If I hire a board-certified psychiatrist to staff a facility I better know that this person can deal with bipolar mania, suicidality, borderline crises, severe transference-related issues, alcohol withdrawal, active psychosis, cognitive decline, etc. These are common outpatient issues. If you can't see yourself enjoy managing these issues, at least semi-frequently, for your career, then this is not a great career for you.

I am good with the idea of handling more acute issues and not mainly doing psychotherapy (I don't prefer to do just psychotherapy, I'd rather mainly listen than actively be a part of it).

Psychiatry as a field is also very much on a continual path in becoming more and more biological and less and less "explorational", for a variety of reasons. Being a psychiatrist carries the same privilege and responsibility of being a physician first and foremost.

Like it's becoming more reliant on medicine instead of psychotherapy?

You're so early on, I think it's hard to put ourselves in your mindset. I definitely concur with the people saying that it's about becoming a physician first and specialist second. The reason for this is that you honestly have no idea at all about what medical specialties will interest you. You haven't really seen them from the practitioner's point of view. You could very well fall in love with orthopedic surgery. All of that said, if you don't want to become a physician, then there are LOTS of other graduate programs that could meet your goals.

I wouldn't do surgery because I'm a little too clumsy for that, and it's way too much pressure. Also in general, I don't really like the idea of being responsible for someone who is in a serious physical condition. I am more comfortable with a serious emotional or mental condition.

 

[Twilque]

As a med student (forced into medicine by immigrant parents, long story blah blah) I really did not like anything in medicine EXCEPT psychiatry, and would have been majorly screwed had I been a couple of years later now where psychiatry is more competitive. I can't imagine having to be forced to do anything else aside from psych! (or god forbid, having to learn about organ physiology or touch a stethoscope, yuck 😉)

I thought psychiatry was one of the least competitive?

Also prozac is often more affordable than therapy, not everyone has the ability to go out and get a good psychologist to do CBT with. As far as reliant on pills...would you view it the same if someone with hypertension took daily medication to control their blood pressure?

Good point, it is more affordable. I'm not against it, I just worry it would mask the real issue and about withdrawal if they stop taking it.

People have very mixed experiences but overall it's a very stressful and busy 8 years of your life that most of your peers spend working decent jobs and having ample free time.

It would probably be stressful in a way that's hard to imagine at this point. But the positive side is that it's a clear path, so it alleviates the stress of not knowing.

 

[Crayola227]

What is meant by "being a physician" isn't completely clear to me. It seems like an emergency room surgeon's role, a dermatologist's role, and a radiologist's role are very different in day-to-day life and in sentiment. I know they are all united by being doctors, but I'm confused on what that means in and of itself...

Yeah, I was mainly thinking of less severe mental illnesses. I see the clear need for medicine in inpatient treatment and/or in more extreme circumstances. I guess I'm concerned about a case in which a person uses a medicine without fixing the underlying issue (if it can be helped with therapy), or if they are given more dosages of medicine than they need.

I am good with the idea of handling more acute issues and not mainly doing psychotherapy (I don't prefer to do just psychotherapy, I'd rather mainly listen than actively be a part of it).

Like it's becoming more reliant on medicine instead of psychotherapy?

I wouldn't do surgery because I'm a little too clumsy for that, and it's way too much pressure. Also in general, I don't really like the idea of being responsible for someone who is in a serious physical condition. I am more comfortable with a serious emotional or mental condition.

As far as not really getting what being a physician means, this is why we tell people to start there. The way to do that is two fold IMHO. One is shadowing different types of physicians and doing research into what the educational path is. For the first, doing shadowing and research about what being a doc is like and picking docs' brains will start to reveal themes into what we do and how we think about problems that will help reveal what is universal-ish to being a physician.

The other, about the educational path, is largely served by the med school pre-reqs you take in college. They really are the foundation of medicine. If you don't find basic biology, cell biology, genetics, and essentially things of that ilk interesting or fascinating, it's hard to imagine someone liking being any type of physician very much, and definitely not the path getting there. Looking at the classes required. Then looking a little further ahead to the typical subjects covered in med school. If the list of bio, o Chem, physics, etc, eventually in med school gross anatomy, histology, physiology, pharmacology, etc, if the giant list of subjects you need to study for at least 6 years and then apply, and get as many straight A's in as you can, doesn't sound fascinating and something you really want to do... I think it's a poor choice in that case.

We all read papers of a scientific bent. As a result we all have some need of some amount of understanding of statistics. Some amount of molecular biology is needed for us to prescribe medications or understand other aspects of care (a radiologist needs to understand the basics here, even. I'll spare the examples unless another doc wants to challenge the assertion).

Lastly, there is a very particular "customer service" aspect we deal with. Everyone in customer service is solving a problem someone has. Ours has the particular flavor that we deal with people who are being made miserable in a particular way, it's their health. This goes back to getting medical experience/shadowing, but in this case it's more particular in that YOU need to be the one responsible for caring for people *in this particular way.* It's great useful people skills for you to say work as a TA teaching college kids something, or for you to volunteer your time reading to small children. But you also need to be challenged by two things: dealing with people with socioeconomic challenge and being understanding/adept at that, since it's a big part of our jobs as physicians, and also dealing with truly ill people, the diseased and dying, the smelly, the grouchy. Think elder care, memory care, developmentally disabled kids, people with medical problems.

If you have a passion for scientific/health topics, and specifically applying science to help people in a specific way, and you truly enjoy working with people suffering in the confines of their bodies, then being a physician might be for you. You figure this out by studying science, and being around physicians doing their thing and then you trying to render what Healthcare you can from where you are, as much as you can.

There's more but this is a decent start.

 

[Crayola227]

One issue is that the competitiveness and even a lot of other aspects of practicing a given specialty can change drastically. It can be very difficult for someone to go to medical school only wanting to be one type of doctor and not being open to the field as a whole. What is the same for all of us, is what we needed to study/master to get into medical school, and then the 4 year experience itself getting the degree (the MD is not very differentiated, it makes you a general physician but not any specific type/flavor) then our first year of internship training as a physician to be licensed also has a fair amount of "generalness" to it. It takes success in all of undergrad and medical school and intern training, to even get to the point where specializing can happen. So it's not for nothing to say, well, first you have to succeed at being a physician, and not any one type.

So for all these reasons, we advise people to want to be physicians first, and hopefully in such a way that they could end up successful and satisfied with a number of different specialties.

It's kinda like, would it be a good idea for someone to attend a liberal arts college only wanting to study piano? Not exactly, because they'll be expected to master even mathematics to a certain point, to take a certain number of history or science classes, and likely music theory classes and other music classes that have little to do directly with piano. So a liberal arts degree is best for someone who is generally interested in a well-rounded education and likes learning and reading about a number of different topics. That doesn't mean that you have to love every topic and that there aren't things you hate or struggle with, but yeah....

And what's more than just the subject matter in med school, is that you don't just have to do these things in a classroom or read about it. You have to rotate and apply surgical, obstetric, psychiatric, pediatric, etc skills to actual patients, whether you like it or not.

We split these things up into fields but the reality is that no matter what our little piece of medical practice is, we all treat whole humans who have all of these things affecting their health. So we all have need of a lot of different skills and knowledge base no matter how we specialize.

You have to succeed as a medical student in becoming an undifferentiated physician before you can be anything else.

 

[hamstergang]

I guess I'm concerned about a case in which a person uses a medicine without fixing the underlying issue (if it can be helped with therapy), or if they are given more dosages of medicine than they need.

So then don't prescribe people more medication than they need?

This isn't an uncommon worry, but it makes no sense to me. If you're worried about overprescribing in Psychiatry, you can go into the field and then just not overprescribe. Why should the practice of others deter you?

 

[TexasPhysician]

What is meant by "being a physician" isn't completely clear to me. It seems like an emergency room surgeon's role, a dermatologist's role, and a radiologist's role are very different in day-to-day life and in sentiment. I know they are all united by being doctors, but I'm confused on what that means in and of itself...

I'd argue that the sentiment and over-arching role is the same. 4 years of medical school and often intern year is more about making us all GP's (general physicians). You are trained to review a brain CT, perform a punch biopsy, treat acne, manage hypertension, deliver a child, adjust a diabetic regimen, etc. Much of this training is forever useful. Depending on the setting, I still actively manage hypertension, glucose levels, acne, thyroid levels, etc. What makes psychiatrists truly great is recognizing when symptoms aren't just psychiatric and properly referring for the correct treatment. Anxiety can stem from a cardiac, endocrine, rheum, neuro, etc. problem. No amount of therapy or psychiatric medication will fix such an issue. Additionally you need to understand how psychiatry interacts with all other fields. You will coordinate plans with obstetricians, etc. on medications based on risks and benefits. You will need to really understand psychopharmacology and how medication could be causing problems for the patient. What kind of rash is an emergency and what does it look like? Once you have assessed the situation and ruled out alternative possibilities, you may find yourself doing therapy +/- low dose medication with benefit, but your thought process didn't start there.

 

[dl2dp2]

Additionally you need to understand how psychiatry interacts with all other fields. You will coordinate plans with obstetricians, etc. on medications based on risks and benefits. You will need to really understand psychopharmacology and how medication could be causing problems for the patient.

Spot on. As I've practiced longer and especially in a subspecialized field, I find that other specialists increasingly rely on my MEDICAL expertise for thorny situations. E.g. gastroenterologists call me about management of alcohol use disorder, surgeons call me on postop buprenorphine management, etc. etc. I can imagine the same can be said about child, etc. Who's actually comfortable writing 10-year-olds with a seizure disorder antipsychotics or even a stimulant? Not really anyone except a child psychiatrist. Who's writing lithium ever--I'll tell you it's not an endocrinologist! It's pretty clear that this field is first and foremost a medical specialty.

That said, interacting with some psychiatrists can at times leave you the impression of "are you really a doctor"? But that's sort of neither here nor there. As someone said, you don't have to be incompetent just because some are.

 

[dl2dp2]

What is meant by "being a physician" isn't completely clear to me. It seems like an emergency room surgeon's role, a dermatologist's role, and a radiologist's role are very different in day-to-day life and in sentiment. I know they are all united by being doctors, but I'm confused on what that means in and of itself...

Yeah, I was mainly thinking of less severe mental illnesses. I see the clear need for medicine in inpatient treatment and/or in more extreme circumstances. I guess I'm concerned about a case in which a person uses a medicine without fixing the underlying issue (if it can be helped with therapy), or if they are given more dosages of medicine than they need.

I am good with the idea of handling more acute issues and not mainly doing psychotherapy (I don't prefer to do just psychotherapy, I'd rather mainly listen than actively be a part of it).

Like it's becoming more reliant on medicine instead of psychotherapy?

I wouldn't do surgery because I'm a little too clumsy for that, and it's way too much pressure. Also in general, I don't really like the idea of being responsible for someone who is in a serious physical condition. I am more comfortable with a serious emotional or mental condition.

I think you should really aim to volunteer and follow a doctor around in a hospital to get a sense of what that's like. If you get a sense of excitement from the type of knowledge and work and the role of that person, then it would be worthwhile for you to pursue as a career.

I think what is common about the role of the physician:
1. you are the final arbiter for a particular case for a particular issue in your expertise area (i.e. you finalize the report as a radiologist. you are responsible for the case as a surgeon. you are the final call for a mole being biopsied, etc).

2. some decisions you make will have a life/death consequence. This is true of ANY specialty including psychiatry.

3. the knowledge base is fundamentally derived from scientific evidence of human biology, statistics, etc. Some elements are more social science-driven and there are parts of applied ethics, narrative medicine, etc., but fundamentally it's an applied science of biology. This is for ANY specialty. And it's not just a distinction between medicine and psychotherapy -- there are newer somatic procedures in psychiatry, neurostimulation, and medical devices, injections, etc. In fact, psychotherapy is becoming more "biological" as they follow neuroscience-driven protocols, especially with psychedelics, etc.

If you have literally zero interest at all in these things (i.e. "not a science person at all"), this field wouldn't be a good field. If you are kind of excited about these things, then it's worth exploring.

4. The job is associated with prestige and money. Let's not glare over this. If you have ambition about being in leadership roles in healthcare and want to deliver treatment, you should get an MD. The salary, market demand, career flexibility between an MD role and a non-MD role can be substantial. Anything that is associated with prestige typically is higher pressure--make no mistake, handling any acutely suicidal or psychotic patient is "high pressure", and it's something you can learn to do better. Sometimes there are long hours, and you have to be comfortable with that. If you want a 100% chill job and don't care about money and prestige, then this field is not a good fit. Also, make no mistake, lots of psychiatric patients have serious physical conditions. If you don't want to deal with anyone who doesn't have cancer, heart disease, stroke, etc. at all at least during training this field is not a good fit. Even in outpatient practice you'll often deal with patients with substantial medical issues, sometimes caused by your meds. If you don't feel comfortable EVER and don't feel that you can learn this field is not a good fit.

Finally, even if you are strictly a psychodynamic psychotherapist, if you are not comfortable with death and dying, and severe illness, and other life/death and related issues (divorce, infertility, death of a close family member, dementia) you wouldn't be a good fit for even that line of job. As someone who practices psychodynamic psychotherapy, I can tell you people generally don't cough up $X per hour to talk about trivia. Even rich people. Especially rich people.

 

[Monocles]

I thought psychiatry was one of the least competitive?

I don't know the specifics as it's been 7 years since my cycle, but I think it's certainly climbing up in terms of competitiveness (although nowhere near derm and plastics, etc). Anecdotally I've seen a ton of applicants with 240+ steps in the recent years, whereas when I was a med student, the residents at the same institutions often had sub 210s STEPs and often were IMGs, etc

 

[Twilque]

@Everyone Thanks for your thoughts!

I think you should really aim to volunteer and follow a doctor around in a hospital to get a sense of what that's like. If you get a sense of excitement from the type of knowledge and work and the role of that person, then it would be worthwhile for you to pursue as a career.

I think what is common about the role of the physician:
1. you are the final arbiter for a particular case for a particular issue in your expertise area (i.e. you finalize the report as a radiologist. you are responsible for the case as a surgeon. you are the final call for a mole being biopsied, etc).

2. some decisions you make will have a life/death consequence. This is true of ANY specialty including psychiatry.

3. the knowledge base is fundamentally derived from scientific evidence of human biology, statistics, etc. Some elements are more social science-driven and there are parts of applied ethics, narrative medicine, etc., but fundamentally it's an applied science of biology. This is for ANY specialty. And it's not just a distinction between medicine and psychotherapy -- there are newer somatic procedures in psychiatry, neurostimulation, and medical devices, injections, etc. In fact, psychotherapy is becoming more "biological" as they follow neuroscience-driven protocols, especially with psychedelics, etc.

If you have literally zero interest at all in these things (i.e. "not a science person at all"), this field wouldn't be a good field. If you are kind of excited about these things, then it's worth exploring.

4. The job is associated with prestige and money. Let's not glare over this. If you have ambition about being in leadership roles in healthcare and want to deliver treatment, you should get an MD. The salary, market demand, career flexibility between an MD role and a non-MD role can be substantial. Anything that is associated with prestige typically is higher pressure--make no mistake, handling any acutely suicidal or psychotic patient is "high pressure", and it's something you can learn to do better. Sometimes there are long hours, and you have to be comfortable with that. If you want a 100% chill job and don't care about money and prestige, then this field is not a good fit. Also, make no mistake, lots of psychiatric patients have serious physical conditions. If you don't want to deal with anyone who doesn't have cancer, heart disease, stroke, etc. at all at least during training this field is not a good fit. Even in outpatient practice you'll often deal with patients with substantial medical issues, sometimes caused by your meds. If you don't feel comfortable EVER and don't feel that you can learn this field is not a good fit.

Finally, even if you are strictly a psychodynamic psychotherapist, if you are not comfortable with death and dying, and severe illness, and other life/death and related issues (divorce, infertility, death of a close family member, dementia) you wouldn't be a good fit for even that line of job. As someone who practices psychodynamic psychotherapy, I can tell you people generally don't cough up $X per hour to talk about trivia. Even rich people. Especially rich people.

Absolutely. I haven't found a doctor to shadow with COVID. I've been doing volunteering in a hospital, but I haven't gotten the fuller view.

I'm interested in the biological component too. If I don't go into psychiatry, I might go into neuroscience research. Or maybe behavioral science research? Hmm. Regardless, I would lose the human interaction, but I think I'd rather not do pure social work.

I'm comfortable with these topics, but the idea of making decisions like "this medicine will have side effects that could probably harm this person, but weighing the pros and cons, it's for the best" are harder. I know it's inevitable that bad things will happen even when you are acting on the best information, but it's difficult to be detached.

I care about job security and financial independence, i.e. knowing that I'll be able to sustain myself and a family. I guess getting an MD is appealing in this regard because it's a clear path; if I complete all the established steps then it works out well, instead of having uncertainty. However, another issue is when I actually have a family. I don't want to become infertile, but I don't want to have a child when I'm not in a position to make it my priority. I can see there are costs there too.

 

[dl2dp2]

I'm interested in the biological component too. If I don't go into psychiatry, I might go into neuroscience research. Or maybe behavioral science research? Hmm. Regardless, I would lose the human interaction, but I think I'd rather not do pure social work.

I'm comfortable with these topics, but the idea of making decisions like "this medicine will have side effects that could probably harm this person, but weighing the pros and cons, it's for the best" are harder. I know it's inevitable that bad things will happen even when you are acting on the best information, but it's difficult to be detached.

I care about job security and financial independence, i.e. knowing that I'll be able to sustain myself and a family. I guess getting an MD is appealing in this regard because it's a clear path; if I complete all the established steps then it works out well, instead of having uncertainty. However, another issue is when I actually have a family. I don't want to become infertile, but I don't want to have a child when I'm not in a position to make it my priority. I can see there are costs there too.

Actually, a career in neuroscience or behavioral science [academic] research, in general, is unable to sustain yourself and a family financially. This line of work is characterized by extreme financial hardship, actually. People who work in this field tend to get paid less than a social worker on average in mid-career, and typically require multiple involuntary moves. Unlike medicine, being a good student who works hard is generally not sufficient for success in this field--some other very helpful factors include family money, luck, and exposure to "the hidden curriculum" through in-the-know social connections.

I'm not sure why writing a med is difficult emotionally, but that's something you can talk to your therapist about.

Psychiatry is actually one of the most women-friendly specialties. Generally, it's problem-free to have a child during residency (PGY2+). It would certainly be WAY more child-friendly than a research career. Of note, a clinically trained psychiatrist can do neuroscience and behavioral research through well-known pathways (research fellowships, etc). A PhD researcher, however, can NEVER practice medicine no matter how much of an expert he/she is on a particular disorder.

 

[Twilque]

Actually, a career in neuroscience or behavioral science [academic] research, in general, is unable to sustain yourself and a family financially. This line of work is characterized by extreme financial hardship, actually. People who work in this field tend to get paid less than a social worker on average in mid-career, and typically require multiple involuntary moves. Unlike medicine, being a good student who works hard is generally not sufficient for success in this field--some other very helpful factors include family money, luck, and exposure to "the hidden curriculum" through in-the-know social connections.

Hmm. It's hard to balance all the different priorities. Job and financial security, interest and purpose, stress, family.

I'm not sure why writing a med is difficult emotionally, but that's something you can talk to your therapist about.

I know you're serious, but this made me laugh. I just don't want to mistakenly cause serious harm to someone, but I know it's something I would need to accept (on some level?) if I went into medicine. I think I know I'm being a little irrational here, so yeah, a therapist might be helpful.

Psychiatry is actually one of the most women-friendly specialties. Generally, it's problem-free to have a child during residency (PGY2+). It would certainly be WAY more child-friendly than a research career. Of note, a clinically trained psychiatrist can do neuroscience and behavioral research through well-known pathways (research fellowships, etc). A PhD researcher, however, can NEVER practice medicine no matter how much of an expert he/she is on a particular disorder.

Would I be ready to have a child at that point, or would I want to focus on the residency? I'd also imagine it would make the pregnancy harder, and I'd inevitably miss out on important parts of my kid's life. I don't want a nanny to be raising my child. I mean, this is all very hypothetical!

 

[dl2dp2]

Would I be ready to have a child at that point, or would I want to focus on the residency? I'd also imagine it would make the pregnancy harder, and I'd inevitably miss out on important parts of my kid's life. I don't want a nanny to be raising my child. I mean, this is all very hypothetical!

Well, a research career is also extremely incompatible with half-time work (i.e. don't want nanny raising my child). You can easily be a half-time or even 25% psychiatrist for any number of years you choose and return to full-time employment without any loss of future income potential. It is all very hypothetical, but you need to know the facts and make your own choices based on facts.

While there's now reasonable evidence suggesting that surgical residency with lots of standing is associated with adverse pregnancy outcomes, there's no evidence that low-impact residency like psychiatry is associated with adverse pregnancy outcomes. There may be some relative increase in risk, but the absolute risk increase is fairly minimal, and is overwhelmed by other more high impact factors (i.e. age of the pregnancy, mental health of the mother, pre-existing conditions, etc.)

 

[MisterKitty]

I literally wouldn’t do any other job related to mental health aside from being a psychiatrist. You really have to want to be a physician first to go the route of being a psychiatrist. If you’re more interested in counseling the worried well and hesitant to use medicines, then I’d recommend becoming an LCSW or psychologist and doing therapy. You won’t make much money though

 

[Monocles]

Would I be ready to have a child at that point, or would I want to focus on the residency? I'd also imagine it would make the pregnancy harder, and I'd inevitably miss out on important parts of my kid's life. I don't want a nanny to be raising my child. I mean, this is all very hypothetical!

You can absolutely be a mom and spouse first and then do psychiatry in your spare time as a 2nd or 3rd life priority.

If you make a conscious decision to set your boundaries and make sure that being a physician doesn't interfere with what's important to you (ex: family, money, hobbies, etc), it's pretty easy to manage in more cush "full-time" jobs or even work part time officially.

I know many friends who had kids during later years of psychiatry residency (pgy3, 4) or fellowship. Most took 3 months of maternity and still managed to graduate on time. If you avoid excessively difficult or malignant programs it should be fairly doable.

 

[Twilque]

Well, a research career is also extremely incompatible with half-time work (i.e. don't want nanny raising my child). You can easily be a half-time or even 25% psychiatrist for any number of years you choose and return to full-time employment without any loss of future income potential. It is all very hypothetical, but you need to know the facts and make your own choices based on facts.

While there's now reasonable evidence suggesting that surgical residency with lots of standing is associated with adverse pregnancy outcomes, there's no evidence that low-impact residency like psychiatry is associated with adverse pregnancy outcomes. There may be some relative increase in risk, but the absolute risk increase is fairly minimal, and is overwhelmed by other more high impact factors (i.e. age of the pregnancy, mental health of the mother, pre-existing conditions, etc.)

Well now you're making it sound so appealing! Like you said before though, it can also be a high-stress job... What kinds of situations are life/death? Over the course of my career, is there a significant chance that a patient of mine will kill themself (How do psychiatrists handle this?)?

I literally wouldn’t do any other job related to mental health aside from being a psychiatrist. You really have to want to be a physician first to go the route of being a psychiatrist. If you’re more interested in counseling the worried well and hesitant to use medicines, then I’d recommend becoming an LCSW or psychologist and doing therapy. You won’t make much money though

I don't think I want my main job to be counseling people verbally. I'm good with people talking about such things, but helping them process them (and doing that constantly) seems like it would be too intense. It's also a concern of job security. But yeah, I have hesitancies about a career where I'm making health decisions for someone that can affect their life negatively... And, I'm not sure if I want to be a physician itself. I guess I could see myself enjoying certain other specialties, like pediatrics or family medicine. I really don't know though, and I don't have a burning desire to do medicine. But if not that, what else?

You can absolutely be a mom and spouse first and then do psychiatry in your spare time as a 2nd or 3rd life priority.

If you make a conscious decision to set your boundaries and make sure that being a physician doesn't interfere with what's important to you (ex: family, money, hobbies, etc), it's pretty easy to manage in more cush "full-time" jobs or even work part time officially.

I know many friends who had kids during later years of psychiatry residency (pgy3, 4) or fellowship. Most took 3 months of maternity and still managed to graduate on time. If you avoid excessively difficult or malignant programs it should be fairly doable.

If I went into psychiatry, I think that's what I would do. I would prioritize my family life first. I don't necessarily see my career being the center of my life, but it's often portrayed that way for going into medicine.

 

[J ROD]

Now, I manage quite a few medical issues on inpatient. BP, DM, etc.
Also on consult service, I deal with tons of medical issues like delirium. Look at EKGs, CT, MRI. Labs.
I am a medical doctor that specializes in psychiatric services.
I highly recommend if you do not have the desire to be a MD and the responsibility it takes and time it takes from your life. Pass and do something else. I enjoyed life until about 24 and then got serious when I realized how I personally felt lke a failure because I always saw myself where I am now. 15 years later. on other side. would not change a thing but wishing I had a few years back. But, I don't feel my age..lol
And, I often get asked if I regret the PharmD first. And I do not. It makes me a better physician.

 

[Monocles]

I don't necessarily see my career being the center of my life, but it's often portrayed that way for going into medicine.

The days of the old school martyr complex are nearing their end. 🙂