Sign psychiatry is right for me?

[yanks26dmb]

Im mid way through my third year and having a very difficult time choosing what to pursue. Essentially I'm down to em and psychiatry. I really like the vibe of the ed, procedures, and the bursts of high stress.

That said, i find myself getting those warm fuzzy feelings whenever i see a patient dealing with psychiatric issues, particularly depression and/or anxiety. I really feel empathy for these patients that is much stronger than ive experienced in other patients. I was on IM service the otherday (which i generally hate) and spenta good 30 minutes talking to a woman w stage 4 CA suffering from anxiety/depression as a result of her illness. It just felt so satisfying.

Maybe I'm just naive, but is this an indication that psychiatry might be the right choice for me?

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[witzelsucht]

I'm a current EM resident who had thoughts of psych in medial school. I ultimately liked being in the "pit", knowing my crew of techs and nurses, and being the guy in charge for resuscitations, etc. I love a good procedure, I like doing dental blocks one minute, fixing a migraine next, then dealing with some CHF on nitro drip. Very cool stuff. U/s guided peripheral lines? Its literally like playing a fun video game at work. Young anxious female fixed with a "therapeutic echo" and IV fluids? Feels like you did a good job.

That being said, I often chart check my psych patients for a while after they've been admitted. Moreso than my ICU people. Its super interesting to see psychotic people start talking to the inpatient team after they've been stabilized. They kind of get fleshed out in the notes as a real person after they are stabilized. Psych would totally be my 2nd residency if I were to be disabled or some such.

So, you have to think, do you want to do cool stuff more than listen to interesting stories? Do you want to see people get better over a course of hours and then disappear, versus get better slowly over a course of months? Versus never really get better and stay institutionalized for a long time? I think procedural fun starts to fade after residency, whereas attending psychiatrists can have patients for years and years and be a real core piece of that person's health and that seems to be a nice thing.

Plus overnight shifts suck.

 

[MacDonaldTriad]

We had a post from a EM doc who converted to psychiatry. He summed up his reasoning in two words: "Butt Pus". As I recall, it lead to a discussion in which the conclusion was that psychiatry is much more sustainable in the long run. I also think the overnight thing is a huge deal. Of course, it is good that there are people who like Butt pus....

 

[OldPsychDoc]

Im mid way through my third year and having a very difficult time choosing what to pursue. Essentially I'm down to em and psychiatry. I really like the vibe of the ed, procedures, and the bursts of high stress.

That said, i find myself getting those warm fuzzy feelings whenever i see a patient dealing with psychiatric issues, particularly depression and/or anxiety. I really feel empathy for these patients that is much stronger than ive experienced in other patients. I was on IM service the otherday (which i generally hate) and spenta good 30 minutes talking to a woman w stage 4 CA suffering from anxiety/depression as a result of her illness. It just felt so satisfying.

Maybe I'm just naive, but is this an indication that psychiatry might be the right choice for me?

 

[yanks26dmb]

One thing i really like about em is the shift work. I also dont mind nights.

Anyone know if there are ER pysch jobs that one could pick up like EM shifts? Id love to schedule some 12s and 24s and get more days off each month to work on building a private practice.

 

[DisorderedDoc417]

I fell similarly between EM and Psychiatry, but I’m now a PGY1 Psychiatry resident. Ultimately, what I noticed in attendings is that the folks in their 40s-50s seemed more burned out and tired in the ED.

I could find umpteen things I genuinely loved about both, and I worked with some absolutely incredible EM faculty at HCMC. It is astounding the clinical acumen they carry around with them and the breadth of situations they are prepared to endure. Still, your average ED doc looks physically “tired” after 10-15 years of taking the rotating night shifts. My anecdotal experience was that the majority of people at that point in their career won’t tell you that it is fun to fight your circadian rhythm, especially when you are no longer a single bachelor, etc.

Likewise, I worked with inspiring psychiatry faculty. Folks in their 40s, 50s, 60s, and even 70s! All of which love their jobs, had no real eye-opening signs of burn-out, and work a very reasonable schedule that allows them other pursuits in life. The warm fuzzies and experiences after speaking to folks with depression will fade with time, so will the U/S guided line placement. I think what you have to search for inside yourself is: when all the magic and “newness” to your specialty wears off, what will you continue to find intellectually stimulating or fulfilling. In other words, when you already know the ropes and much of it is second nature, what would you rather be doing?

Do you want to see your patients get better with time? Do you want to wash your hands of folks after they have been stabilized? Do you want a diversity/variety to your practice (inpatient/outpatient/even psych EM shifts if that is your gig)?

You have some soul searching to do, both specialties have their positives and negatives. I am confident you will find your home in Psychiatry, but you might call me a little biased.

 

[SmallBird]

One thing i really like about em is the shift work. I also dont mind nights.

Anyone know if there are ER pysch jobs that one could pick up like EM shifts? Id love to schedule some 12s and 24s and get more days off each month to work on building a private practice.

Yes absolutely, many places with a psych ED offer this type of arrangement. Unfortunately, although the work is quite as draining, from what I’ve seen the pay (around $150/hr) is worse than for ED docs at equivalent institutions (around $220/hr).

 

[FlowRate]

Your post reads like the reasons I ended up going psych instead of EM/Gas/Neuro. I was inherently drawn to the psychosocial aspects of people's care. I did sub-I's in EM and Neuro and while I liked them, it just wasn't my thing compared to psych.

 

[Blitz2006]

Yes absolutely, many places with a psych ED offer this type of arrangement. Unfortunately, although the work is quite as draining, from what I’ve seen the pay (around $150/hr) is worse than for ED docs at equivalent institutions (around $220/hr).

Agreed. But here in NYC, psych ER docs work 3 x 12s a week, and then do a couple days of PP on the side in that week. So you end up making very good $ (300-350k) if you want..

 

[Blitz2006]

One thing i really like about em is the shift work. I also dont mind nights.

Anyone know if there are ER pysch jobs that one could pick up like EM shifts? Id love to schedule some 12s and 24s and get more days off each month to work on building a private practice.

Absolutely. Lots of ER Psych jobs, where you do 12 hr shifts. You can also do per diem/moonlighting shifts. I've heard rates here in NYC area of around $150-$200/hr. And like I said in earlier post, you can do a 1-2 days a week of PP if you want to mix it up.

The beauty of psych is there lots of flexibility:

1) Outpatient
2) Inpatient
3) Jail
4) Suboxone/Methadone Clinic
5) CL
6) ER

ER you basically have just....ER (and I guess urgent care). Plus psychiatry you are a specialist/expert. You have to ask if that is something you want to be?

and obviously on this forum you are going to get bias...so I hope you've discussed on the ER forum!

 

[Nasrudin]

These are really vastly different ways of interacting with human beings. EM doc's are like air traffic controllers. A dozen or more blips on the radar moving in different directions, speeds, altitudes with all manner of problems to process and dispo. Psych is on the ground. in the bush. Noting the terrain, the topography, mythologies, jokes, stories, of one individual universe. one unique one after the other.

The choice between these are so dissimilar as to render it obvious to anyone with even an inkling of self familiarity.

 

[DisorderedDoc417]

One might suggest that we clarify what is meant by, "in the bush".

 

[Evidence Based]

Maybe I'm just naive, but is this an indication that psychiatry might be the right choice for me?

Yes. Liking psych patients is a huge reason I chose psych.

"Search your feelings Luke, you know it to be true."

 

[Bartelby]

I debated between psych and EM myself, witzel provides some good food for thought.

EM is a great specialty in many ways. From what I've seen, it is fast-paced, you feel like you accomplish a lot each shift, and you feel like you can take on anything that comes through the door. You will always be working on diagnostic puzzles, and you will have a tremendous breadth of skill (including procedures).

On the flip side, you will always work hard on EM. You will work nights and weekends. You will see a parade of new people, and you will not get the satisfaction of following and getting to know your own patients. The pace may burn you out. You will also find leisurely chats are limited.

In psychiatry, you can develop deeper relationships with patients than in many other specialties. You get to know them, and you get to see them get better over time. Mental illness and wellness are fascinating, and you can spend more than a lifetime learning about them. Formulation of a patient's problems, and good treatment of those problems, provides a great deal of intellectual satisfaction. You can enjoy a more leisurely pace, and you can carry your training into many different settings (inpatient, ER, consult, outpatient, partial program, detox center, forensic, cash-based therapy practice or a community mental health center, on and on). You can easily work 9-5, or less, in a style that suits you.

On the flip side, you don't often get the immediate reward of stabilizing a critical patient or quickly solving a problem. You will feel like a specialist, and your comfort zone (in contrast to "taking on anything that comes through the door") will significantly narrow. You will not do procedures. You may sometimes miss the rush of a delicate procedure, an incoming trauma patient, or a code blue.

I chose psych, and I don't regret it at all! I love my work. With that said, I feel confident I could be happy in EM as well. If you envision yourself working a few weeks in a psych setting versus a few weeks in the ER, what feels the most "right" to you? I'd say go with that.

 

[yanks26dmb]

Yes absolutely, many places with a psych ED offer this type of arrangement. Unfortunately, although the work is quite as draining, from what I’ve seen the pay (around $150/hr) is worse than for ED docs at equivalent institutions (around $220/hr).

Thanks for that info. I'd be lying if i said money didnt play a part. It seems if one is in EM and willing to do locums and travel to highest paying gigs a few times a month, they can do really well. I feel like ill be taking a major pay cut by going w psych. Is that your feeling as well?

 

[DisorderedDoc417]

Thanks for that info. I'd be lying if i said money didnt play a part. It seems if one is in EM and willing to do locums and travel to highest paying gigs a few times a month, they can do really well. I feel like ill be taking a major pay cut by going w psych. Is that your feeling as well?

Providers in my hospital make from 250k to 600k and everywhere in-between. It depends on what you want to do with your time. They also don’t have to give up weekends.

 

[J ROD]

My main interest were Psych and EM. If you love the ED, there are plenty of opportunities to work as a Psy ED attending. I might still do that myself. After doing work in Psych now, I prefer inpatient....outpatient also is good. Probably will do a mix.

 

[bonedrone14]

I can't put anything more persuasive on paper than what's been said. I thought us EM vs psych folks were more rare but I guess not. I was torn until August of 4th year.

Im not sure of your life situation, but for me, that was about 1/3 of the deciding factor. Nights was no big deal in med school until I had kids. Then it (for me) was awful. Some people still pull them and aren't bothered. I couldn't envision my life like that. In psych, I can work surgeon hours if I want, but I'm not required by any means to. If I wanted to work 20 hours a week i could. I guess you could do the same in em.

Another big deciding factor I looked at was practice opportunities. This has been enumerated here already, but in psych, even without a fellowship, you can do straight inpt, outpt, consults, ed, substance/detox, some forensic evals, work in the prison, and it's probably the easiest specialty there is to open up your own private practice because you don't need any equipment. I was afraid I'd get bored working in the same setting. After essentially being groomed to be a professional rotator in med school, the idea of never stepping outside of the ed was kind of a downside to me. The opportunity to change jobs easily within psych was a huge plus. The job market for both is hot so you can't lose there.

Finally, I realized that in my spare time, the journals I could actually enjoy reading were psychiatric. I could make myself read about stemi management or acls, but I really just found psychosis and mania fascinating. So see if you have one type of info that you find yourself falling down the Wikipedia hole reading about in your free time and maybe that's a good sign.

Both are pretty good fields so you can't choose wrong unless you do...but with that said, when I was applying, the word was psych was pretty easy to transfer into as a pgy2 if someone felt they made the wrong decision. So there's that. Good luck!

 

[Blitz2006]

Thanks for that info. I'd be lying if i said money didnt play a part. It seems if one is in EM and willing to do locums and travel to highest paying gigs a few times a month, they can do really well. I feel like ill be taking a major pay cut by going w psych. Is that your feeling as well?

If you are willing to clock 50 to 60 hours a week in a large market (SF/LA/NYC) you can crank out 400-500k in psych, with a mix of salary and cash pp. I'm getting lots of job offers now and the average around the country for a regular 40 hr week is 275 to 300k, plus you can make more with calls. 350k for less desirable places in the midwest and south.

I know here in NYC the average pay for ER is around 250k. But I know if you head out of the city it goes up to 300k in the northeast, and I heard Midwest you can do 350-400k. But obviously ER forum will provide you more accurate info.

And remember as a Psychiatrist you can work into your 70s..studies have shown that ER docs do burnout the most

Burnout: Emergency Medicine Hit Hardest | HealthLeaders Media

60% is the burnout rate for ER docs. So I personally feel in the long run you will be taking a pay cut going into ER...some food for thought.

 

[yanks26dmb]

If you are willing to clock 50 to 60 hours a week in a large market (SF/LA/NYC) you can crank out 400-500k in psych, with a mix of salary and cash pp. I'm getting lots of job offers now and the average around the country for a regular 40 hr week is 275 to 300k, plus you can make more with calls. 350k for less desirable places in the midwest and south.

I know here in NYC the average pay for ER is around 250k. But I know if you head out of the city it goes up to 300k in the northeast, and I heard Midwest you can do 350-400k. But obviously ER forum will provide you more accurate info.

And remember as a Psychiatrist you can work into your 70s..studies have shown that ER docs do burnout the most

Burnout: Emergency Medicine Hit Hardest | HealthLeaders Media

60% is the burnout rate for ER docs. So I personally feel in the long run you will be taking a pay cut going into ER...some food for thought.

You bring up a good point. I never really considered the longevity of psych vs. EM docs in how that would contribute to overall earnings...definitely something to consider.

I'm more than happy to work in the 50ish hr/week range. How confident are you of the odds of achieving those salary figures, even in hot California markets (where I happen to be from and hope to live and work)? What kind of work are those docs doing who reach 4-500k? I was under the impression getting that high in psych was really only possible with private practice.

 

[Blitz2006]

You bring up a good point. I never really considered the longevity of psych vs. EM docs in how that would contribute to overall earnings...definitely something to consider.

I'm more than happy to work in the 50ish hr/week range. How confident are you of the odds of achieving those salary figures, even in hot California markets (where I happen to be from and hope to live and work)? What kind of work are those docs doing who reach 4-500k? I was under the impression getting that high in psych was really only possible with private practice.

You are correct. You would have to do a mix of hospital job + pp in the evrnings/Saturdays to hit that number. But doable, especially in SF and LA where ppl can afford cash.

I know attendings here that do 8 to 4 CL or Inpatient, M to F, and then couple nights a week of PP plus maybe every other Saturday. Works out to 60 hrs/wk

But I think the big pull of psych is that you can make decent money with a lot of flexibility, which makes it unique compared to any other speciality.

If you get bored of inpatient, then switch to ER. Get bored of that? Join a rehab and work at a methadone clinic. Bored again? Jump into an outpatient clinic.

And you can even diversify more in psych by doing a "non traditional" fellowship like sleep or pain. Run a sleep lab after if you want.

 

[uname943]

I'm more than happy to work in the 50ish hr/week range. How confident are you of the odds of achieving those salary figures, even in hot California markets (where I happen to be from and hope to live and work)? What kind of work are those docs doing who reach 4-500k? I was under the impression getting that high in psych was really only possible with private practice.

Today you are unlikely to make 400-500k working only 50 hours a week as a psychiatrist. However, salaries in psychiatry are rising rapidly. As a MS4, I was expecting to be paid 200k for a middle-the-road job. By the time I hit PGY4, the lowest-paying options were offering 240k.

You don't have to do private practice to make a lot of money doing psych. Pay in psych is also high doing locums tenens work for systems struggling to hire psychiatrists. See: the California prison system. The grapevine tells me stories of locums prison docs making 500-600k+

Our EM colleagues make much more than we do. If you match into EM and decide it's really not for you, transferring to psych is relatively easy. Going the other way, I suspect is much harder.

 

[yanks26dmb]

Today you are unlikely to make 400-500k working only 50 hours a week as a psychiatrist. However, salaries in psychiatry are rising rapidly. As a MS4, I was expecting to be paid 200k for a middle-the-road job. By the time I hit PGY4, the lowest-paying options were offering 240k.

You don't have to do private practice to make a lot of money doing psych. Pay in psych is also high doing locums tenens work for systems struggling to hire psychiatrists. See: the California prison system. The grapevine tells me stories of locums prison docs making 500-600k+

Our EM colleagues make much more than we do. If you match into EM and decide it's really not for you, transferring to psych is relatively easy. Going the other way, I suspect is much harder.

Thanks for your response. I really like the idea of locums as I dont mind travel a few times a month if it will bring in higher rates. The idea of doing a 2-3 12s or even 24s a week then coming home was what was particularly attractive about EM. Didn't realize this was possible in psych as well. Will keep this in mind moving forward.

 

[surfguy84]

Today you are unlikely to make 400-500k working only 50 hours a week as a psychiatrist. However, salaries in psychiatry are rising rapidly. As a MS4, I was expecting to be paid 200k for a middle-the-road job. By the time I hit PGY4, the lowest-paying options were offering 240k.

You don't have to do private practice to make a lot of money doing psych. Pay in psych is also high doing locums tenens work for systems struggling to hire psychiatrists. See: the California prison system. The grapevine tells me stories of locums prison docs making 500-600k+

Our EM colleagues make much more than we do. If you match into EM and decide it's really not for you, transferring to psych is relatively easy. Going the other way, I suspect is much harder.

Can anyone comment on some of the higher end psychiatry locums hourly rates they've seen?

 

[Sunny in Psych]

Im mid way through my third year and having a very difficult time choosing what to pursue. Essentially I'm down to em and psychiatry. I really like the vibe of the ed, procedures, and the bursts of high stress.

That said, i find myself getting those warm fuzzy feelings whenever i see a patient dealing with psychiatric issues, particularly depression and/or anxiety. I really feel empathy for these patients that is much stronger than ive experienced in other patients. I was on IM service the otherday (which i generally hate) and spenta good 30 minutes talking to a woman w stage 4 CA suffering from anxiety/depression as a result of her illness. It just felt so satisfying.

Maybe I'm just naive, but is this an indication that psychiatry might be the right choice for me?

Believe it or not, you are in the trenches with psych patients as much as any other specialty... Not only is there an art to treating these patients, but a science. You will find yourself changed by them and they by you. You will use science to treat them and intuition and experience to assess them. It does not come easily to all providers. I hate to see residents go into psych bc they think it is easy. The force is strong with you.