Starting 3rd year interested in CAP Psych but I love the OR/procedures

[HinduHammer]

Hey all,
I am very interested in psychiatry, specifically CAP. I attend med school in the midwest and ideally would like to either do Psych at UCLA/UCSD or triple board at CCH/Pitt. My ideal career would be CAP psychiatry in So Cal where I could also provide psychotherapy, life coaching and mentorship, and pursue hobbies outside of medicine. I also would like to make alot of money, so I am thinking PP.

Seems like a pretty good goal, right? My only problem is that I just started Surgery rotation and I love the OR. I'm not a huge fan of internal medicine life, but I do like thinking about anatomy, and doing procedures like chest tubes, suturing etc. This is why I am considering triple board.

I guess, my question is, what kinds of things should I be thinking about/exploring as it relates to my future career? I am older (graduate MD at 34), single with no prospects, and have tons of interests outside medicine. Ideally I want to be in a huge, young, vibrant city where I can make money, help people, and provide counseling/mentoring/coaching service (<--- I had a life changing experience and have discovered the value of CBT/life coaching). I think psychiatry would provide this.

BUT-- like I said, I have this love of the OR. I don't want to pursue psychiatry and wake up finally married at age 50 or whatever and wish I had been a surgeon. Alternatively, I don't want to wake up at age 41 and still single, miserable, and a PGY-6 in plastics/urology/ent/gen-surg and hate my life, have back problems, lost all my remaining hair due to stress, etc.

Can you guys help me out? What kind of questions should I be asking myself and residents/attendings? I definitely think about income potential, and I see various sources say different things for CAP psych- what do you guys think about salary prospects of a CAP psych in SoCal/TX/FL vs an ophtho or Anesthesiologist? Is there any benefit to doing triple board besides being able to put in a few chest tubes in residency? Any thoughts or advice you have would be helpful. FYI I haven't taken Step 1 yet. I had some health problems and will have a 6 week study break after my 2nd clerkship to take step 1.

Thanks and Happy 4th (which means I got to leave neurosurg rotation after rounding lol).
HH

---

Members don't see this ad.

 

[hamstergang]

First thing I'm wondering is why you seem to be placing life coaching on par with psychotherapy? Life coaching is something you can do now as it doesn't take a degree. If a therapist seems like a life coach they're probably doing therapy incorrectly.

That aside, you can several other threads of people debating going into surgery vs psychiatry (both here and in the med student forum). I would make sure you get adequate exposure to both in rotations (have you even done a psych rotation yet?).

As for the triple board, others think it more useful than I, but certainly it won't lead to a job where you can be putting in chest tubes and doing psychotherapy as no such job exists.

 

[calvnandhobbs68]

You mean triple board with peds? You don't get that many procedures in a regular peds residency much less in the compressed peds residency you get in a triple board program. You'll get to do LPs during your ER and NICU rotations, a few intubations (almost all babies) and probably a decent amount of suturing simple lacs and draining simple abscesses during your ER rotations. Bigger stuff than that will be the fellow of whatever rotation you're on (unless they don't want more procedures...unlikely) or surgery.

You seem fairly naive about what each specialty does. Also likely you just started 3rd year (it's about that time of year). Also seem pretty hung up on money. If you want a ton of money with lots of procedures, do derm or plastics. Even family medicine you could set yourself up to do a bunch of small procedures and likely boost your income potential (I know an FP doc who works in an ER and another one who does his own biopsies, I+Ds in office and whatnot). Otherwise, finish out getting exposure to all your rotations including your psych rotation. If you end up wanting to do something really competitive late, you can always take a research year between 3rd and 4th year.

 

[michaelrack]

If $ and lifestyle are most important, do plain child psych

 

[DokterMom]

Experience your rotations fully and take your STEP 1.
Each of those should bring your options into better focus.

 

[HinduHammer]

First thing I'm wondering is why you seem to be placing life coaching on par with psychotherapy? Life coaching is something you can do now as it doesn't take a degree. If a therapist seems like a life coach they're probably doing therapy incorrectly.

That aside, you can several other threads of people debating going into surgery vs psychiatry (both here and in the med student forum). I would make sure you get adequate exposure to both in rotations (have you even done a psych rotation yet?).

As for the triple board, others think it more useful than I, but certainly it won't lead to a job where you can be putting in chest tubes and doing psychotherapy as no such job exists.

I totally realize that life coaching is not on par with psychotherapy, but it is something that I would like to try doing. It would fit more into my career as a psychiatrist vs a urologist for example. If I am envisioning things right I would have a PP, own/rent office space, and offer all my services from there. I have not done a full psych rotation however I did research with a CAP last summer and also shadowed him once a week through a clinical shadowing program for M2s. I was in clinic with him one morning a week and I saw what it was like: very rewarding and at times sad working with the children, and alot of time spent on the phone gathering collateral and working with social workers etc. Re Triple Board, I had this fantasy of like doing CAP 3-4 days/week PP and then being a peds hospitalist one-two shifts a week. However others have pointed out including someone I know doing a TB that in the end most people just do CAP full-time.

You mean triple board with peds? You don't get that many procedures in a regular peds residency much less in the compressed peds residency you get in a triple board program. You'll get to do LPs during your ER and NICU rotations, a few intubations (almost all babies) and probably a decent amount of suturing simple lacs and draining simple abscesses during your ER rotations. Bigger stuff than that will be the fellow of whatever rotation you're on (unless they don't want more procedures...unlikely) or surgery.

You seem fairly naive about what each specialty does. Also likely you just started 3rd year (it's about that time of year). Also seem pretty hung up on money. If you want a ton of money with lots of procedures, do derm or plastics. Even family medicine you could set yourself up to do a bunch of small procedures and likely boost your income potential (I know an FP doc who works in an ER and another one who does his own biopsies, I+Ds in office and whatnot). Otherwise, finish out getting exposure to all your rotations including your psych rotation. If you end up wanting to do something really competitive late, you can always take a research year between 3rd and 4th year.

Hmm thanks good things to think about. I would love having that knowledge/ability of even simple stuff like LPs, intubations, suturing. But I wonder if I don't use it like how soon I will forget how to do it- just 1 or 2 years out of residency? I did shadow a week in plastics and it was dope, however I think I like more patient contact. Gen surg guys follow their patients in SICU, OBs see their patients in clinic, ENTs manage things medically too. Also I am not sure if I want to do a grueling 6 year surgical residency, or that I will have the Step 1 scores to do so. Most people say that if I want to do child psych then a Triple Board program would not be beneficial.

If $ and lifestyle are most important, do plain child psych

Thanks for the feedback. What is your practice model- PP? group? hospital C/L work? Any tips you have on selecting a residency or integrated program?

Experience your rotations fully and take your STEP 1.
Each of those should bring your options into better focus.

Definitely agree, but these are still things I think about and inform decisions on how I spend my free time (research vs shadowing in the OR, etc.)

 

[michaelrack]

I totally realize that life er as a psychiatrist vs a



Thanks for the feedback. What is your practice model- PP? group? hospital C/L work? Any tips you have on selecting a residency or integrated program?

.)

I am not child psych and have no idea about selecting residency. You would want to avoid hospital c and L work

 

[nexus73]

Become a dermatologist

 

[zzzdrugs]

.

 

[Shikima]

Get your Peds and Child psych out of the way. This way you can sew the kid up while lecturing parents on how to be better parents.

 

[psyguru]

I did not read all the replies above so forgive any repeats. One way for psychiatrists to do procedures is to do fellowships in Pain or Sleep (you can treat sleep apnea). ECT and other physical treatments involve procedures. You could do also do a combined neurology and psychiatry residence and later do the child psychiatry fellowship.

 

[ExcaliburPrime1]

Your question asks us to attempt to not only read your mind (because you're not sure) but to have clairvoyance beyond that. Impossible.

If you truly love the OR, pursue a surgical specialty. Private practice psychiatrists don't really do that much life coaching - you'll likely end up adjusting medications on adolescents with complicated psychiatric histories and sad stories without a single procedure in sight!

 

[dl2dp2]

Your question asks us to attempt to not only read your mind (because you're not sure) but to have clairvoyance beyond that. Impossible.

If you truly love the OR, pursue a surgical specialty. Private practice psychiatrists don't really do that much life coaching - you'll likely end up adjusting medications on adolescents with complicated psychiatric histories and sad stories without a single procedure in sight!

I would second that as well. In PP psychiatry you might get a chance to do a lot of psychotherapy, some of which might have a flavor of life coaching. However, in the vast majority of jobs with a facility, psychopharmacology is the main work, and it feels very similar to internal medicine/neurology and has a very similar pace (15-30min followup visits, endless patients). PP is lucrative and allows for a mix of cases, but keep in mind that invariably in PP people still have predominantly a psychopharm orientation (i.e. you still do mostly pharm appointments, but you get 45min instead of 30min to really provide a high quality management).

Psychopharm for C&A is highly complex and has layers of issues not typical in adult. You need time to collect information and think through options. Outcomes are often variable and unpredictable. IMHO, it's very rewarding and technical, but typically not what people imagine what a "shrink" does. I'd say in the last 5-10 years, outpatient psychiatry practice has really changed a lot, and it def feels much more like a high complexity cognitive subspecialty like endocrine or rheum. People also tend to be sicker, likely reflecting a worsening shortage.

 

[HinduHammer]

I did not read all the replies above so forgive any repeats. One way for psychiatrists to do procedures is to do fellowships in Pain or Sleep (you can treat sleep apnea). ECT and other physical treatments involve procedures. You could do also do a combined neurology and psychiatry residence and later do the child psychiatry fellowship.

Hey that is so funny, I was literally starting to look into pain fellowships a day or two before you mentioned this. Pain does sound like an amazing combination for my specific interests. Do you have any personal experience w/psychs matching into these kind of fellowships? As in do you or someone you know took this route? I am in the midwest and would really like to match onto the west coast maybe UCLA for psych, and either do CAP or Pain fellowship.....or maybe after end of third year, decide to do like Plastics or OB/Gyn lol. Haven't taken step 1 yet, and I am an average med student for my class, however my school produces very high board scores.

Your question asks us to attempt to not only read your mind (because you're not sure) but to have clairvoyance beyond that. Impossible.

If you truly love the OR, pursue a surgical specialty. Private practice psychiatrists don't really do that much life coaching - you'll likely end up adjusting medications on adolescents with complicated psychiatric histories and sad stories without a single procedure in sight!

Thanks for the insight on PP psychs. Guess life coaching will just be my hobby that I freely give to ppl who seek me out...

I would second that as well. In PP psychiatry you might get a chance to do a lot of psychotherapy, some of which might have a flavor of life coaching. However, in the vast majority of jobs with a facility, psychopharmacology is the main work, and it feels very similar to internal medicine/neurology and has a very similar pace (15-30min followup visits, endless patients). PP is lucrative and allows for a mix of cases, but keep in mind that invariably in PP people still have predominantly a psychopharm orientation (i.e. you still do mostly pharm appointments, but you get 45min instead of 30min to really provide a high quality management).

Psychopharm for C&A is highly complex and has layers of issues not typical in adult. You need time to collect information and think through options. Outcomes are often variable and unpredictable. IMHO, it's very rewarding and technical, but typically not what people imagine what a "shrink" does. I'd say in the last 5-10 years, outpatient psychiatry practice has really changed a lot, and it def feels much more like a high complexity cognitive subspecialty like endocrine or rheum. People also tend to be sicker, likely reflecting a worsening shortage.

thanks for the insight, that is a bit disheartening to hear but I appreciate the dose of first hand experience. When I shadowed the head child psych here at my U for one morning a week it seemd pretty chill. Interviewed cute kids, interviewed tragic kids, had a meeting with all the docs, nurses, social workers, etc, then spent the rest of the morning gathering collateral. For some reason this doesn't seem to reconcile with your account of CAP. Maybe its PP vs academic?

 

[dl2dp2]

thanks for the insight, that is a bit disheartening to hear but I appreciate the dose of first hand experience. When I shadowed the head child psych here at my U for one morning a week it seemd pretty chill. Interviewed cute kids, interviewed tragic kids, had a meeting with all the docs, nurses, social workers, etc, then spent the rest of the morning gathering collateral. For some reason this doesn't seem to reconcile with your account of CAP. Maybe its PP vs academic?

I'm not a practicing CAP but am in academia so I can't tell you what it's like "typically" a PP CAP, but from what I've heard, it's not a lot different from a usual psychiatry practice. I'm just summarizing the math: when you don't see a lot of patients, your revenue decreases. So in order to make it work out there are a few ways: 1) only see high paying private cash patients--this only works in a few places; 2) having other revenue supplements such as grants and administrative work--you don't seem to be interested in this route and I suspect the head child psych person's clinical load seems light because of that; 3) taking a lower salary and/or work part time -- this often works as a lot of MDs now are married to other MDs or other well paid professionals, so they don't have to work very much, esp. at a LCOL area.

In terms of money, I think for the total # of hours you work the salary is comparable. There's dramatically less call in psychiatry (and no-call jobs are plenty) compared to anesthesia and surgery, and the hours tend to be much more controllable (i.e. 4 days of 10 hours, etc.) CAP is in critical shortage, I would say you can with some effort find a job 300k+ pretty much anywhere in the country, working likely less than 50 hours a week. However, as I said, the hours you put in are very different from what you imagined. It's mostly (often very complicated) med management AND care management (i.e. very often you are sort of the supervising manager of a complex case with other specialty psychotherapy providers like ABA/DBT, etc.). So if you think you might be interested in that kind of work, then it's a compelling reason to go into this field. If you are a quality child psychiatrist, at times the effect of your treatment is very dramatic, I'd say not less than surgery, but usually it occurs in months/years rather than days. I would say bad outcomes when occur are quite a bit rarer. More often you know at the start the patient wouldn't do well for a period of time. It's just a totally different style of practice, again much more similar to outpatient cognitive specialties like endocrine or rheum (but in general paid much better usually due to the shortage), etc. than a procedural specialty.