Surgery to psychiatry

[zombietrainer1]

Hi everyone, M3 here who has been working towards a residency in neurosurgery for the past couple of years. I did my surgery rotation a few months ago, and loved it. I thrived on the intensity and pace, really enjoyed the "no BS" attitude, and absolutely loved being in the OR. I have thought long and hard about the lifestyle, commitment involved, and bleak job market (in Canada at least), and decided that the career was worth it for me.

HOWEVER, I recently completed my psych rotation, and I don't think I've ever felt more suited to a career/specialty. I always enjoyed hearing patients' stories, and found myself extremely immersed in conducting interviews. I felt that I could really empathize with patients' concerns, largely because of my own extensive family history of mental illness. Furthermore, I have come to realize that the parts of the brain that interest me the most are those that control emotions, mood, and behaviour, and that the "software" issues interest me more than the "hardware" issues. I'm especially interested in neuromodulation and neuropsychiatry, and would almost certainly do serious research in these fields in the future.

So my question to you all is: was anyone here interested in surgery, and made the switch to psychiatry? It feels so difficult to "let go" of surgery and accept that I will never be in an OR again, but I seriously feel like psychiatry may be my calling. Surprisingly, the lifestyle and years of training involved in these specialties has very little to do with this conflict I'm experiencing. Thank you very much for your time, much appreciated.

---

Members don't see this ad.

 

[wolfvgang22]

Not me, but my buddy from med school called me up when we were PGY1 and asked me about switching from Neurosurg. He made the switch and has been quite happy. Shame for neurosurg to lose a physician of his quality.

 

[Stagg737]

So my question to you all is: was anyone here interested in surgery, and made the switch to psychiatry?

Yo.

I came into med school knowing I wanted to cut and being 99% sure I wanted to do ortho (or at the very least sports med). Didn't enjoy my surgery rotation as much as I thought, which was disappointing, but still really wanted to do something hands on. Did my psych rotation and pretty much fell in love with the field. The other thing about psych is that it's lifestyle enough that even if I don't get to do as much "hands on" stuff at work, there's plenty of time for hobbies. There are some procedures you can do in psych (ECT, TMS, Botox if you really want to do that), but it's not the same as surgery. Coming to the end of intern year and have generally enjoyed residency a lot so far.

Plus, if you're really interested in research, there's so much to do with psych. If you know what you're doing I feel like there's a ton to be done.

 

[Sushirolls]

I was setting my med school app up for surgery, but had similar sentiments as you after doing my psych rotation. I remember thinking "@!$#... I like psych." Opted for psych in the end. Overall happy I did, but at times day dreaming does set in. Did an elective in 4th year of med school for neurosurgery, when match results posted. They were surprised I'd do so such a thing when applying for psych, but that too was a good month and they were trying to recruit me to switch after doing intern year. Tempting but I stayed the course. I get my fix of 'hands on' by doing outside things: wood projects, tractor time, hunting, brush clearing, etc. As I get older, I value the option to get the heck away from hospital politics and open my own practice - that level of independence is priceless. Surgeons will always be swimming thru a sea of politics with a hospital, and they have a shelf life - laparoscopy kills your shoulders - 30 yours or less of practice time. Also with time being on call and paged for ridiculous things just gets old. There is always a new nurse, a new doc, a new some one who needs guidance in what to page for and when it comes at the expense of your sleep 3AM it loses its allure. You will have days during psych residency where you think "whoops, should have done surgery... and its too late, no program will take a psych resident jumping ship." But as time marches on those thoughts will be less, and life priorities will expand beyond what you do at work.

Look within yourself and find out what will make you want to get out of bed every morning and what will you want to do for the next 30 years. It's your life, choose wisely.

ECT is closest niche in psych to scratch that OR itch that may still simmer in the background. Could throw a stitch or two with buprenorphine rods q6 months, but even that might just need a steri strip only.

 

[MacDonaldTriad]

I can think of twice when we have seen fully trained neurosurgeons retrain in psychiatry. Both expressed zero regret and were some of the most unflappable psych residents I have seen. I have never heard of anyone going from psych to neurosurgery, maybe it is because why would I hear about this, maybe it is because the neurosurgery selection process isn't friendly to this, but it could also be that almost no one wants to go in that direction.

 

[psychattending]

I was going to do neurosurgery before I decided on psych.

 

[ridethecliche]

I was setting my med school app up for surgery, but had similar sentiments as you after doing my psych rotation. I remember thinking "@!$#... I like psych." Opted for psych in the end. Overall happy I did, but at times day dreaming does set in. Did an elective in 4th year of med school for neurosurgery, when match results posted. They were surprised I'd do so such a thing when applying for psych, but that too was a good month and they were trying to recruit me to switch after doing intern year. Tempting but I stayed the course. I get my fix of 'hands on' by doing outside things: wood projects, tractor time, hunting, brush clearing, etc. As I get older, I value the option to get the heck away from hospital politics and open my own practice - that level of independence is priceless. Surgeons will always be swimming thru a sea of politics with a hospital, and they have a shelf life - laparoscopy kills your shoulders - 30 yours or less of practice time. Also with time being on call and paged for ridiculous things just gets old. There is always a new nurse, a new doc, a new some one who needs guidance in what to page for and when it comes at the expense of your sleep 3AM it loses its allure. You will have days during psych residency where you think "whoops, should have done surgery... and its too late, no program will take a psych resident jumping ship." But as time marches on those thoughts will be less, and life priorities will expand beyond what you do at work.

Look within yourself and find out what will make you want to get out of bed every morning and what will you want to do for the next 30 years. It's your life, choose wisely.

ECT is closest niche in psych to scratch that OR itch that may still simmer in the background. Could throw a stitch or two with buprenorphine rods q6 months, but even that might just need a steri strip only.

As someone that set their entire post college application for med school and residency for surgery before falling for psych as a third year, I really appreciate reading this.

I may reach out to you at some point if you don't mind. Glad the switch has been great to you!

 

[PsyDr]

I am friends with a psychiatrist who left a surgical residency two years into it. Her stated reason for leaving surgery was something to do with misogyny.

She has a full practice. Excellent with dementia cases. Very caring for bread and butter affective disorders. But she quickly goes into matter of fact, surgeon mode around substance abusers and personality disorders.

Lives in a $1MM house. Creates her own schedule. Is home by 5:30pm every night.

 

[zombietrainer1]

Thanks everyone for your insight, I really appreciate it! Lots to think about in the weeks ahead.

 

[SourceOfDenial]

I am friends with a psychiatrist who left a surgical residency two years into it. Her stated reason for leaving surgery was something to do with misogyny.

She has a full practice. Excellent with dementia cases. Very caring for bread and butter affective disorders. But she quickly goes into matter of fact, surgeon mode around substance abusers and personality disorders.

You mean people with a substance use disorder?

 

[Merely]

You people people with a substance use disorder?

Does everyone that abuses a substance have a substance use disorder?

 

[SourceOfDenial]

Does everyone that abuses a substance have a substance use disorder?

If you mean ‘does everyone who uses a substance have a substance use disorder?’ No.

 

[Merely]

If you mean ‘does everyone who uses a substance have a substance use disorder?’ No.

No, I asked does everyone who abuses a substance have a disorder. Can you abuse without having a disorder or do you call all abusers psychiatrically disordered?

 

[PsyDr]

You mean people with a substance use disorder?

No, I didn't. That's why I didn't use that term.

If you're going for the entire person first language debate, it's based upon the idea of conflating diagnosis with disability. But diagnosis is not the same as disability. Which is supported by definitions about disability from such organizations as the WHO, AMA, APA, etc.

I'd be happy to discuss this with you, but it's like the the paraphrased Shaw quote, "Arguing with a a lawyer is like wrestling a pig in mud: sooner or later you realize that they like it."

 

[clausewitz2]

No, I didn't. That's why I didn't use that term.

If you're going for the entire person first language debate, it's based upon the idea of conflating diagnosis with disability. But diagnosis is not the same as disability. Which is supported by definitions about disability from such organizations as the WHO, AMA, APA, etc.

I'd be happy to discuss this with you, but it's like the the paraphrased Shaw quote, "Arguing with a a lawyer is like wrestling a pig in mud: sooner or later you realize that they like it."

Person first language is also based on ideas of not othering people and reducing their whole humanity to a specific stigmatized behavior. As a former linguist, I am not super impressed by this since I think it conflates facts about English morphosyntax with ideas about systems of oppression, but saying that it is only or primarily about some notion of disability as defined by WHO/APA is just plain weird and more importantly critically misunderstands the objection.

 

[SourceOfDenial]

No, I didn't. That's why I didn't use that term.

If you're going for the entire person first language debate, it's based upon the idea of conflating diagnosis with disability. But diagnosis is not the same as disability. Which is supported by definitions about disability from such organizations as the WHO, AMA, APA, etc.

I'd be happy to discuss this with you, but it's like the the paraphrased Shaw quote, "Arguing with a a lawyer is like wrestling a pig in mud: sooner or later you realize that they like it."

Do you call patients substance abusers when you talk to them?

Is there still debate about person first language? My patients with cancer aren’t cancerous—they are people with cancer. Outside of mental health I can think of only two or three illnesses where the person and illness are conflated(and one is sickle cell, an equally stigmatized illness). Referring to people by their disease is largely isolated to mental health in general and then the most stigmatized populations within. I think it’s pretty telling when a clinician uses certain language around colleagues and other terminology in the presence of clients.

 

[PsyDr]

@clausewitz2 depends. Some subgroups of people prefer non-person first language. For example: some neurodiversity individuals prefer being called autistic, as the disorder is a key part of their experience. Deaf (with the D) also have similar ideas and would be pissed off as hell to hear deafness referred to as a disability.

I'm sure we could both agree that the basis of something is critically important for determining the validity of downstream results.


@SourceOfDenial I do, and I imagine my presentation and history makes this seem like I do this in a confrontational manner. But I do so in a very humane, and sensitive way that sometimes takes many sessions. It usually takes a lot of work to review how often a substance is or was used, when it's used or was used, how they use or used, if they are able to limit their use once they start, how that affects or affected their life, if there is a family history of predisposition towards this, what substance use gets or got, what it takes or took away, how much time and effort they have exerted towards maintaining their use, etc. The goal is to raise self awareness that they have a tendency to abuse substances, even when others can simply use.

The reason is that people can be 100% sober and still be a substance abuser. One can treat substance use disorders into remission. But the literature shows that in many of these disorders, relapse is the rule. If one reviews the relapse prevention literature, one sees the outside of social skills training the majority of evidence backed strategies require the individual to be aware of the tendency towards substance abuse. Helping people to see that they tend to abuse substances, when others can simply use, is a method to increase insight. One cannot behaviorally contract, self monitor, seek brief interventions, etc, if one doesn't see they have a tendency towards substance abuse.

It's really unfair to be born with such stuff. And it sucks that for some people one drink is too many and a thousand is not enough. But knowing that allows one to act upon it.

 

[clausewitz2]

@clausewitz2 depends. Some subgroups of people prefer non-person first language. For example: some neurodiversity individuals prefer being called autistic, as the disorder is a key part of their experience. Deaf (with the D) also have similar ideas and would be pissed off as hell to hear deafness referred to as a disability.

I'm sure we could both agree that the basis of something is critically important for determining the validity of downstream results.


@SourceOfDenial I do, and I imagine my presentation and history makes this seem like I do this in a confrontational manner. But I do so in a very humane, and sensitive way that sometimes takes many sessions. It usually takes a lot of work to review how often a substance is or was used, when it's used or was used, how they use or used, if they are able to limit their use once they start, how that affects or affected their life, if there is a family history of predisposition towards this, what substance use gets or got, what it takes or took away, how much time and effort they have exerted towards maintaining their use, etc. The goal is to raise self awareness that they have a tendency to abuse substances, even when others can simply use.

The reason is that people can be 100% sober and still be a substance abuser. One can treat substance use disorders into remission. But the literature shows that in many of these disorders, relapse is the rule. If one reviews the relapse prevention literature, one sees the outside of social skills training the majority of evidence backed strategies require the individual to be aware of the tendency towards substance abuse. Helping people to see that they tend to abuse substances, when others can simply use, is a method to increase insight. One cannot behaviorally contract, self monitor, seek brief interventions, etc, if one doesn't see they have a tendency towards substance abuse.

It's really unfair to be born with such stuff. And it sucks that for some people one drink is too many and a thousand is not enough. But knowing that allows one to act upon it.

As I said, I am not persuaded by some specific arguments about person first language (the agentitive suffix "-er" in English absolutely designates "a person who does X habitually" and is not at all denying the humanity of the person involved. What I was saying was that the argument that seems to have the widest currency in favor of person-centered language is that referring to someone by a stigmatized attribute alone others them.

I don't object to any of your examples but I don't think that later argument is one that can be settled by looking at how the APA defines the concept of disability. Those definitions set by a professional organization seem at best orthogonal to philosophical and language-analytic questions.

 

[PsyDr]

As I said, I am not persuaded by some specific arguments about person first language (the agentitive suffix "-er" in English absolutely designates "a person who does X habitually" and is not at all denying the humanity of the person involved. What I was saying was that the argument that seems to have the widest currency in favor of person-centered language is that referring to someone by a stigmatized attribute alone others them.

I don't object to any of your examples but I don't think that later argument is one that can be settled by looking at how the APA defines the concept of disability. Those definitions set by a professional organization seem at best orthogonal to philosophical and language-analytic questions.

Yeah, I perhaps did not explain that well. There is a significant difference between diagnosis and disability. The WHO, AMA, etc have indicated that disability is an interaction between the resulting behavior of one's diagnosis, and what the relevant environment is able to do to accommodate this behavior.

If the stated purpose of person first language is to protect people with disabilities, then diagnosis has little to do the subject matter.

In the example of substance abusers: They likely have a substance use disorder diagnosis. Maybe in remission, maybe not. I would think that the individual in remission would have extremely limited to nonexistent disability. The same is likely not true to someone with a severe substance use disorder. That makes the entire idea of protecting the individual with the disability pointless.

If the actual purpose of person first language is to be respectful to an individual, then that is an individually based decision that cannot be fixed by generalized prescriptive language. I would think a banal example of this would be dealing with an adolescent that wants to be called a new name.

Beyond the pragmatic, I think some of the differences between our viewpoints are in our approaches. I prefer logic over linguistics.

 

[Shufflin]

Person first language is also based on ideas of not othering people and reducing their whole humanity to a specific stigmatized behavior. As a former linguist, I am not super impressed by this since I think it conflates facts about English morphosyntax with ideas about systems of oppression, but saying that it is only or primarily about some notion of disability as defined by WHO/APA is just plain weird and more importantly critically misunderstands the objection.

You seem to miss or discredit the point of others in pursuit of your own intellectual speak. Seems to be a trend.

 

[clausewitz2]

You seem to miss or discredit the point of others in pursuit of your own intellectual speak. Seems to be a trend.

No, @PSYDR clarified quite nicely and made himself understood. They said explicitly they enjoy arguing about this sort of thing so I will apologize if they feel slandered or discredited but I think you are misreading the situation. The intent (on my end, at least) is to seek conceptual clarity for better understanding.

Yeah, I perhaps did not explain that well. There is a significant difference between diagnosis and disability. The WHO, AMA, etc have indicated that disability is an interaction between the resulting behavior of one's diagnosis, and what the relevant environment is able to do to accommodate this behavior.

If the stated purpose of person first language is to protect people with disabilities, then diagnosis has little to do the subject matter.

In the example of substance abusers: They likely have a substance use disorder diagnosis. Maybe in remission, maybe not. I would think that the individual in remission would have extremely limited to nonexistent disability. The same is likely not true to someone with a severe substance use disorder. That makes the entire idea of protecting the individual with the disability pointless.

If the actual purpose of person first language is to be respectful to an individual, then that is an individually based decision that cannot be fixed by generalized prescriptive language. I would think a banal example of this would be dealing with an adolescent that wants to be called a new name.

Beyond the pragmatic, I think some of the differences between our viewpoints are in our approaches. I prefer logic over linguistics.

I think there is a worldview difference more than a difference in how much we like logic but that may collapse to the same thing. If by 'linguistics" you mean conceptual analysis than clearly we differ and you are right. I don't accept that one of us is using logic and the other isn't but we clearly do have different axioms and thus that logic leads us to different conclusions.

 

[PsyDr]

No, @PSYDR clarified quite nicely and made himself understood. They said explicitly they enjoy arguing about this sort of thing so I will apologize if they feel slandered or discredited but I think you are misreading the situation. The intent (on my end, at least) is to seek conceptual clarity for better understanding.




I think there is a worldview difference more than a difference in how much we like logic but that may collapse to the same thing. If by 'linguistics" you mean conceptual analysis than clearly we differ and you are right. I don't accept that one of us is using logic and the other isn't but we clearly do have different axioms and thus that logic leads us to different conclusions.

I don't feel personally attacked at all. The point is the point, not who is making it.

I should clarify: I did not mean you were illogical. I meant I try, imperfectly, to approach things from the academic tradition of formal logic. Not as in, Spock or as in an informal "logical" way. In that tradition, if the initial premise is flawed, so is the resulting products. I see person first language as being based upon a flawed premise (i.e., conflating diagnosis with disability). Therefore, it's not a great idea. I saw your position to be based upon relative linguistics, which isn't wrong, it's just a different approach.

 

[Ludwig2000]

Hi everyone, M3 here who has been working towards a residency in neurosurgery for the past couple of years. I did my surgery rotation a few months ago, and loved it. I thrived on the intensity and pace, really enjoyed the "no BS" attitude, and absolutely loved being in the OR. I have thought long and hard about the lifestyle, commitment involved, and bleak job market (in Canada at least), and decided that the career was worth it for me.

HOWEVER, I recently completed my psych rotation, and I don't think I've ever felt more suited to a career/specialty. I always enjoyed hearing patients' stories, and found myself extremely immersed in conducting interviews. I felt that I could really empathize with patients' concerns, largely because of my own extensive family history of mental illness. Furthermore, I have come to realize that the parts of the brain that interest me the most are those that control emotions, mood, and behaviour, and that the "software" issues interest me more than the "hardware" issues. I'm especially interested in neuromodulation and neuropsychiatry, and would almost certainly do serious research in these fields in the future.

So my question to you all is: was anyone here interested in surgery, and made the switch to psychiatry? It feels so difficult to "let go" of surgery and accept that I will never be in an OR again, but I seriously feel like psychiatry may be my calling. Surprisingly, the lifestyle and years of training involved in these specialties has very little to do with this conflict I'm experiencing. Thank you very much for your time, much appreciated.

OP, what did you decide?

 

[Liquid8]

Remember working with a guy who had tried to switch from surgery to psychiatry. The story went that members of his family were all surgeons overseas, but while he had quite a bit of experience just couldn't get onto the training programme - this is despite being the go-to guy when laparoscopic procedures were converted to opens.

At some point he got fed up, took a break and worked in some psych rotations before deciding to apply for psychiatry. Can remember he was always in two minds as early on he would still be involved in private assisting on the weekends and seemed to struggle with concepts like the MSE and risk assessments, although we did try and help him out. I know the vagueness of management got to him, and in the end he went off to become a rural general practitioner and still does both surgery and psychiatry.

 

[dl2dp2]

Job market is generally better in psychiatry than surgery. Not being able to find a job in neurosurgery or general surgery will never happen, but you might not be able to live in exactly the spot you want. Whereas, in psychiatry you will have lots of opportunities in any major metro, and even MORE opportunities (though of a different type) outside of metro areas.

A research career is also somewhat easier to carve out in psychiatry. There are neurosurgeons who are engaged in a career in functional neurosurgery and related areas, but it is with difficulty. Mainly due to significant conflict in lifestyle and flexibility.