Switching into psych?

[drgrant]

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I just started an IM subspecialty fellowship and am having grave reservations about the future. I had always been interested in psychiatry but made a last minute change when applying to residency. Now I am unbelievably thinking of quitting and applying for psych residency. Would any programs accept an IM grad into a PGY2 spot? Is it a fools errand to think the grass is greener, or best to stick it out?

 

[SeniorWrangler]

Not at all, people do it sometimes, although you'd probably have to make up a couple of rotations.

 

[Merovinge]

You can frequently get a PGY2 spot with on-time graduation by giving up elective time in PGY4 year so that all ACGME requirements are met. Doing it or not will require significant discussion with mentors and close friends/family. You will have a big leg up on consultation psychiatry if that interests you!

 

[PistolPete]

You can definitely get a PGY-2 spot. Have you thought about tailoring your general IM practice to psychiatric patients? Plus, many medical issues overlap with psych. This would save you from another 3 years of indentured servitude. Remember, the vast majority of psychotropics are prescribed by PCP's, not psychiatrists.

But otherwise, I think psychiatry is a hidden gem! If you want to do it, go for it!

 

[Moose A Moose]

Have at it, man. We're talking about the rest of your life.

 

[northernpsy]

You definitely CAN switch if you want to. I know of several people who switched into Psych from other specialties - including people who switched after becoming attendings for another specialty.
SHOULD you switch? I think that's impossible for any of us to answer. What is it that you don't like about your fellowship?

 

[drgrant]

Overall I find the subject matter interesting enough and I like the patient contact. It's more the future of medicine in general that worries me and I think IM non procedural based specialties are most affected. I just see busier and busier schedules, increasing documentation and declining reimbursements which is burning people out left and right. I see so many postings about people wanting to abandon ship, find non clinical careers, retire early etc. that it makes me wonder if I should just get out now. Psychiatry seems a bit protected from this, maybe because there are more opportunities for true private practice, avoiding medicare.

 

[Merovinge]

Overall I find the subject matter interesting enough and I like the patient contact. It's more the future of medicine in general that worries me and I think IM non procedural based specialties are most affected. I just see busier and busier schedules, increasing documentation and declining reimbursements which is burning people out left and right. I see so many postings about people wanting to abandon ship, find non clinical careers, retire early etc. that it makes me wonder if I should just get out now. Psychiatry seems a bit protected from this, maybe because there are more opportunities for true private practice, avoiding medicare.

We can also bill 99214 with 90833's to preserve long patient contact time while still making reasonable reimbursement!

 

[MacDonaldTriad]

I believe some PGY-II spots are in the match, but applications start in a couple of weeks. If you go this route you will not be starting before 7/01/17. This means you could conceivably finish your subspecialty training if that is one year. If I had a PGY-II spot, I think a board eligible internist would be great. I might have some worry that come July you may decide to go into practice as training fatigue can be real. Alternatively, you may find a program with a current PGY-II opening and slip in to a program where someone left. This would involve your needing to get the blessing of your current training director and then risk not being selected. This also requires a lot of geographic flexibility unless you are lucky enough to find one where you want to be.

And no, you are not crazy for liking psychiatry more than internal medicine.

There should be a support group for physicians who didn’t go into psychiatry because of perceived stigma and then regretted it. I can name a few people who moved away from psychiatry, but the supply of trainees who want to change into psychiatry seems to be very large. I know we are biased, but this observation has been true for a long time and it should tell medical students something. Not going into psychiatry because you are worried about what people think isn’t a good plan. Even if you do go into psychiatry and somehow continued to care about what people think, you can work on that in your own analysis.
😉

 

[drgrant]

Lots to think about, not much time. The fellowship is 3 years so I was expecting to be in training a bit longer which might help with the training fatigue. It's a shame how much unhappiness is in the field right now. All you hear at work is nurses complaining, docs complaining, it takes a toll.
Thanks everyone.

 

[northernpsy]

Ahhh, your concerns definitely seem valid to me. Generally I do think you're right that we in Psychiatry have more options to work independently than a lot of other specialties do, since psychiatry has low overhead, there are patients out there who are willing to pay cash if necessary to get access, and just the fact that we are in serious shortage means that even when we work for an employer we have some leverage to negotiate the terms of how we will work. Though there definitely are psychiatry jobs that are a grind, you don't have to work that way in Psych if you don't want to.

As a bit of a side note, while this isn't directly related to your dilemma, when I was looking at the schedule for this year's Academy of Psychosomatic Medicine conference, I noticed this paper is being presented and thought you might find it interesting since it speaks to the issue of burn out in oncology and how that might possibly affect patients:
http://bit.ly/2bAk2OU