The future of CAP

[edumacator]

I've been cruising this forum for a while now and finally signed up. I won't bore you with my life story - suffice to say that I live in the Southeast and am considering attending medical school with an eye towards becoming a child psychiatrist. I am in my mid-30s with a wife and child so this is not a decision I can make lightly.

I have, therefore, a stack of questions. Please bear with me if they seem obvious to you.

Child psychiatrists train longer than those working exclusively with adults. Why is this? Pediatricians train for three years. Ditto internists. A combined board program takes four. Psychiatrists, in contrast, spend four years in residency and an additional one to two years in fellowship if they want certification to work with kids. Is it set up this way to enable practitioners flexibility to work across the age spectrum or is it because child psychiatry is treated as an afterthought?

Any thoughts on the five-year triple-board programs that offer certification in pediatrics, CAP, and adult psychiatry?

I've seen some interesting calculations re. the salary differential between adult and child psychiatry and the opportunity costs of an extra year or two of fellowship versus going straight into practice after residency. Is the opportunity cost really that significant? Can a CAP MD quickly make up the difference?

I've read a variety of opinions on several disparate threads about the anticipated future demand for CAP practitioners and I would love some clarification. The consensus seems to be that the demand will grow. Simultaneously, I read on another thread that psychiatry has one of the oldest median ages among practitioners which will exacerbate this need over the next two decades. Yet, psychiatric NPs are increasing in number as well. Given the ever-increasing demand to reduce medical costs, I'm sure these NPs will position themselves as a cost-effective alternative. The recent thread posted on this topic was fascinating but, as a lay person, I have to ask: what's the real deal here? And, while we're at it, what is the One True Faith?* (For the record, I am myself a nursing school escapee and would be far more comfortable being treated by a physician.)

What are malpractice rates like? Say, in the Southeast? I don't need a raw number per se but a sense of the % of salary would be appreciated.

While we're at it, how often are psychiatrists sued?

Are you a Niles or a Frasier?

I suspect I'll have more questions crop up but I'll stop for now. Looking back, it seems that most of my questions are financial. I suppose it's because money will be the determining factor in whether or not I can make a serious go of this. I look forward to your responses.

Thank you for your time.

___________________

*For those of you wondering, my own feeling on this subject mirrors Reverend Lovejoy's: Western Branch Reform Presby-Lutheranism.

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[billypilgrim37]

Child psychiatrists train longer than those working exclusively with adults. Why is this?... Is it set up this way to enable practitioners flexibility to work across the age spectrum or is it because child psychiatry is treated as an afterthought?

The opposite. Child psychiatry is really hard. It's hard to be a good child psychiatrist without at least first learning how to assess and treat relatively static mental illness. Child psychiatry adds on an entire layer of development. It's like turning the video game on to the really hard level. It's nice to be able to work with adults as well, but that's not the point.

Any thoughts on the five-year triple-board programs that offer certification in pediatrics, CAP, and adult psychiatry?

Some of my best friends are in the triple board program, and I will say that triple board, for the vast majority of folks who want to be a child psychiatrist, is an unmitigated, absolute waste of time and effort.

I've seen some interesting calculations re. the salary differential between adult and child psychiatry and the opportunity costs of an extra year or two of fellowship versus going straight into practice after residency. Is the opportunity cost really that significant? Can a CAP MD quickly make up the difference?

It depends on a lot of things. With my personal career goals, I will probably lose money doing the fellowship. For many people, especially those in private practice, you probably clear your losses within ten years without much difficulty. The only reason to do a child psychiatry fellowship is because you want to be a child psychiatrist. The economics are such that deciding to do so won't hurt you and might even help you.

What's the real deal here?

If they train a bunch of NPs, it might take less than two months for me to see a new patient. It's silly to think that a rise of NPs will suddenly leave us without well paying jobs, especially in the psychiatric subspecialties. Lower paying? Maybe. So low that all this training wasn't worth it? Probably not.

And, while we're at it, what is the One True Faith?

Bokononism.

What are malpractice rates like? Say, in the Southeast? I don't need a raw number per se but a sense of the % of salary would be appreciated.

Low. Lower than most other specialties. Unless, like the SEC, you are speculating that the Southeast contains West Virginia.

While we're at it, how often are psychiatrists sued?

Rarely, but not never.

Are you a Niles or a Frasier?

Hannibal Lecter.

 

[notdeadyet]

Child psychiatrists train longer than those working exclusively with adults. Why is this?

Keep in mind that child psychiatrists are double boarded as child/adolescent psychiatrists and adult psychiatrists.

Any thoughts on the five-year triple-board programs that offer certification in pediatrics, CAP, and adult psychiatry?

It's probably a great option for a very small handful of people out there with very, very specific career goals. I don't think it's necessary for 99% of child psychiatrists.

Is the opportunity cost really that significant? Can a CAP MD quickly make up the difference?

That's going to be entirely up to you and your career goals. Whether your environment is academic, small group, HMO, public, etc. Whether you want to be in a city (and which city) vs. suburban vs. rural environment. Etc. etc. You do need to be more conscious of opportunity cost than most folks because odds are you're going to have a shorter career.

At the end of the day, you can make a very nice chunk of change with adult or child psychiatry. Go with what you find you're passionate about. I can think of few worse career mistakes to make as a psychiatrist than to pursue child psych if you don't really love child psych.

The consensus seems to be that the demand will grow.

Everything I've read and heard indicates that for the reasons you mention and others, demand for psych and particularly child psych will continue to grow. Psych NPs are but a small blip on the radar. I'd look to family NPs as an indication for impact. You can incorporate them into your private practice and they can be very profitable. I also don't know of any FP's who have lost their job to a NP or are having trouble finding jobs.

What are malpractice rates like? Say, in the Southeast? I don't need a raw number per se but a sense of the % of salary would be appreciated.

When you cruise for salaries offered, they almost always include malpractice rates.

While we're at it, how often are psychiatrists sued?

Less than any other specialty. And don't sleep with your patients and your odds of being sued go down dramatically.

I suppose it's because money will be the determining factor in whether or not I can make a serious go of this. I look forward to your responses.

I went to med school roughly the same time in life as you. I was concerned about money, sitting in a classroom all those years, being "the old guy" every step of the way, working long hours, etc. I left a very nice career and comfortable life to do so and by my math, this new path ends up being a money loser compared to if I'd stayed in the career I gave up. I don't regret my choice in the slightest.

 

[edumacator]

The opposite. Child psychiatry is really hard. It's hard to be a good child psychiatrist without at least first learning how to assess and treat relatively static mental illness. Child psychiatry adds on an entire layer of development. It's like turning the video game on to the really hard level. It's nice to be able to work with adults as well, but that's not the point.

Keep in mind that child psychiatrists are double boarded as child/adolescent psychiatrists and adult psychiatrists.

Ah. That makes sense.

Some of my best friends are in the triple board program, and I will say that triple board, for the vast majority of folks who want to be a child psychiatrist, is an unmitigated, absolute waste of time and effort.

It's probably a great option for a very small handful of people out there with very, very specific career goals. I don't think it's necessary for 99% of child psychiatrists.

Good to know. I won't give it another thought.

It depends on a lot of things. With my personal career goals, I will probably lose money doing the fellowship. For many people, especially those in private practice, you probably clear your losses within ten years without much difficulty. The only reason to do a child psychiatry fellowship is because you want to be a child psychiatrist. The economics are such that deciding to do so won't hurt you and might even help you.

That's going to be entirely up to you and your career goals. Whether your environment is academic, small group, HMO, public, etc. Whether you want to be in a city (and which city) vs. suburban vs. rural environment. Etc. etc. You do need to be more conscious of opportunity cost than most folks because odds are you're going to have a shorter career.

I used to be a special education teacher and worked with a number of kids on a variety of meds. It was, to say the least, an illuminating experience. Coupled with the attitudes of some of my colleagues - "he needs to be on something... that boy just ain't right" - and I began to think that there was a lot of casual pill-popping in the pediatric world. The more I looked into it, the more interesting it became... and now, here I am, contemplating a career change.

BTW, someone on another thread mentioned that while psychiatrists don't exactly rake it in, they could still make in the neighborhood of $175K/year. For those of you who think that isn't a lot of money, I brought home a monthly net of roughly $2,300 this past year teaching at a public school. And that's with a Ph.D. So to me, $175K/year is raking it in. I suspect, therefore, that my idea of opportunity cost is somewhat different from most of yours.

If they train a bunch of NPs, it might take less than two months for me to see a new patient. It's silly to think that a rise of NPs will suddenly leave us without well paying jobs, especially in the psychiatric subspecialties. Lower paying? Maybe. So low that all this training wasn't worth it? Probably not.

Everything I've read and heard indicates that for the reasons you mention and others, demand for psych and particularly child psych will continue to grow. Psych NPs are but a small blip on the radar. I'd look to family NPs as an indication for impact. You can incorporate them into your private practice and they can be very profitable. I also don't know of any FP's who have lost their job to a NP or are having trouble finding jobs.

That's a relief.

Low. Lower than most other specialties. Unless, like the SEC, you are speculating that the Southeast contains West Virginia.

When you cruise for salaries offered, they almost always include malpractice rates.

Good to know. Also, I am not in West Virginia.

Rarely, but not never.

Less than any other specialty. And don't sleep with your patients and your odds of being sued go down dramatically.

Also good to know. And also a relief.

Hannibal Lecter.

Great, now I want some Chianti. Thanks a lot.

At the end of the day, you can make a very nice chunk of change with adult or child psychiatry. Go with what you find you're passionate about. I can think of few worse career mistakes to make as a psychiatrist than to pursue child psych if you don't really love child psych.

From what I've experienced, I think I'd love it. But a lot has to come together for it to work for me: I need to take the pre-requisites, do well, take the MCAT, do well, apply, interview, get in, and get a decent financial aid package. If any one of those dominos falls, I don't go.

We shall see.

I went to med school roughly the same time in life as you. I was concerned about money, sitting in a classroom all those years, being "the old guy" every step of the way, working long hours, etc. I left a very nice career and comfortable life to do so and by my math, this new path ends up being a money loser compared to if I'd stayed in the career I gave up. I don't regret my choice in the slightest.

I don't have as much to walk away from financially - see the public school teacher note above - but there are other sacrifices I may not be willing to make. Specifically, there will be times during late med school and early residency that I'll leave my wife as a single mother for weeks at a stretch. My daughter will be between 7 and 12 during that stretch, which is a critical time in her development and in her relationship with me. Given the choice, I'd rather be there for her than busting my butt taking call.

I still have a lot to think about but this feedback has been invaluable. Thank you.

 

[nitemagi]

Bokononism.

to Vonnegut.

 

[nitemagi]

While we're at it, how often are psychiatrists sued?

According to my malpractice company, psychiatrists are sued on average every 33 years. Compared to some surgical subspecialties that're every 3-5 years.

Having just been on the job market, I put my CV out and got deluged with job postings. Many jobs throughout the south that I saw (where there's a RiDiculous need for psychiatrists), common salaries were in the low 200's (200-230/yr), plus benefits, no call, lifestyle perks, etc.

 

[Salpingo]

According to my malpractice company, psychiatrists are sued on average every 33 years. Compared to some surgical subspecialties that're every 3-5 years.

Having just been on the job market, I put my CV out and got deluged with job postings. Many jobs throughout the south that I saw (where there's a RiDiculous need for psychiatrists), common salaries were in the low 200's (200-230/yr), plus benefits, no call, lifestyle perks, etc.

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

Not only that, but the amount you're sued for is significantly less.

Bokononism

The hand that stocks the drug stores rules the world.

 

[edumacator]

According to my malpractice company, psychiatrists are sued on average every 33 years. Compared to some surgical subspecialties that're every 3-5 years.

Having just been on the job market, I put my CV out and got deluged with job postings. Many jobs throughout the south that I saw (where there's a RiDiculous need for psychiatrists), common salaries were in the low 200's (200-230/yr), plus benefits, no call, lifestyle perks, etc.

Not bad. I read someplace that child psychiatrists in my zip code make roughly $175K. I'm generally not motivated by money but I'll freely admit that it doesn't hurt.

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

Not only that, but the amount you're sued for is significantly less.

Thank you for sharing that.

I have to confess a previously unexpressed hope that some respondent would write something that would cause me to change my mind about, or at least seriously reconsider, going to medical school. Thus far, you have all failed.

Darn you.

 

[nitemagi]

I have to confess a previously unexpressed hope that some respondent would write something that would cause me to change my mind about, or at least seriously reconsider, going to medical school. Thus far, you have all failed.

Darn you.

It's really really hard with a lot of effort for seemingly no reward for many years, with a lot of hours and chronic sleep deprivation. It'll take some work to not lose at least a piece of your soul during the long indoctrination. You'll also have to deal with cutthroat people who've gone into medicine for the worst reasons and have little humanity left, yet get showered with praise by others with equally little humanity. You'll spend months if not years memorizing things you may never use again, and with people who in regular life you'd rather shoot yourself in the foot than be around.

How's that?

Salary.com is unreliable. Try here

 

[michaelrack]

Ah.BTW, someone on another thread mentioned that while psychiatrists don't exactly rake it in, they could still make in the neighborhood of $175K/year. For those of you who think that isn't a lot of money, I brought home a monthly net of roughly $2,300 this past year teaching at a public school. And that's with a Ph.D. So to me, $175K/year is raking it in. I suspect, therefore, that my idea of opportunity cost is somewhat different from most of yours.
.

175k would be on the low end of the salary spectrum for a private prac adult psychiatrist

 

[Chimed]

I used to be a special education teacher and worked with a number of kids on a variety of meds. It was, to say the least, an illuminating experience. Coupled with the attitudes of some of my colleagues - "he needs to be on something... that boy just ain't right" - and I began to think that there was a lot of casual pill-popping in the pediatric world. The more I looked into it, the more interesting it became... and now, here I am, contemplating a career change.

BTW, someone on another thread mentioned that while psychiatrists don't exactly rake it in, they could still make in the neighborhood of $175K/year. For those of you who think that isn't a lot of money, I brought home a monthly net of roughly $2,300 this past year teaching at a public school. And that's with a Ph.D. So to me, $175K/year is raking it in. I suspect, therefore, that my idea of opportunity cost is somewhat different from most of yours.

A background in special ed would be a great asset in child psych! Although I don't have that background, I come from a family of educators--special ed teachers, elementary school principle, school counselors. It is very helpful to have some background and know that side of a kids picture. If you're interested in education issues, you could likely make a nice niche for yourself by working in school districts as a consultant.

I'm with you on the finacial aspect. I also came into medicine later in life and didn't enter medical school until my early 30's. I'm now in my 2nd year of a child fellowship. I really love what I do and on most days I walk around just feeling thankful that I'm able to work with a lot of cool kids and families. But there is no doubt that it's a long road and I'm sure my pressure of wanting to get finished is different then my younger collagues. But because I love to toture myself, I've decided to add extra time to do a research track..... When I'm getting antsy about my salary, I just remind myself that even as a resident, I make most then most people in the country and have it pretty good (~59K).

Best wishes with you decision!

 

[edumacator]

It's really really hard with a lot of effort for seemingly no reward for many years, with a lot of hours and chronic sleep deprivation. It'll take some work to not lose at least a piece of your soul during the long indoctrination. You'll also have to deal with cutthroat people who've gone into medicine for the worst reasons and have little humanity left, yet get showered with praise by others with equally little humanity. You'll spend months if not years memorizing things you may never use again, and with people who in regular life you'd rather shoot yourself in the foot than be around.

How's that?

Thank you. That helps.

175k would be on the low end of the salary spectrum for a private prac adult psychiatrist

Nope, doesn't help in the least. But I appreciate the input.

Salary.com is unreliable. Try here

This was highly illuminating. The articles were interesting as well. Thank for this - I'd never heard of this publication before.

A background in special ed would be a great asset in child psych! Although I don't have that background, I come from a family of educators--special ed teachers, elementary school principle, school counselors. It is very helpful to have some background and know that side of a kids picture. If you're interested in education issues, you could likely make a nice niche for yourself by working in school districts as a consultant.

I'm with you on the finacial aspect. I also came into medicine later in life and didn't enter medical school until my early 30's. I'm now in my 2nd year of a child fellowship. I really love what I do and on most days I walk around just feeling thankful that I'm able to work with a lot of cool kids and families. But there is no doubt that it's a long road and I'm sure my pressure of wanting to get finished is different then my younger collagues. But because I love to toture myself, I've decided to add extra time to do a research track..... When I'm getting antsy about my salary, I just remind myself that even as a resident, I make most then most people in the country and have it pretty good (~59K).

Best wishes with you decision!

Thank you. My hope is to someday work with educators as peers as well as in a professional/consultant capacity about children with special needs in addition to formal psychiatric work with parents, kids, and families. God knows, we special ed teachers need all the help we can get.

Confidentiality issues notwithstanding, all teachers need to know what meds their students are on so they can make the necessary accommodations. If Little Johnny keeps dozing off in class because his meds make him drowsy, and the teacher knows only that Little Johnny doesn't seem to care enough to pay attention, punishment would be counterproductive. I've also worked with a number parents (mostly poor and with little education) who are simply overwhelmed by their kids' behavior and can barely keep track of what meds to give, never mind ensuring the proper timing of administration and managing the side effects.

Personally as well as professionally, it's come to the point that I feel compelled to do... well, something.

Our school nurses do what they can but with budget cutbacks meaning more RN layoffs, in-school Rx administration is being increasingly relegated to administrators, who in turn have been known to pass the responsibility to clerical staff because they - the admins - have too many spinning plates already. While well-meaning, most principals and secretaries have no training at all in medicine and have no idea what side effects to watch for with unfamiliar medications.

As a teacher, I'd be comfortable administering, say, Advil so long as I spoke to a parent first and had written consent to give it. But a prescription drug like Haldol or Risperdal? No effing way. Depending on the school, if I turn my back for one second I risk the whole bottle disappearing. I mean, my God, can you imagine a classroom full of ten-year-olds with akathisia? It'd be like... like... like a room full of ten-year-olds.

*shudder*

Joking aside, it's partly this frustration that's prodding me to consider going into psychiatry. I'm at least three years away from starting med school, assuming I get in at all - my undergraduate transcript accurately reveals a thoroughly unmotivated young man, although I carried a 3.6 through my MA and PhD - so I have a lot of time to consider the wisdom of this idea.

As always, thank you for your encouragement and feedback. I look forward to whatever other thoughts you may wish to share.

 

[fiatslug]

I finished a CAP fellowship a year ago and am curretly seeing only adults in a job that I really enjoy (and is a fantastic Working Mama physician job ). I miss child, I'm wistful for it, and may return to it at some time, but make no mistake: the practice of child psychiatry is a lot more work than adult (not just the training!). There's a ton of uncompensated time (by insurance companies anyway--in PP in a lucrative area, you can charge for a lot of the collateral that needs to be done, I'd imagine) that doing a good job as a child psychiatrist requires (imagine teaching adults vs the special ed children you used to do--which btw would be an *amazing* background to have as a child psychiatrist!--if your adult student doesn't show up to Comp 101, oh well, they're marked as absent. If your fetal EtOH kid who has no frontal lobe impulse control didn't get off the bus to come to school, well... marshall the police and go on from there! Similarly, an adult is pretty much on their own about whether or not they choose to come into tx, unless there's DTS/DTO going on. Kids, OTOH... the systems issues are huge).

The other thing to think of (also speaking as an Elder in med school--I started at 30) is that med school admissions always tighten up in craptastic economies. I don't envy anyone trying to get in now. And while your background sounds awesome, admission committees really have a fondness for 22 yos (much as they may claim to love the non-traditional applicant ). So be prepared to bust your ass, and be willing/able to move your family anywhere you get in.

Good luck!

 

[edumacator]

I finished a CAP fellowship a year ago and am curretly seeing only adults in a job that I really enjoy (and is a fantastic Working Mama physician job ). I miss child, I'm wistful for it, and may return to it at some time, but make no mistake: the practice of child psychiatry is a lot more work than adult (not just the training!). There's a ton of uncompensated time (by insurance companies anyway--in PP in a lucrative area, you can charge for a lot of the collateral that needs to be done, I'd imagine) that doing a good job as a child psychiatrist requires (imagine teaching adults vs the special ed children you used to do--which btw would be an *amazing* background to have as a child psychiatrist!--if your adult student doesn't show up to Comp 101, oh well, they're marked as absent. If your fetal EtOH kid who has no frontal lobe impulse control didn't get off the bus to come to school, well... marshall the police and go on from there! Similarly, an adult is pretty much on their own about whether or not they choose to come into tx, unless there's DTS/DTO going on. Kids, OTOH... the systems issues are huge).

The other thing to think of (also speaking as an Elder in med school--I started at 30) is that med school admissions always tighten up in craptastic economies. I don't envy anyone trying to get in now. And while your background sounds awesome, admission committees really have a fondness for 22 yos (much as they may claim to love the non-traditional applicant ). So be prepared to bust your ass, and be willing/able to move your family anywhere you get in.

Good luck!

I hope the admissions committee sees the link between a special education background and working as a psychiatrist. I have a couple of special ed interviews lined up - we recently moved to this city so my wife could take advantage of a job opportunity - so, with luck, I can soon stop saying that I "used to" work with special needs kids. As for the uncompensated time issue... ever been an elementary school teacher? I'm used to it. You do what you have to do to get the job done. You can complain all you like but it still needs to be done, no excuses, not when there are kids involved.

I would imagine that graduate programs across the board are experiencing a swell of applicants in this recession, although perhaps not as much as in the past given media hype about heavy debt and poor job prospects for those graduating with newly-minted diplomas. In addition to you wonderful folks, I've been soliciting career feedback from friends who are in the medical profession. My best friend from high school, who did the MD-PhD thing and is now a pediatric oncology fellow in the mid-Atlantic, advised me in the strongest possible terms to not go to medical school. His argument was almost entirely economic, with warnings that Congress will continue to slash Medicare and Medicaid reimbursements and how many of his med school classmates have been, in his words, "royally f**ked over" between decreasing salaries, mortgages, and student loan debt. The legislation in Arizona cutting payments for certain transplant patients really riled him up.

His take-home message was that it would be irresponsible for me to take out major loans at a time when I should be saving up for my kid's college tuition, never mind a house down payment, and that I should focused on earning money, not borrowing it to spend on tuition.

It was a very interesting conversation and certainly gives me pause. But, as I said, I'm at least three years away from starting as an MS1 (which sounds like a virus to this layman) so I'm continuing to solicit advice. Do you suppose my friend's concerns apply to CAP and to the mental health field in general?

As for the quoted line I bolded... busting my ass? No problem. Moving anywhere I get in? Assuming I go through with this, I will apply to only one place: the public medical school in the city we now call home. It is the least expensive medical education available to me. And if it doesn't come through, I will simply need to find meaningful work in another field of endeavor. I want to do this. I want very much to do this. But not at the expense of my family's future.

 

[nitemagi]

I hope the admissions committee sees the link between a special education background and working as a psychiatrist. I have a couple of special ed interviews lined up - we recently moved to this city so my wife could take advantage of a job opportunity - so, with luck, I can soon stop saying that I "used to" work with special needs kids. As for the uncompensated time issue... ever been an elementary school teacher? I'm used to it. You do what you have to do to get the job done. You can complain all you like but it still needs to be done, no excuses, not when there are kids involved.

I would imagine that graduate programs across the board are experiencing a swell of applicants in this recession, although perhaps not as much as in the past given media hype about heavy debt and poor job prospects for those graduating with newly-minted diplomas. In addition to you wonderful folks, I've been soliciting career feedback from friends who are in the medical profession. My best friend from high school, who did the MD-PhD thing and is now a pediatric oncology fellow in the mid-Atlantic, advised me in the strongest possible terms to not go to medical school. His argument was almost entirely economic, with warnings that Congress will continue to slash Medicare and Medicaid reimbursements and how many of his med school classmates have been, in his words, "royally f**ked over" between decreasing salaries, mortgages, and student loan debt. The legislation in Arizona cutting payments for certain transplant patients really riled him up.

His take-home message was that it would be irresponsible for me to take out major loans at a time when I should be saving up for my kid's college tuition, never mind a house down payment, and that I should focused on earning money, not borrowing it to spend on tuition.

It was a very interesting conversation and certainly gives me pause. But, as I said, I'm at least three years away from starting as an MS1 (which sounds like a virus to this layman) so I'm continuing to solicit advice. Do you suppose my friend's concerns apply to CAP and to the mental health field in general?

As for the quoted line I bolded... busting my ass? No problem. Moving anywhere I get in? Assuming I go through with this, I will apply to only one place: the public medical school in the city we now call home. It is the least expensive medical education available to me. And if it doesn't come through, I will simply need to find meaningful work in another field of endeavor. I want to do this. I want very much to do this. But not at the expense of my family's future.

Consider many factors, including in state tuition, vs. other schools that may offer a decent amount of financial aid. I went to a private school and got about half my tuition/expenses covered in financial aid. And look at some $ breakdowns for financial outcomes with and without med school.

Admissions may look favorably on you as an educator, but their first priority is knowing you can handle the curriculum (the science), and haven't overly-narrowed your possibilities too early (best to say you have an interest in X, but of course have an open mind to whatever you discover in med school).

 

[jettavr6]

Just like someone above mentioned, 175k is definitely on the low end for a thriving private practive. Psychiatry is on the upswing; high demand with a shortage of providers.

 

[edumacator]

Consider many factors, including in state tuition, vs. other schools that may offer a decent amount of financial aid. I went to a private school and got about half my tuition/expenses covered in financial aid. And look at some $ breakdowns for financial outcomes with and without med school.

Admissions may look favorably on you as an educator, but their first priority is knowing you can handle the curriculum (the science), and haven't overly-narrowed your possibilities too early (best to say you have an interest in X, but of course have an open mind to whatever you discover in med school).

Thank you for this. It's unlikely, however, that I will apply to any schools other than the single public medical school in my current city. (There are no private options here.) My wife loves her new job, our daughter is in a terrific school, we've found a church we like (and I usually hate going to church), and we're already putting down roots. I could see uprooting us for, say, residency. At least that comes with a salary and the chance to establish connections for building a private practice. But moving just to go to school, only to face the likelihood of moving again after graduation? I can't do that to them. My wife grew up in an Army family. She's moved enough.

As for admissions, I've mentioned before that I won't even bother applying if I score below an A, or maybe an A-minus, in any of the pre-requisite courses. If introductory biology is too tough master, I doubt I'll have any better luck with anatomy or pharmacology.

I'm also not 100% wedded to psychiatry. While it's by far my primary interest, I could also envision myself in pediatrics or perhaps family practice. The idea of clinic work is very appealing and whatever I do, I hope it involves working with kids. Even the obnoxious ones crack me up sometimes.

Of course, I'll cross that bridge when I get to it and do so with an open mind. I hope, whatever happens, that I don't develop an interest in some hyper-specialized area that keeps me a resident/fellow into my 50s.

Just like someone above mentioned, 175k is definitely on the low end for a thriving private practive. Psychiatry is on the upswing; high demand with a shortage of providers.

I looked at the teacher salary scale in my city earlier today and I'd be thrilled to make half of $175K. Thankfully, money isn't my primary motivation. But I sure wouldn't object to a raise.

 

[Sneezing]

Debts right now even in the $300k range are still a good deal. If you can live on your 2300 a month salary even as a resident and several years out you will be in great shape. From what you put your daughter at you'll be able to pay for her college as she is attending it. By the way, parents have no obligation to their children's college education, IMO. Depending on the specialty and the residency you would hypothetically match at there is the ability to moonlight as a resident. This affords extra income - but comes at the cost of less family time. Residents I've seen who are career changers and have established families don't really moonlight that munch, its more so to cover the acute cost of a home repair here and there.

What's your LONG term goal? Do you see yourself wanting to retire at 50? 60? 70? never? If you are looking for an early retirement than medicine wouldn't be a wise switch. If you are looking to work until you die than medicine will definitey be worth it and psychiatry has a longer shelf life so to speak than other fields.

What age range is your interest? This could shape your goals. You can also be a general psychiatrist and see the older adolescents and not do the fellowship.

 

[edumacator]

Debts right now even in the $300k range are still a good deal. If you can live on your 2300 a month salary even as a resident and several years out you will be in great shape. From what you put your daughter at you'll be able to pay for her college as she is attending it. By the way, parents have no obligation to their children's college education, IMO. Depending on the specialty and the residency you would hypothetically match at there is the ability to moonlight as a resident. This affords extra income - but comes at the cost of less family time. Residents I've seen who are career changers and have established families don't really moonlight that munch, its more so to cover the acute cost of a home repair here and there.

If the day comes that I find myself a PGY III or IV, I'll probably moonlight only sparingly. I figure at that point, which would be circa 2021-22, resident salaries at that level would be in the $60-70K range. Coupled with my wife's salary, even assuming no raise at all, we could do quite well and keep our kid(s) in a good private school.

And, for those of you thinking that a public school would serve us just as well, let me say for the record that as a public school teacher, there is no way on God's green Earth I would put my kid in a public school so long as our test-til-you-drop mandates are in place. Personally, I'd prefer to work at a private school myself but the money is better in the public schools and I get a great deal of satisfaction working with underprivileged children. I'm doing what I can to effect change from within.

To address your point about paying for college, I disagree. But those are my values, not yours. My folks made sure I didn't have a penny of debt when I graduated, for which I remain profoundly grateful. I'm determined to assure the same for my own children. And if I'm faced with the choice of their college or my med school, I'll choose their college without a moment's hesitation or regret.

What's your LONG term goal? Do you see yourself wanting to retire at 50? 60? 70? never? If you are looking for an early retirement than medicine wouldn't be a wise switch. If you are looking to work until you die than medicine will definitey be worth it and psychiatry has a longer shelf life so to speak than other fields.

I intend to work as long as I can. I'd love to work into my 70s, assuming I'm still healthy enough to do so. To me, it's one of the smaller joys of psychiatry. Since it's primarily cerebral work - no worries about stitching up cuts with unsteady hands - I expect to have a fairly long professional shelf life.

The thought of total retirement, with its attendant talk show addictions and shuffleboard tournaments, fills me with dread. I stay intellectually engaged in something even in my so-called down time, usually writing or reading. For instance, I'm working on a book right now about standardized testing in public education, interviewing colleagues and researching its history. I also published a novel over the summer and am working on another.

So one way or another, I'll never retire. Heck, I expect to hit my 100th birthday in good health and be known to all and sundry as "Ol' Doc Edumacator." I could do that anyway with just the PhD, I suppose, but you get the idea.

What age range is your interest? This could shape your goals. You can also be a general psychiatrist and see the older adolescents and not do the fellowship.

My primary age range of interest is actually pre-adolescent, although all manner of psychiatric disorders interest me irrespective of age. For little kids, though, it seems that there's so much yet to be discovered and properly understood about how the developing brain/mind works, how underlying pathologies interact, and how assorted pharmacopeia influence it all. In some ways, psychiatry comes closer than any other scientific field to answering the question, "what does it mean to be human?" And so much of it starts in the primary years.

Granted, most of my professional experience has been at the elementary school level so perhaps I'm somewhat biased. Experience with adolescents may prove just as fascinating. I've worked with second-graders taking multiple psychotropic drugs and fourth-graders who've been hospitalized for behavior disorders. I recall one student who refused to go the bathroom unaccompanied because s/he heard voices and saw demonic images in the mirror every time s/he went in alone. Of course, this student started seeing a psychiatrist but we teachers had a behavior plan to implement and accommodate to ensure that this student was able to learn with minimal distraction. I think we set the student up for a good chance at a normal - whatever that means - adulthood.

So, to me, kids are the ones to work with.

Working in special education, I know that there's a great deal I can do for my kids but I can't shake the idea that I could so much more as a mental health professional. Maybe I'm suffering from grass-is-greener syndrome. God knows I do enjoy sleeping in, although I think I'm already in the wrong line of work for that. And I enjoy the time I have with my family, time I wouldn't have as a fledged psychiatrist, never mind as an MS3 or a resident.

I'm still weighing the trade-off. I suppose the real opportunity cost, referenced in previous posts, isn't financial. It's time. Time I won't get back.

Thank you for your response.

 

[OldPsychDoc]

Thank you for this. It's unlikely, however, that I will apply to any schools other than the single public medical school in my current city. (There are no private options here.) My wife loves her new job, our daughter is in a terrific school, we've found a church we like (and I usually hate going to church), and we're already putting down roots. I could see uprooting us for, say, residency. At least that comes with a salary and the chance to establish connections for building a private practice. But moving just to go to school, only to face the likelihood of moving again after graduation? I can't do that to them. My wife grew up in an Army family. She's moved enough.

As for admissions, I've mentioned before that I won't even bother applying if I score below an A, or maybe an A-minus, in any of the pre-requisite courses. If introductory biology is too tough master, I doubt I'll have any better luck with anatomy or pharmacology.

I'm also not 100% wedded to psychiatry. While it's by far my primary interest, I could also envision myself in pediatrics or perhaps family practice. The idea of clinic work is very appealing and whatever I do, I hope it involves working with kids. Even the obnoxious ones crack me up sometimes.

Of course, I'll cross that bridge when I get to it and do so with an open mind. I hope, whatever happens, that I don't develop an interest in some hyper-specialized area that keeps me a resident/fellow into my 50s.



I looked at the teacher salary scale in my city earlier today and I'd be thrilled to make half of $175K. Thankfully, money isn't my primary motivation. But I sure wouldn't object to a raise.

Given all of the above, I hope that you will also consider a PA program if you can't quite reach your aspirations to medical school (though frankly, I'd love to see you make it all the way into CAP!).

 

[edumacator]

Given all of the above, I hope that you will also consider a PA program if you can't quite reach your aspirations to medical school (though frankly, I'd love to see you make it all the way into CAP!).

You're very kind. Thank you!