The Future of Psychiatry

[Dreamin]

---

Members don't see this ad.

I loved my psychiatry rotation this year and it was the first time I felt like I could really make a difference in the lives of my patients. I am very interested in pursuing a residency in psychiatry...however, I have a few concerns based on what other physicians have said to me:

One physician told me that I wouldn't be able to make a living because the reimbursements will be drastically cut back by insurance companies in the near future. I don't care about a big pay check, but I do hope to be able to pay off loans and support a family.

Another physician told me that soon psychologists will have prescribing rights across the country and that there would be no difference anymore between psychologists and psychiatrists. I disagree with this due to recent failed attempts by psychologists in Hawaii, but this physician demanded that it is only a matter of time. Do you see this as a problem for psychiatry in the future?

Where do you see the future of psychiatry in the next 20 years? Will there always be a need for psychiatrists?

It's an amazing field, I just don't feel that I know enough yet about these issues to respond to people when they question the field.

 

[Anasazi23]

I loved my psychiatry rotation this year and it was the first time I felt like I could really make a difference in the lives of my patients. I am very interested in pursuing a residency in psychiatry...however, I have a few concerns based on what other physicians have said to me:

One physician told me that I wouldn't be able to make a living because the reimbursements will be drastically cut back by insurance companies in the near future. I don't care about a big pay check, but I do hope to be able to pay off loans and support a family.

This is false. Psychiatrists make well over 100k, and many make 200k+. One could argue the opposite given the mental health parity payment legislation. If you're talking straight medicaid, that may be true.

Another physician told me that soon psychologists will have prescribing rights across the country and that there would be no difference anymore between psychologists and psychiatrists. I disagree with this due to recent failed attempts by psychologists in Hawaii, but this physician demanded that it is only a matter of time. Do you see this as a problem for psychiatry in the future?

This has been hashed out ad naseum on these boards about psychiatrists. There are lots of differences between psychiatrists and psychologists - prescription privilages or not. Psychologists serve an important purpose in the field of mental health, and can be great at what they do (assessment and testing), but have a tiny fraction of the medical knowledge that psychiatrists have. Please don't re-hash this out on this thread. Psychiatrists will always be considered the premier mental health care provider, given their physician status. Since psychiatry is a specialty of medicine, this won't change.

Where do you see the future of psychiatry in the next 20 years? Will there always be a need for psychiatrists?

As long as there are people in the world who live their lives and experience life, there will be a need for psychiatrists.

It's an amazing field, I just don't feel that I know enough yet about these issues to respond to people when they question the field.

Why would people question the field? Ignorance is the most likely answer. Afraid you won't be a "real" doctor? Have fun with hypertension, diabetes, cellulitis, pneumonia and CHF for the rest of your life. You can keep it.

 

[i61164]

I am working on my second career here, so I think I am qualified to say "do what you love." Money, stability, and even respect are worthless if you have no passion for your job. Tell those people that if they think otherwise they are perfectly free to choose a lifetime of unfulfilling boredom.

Also, I second what Sazi said. If you need ammo, just start reading some old threads. Psychiatry vs. psychology gets beaten to death every five minutes around here.

 

[sga430]

i agree with Anasazi23. if you are worried about $ then do child psychiatry or do a fellowship in pain after psychiatry. i feel part of the reason psychiatrist dont make as much as others because they work less hours. check out:

http://phius.com/medicine/medx/perhour.htm

click on the table header to rank per that attribute

u can see that psychiatrists, although on the low end of hourly wages, are higher than IM, FP and peds. but i would guess that 40%-50% of all docs are IM, FP and peds. so per hourly shrinks do better than a lot.

then if u will notice that in hours least worked (i hope my interpretation is correct) , psychiatrists are ranked 5. so we don't put in the hours like the others.

i hear a lot of docs tell me to go into what makes me money. i am sure there are docs out ther who regret doing radio and wish they were doing some thing interesting.

some docs say work 10 years in anaesth or radio, retire and then do psychiatry.

u have to make up ur mind. but even as a shrink u will be making more than like 90% of the population.

my advice: marry a dermatologist or anesthesiologist.

 

[Dreamin]

i agree with Anasazi23. if you are worried about $ then do child psychiatry or do a fellowship in pain after psychiatry. i feel part of the reason psychiatrist dont make as much as others because they work less hours. check out:

http://phius.com/medicine/medx/perhour.htm

click on the table header to rank per that attribute

u can see that psychiatrists, although on the low end of hourly wages, are higher than IM, FP and peds. but i would guess that 40%-50% of all docs are IM, FP and peds. so per hourly shrinks do better than a lot.

then if u will notice that in hours least worked (i hope my interpretation is correct) , psychiatrists are ranked 5. so we don't put in the hours like the others.

i hear a lot of docs tell me to go into what makes me money. i am sure there are docs out ther who regret doing radio and wish they were doing some thing interesting.

some docs say work 10 years in anaesth or radio, retire and then do psychiatry.

u have to make up ur mind. but even as a shrink u will be making more than like 90% of the population.

my advice: marry a dermatologist or anesthesiologist.

As I said before in my post, I don't care about the salary. I don't appreciate the "marry a dermatologist or anesthesiologist comment" because that was not my point at all in making the original post.

I was simply posting a question regarding the large amount of negative comments I have received from physicians on my third year rotations about psychiatry as a career.

Anasazi23 I am not trying to "re-hash" anything. I have read this board for years...I was just curious how others handle these negative comments and what your thoughts are currently.

 

[OldPsychDoc]

...I have read this board for years...I was just curious how others handle these negative comments and what your thoughts are currently.

When I was a student/intern and got these comments, I usually just had to bring up 1-2 local examples of bipolar surgeons, drug-addicted anesthesiologists, borderline OB/GYNs, or obsessive-compulsive internists to help the questioner see the point...

 

[Pterion]

I was simply posting a question regarding the large amount of negative comments I have received from physicians on my third year rotations about psychiatry as a career.

Anasazi23 I am not trying to "re-hash" anything. I have read this board for years...I was just curious how others handle these negative comments and what your thoughts are currently.

I used to work with psychiatrist who dealt with this admirably. He never stooped to the grade-school name calling and insults, regardless of how well articulated. Right before I left that job I had a chance to ask him this very question. His response (paraphrasing of course) was that in many physicians, especially in primary care, it boiled down to having a great deal of difficulty tolerating ambiguity. They want 1.) A disease that 2.) always had these lab findings and could 3.) be alleviated by 4.) this medication or 5.) that referral. Psychiatrists don't have the luxury of such preoperational thinking. They must be willing and able to accommodate the wide diversity of signs, symptoms and environmental variables. They must be unconstrained by either the mental or physical picture and can only succeed in integrating both, etc, etc.

Or, in the immortal words of Austin Millbarge "We mock what we don't understand".

 

[i61164]

borderline OB/GYNs

Is that why everyone has such a miserable time on the OB/GYN rotation? I was reading a thread the other day where people were recommending suicide as a way to make the rotation more tolerable. There were also a lot of comments like "I would rather stick red hot pokers in my eyeballs than spend on more minute on L&D." I can't convince myself that all of this negative sentiment is unfounded.

And you thought psychiatry has a bad rep. Trust me, browse the "clinical rotations" forum. You will see that psych is the second most undesirable specialty for most people. I can live with that. Actually it kind of amuses me.

 

[MBK2003]

Is that why everyone has such a miserable time on the OB/GYN rotation? I was reading a thread the other day where people were recommending suicide as a way to make the rotation more tolerable. There were also a lot of comments like "I would rather stick red hot pokers in my eyeballs than spend on more minute on L&D." I can't convince myself that all of this negative sentiment is unfounded.

A big part for me when I was a medical student was the profound difference in level of job satisfaction, happiness, and overall outlook on the field among the residents. At my medical school the psych residents were genuinely happy with what they did, liked to have medical students when they were on call so that they could teach, and for the most part liked their patients. I never saw that in IM, surgery, or ObGyn. The peds residents were happy people, but were too overworked to teach the med students and the same with the FP people.

As a PGY-3 looking back on a long year of outpatient, I can say that for the most part I love what I do, I really care about my patients and they only occasionally drive me ape ****. My supervisors are still satisfied doing psychiatry and still love to regale me with tales of the most recent borderline tantrum in session. My classmates enjoy their cases and we share interesting stories about "the craziest intake in the world." Speaking with supervisors, a big key to remaining happy in the field is remaining current in your knowledge and maintaining a network of psychiatrists with whom you meet regularly for a "peer supervision." I imagine working as one of the 2 remaining child psychiatrists in Wyoming, it could be a pretty isolating and desolate experience ("JJ wouldn't be destroying the house and getting suspended from school if you actually gave him the Concerta we discussed and you agreed to the last 4 appts" x10 qd).

I am in NYC and there's plenty of money to be made in private practice with full fee self-pay pts, but speaking with people elsewhere, there's a great need for psychiatry and well-trained people can command full fee pts who then turn around and submit bills to their insurance for partial out-of-network reimbursement. Also, lots of people supplement their income with forensic evals and moonlighting. Someone I know is the "available by phone" psychiatrist for an agency that will page him if the clinical director has a question about whether a patient should be admitted or discharged from the ER -> literally he gets called 1-2x per month, makes his "recommendation" by phone, and then gets paid $20K per year for his availability. I also know someone who does mental health consults for the local jails - he gets a salary, benefits, and makes "recommendation" that the jail PCP can institute, it constitutes only a small amount of time from his day and yet provides health insurance for him & his family. I moonlight at a local hospital covering the inpatient unit, ER, and floor consults for a decent hourly salary. Not only is the money nice, but I get to see a completely different system of care and get to see that there is well-practiced community psychiatry outside the ivory tower of academia.

Bottom line, if you like it do it, the money will be there if you look for it.

MBK2003

 

[sga430]

sorry about the "marry a derm" comment. it was in good humor.

this thread does give me a lot of great ideas. i liked the idea about the phone availabilty for 20k.

i noticed my sister who is a dentist subscribes to this magazine about dental economics. they discuss how to set up ur practice, etc. i wonder if there is a similar magazine for psychiatry.

 

[Dreamin]

sorry about the "marry a derm" comment. it was in good humor.

this thread does give me a lot of great ideas. i liked the idea about the phone availabilty for 20k.
QUOTE]


It's all good! Thanks to everyone for their input!

 

[pschmom1]

I used to work with psychiatrist who dealt with this admirably. He never stooped to the grade-school name calling and insults, regardless of how well articulated. Right before I left that job I had a chance to ask him this very question. His response (paraphrasing of course) was that in many physicians, especially in primary care, it boiled down to having a great deal of difficulty tolerating ambiguity. They want 1.) A disease that 2.) always had these lab findings and could 3.) be alleviated by 4.) this medication or 5.) that referral. Psychiatrists don't have the luxury of such preoperational thinking. They must be willing and able to accommodate the wide diversity of signs, symptoms and environmental variables. They must be unconstrained by either the mental or physical picture and can only succeed in integrating both, etc, etc.

If these "types" of doctors want consistency and predictability then maybe they should be mechanics. Medicine is forever evolving, maybe this doc should go back to school b/c I think he's forgotten!!!!!