The road not taken
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Absolutely! Very interesting pathology, lots of career opportunities, the ability to practice any location, the ability to practice in so many different types of settings, good work life balance, feeling I genuinely make a difference all made this a great choice for me (as a start).
I was torn between psychiatry and emergency medicine, browsing through their forum from time to time I feel even more convinced I made the right choice.
I was torn between psychiatry and emergency medicine, browsing through their forum from time to time I feel even more convinced I made the right choice.
Yes. I went to medical school expressly to become a psychiatrist. I did enjoy rotations in pediatrics, surgery, infectious disease, and neurology but none of them were better than psychiatry.
Whether I would go to medical school again or not is a more difficult question.
Whether I would go to medical school again or not is a more difficult question.
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Hypotheticals based on time frame, if my current day knowledge was sudden transmitted into my prior self brain:
College - forget premed... econ/art double major YOLO followed by MBA
M1 year - withdrawn instantly and gone back to school for econ lol.
M2 year - if I had gone up to this point I would have applied to an MD track in one of the big 3 finance firms (Bain, McKinsey, or Boston group) and tried my hands in corporate finance
M3/M4 year - if I didn't get my foot into finance probably would have done the same and applied to psych (aka this timeline)
This timeline is probably the most efficient and gets me to my FIRE goal quicker than the current timeline. Although in an alternate universe... if I end up being an economist in my day job, would I love it too much to ever give it up or even want to retire...? hmmm
College - forget premed... econ/art double major YOLO followed by MBA
M1 year - withdrawn instantly and gone back to school for econ lol.
M2 year - if I had gone up to this point I would have applied to an MD track in one of the big 3 finance firms (Bain, McKinsey, or Boston group) and tried my hands in corporate finance
M3/M4 year - if I didn't get my foot into finance probably would have done the same and applied to psych (aka this timeline)
This timeline is probably the most efficient and gets me to my FIRE goal quicker than the current timeline. Although in an alternate universe... if I end up being an economist in my day job, would I love it too much to ever give it up or even want to retire...? hmmm
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Agreed on that last part. If I could go back I would strongly consider joining the Air Force to pay for medical school. But would also seriously think about just moving to a larger city and getting a job in a major corporation. I have friends who got into entry level jobs 15 years ago and are now making $150-200 salary range or more having worked their way up the corporate ladder.
I would not be super thrilled entering the psych landscape in 2029. Those that have their gigs now for last few years hit a great time and they r probably set for the next decade. Np encroachment is real and i would pick surgical/rads which likely stay immune to np encroachment.
I still wonder from time to time if I would’ve been happier in IM and doing nephro or pulm/CCM, but the things that have tended to really frustrate me as of late to make me wonder this are still present in most other areas of medicine (just different flavors of the same issues), systems level issues, and general frustration with residency/training. The grass is always greener on the other side. I know had I gone with IM I’d be wondering if I should’ve done psych instead and if I’m truly being honest with myself, would probably be more frustrated and possibly burnt out at this point. Psych is definitely more conducive to my personality, I’m genuinely interested in the pathology, and I enjoy the closer relationship of psych to philosophy, all aspects of psychology (not just abnormal/clinical psychology), and sociology; it complements my outside interests which helps with staying engaged, but doesn’t overlap completely to where there’s no boundary between work and hobbies/interests (which happened with my previous career track and I was miserable). The flexibility in terms of practice setting, location, and specific patient population, options for side work, lifestyle, and ability to continue to practice into old age if so inclined are all pluses compared to other areas of medicine. If I could go back in time I would still go to med school even if it meant taking the same protracted route to get there (though if I had to start over at this stage in life it would be a hard no). There are definitely things I would do differently, which may make choosing between IM and psych harder than it already was. But I’m overall happy with where I’ve ended up and I think even in the hypothetical situation of going back and doing some things differently I’d still be happier in psych.
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If I was back in medical school and had to choose a medical specialty, I would choose psychiatry without hesitation.
If I was back in college, I'm not sure if I would go to medical school. This isn't a popular thing to say but I would have been financially better off if I went into nursing and became a psychiatric NP. The sacrifice to become a physician is huge, especially when you consider the time value of money.
The other option is to go into AI / robotics and build cool things but that means I'll likely end up in a place I don't want to live if I wanted to have good jobs.
At the end of the day, I could probably do any work as long as I get time away to think deeply.
If I was back in college, I'm not sure if I would go to medical school. This isn't a popular thing to say but I would have been financially better off if I went into nursing and became a psychiatric NP. The sacrifice to become a physician is huge, especially when you consider the time value of money.
The other option is to go into AI / robotics and build cool things but that means I'll likely end up in a place I don't want to live if I wanted to have good jobs.
At the end of the day, I could probably do any work as long as I get time away to think deeply.
Definitely. I would not recommend chosing medicine to myself again, however, if I had to chose another specialty.
Although when I look around, there aren't very many other professions that appeal to me anymore.
I think a lot of the modern dissatisfaction with medicine is from it becoming more and more commoditized and corporate. But that phenomenon is hard to escape from in America; even in other professions.
Although when I look around, there aren't very many other professions that appeal to me anymore.
I think a lot of the modern dissatisfaction with medicine is from it becoming more and more commoditized and corporate. But that phenomenon is hard to escape from in America; even in other professions.
2028-2029 is when I'll be entering the field as an attending, barring the unforeseen. I know NP encroachment is inevitable, but I'm hoping it isn't so dystopian that I can't find employment without having to supervise them at least.
Some on this forum predict a two-tier system emerging with respect to receiving physician care vs nurse practitioner care, but between the publishing of books like Patients at Risk and this issue becoming salient to the current generation of medical students and residents, I suspect there will be more public consumer push-back against the cheapening of medical care in the next few years as the previously obfuscated unknown unknown of patients believing they are being treated by a "doctor" stops remaining a preformed assumption and starts becoming a more frequent question.
Or at least that's what I tell myself to keep grinding away.
I would not be super thrilled entering the psych landscape in 2029. Those that have their gigs now for last few years hit a great time and they r probably set for the next decade. Np encroachment is real i would pick surgical/rads which likely stay immune to np encroachment.
You'll find a job then that is not the issue. You will likely make less than the recent increase over the last few years. This isn't just for psych but for most specialties. Everyone wants to save $ and if you can hire 1-2 docs and have 5 midlevels under each it drastically saves cost for the organization and that is what most are all about. In 10 years midlevel's may have full autonomy. So yes you will find a job that is not the issue. If i were in your shoes i would go towards a field more protected field like surgery subspecialty or rads or IM subspecialty. This is the advice I would give for someone so far out.
You'll find a job then that is not the issue. You will likely make less than the recent increase over the last few years. This isn't just for psych but for most specialties. Everyone wants to save $ and if you can hire 1-2 docs and have 5 midlevels under each it drastically saves cost for the organization and that is what most are all about. In 10 years midlevel's may have full autonomy. So yes you will find a job that is not the issue. If i were in your shoes i would go towards a field more protected field like surgery subspecialty or rads or IM subspecialty. This is the advice I would give for someone so far out.
That's a reasonable opinion but I strongly disagree. I don't think most people planning on becoming psychiatrists could handle rads (seriously you are going to sit in a room and read images all day instead of the most talk-oriented field of medicine?). IM proceduralists do get paid very well but they often have terrible call schedules (cards, GI). Subspecialty surgery is such a different experience than psychiatry, appointments are absurdly quick, you tell people they have terminal cancer in less time than I used to spend on ADHD follow-ups in those fields.
If you find a field of medicine you actually like, choose that without any regard to pay, you can make the money work in 99+% of situations within any field. Even Peds or path! Psychiatry has more protection against midlevels than most non-procedural fields because there is a such a vibrant cash pay practice. Mental health diagnosis are only increasing, and baring some major unforeseeable changes in the next few decades, demand will be up dramatically, unlike say a field like rad/onc.
If i could do it all again I would have signed up for military med and gotten paid / tuition paid for. I just didnt know 100% I was going to be a psychiatrist.
I definitely would do this again though.
I definitely would do this again though.
If I was in med school, yes I'd choose psych again.
If it was prior to med school, I would not have gone to med school.
If it was prior to med school, I would not have gone to med school.
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Yes to med school and yes to psych. My job and life in general are wonderful. I'm sure I would have been happy on the many other paths my life could have taken, but I have nothing to regret and my future looks bright.
I'd definitely choose psych. Lifestyle and sleep are important to me, and very few fields compare to psych in that regard. It's also the most interesting field in terms of variety. Yes, the diagnoses are fairly limited, but cook book medicine and just following algorithms bores me. I'd be miserable in a lot of other fields.
I'm not 100% sure I'd choose med school again though. I started late (26yo) and missed a lot of things I wanted to do during this time of my life. Part of that is d/t the social path I took, but the time, energy, and financial sacrifice committed to school was definitely a huge impact. I love teaching, so may have been happier doing something in STEM and shooting for a position as a college prof. Not as financially lucrative, but likely would have had a lot more control of my schedule.
What is this? I've never heard of it but sounds interesting.
May not be popular as an ethical statement from a standard of treatment perspective, but completely understandable from a financial perspective. So many of the night nurses at one of our hospitals are awful because they just sit there and do their NP homework all shift. If I could have started getting paid for training/school right after undergrad instead of paying $40k+/yr for 4 more years that would be pretty hard to pass up.
I'm not 100% sure I'd choose med school again though. I started late (26yo) and missed a lot of things I wanted to do during this time of my life. Part of that is d/t the social path I took, but the time, energy, and financial sacrifice committed to school was definitely a huge impact. I love teaching, so may have been happier doing something in STEM and shooting for a position as a college prof. Not as financially lucrative, but likely would have had a lot more control of my schedule.
What is this? I've never heard of it but sounds interesting.
May not be popular as an ethical statement from a standard of treatment perspective, but completely understandable from a financial perspective. So many of the night nurses at one of our hospitals are awful because they just sit there and do their NP homework all shift. If I could have started getting paid for training/school right after undergrad instead of paying $40k+/yr for 4 more years that would be pretty hard to pass up.
Radiology would have got a much stronger look. I talked myself out of it thinking I'd be bored after a few years, but in today's lens the ability to have less interactions with people could be nice. Most recent psychiatry frustration is sea of cannabis patients getting ticked off they don't get a stimulant and then plaster their frustrations all over the internet and on google reviews.
IM with a cash only DPC style practice would be considered, too.
IM with a cash only DPC style practice would be considered, too.
I don't remember which one but last year when I was nearing the end of fellowship training and looking for jobs, one of the "big three" specifically had an MD track where they were poaching rising M2s to come work for corporate consulting instead of going through the traditional M3 clinical route.
EDIT: actually I found it. It was McKinsey. Their application cycles are seasonal so if anyone is interested keep an eye on this page in the next few months.
MD Fellow | Careers
You’ll work in teams of typically 3 – 5 consultants, playing an active role in all aspects of client engagement.This includes gathering and analyzing information, formulating and testing hypotheses, and
Physicians work very hard for their revenue. A friend of mine in real estate may work hard around closing certain deals, but otherwise he is paid by rent checks every month. While physicians train hard for years accumulating debt, he lived modestly and accumulated assets. His assets can sustain him forever. Our minds can sustain us, but we can’t walk away whenever we want.
Once the decision is made to do medical school, I still believe psychiatry was the best choice for me.
I am the third generation psychiatrist in my family and the last one still working in the field. The other half a dozen ( mostly dead but some retired) all predicted that the field was going to hell in a hand basket and here I am telling you that things have never been better. If it were not for psychiatry, I would hate medicine. I have no regrets and would not have changed a thing if given the chance. For all of you pessimists who worry about "encroachment" and lack of parity. Encroachment is a result of our inability to fill the vacuum of need and parity is largely a result of the majority of us working in a cash only practice. There are many worse problems that can make psychiatry undesirable. We have never had it better than it is now.
Maybe I shouldn't scold the chicken littles and encourage the doom Sayers. It will only keep us rare and well paid.
Maybe I shouldn't scold the chicken littles and encourage the doom Sayers. It will only keep us rare and well paid.
My advice to all is to save and invest heavy early in career and have some chance to get passive income. Once this is set then work towards passive income meeting yearly expenses and go PT. If most could do wci live like a resident 5-7 years depending on debt they would be set. Got a few colleagues who just finished this live like a resident challenge and all are planning for an under 50 retirement.
People don't understand that due to such late start in earning as a physician along with debt you need to play catch up. Wish more were told about this in med school/residency but they fear too many retirements by 45 so who knows.
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The average psychiatrist considers the hours in med school and residency to be terrible, but keep in mind associates at consulting firms (and investment banks) work 110-120 hours a week. That's literally what the average psychiatrist works in 3-4 weeks.
On the bright side, consulting associates don't have to do call or nightfloat. But that's because they're expected to work at all times. Nights, weekends, holidays, honeymoons are all fair game. Money needs to be made because the managing director's (ironically M.D.) $20 million income doesn't magically happen and clients want their billion dollar transactions done now.
They average psychiatrist also doesn't have the mindset of the average business person, let alone someone at a consulting firm. We spend too much time debating things like receptor discrepancies in Stahl's, why someone needs Effexor levels, or if we should sign a terrible employment contract. By the time we finish debating such things, a 21 y.o. business school student wqould've put together a case study and business plan on how to create a national telepsych company or consolidate the mental health field and utilize midlevels to make a profit.
There's no reason why physicians can't do both and create income from labor and assets. An average psychiatrist working an average job can accumulate $300k-$400k post-tax in a couple of years, or $150k-200K assuming half it is blown on loans and lifestyle. And a full 20% of med students have no educational debt.
No opinion on this, but it is such a wonderful poem to ponder:
www.poetryfoundation.org
Apparently, the poem was originally meant in jest toward one of Frost's friends. You can read a lot or not so much into the poem.
Third stanza, fifth line is the gut punch. But it can be light, too.
The Road Not Taken
Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth; Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted wear;…
www.poetryfoundation.org
Apparently, the poem was originally meant in jest toward one of Frost's friends. You can read a lot or not so much into the poem.
Third stanza, fifth line is the gut punch. But it can be light, too.
We certainly should be. We are just farther behind. At age 20, I’m busting my behind to maintain my gpa and prep for the MCAT. My buddy is barely passing business classes and becoming a realtor on the side. At 22, I’m accumulating debt in medical school that absorbs my time. My friend is selling homes, working part-time for a corporation that pays him to find new locations, and starts investing in small properties. At 27, I’m in debt and finally buying my first home - barely making ends meet as an intern. My friend is rehabbing larger commercial projects with investor money, renting out multiple commercial properties, developed his own brokerage, and started another business out of one of his properties. At 32, I am finally making physician money. My friend is slowing down. He sporadically finds neglected commercial properties and upon revitalizing them ends up on the cover of local magazines. In comparison, his road was more social and will reach early retirement faster. I likely find more fulfillment in my work, and I certainly enjoy being a psychiatrist. I’m now accumulating my own real estate investments.
I think you overestimate the drive and overall speed of business majors. Lets just say I went to undergrad at a place with arguably the top undergrad business program in the country when I was there and a top 30 MBA program. Several friends in the business program (2 of whom were "pre-med" until sophomore year), all of whom ended up getting MBAs and becoming "consultants" as well. Case study and business plan in the same time? Probably not. Cool looking powerpoint filled with business buzzwords that doesn't really say anything? Probably. There's a reason they get paid by the hour to "consult" and it's not because they do things quickly lol.
I actually think the reason so many people in medicine would not succeed in consulting is because of the overall uselessness of what the vast majority of consultants do would become mind numbing. I mean, I'm probably improving at least 1 person's life a day even if it's not all of them. As a consultant, you're a highly paid middleman basically being paid to extract money from another business in order to impart some half useless knowledge in an industry you likely actually know very little about.
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To be fair, the average 22 y.o. is neither in med school nor investing in small properties.
The grass is always greener. If you go to the industrial side of town, you'll see lots of small cinder block buildings with nondescript company names like "Industrial Screw Co." Each of those businesses represents at least one owner who makes $1M-$5M. There are a lot more of them than doctors, and they invariably live in the same neighborhoods as doctors, but in bigger houses. Most will say they want their kids to go to college and get an office job like doctor or lawyer so they wouldn't have to work so hard.
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Yes! Only in this field can a patient greet you with: “Hey, bitch! Are you my doctor today?” and it can totally be okay 😆😂
I would pick psychiatry again without hesitating for a second
This is both a job and my main hobby, when im not at work im studying psychiatry, when im doing neither im talking about psychiatry with my wife who is also a psychiatrist
They could pay me half the amount and id still do this job the same, i just love it
This is both a job and my main hobby, when im not at work im studying psychiatry, when im doing neither im talking about psychiatry with my wife who is also a psychiatrist
They could pay me half the amount and id still do this job the same, i just love it
Bring the competition! These NP's, for the most part, are clueless. I can spot an NP regimen from a mile away. Once patients see how it should be done they start steering clear. Train well, keep practicing, work hard, fear not.
The future is bright in psychiatry.
It’s hard to argue “average” 22 year old debates amongst physicians that likely scored very high in college.
Getting a job making $50k at 22 and putting the minimum down payment on a cheap duplex in suburbia was likely very achievable for most here (especially if you worked from 16-22 because gpa mattered little). Renting the other side pays your mortgage. Save what would have been your rent each month to buy another duplex in 1-2 years. Looking back, it would have been easy.
Looking forward, I love what I do, so I’m not complaining either.
This is a bit much..the vast majority of the time there’s no way to tell the difference between an NP and MD regimen..let’s not get overzealous..
Id love for this to be true. See primary care on how this doesnt change patients staying with np and pcp's struggling to find local jobs that got taken by these terrible nps.
Hours in the top 3 strategy consulting firms are terrible and stay terrible. The compensation can be huge if you become a partner but most people choose to leave after a year or two because of burnout — they see how busy the partners are and say “no thanks.”I don't remember which one but last year when I was nearing the end of fellowship training and looking for jobs, one of the "big three" specifically had an MD track where they were poaching rising M2s to come work for corporate consulting instead of going through the traditional M3 clinical route.
EDIT: actually I found it. It was McKinsey. Their application cycles are seasonal so if anyone is interested keep an eye on this page in the next few months.
MD Fellow | Careers
You’ll work in teams of typically 3 – 5 consultants, playing an active role in all aspects of client engagement.This includes gathering and analyzing information, formulating and testing hypotheses, andwww.mckinsey.com
It can be a good springboard to good corporate roles that are more sustainable, or to high finance roles that are more lucrative (but less sustainable).
Some of the projects are sexy but many are boring and grueling, with unnecessary edits in PowerPoint that end up being disregarded anyway. It’s like being an intern, but where your attending is changing the plan every day because the patient keeps asking them to, so you have to pull late hours.
Going to have to disagree with you. FWIW, I've seen a number of MD's who seem to not have a clue either, so there's that.
