The state of psychiatry

learn how to start a private practice
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
DD214_DOC

DD214_DOC

Full Member
Verified Member
Army
Physician
20+ Year Member
Joined
Jun 23, 2003
Messages
5,786
Reaction score
912
I'm an upcoming M4 interested in psych. I have narrowed my field list to FM, IM, or psych. I have a real intellectual interest in psych and have found that, of all the subjects, it is only the one of two areas that I don't have to take my ADD meds to actually study. I really enjoy learning psych-related stuff.

However, lifestyle is also very important to me. I know psych has a pretty good lifestyle, but I don't know the specifics. I will owe the MILITARY some time as well, but when I get out what type of money and hours can I expect? Are psychiatrists in as much business/financial trouble as family docs? I know a lot of FM docs are closing their doors or selling to hospital systems because they cannot afford the overhead.

My only reservation with psych is that I feel I will miss out on the majority of what "medicine" really is.

Are the fellowships difficult? I think I would really enjoy forensic psych or maybe C-L psych.

Also, how competitive is psychiatry? I have a family with a small child and ADD and sleep apnea, so I'm not exactly top of the class. Don't know what my board score is. I should have gotten honors on my psych rotation, but the other student I was working with got it (He was an MD student from the attending's alma mater who said he was interested in psych too, although I know he wasn't)

I am considering a combined IM/psych program to alleviate the above-mentioned problem. Any tips, info, advice appreciated. THanks.
Members don't see this ad.
 
HooahDOc said:
I'm an upcoming

I am considering a combined IM/psych program to alleviate the above-mentioned problem. Any tips, info, advice appreciated. THanks.
Click to expand...

I struggled with this and decided there really was no point in IM/Psych. Remember, most of the IM training in IM/Psych is inpatient - gen med, renal, critical care, cards - not stuff you'd use much in your psych practice. In an ideal world, it'd be great. However, people end up doing one or the other. You can do it to keep your options open, but eventually you're gonna have to pick.

FM/Psych I think makes more sense. IF you're wanting to do a combined residency to keep your options open, FM/Psych does that a lot better than IM. Although I still realized I'd have to pick one sooner or later and just applied straight psych.
 
Members don't see this ad :)
Dakota said:
I'm not a psychiatrist, so take this fwiw, but IM/Psych makes a lot of sense if you want to do CL. Doc S can give you more nitty-gritty about CL, but being more comfortable with the medicine can only help.
Click to expand...

Actually, I disagree. A rigorous intern year and a solid CL fellowship is enough for a career in CL. To my eye, the time away from psychiatry, the extra year in training, and the god-awful cost required to get/maintain boarding in Medicine, Psychiatry, and CL (plus the oft discussed fact that you can only practice/bill for one specialty at a time) all add up to the dual training not being worth it. I'd also emphasize that psychiatry IS REAL MEDICINE. We get called when the "real doctors" can't figure out what the f#$% is going on, so they chalk it up to psychosis/malingering/factitious DO. Sometimes it is, but lots of times it isn't - it's a "real" diagnosis that they've overlooked. House is a CL psychiatrist.
 
Dakota said:
I'm not a psychiatrist, so take this fwiw, but IM/Psych makes a lot of sense if you want to do CL. Doc S can give you more nitty-gritty about CL, but being more comfortable with the medicine can only help.
Click to expand...

I have to disagree with this; I don't think it would hurt you per se, but I seriously doubt the primary team will care too much about the psychiatrist's input about the purely medical aspects of patient care. Nevermind the fact that we should keep up with our medical training in psychiatry not just med/psych. :)


edit: beaten, darn the refresh button
 
Last edited:
I would only reccomend a combined med/psyche program to someone who truly wants to do both clinically, which is unorthodox. It really does not increase your pay and you'll be working very hard. Pay of course isn't everything, but if the desire truly is just for knowledge & not for money, you can satisfy that knowledge by doing a lot of CMEs, reading up on IM and keeping in good contact with the IM department.

A guy I work with has graduated from a FP & psyche residency, forensic psychiatry fellowship & has a law degree.

Geez. And he's making about the same amount I do.
 
HooahDOc said:
Is there anything to stop a board-certified psychiatrist from moonlighting in a clinic just to get his "regular medicine" fix?
Click to expand...

From what I've been told, no there isn't. But that will probably vary from state to state. I have considered that myself, as I really do enjoy 'real medicine'.
 
Chimed said:
That makes sense....Where did you hear that from?
Click to expand...

A sudden flash of insight during my fellowship:

Foul-mouthed, curmudgeonly, brilliant attending
Runs a fellowship with 3 fellows per class
He verbally abuses his fellows to enhance their clinical thinking and loves teaching more than anything else (except maybe solving a problem no-one else could)
Insists that "everybody lies" and that we need to "think dirty" about our patients
Regularly bucks authority and the rules/regs of the hospital
Hates "touchy-feely" medicine
Works at an Ivy League hospital roundly regarded as "the best"
Is routinely called to see patients that no-one else can diagnose but all present with neuropsychiatric signs/symptoms

I realized that not only is he a CL psychiatrist, but he is my fellowship director.

Finding out that a sibling of a former trainee was one of the chief writers for the show really just confirmed my suspicion.
 
Finding out that a sibling of a former trainee was one of the chief writers for the show really just confirmed my suspicion.
Click to expand...

Hahahaha...

If I remember correctly House is a Nephrologist & Infectious Disease, though I'd really have to double check on that.

But in several episodes, I kept thinking to myself--this guy, he really sounds more like a C/L psychiatrist--a REAL C/L psychiatrist, not someone who just throws an SSRI or Haldol at every patient. The episode where he diagnosed Wilson's Disease got me to start noticing that.

House several times incorporates a psychiatric perspective into his diagnostic skills. I've rarely seen any non-psychiatrist do that except for Family Practitioners.
 
Members don't see this ad :)
I've heard several people say that house is a C/L psychiatrist. And they weren't psychiatrists themselves (other kinds of doctors).
 
Doc Samson said:
I realized that not only is he a CL psychiatrist, but he is my fellowship director.
Finding out that a sibling of a former trainee was one of the chief writers for the show really just confirmed my suspicion.
Click to expand...

:lol: This is great!

(Is there also a character based upon "Doc Samson" on the show?)
 
HooahDOc said:
I'm an upcoming M4 interested in psych. I have narrowed my field list to FM, IM, or psych. I have a real intellectual interest in psych and have found that, of all the subjects, it is only the one of two areas that I don't have to take my ADD meds to actually study. I really enjoy learning psych-related stuff.

However, lifestyle is also very important to me. I know psych has a pretty good lifestyle, but I don't know the specifics. I will owe the MILITARY some time as well, but when I get out what type of money and hours can I expect? Are psychiatrists in as much business/financial trouble as family docs? I know a lot of FM docs are closing their doors or selling to hospital systems because they cannot afford the overhead.

My only reservation with psych is that I feel I will miss out on the majority of what "medicine" really is.

Are the fellowships difficult? I think I would really enjoy forensic psych or maybe C-L psych.

Also, how competitive is psychiatry? I have a family with a small child and ADD and sleep apnea, so I'm not exactly top of the class. Don't know what my board score is. I should have gotten honors on my psych rotation, but the other student I was working with got it (He was an MD student from the attending's alma mater who said he was interested in psych too, although I know he wasn't)

I am considering a combined IM/psych program to alleviate the above-mentioned problem. Any tips, info, advice appreciated. THanks.
Click to expand...


1) it's hard to predict what lifestyle will be like in the future. Psych tends to be one of the lower paying specialties, but it all depends on how much you want to work and in what setting.
2) if you feel like you'll miss out on the majority of what "real medicine" is(and regret that), you probably shouldn't do psych. as a psychiatrist you won't be managing acute renal failure, you won't be putting in chest tubes or central lines, you won't be trying to decide whether to intubate a copder. Now you will have to know things like- "which psychotropics should I avoid to make sure this patient with ckd doesn't tip over into arf"....but thats the "medicine" you need to know.
3) psychiatry is fairly non-competitive
4) as for doing dual IM/Psych, it probably helps some if you want a career in academia, although most academic psychiatrists didnt go this route. It probably also helps some if you want to work inpatient geri psych ward someday. and if you want to do inpatient work at a state hospital some of them like to have an IM/Psych person there. And some, depending on the size, just hire an internist or PA/NP to handle medical stuff....it just depends. But if you want to work for kaiser or community mental health or outpatient private practice doing IM/psych would be useless......
 
stupid question, what's CL?
 
whopper said:
Hahahaha...

If I remember correctly House is a Nephrologist & Infectious Disease, though I'd really have to double check on that.

But in several episodes, I kept thinking to myself--this guy, he really sounds more like a C/L psychiatrist--a REAL C/L psychiatrist, not someone who just throws an SSRI or Haldol at every patient. The episode where he diagnosed Wilson's Disease got me to start noticing that.

House several times incorporates a psychiatric perspective into his diagnostic skills. I've rarely seen any non-psychiatrist do that except for Family Practitioners.
Click to expand...

What do you mean by this?
 
In the Wilson's disease episode, the patient's psychosis, House mentioned didn't have a Schizophrenic flavor to it. As I was watching the episode, I agreed with him. There's an art to psychiatry--an art that can only be achieved after the technicals have been mastered, because the subjective art must be within the bounds of evidence based medicine.

But that one episode..where he was thinking that the Wilson's disease patient wasn't schizophrenic, that's what I'm talking about.
 
What is their income potential like?
Click to expand...
It depends on how many hours the person wants to work.

Several hospitals want someone doing CL on a least a part time basis. Some doctors do it at multiple hospitals. Some do it at only 1. Some do it in addition to other duties such as inpatient.
 
Last edited:
HooahDOc said:
So are C-L docs typically employees of a hospital? What is their income potential like? The actual society's website was a bit .. lacking.
Click to expand...

Typically, we are salaried - which I prefer given the feast or famine nature of the job (some days I get called on 10 patients and end up staying late at the hospital, some days I don't get called at all and get to catch up on reading and writing). Actual salary varies broadly, but is usually on par with what the institution would pay for inpatient work (perhaps a little more given the subspecialty status). Some folks work independently, contracting their services to a few local hospitals (typically smaller community places), but the paperwork involved in pursuing reimbursement can be frustrating. Mnay of us supplement our salary with some private outpatient work "on the side."

Which website did you look at? apm.org?
 
I'd only do med/psych or neuro/psych if you wanted to do the med or neuro with a bit of a psych emphasis (which is hard to manage). If you want to do it the other way around, I agree it would be a waste of time.

I'd say House isn't c/l because of content but because of process. Asides from being a bit Aspergery--which makes you friends nowhere--he spends time with patients, thinks broadly, and enjoys being playfully provocative. That is MUCH more like a psychiatrist than an internist.
 
You must log in or register to reply here.
Next unread thread

Similar threads

P
What is the future of psychiatry?
2
Replies
70
Views
5K
nolapsych
N
U
Chances of matching into top psychiatry programs?
Replies
10
Views
1K
DO_or_Die
D
clement
College Psychiatry
Replies
19
Views
1K
clement
clement
K
Psychiatry salary
Replies
16
Views
2K
Kalogada
K
P
Forensic Psychiatry Fellowship
Replies
4
Views
1K
PsychMD1987
P
Top