Thinking about going into Psych

[PossiblyPsych]

I'm looking for an unbiased opinion. Before medical I had planned on going into psychiatry, and matriculated for that reason. I was a good student, but not an all-star by any means in college. Anyway, I have been doing alot better in medschool than I ever imagined. Since I started, I had lost my interest in psych and started to focus on other fields , mostly b/c of the overwhelming competetive attitude of my classmates ("if you don't do R-O-A-D, Cardiothoracic, etc..."). Fast forward to 3rd year. Finished my psych rotation a little while back, and absolutely loved it. Could easily see myself doing it as a career. Doesn't feel like work.

Now the question I ask myself is: Do I do psych, which I very much like, make half the money. Or bypass it to do ROAD, which i am neutral towards, and make twice as much? (I am going to be in a good deal of debt, upwards 220+)

Another question I'm afraid of asking: Does quality of residency help achieve better positions when working in the real world? Is a top psych residency worth anything besides having a name-brand attached to your name? Fellowship worth it?

What do you guys think? For completeness, top 1/3 class, Step 1 246, middle tier school. Good clinical grades. published research in related field.

Please keep the whole, money is evil thing to yourself, i want a constructive discussion on practical matters. Thanks!

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[sunlioness]

This may sound cliched, but follow your heart. Medicine is hard work no matter what specialty you go into. If you enjoy getting up and going to work every day (or most days), it makes it that much easier. You'll make plenty of money as a psychiatrist and will pay off your loans and if it's what you truly love to do, you will enjoy your life that much more because of it.

 

[peppy]

You never know what the future will hold for compensation.
Anesthesia has historically been part of ROAD but it's not exactly a golden ticket anymore now that CRNAs are invading the field.
If, like me, you find Derm conditions to be varying levels of unpleasant to downright disgusting (as I have ever since I watched an attending squeeze an incredible amount of pus out of the face of a teen with cystic acne)), you'd feel like a jerk if you went for Derm and in 10 years the field is mostly taken over by Derm NPs or something.
This is why it's good to do something you actually enjoy. Then the money is a bonus if it comes but you don't hate your life if the money doesn't pan out.

 

[Chimed]

Now the question I ask myself is: Do I do psych, which I very much like, make half the money. Or bypass it to do ROAD, which i am neutral towards, and make twice as much? (I am going to be in a good deal of debt, upwards 220+)

Please keep the whole, money is evil thing to yourself, i want a constructive discussion on practical matters. Thanks!

From a "practical matters" standpoint, you can look up how much psychiatrist make. The last I read, the average adult psychiatrist makes ~180K per year. Depending on where you want to work and what type of practice you have, you may not make that for a few years after graduating. But you could also end up making a lot more. You'll have to do the math and figure out if you could live with that while paying off loans. For myself, that's plenty. I'm also doing a child fellowship, so I have the option of making more. But I'm going for an academic career and will end up settling for far less then I could make in private practice. I also have a 200K loan debt and the idea of having to pay all that off is daunting. But I would rather do what I'm happy doing then making a lot of money; but again, it's not like I'm going to starve even with the debt.

I say, do what you love! You'll be doing this for years and years and if you're not happy, then who cares about how much money you're going to make?

 

[masterofmonkeys]

Make close to 200k doing something you love. Or make 300-500 doing something you don't like as much. Well, the decision involves money and what it does for you.

Paying off the debt? Not an issue. I don't budget, and even in residency (3k take home per month) I'm able to pay down at least some of the principal every month, while not slouching on wasting money on toys and fun. The debt is just not that big a deal in the end from a lifestyle perspective.

So the question comes down to, what does that extra money get you? And is it enough to make up for the lack of job satisfaction (in a quantitative sense roughly 1/3 of your waking hours)?

We have no idea what's important to you and what you could do with that money. I am a firm believer in money not equaling happiness, but I also believe that there is pragmatic freedom that money gets you.

Maybe you enjoy ortho half as much as psych. But being able to work 50% in ortho and make the same money gives you 2.5 days a week to pursue your passion as a writer or an operatic singer even if you never make a dime doing it. And maybe that package deal is better than just working psych.

*shrug* Figure out what the money does for you, and that's your answer.

 

[PossiblyPsych]

Thank you for the reply fella's. I definately have some things to figure out. I guess one question I was curious about, and need to clarify a bit is:

What kind of opportunities does going to a MGH/Mclean, Columbia, Cornell, UCSF, etc. open up for a psychiatric graduate? I understand that alot of different residency programs, for example EM, most say the program does not matter much, especially if you would like to practice in the community. Is this the case for Psychiatry? Or is there a tremendous benefit to going to a more prestigious program? And what kind of applicant are these places looking for.

I've searched for these answers and found a glimpse here and there, but nothing directly. Thanks.

 

[OldPsychDoc]

Thank you for the reply fella's. I definately have some things to figure out. I guess one question I was curious about, and need to clarify a bit is:

What kind of opportunities does going to a MGH/Mclean, Columbia, Cornell, UCSF, etc. open up for a psychiatric graduate? I understand that alot of different residency programs, for example EM, most say the program does not matter much, especially if you would like to practice in the community. Is this the case for Psychiatry? Or is there a tremendous benefit to going to a more prestigious program? And what kind of applicant are these places looking for.

I've searched for these answers and found a glimpse here and there, but nothing directly. Thanks.

The "prestige" programs primarily matter if you are hoping to have an academic career in those same "prestige" programs.

 

[Addiction]

If your sole reason for not going into Psychiatry is money even though it is the specialty you love the most you have been misinformed about the financial opportunities in Psychiatry. Hard-working psychiatrists can easily make $300-$500K. My cousin is an attending in New York and completed an Addiction fellowship after general psychiatry residency. He works two jobs (ER and a dual diagnosis attending) and pulls in $400K+ putting in around 50+ hours a week with most of his weekend time free to spend time with his kids.

If you are willing to put in the same hours that other specialities put in (50-60 hours/week) you can make just as much as the ROAD specialties. And if you're business savvy you can make a lot more.

 

[VMSmith]

What kind of opportunities does going to a MGH/Mclean, Columbia, Cornell, UCSF, etc. open up for a psychiatric graduate? I understand that alot of different residency programs, for example EM, most say the program does not matter much, especially if you would like to practice in the community. Is this the case for Psychiatry? Or is there a tremendous benefit to going to a more prestigious program? And what kind of applicant are these places looking for.

There are a few circumstances where the brand of your residency matters after residency - one is if you want an academic career at one of those institutions and another is if you want to practice in one of those cities and treat the super-elite patients that gravitate towards those brand names and to have access to the referral networks of those programs' graduates.

Otherwise, the value of training at one of those programs comes from having access to the "cutting edge" research and thinking that goes on there. You can definitely make the argument that non-brand-name programs also have that going on though.

 

[Addiction]

Why are psychiatrists in general so afraid or uncomfortable talking about income potential in the field? Is it the type of people who go into psychiatry or just that everybody thinks making a lot of money is psychiatry is just not possible? I'm interested in hearing what people think.

 

[dl2dp2]

Just to echo other's posts. I recently made the same decision about residency choice. If you really like psych, I think you should do psych.

(1) There *are* ways to make money in psych, ESPECIALLY if you go to a top program. And it sounds like you are a strong candidate. This should not be an issue. All of the ROAD specialties make money through doing a large quantity of repetitive work. This is feasible in psych as well. Also, it's unlikely that you can enjoy the same lifestyle in psych in a ROAD specialty and make TWICE as much. How many dermatologists and ophthalmologists in big cities make $400k+? Also, they DEFINITELY don't make this much starting out. The more likely scenario is that in similar practice venues (academic vs. academic, PP vs. PP), ROAD makes 30-40% more. With progressive income tax, that 30% translates to 15% take home. And likely the ROAD salaries based purely on high volume procedures will decrease in the future. You are banking on something very uncertain here.

(2) While debt is an issue, in practice it's less of an issue after graduating.

(3) I think one has to make up one's mind about psych because it's not like anything else in medicine. You have to be okay with it yourself as that's going to be your professional identity. Once that decision is made, everything else is trivial.

Think this through and be careful. Of course you always have the option of switching specialties later on, especially if you are a good candidate. You don't know what's gonna happen in the future with regard to salaries. You should make your decision based on your current info, which is that you love psych.

 

[235750]

It sounds like your motivations to do a ROAD specialty are due to a misunderstanding of your debt and how you can pay it back.

Your debt isn't that bad. As former professional students, my wife and I will have almost triple the debt you have (600k) which does not include our house. We plan to have our education paid off in 8 yrs, mostly due to this program. And we'll be taking the lowest paying psychiatry positions out there. It's really not as bad as you think.

You should talk to your financial aid department or an attending who recently finished his/her training to get some perspective on loan repayment. Good luck in your decisionn