This article is for all you medical students deciding on Psych...

Aug 29, 2015
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Bright in that there is "high demand" of course but not bright in that there are many reasons for "low supply," right?

The article itself was reasonable enough, but reading the Medscape comments section (while generally never a good idea in an online setting I know) was really quite sad, with many psychiatrists talking about quitting and the destruction of their practices. In trying to decide on psych, I'm not sure that was helpful to read those :(

However, this is in contrast to most of the real life psychiatrists who I have been talking to recently; I know I am picking out a biased sample, but I've been talking to some really nice and very happy psychiatrists. They are all encouraging me to go into psych and lament the lingering misconceptions. Many would and have encouraged their own kids to go into psych. And so I have not found many really upset psychiatrists in real life.

In being a med student deciding on psych, I could really use some encouragement from stories of psychiatrists between 1 and 10 years out of residency if there are any out there that are happy and for some reason checking message boards like this. My fear of "pill mills" has been re-sparked by the comment section of that article. It would also be awesome if anyone has ever collated realistic resident job offers seen in the last couple years.
 
Aug 29, 2015
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Medical Student
In my naive mind, here's where I am at...


Cons of psychiatry:

  • pressure to do visits too quickly in many health systems, making it sad when you feel like you aren't doing your best for your patients
  • patients can be emotionally draining at times (perhaps more so than other specialties since you see fewer constitutionally happy patients)
  • lower salary than most specialties, making it harder to pay back loans in a reasonable amount of time
  • while some might include "lower respect," I am not concerned about this; those who matter don't mind (or respect you even more) and those who mind don't matter
  • possibly more lower tier physician colleagues
  • along with EM, possibility for more abusive patients
  • along with EM, FM, pain, others, more drug seeking patients that could undermine your trust in patients and people
Unclear in psychiatry:

  • payment schemes in the future
  • having enough time for patients
  • practice scope creep from mid-levels, though with such shortages, it seems like there might just be more opportunities for psychiatrists to be leaders, or this may be a pipe dream
  • being able to pay off loans in a reasonable amount of time while living frugally (this I would love to hear people 5 years out comment on)

Pros of psychiatry:

  • fascinating patient stories
  • meaningful work and great need out there
  • awesome neuroscience research ongoing and on the horizon, making the "hard science" stuff there if you want it
  • the most interesting stuff to read about to stay knowledgeable, i.e. far better literature reading than remembering a myriad of extensive algorithms in EM or IM etc
  • it's the closest field to philosophy and the quest for understanding what it means to live a good life
  • it's the field with the most colleagues interested in literature and human narratives
  • interesting and nice colleagues, at least more so on average than other specialties
  • despite visits often being about meds there is still much more time to talk to patients than any other specialty out there (true, no? in primary care it seems like you are really lucky if you get 5 minutes about the patient's life, whereas psych it seems like even a 20 minute "med" visit usually has about 17 minutes about the patient's life)
  • very high demand (and thus more flexibility)
  • colleagues that have for the most part gone into the field for true passion for it, without always wondering if it was the money that was driving them
  • possibility for "normal working person hours" if you want it and care about family and friends, i.e. you can work a 40 hour week while still making a decent salary
  • possibility for part time set-ups while still making decent money
  • possibility to work until old age, older age than almost any other specialty
  • potential for telehealth in the future, giving you more flexibility if you want it
  • one of the last specialties where private practice is still doable
  • silly but potential to have a zen and peaceful office that you design and decorate if doing outpatient
  • more interesting career sprout-offs than most other specialties
  • incredible diversity in career paths
  • highest overall job satisfaction after derm, but 10x more interesting than derm

I'm still trying to figure this out and decide what to do with the rest of my life. Candid comments on any of the above would be much appreciated.


I'm still swayable either way. I'm leaning toward yes and making the leap.
 
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nitemagi

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In my naive mind, here's where I am at...
Cons of psychiatry:
  • pressure to do visits too quickly in many health systems, making it sad when you feel like you aren't doing your best for your patients
  • patients can be emotionally draining at times (perhaps more so than other specialties since you see fewer constitutionally happy patients)
  • lower salary than most specialties, making it harder to pay back loans in a reasonable amount of time
  • while some might include "lower respect," I am not concerned about this; those who matter don't mind (or respect you even more) and those who mind don't matter
  • possibly more lower tier physician colleagues
  • along with EM, possibility for more abusive patients
  • along with EM, FM, pain, others, more drug seeking patients that could undermine your trust in patients and people
-Short visits exist in many specialties, not just psych. We have to advocate for ourselves.
-Psych patients are in every specialty. It's important to know how to manage them, and to deal with the emotions you feel in clinical practice. Or you can do an a different specialty and just get bitter that they're all just "psych"

Overall I believe if you can understand them, then you get less bitter.
 
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Doctor Bagel

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-Short visits exist in many specialties, not just psych. We have to advocate for ourselves.
-Psych patients are in every specialty. It's important to know how to manage them, and to deal with the emotions you feel in clinical practice. Or you can do an a different specialty and just get bitter that they're all just "psych"

Overall I believe if you can understand them, then you get less bitter.
Yeah, those complaints about volume pressures, short visits and bureaucratic hassles would be made by doctors in any specialty. Check out gomerblog and kevinmd.
 
Aug 29, 2015
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those complaints about volume pressures, short visits and bureaucratic hassles would be made by doctors in any specialty. Check out gomerblog and kevinmd
Definitely agree, was more suggesting that it's a bigger disservice and sadder thing to be time pressured in psych versus, for example, a 5 minute ortho clinic visit. In ortho, while it may not be enjoyable for the orthopod to have to go so fast, it is unlikely the patient could be significantly harmed from the speed at which he goes over the x-ray with the patient. In psych it seems like the time is more critical and the patient could be at greater risk with a time-pressured psychiatrist, if that makes sense. The orthopod would still be doing close to his or her "best" for their patient, the psych doc would not.

I have seen lots of psychiatrist find ways of making sure they have enough time for patients though.
 

Shikima

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You've got the option to run the clinic which suits you the best way and how it relates, if any, to any fellowship work you do.
As they say, the world is your oyster.
 

SomeDoc

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Blitz, your identity is showing on the medscape article link. Log out of medscape and then see if you can post the link to the article.
 

Monkey House

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Last year saw the largest percent increase** in applicants in psychiatry compared to any other specialty. I think applicants are now realizing all the pros of psychiatry. My prediction is this trend will continue this year as well.

**
"In 2015, we saw a 13% increase in the number of medical students who chose a residency in psychiatry — the largest increase of any medical specialty," Dr Binder told Medscape Medical News."
 
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Blitz2006

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I posted a lot of pros for Psych on this thread, in greater detail.

http://forums.studentdoctor.net/threads/why-is-psych-not-competitive.1137424/page-4

Check out post #177.

But to summarize Pros of Psychiatry:


1) Best Job Market in the business. You can work in LA or NYC or SF if you really want to.

2) Huge flexibility - You can do Addiction to Forensics to Child to Neuropsych to CL , wide spectrum (and apart from Child Psych, you don't HAVE to do a fellowship, like other specialties)

3) Money is good - You can easily earn 300k - which is on par with Optho/Non-interventional Cards/Rads/General Surgery, etc. And if you're in a big market like LA/NYC, cash only practice can lift you into the 400-500k arena.

http://www.medscape.com/features/slideshow/compensation/2013/psychiatry

19% of psychiatrists earn >300k. But what's even more impressive is that 70% of psychiatrists work <40 hours/week. 20% work between 40-50 hours a week.

So 90% of psychiatrists work <50 hrs/week. This is a scary stat. I'm dumbfounded when I hear people say Psych is "low paying". Not true at all. And its going up every year, 10% increase this year, 15% last year. Not getting smacked by Obamacare like Optho/Cards/Rads.

So we can extrapolate and say that if you clear 50 hrs (8-6 x 5 days a week) you can easily clear 300k, approach 350. Not bad for no on calls or wkd. And if you want to put in cardiology/general surgery type hours (60-65/week by doing evening PP/ECT in AM) it can be much higher than 350.

I'm not saying its Derm/Ortho money, but its definitely middle to upper tier if you look at it per hour.

4) You have the choice of working 60 hours a week or 30 hours a week. Whatever you want.

5) There is so much to learn in Psychiatry, so much unknown still. DBS for Depression? Ketamine for Depression? Future drugs for Dementia. Neuropsychiatry fellowships only started in 2004. Now there are over 30 available. Im obviously biased as I loved this stuff, but it truly is "cutting-edge". FMRIs/PET Scans, Neuroimaging. My attending said last week the future in psychopharm pharmaceuticals is dementia drugs. And with the baby boomers approaching old age....

6) Going along with flexibility, you can do inpatient/Outpatient/ER Psych/Work in Jails/do some ECT, and mix and match all of these. You're not restricted to just stenting or scoping or doing outpatient all day. or like ER docs who can never really start a private practice. With Psych you can start off doing ER/CL, then switch over to inpatient, then close out your career as outpatient. Or vice-versa!

7) Mental Stigma is in my opinion a good thing about psychiatry. Its a paradoxical effect, in that people are now talking about Psychaitry because of the stigma. After cancer, I feel people (non-medical) are now talking about mental health in the public. You don't really hear people talk about arthritis or psoriasis openly. So I dunno, we'll see.

8) Malpractice is one of the lowest. You are not paying 200K/year like OBGYN or Neurosurg Keep this in mind. Its not only how much you earn, but how much is taken away from you.

9) Overhead costs are low. Related to previous point. Psych overhead is roughly 20-25%. Compared to Optho (which is highest) that I read is 38%


Best advice I received as a medical student from a resident:

"Choosing a specialty is like buying a stock. You want to buy low, and sell high"

Its time to buy into Psych :)
 
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