What field of medicine is similar to Psychiatry?

[J ROD]

is there any field in medicine that is close to Psychiatry? I worry that as a Psychiatrist I will lose my clinical skills on what some would call "real" medicine.

I think IM and FM are the closest I can think of. Sometimes, I think I should just do an IM/Psy combined. That way I can do both. And I love having variety.

But, I have read and hear that usually you have to pick. I want to do Psy but also want to use my stethoscope too.

Any thoughts.....

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[CoxMD]

Many minor and chronic psychiatric conditions are treated by PCPs. Family medicine may have the balance that you are looking for.

 

[J ROD]

I like the issues in pure Psy more than FM though. I really get sick of the same stuff in FM. You dont really get to handle all the indepth Psy issues in 15 min appts in FM.

I rather do IM than FM personally. Plus, you have the option of all those fellowships.

 

[kexy]

Maybe look into combined IM/Psych --> psychosomatic medicine. I had a lecturer who took this path, and his job seemed pretty awesome. He basically deals with patients that other doctors can't/won't diagnose. Some of them have problems with true 'medical' causes, but most of their problems are probably psychological (depression, somatic symptom disorder, etc.). Or both.

 

[Anastomoses]

You could insist on mandatory auscultation + physicals for all your psych patients?

I just think it's so cool that there are people out there who want to do psychiatry and others who want to deliver babies. Super cool.

 

[JP2740]

You can pick up a lot in OB/GYN im sure

 

[KinasePro]

Consult-liason psychiatry. They're basically psych hospitalists who evaluate medical & surgical inpatients for possible psych issues. Need to know a lot of medicine, and can do physicals as much as you're comfortable.

 

[J ROD]

Yeah, I agree. I just dont know if the IM/Psy route is the best or do a fellowship after Psy. And, I hear you dont even need the fellowship to do C/I Psy. But, I hear those that do are really bad ass.

 

[Perrotfish]

is there any field in medicine that is close to Psychiatry? I worry that as a Psychiatrist I will lose my clinical skills on what some would call "real" medicine.

I think IM and FM are the closest I can think of. Sometimes, I think I should just do an IM/Psy combined. That way I can do both. And I love having variety.

But, I have read and hear that usually you have to pick. I want to do Psy but also want to use my stethoscope too.

Any thoughts.....

Pediatrics with an adolescent medicine fellowship. The fellowship is at least half psych, and many of the jobs are basically inpatient psych (particularly units devoted to feeding disorders), but the clinic has has a decent amount of general medical stuff as well. Of course the pathway is 6 years and goes through a general pediatric residency.

If you like inpatient medicine I think med/psych is also a good option.

Of course, if you have a high loan burden, I would say to avoid long training pathways and to just do psych.

 

[J ROD]

Peds no way. The less I work with kids the better to me. I dont mind some but not all day.

I want to be mainly Psy. I find it more interesting. I like the pathology.

IF I had it my way I could do consults to the ER mostly and the floor. And then do some private practice stuff too.

And I hear unless academics is your choice route, then the combined Psy/IM is not a good idea. Because you basically have to pick one.

SO, I guess I need to know more about what C/L Psy does. Do they actually use some medicine in addition to Psy. Like they think it is a Psy issue but after I examine them I can say not so fast....it is more a med issue. I need to get more exposure to what they do.

I also like the mental aspects of pain and consider the Psy....Pain fellowship route. But, I hear that is not really an option. Few from Psy can get in.

So, I guess after some reading Psy would be my best route since I like that the most and then find a way to use my med knowledge. Then, look at fellowships. I know the Psychosomatic fellowship in Psy is relatively new and may find a specific spot.

I dont want to round forever on med wards. And deal with mostly IM issues. I rather deal with Psy issues and still some med. I would like to be solid in IM and FM matters when needed though.

 

[VA Hopeful Dr]

Do psych, get a job in a long-term ward at a state hospital. You deal with their crazy AND have to manage their medical issues - metabolic stuff from the antipsychtics, random illness/injury, blood pressure and so on.

EDIT: Psych/IM would serve you well for this, but that's a longer haul in residency.

 

[J ROD]

Do psych, get a job in a long-term ward at a state hospital. You deal with their crazy AND have to manage their medical issues - metabolic stuff from the antipsychtics, random illness/injury, blood pressure and so on.

EDIT: Psych/IM would serve you well for this, but that's a longer haul in residency.

I would imagine state hospital pay is not that good though. I will have a good deal of loans and need to get a good paying job as well in Psy. I cant make below 200K. I have run the numbers. I can after I pay the loans back. What about the VA?

 

[J ROD]

From the ABPN,

"Candidates in the subspecialty of psychosomatic medicine are those in the field of psychiatry, who are seeking ABPN Board Certification. Psychosomatic medicine is a subspecialty that involves the diagnosis and treatment of psychiatric disorders and symptoms in complex medically ill patients. This subspecialty includes treatment of patients with acute or chronic medical, neurological, obstetrical or surgical illness in which psychiatric illness is affecting their medical care and/or quality of life such as HIV infection, organ transplantation, heart disease, renal failure, cancer, stroke, traumatic brain injury, high-risk pregnancy and COPD, among others. Patients also may be those who have a psychiatric disorder that is the direct consequence of a primary medical condition, or a somatoform disorder or psychological factors affecting a general medical condition. Psychiatrists specializing in Psychosomatic Medicine provide consultation-liaison services in general medical hospitals, attend on medical psychiatry inpatient units, and provide collaborative care in primary care and other outpatient settings."

I like the sound of that. If that is what they truly do, then this sounds like the best route for me. Not to mention I am a pharmacist as well. So, I know the drugs pretty well.

 

[loltopsy]

I would imagine state hospital pay is not that good though. I will have a good deal of loans and need to get a good paying job as well in Psy. I cant make below 200K. I have run the numbers. I can after I pay the loans back. What about the VA?

VA pay is worse than hospital pay, at least the one in my area is. Private practice is a better paying option.

 

[RockDoc7]

From the ABPN,

"Candidates in the subspecialty of psychosomatic medicine are those in the field of psychiatry, who are seeking ABPN Board Certification. Psychosomatic medicine is a subspecialty that involves the diagnosis and treatment of psychiatric disorders and symptoms in complex medically ill patients. This subspecialty includes treatment of patients with acute or chronic medical, neurological, obstetrical or surgical illness in which psychiatric illness is affecting their medical care and/or quality of life such as HIV infection, organ transplantation, heart disease, renal failure, cancer, stroke, traumatic brain injury, high-risk pregnancy and COPD, among others. Patients also may be those who have a psychiatric disorder that is the direct consequence of a primary medical condition, or a somatoform disorder or psychological factors affecting a general medical condition. Psychiatrists specializing in Psychosomatic Medicine provide consultation-liaison services in general medical hospitals, attend on medical psychiatry inpatient units, and provide collaborative care in primary care and other outpatient settings."

I like the sound of that. If that is what they truly do, then this sounds like the best route for me. Not to mention I am a pharmacist as well. So, I know the drugs pretty well.

I'm a psychiatric social worker working in county psych. I can tell you that state hospital/prison pay is much more significant. One of our psychiatrists here got a flyer stating that any board caertified psychiatrist will have a starting annual salary of $240,000 and increase from there (whether you've been working for many years or fresh out of board cert). I was skeptical at the salary until he showed me the flyer. Kinda crazy in a great way.

As a side note, the Psychosomatic subspeciality sounds pretty incredible and seems to fit very well with what you are looking for. Good luck to ya mate.

 

[J ROD]

I'm a psychiatric social worker working in county psych. I can tell you that state hospital/prison pay is much more significant. One of our psychiatrists here got a flyer stating that any board caertified psychiatrist will have a starting annual salary of $240,000 and increase from there (whether you've been working for many years or fresh out of board cert). I was skeptical at the salary until he showed me the flyer. Kinda crazy in a great way.

As a side note, the Psychosomatic subspeciality sounds pretty incredible and seems to fit very well with what you are looking for. Good luck to ya mate.

I heard the money is there in Cali before. I am in the Southeast. If I could get that here, I would be def be down for that. lol

 

[VA Hopeful Dr]

I would imagine state hospital pay is not that good though. I will have a good deal of loans and need to get a good paying job as well in Psy. I cant make below 200K. I have run the numbers. I can after I pay the loans back. What about the VA?

I don't know the numbers for psych pay, but in Columbia the VA pays its hospitalists pretty well.

I also don't know what DMH pays, I only did some moonlighting so actual salaries weren't an issue.

 

[J ROD]

I don't know the numbers for psych pay, but in Columbia the VA pays its hospitalists pretty well.

I also don't know what DMH pays, I only did some moonlighting so actual salaries weren't an issue.

Just looking at the state jobs website.....it looks around 125K.

maybe there is some kind of extra pay I dont know of to compensate that.....but that is way too low.

 

[VA Hopeful Dr]

Just looking at the state jobs website.....it looks around 125K.

maybe there is some kind of extra pay I dont know of to compensate that.....but that is way too low.

Those are for outpatient mental health offices. There's 1 advertised inpatient job up near Anderson, but salary isn't mentioned. My guess would be starting 150k, but every psych I met up there did some of the inhouse moonlighting (which I did as a resident) to make up the difference. $65/hour doesn't seem like much until you consider that in the 24h weekend shifts I did, I'd usually have 1-2 admissions and maybe 2-3 calls in that time. No night admissions, very self-sufficient nurses. I usually spent 20 of those hours sleeping/watching movies in the call room. Same thing applies to overnight weekday.

If you do one weekend overnight/month that's 18k, add on 12k if you do 1 weeknight shift per month. Now we're talking closer to 180k/year. Plus, state benefits are pretty good.

 

[J ROD]

Those are for outpatient mental health offices. There's 1 advertised inpatient job up near Anderson, but salary isn't mentioned. My guess would be starting 150k, but every psych I met up there did some of the inhouse moonlighting (which I did as a resident) to make up the difference. $65/hour doesn't seem like much until you consider that in the 24h weekend shifts I did, I'd usually have 1-2 admissions and maybe 2-3 calls in that time. No night admissions, very self-sufficient nurses. I usually spent 20 of those hours sleeping/watching movies in the call room. Same thing applies to overnight weekday.

If you do one weekend overnight/month that's 18k, add on 12k if you do 1 weeknight shift per month. Now we're talking closer to 180k/year. Plus, state benefits are pretty good.

I see. I never knew the difference. Yeah, I could do that for a bit to get experience and see if they actually will forgive the loan debt if you work for a public sector. I really would hope that option works.

 

[Armadillos]

One thing to consider based on talking to people in fields like social work, counseling,etc is that because a lot of times whatever agency/practice/treatment facility/etc they are working for doesn't really have immediate access to any other MDs the psychiatrist kind of becomes the go to person for any sort of medical question.

So while you might not necessarily be treating all these people's medical conditions, when someone tells their social worker they started coughing up blood last week but aren't concerned about it, the social workers are immediately looking for you as the MD for advice or if someone has a seizure in the substance abuse counsellor's office down the hall, they are going to be knocking on your door.

 

[neurodoc]

Neurology.

 

[J ROD]

Neurology.

True in some aspects but not the way I like.

I dont care for the work.

 

[evilbooyaa]

One of the psychiatrists at the psych ward I did rotations at did all of the psych consults that came into the hospital. He had to grab his stetho for every consult at least to say he listened to the lungs and heart.

 

[Kahreek]

you can/have to use your stetho to gain attention of some psychotic patients, uhm.

Strategies to settle down a psychotic aside, i think checking vitals is a important step to assess medication status, excitability, etc,etc I am sure they have many uses for it. Especially psychiatric departments integrated in major hospitals that treat patients with other diseases, do counseling and management for normal/borderline normal/on psy medication patients in other departments.

 

[michaelrack]

He had to grab his stetho for every consult at least to say he listened to the lungs and heart.

Not required (at least when I do psych consults on the med wards it is not required).

 

[evilbooyaa]

Not required (at least when I do psych consults on the med wards it is not required).

I think these were ED consults, so besides the ER physician, no one else had been in to see them yet.

 

[michaelrack]

I think these were ED consults, so besides the ER physician, no one else had been in to see them yet.

still not required. The ED doc is responsible for doing the physical exam and medically clearing the patient.

 

[evilbooyaa]

still not required. The ED doc is responsible for doing the physical exam and medically clearing the patient.

Interesting. Wonder why he did it then.

 

[michaelrack]

Interesting. Wonder why he did it then.

Maybe he feels insecure and does it so he fees like a real doctor (I am not saying that psychiatrists aren't real doctors, just that this might be his motivation).

 

[pietachok]

I haven't read the whole thread, but why aren't you considering Neurology?
Many of the chronic neurologic diseases are also associated with psychiatric symptoms or dementia.
Acute and chronic neuro conditions can completely impact personality, decision making, etc., so I would say that has a heavy psych component.
Addiction, chronic pain, dementia, delirium all straddle neuro/psych.
And there are many patients who require a thorough medical evaluation (thyroid, autoimmune, etc.) to differentiate between neurologic versus "psychiatric" etiology when presenting with psychosis/AMS, so you will retain and use your "medical" exam and diagnostic skills.

 

[Kahreek]

i agree with this post.
Unless you really hate neuroanatomy, but hey everyone hates neuroanatomy when it has no clinical meaning. It gets way better with clinical practice.

 

[J ROD]

Again, I dont like the path and stuff I would see in Neuro. I have shadowed it some and didnt like it at all honestly.

I feel the Psy route with Psychosomatic fellowship would make more sense for me.....OR

if I get into Pain and like it......perhaps trying to do the Pain fellowship from Psy.

I know it is very hard but I dont want to take the other paths and if I didnt get Pain, I would not want to do Anes, PMR, or Neuro.

 

[Anastomoses]

Again, I dont like the path and stuff I would see in Neuro. I have shadowed it some and didnt like it at all honestly.

I feel the Psy route with Psychosomatic fellowship would make more sense for me.....OR

if I get into Pain and like it......perhaps trying to do the Pain fellowship from Psy.

I know it is very hard but I dont want to take the other paths and if I didnt get Pain, I would not want to do Anes, PMR, or Neuro.

it could be the red wine but I just love that stewie and his tan.

 

[gbv]

Your inclinations sound about right..C/L. From what you've posted and your clinical interests it sounds like it would be a hand-in-glove fit, I was VERY similar to you: loved neuroscience, hated clinical neurology, loved clinical psychiatry, liked IM quite a bit too but not enough to do it ALL the time. Most of my clinical work is consultation Psych and I absolutely love it--love the varied pathology and one also has the opportunity to keep one's general medicine knowledge sharp. Plus it's just plain fun.

 

[J ROD]

it could be the red wine but I just love that stewie and his tan.

thank God you are a woman.......

 

[slickster032]

There's a ton of "real medicine" in psychiatry. I'm a pgy-1, doing inpatient this month. so far on inpatient psych, I've successfully bridged a guy on warfarin who was brought in for psych decompensation (he stopped taking his warfarin for three weeks, no acute PE or DVT which would have gone straight to medicine lol). I'm managing someone's chronic pain (discontinuing opiates) in addition to substance dependence. I diagnosed a case of hashimoto's thyroiditis after ordering TSH then TPO antibodies (consulted endo for management). I consult when appropriate and when I don't know what the hell I'm doing. I had another lady with panic attacks in ED sent to psych, checked her tsh it was <.01. I've worked up TBI vs ADHD.

On call you routinely get called for medical stuff, unless it's a code and the person is crashing. Someone fell, you get called. Orthostatic hypotension, you get called. Hypertension, you get called. SIRS, you get called. Somebody trying to leave AMA who's demented/delirious, you get called. At least where I am training, on the psych units you are the primary MD and will get paged about anything medical or psychiatric going on with the patient. You can consult when appropriate and I do, but if I feel like I can handle it, I handle it myself.

A lot of time really sick psych patients only see their psychiatrist so you end up doing a lot of PCP stuff. Plus there's a lot of overlap between mental illness/neurologicla disorders/medical disorders. plus medical disorders can masquerade as psych disorders and vice versa. Don't buy into that stigma that psychiatrists aren't real doctors. We prescribe some of the most dangerous medications in all of medicine: lithium, clozaril, vpa, etc which all have a ton of medical complications that you are responsible to monitor. You wouldn't believe how much **** gets missed on psych patients because they're hard and a lot of ED docs, understandably so, want to get rid of them ASAP. Just because an ED doc cleared someone, does not mean they didn't miss anything. I had a guy cleared from ED who was floridly psychotic, disorganized, sent to the psych unit (at our facility we are required to do physical exams on everyone who comes into the psych unit). He had rebound tenderness, transferred to gen surgery, diagnosed with appendicitis, had surgery, back on our unit after a couple days.

If you love psych do it, don't not do it because you're afraid of not being a "real doctor" and practicing "real medicine." Yes, you will stigmatized by your non-psych physicians and that's something you'll have to deal with. Psychiatry is an awesome field.

 

[J ROD]

Good post. Thanks. I look forward to handling that stuff and I already know some of it being a pharmacist.

I have done Coumadin and Pain stuff. etc.

 

[SteinUmStein]

There's a ton of "real medicine" in psychiatry. I'm a pgy-1, doing inpatient this month. so far on inpatient psych, I've successfully bridged a guy on warfarin who was brought in for psych decompensation (he stopped taking his warfarin for three weeks, no acute PE or DVT which would have gone straight to medicine lol). I'm managing someone's chronic pain (discontinuing opiates) in addition to substance dependence. I diagnosed a case of hashimoto's thyroiditis after ordering TSH then TPO antibodies (consulted endo for management). I consult when appropriate and when I don't know what the hell I'm doing. I had another lady with panic attacks in ED sent to psych, checked her tsh it was <.01. I've worked up TBI vs ADHD.

On call you routinely get called for medical stuff, unless it's a code and the person is crashing. Someone fell, you get called. Orthostatic hypotension, you get called. Hypertension, you get called. SIRS, you get called. Somebody trying to leave AMA who's demented/delirious, you get called. At least where I am training, on the psych units you are the primary MD and will get paged about anything medical or psychiatric going on with the patient. You can consult when appropriate and I do, but if I feel like I can handle it, I handle it myself.

A lot of time really sick psych patients only see their psychiatrist so you end up doing a lot of PCP stuff. Plus there's a lot of overlap between mental illness/neurologicla disorders/medical disorders. plus medical disorders can masquerade as psych disorders and vice versa. Don't buy into that stigma that psychiatrists aren't real doctors. We prescribe some of the most dangerous medications in all of medicine: lithium, clozaril, vpa, etc which all have a ton of medical complications that you are responsible to monitor. You wouldn't believe how much **** gets missed on psych patients because they're hard and a lot of ED docs, understandably so, want to get rid of them ASAP. Just because an ED doc cleared someone, does not mean they didn't miss anything.

If you love psych do it, don't not do it because you're afraid of not being a "real doctor" and practicing "real medicine." Yes, you will stigmatized by your non-psych physicians and that's something you'll have to deal with. Psychiatry is an awesome field.

Round of applause for this post. Seriously, anyone who thinks psychiatrists can get away without knowing their medicine either has not done a real psych rotation or has only worked with garbage psychiatrists. Managing chronic bipolar patients who have elevated LFTs with vpa and Cr bumps with lithium (are they real? are they acceptable?), managing patients undergoing ECT with a real seizure disorder on multiple AEDs (with the help of neuro of course), managing schizophrenics with HTN, HLD, who are already 70 lbs overweight who haven't seen a PCP in 10 years and probably will never see one again, and on and on. There is real medicine in psychiatry and honestly it's a ton of fun and a challenge. Psychiatrists ignore medicine at their patients' peril.

Everything's fluffy social situations and psychodynamic posturing until your patient's QTc is 520 from the drugs you prescribed because you weren't paying attention. Don't be that doc. And don't give psychiatrists crap until you're the one writing for heroic doses of clozaril for the man who thinks the insects in his apartment have microchips that are recording his conversations.

 

[michaelrack]

A lot of time really sick psych patients only see their psychiatrist so you end up doing a lot of PCP stuff.
=.

only during residency

 

[michaelrack]

Managing chronic bipolar patients who have elevated LFTs with vpa and Cr bumps with lithium (are they real? are they acceptable?), .

IN the real world (non-academia/residency), this is handled by slightly reducing the dose of med and consulting the relevant specialist or the patient's pcp.
--------------------

Having some medical knowledge will make you a better psychiatrist, but 5 years post-residency you won't be doing any pcp type activities.

 

[b-real]

Round of applause for this post. Seriously, anyone who thinks psychiatrists can get away without knowing their medicine either has not done a real psych rotation or has only worked with garbage psychiatrists. Managing chronic bipolar patients who have elevated LFTs with vpa and Cr bumps with lithium (are they real? are they acceptable?), managing patients undergoing ECT with a real seizure disorder on multiple AEDs (with the help of neuro of course), managing schizophrenics with HTN, HLD, who are already 70 lbs overweight who haven't seen a PCP in 10 years and probably will never see one again, and on and on. There is real medicine in psychiatry and honestly it's a ton of fun and a challenge. Psychiatrists ignore medicine at their patients' peril.

Everything's fluffy social situations and psychodynamic posturing until your patient's QTc is 520 from the drugs you prescribed because you weren't paying attention. Don't be that doc. And don't give psychiatrists crap until you're the one writing for heroic doses of clozaril for the man who thinks the insects in his apartment have microchips that are recording his conversations.

That may be the case for you, but I sure get a lot of transfers to my ED from the psych unit for BP 160/92 and blood glucose of 320...