What's the downside?

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Hi All,

I'm a soon-to-be 4th year slowly whittling down my list of possible specialties. Right now I'm leaning heavily towards psychiatry. (It's the rotation I had the most fun on 3rd year and it has the most interesting diseases.)

I'd love it if you residents and attendings could describe what you see as the downsides to being a psychiatrist? I want to enter the field with my eyes open to all the downsides as well as the fun.

Thanks! :)
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CaMD said:
Hi All,

I'm a soon-to-be 4th year slowly whittling down my list of possible specialties. Right now I'm leaning heavily towards psychiatry. (It's the rotation I had the most fun on 3rd year and it has the most interesting diseases.)

I'd love it if you residents and attendings could describe what you see as the downsides to being a psychiatrist? I want to enter the field with my eyes open to all the downsides as well as the fun.

Thanks! :)
Click to expand...

search for the thread on the New York Ax-murderer.....this might be a bit of a downside...
 
Love psychiatry. Very glad I'm in it and its a dream come true.

Things I don't like about it? Very few--most of the things I don't like about it would've happened in any field of medicine.

But from the perspective of a 4th year MS, here were some letdowns....

-Some psychiatrists have forgotten their medicine to the point where its shameful. Don't allow this to happen to you. However its annoying seeing some of the older attendings do things which show their lack of medical knowledge
-I learned several clinically relevant bits of data while obtaining my B.S. in psychology that isn't taught in psychiatry. Many of the things I learned in psychology were tested to the point where we really had to study it hard. In psychiatry, many of the lectures aren't tested and you're half asleep in lecture because you were on call the night before. Several residents aren't too concerned about picking up stuff they're not going to be tested on.
-Lots of the medical data you learned as a MS will not be used in psyche-e.g. delivering a baby, casting a broken bone etc.
-you might miss doing certain things you did in the other fields--suture, procedures


Every field will have its ups & downs.
 
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I am soon-to-be psych pgy1. one of the things i get tired of is the feeling that i always need to explain to people "why psychiatry." family and close friends will always ask why you picked your field of medicine- I'm talking about complete strangers.

at the bar the other night a friend of mine introduced me to a girl (that he was hitting on) and mentioned that i was soon to start a psych residency, next comment from this lady "it's so stupid that people actually think taking a pill will make them feel different. why would you ever get into that field?"

Granted, you don't have to respond or try and justify your position- you can just listen and move on. it's just the fact that you have to continually hear that kind of crap. you get the same stuff, to a degree, in select other fields (only pervs go into OB, gas is so boring, etc) but i think the public perception of psychiatry is just way off from what we really do.

everything else is all roses! :laugh:

good luck w/your decision- it's never easy.
 
Thanks for your replies. :)

The whole "forgetting the rest of medicine" thing is definitely leading to some hesitation in my mind, as is not getting to do procedures. If psych had some procedures (aside from ECT, which I found underwhelming to watch) I would be 100% on board already!!

But really, going into any specialty is going to lead to a lapse of information in all the others. And I liked IM, but I didn't love it.

When I say I'm considering psychiatry to other doctors I either get an "oh" and then silence, which I interpret as judgement that I'm weird or a flake or something or I get an enthusiastic "I loved my psychiatry rotation and I strongly considered it." I haven't told anyone outside the hospital yet. I can definitely see other people's unrequested opinions really frustrating me/pissing me off.
 
Clearly, every field has issues.

Psychiatrist not being "chick magnets" is really not a disadvantage. Do you really want the gold diggers that come chacing after you when you claim you are a "Surgeon" or a "Heart Doctor"?

Only disadvantage in Psychiatry is lack of procedures but that is the price of being in a specialty with the advantage of not needing to worry about the success of a procedure on the first few days after it. So you live more care free.

As a matter of fact, I enjoy the reaction I get when I tell them I am starting psychiatry. Snarcky comments by them is followed by the typical, "I see, and how long have you been feeling that way?"
 
Another possible downside is that it can be taxing to work with psychiatric patients. You often end up holding feelings of hopelessness, depression, anger, frustration etc. from patients, families, and other members of the health care team. Of course, it is rewarding to be able to be helpful with problems that others are not as skilled with, but many of our patients do not improve as much as they or we would like. It's like any chronic medical illness, except our patients are often younger and more stigmatized.

That said, we are lucky to be trained in just how to recognize and manage these feelings. This comes in handy not just with patients, but as an important life skill.
 
Faebinder said:
Clearly, every field has issues.

Psychiatrist not being "chick magnets" is really not a disadvantage. Do you really want the gold diggers that come chacing after you when you claim you are a "Surgeon" or a "Heart Doctor"?
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Hey, Sazi and whopper don't seem to have any trouble getting chicks! (Posts #5 & 10) :D
 
"Forgetting your medicine" isn't unique to psychiatry.
I was rotating with an Orthopedic surgeon not long ago and the patient was complaing about a rash on her knee.
Silence in the room. The Orthopod looks at me (MS-IV) and says, "Know anything about skin?"
 
Faebinder said:
Clearly, every field has issues.

Psychiatrist not being "chick magnets" is really not a disadvantage. Do you really want the gold diggers that come chacing after you when you claim you are a "Surgeon" or a "Heart Doctor"?

Only disadvantage in Psychiatry is lack of procedures but that is the price of being in a specialty with the advantage of not needing to worry about the success of a procedure on the first few days after it. So you live more care free.

As a matter of fact, I enjoy the reaction I get when I tell them I am starting psychiatry. Snarcky comments by them is followed by the typical, "I see, and how long have you been feeling that way?"
Click to expand...

Don't forget to say "Interesting. Tell me about your relationship with your mother" since most people don't know what the dif between psychiatry and psychology, and since that question makes them freak out. ;)
 
MaddieMay said:
Don't forget to say "Interesting. Tell me about your relationship with your mother" since most people don't know what the dif between psychiatry and psychology, and since that question makes them freak out. ;)
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I don't think the question has anything to do with the difference between psychiatry and psychology.

I doubt psychologists who do animal research, or genetics, or just CBT, or neuropsychiatric assessment, etc., ask that question much. Psychiatrists with a broad biopsychosocial perspective, and certainly those who are psychodynamically oriented, however, will (not always in a stereotypical way) ask about childhood and especially relationships with parental figures.

And vice versa.
 
whopper said:
-you might miss doing certain things you did in the other fields--suture, procedures
Click to expand...

These things are actually what's pushing me towards psych! I don't care to ever do another procedure. I often wonder, though, if I should follow my gut and go with psychiatry, or push through my anxiety about procedures and go with family medicine. It's going to be a hard decision!
 
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marie337 said:
These things are actually what's pushing me towards psych! I don't care to ever do another procedure. I often wonder, though, if I should follow my gut and go with psychiatry, or push through my anxiety about procedures and go with family medicine. It's going to be a hard decision!
Click to expand...


Well, if it's truly your gut telling you to go for psych, then that's what you do. Procedures make me anxious too, but in addition to that no matter how good I was at them, I still wouldn't like them. It's an important distinction to make. :)
 
masterofnone said:
I am soon-to-be psych pgy1. one of the things i get tired of is the feeling that i always need to explain to people "why psychiatry." family and close friends will always ask why you picked your field of medicine- I'm talking about complete strangers.


An option is to answer "the voices in my head told me so". Nobody ever questioned me further.
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Not a Chick magnet?

Most of the girls I've met looking for a guy, if they were after a profession just wanted a doctor. They didn't seem to care so much if it was psychiatrist vs a cardiologist.

Word of advice to single doctors out there--my wife is a former opera singer. Several music majors are always on the lookout for someone with a stable profession and several of them are hot women. IF you're in NYC--Manhattan School of Music, NYU's Arts' program & Juliard are good hook up places--and its not like these girls aren't intelligent & talented.

All her friends would ask me to hook them up with a resident, but at that time she was in NYC & I was in South Jersey, so the distance factor messed up any matchmaking.
 
the thing is, the voices in my head did tell me to get into psychiatry- that's why I hate it when people bring it up...it makes me paranoid that they're reading my thoughts again :scared:

as to the "chick magnet" statements...that was not the way I was headed. I agree w/whopper, if someone does care what you do for a living "physician" is usually good enough. My point was simply that people don't wrinkle up their nose and question why my optho or gen surgery friends got into their line of work.

Obviously, it's not that big of a deal to me or I wouldn't have entered into the field- just trying to give the OP my take on the only, slight, negative.
 
psydoc said:
masterofnone said:
I am soon-to-be psych pgy1. one of the things i get tired of is the feeling that i always need to explain to people "why psychiatry." family and close friends will always ask why you picked your field of medicine- I'm talking about complete strangers.


An option is to answer "the voices in my head told me so". Nobody ever questioned me further.
Click to expand...

Wow, I can already see the reaction... I am so using this the next time I get asked why psych. This should be fun. :laugh:
Click to expand...
 
whopper said:
IF you're in NYC--Manhattan School of Music, NYU's Arts' program & Juliard are good hook up places--and its not like these girls aren't intelligent & talented.
Click to expand...

I matched at Mt Sinai ... and I'm single ... so please PM me if you're joking because I may try this!
 
Haha...

I wouldn't be so quick. We have a running joke that anyone that comes in from the School of Visual Arts gets Borderline PD until proven otherwise.


Agree with OPD. Hone your axis II detecting skills before you announce that in the bar.
 
I've heard that divorce rates among psychiatrists are high compared to other specialties. I don't know anything else about any of these correlational studies other than one was done at Hopkins in the 90's - no clue on the N, control of confounders, etc etc and couldn't find a previous thread on it.
 
I wouldn't be so quick. We have a running joke that anyone that comes in from the School of Visual Arts gets Borderline PD until proven otherwise.
Click to expand...

True, and I was going to go into art, but didn't like most of the artists I met. There's 2 general typs in art school. Those that are disciplined and they're not BPD. Then there's those that think to be a true "artiste" they need to be a borderline because that makes them "unique" (which we all know if full of $hit). Just that they don't know acting this way just shows how idiotic they are. (Just a generalization, but lots fit into this).

But don't go for the undergraduate girls, go for the women in the graduate programs. By then the borderlines often don't get a graduate degree, and if they did, the BPD has mellowed considerably.

Ah heck, NYC is just chock full of women. You shouldn't have too much of a problem unless you're too busy (which makes for a great & valid excuse to bring up if you meet a girl and it just doesn't work out & need to break up).

I guess I'm getting old because I'm reccomending to you residents to get a good girl (or any significant other). Makes life a heck of a lot more stable which is what you need during residency.

(Sorry to get OT)
 
whopper said:
True, and I was going to go into art, but didn't like most of the artists I met. There's 2 general typs in art school. Those that are disciplined and they're not BPD. Then there's those that think to be a true "artiste" they need to be a borderline because that makes them "unique" (which we all know if full of $hit). Just that they don't know acting this way just shows how idiotic they are. (Just a generalization, but lots fit into this).

But don't go for the undergraduate girls, go for the women in the graduate programs. By then the borderlines often don't get a graduate degree, and if they did, the BPD has mellowed considerably.

Ah heck, NYC is just chock full of women. You shouldn't have too much of a problem unless you're too busy (which makes for a great & valid excuse to bring up if you meet a girl and it just doesn't work out & need to break up).

I guess I'm getting old because I'm reccomending to you residents to get a good girl (or any significant other). Makes life a heck of a lot more stable which is what you need during residency.

(Sorry to get OT)
Click to expand...

Wow, am I glad I don't have to worry about this stuff anymore--maybe "the BPD has mellowed considerably"? :eek: Dating just sucks. Best thoughts to those searching!

My advice, marry a doctor so you can work part-time. :p
 
I remember this "infamous" girl when I was in psychology grad school. She would give all her potential boyfriends a WAIS-R to "make sure they were intelligent enough for her."

Problem was, she wasn't too bright herself. I think she choked on a block design cube once.
 
Talking about women. I was in Las Vegas a few months ago, trying my luck on the machines with progressive jackpot (I heard that you need to have maximum bets for each pull to be eligible for the progressive jackpot and that helps even the house advantage a little). I was constantly looking for the $1million+ machine to pull. Then I suddenly realized, "why bother? every doctor is a jackpot! If he/she works for 10+ year, he/she will surely pull down at least $1 million culmulatively!" what a realization, eh?

As for downside in psychiatry, I hear the complaint of "not knowing enough medicine years out" over and over. This is the usual complaint by students coming out of medical school. But what they failed to realize is that psychiatry is a SPECIALTY. You are not supposed to keep up with general medical knowledge all the time. It would have been impossible (imagine how many different types of antihypertensives will be coming out year after year). Just like dermatologists, ophthalmologists, etc. psychiatrists are specialists who learn how to do psychotherapy (individual, groups, couples, etc.) and very good at psychotropic medications. They are PAID to be specialists, not GP's who adjust pts' diabetic or HTN meds. If you want to know everything (and nothing very well), then go into internal medicine or family medicine.

The only downside I know is to deal with borderline pts. But it is not like these pts don't see doctors (they have to visit their ob yearly for pap smear for example). Just that psychiatrists are more acutely aware of the interpersonal dynamics.
 
Thewonderer said:
The only downside I know is to deal with borderline pts. But it is not like these pts don't see doctors (they have to visit their ob yearly for pap smear for example). Just that psychiatrists are more acutely aware of the interpersonal dynamics.
Click to expand...

That's a good thing to remember. All specialties in medicine deal with "difficult" patients. They are no less annoying in a general medicine clinic than they are on the couch. Psychiatrists have the advantage of tools that they learn to deal with the borderline patient, whereas the only recourse most other doctors have is to get angry.
 
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Anasazi23 said:
I remember this "infamous" girl when I was in psychology grad school. She would give all her potential boyfriends a WAIS-R to "make sure they were intelligent enough for her."

Problem was, she wasn't too bright herself. I think she choked on a block design cube once.
Click to expand...

WAIS-R? Damn you must be old Anasazi....:laugh: I'm kidding, it was probably only the mid 90's
 
biggest downside, i think, is psych docs usually can't wear scrubs
 
b
 
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OldPsychDoc said:
Just wait until after you get through your intern year so that you can fine-tune your "Borderline detector".
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paradoxasaur- A creature that, if you don't believe in it, it exists. If you believe it exist, then it does not exist.
"Hello I am a twenty one year old 120 pound virgin with c-sized breasts who does not have a boyfriend and is not crazy." -The words of a paradoxasaur.

From the routine of Dimitri Martin
 
One downside I forgot to mention that I'm telling the medstudents I see in my area is that psychiatry is one of the few professions where you're often telling a patient to do something they don't want.

You got a psychotic patient who threatens to kill people, and you tell them you can't discharge them, a few weeks later you're in court trying to make them take court ordered meds while they're yelling obscenities at you. (which actually is something I want to happen because this let's the judge know that my claims that the person has mental problems are valid).

This isn't every branch of psychiatry, but it is one you encounter in inpatient psychiatry.

You try to get a lot of people with substance abuse off the illicit substances, and often times they're going to fail. You can't let that get you down. You need to help them, but with good boundaries so they don't take advantage of you.

Borderlines-same thing. A lot of manipulation, unstability, and boundary issues with these patients.

Counter that with most other fields where the patient pretty much all the time wants what you offer them, and if they don't want it, you don't have to do much, they just walk out. In psyche, I'd say the times you do something counter to what your patient wants is more vs the other branches, and when they refuse, you're work still isn't done. Often times its just the beginning.

Sorry to cut into the fun discussion about dating women (and no, I'm not like my David Hasslehoff leather jacket/speedo wearing avatar at all, I'm actually a big geek.)
http://www.ebaumsworld.com/pictures/view/239676/
http://www.ebaumsworld.com/pictures/view/10323/
 
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