Why do I read about people switching into psych, but not the other direction?

[Prime2000]

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Just curious why people seem to switch into psych from specialties such as surgery, IM, EM, etc. but I never read about psych residents saying "hey, I want to do surgery after all" and switch? Are those other specialties as bad for burnout as people say but some just don't believe it until they are into them and then decide to switch? And why switch into psych, is it perceived to be a less intense residency/specialty?

 

[OldPsychDoc]

Just curious why people seem to switch into psych from specialties such as surgery, IM, EM, etc. but I never read about psych residents saying "hey, I want to do surgery after all" and switch? Are those other specialties as bad for burnout as people say but some just don't believe it until they are into them and then decide to switch? And why switch into psych, is it perceived to be a less intense residency/specialty?

Why indeed, Prime? Why indeed? 😀

 

[psychattending]

Just curious why people seem to switch into psych from specialties such as surgery, IM, EM, etc. but I never read about psych residents saying "hey, I want to do surgery after all" and switch? Are those other specialties as bad for burnout as people say but some just don't believe it until they are into them and then decide to switch? And why switch into psych, is it perceived to be a less intense residency/specialty?

My unscientific impression is that most people, who switch into psych, had enjoyed it as a student but were hesitant to choose it (peer pressure?). After starting their residency training, they realize that what they like most is psych and that it is important to do what they like. I suspect that switching out of psych occurs less often because people who choose it have resisted pressure to do something else.

 

[Prime2000]

My unscientific impression is that most people, who switch into psych, had enjoyed it as a student but were hesitant to choose it (peer pressure?). After starting their residency training, they realize that what they like most is psych and that it is important to do what they like. I suspect that switching out of psych occurs less often because people who choose it have resisted pressure to do something else.

Makes sense.

 

[hippiedoc13]

My unscientific impression is that most people, who switch into psych, had enjoyed it as a student but were hesitant to choose it (peer pressure?). After starting their residency training, they realize that what they like most is psych and that it is important to do what they like. I suspect that switching out of psych occurs less often because people who choose it have resisted pressure to do something else.

Agreed. That seems to be the story of most folks I've met who came in as PGY-2s. I actually know only 1 person who switched *out* of psych...one of the guys in my intern class decided he wanted to do internal medicine instead. When we heard that, the rest of us thought he was crazy. 😉

 

[OldPsychDoc]

Agreed. That seems to be the story of most folks I've met who came in as PGY-2s. I actually know only 1 person who switched *out* of psych...one of the guys in my intern class decided he wanted to do internal medicine instead. When we heard that, the rest of us thought he was crazy. 😉

I can think of three who switched after PGY1--two I think caved to substantial family pressure to be a "real" doctor 🙄🙄🙄, and the third came screaming back after a year in Occupational Medicine, ended up doing child psych and doing quite well in the end. (We pardoned him for temporary insanity. 😀)

 

[peppy]

Honestly, I think the main reason you don't see a lot of people switching out of psych is that I don't think any of the other specialties will give you credit for the PGY-1 in psych, so you will probably have to redo your intern year if you switch out of psych. In contrast, you can get credit from psych programs for having done a PGY-1 in medicine (making it easy to switch from IM or Neuro into psych). Nobody wants to redo their intern year, so that is a strong incentive to stick with psych after you pick it.
Still, switches do happen out of psych. Someone who used to frequently post here a few years ago wound up switching from psych into IM or FM (I don't think they ever posted about why though).

Psych is perceived as an easy specialty by many people, but there are definitely aspects of it that can be draining or very unpleasant. Non-compliance with treatment, manipulative behavior, and poor hygiene are things that many doctors don't enjoy dealing with from patients and psychiatrists see more of all those things as part of the nature of mental illness. As a med student, you may not be as irritated by the homeless people who feign mental illness in an effort to get a place to stay as you might be once you are the resident who keeps getting called about them.
There are also apparently psych programs that make their interns work just as hard as IM residents. As part of the decision making process, I think it does help to ask yourself if you would still want to do psych over IM (or some other field) if you had to put as many hours into psych as those other fields.

 

[Regnvejr]

We had one person who decided on pathology, and within a few months knew that was a mistake, and next year came back. Excellent psychiatrist, by the way. And we had a couple of FP residents come our way as well.

Why do others pick psychiatry? Not sure, but I did it because I enjoyed my 3rd-year rotation. And I still love it, getting up and get to do psychiatry. Life is good, I never looked back.

 

[psychattending]

Honestly, I think the main reason you don't see a lot of people switching out of psych is that I don't think any of the other specialties will give you credit for the PGY-1 in psych, so you will probably have to redo your intern year if you switch out of psych. In contrast, you can get credit from psych programs for having done a PGY-1 in medicine (making it easy to switch from IM or Neuro into psych). Nobody wants to redo their intern year, so that is a strong incentive to stick with psych after you pick it.
Still, switches do happen out of psych. Someone who used to frequently post here a few years ago wound up switching from psych into IM or FM (I don't think they ever posted about why though).

Psych is perceived as an easy specialty by many people, but there are definitely aspects of it that can be draining or very unpleasant. Non-compliance with treatment, manipulative behavior, and poor hygiene are things that many doctors don't enjoy dealing with from patients and psychiatrists see more of all those things as part of the nature of mental illness. As a med student, you may not be as irritated by the homeless people who feign mental illness in an effort to get a place to stay as you might be once you are the resident who keeps getting called about them.
There are also apparently psych programs that make their interns work just as hard as IM residents. As part of the decision making process, I think it does help to ask yourself if you would still want to do psych over IM (or some other field) if you had to put as many hours into psych as those other fields.

Peppy, from my experience having to do an extra year is not at all in the resident's mind who wants to switch. They are looking for a way to do what they like doing. All the ones who come to me wanting to switch into psych assume that they will have to be an intern again. Those who don't are quite pleased when they find out that they don't. In my lifetime I have known two residents who switched out of psych. One decided she liked neuro and the other decided she like neuropath more. Neither cared about starting over they just wanted to do what they determined they liked.

 

[DrSno]

I can think of three who switched after PGY1--two I think caved to substantial family pressure to be a "real" doctor 🙄🙄🙄,

I always thought "real" doctor just referred to being an MD as opposed to a PhD, optometrist, DO, or DDS.

 

[psychotrope]

Just curious why people seem to switch into psych from specialties such as surgery, IM, EM, etc. but I never read about psych residents saying "hey, I want to do surgery after all" and switch? Are those other specialties as bad for burnout as people say but some just don't believe it until they are into them and then decide to switch? And why switch into psych, is it perceived to be a less intense residency/specialty?

On the interview trail so far I've heard of several examples of people switching out of psych into other fields.....mostly fm and im. One into neurology.

I couldn't imagine doing anything other than psychiatry. However, if you cruise other boards on sdn you will see that others feel differently.

I guess the reasons some would switch out of psychiatry are for:

1) money
2) prestige

I dont care about either of those, so it doesn't matter to me 🙂

 

[TheWowEffect]

I know about a guy who did a Psychiatry residency, then a child fellowship and then did a Neurology residency. I am not sure if he might have gone for a neurology-related fellowship too.

 

[whopper]

I did know one guy who switched from pathology to IM. He felt pathology was not enough hands on, and was too lab geek.

However, yes, from my own experience it seems most people switch to psychiatry, and not many people switch out of psychiatry to another field. Of course my perspective may be biased because as a psychiatrist, I know more people in this field. This can create a bias.

 

[DrSno]

I guess the reasons some would switch out of psychiatry are for:

1) money
2) prestige

But people keep mentioning they commonly switch to FM. It provides no more of either of those. And IM only does if they go on to a subspecialty.

 

[psychotrope]

But people keep mentioning they commonly switch to FM. It provides no more of either of those. And IM only does if they go on to a subspecialty.

fm doesn't provide more prestige within medicine. But in the community most places it does. IM does within medicine and in the community.

 

[DrSno]

IM does within medicine and in the community.

Why would a general internist have more respect within the medical community than a psychiatrist? Obviously a gastroenterologist or a cardiologist or other subspecialists would, but I don't understand why a PCP would.

 

[psychotrope]

Why would a general internist have more respect within the medical community than a psychiatrist? Obviously a gastroenterologist or a cardiologist or other subspecialists would, but I don't understand why a PCP would.

because many physicians in various fields respect people who manage heart failure, diabetes complications, etc more than people who treat psychotic, manic, depressed, and agitated patients.

That doesn't bother me, but I think if you scan all the sdn forums carefully you will see that amongst *some* of the housestaff posters.....

 

[Doctor Bagel]

Why would a general internist have more respect within the medical community than a psychiatrist? Obviously a gastroenterologist or a cardiologist or other subspecialists would, but I don't understand why a PCP would.

It doesn't make sense, but it happens. People outside of the medical world don't seem to really know what is and what isn't prestigious in the medical world. For example, a non-medical person would think being an FM doc would be as a prestigious as being a dermatologist. However, there's a general perception both in and outside of the medical world that psychiatrists aren't real doctors -- in fact, lots of people probably don't even know that psychiatrists are MD/DOs.

Also, in the medical world, IM still holds a certain level of respect because it's considered to be a the thinking person's specialty. Back in the day, the top students all went into IM.

 

[peppy]

Peppy, from my experience having to do an extra year is not at all in the resident's mind who wants to switch. They are looking for a way to do what they like doing. All the ones who come to me wanting to switch into psych assume that they will have to be an intern again. Those who don't are quite pleased when they find out that they don't. In my lifetime I have known two residents who switched out of psych. One decided she liked neuro and the other decided she like neuropath more. Neither cared about starting over they just wanted to do what they determined they liked.

Fair enough. 🙂 I have heard about and met lots of people who have switched between various fields, but haven't gotten into their stories in much depth to know how important the issue of repeating years is typically to people. While there are certainly people who feel strongly enough about switching fields that repeating years of residency is not a deterrant, some people have such a hard time with residency that I would expect that they would be hesitant to start over from the beginning after getting partway through it.

 

[Sneezing]

Why would a general internist have more respect within the medical community than a psychiatrist? Obviously a gastroenterologist or a cardiologist or other subspecialists would, but I don't understand why a PCP would.

I believe that a person who holds the belief a specialist has more prestige or respect than a generalist like IM, FP, Peds, or General surgery is a fool. To do the job well, and undertake the responsibility of being the primary physician for a surgical or medical issue is monumental. How often do you see on discharge summaries or hear people say, "Follow up with your primary." "Sorry, I don't handle that, you need to ask your Doctor." "Whoa, this is out of our hands, call THE surgeon."

It is far easier to seclude oneself in a specialty and know a very short differential. A smal list of drugs. A small list of disease presentations.

Yes, it is possible to 'hide' in primary care or general surgery and just refer all day or only to lap choles all day. But if you are doing your job and even going as far as not letting insurance companies constrict your practice of medicine, than your impact on society and the patient is far greater than any specialist.

 

[peppy]

Also, in the medical world, IM still holds a certain level of respect because it's considered to be a the thinking person's specialty. Back in the day, the top students all went into IM.

And the flip side of that is a lot of surgeons like to look down on IM doctors for standing around talking about minor changes in electrolytes all day and
not "doing" enough. Trying to get into a career for prestige reasons is a losing battle. No matter what you do, someone out there won't be impressed. 🙂 Each specialty has its reasons for why some people respect it and others look down on it.

I think one reason why the general public often respects family doctors more than psychiatrists is simply because visiting a family doctor is more familiar to most people. The mental association many people still have between psych and "One Flew Over the ****oo's Nest" style treatment makes it seem weird and scary.

 

[Sharpie1]

how is it possible for all these people to be switching into psych, when supposedly the match always fills almost to capacity? if most people are switching in, and not out, of psych, where are the extra spots coming from?

 

[OldPsychDoc]

how is it possible for all these people to be switching into psych, when supposedly the match always fills almost to capacity? if most people are switching in, and not out, of psych, where are the extra spots coming from?

Since they are no longer US allopathic seniors, they are eligible to sign outside the match, so available slots for the match are reduced accordingly.

 

[rpkall]

We had one person who decided on pathology, and within a few months knew that was a mistake, and next year came back. Excellent psychiatrist, by the way. And we had a couple of FP residents come our way as well.

Pathology seems like a good alternative. Good work hours, interesting material... Just no patient contact. Perfect for a burnt out psychiatrist, no?

What was his problem with Pathology, just out of curiosity?

 

[NJWxMan]

Pathology WAS a great field but it has now been subject to complete flooding of the field with large numbers of residency graduates. It's nearly impossible to find a job the first six months out and even more difficult to find a position that is NOT a locum tenens.

 

[Regnvejr]

Pathology seems like a good alternative. Good work hours, interesting material... Just no patient contact. Perfect for a burnt out psychiatrist, no?

What was his problem with Pathology, just out of curiosity?

Her main problem was with what she called "petty bickering" and personality clashes. Not necessarily the field itself, though when she came back, she did appreciate patient contact.

 

[rpkall]

Pathology WAS a great field but it has now been subject to complete flooding of the field with large numbers of residency graduates. It's nearly impossible to find a job the first six months out and even more difficult to find a position that is NOT a locum tenens.

Hm. I had no idea..

I guess Psychiatry has that going for it, at least. There's not bound to be a shortage of patients in need.

 

[OldPsychDoc]

Pathology WAS a great field but it has now been subject to complete flooding of the field with large numbers of residency graduates. It's nearly impossible to find a job the first six months out and even more difficult to find a position that is NOT a locum tenens.

Do you think that maybe there was a bit of a "CSI-factor" here, like there was with "ER" a dozen years ago? "Wow, look how cool it is to be a forensic pathologist!"

 

[whopper]

I'd suspect so, in fact that may have some explanation with the increase in people applying into psychiatry. Forensic investigations while often the area of pathologists, some think psychologists and psychiatrists regularly engage in this as well.

I remember people while I was in medschool wanting to get into an ER program were upset because of the dramatic upswing. Some of them were complaining about how about the upswing were all poseurs, and the real people like themselves would have a much more difficult time getting in.

 

[ativan]

Just curious why people seem to switch into psych from specialties such as surgery, IM, EM, etc. but I never read about psych residents saying "hey, I want to do surgery after all" and switch? Are those other specialties as bad for burnout as people say but some just don't believe it until they are into them and then decide to switch? And why switch into psych, is it perceived to be a less intense residency/specialty?

I am a psych resident who's thinking of switching, maybe into a combined residency of some kind. I loved psych as a med student--especially the neuroscience and psychodynamics--but as an intern I am getting bored and frustrated. Seeing psychotic patients day in and day out where the only differential diagnosis is schizophrenia vs schizoaffective, or bipolar manic vs bipolar manic gets boring quickly. The treatments are the same for almost everyone on the unit. Psych residents do mountains of paperwork, sit through very long rounds, and must hold endless family meetings which I doubt surgical interns are doing. I'd vastly prefer to change dressings and drain abscesses or do something like that than fill out one more form or see another second cousin or talk to another former apartment manager who barely knows the patient and cannot tell me anything medically important about them. At work I would never complain because I know those things are my job, but I'm just saying, there are residents in psych who question if they made the right choice some days. Give me cholecystitis vs cholangitis anyday is how I feel sometimes lately. If I could work with a different group of psych patients for awhile, maybe I'd feel different, I don't know... Obviously I realize there are not combined surgical/psych residencies but I wonder about med/psych and if it would be more in line with my interests.

 

[Doc Samson]

I am a psych resident who's thinking of switching, maybe into a combined residency of some kind. I loved psych as a med student--especially the neuroscience and psychodynamics--but as an intern I am getting bored and frustrated. Seeing psychotic patients day in and day out where the only differential diagnosis is schizophrenia vs schizoaffective, or bipolar manic vs bipolar manic gets boring quickly. The treatments are the same for almost everyone on the unit. Psych residents do mountains of paperwork, sit through very long rounds, and must hold endless family meetings which I doubt surgical interns are doing. I'd vastly prefer to change dressings and drain abscesses or do something like that than fill out one more form or see another second cousin or talk to another former apartment manager who barely knows the patient and cannot tell me anything medically important about them. At work I would never complain because I know those things are my job, but I'm just saying, there are residents in psych who question if they made the right choice some days. Give me cholecystitis vs cholangitis anyday is how I feel sometimes lately. If I could work with a different group of psych patients for awhile, maybe I'd feel different, I don't know... Obviously I realize there are not combined surgical/psych residencies but I wonder about med/psych and if it would be more in line with my interests.

You're an intern - it will get better. I HATED inaptient psychiatry, if that's all we did then there's no way I'd even have entered the field. Ahead of you there's time on CL, emergency, C&A, and so on. We have more variety in terms of how many different things you can combine into a job than any other field. Don't make any hasty decisions.

And oh yeah, I hate family meetings too - that's why I hired a social worker to do them for me (sometimes I make a special guest appearance, but my SW always says "Dr. DS is very busy - he only has a couple of minutes to answer any other questions you might have.").

 

[OldPsychDoc]

You're an intern - it will get better. I HATED inaptient psychiatry, if that's all we did then there's no way I'd even have entered the field. Ahead of you there's time on CL, emergency, C&A, and so on. We have more variety in terms of how many different things you can combine into a job than any other field. Don't make any hasty decisions.

And oh yeah, I hate family meetings too - that's why I hired a social worker to do them for me (sometimes I make a special guest appearance, but my SW always says "Dr. DS is very busy - he only has a couple of minutes to answer any other questions you might have.").

They must teach that phrase in social work school! 😀

Also, to our young padawan ativan--I agree with the above. It sounds like you're suffering from too much of the same thing. Hang in there a bit longer and you can branch out.

 

[wolfvgang22]

Pathology WAS a great field but it has now been subject to complete flooding of the field with large numbers of residency graduates. It's nearly impossible to find a job the first six months out and even more difficult to find a position that is NOT a locum tenens.

Is this a danger for psych?

 

[Sneezing]

Absolutely not. Pathologists are dependent on JOBS. They have machines that cost $100,000+ and require frequent calibrations, cleaning, and repairs. The very machines that make their job are the very thing that permit them to be saddled to and man handled by large corporations like Qwest and LabCorp. We are able to get jobs and start PRACTICES. In summary, our private practice start up costs are the lowest of all medicine ensuring us the path of autonomy. We also have the most intimate field in medicine. The one that patients with money will most resist becoming just another heartless corporation. If you were in need of a psychiatrist would you want to seek out Dr. MentalHealthMaster, or Dr. KaiserWalmartPleaseTakeANumber?

And if the market were to ever flip upside down and have an oversaturation of psychiatrists there would always be preference for us over the lesser trained options...

 

[BabyPsychDoc]

Boy, am I behind the times...I did not even recognise OPD's post due to his new avatar 😳

To the OP:

1) Stigma of psychiatry prevents some from applying earlier in their career - only when they realize that they REALLY do not want to do anything other than psych, do they choose to switch.

2) Psychiatry as a specialty required higher degree of emotional maturity than some other specialties.

3) Added life experience and clinical experience is looked upon favourably in psych but not in other specialties.

4) Psych is so good, you would not want to switch!😛

5) Finally, some people DO switch. However, it is more difficult to switch from psych due to "loss of medical skills" - real or perceived.

 

[Regnvejr]

Is this a danger for psych?

Not even close. Tripple or quardruple the capacity of residencies to put out new psychiatrists, and MAYBE the needs will be covered