Why is Psych not competitive?

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Careful, lest you expose too much about what satiety drives you. I hope such predispositions don’t drive most GYNs towards their field of practice. Oh, maybe I do hope, something must motivate them, and it is hard to imagine what that is.:rolleyes:

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Love the Omega Man reference. I saw it as a kid and didn't remember until I looked it up. Basically I am Legend with Will Smith is the modern update for people who are more apt to let obscure science fiction references slide--obviously not this kid.

Keeping with the science fiction theme I think psychiatry is one of the jobs that will be most resistant to being taken over by software applications. I think once Hal is diagnosing mental illnesses with his smooth creepy voice, skynet will have arrived and it'll be time to get underground quickly.
 
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Thank you for saying ortho can even make up to $1.5 million.

Anesthesia can still make very high salary. I have seen it. But now the whole gas group opt'ed out of all insurance plan about 3 months ago so they are now out of network. They can then charge $7000 (insane amount but they don't care. They just want to charge an insane amount just to see how much of the charge ends up "sticking", i.e. considered usual customary).

I guess you haven't heard about out of network daily maxes now?

Very few spine guys nowadays make over $700k. Any physician can make up to or over $1.5 million. In fact, I know one psychiatrist who makes a little over $1.5 million.
 
The only question is; can you tolerate hearing the following sentence? “I worked so hard to raise you and I girded you from my loins just to have you become the wrong kind of doctor?” If the answer is yes, happiness is just around the corner. Drink the Kool-Aid and join Matthias (1971 Charlton Heston movie, The Omega Man, doesn’t stand up very well, but a lot better than Soylent Green). :rolleyes:

What if our parents said "YES! That's awesome!"

Made man?
 
Still don't get why psych is not competitive. The worse answer I got was "PSYCH DOESNT MAKE $$$", which is not true. It's probably cuz medical students study the body and a field that deals with emotions and mental disorders is less tangible. But that's what makes it exciting :D
 
Still don't get why psych is not competitive. The worse answer I got was "PSYCH DOESNT MAKE $$$", which is not true. It's probably cuz medical students study the body and a field that deals with emotions and mental disorders is less tangible. But that's what makes it exciting :D
It's multifactorial--all of the above, plus.
Academic medicine is still dominated by a procedurally-dominated prestige culture, and it's still the exception more than the rule that a medical school actually emphasizes the humanities over the sciences in its admission process. So there's still a self-selection of those who are not predisposed to be fascinated by folks with "unusual thinking" and other oddities.
Be proud to be among the Chosen. :D
 
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I think there is also a piece of this that involves the gap between the socioeconomic backgrounds typical of med students and the status in which most chronically mental ill people find themselves (the population you are most likely to encounter on a clerkship, say). Whereas on surgery you can maybe ignore life circumstances for the most part, it stares you in the face on psych. I have heard too many residents and students on other services express a desire to escape academic centers and work only with "normal" people, by which they seem to mean "upper middle class like me".

Harder to do that in psych (which is a feature rather than a bug for me), though I guess a cash only practice with steep rates would be a good start...
 
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I think there is also a piece of this that involves the gap between the socioeconomic backgrounds typical of med students and the status in which most chronically mental ill people find themselves (the population you are most likely to encounter on a clerkship, say). Whereas on surgery you can maybe ignore life circumstances for the most part, it stares you in the face on psych. I have heard too many residents and students on other services express a desire to escape academic centers and work only with "normal" people, by which they seem to mean "upper middle class like me".

Harder to do that in psych (which is a feature rather than a bug for me), though I guess a cash only practice with steep rates would be a good start...

I knew my liberal guilt was good for something...
 
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I think there is also a piece of this that involves the gap between the socioeconomic backgrounds typical of med students and the status in which most chronically mental ill people find themselves (the population you are most likely to encounter on a clerkship, say). Whereas on surgery you can maybe ignore life circumstances for the most part, it stares you in the face on psych. I have heard too many residents and students on other services express a desire to escape academic centers and work only with "normal" people, by which they seem to mean "upper middle class like me".

Harder to do that in psych (which is a feature rather than a bug for me), though I guess a cash only practice with steep rates would be a good start...

I'm going to be serious for a second here. I feel like the healthcare system in America is broken. Insurance companies from what I know reimburse for procedures more so than for good patient health maintainence. It seems like this is where the medical field has gone to and that's why ROAD specialities were traditionally considered more competitive (not sure how true that is anymore with anesthesia and rads not being as competitive as they once were). Yet, I feel like specialities like FM and psych are needed in order to deal with more of the preventive care issues that are really what's needed to make the patient population more healthy.

I think there is something wrong when fields that emphasize preventive care, which is what's needed in this country, like FM/psych/IM/peds are looked down upon, while fields that emphasize procedures, although these fields are important, are the fields that other people want to compete for. It doesn't really help the healthcare crisis in the country. =/
 
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Still don't get why psych is not competitive. The worse answer I got was "PSYCH DOESNT MAKE $$$", which is not true. It's probably cuz medical students study the body and a field that deals with emotions and mental disorders is less tangible. But that's what makes it exciting :D
One of the ortho docs during my surgery rotation said that when he applied for residency, pretty much anyone with a pulse could get into ortho (early 80's), whereas IM and rads were super competitive. I heard similar stories for derm back in the day. I think these things are fairly cyclic, and with increasing reimbursements for psych while everything else seems to be stagnant or even decreasing, psych may become super competitive in the next decade or two. Hell just looking at the most recent match, more and more AMG's matched psych than previous years, so in so far as that is an estimate of competitiveness, we're already moving in that direction.

Oh well, lets strike when the iron's hot, here's hoping for a great future :)
 
I'm going to be serious for a second here. I feel like the healthcare system in America is broken. Insurance companies from what I know reimburse for procedures more so than for good patient health maintainence. It seems like this is where the medical field has gone to and that's why ROAD specialities were traditionally considered more competitive (not sure how true that is anymore with anesthesia and rads not being as competitive as they once were). Yet, I feel like specialities like FM and psych are needed in order to deal with more of the preventive care issues that are really what's needed to make the patient population more healthy.

I think there is something wrong when fields that emphasize preventive care, which is what's needed in this country, like FM/psych/IM/peds are looked down upon, while fields that emphasize procedures, although these fields are important, are the fields that other people want to compete for. It doesn't really help the healthcare crisis in the country. =/
I hate overstated politicized catchphrases like "healthcare crisis". Of course there are problems and always will be, but phrases like that and the system is broken are just ways to engender fear. Even more positive words like preventative care are politicized. After all, who would balk at providing something good like "preventative care". Operational definitions are crucial to the science of medicine so try to keep the overgeneralizations and catastrophizing to a minimum.

The truth is that I tend to agree with some aspects of the point that you are making. Although I wonder at times if our model of medicine is geared much towards prevention and sometimes the treatment can be worse than the illness. A good example of this can be found in crisis debriefing after traumas. It was intended to prevent PTSD but it was found to make it worse in some people. I actually see a similar dynamic play out everyday in my practice especially with kids. Telling people that pain and suffering is part of life isn't popular though. Ironically, my patients feel much better when they are told it is okay to feel bad when bad things happen.
 
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Thank you for saying ortho can even make up to $1.5 million.

Derm is still doing very well with procedures after procedures. Ophthal can still make a lot via volume. They are getting very efficient.

Anesthesia can still make very high salary. I have seen it. The movement toward making the whole group/department out of network and start sticking the insurance company and the patients with out-of-network bill amounts. And balance bill like crazy, while refusing to give in and offer any rate reduction/negotiation with patients who have high deductible plan. The Anesthesia group I had the misfortune of having been involved with, went one step further. I got my surgeon's EOB's and hospital EOB's first 3 weeks of the procedure. Done. They did the surgery and provided the service, and they are in-network so let's get paid. The anethesia's EOB did not arrive until 2.5 months later. That was fishy....why? Because Anesthesia wants all the other claims from the hospital and surgeon get cleared and ANY deductibles are met. Then they will swoop in and take all the fat insurance checks.

As an hypothetical example, Mr. Jones, has a high deductible plans and it is $5000 per calendar year. Because it is high, the out of network and in network deductibles are combined. Mr Jones gets admitted through ER and received emergency surgery. The gas guy and the trauma surgeon are involved. Right after the surgery, the trauma surgeon and the hospital submit their bills right away so Mr. Jones finally hits the deductibles (that $5000 deductibles are met but just not sure if surgeon or the hospital will need to go after the patient for that $5000). Then the gas guy comes in from the side and bang, submit the bill 2.5 months later after all the deductibles have already been made.

In this example, for the procedure involved, say, the gas guy's in-network rate would have been $1200 while the patient is responsible for 10% co-insurance = $120. But now the whole gas group opt'ed out of all insurance plan about 3 months ago so they are now out of network. They can then charge $7000 (insane amount but they don't care. They just want to charge an insane amount just to see how much of the charge ends up "sticking", i.e. considered usual customary). And when the EOB comes back, it says, $4200 is the usual customary and for out of network, co-insurance is 40% and the plan pays 60% so 0.6 x $4200 = $2520. Bang. instead of getting paid a meager $1200 after being locked into an in-network rate, they are now paid twice the amount of their old rate. Then the gas guy gets greedy and come after the patient and balance bill him/her for the missing $1680 to make up the usual customary rate of $4200. You can now forget about reaching anyone from the gas group's front desk person. Instead, they don't have an office and they don't have a desk. The only person you can call is on your collection letter, this 1800 guy on the other side of the coast. And that 1800 person just repeats the same mantra over and over again, as though you will just pay because they keep repeating it.

Now coming after someone for that missing $1680 which is pt's responsibility is totally legal. If you honor the usual customary rate of $4200 that the insurance calculated the benefits based on, then you do need to make reasonable attempt to collect the remaining $1680.

But that is a lot of money nevertheless.

Yes, I just showed you the current and future of many gas groups and their way to make $1 million without becoming a pain guy.
I'm sorry what's the point of this? Why does this have anything to do with psych and why do you think we all care? I suppose I can't speak for anyone else but I don't give a damn what specialties can make a million dollars. That doesn't have any impact on how I feel about psych
 
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I'm sorry what's the point of this? Why does this have anything to do with psych and why do you think we all care? I suppose I can't speak for anyone else but I don't give a damn what specialties can make a million dollars. That doesn't have any impact on how I feel about psych

His point was that psych doesn't make as much dollars as fields such as ortho, optho, gas or anesthesia, which is why it's not competitive. If salary is the deciding factor on what's competitive and what's not, then I fear for the future of medicine. I'm also going to say it again. I think psych makes a lot on a per hour basis rather than on a yearly basis.

*sigh* I mean, there are many patients who get stigmatized due to their mental health issues and these don't get addressed as these people are called "draining". Then, medical students don't want to go into psych because the field is emotionally draining. And then you have a lot of psychiatrists giving pills instead of understanding the underlying issues that are affecting their patients. All the while, you have a mental health population increasing each year who are thrown to the fridges of society without any way to get the care that they need -__________-

Kinda makes me mad >_>
 
Lol still don't get what's not prestigious about knowing about emotions and love
I really feel like you're overselling psychiatry. Some psychologists are big on the experimental stuff you're talking about, as they cannot prescribe in most states and done are eager to expand their toolbox, but psychiatry is more medication coupled with well-established psychotherapy like CBT and the like. Psychiatrists aren't Jedi, FFS.
 
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I really feel like you're overselling psychiatry. Some psychologists are big on the experimental stuff you're talking about, as they cannot prescribe in most states and done are eager to expand their toolbox, but psychiatry is more medication coupled with well-established psychotherapy like CBT and the like. Psychiatrists aren't Jedi, FFS.

Lol and yet I thought psychotherapy involves understanding the destructive thought processes that leads to a patient's impairment of functionality and trying to replace them with positive thought processes. Part of that equation has to involve understadning the patient's emotional reasoning or understanding the relational issues that come from that patient's life.
 
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I really feel like you're overselling psychiatry. Some psychologists are big on the experimental stuff you're talking about, as they cannot prescribe in most states and done are eager to expand their toolbox, but psychiatry is more medication coupled with well-established psychotherapy like CBT and the like. Psychiatrists aren't Jedi, FFS.
I actually am a jedi
 
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Lol and yet I thought psychotherapy involves understanding the destructive thought processes that leads to a patient's impairment of functionality and trying to replace them with positive thought processes. Part of that equation has to involve understadning the patient's emotional reasoning or understanding the relational issues that come from that patient's life.
Understanding people isn't a super power, nor do you need to be a psychiatrist to do so. Most of the sort of things you seem to be interested skirt more into pseudoscience and the sorts of garbage one might dig out of a self help book.
 
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Understanding people isn't a super power, nor do you need to be a psychiatrist to do so. Most of the sort of things you seem to be interested skirt more into pseudoscience and the sorts of garbage one might dig out of a self help book.

You sure? Because I'm pretty sure "why is this patient not taking his meds?" is 60% of the consults I've been taking this month. We clearly DO have such a magic superpower in the eyes of IM services. :rolleyes:
 
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Lol and yet I thought psychotherapy involves understanding the destructive thought processes that leads to a patient's impairment of functionality and trying to replace them with positive thought processes. Part of that equation has to involve understadning the patient's emotional reasoning or understanding the relational issues that come from that patient's life.
you are completely clueless and dont seem to understand what psychiatrists do. perhaps this is why it is hard for you to understand why psychiatry isn't competitive.
 
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Bmewriter I think the sort of stuff you're focused on is part of the reason why there's such a poor perception of psychiatry as a field of medicine. I'm just redacting the rest of my comment. Sigh.

One of the ortho docs during my surgery rotation said that when he applied for residency, pretty much anyone with a pulse could get into ortho (early 80's), whereas IM and rads were super competitive. I heard similar stories for derm back in the day. I think these things are fairly cyclic, and with increasing reimbursements for psych while everything else seems to be stagnant or even decreasing, psych may become super competitive in the next decade or two. [...]

Oh well, lets strike when the iron's hot, here's hoping for a great future :)

This. I think a lot of people don't realize this but there was a time not too long ago when Derm and Ortho were easy to get into and peds was super competitive. Things cycle. You're right that we are getting in at the right time (hopefully) - that's what I've been told by many people in the field. I don't think this means Psych will earn $280-320k on average, but that $240-250k will be more of the norm and that the average Step1 score will probably settle around 230-235 for a while. It's never going to be more competitive or lucrative than IM or procedural fields but it'll be better than where it is right now.

Derm will continue to earn a lot of money. Path recently got nuked, Onc got crushed about a decade ago, Anesthesia and Rads will always think the sky is falling because too many of them went in for the ROAD aspects until the current generation cycles out and you get several years of residents who enter the field with an expectation of making $350k with heavy hours and a lot of responsibility, PM&R is jumping into the whole lifestyle thing too late as steroid injections and EMGs already got knocked and Pain is in everyone's sights right now. In spite of this, you will meet specialists in any and all fields making >$1 million right now and going forward, more in some than others. But using those as the crux of your argument is silly as it's just not the norm. Current salary averages are similarly useless because they're capturing physicians who are earning salaries grounded in the 90s heydays of their fields. Looking at AMGA/MGMA 2013 values makes you feel kind of terrible for going into Psych when you see most specialties with a median over 300 and several 400++ but I predict that when you do another survey in 10 years you'll see a drop across the board in these.
 
you are completely clueless and dont seem to understand what psychiatrists do. perhaps this is why it is hard for you to understand why psychiatry isn't competitive.

You must have missed the lecture on infinite power. That's ok, the rest of us showed up. ;)
 
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You sure? Because I'm pretty sure "why is this patient not taking his meds?" is 60% of the consults I've been taking this month. We clearly DO have such a magic superpower in the eyes of IM services. :rolleyes:
The magic power is time to talk about the issue IM doesn't have. Also experience actually hearing where patients are coming from instead of "the patient won't take the med I prescribed no matter how many times I repeat myself."
 
. Hell just looking at the most recent match, more and more AMG's matched psych than previous years, so in so far as that is an estimate of competitiveness, we're already moving in that direction.
Why do people keep repeating the myth that psychiatry is getting more competitive? It isn't. The fact has been a slight decline in the proportion of medical students going into psychiatry in recent years. This year the minor uptick on the year before (0.3% increase in absolute terms btw) actually just takes us back to 2010 levels. Between 2006-2010 about 4.5% of medical students matched into psych. This year it was 4.6%. There was a decline after that until this year. As for the absolute numbers, this simply reflects the significant increase in medical school spots. The increase in board scores reflects a general increase in average scores across the board, with psychiatry still having one of the lowest average board scores amongst specialties.

Psychiatry is NOT getting more competitive. I for one am glad. This is awesome for us. Applicants have their pick of residencies. And it gets better after that. I got into my top choice forensic fellowship and only had to interview at one place for fellowship! You can't do that in competitive specialties. You also have your pick of jobs and plenty of opportunity to set up a private practice. you can live where you like - even NYC isn't really saturated.

Also let's not forget the overwhelming majority of medical students are unsuited for psychiatry and it is a very good thing that people who would be terrible at it are not pursuing the field.

The main downside to the lack of competitiveness is that it does breed some complacency and the overall standards of care in the community are much lower than I might like
 
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Why do people keep repeating the myth that psychiatry is getting more competitive? It isn't. The fact has been a slight decline in the proportion of medical students going into psychiatry in recent years. This year the minor uptick on the year before (0.3% increase in absolute terms btw) actually just takes us back to 2010 levels. Between 2006-2010 about 4.5% of medical students matched into psych. This year it was 4.6%. There was a decline after that until this year. As for the absolute numbers, this simply reflects the significant increase in medical school spots. The increase in board scores reflects a general increase in average scores across the board, with psychiatry still having one of the lowest average board scores amongst specialties.

Psychiatry is NOT getting more competitive. I for one am glad. This is awesome for us. Applicants have their pick of residencies. And it gets better after that. I got into my top choice forensic fellowship and only had to interview at one place for fellowship! You can't do that in competitive specialties. You also have your pick of jobs and plenty of opportunity to set up a private practice. you can live where you like - even NYC isn't really saturated.

Also let's not forget the overwhelming majority of medical students are unsuited for psychiatry and it is a very good thing that people who would be terrible at it are not pursuing the field.

The main downside to the lack of competitiveness is that it does breed some complacency and the overall standards of care in the community are much lower than I might like

Congrats man. I like what's possible for me too. Private practice with a low overhead business model is unheard of in NYC/SF outside of psychiatry--that I know of at least. I might apply to fellowship as well with what would be ridiculous geographic restriction in other fields.
 
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The magic power is time to talk about the issue IM doesn't have. Also experience actually hearing where patients are coming from instead of "the patient won't take the med I prescribed no matter how many times I repeat myself."

eh, problem is the time issue is bull****. Most of the time what we find out (or don't) is 2/2 IM not taking complete H+Ps. (It's particularly glaring that surgery/neuro/etc doesn't seem to have the same problem). The moment there's any "psych issues" it's suddenly someone else's problem. There's a couple attendings where I'm at who almost take pride in not being able to do a good mental status assessment and that attitude trickles down to the residents. It's REALLY bad when ortho seems to do a better job at recognizing delirium/dementia than medicine.
 
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I'm surprised it took like 3 pages for someone to point out how ridiculous OP sounds with all this "power of emotions" nonsense. No offense. I know I only have like 3 posts to my name, but I've lurked for a while, so please forgive me if I'm completely missing some inside joke here or something. I feel like that's completely missing the point of what is awesome about psychiatry; the interplay between our innate biology and its effect on our mind, and vice versa, is what, I think, is amazing. Maybe that's just a differently-worded version of OP, I dunno.

Anyway, I am genuinely interested in this question. When I was done with my psych rotation, it almost seemed too good to be true that psych was so non-competitive that a score like mine could have a decent chance at getting in somewhere really good, as opposed to perhaps getting in somewhere average with, say, IM or OB as I was pondering before. The money seems to be the 1/2 the answer to me, though that's on the rise, but I do feel like it might have a ceiling due to lack of procedures. Throughout med school, I always just felt something was "off" between the way I tackled material, med school, ways of thinking, etc, and the rest of my classmates, and I think I might have found the answer to that during my psych rotation, though I can't be entirely sure of that. Seems to me a combo of those two things that keeps psychiatry in the lower echelons of competitiveness. And I'm not complaining.
 
I'm surprised it took like 3 pages for someone to point out how ridiculous OP sounds with all this "power of emotions" nonsense. No offense. I know I only have like 3 posts to my name, but I've lurked for a while, so please forgive me if I'm completely missing some inside joke here or something. I feel like that's completely missing the point of what is awesome about psychiatry; the interplay between our innate biology and its effect on our mind, and vice versa, is what, I think, is amazing. Maybe that's just a differently-worded version of OP, I dunno.

Anyway, I am genuinely interested in this question. When I was done with my psych rotation, it almost seemed too good to be true that psych was so non-competitive that a score like mine could have a decent chance at getting in somewhere really good, as opposed to perhaps getting in somewhere average with, say, IM or OB as I was pondering before. The money seems to be the 1/2 the answer to me, though that's on the rise, but I do feel like it might have a ceiling due to lack of procedures. Throughout med school, I always just felt something was "off" between the way I tackled material, med school, ways of thinking, etc, and the rest of my classmates, and I think I might have found the answer to that during my psych rotation, though I can't be entirely sure of that. Seems to me a combo of those two things that keeps psychiatry in the lower echelons of competitiveness. And I'm not complaining.

Yes, I think you are on to something.

During my IM rotation, I had a patient that ended up having some interesting psych pathology that apparently wasn't at all documented in past records. Pt was a talker, as well.

I interviewed pt for a very long time.

When I told my residents about the experience and how long the interview took, they seemed almost apologetic to me for giving me the case. (Like "Oops, our bad, sorry about the psych issues. Didn't mean to get you stuck with that.")

In reality, that was the highlight experience during the entire rotation and the interview only took so long because I was having a good time.

When I explained this to the other med student on rotation with me, he looked completely bewildered as to what was so fascinating (coincidentally, he is hoping to match IM).

...To each their own.
 
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Had a shadowing premed tagging along with me in an evening peds clinic where somebody walked in with what was probably their first schizophrenic episode (met all criteria, very classical text books looking, etc). I interviewed for ages (slow clinic) and then afterwards spontaneously lectured to premed for a good fifteen minutes. This spontaneous enthusiasm has been notably absent from patient encounters without psych comorbidity.
 
Hells yeah. The Fleas can suck it!

We can also recognize paradoxical reactions to Benadryl/phenergan. Sometimes I call the primary medicine resident about their patient's bizarre behavior, then read the chart every day to see how long it takes them to realize that the nurse is giving Benadryl 50mg twice every night for sleep, and it's making them crazy.
First I have heard of this one and since it is such a common med for a variety of reasons this piqued my curiosity. How common is the paradoxical reaction to benadryl/diphenhydramine? How serious is it? How quickly does it resolve? Is it more common in geriatric or otherwise impaired?
 
I've seen it many times, usually in people who have a touch of baseline dementia. I've also had to explain to medicine over and over again that anesthesia makes old people crazy, so don't worry that they're being sexually inappropriate and combative for the first few days after surgery.

And yeah, I'm from Ortho, so...
Ahh. They also don't seem to know that opiates make them more prone to falls and benzos can cause delirium. It seems that they tend to think the baseline for geriatric patients is severe dementia and they don't seem to realize that when last week the patient was living outside the hospital, buying groceries, and even cooking them up without forgetting to turn the stove off and now they can't remember what decade it is or their own name that is not a sign of dementia. Sudden onset with rapid improvement = delirium. Slow chronic progressive and irreversible decline = dementia. It seems so simple, yet they miss it a lot. Must be a psychological explanation for that, but can't think of it right now. Oh, and one of the docs I connect with best here at the hospital is ortho. He seems to be one of the most normal out of the bunch. Hmmm.
 
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Ahh. They also don't seem to know that opiates make them more prone to falls and benzos can cause delirium. It seems that they tend to think the baseline for geriatric patients is severe dementia and they don't seem to realize that when last week the patient was living outside the hospital, buying groceries, and even cooking them up without forgetting to turn the stove off and now they can't remember what decade it is or their own name that is not a sign of dementia. Sudden onset with rapid improvement = delirium. Slow chronic progressive and irreversible decline = dementia. It seems so simple, yet they miss it a lot. Must be a psychological explanation for that, but can't think of it right now. Oh, and one of the docs I connect with best here at the hospital is ortho. He seems to be one of the most normal out of the bunch. Hmmm.

[IM]C'mon, you know better. Everything you listed is a "psych problem" for a "psych patient" and you as the psychiatrist must take this patient off of my service immediately and place them on the psych unit where you can deal with their "psych problems". [/IM]
 
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[IM]C'mon, you know better. Everything you listed is a "psych problem" for a "psych patient" and you as the psychiatrist must take this patient off of my service immediately and place them on the psych unit where you can deal with their "psych problems". [/IM]
classic turf to psychiatry
 
classic turf to psychiatry

And worse, I've seen more than enough consult psychiatrists without a backbone who would rather take an unstable patient to a unit where the level of nursing care is insufficient for their needs than offend a consulting physician.

If the hospital were a playground, psychiatrists would be the ones getting their lunch money stolen.
 
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And worse, I've seen more than enough consult psychiatrists without a backbone who would rather take an unstable patient to a unit where the level of nursing care is insufficient for their needs than offend a consulting physician.

If the hospital were a playground, psychiatrists would be the ones getting their lunch money stolen.

Ouch
 
If the hospital were a playground, psychiatrists would be the ones getting their lunch money stolen.

Although really at most academic places the inpatient psych docs are the ones doing the lunch money stealing b/c almost all their patients are unfunded so their salaries are being subsidized by medical/surgical beds in the hospital
 
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If the hospital were a playground, psychiatrists would be the ones getting their lunch money stolen.
Time to get all types of Ralphie on these bullies ... metaphorically speaking of course.
 
The increase in board scores reflects a general increase in average scores across the board, with psychiatry still having one of the lowest average board scores amongst specialties.

I've seen this comment made on several different threads but, correct me if I'm wrong here, since boards are standardized its impossible for there to be an increase in the general average. Unless of course the standardizers just put 230 in the middle of the bell curve instead of 220, but i don't think that's the case.
 
I've seen this comment made on several different threads but, correct me if I'm wrong here, since boards are standardized its impossible for there to be an increase in the general average. Unless of course the standardizers just put 230 in the middle of the bell curve instead of 220, but i don't think that's the case.

http://en.m.wikipedia.org/wiki/USMLE_Step_1

Numbers tell a different story
 
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And worse, I've seen more than enough consult psychiatrists without a backbone who would rather take an unstable patient to a unit where the level of nursing care is insufficient for their needs than offend a consulting physician.

If the hospital were a playground, psychiatrists would be the ones getting their lunch money stolen.

Why do you think that is? Presumptuous of me to say, but I'll be damned if I get pushed around as an attending.
 
And worse, I've seen more than enough consult psychiatrists without a backbone who would rather take an unstable patient to a unit where the level of nursing care is insufficient for their needs than offend a consulting physician.

If the hospital were a playground, psychiatrists would be the ones getting their lunch money stolen.
This one put me in the right mood this morning. :rofl:
Imagine how I feel as a psychologist working at a hospital. I'm even less of a real doctor than a psychiatrist.
uncle.jpg
 
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This one put me in the right mood this morning. :rofl:
Imagine how I feel as a psychologist working at a hospital. I'm even less of a real doctor than a psychiatrist.
uncle.jpg
Farkas has butt-whooping on the horizon!
 
Hard to say for sure because NBME keeps its methodology secret. If I had to guess, I suspect it is a combination of not renorming the scale with an intensive testing sample every year plus fairly strong downward score stickiness (I.e. a desire not be seen as "penalizing" students by a sharp reduction in scores across the board in a short time frame).

At the end of the day, they may also be taking their rhetoric that they are only a licensing exam seriously, in which case a slow upward drift is to be expected.
 
You can go earn $1 million per year and do fun things that don't involve spending your valuable time here.

Every so often we get someone who comes in here and just yacks about how psychiatry is BS. It's actually quite a lot less than I remember it being years ago. Hey like you said, WTF even waste that time if that's their opinion? I don't go to a gay bar and try to convert everyone into being straight. Maybe those people that like to yack about psychiatry being BS do that in their spare time.

In terms of money anything over 300K is realistic in private practice and this is only doing 40 hours a week. 300K is very conservative. As mentioned above 375K is still within the realm of being very realistic. I know one psychiatrist working 80 hours a week almost making 1 million. I know many psychiatrists that are good businessmen that make about 1 million.

So if you factor our profession earning potential, it's really not significantly worse if you factor it in hour per hour. Yes surgeons make more money on average vs us but they also work a heck of a lot more. Many psychiatrists making about 200K or less choose not to work crazy hours or are vested in interests outside the money such as academia.

Just my opinion. Once you're out of debt, making more than about 200K, doesn't really make much of a difference unless you want the expensive toys. I don't care for the expensive toys. What I want is a nice house and reliable stuff. I don't need to make 400K a year. So for now I'm content with academia and I love teaching. The debt factor, however is something that does seriously need to be considered.

The big thing for me I'm not getting from academia that I want is the psychological satisfaction of running something that is profitable-not because of the money but because of something I'm going to describe as being a successful hawk, but doing so in a way that really does offer good treatment. So every so often the idea of leaving and starting a private practice enters my head now and then. While I worked for the state and I get this in academia too (though not as bad) the inefficiency sometimes bugs me.
 
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