why Psych?

[Rpre19]

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hey there

I have to admit Psych wasnt even on my radar in considering a career choice but I found I really enjoy it...I am trying to decide btwn Fam Med & Psych (within the next month or so) & so I was wondering what made some of you go into psych vs. a GP field, where one could certainly deal with psych issues & have some variety in medicine.

its funny cuz all throughout my 3rd yr, all my attendings & residents made mention in my evaluations of how much I paid attention to psychosocial issues of the pts--yet i never made the connection that I might like psych...talk about lack of insight...duh!

thanks for your help in figuring out my life 😀

 

[PsychMD2100]

Aside from its intellectual challenge and a long-standing fascination with behavioral science, psych has many real-world advantages over FP.

In FP, you're continually expected to know an ever-expanding number of things about an ever-expanding number of specialties. It's extraordinarily hard to do FP well. It's hard enough to master a specialty (ie psychiatry). It's near impossible to master multiple specialties (peds, ob, psych, IM, surgery).

Psychiatry is also one of the few fields remaining where you can control your schedule, practice location, work hours, and whether or not you'll take managed care. You can do the standard employee-type work for Kaiser or you could go it alone in a boutique practice. The field is wide open and there's a nationwide shortage of psychiatrists, particularly in rural/inner city areas.

 

[gbv]

Similar to the previous poster, I like the intellectual challenge of the field, I like the research opportunities and directions, and I find the fact that a lot of the pathology is being better understood/currently being laid down in greater detail very exciting. Also, during my third year rotations, it was the specialty more than any other (save some of surgery) that I witnessed patients get significantly better b/w admission and discharge (I did work with some great psychiatrists, but I don't think this is unique to my institution, as I did an away on the other side of the country and witnessed a lot of the same).

Also, PsychMD2100 raises good points about just the nuts and bolts of the practice of the field--a lot of flexibility, a lot of practice options, and a lot of health settings in which to work.

And, on top of all that, I love working with the patient population, and I find their getting better really satisfying and gratifying--cos I'm selfish like that

 

[PsychMD2100]

Agree with gbv,

In addition to noticeable improvements in patients, there is also a genuine appreciation of my colleagues in psychiatry.

Contrary to all the stereotypes of psychiatrists needing a psychiatrist, I've found many of my colleagues to be some of the better-adjusted people in the hospital. In many of the hardcore "medical" fields (ie neurosurgery, cardiology), I find that many doctors are still trying to prove something. Even when they become attendings, they still aren't very happy.

Psychiatry, for me, is unique in the way that it blends science, medicine, philosophy, and social science. While all fields of medicine have an "art" component, I feel as though psychiatry has a greater proportion of "art" when it comes to its daily practice.

Even if you decide you don't want to do psych for life, you can still teach, consult, and testify, or even write books.

 

[maranatha]

Agree with gbv,
Psychiatry, for me, is unique in the way that it blends science, medicine, philosophy, and social science. While all fields of medicine have an "art" component, I feel as though psychiatry has a greater proportion of "art" when it comes to its daily practice.

IMHO, PsychMD2100's statement above illustrates one of the coolest aspects of psychiatry. To be able to blend the "art" of psychotherapy with hardcore neuroscience and pharmacology makes psychiatry the best field in medicine. Also, patients with psychiatric diseases are the most neglected and misunderstood population and are, therefore, in desperate need of good care. What an awsome way to help!

 

[Dartos Vader]

another tidbit to consider. Psych typically has a high satisfaction rate. Psychiatrists also tend to stay in practice for a long time when compared with other medical fields.

On the con side: for the rest of your life people will think they are the first ones to say "whoa, I better not say anything or you'll analyze me, haha" when you tell them your profession.🙄

 

[Therapist4Chnge]

Contrary to all the stereotypes of psychiatrists needing a psychiatrist, I've found many of my colleagues to be some of the better-adjusted people in the hospital.

I think seeing someone regularly can be pro-active, instead of only reactive. I often wonder why more people don't having someone they see, especially when they KNOW the benefits that can come from being able to meet with someone and process various life experiences.

It is odd, there is still a stigma within the health profession against seeing someone for yourself, yet we often talk about the stigma as it relates to our patients, and often ignore our own issues with it. I also think there is an important distinction between consulting with a colleague, and having your own clinician. Often when the subject comes up people say, "Oh, I consult when I need to", but the needs for consulting with someone, and personal needs are different animals, yet people try and make due with the former, instead of addressing the latter.

-t

 

[musm2008]

I've seen more of a stigma with doing family than psych. It seems like people look down on FPs for not knowing as much as IM docs. But then with psych, there's no comparison. It's something that a lot of people don't want to deal with, but they have to since patients have psych issues, so they are grateful for psychiatrists.
I had a blast on family medicine and they actually do A LOT of psych treatment. They refer out schizos and such, but fel comfortable maintaining their meds.

 

[Dartos Vader]

I've seen more of a stigma with doing family than psych. It seems like people look down on FPs for not knowing as much as IM docs. But then with psych, there's no comparison. It's something that a lot of people don't want to deal with, but they have to since patients have psych issues, so they are grateful for psychiatrists.
I had a blast on family medicine and they actually do A LOT of psych treatment. They refer out schizos and such, but fel comfortable maintaining their meds.

I think the stigma you encounter most from the lay public is "Why did you go to medical school if you weren't gonna be a real doctor?" or something like that. Usually the person then proceeds to ask your advice on a million issues, even though you're not a "real doctor"

 

[musm2008]

I think the stigma you encounter most from the lay public is "Why did you go to medical school if you weren't gonna be a real doctor?" or something like that. Usually the person then proceeds to ask your advice on a million issues, even though you're not a "real doctor"

who cares about them?

 

[Dartos Vader]

who cares about them?

agreed👍. I'm just saying that's what you encounter. When my dad asks me why I picked psych and not surgery or medicine I just tell him I picked the field where I would be of the most use to the entire family. That usually does the trick.

 

[Therapist4Chnge]

agreed👍. I'm just saying that's what you encounter. When my dad asks me why I picked psych and not surgery or medicine I just tell him I picked the field where I would be of the most use to the entire family. That usually does the trick.

You better be careful, they may try and take you up on that!

My extended family has already tried.....thankfully I could just refer back to ethics and whatnot as my reason to avoid them like the plague.



-t

 

[Rpre19]

Hey all,
these are great replies. Thank you so much. & this conversation happened yesterday in the fam med practice I'm rotating in:

Pt: So, what specialty are you goin into?
Me: Probably Psych
Pt: So, you have to go all through medical school for that?


Does that mean I'm in the club now?

 

[MacGFlow]

i feel the same way sometimes. when people ask me what kind of medicine i'm considering going into, i almost (almost!) feel embarrassed telling them that psych is highest on my list. some people scoff, and yes, i have also been asked why i'm in medical school if all i want to do is go into psych. and then i get angry at myself for succumbing to the stigma and (almost!) feeling embarrassed about having an interest in something in which i am genuinely interested. and then i think about it too much and i realize i'm being neurotic. i'd just as soon not answer sometimes because the responses people give are inane. it's absurd.

 

[musm2008]

About half of the people I tell say "really? I was going to do psych......" Then another third just look at me not saying anything. I know exactly what that second group of people is thinking. At least be polite and say "that's interesting" even if you don't mean it.

 

[MBK2003]

I get the range of responses:
Lay people and uninformed family members: "How can you work with people like that every day?" As if they or their children couldn't have a mental illness.

Physicians in other specialties (but not usually FP): "I'm glad someone is willing to work with people like that because I can't deal with them."

I have noticed one positive aspect of psychiatry training is that lots of medical school dean and MDs who have successfully moved into health care administration are psychiatrists. Having spoken to a couple of them, they can't stop talking about how the psychiatry training in dealing with defense mechanisms and narcissistic PD (particularly Kohutian approaches) is an enormous asset in those positions.

MBK2003

 

[billypilgrim37]

I thought the whole purpose of having an administration at all was so the pathologists could have an opportunity to interact with other human beings...

 

[PsychMD2100]

Nice one billypilgrim!

I too noticed that tons of pathologists occupy some pretty powerful positions. Psych seems to be a close second.

To the earlier posters, I just had a conversation today with a nonmedical person who asked me what residency I was doing. I told him and he proceeded to tell me with conviction about how most psychiatrists "go insane" themselves.

I do know that psychiatrists have a higher-than-average rate of suicide when compared to other physician groups. However, I was surprised about how convinced he was of the "fact" that we "go insane" as a matter of course.

I kept my cool and replied "I don't believe that's been documented" and he said "Oh, no, this is a proven fact." At that point, I just let him be and finished the conversation. Everywhere you go, there will always be people that are ignorant.

Remember, though, that the ROAD specialties also have their egos bruised daily. "Oh you're an x ray tech" or "So you fit glasses" gets old.

Pick the field, not what others think about it.

 

[Dartos Vader]

On my family med rotations they loved having a psych wannabe there. All the attendings and residents had different topics they wanted me to do a presentation on (thank you kaplan and saddock!). And they constantly wanted input on mental health patients. FPs deal with a ton of psych issues (especially in underserved clinics). Their attitude was that psych was a huge part of their practice and they couldn't remember nearly as much as they would like.

PsychMD, I agree with you about ROADs getting teased. When you think about it, if we're not real doctors, who is? People have some idea about who a real doctor is, and unfortunately, that doctor hasn't existed for a long time. We're all one big dysfunctional family and we need each other to get by!

 

[Therapist4Chnge]

All the attendings and residents had different topics they wanted me to do a presentation on (thank you kaplan and saddock!).

That really is a great book. It isn't all encompassing by any means//...but it does a very good job of knowing enough about a number of different things without too much clutter.

-t

 

[drwatson]

This is a great thread. I am also struggling with Family & Psych. I read a book called Heirs of General Practice and it said that when Family Medicine became a residency that the Psychiatry numbers went down. The thinking is that the personalities attracted to Family Medicine are the same that are attracted to Psych.

 

[PsychMD2100]

Something to consider is how family gets its "turf" carved up all the time. I know that at one general hospital, the surgeons lobbied hard enough to restrict all endoscopy to GI/Gen Surg only. Because of liability, family practice was not allowed to do L & D without having a written agreement for OB coverage. Derm also found its way to prevent FP from doing a number of skin procedures.

I doubt anyone will try to push for ECT privileges or want to manage schizophrenics.

Bottom line, both fields have their appeal but psych has clearer definition as a discipline.

 

[johnsonamj]

I posted this in the combined residency forum, but hopefully I'll get more bites here. Does anyone have experience with double board programs in FM and psych? What do you think?

 

[BabyPsychDoc]

I posted this in the combined residency forum, but hopefully I'll get more bites here. Does anyone have experience with double board programs in FM and psych? What do you think?

Why on earth would anyone want to do a double board program? I mean, surviving one residency is bad enough, but two?! Also, if you think about it, after you have gone through the residency and got certified how are you going to keep your certification current in BOTH fields?

 

[swanny]

Great thread, and I'll second many of the comments above. What I point out to those considering Family vs. Psych is that, as a psychiatrist, I get to spend 20-60 minutes with my patients when they visit (and sometimes longer for complicated evals and family sessions). The average time a FP spends with a patient is 4-9 minutes. I love patient contact-and no other specialty allows me as much. Many of the students I see interested in FP also seem to like patient interaction. When they rotate with me in my outpatient office, they often comment positively on the length of time and the relationship that the patient and their family has with me.