Why Psychiatry?

[Drrrrrr. Celty]

I was kind of inspired to make this thread based on an a suggestion thread about how to help people choose a specialty.

Going off it, I wanted to hear a bit of input from people about why they ended up choosing psychiatry versus another field and whether they still feel the same way about it or what they enjoy about their field currently.

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[Stagg737]

About to start residency, so can't get into the "currently" part too much. I chose psych for a lot of reasons though. I liked most of the patients and loved working with 1 or 2 specific subsets of patients on my rotations. I felt like a lot of fields started to get a bit repetitive after a while. I got bored with surgery after the 3rd lap chole and seeing that the routine became mundane pretty quickly. I got tired of dealing with the same diabetic patients who weren't controlling their serum glucose because they loved ice cream too much. Most fields just got boring pretty quick. With psych, the more you delved into each patient's history the more unique each one became. You can see 10 cases of depression in a day and they could all be completely unique which I loved. Every day was something new which I appreciated a lot.

There's also a lot more research and exploration to be done in the field. In some fields it's tough to make major advancements, but in psych there's still a lot for us to figure out. I love the idea that there is still so much that can be contributed to the field and that there's so much potential for growth. There's also so many other forms of opportunity. Unlike some fields, there's a genuine severe shortage of every kind of psychiatrist so you can make a career doing almost anything. You can be an uber-focuses sub-specialist treating a single condition in a single demographic in a specific way or you can generalize. Either way the opportunity is likely going to be there almost anywhere in the country. You can do inpatient or outpatient or both. So the opportunity and demand of the field was also a massive plus for me.

The more selfish thing I love is the lifestyle. I have no problem with busting my butt and working hard, but I also want to be able to be there for my kids and family. I don't want to be the parent who's a stranger to their kids until they're in middle school. I know I'll miss things in their life as every physician would, but at least I know I can still be there for the important stuff. There were other fields I strongly considered during my clinical years (EM and OB/Gyn specifically), but the ability to really control my life in psychiatry made it an easy choice over the other two.

However, the most important thing for me was that even the things I strongly disliked in other fields I actually enjoyed in psych. For example, I hated pharmacology in my first 2 years of med school. I was really bad at remembering drug names and receptors and just really struggled to get it to sink in. Because of this I was really worried that I'd end up hating clinicals. However, I love psychopharm. For some reason it fascinates me and all the stuff that I struggled with in pre-clinical years just seemed to click on rotations. For the first time I actually wanted to read more articles and learn more about the drugs we were using instead of just trying to be proficient. It really renewed my sense of curiosity and desire to really understand what I was studying instead of just trying to learn it so I could help my patients. I felt this way with one or two other fields as well, but not in the same way that psychiatry really stoked the fires of my educational process.

So I had a lot of things that I was looking for in a field (some I didn't even realize until my rotations) and psych just checked off all those boxes and then some. Maybe this post was a bit starry-eyed, but I feel like even if I do end up becoming much less enthusiastic about psych I will still have a life outside of work that I can enjoy. Sorry that this ended up being a long post, but there's so much about the field I love and with residency approaching quickly I'm at a point where my fervor is pretty elevated (promise I'm not manic though!).

 

[Shufflin]

Med students know very little about what a specialty is really like, which is fine, because you simply can't without practicing it for a few years. So the first division is: do you love to cut and be in the OR or not? That's the first branch in the decision tree. After that, it's all about the Stars Theory. What is the Stars Theory you might ask? My theory is that a med student picks a specialty for which all the right 'stars line up'. What the heck does that mean? "When the stars align" means things fell into place personally for you lifting one specialty above all the others. The rotation went well for you, the department director seems to click with you more than others, the subject matter or anatomical focus fascinated you, you may have scored better on the shelf, a patient in that field resonated with you, an attending said one thing to you that struck a chord, you were in the mood for doing X and Y when on that day X and Y happened, someone gave you a compliment that was pivotal, etc. It's extremely subjective. Almost like deciding whom to marry. The stars line up between the things you think represent that specialty and you (beware that your concept of self will change as you reach certain milestones in life).

Now that I'm practicing for a year after fellowship, I can tell you what I truly appreciate about Psychiatry. The mind is the final frontier, and I like psychosis, depression, mania, and those things. Psychiatry is an amazing balance of close patient interaction, fascinating work that changes daily, presentations that are not clear cut (I love that), pretty high pay in the right setup (and its only going up), very high demand everywhere, can work as little or as much as you want, low stress most (but not all) of the time, and patients who have dramatic improvement where about once a week you get a hug. It's also the one specialty where how you speak to a patient, the interpersonal dynamic, is part of the treatment. If you're not good at that, then you should really stay clear.

 

[NickNaylor]

I had no intention of going into psychiatry when I started medical school and had other fields that I was interested before “discovering” psychiatry. I really liked pediatrics and was planning on doing that until my psychiatry clerkship. I was also interested in dermatology but I didn’t pursue that for a couple of reasons, namely I was horrendously bored when I did an elective rotation in it. In another life I probably would have done general surgery, but the work/life balance was a bit of a deal-breaker for me given my circumstances at the time.

I chose psych for both pragmatic and abstract reasons.

Pragmatic:
- It’s a fairly non-competitive field, which meant that I could, with a fairly high degree of certainty, choose where my wife and I would end up. This was important especially to my wife as there were certain areas of the country she wanted to avoid. This would not have been possible with, say, dermatology, where the strategy is more “apply and pray.”

- The field is in demand, which means no shortage of job opportunities. I thought graduating into a growing job market would be a better position to be in.

- It is one of the few remaining fields where starting a solo practice is feasible. That’s not to say that you can’t do it with other fields but that it is relatively easier in psychiatry.

- Depending on your income desires, the work/life balance can be fairly reasonable.


Abstract/Idealistic:
- I find the work very interesting. While the number of diagnoses is relatively low, each case is unique and different. I’m not yet cynical enough to have had this interest completely crushed yet.

- I liked the whole idea of psychotherapy and wanted to have this as a skill. The idea of using a relationship and talking with someone to improve their health was interesting to me.

- The extent to which research in psychiatry/neuroscience is occurring means that, theoretically, the opportunities for paradigm-shifting changes in treatment are higher than in many other fields. It’s an exciting field that has the potential to undergo a renaissance a la medicine in general after the discovery of antimicrobials.

- I like that you really get to know your patients. Naive or not, getting to know someone and having a very specialized set of skills to help them in a meaningful way was one of the things that drew me to medicine in the first place. Psychiatry was one of the few fields that I rotated on where the doctor-patient relationship still plays a fairly important role in the practice.

- I have personal experience dealing with psychiatric disorders (dad has “for real” bipolar disorder, I developed significant anxiety in medical school that was treated completely successfully with an SSRI), thus I had a first-hand appreciation for the, at times, substantial impact our bread and butter diagnoses can have on people. That’s not to say that’s not true in other cases of medicine by any means, but this added more meaning to the whole endeavor to me.

- It is one of the few fields left where the whole endeavor is somewhat ill-defined and there is some degree of controversy about what it is that we do. See, e.g., anti-psychiatry movements. Again, I find this interesting.


I am more cynical now than I was when I started and did not appreciate the challenge of dealing with psychiatric issues. I had not conceived of the idea that, apart from people that lacked insight (e.g., psychosis), a large number of people would not be interested in receiving treatment for whatever it is that they reportedly wanted help with. I also didn’t have an appreciation for how ineffective many of our treatments are. I would still say that much of what I wrote above is true, but I am less naive about those things than I was before starting residency.

Godspeed in your personal statement writing.

 

[TexasPhysician]

I enjoyed a lot of medical school and various different fields. I would have probably even enjoyed gen surg if the residents/faculty were nicer.

Knowing that I enjoy so much of medicine and other aspects of life, I started by narrowing my choices to the top lifestyle fields.

I cut the options to derm, gas, rads, pmr, psych, and em. Night shifts aren’t my thing, so goodbye em. Rads was fun for awhile but the dark room got old quick. I didn’t feel confident about my derm knowledge even after setting up my application ms1-2 to apply derm (everything looked like the same rash to me). My medical school had little access to pmr, so I couldn’t get a good handle on whether it was for me.

Gas was fun. I probably could have gone that route instead and have been happy, probably with a pain fellowship.

I’m more business minded and realized that i wanted to have my own practice with autonomy. That appeared more difficult with gas. My psych faculty were great and I enjoy people, so it seemed like a good fit.

I enjoy it more than I ever expected that I would.

 

[Drrrrrr. Celty]

So you guys overall feel like you could have gone into other fields. I've always been a bit worried that despite psychiatry being my first choice I could see myself in other fields too and whether that's sign I still need convincing.

 

[Mad Jack]

I enjoyed a lot of medical school and various different fields. I would have probably even enjoyed gen surg if the residents/faculty were nicer.

Knowing that I enjoy so much of medicine and other aspects of life, I started by narrowing my choices to the top lifestyle fields.

I cut the options to derm, gas, rads, pmr, psych, and em. Night shifts aren’t my thing, so goodbye em. Rads was fun for awhile but the dark room got old quick. I didn’t feel confident about my derm knowledge even after setting up my application ms1-2 to apply derm (everything looked like the same rash to me). My medical school had little access to pmr, so I couldn’t get a good handle on whether it was for me.

Gas was fun. I probably could have gone that route instead and have been happy, probably with a pain fellowship.

I’m more business minded and realized that i wanted to have my own practice with autonomy. That appeared more difficult with gas. My psych faculty were great and I enjoy people, so it seemed like a good fit.

I enjoy it more than I ever expected that I would.

Are you me?

 

[Mad Jack]

So you guys overall feel like you could have gone into other fields. I've always been a bit worried that despite psychiatry being my first choice I could see myself in other fields too and whether that's sign I still need convincing.

I could be happy in a great number of fields, but psychiatry had the best balance of aspects I desired overall.

A good strategy is finding the things you hate most in medicine and eliminating those things as much as possible.

 

[Drrrrrr. Celty]

I could be happy in a great number of fields, but psychiatry had the best balance of aspects I desired overall.

A good strategy is finding the things you hate most in medicine and eliminating those things as much as possible.

That's kind of how I came to psych haha. I loved Medicine and Psych. But the things I loved most about medicine I loved more in Psych.

 

[Stagg737]

So you guys overall feel like you could have gone into other fields. I've always been a bit worried that despite psychiatry being my first choice I could see myself in other fields too and whether that's sign I still need convincing.

Yup. There were 3 or 4 fields I think I could have been pretty happy working in (Psych, EM, OB/Gyn, FM), but when I think about my long term goals and the flexibility for career options psych has, it became a much easier decision. There'll always be that "what if" thought sitting in the back of your mind, but you can never really answer that unless you go back and do another residency. Your best bet is to get as much exposure as possible in med school (I had 4 psych rotations under my belt before I submitted my ERAS app) and just go for it.

 

[Mad Jack]

Yup. There were 3 or 4 fields I think I could have been pretty happy working in (Psych, EM, OB/Gyn, FM), but when I think about my long term goals and the flexibility for career options psych has, it became a much easier decision. There'll always be that "what if" thought sitting in the back of your mind, but you can never really answer that unless you go back and do another residency. Your best bet is to get as much exposure as possible in med school (I had 4 psych rotations under my belt before I submitted my ERAS app) and just go for it.

Yeah, it was psych, IM, FM, and anesthesia for me. Psych just won overall.

 

[Attending1985]

I like the pace of psychiatry, the patient encounters, the psychology aspect. The one thing I didn’t know before training was the question of safety and efficacy of treatments. I just assumed they were both safe and effective because I was naive. This weighs on me heavily and for this reason I wish I would’ve chosen IM.

 

[AD04]

Two words: crazy chicks.

Two more words: cash practice.

Bonus words: No more rectal exams.

Unlike the SDN gunners, I hated medical school. But it was worth it for psychiatry.

Every year, I enjoy it more and more. I don't see myself ever retiring.

 

[TheOther]

Yeah, it was psych, IM, FM, and anesthesia for me. Psych just won overall.

EM, anesthesia, gen surg, ortho, and psych for me. Psych won as well -- or at least, I guess I'll find out in March.

Every year, I enjoy it more and more. I don't see myself ever retiring.

Vibin on this.

 

[Candidate2017]

Why psychiatry? Because I wouldn't have time to post on SDN if I have chosen any of the other specialties I also enjoyed.

 

[Stagg737]

Why psychiatry? Because I wouldn't have time to post on SDN if I have chosen any of the other specialties I also enjoyed.

Gotta keep those priorities straight.

 

[cherryvanilla11]

EM, anesthesia, gen surg, ortho, and psych for me. Psych won as well -- or at least, I guess I'll find out in March.


Vibin on this.

Really curious as to how you considered both ortho and psych lol. Why choose psych?

 

[NickNaylor]

Really curious as to how you considered both ortho and psych lol. Why choose psych?

I really enjoyed general surgery - so much so that I seriously considered going into it.

To use your example, there seems to be this incorrect assumption that the people that go into psychiatry are teddy bears who have no interest in "real" medicine while those who go into surgical fields can't talk their way out of a paper bag. Things are a little more complicated than that. I knew many people in medical school who really liked and considered psychiatry but ultimately went into other fields (e.g., derm, ENT, OB/GYN).

 

[shaosoldier]

Just my two cents, I chose psychiatry because I feel it's a common and misunderstood barrier towards patients returning to do whatever it is they do in life -- whether it's deep despair or frank psychosis -- our duty is to bring them back as best as we can. The concept of helping your patients return to their day to day is, in my own opinion, the basis of any medical specialty.

 

[shaosoldier]

I really enjoyed general surgery - so much so that I seriously considered going into it.

To use your example, there seems to be this incorrect assumption that the people that go into psychiatry are teddy bears who have no interest in "real" medicine while those who go into surgical fields can't talk their way out of a paper bag. Things are a little more complicated than that. I knew many people in medical school who really liked and considered psychiatry but ultimately went into other fields (e.g., derm, ENT, OB/GYN).

100% agree. For those interested in psychiatry, in my own eyes we are specialist and masters of psychiatry and psychopharmacology, our basis will always be as a physician. We augment our medications with psychotherapy, whether it be our own abilities or that of a psychologist kinda like how Physiatrist (PM&R) work with physical therapist.

 

[ksharp33]

Med students know very little about what a specialty is really like, which is fine, because you simply can't without practicing it for a few years. So the first division is: do you love to cut and be in the OR or not? That's the first branch in the decision tree. After that, it's all about the Stars Theory. What is the Stars Theory you might ask? My theory is that a med student picks a specialty for which all the right 'stars line up'. What the heck does that mean? "When the stars align" means things fell into place personally for you lifting one specialty above all the others. The rotation went well for you, the department director seems to click with you more than others, the subject matter or anatomical focus fascinated you, you may have scored better on the shelf, a patient in that field resonated with you, an attending said one thing to you that struck a chord, you were in the mood for doing X and Y when on that day X and Y happened, someone gave you a compliment that was pivotal, etc. It's extremely subjective. Almost like deciding whom to marry. The stars line up between the things you think represent that specialty and you (beware that your concept of self will change as you reach certain milestones in life).

Now that I'm practicing for a year after fellowship, I can tell you what I truly appreciate about Psychiatry. The mind is the final frontier, and I like psychosis, depression, mania, and those things. Psychiatry is an amazing balance of close patient interaction, fascinating work that changes daily, presentations that are not clear cut (I love that), pretty high pay in the right setup (and its only going up), very high demand everywhere, can work as little or as much as you want, low stress most (but not all) of the time, and patients who have dramatic improvement where about once a week you get a hug. It's also the one specialty where how you speak to a patient, the interpersonal dynamic, is part of the treatment. If you're not good at that, then you should really stay clear.

Just curious.. what kind of fellowship did you do?