Will Psych Lifestyle Ever Change?

[Psychapplicant133]

Psych is becoming competitive as mental health stigma has dropped dramatically, and Gen Z is not the biggest fan of long hours. Psych is super popular for being a lifestyle specialty, and perhaps one of the biggest reasons people do psych is for the lifestyle. I've heard "I love working IM/surg/whatever, but I want a life outside of medicine, that's why I chose psychiatry."

With more and more Gen Z trying to get into psych for the lifestyle, how do you anticipate this changing psych? Will jobs become harder to find that are more lifestyle focused? I just imagine that with so many individuals trying to do a speciality because of low hours might negatively impact the specialty

---

Members don't see this ad.

 

[clozareal]

With more and more Gen Z trying to get into psych for the lifestyle, how do you anticipate this changing psych? Will jobs become harder to find that are more lifestyle focused? I just imagine that with so many individuals trying to do a speciality because of low hours might negatively impact the specialty

The whole lifestyle part of it is that you can start your own private practice, have your own autonomy that comes with flexibility and good pay without having to ask The Man for permission to wipe your own butt. More people going into PP will create a void in employer based jobs so I don't think it'll make it harder to find a job. You can work anywhere you'd like in psych.

It's going to make for better psychiatrists who are happier, have a good work-life balance, and can really enjoy their jobs. Those who only want it for the lifestyle are already weeded out before or during medical school, although this isn't true for mid-levels.

During residency, I loved my job but hated how many hours I worked. Now I love my job and my hours (15-20 clinical hours per week).

 

[TexasPhysician]

Like many fields, psych has an electively good lifestyle. You can work 15 hours/week or 60+. I know plenty doing 50+

There are also EM people doing however number of shifts they want. There are rads doing their shifts essentially on the beach in Puerto Rico. Hospitalists can love their 7 on/7 off schedules. I don’t see things changing from lifestyle variables.

The bigger changes in psych and medicine in general is the influx of midlevels.

 

[Bartelby]

A big influx of people who value lifestyle coming into psychiatry sounds like it would help maintain the current lifestyle friendly nature of the specialty.

 

[Sushirolls]

Bigger issues in psych are the ways its practiced. Does it morph to something that just isn't worth supporting...

Therapists telling patients they have ADHD go get assessed/diagnosed by your psychiatrist and get treated.
Therapists telling patients I have an ESA, they are great, you would benefit too, go get a letter from your Psychiatrist, or I'll write you one.
Patient recently lambasted me for daring to use the word obesity.
Pronouns. No one wins that game. How dare you use the wrong pronoun!
Cannabis isn't good, how dare you suggest to me it isn't.
I think I sleep fine, I barely snore, why are you suggesting I get a sleep study?
I have a job, relationships, some education, minor depression/anxiety, few quirks, "I think I have autism and want to be assessed"
I don't want to take pills doc [already has med list of 10+ supplements]
I am a millennial, Gen Z, working a job is like, hard, um, yeah, I don't have free time, and need to cook and clean... I want FMLA for XYZ
I only want psychedelics doc. *already on cannabis, opioids, etc

But the big theme summary, to the threat to the future of psychiatry is it trending away from pushing/encouraging people to have personal responsibility for their lives, actions, mood, behavior, etc. But instead giving every patient the Warm & Fuzzy Blanket, fresh from Milan, manufactured by a new upstart company called Victimhood.

Recently had patient Doe. Taking drug A and C. Previous psych gave diagnosis A and B. History not supportive of B, and questionably A, too. Needs sleep study on top of all this. Needs to stop taking drug A and C. I made clear won't prescribe drug B and S. Doe, like nah, I'll keep seeing original psych many hours away. Fast forward in time many months, ends up on news. Doe did what? Ends up in jail. Gets mental health court and virtually no sentence. My consult was never subpoenaed. Doe gets off light because of mental health when really, was alerted by me, the ramifications of taking drug A and C and should probably get normal court and normal consequences.

 

[clozareal]

Bigger issues in psych are the ways its practiced. Does it morph to something that just isn't worth supporting...

Therapists telling patients they have ADHD go get assessed/diagnosed by your psychiatrist and get treated.
Therapists telling patients I have an ESA, they are great, you would benefit too, go get a letter from your Psychiatrist, or I'll write you one.
Patient recently lambasted me for daring to use the word obesity.
Pronouns. No one wins that game. How dare you use the wrong pronoun!
Cannabis isn't good, how dare you suggest to me it isn't.
I think I sleep fine, I barely snore, why are you suggesting I get a sleep study?
I have a job, relationships, some education, minor depression/anxiety, few quirks, "I think I have autism and want to be assessed"
I don't want to take pills doc [already has med list of 10+ supplements]
I am a millennial, Gen Z, working a job is like, hard, um, yeah, I don't have free time, and need to cook and clean... I want FMLA for XYZ
I only want psychedelics doc. *already on cannabis, opioids, etc

But the big theme summary, to the threat to the future of psychiatry is it trending away from pushing/encouraging people to have personal responsibility for their lives, actions, mood, behavior, etc. But instead giving every patient the Warm & Fuzzy Blanket, fresh from Milan, manufactured by a new upstart company called Victimhood.

Recently had patient Doe. Taking drug A and C. Previous psych gave diagnosis A and B. History not supportive of B, and questionably A, too. Needs sleep study on top of all this. Needs to stop taking drug A and C. I made clear won't prescribe drug B and S. Doe, like nah, I'll keep seeing original psych many hours away. Fast forward in time many months, ends up on news. Doe did what? Ends up in jail. Gets mental health court and virtually no sentence. My consult was never subpoenaed. Doe gets off light because of mental health when really, was alerted by me, the ramifications of taking drug A and C and should probably get normal court and normal consequences.

What does this have to do with lifestyle?

 

[Sushirolls]

Read my first two sentences, again.

The field of psychiatry changes over time. People go into psychiatry to practice what it is now. But in 5 to 10 to 15 years from now, its nots the same. In my years of practice things have already changed since residency. I've already had thoughts, what the heck are we doing? How is this even helping people. Do I even want to contribute towards this? If what you sign up for originally isn't what you're doing, that could be a negative - and people then don't want to go into the field.

This is the counterpoint to the demand of psychiatry in the community. The counterpoint towards the rising competitiveness from medical school applicants going into the field. Is it still a lifestyle field when you don't even value or enjoy the work you are doing?

 

[clozareal]

Read my first two sentences, again.

The field of psychiatry changes over time. People go into psychiatry to practice what it is now. But in 5 to 10 to 15 years from now, its nots the same. In my years of practice things have already changed since residency. I've already had thoughts, what the heck are we doing? How is this even helping people. Do I even want to contribute towards this? If what you sign up for originally isn't what you're doing, that could be a negative - and people then don't want to go into the field.

This is the counterpoint to the demand of psychiatry in the community. The counterpoint towards the rising competitiveness from medical school applicants going into the field. Is it still a lifestyle field when you don't even value or enjoy the work you are doing?

Your point is more to do with the content of psychiatric practice rather than how the job can be structured. I don't see the level of autonomy, flexibility in both schedule and location, or income potential changing for the negative in the next 5-15 years.

 

[nexus73]

Gen Z seems much more willing to unionize which I think will be better for work life balance. Physician unions may also mitigate the proliferation of midlevels, or at least midlevel supervision with zero pay to the supervising physician. If RN unions keep pushing we'll have psych RNs working three 12s making as much as psychiatrists in 10 years. I think physician unions for certain specialties are inevitable (hospitalist, ED, inpatient psych)

 

[J ROD]

Changed over the outpatient last couple of years and feel basically now a drug dealer for stimulants and benzodiazepines. PCP are refusing to write them and sending them to psychiatry. Other issues is the "my therapist gave me a self assessment and I was ADHD, I need a stimulant. I think I have Autism and want to be tested.". They have been misdiagnosed for years by multiple psychiatrists and don't have BPD or traits. I refer to them as the "truth seekers". Luckily I have a PhD nearby that will test them properly for a nominal fee. ADHD too.

 

[clausewitz2]

Changed over the outpatient last couple of years and feel basically now a drug dealer for stimulants and benzodiazepines. PCP are refusing to write them and sending them to psychiatry. Other issues is the "my therapist gave me a self assessment and I was ADHD, I need a stimulant. I think I have Autism and want to be tested.". They have been misdiagnosed for years by multiple psychiatrists and don't have BPD or traits. I refer to them as the "truth seekers". Luckily I have a PhD nearby that will test them properly for a nominal fee. ADHD too.

Y'all know you are allowed as an outpatient psychiatrist to just say 'no' to someone requesting any medication you think isn't a good idea, right?

EDIT: if denying people things they earnestly want is something you think you might struggle with, definitely avoid outpatient work to any reading.

 

[J ROD]

I will show I have grown and not reply with a smartass answer. Yes, I do know I do not have to write them. I often times do not. Just creates problems when others refer to you saying you will. Patients get pissed as of course medicine is about having it your way like Burger King. Hence, why I refer ones I question to get tested and cut benzo doses all day long. Make them come back monthly for a new Rx. I do not mind low dose benzos as rescue. I just hate it when PCP sends me a Xanax 6mg per day and then I have to taper them off and deal with it. I think it is

 

[VA Hopeful Dr]

I will show I have grown and not reply with a smartass answer. Yes, I do know I do not have to write them. I often times do not. Just creates problems when others refer to you saying you will. Patients get pissed as of course medicine is about having it your way like Burger King. Hence, why I refer ones I question to get tested and cut benzo doses all day long. Make them come back monthly for a new Rx. I do not mind low dose benzos as rescue. I just hate it when PCP sends me a Xanax 6mg per day and then I have to taper them off and deal with it. I think it is

Pre-screen your referrals. Local psych group here refuses all ADHD consults and 99% of anxiety referrals.

 

[J ROD]

Pre-screen your referrals. Local psych group here refuses all ADHD consults and 99% of anxiety referrals.

I do but I also work for the "hospital" and can only do so much. For me, I rather deal with above than run my own business. I have other business ventures I hope to pursue and get out all together except for some prn work in a few years.

 

[tr]

I just hate it when PCP sends me a Xanax 6mg per day and then I have to taper them off and deal with it. I think it is

I find benzo tapers quite satisfying personally. People always seem so much better/happier once they're off.

 

[DOswag]

Read my first two sentences, again.

The field of psychiatry changes over time. People go into psychiatry to practice what it is now. But in 5 to 10 to 15 years from now, its nots the same. In my years of practice things have already changed since residency. I've already had thoughts, what the heck are we doing? How is this even helping people. Do I even want to contribute towards this? If what you sign up for originally isn't what you're doing, that could be a negative - and people then don't want to go into the field.

This is the counterpoint to the demand of psychiatry in the community. The counterpoint towards the rising competitiveness from medical school applicants going into the field. Is it still a lifestyle field when you don't even value or enjoy the work you are doing?

Changed over the outpatient last couple of years and feel basically now a drug dealer for stimulants and benzodiazepines. PCP are refusing to write them and sending them to psychiatry. Other issues is the "my therapist gave me a self assessment and I was ADHD, I need a stimulant. I think I have Autism and want to be tested.". They have been misdiagnosed for years by multiple psychiatrists and don't have BPD or traits. I refer to them as the "truth seekers". Luckily I have a PhD nearby that will test them properly for a nominal fee. ADHD too.

Agree with all of this. In 5 years since residency things have changed. Tired of getting the "my therapist thinks I have ADHD" or "I watched a tik tok video from a friend and think I may be autistic". PCP's just sending them to me because they don't want to prescribe stims or benzos anymore. Unfortunately the group I work with plasters is on line that we do adhd testing... I've sent many adults inquiring about autism to a clinic right down the road that does all manner of testing for things.

The growing amount of information on social media is altering the populace as well to pathologize everything.

 

[finalpsychyear]

I do but I also work for the "hospital" and can only do so much. For me, I rather deal with above than run my own business. I have other business ventures I hope to pursue and get out all together except for some prn work in a few years.

I hear you. The job funds these future ventures which seem like your end goal by the end of the decade at the latest.

 

[Sushirolls]

Pre-screen your referrals. Local psych group here refuses all ADHD consults and 99% of anxiety referrals.

Huh.
I like anxiety patients. Couldn't imagine screening them out.

 

[Sushirolls]

I find benzo tapers quite satisfying personally. People always seem so much better/happier once they're off.

So true, but its the initial kicking and screaming from day 1 that is the issue.

 

[Sushirolls]

Agree with all of this. In 5 years since residency things have changed. Tired of getting the "my therapist thinks I have ADHD" or "I watched a tik tok video from a friend and think I may be autistic". PCP's just sending them to me because they don't want to prescribe stims or benzos anymore. Unfortunately the group I work with plasters is on line that we do adhd testing... I've sent many adults inquiring about autism to a clinic right down the road that does all manner of testing for things.

The growing amount of information on social media is altering the populace as well to pathologize everything.

I spend a few minutes educating that "testing" isn't needed and ADHD is clinical diagnosis. And if you get seen by a real, board certified Neuropsychologist, they know how to write reports and detail the limitations of the findings i.e. depression not at remission, anxiety not at remission, SUDs, untreated OSA, the list goes on, for things that are confounders and require treatment at our level before a neuropsych send off.

Local PsyD/PhD types doing reports are just garbage. Oh, you glazed over their depression? Didn't consider OSA? No mention of the cannabis? But yet you clearly stamp ADHD. Those 2 year fellowships exist for a reason for psychologists.

 

[clozareal]

Local PsyD/PhD types doing reports are just garbage. Oh, you glazed over their depression? Didn't consider OSA? No mention of the cannabis? But yet you clearly stamp ADHD. Those 2 year fellowships exist for a reason for psychologists.

Not to mention that very few neuropsychologists are board certified.

 

[R. Matey]

Local PsyD/PhD types doing reports are just garbage. Oh, you glazed over their depression? Didn't consider OSA? No mention of the cannabis? But yet you clearly stamp ADHD. Those 2 year fellowships exist for a reason for psychologists.

Neuropsych testing won't pick up ADHD nor do most neuropsychologists that are worth their salt even take these referrals. But I agree, in principle, that if you set yourself up a psychologist that 'does ADHD' referrals, you are in effect a hammer and your patients nails.

 

[Stagg737]

Y'all know you are allowed as an outpatient psychiatrist to just say 'no' to someone requesting any medication you think isn't a good idea, right?

EDIT: if denying people things they earnestly want is something you think you might struggle with, definitely avoid outpatient work to any reading.

Pre-screen your referrals. Local psych group here refuses all ADHD consults and 99% of anxiety referrals.

I've started doing this pretty heavily for my consult clinic and they still sneak through constantly. 4 of my 5 last consults have been for non-ADHD related stuff (depression/anxiety mostly) where the referring MD/NP specifically tells us it's "not for ADHD" and then the patients either pull out the "Oh, and by the way can we talk about my ADHD" at the end of the appointment or they wait until the follow up to do the same thing. I'm at the point where I'm considering sending a letter to our referring docs that ADHD evals need to be directed to our psychologist. I've also started just punting some of these patients to our psychologist myself after I tell him my concerns and have him do a DIVA. I would do this myself, but I don't want it to get out that I'm doing ADHD testing because I know I'll get flooded with referrals just for that which will take an exorbitant amount of my time.

Unfortunately, because I see largely rural patients many of them do have unrecognized pathology (mostly ADHD, mild ID/borderline functioning, dementia, BPD, and PTSD/trauma; also autism to a lesser extent), some of which there is nothing I'm actually going to be able to do. I can't count how many times I've had to turn away a patient with blatantly obvious dementia away or tell primary patient needs to be referred to neuro (which is abundant in most of those locations for some reason) or geriatrics (less abundant and desperately needed) because seeing me a couple of times isn't going to help them.

ETA: Even with screening, I'm seeing a ton of patients trying to casually address "ADHD" because someone else told them they should ask or they saw something on social media. It's actually refreshing to get a consult for "patient was treated for ADHD as a child and did well, no longer on meds and struggling, assist with restarting meds" vs the typical "I can't concentrate" consult that is more typical.

 

[VA Hopeful Dr]

Huh.
I like anxiety patients. Couldn't imagine screening them out.

I suspect a lot of our PCPs are dumping their benzo patients on psych and that is probably what led to this screening out

 

[SPsych6]

Like many fields, psych has an electively good lifestyle. You can work 15 hours/week or 60+. I know plenty doing 50+

There are also EM people doing however number of shifts they want. There are rads doing their shifts essentially on the beach in Puerto Rico. Hospitalists can love their 7 on/7 off schedules. I don’t see things changing from lifestyle variables.

The bigger changes in psych and medicine in general is the influx of midlevels.

The midlevel are an issue. I just left Colorado because of their laws regarding midlevel providers. Colorado is going to have a lot of malpractice cases with what laws they are passing. Otherwise the lifestyle won't change. If you look at the recent ABPN certificates handed out this last year, there really aren't that many of us around.

 

[comp1]

I can't imagine moving because of midlevel law changes, particularly since independent practice will be everywhere eventually. It's just not going to have that much of an impact. I mean you can already look at independent practice states versus non and you just will not see a COL adjusted pay difference. There's more than enough work for everybody.

 

[Sushirolls]

I left an area saturated by ARNPs. It was an impact there in PP sphere.
Big Box shops had turn over as were toxic.
One that wasn't as toxic was retaining and expanding.
It does and can impact growth. The PP clinics were all competing for the same non-UHC, non-XYZ patients.

 

[psyspy]

Bigger issues in psych are the ways its practiced. Does it morph to something that just isn't worth supporting...

Therapists telling patients they have ADHD go get assessed/diagnosed by your psychiatrist and get treated.
Therapists telling patients I have an ESA, they are great, you would benefit too, go get a letter from your Psychiatrist, or I'll write you one.
Patient recently lambasted me for daring to use the word obesity.
Pronouns. No one wins that game. How dare you use the wrong pronoun!
Cannabis isn't good, how dare you suggest to me it isn't.
I think I sleep fine, I barely snore, why are you suggesting I get a sleep study?
I have a job, relationships, some education, minor depression/anxiety, few quirks, "I think I have autism and want to be assessed"
I don't want to take pills doc [already has med list of 10+ supplements]
I am a millennial, Gen Z, working a job is like, hard, um, yeah, I don't have free time, and need to cook and clean... I want FMLA for XYZ
I only want psychedelics doc. *already on cannabis, opioids, etc

But the big theme summary, to the threat to the future of psychiatry is it trending away from pushing/encouraging people to have personal responsibility for their lives, actions, mood, behavior, etc. But instead giving every patient the Warm & Fuzzy Blanket, fresh from Milan, manufactured by a new upstart company called Victimhood.

Recently had patient Doe. Taking drug A and C. Previous psych gave diagnosis A and B. History not supportive of B, and questionably A, too. Needs sleep study on top of all this. Needs to stop taking drug A and C. I made clear won't prescribe drug B and S. Doe, like nah, I'll keep seeing original psych many hours away. Fast forward in time many months, ends up on news. Doe did what? Ends up in jail. Gets mental health court and virtually no sentence. My consult was never subpoenaed. Doe gets off light because of mental health when really, was alerted by me, the ramifications of taking drug A and C and should probably get normal court and normal consequences.

This is a followup to this as well as your recent DM to me.

I too stand against the wokeism and abrogation of personal responsibility that has taken hold in modern times. I make this known to my colleagues but tread softly with it because most don’t agree with me and I’m only an intern. And even though psych as a whole is highly susceptible to this paradigm, don’t you as a psychiatrist have the authority to terminate patients and have various jobs/ways of practicing to choose from? At least on the inpatient units, I and a few others don’t shy away from encouraging patients with hx of maladaptiveness to take some personal responsibility. Ultimately patients in the long run hurt themselves by refusing personal responsibility, so it’s not like you’re giving substandard care by giving meds but also reminding “you have to do some work on your own too”

If that patient who lambastes you for saying “obesity” isn’t a good fit for your practice for additional reasons, can you not terminate?

Lastly, your scenario with patient Doe seems like a “reap what you sow” kind of deal. The fact that all that happened in that way seems like the fault of our american institutions and culture. If it’s not affecting you directly, I’d not pay mind. Have you testified in criminal court and been cross examined before? Was it previously the norm for the prosecution to subpoena consults like that?

 

[psyspy]

Could change. There is increasing pressure to see more patients in the same time frame. Part of it is inflation (and psych gets paid lower than other specialties generally), midlevels seeing certain volumes of patients, and admin squeezing as much out of you as possible. Also documentation in psych can take long and will continue to get worse like it has for every specialty.

I think there’s somewhat of a chance that psych will become less chill due to having to “prove yourself” in presence of midlevels who are cheaper to hire and who, in some cases, are “skilled” enough to see high volume. Attendings covering multiple jobs used to be the exception, and now seems to be becoming more common. In the same vein, lots of graduating residents I know of have no interest in juggling multiple jobs, but at the same time don’t care to make too much money.

Attendings continue to chime in

 

[psyspy]

Gen Z is also 27yo and younger. When they all eventually realize how much houses cost in 2024 via our recent hyperinflation run in their favorite places that they constantly see on social media (California, Florida, NY, etc), most of them will eventually cave from their stance on “no long hours”

 

[finalpsychyear]

There's a reason I've been working 2 fte for 8 years. I don't like what I'm seeing and need to make the most of it. I hope I'm wrong.

 

[psyspy]

There's a reason I've been working 2 fte for 8 years. I don't like what I'm seeing and need to make the most of it. I hope I'm wrong.

What kind of jobs are they. How many hours and patients per day does it put you at?

 

[Sushirolls]

This is a followup to this as well as your recent DM to me.

I too stand against the wokeism and abrogation of personal responsibility that has taken hold in modern times. I make this known to my colleagues but tread softly with it because most don’t agree with me and I’m only an intern. And even though psych as a whole is highly susceptible to this paradigm, don’t you as a psychiatrist have the authority to terminate patients and have various jobs/ways of practicing to choose from? At least on the inpatient units, I and a few others don’t shy away from encouraging patients with hx of maladaptiveness to take some personal responsibility. Ultimately patients in the long run hurt themselves by refusing personal responsibility, so it’s not like you’re giving substandard care by giving meds but also reminding “you have to do some work on your own too”

If that patient who lambastes you for saying “obesity” isn’t a good fit for your practice for additional reasons, can you not terminate?

Lastly, your scenario with patient Doe seems like a “reap what you sow” kind of deal. The fact that all that happened in that way seems like the fault of our american institutions and culture. If it’s not affecting you directly, I’d not pay mind. Have you testified in criminal court and been cross examined before? Was it previously the norm for the prosecution to subpoena consults like that?

I have my own private practice. I do encourage people. But only so far as not actively performing therapy beyond supportive.

I haven't 'fired' a patient in years. But patients do ghost and find alternative options.

Subpoenas are not the norm.

 

[Splenda88]

I suspect a lot of our PCPs are dumping their benzo patients on psych and that is probably what led to this screening out

These benzo and opioid patients are miserable. I always find it amusing as a hospitalist that these patients always forget other medications they are taking except for benzo/opioids.

I am glad I only have to prescribe these things while they are in the hospital.

These medications are being handed too easily in small town and rural America. I did not see that level of crazy prescribing where I did residency (major city).