Worried about the future

[Anotherwin]

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I am a currently in my PGY-2 year, and my third year is fast approaching on the horizon. I have been thinking more about the future and I keep worrying about the fact that I cannot conceptualize what life will be like as an attending. I do not know how much money I need to earn to truly be content. I do not know if the kind of practice setting I want (cash based with dedicated therapy patients) will still be feasible by the time I graduate, or how my ethnic background will influence the perception prospective patients will have on me. The more I try to think of things to come to grounded conclusions, the more questions arise. I would appreciate hearing from you folks who struggled with similar worries about your future careers and how you ameliorated said worries.

 

[TexasPhysician]

This is just my opinion, but I felt like academia was a bubble. What happens in academia is not often how the real world works. I didn’t get a good feel for what I wanted to do within psych or how likely it was until I had tried moonlighting at multiple places.

Cash based with dedicated therapy is certainly possible, but you will need to market yourself well.

 

[Merovinge]

Cash practices are a huge part of modern psychiatry (for better or worse). I agree with Texas that moonlighting would be a good way to see the actual world. If that's not possible you can always pick a first job that allows you to moonlight and that does not have a non-compete.

I would typically avoid going straight into solo cash PP after training, I think it's better to develop your network/potential referral sources and solidifying your clinical skills first (possible at IP/RTC/PHP/IOP). Other people on this board disagree. A few years of employed or contracted work is also a guaranteed way to get your finances off to the right direction.

 

[shoomer]

I talked to a ton of employers/recruiters and what I wanted began to crystallize as I found my personal preference of CL > IP > OP. I ended up with an IP role as the CL options didn't fit what I was looking for.

I don't think you can conceptualize attending life fully before starting unless you stay where you trained and have already rotated in that position. Most people are not figuring everything out from their very first job.

Sit down and rank your priorities (practice setting, compensation, location, lifestyle, etc) then determine what you are comfortable compromising on.

The future inherently comes with uncertainty. Reframe your anxiety by recognizing that you have incredible flexibility in psychiatry.

 

[Ironspy]

Agree with the above. If you’re struggling with anxiety outside of work as well, you may benefit from seeing a therapist to help sort through your thoughts.

 

[comp1]

I knew I wanted inpatient psych from my very first day on the clerkship, but I do know other people have gone through some of this. The important thing is that, in general, attending life will be better than resident life. I'd be interested to hear more about your financial concerns, that seemed somewhat unique. What did you mean by that?

 

[Stagg737]

Agree with all of the above, but to add another point OP is only a PGY-2 and likely hasn't even started their outpatient year. OP, how do you know you even want outpatient? I know plenty of people that thought they'd love outpatient who ended up hating it (and the opposite). On top of that, outpatient at academic programs is often very different from outpatient PP, unless you've done a few rotations in clinics similar to what you're talking about why do you think you want cash only PP + therapy? I agree with others that going straight into that out of residency can be difficult and often takes time to build up that type of practice. If you become confident that this is what you want, it would probably be best to start building that practice during your PGY-4 year if possible.

In terms of addressing the anxiety, it's important to understand that many fresh graduates do not start out in their ideal role and end up transitioning into something else at some point. This idea that once you're an attending everything magically falls into place is a myth. Yes, there's many positives about attendinghood (stability/need for us, increased pay, ability to bargain and negotiate contracts, etc) but reframing our thoughts from "I'm going to do something I love and don't need to struggle anymore" to "Now I have the tools, credentials, and autonomy to grow and build the career that I want" is important. Yes, things get easier at some point, but the biggest learning curve in our field is probably the first year of practice as an attending. Understanding this and that it will take time to adapt (and that this is normal!!!) will hopefully help normalize some of those anxieties. If it's more just about your anxiety with lack of control or managing uncertainties then I agree with Ironspy that seeking therapy for yourself is probably wise.