Would you still choose psych?

[mymembernames]

If you had a chance to go back and knowing what you know now (psych residents / attendings) would you have still chosen and done psych? Why or why not?

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[OldPsychDoc]

I am older now I have more than what I wanted
But I wish that I had started long before I did...

 

[liquidshadow22]

I would have become a surgeon instead. I like doing something active with my time and seeing immediate results.

If you enjoy sitting in front of a computer and writing notes X infiniti for the rest of your career, pick a nonsurgical speciality. I didn't realize how much of your time is spent with documentation and just writing scripts, putting in orders etc. It's not exactly exciting work.

The lifestyle is good in psychiatry, the pay great for what you're doing, low malpractice etc, but if you like immediate results, then become a surgeon. There are many days I feel that the work I do is pointless. There are certainly patients I feel I am helping but to me it's a small %. What I like most about psychiatry is the interactions because at the end of the day I am a people person, but this unfortunately is overshadowed by all the other boring crap you have to do, which takes up most of your time.

 

[solitarius]

When I got to medical school, I wondered why all the people are weird. Now four years in, I totally see it. Medicine is a boring grind. It needs the timid wonks to work internal medicine and the workaholic machines to man the OR.

I am neither. I am going into Psych because the patients are interesting, and I like talking to them. I cannot be bothered to check serum electrolytes or stand 18 hours a day in the OR. F# that.

 

[TexasPhysician]

I love what I do. I’m glad I had the drive to do medical school. Assuming I did medical school again, I would definitely choose psychiatry again.

 

[michaelrack]

When I got to medical school, I wondered why all the people are weird. Now four years in, I totally see it. Medicine is a boring grind. It needs the timid wonks to work internal medicine and the workaholic machines to man the OR.

I am neither. I am going into Psych because the patients are interesting, and I like talking to them. I cannot be bothered to check serum electrolytes or stand 18 hours a day in the OR. F# that.

Alot of your inpatients will be low in potassium or have other electrolyte abnormalities

 

[WisNeuro]

Alot of your inpatients will be low in potassium or have other electrolyte abnormalities

And if you start seeing gero patients, hoo boy.

 

[FlowRate]

There are certain key stages at which specific personal life factors could have changed that would have potentially led to my choosing a different specialty. Overall, I'm happy with psychiatry and enjoying the work. We have a relatively work heavy residency and it's still far easier than the majority of other specialties, which is a plus.

 

[dl2dp2]

When I was a med student i was actually very very hesitant to go into psych--aspects of psych, esp. in older teaching faculty annoyed me. Since then (which was not that awful long ago) the field has improved (in some ways dramatically). This is quickly reflected in the market value. The field is now solidly in the middle of the pack, above most of the cognitive IM specialties and possibly neurology/EM/OB in terms of competitiveness. If I were a med student now knowing what I know today I'd go into psych in a heartbeat.

The field itself is very diverse and much larger than say derm/some small competitive specialty in IM like allergy or subspecialty surgeries. I'd say top 10-20% of psych jobs (i.e. lucrative private jobs, one level up subspecialist in facilities) compare favorably with any of the best jobs in medicine. The material content also improved. There's still some remnant of things I don't like (i.e. social work) but most of the day to day work is complicated med management, case management (i.e. big picture treatment planning), team management etc. I'm surprised by how much I think about the brain, and how the system (i'm including here both admin, other doctors and patients) now conceptualize psychiatrists as more of a medical subspecialist rather than some garbage dump--with the shortage it's cheaper to pay for social workers.

With the new treatments on launching pad this medicalization of psychiatry will continue--happening in every field. Neurology feels now more like cardiology than a cognitive IM specialty. The technological progress on psychotherapy is just not anywhere close to on the med/device side, and most of the money etc. get spent on new tech. With money comes prestige and salary bump. Most of the core IM work IMO (i.e. actually talking to a patient and examine a patient) will be relegated to mid levels at a facility, except for cash jobs.

 

[deleted587934]

When I was a med student i was actually very very hesitant to go into psych--aspects of psych, esp. in older teaching faculty annoyed me. Since then (which was not that awful long ago) the field has improved (in some ways dramatically). This is quickly reflected in the market value. The field is now solidly in the middle of the pack, above most of the cognitive IM specialties and possibly neurology/EM/OB in terms of competitiveness. If I were a med student now knowing what I know today I'd go into psych in a heartbeat.

The field itself is very diverse and much larger than say derm/some small competitive specialty in IM like allergy or subspecialty surgeries. I'd say top 10-20% of psych jobs (i.e. lucrative private jobs, one level up subspecialist in facilities) compare favorably with any of the best jobs in medicine. The material content also improved. There's still some remnant of things I don't like (i.e. social work) but most of the day to day work is complicated med management, case management (i.e. big picture treatment planning), team management etc. I'm surprised by how much I think about the brain, and how the system (i'm including here both admin, other doctors and patients) now conceptualize psychiatrists as more of a medical subspecialist rather than some garbage dump--with the shortage it's cheaper to pay for social workers.

With the new treatments on launching pad this medicalization of psychiatry will continue--happening in every field. Neurology feels now more like cardiology than a cognitive IM specialty. The technological progress on psychotherapy is just not anywhere close to on the med/device side, and most of the money etc. get spent on new tech. With money comes prestige and salary bump. Most of the core IM work IMO (i.e. actually talking to a patient and examine a patient) will be relegated to mid levels at a facility, except for cash jobs.

Out of curiosity, what annoyed you about the older teaching faculty?

 

[Monocles]

1000x yes!

If I could go back in time and prevent myself from every applying to med school I would do that first. But if I'm stuck in medicine then psychiatry is by far the least painful field.

If I had to apply for residency again I would definitely pick a program that maximises the amount of child exposure though. Yuck. Only 115 more days of working with grown-ups! (well, aside from families but still...)

 

[dl2dp2]

Out of curiosity, what annoyed you about the older teaching faculty?

People who were in their late 50s and 60s at the time (about 10 years ago) were uniformly not great psychopharmacologists unless they were researchers. Fluoxetine came on the market in 1986, and olanzepine didn't come on the market until 1990s, so these folks were not trained on modern psychopharmacology or neuroscience. They typically discount meds as either 1) intolerable 2) not effective vs. psychoanalytic treatment, which was what they grew up with and refused to give up. Interestingly, this was more prevalent in inpatient/CL context, which was where med school training takes place, because the attendings who taught in these contexts tend to move less frequently and older. So they give off the impression that psychiatry is some mishmash of psychobabble and being sensitive to "social determinants of mental health".

Within academia there was also a sea change in the late 90s early 2000s. Prior to that all the department chairs were psychoanalysts. After that NONE of the chairs were psychoanalysts. Most of the chairs are geneticists or clinical trialists, a few basic neuroscientists, a few implementation science people. It's kind of shocking in retrospect how far the idea that mental illnesses are brain disorders has been widely accepted now as fundamentally true, and how controversial it was even 10-15 years ago.

Not that these factors are not fundamentally important, but practice of psychiatry has moved very far away from that and there's no sign that it's coming back. The distance between psychiatry, psychoanalysis and social work has grown quite substantially.

 

[thoffen]

I would have become a surgeon instead. I like doing something active with my time and seeing immediate results.

If you enjoy sitting in front of a computer and writing notes X infiniti for the rest of your career, pick a nonsurgical speciality. I didn't realize how much of your time is spent with documentation and just writing scripts, putting in orders etc. It's not exactly exciting work.

The lifestyle is good in psychiatry, the pay great for what you're doing, low malpractice etc, but if you like immediate results, then become a surgeon. There are many days I feel that the work I do is pointless. There are certainly patients I feel I am helping but to me it's a small %. What I like most about psychiatry is the interactions because at the end of the day I am a people person, but this unfortunately is overshadowed by all the other boring crap you have to do, which takes up most of your time.

A lot of that depends on your practice setting, which is one of the best things about psych. If you don't like what you are doing, it's relatively easy to switch gears completely. Of course, it may come with some sacrifice and there's no way to get around administrative BS overall.

Personally, I think psychiatry can do more than other specialties. For example, I find being able to sit with someone and appreciate together the hopelessness of their situation one of the most valuable gifts that can ever be given. Surgical outcomes are often way over appreciated compared to reality, and personally I don't think I could handle being confronted with all of the harm surgery can cause. Not that psychiatrists don't harm patients sometimes.

 

[Monocles]

Personally, I think psychiatry can do more than other specialties. For example, I find being able to sit with someone and appreciate together the hopelessness of their situation one of the most valuable gifts that can ever be given. Surgical outcomes are often way over appreciated compared to reality, and personally I don't think I could handle being confronted with all of the harm surgery can cause. Not that psychiatrists don't harm patients sometimes.

Can you share some advise on how to appreciate the "sense of hopelessness"? I personally feel overwhelmed by patients who virtually nothing can be done for. Maybe I'm just still not quit there in terms of training.

 

[prominence]

If given the option knowing what I know now, I would not choose to go medical school

 

[NickNaylor]

At the start of medical school, I never would've said that I was going to become a psychiatrist. And there were a few different fields that I found interesting in medical school and could've seen myself being satisfied in. Now that I'm a few months away from finishing residency, I can say that I love my work and am happy that I chose to go into psychiatry. I'm very much looking forward to my career.

 

[thoffen]

Can you share some advise on how to appreciate the "sense of hopelessness"? I personally feel overwhelmed by patients who virtually nothing can be done for. Maybe I'm just still not quit there in terms of training.

It's really just an empathetic response. But chances are you are mostly there with your feeling overwhelmed. If you can shift your attention to that being something your patient is feeling and transferring to you via projective identification as communication rather than manipulation, you can realize you feeling hopeless is a good thing here. It's not your fault. It's because you're brave enough to recognize that someone is really suffering in this way. If you can do that and be willing to accept it instead of hoping to take it away when you really aren't able to or to throw the hopelessness back on your patient, then the empathetic response is automatic.

 

[Shufflin]

I'm very fortunate to have landed an excellent job situation so that really biases me to say YES I would choose psych again. I've worked in corporate American where all the drags of a job are very real. I'm at a place where the CEO is giving me full reign to take leadership roles and pretty much do whatever I want across various delivery models of the specialty, which points to my overall point and that is in many parts of the country psychiatry is somewhat parched of leadership, good leadership. And then I feel I make a difference for patients, seeing them make real strides in daily living. It's not all patients, and some never improve, but it's nearly every day.

Could I be happy in neurosurgery or radiology which were my other close contenders? Sure, but this specialty was a calling really.

I couldn't be happier, but take heed, listen to the disillusioned because there is truth there too.

 

[solitarius]

Personally, I think psychiatry can do more than other specialties. For example, I find being able to sit with someone and appreciate together the hopelessness of their situation one of the most valuable gifts that can ever be given. Surgical outcomes are often way over appreciated compared to reality, and personally I don't think I could handle being confronted with all of the harm surgery can cause. Not that psychiatrists don't harm patients sometimes.

Beautifully said.

 

[liquidshadow22]

A lot of that depends on your practice setting, which is one of the best things about psych. If you don't like what you are doing, it's relatively easy to switch gears completely. Of course, it may come with some sacrifice and there's no way to get around administrative BS overall.

Personally, I think psychiatry can do more than other specialties. For example, I find being able to sit with someone and appreciate together the hopelessness of their situation one of the most valuable gifts that can ever be given. Surgical outcomes are often way over appreciated compared to reality, and personally I don't think I could handle being confronted with all of the harm surgery can cause. Not that psychiatrists don't harm patients sometimes.

One does not need to do 4 years of medical school + 4 years of residency to empathize with the hopelessness of a patient's plight. Any doctor or even person, can do that.

I agree that surgery doesn't always fix things but just the idea of starting an operation and finishing it, to me, would likely provide a more tangible sense of accomplishment than most things we can do in psychiatry. I understand that we can and do help patients, it's just usually a more gradual benefit with medication/therapy in most cases.

I haven't done much ECT, maybe I will enjoy doing that.

 

[thoffen]

One does not need to do 4 years of medical school + 4 years of residency to empathize with the hopelessness of a patient's plight. Any doctor or even person, can do that.

I agree that surgery doesn't always fix things but just the idea of starting an operation and finishing it, to me, would likely provide a more tangible sense of accomplishment than most things we can do in psychiatry. I understand that we can and do help patients, it's just usually a more gradual benefit with medication/therapy in most cases.

I haven't done much ECT, maybe I will enjoy doing that.

I realize in my response to you I missed your own feelings of (relative) hopelessness and devalued your idea to escape it. Honestly, you might be a person where surgery is a better fit. If you can bring to it a greater humanism, it will be a great thing.

Obviously psychiatry has no special privilege when it comes to empathy. My experience is that choosing this specialty has allowed me the privilege of sharing in the lives of a great number of people whom I would never have been able to relate to otherwise. And that experience continues to greatly enliven me. I do not think it is something I would have gotten elsewhere.

 

[finalpsychyear]

After considering dental school and taking time away from medical school where i almost went into business school.... staying in medicine and going into psych was the best decision i ever made. Amazing lifestyle/autonomy is not present in all fields but the ability to always make more money if you choose goes for all medical fields. However, never having a boss for the rest of my career ( 2029 retirement) is utterly priceless..


Honestly, I feel those who are not enjoying psych are stuck in some organization with poor autonomy or overworked at some CMHC. Anyone in psych can go in most areas and have a really good private office. It is rare these days to be a solo doc but psych is very low in overhead that can make it still feasible. I think if you have your own office working 10-4, 4 days a week, no wknds, accepting certain patients only with no call that is going to add vastly to your job satisfaction.

 

[Attending1985]

I would choose something else. Too many patients just wanting controlled substances. Just in general people wanting to get rid of all negative emotions no matter what the cost with very little insight. Most people you will see have emotional disturbances and lack of maturity but will demand psychiatric drugs and diagnoses. If you do good work you will often be the bad guy. And all the toxicities of the medications that put peoples heath at risk. You encounter these issues in other areas of medicine but this is all psychiatry is. Also a lot people that work in mental health have their own issues which can make the workplace unpleasant.

 

[SourceOfDenial]

[QUOTE="liquidshadow22, post: 20769144, member: 104898]

I agree that surgery doesn't always fix things but just the idea of starting an operation and finishing it, to me, would likely provide a more tangible sense of accomplishment than most things we can do in psychiatry. I understand that we can and do help patients, it's just usually a more gradual benefit with medication/therapy in most cases.

[/QUOTE]

Hanging drywall gives that tangible sense of accomplishment too.

 

[Sushirolls]

When this fantasy manifests I've at times drifted towards Radiology or Neurosurgery. But realistically my life path choices would very much so lead me right where I am today.

The sentiments expressed above about lament for those in the employed psych positions. I've experienced that definitely tore at my zeal for the work. I've regained so much more with opening my own solo practice. The part of me that almost went into surgery is appeased by doing ECT. ECT is my number one love in psychiatry. Simply because it works and undeniably is the best treatment modality for most of its indications. I enjoy seeing the bigger win when patients transition from deep dark dysfunction, to then having anxiety about what will they do with their life now that they can.

Unfortunately with ECT, you will run into walls of bureaucracy, hospital politics, CMS discrimination, and a sea of other headaches you wouldn't expect in getting a service up and running. It will take a year minimum to check the boxes...

 

[Trismegistus4]

I would choose something else. Too many patients just wanting controlled substances. Just in general people wanting to get rid of all negative emotions no matter what the cost with very little insight. Most people you will see have emotional disturbances and lack of maturity but will demand psychiatric drugs and diagnoses. If you do good work you will often be the bad guy. And all the toxicities of the medications that put peoples heath at risk. You encounter these issues in other areas of medicine but this is all psychiatry is. Also a lot people that work in mental health have their own issues which can make the workplace unpleasant.

I strongly agree with this. Way too many are coming in mainly for secondary gain-type reasons: controlled substances, FMLA/disability forms, emotional support animal letters; I even recently had a guy ask me to write a letter in support of Medicare (yes, he's on SSDI) paying for a psychiatric service dog for his PTSD, which he claims to have as a result of military combat, yet I doubt he was ever even in the military since he has a long history of claiming he's trying to get in with the VA but they keep mysteriously "losing his records" or something. Very few people actually want to get better, they just want the escape of being sedated with controlled substances, or have everyone else think they're special because they get to drag a damn dog into a public place where it doesn't belong.

As others have said, some of this is a function of being in an employed environment, as more and more of us are. We can't screen patients out or have them told at the time of referral "Dr. So-and-so doesn't do that;" these people are just placed on our schedule with no say or input from us, and that's not going to change, not only for financial reasons but because part of the reason we are there is to placate the primary care doctors by giving them someone to punt to. But I don't want the responsibility of running my own practice, so no, if I could go back, I would choose a non patient care specialty like radiology or pathology.

 

[Sushirolls]

I strongly agree with this. Way too many are coming in mainly for secondary gain-type reasons: controlled substances, FMLA/disability forms, emotional support animal letters; I even recently had a guy ask me to write a letter in support of Medicare (yes, he's on SSDI) paying for a psychiatric service dog for his PTSD, which he claims to have as a result of military combat, yet I doubt he was ever even in the military since he has a long history of claiming he's trying to get in with the VA but they keep mysteriously "losing his records" or something. Very few people actually want to get better, they just want the escape of being sedated with controlled substances, or have everyone else think they're special because they get to drag a damn dog into a public place where it doesn't belong.

As others have said, some of this is a function of being in an employed environment, as more and more of us are. We can't screen patients out or have them told at the time of referral "Dr. So-and-so doesn't do that;" these people are just placed on our schedule with no say or input from us, and that's not going to change, not only for financial reasons but because part of the reason we are there is to placate the primary care doctors by giving them someone to punt to. But I don't want the responsibility of running my own practice, so no, if I could go back, I would choose a non patient care specialty like radiology or pathology.

Keep fighting the good fight and say no. We strive to help our patients with boundaries, you can do the same. I don't sign for support animals. Don't think the patient is disabled? Don't do the paper work and tell the patient why. Or if you are doing FMLA, have the hitch that its conditioned on doing an IOP or PHP simultaneously. Don't prescribe the controlled substances if don't want/believe in doing so.

Or if the disability, FMLA etc is appropriate, have the patient come in for a 30min follow up and fill it out while they are in the office so you have billable time and they get it immediately, know whats in it, and they help you add those extra details you might not have been aware of.

Recently a dog bit the face of a 5 year girl in the airport. I tell patients that unless its an officially trained dog/animal with paper work to validate it, I won't sign for it. If the dog bites a child, or runs on the airport tarmac, or ruins a store I could potentially be liable. I tell this to patients, you want an official treatment you need an official animal. Can reduce liability to be able to say this animal was trained by this standard, with this agency. No one follows thru, and they then just go to their primary care or someone else to get it done.

If you don't want to run your own practice you can always seek out the small psych specific groups that are representing quality - could be the environment you seek.

 

[tellme_areyoufree]

So far I'm very happy with my choice of psychiatry. In my intern year I've felt challenged (in a positive sense), and I love the patients I work with. I see a positive outlook in terms of professional opportunities. I feel like I could go multiple subspecialty directions and still be happy (although I'm pretty set on child). I'm seeing more respect from other specialities than I saw in medical school (could be because of a geographic change, but I also feel like I'm seeing a shift in respect over all... granted, my perspective is limited).

Plus I get to be in the same field as people like OldPsychDoc, and who doesn't love people who quote Crosby, Stills & Nash?

So yeah. I'd pick psych again in a heartbeat.

 

[erg923]

because they get to drag a damn dog into a public place where it doesn't belong.

Derail warning: Emotional Support Animals/Pets:

Just wanted to comment on this because it has become quite pervasive in the last 5 years or so.

We all want to do what best for our patients, but overruling and trampling on the rights of landlords or other private businesses/business owners because we have an MD. or Ph.D. does not seem wise or appropriate. I can't understand why so many would think this appropriate use of their authority? Ones refusal to engage in empirically-based treatment for a disorder should not give you and me the right to interfere with private businesses and their policies.

Derail warning: Disability

Its damn hard to be soooo disabled from a psychiatric disorder that you can not perform work according to the definition/scope of "work" and the definition/scope of "impairment" as defined by most guidelines---Social Security in particular. There is alot of legalese definitions here that I suspect psychiatrists ignore when they fill out these forms? Thats what you are being asked. Not should they work...or would they be a good employee?

 

[Attending1985]

I strongly agree with this. Way too many are coming in mainly for secondary gain-type reasons: controlled substances, FMLA/disability forms, emotional support animal letters; I even recently had a guy ask me to write a letter in support of Medicare (yes, he's on SSDI) paying for a psychiatric service dog for his PTSD, which he claims to have as a result of military combat, yet I doubt he was ever even in the military since he has a long history of claiming he's trying to get in with the VA but they keep mysteriously "losing his records" or something. Very few people actually want to get better, they just want the escape of being sedated with controlled substances, or have everyone else think they're special because they get to drag a damn dog into a public place where it doesn't belong.

As others have said, some of this is a function of being in an employed environment, as more and more of us are. We can't screen patients out or have them told at the time of referral "Dr. So-and-so doesn't do that;" these people are just placed on our schedule with no say or input from us, and that's not going to change, not only for financial reasons but because part of the reason we are there is to placate the primary care doctors by giving them someone to punt to. But I don't want the responsibility of running my own practice, so no, if I could go back, I would choose a non patient care specialty like radiology or pathology.

I really think primary care has created a lot of these problems. They overuse psychiatric medications for pretty much any reason, enable people, create disasters then punt them to you. Of course psychiatrists do this too but at least there’s less of us so less damage done.

 

[Attending1985]

To add although I wouldn’t choose psych I still like working with patients. I would do IM and be a hospitalist.

 

[Taddy Mason]

...and who doesn't love people who quote Crosby, Stills & Nash?

 

[liquidshadow22]

[QUOTE="liquidshadow22, post: 20769144, member: 104898]

I agree that surgery doesn't always fix things but just the idea of starting an operation and finishing it, to me, would likely provide a more tangible sense of accomplishment than most things we can do in psychiatry. I understand that we can and do help patients, it's just usually a more gradual benefit with medication/therapy in most cases.

Hanging drywall gives that tangible sense of accomplishment too.[/QUOTE]

Sure but you're comparing surgery, a skill that requires years of training and study to perfect and master with high risk /reward for the benefit of another human being, with a rudimentary task that can be done with a middle school education.

 

[SourceOfDenial]

Hanging drywall gives that tangible sense of accomplishment too.

Sure but you're comparing surgery, a skill that requires years of training and study to perfect and master with high risk /reward for the benefit of another human being, with a rudimentary task that can be done with a middle school education.[/QUOTE]
Sounds like you haven’t done much framing, or hung any drywall.

 

[futuredo32]

For the love of God, NO. I am applying for a second residency in FP next cycle. I don't mind a little psych but you don't use the majority of what you used in med school and I find it SO monotonous. I had a GREAT attending for a psych rotation who made the rotation so fun and I think that colored my view of psych immensely. One of my top 3 regrets in life.

 

[futuredo32]

After considering dental school and taking time away from medical school where i almost went into business school.... staying in medicine and going into psych was the best decision i ever made. Amazing lifestyle/autonomy is not present in all fields but the ability to always make more money if you choose goes for all medical fields. However, never having a boss for the rest of my career ( 2029 retirement) is utterly priceless..


Honestly, I feel those who are not enjoying psych are stuck in some organization with poor autonomy or overworked at some CMHC. Anyone in psych can go in most areas and have a really good private office. It is rare these days to be a solo doc but psych is very low in overhead that can make it still feasible. I think if you have your own office working 10-4, 4 days a week, no wknds, accepting certain patients only with no call that is going to add vastly to your job satisfaction.

I'm not enjoying psych. I have a small private practice and also work in a clinic where I get paid hourly and pick and choose when I will work , I can fire patients there, the clinic owner doesn't ever say anything negative and can take as much time off as I want with short notice and they have a high no show rate so I am not overworked . I moonlight one weekend a month because the money for that is amazing. And...…….. I am applying t0 FP next year. I just find it so monotonous. I like a little psych but not exclusively.

 

[SourceOfDenial]

For the love of God, NO. I am applying for a second residency in FP next cycle. I don't mind a little psych but you don't use the majority of what you used in med school and I find it SO monotonous. I had a GREAT attending for a psych rotation who made the rotation so fun and I think that colored my view of psych immensely. One of my top 3 regrets in life.

What are the other two?

 

[futuredo32]

What are the other two?

That's way too personal.

 

[Roxas]

What are the other two?

Salad when I should have got the soup.

 

[SourceOfDenial]

Salad when I should have got the soup.

Does that count as one regret? Or two?

Always go for the soup. Always.

 

[Evidence Based]

As someone who's just finishing up my medicine months in my internship (and as someone who really enjoys internal medicine), zero regrets. This is really an awesome field, albeit with plenty of drawbacks (like any other specialty ever). I find that the drawbacks of psychiatry are not the things I care particularly about, and the good things about it are things I really enjoy.
Having seen the life of an internist and lived the life of a medicine resident for long stretches, zero regrets about "hanging up my stethoscope." Nothing but complete respect for my internist colleagues, but that lifestyle is just not appealing to me. I personally never considered surgery because I like seeing the sun, and I would prefer to not get divorced.

 

[Monocles]

I'm not enjoying psych. I have a small private practice and also work in a clinic where I get paid hourly and pick and choose when I will work , I can fire patients there, the clinic owner doesn't ever say anything negative and can take as much time off as I want with short notice and they have a high no show rate so I am not overworked . I moonlight one weekend a month because the money for that is amazing. And...…….. I am applying t0 FP next year. I just find it so monotonous. I like a little psych but not exclusively.

Wait, are you a resident or attending? If you're close or done with training anyway, why not just get super chill gigs that pay a ton of money and then go to a different career altogether? Are you sure that the same things that you dislike about psych would not be present in any other medical field?

 

[Monocles]

I strongly agree with this. Way too many are coming in mainly for secondary gain-type reasons: controlled substances, FMLA/disability forms, emotional support animal letters; I even recently had a guy ask me to write a letter in support of Medicare (yes, he's on SSDI) paying for a psychiatric service dog for his PTSD, which he claims to have as a result of military combat, yet I doubt he was ever even in the military since he has a long history of claiming he's trying to get in with the VA but they keep mysteriously "losing his records" or something. Very few people actually want to get better, they just want the escape of being sedated with controlled substances, or have everyone else think they're special because they get to drag a damn dog into a public place where it doesn't belong.

As others have said, some of this is a function of being in an employed environment, as more and more of us are. We can't screen patients out or have them told at the time of referral "Dr. So-and-so doesn't do that;" these people are just placed on our schedule with no say or input from us, and that's not going to change, not only for financial reasons but because part of the reason we are there is to placate the primary care doctors by giving them someone to punt to. But I don't want the responsibility of running my own practice, so no, if I could go back, I would choose a non patient care specialty like radiology or pathology.

I would choose something else. Too many patients just wanting controlled substances. Just in general people wanting to get rid of all negative emotions no matter what the cost with very little insight. Most people you will see have emotional disturbances and lack of maturity but will demand psychiatric drugs and diagnoses. If you do good work you will often be the bad guy. And all the toxicities of the medications that put peoples heath at risk. You encounter these issues in other areas of medicine but this is all psychiatry is. Also a lot people that work in mental health have their own issues which can make the workplace unpleasant.

This sums up probably what I dislike the most about the field also. However, do these problems go away if you're exclusively working in child psych? What about working with a more high-functioning population? (ex: other professionals, college students, etc)

 

[dl2dp2]

This sums up probably what I dislike the most about the field also. However, do these problems go away if you're exclusively working in child psych? What about working with a more high-functioning population? (ex: other professionals, college students, etc)

Child, in the employed facilities context, is way worse. Not only are you dealing with the child (and more commonly, adolescent malingerers), now you are dealing with the parents who are of this type. The extent of social work becomes less manageable.

You can get away from malingering and related issues by starting a private practice, or work for a group practice with a good mix of insurance. Issues of this type are mainly associated with social ills that you can do little about, and hence contexts matter a great deal. If you focus on working adults you'll realize that most people want/need to get better from mental health issues and you get few malingerers. Still, personality disorders (primary gain, narcissism induced work failure, family conflict etc) are common regardless and you should be trained to deal with them in a technical way in routine outpatient practice.

Unfortunately the issues of this type that are associated with insurance sorting, hospital administration, malingering, social ills etc are prevalent in almost all specialties in medicine from EM to OBGYN to even surgery. You do get hit square in the face if you work in a public facility in psychiatry, but it's just part of being a doctor---medicalization helped this somewhat: friends who work at outpatient facilities are now rarely expected do any serious therapy with malingerers, which limits interaction (hence the "insight problem" is no longer yours). Conflicts re: medications are now directed into a formal bureaucratic review and quality algorithm, absolving individual physician from significant individual level responsibility. IMO people who get burnt out have unrealistic expectations of therapeutic interaction with the wrong patient. For public psych, the field is increasingly going in the direction of any other medical subspecialty (like oncology), i.e. malingering/drop out/poor engagement/med misuse etc is treated like routine mortality and another number at some panel review. But if you went into psych to "really help people" (like a therapist) it becomes problematic, and I would caution you against going into psych for that reason these days--it's still possible in a very narrow set of very super subspecialized ways, but by and large, that type of jobs is not the norm anymore.

 

[hamstergang]

Child, in the employed facilities context, is way worse. Not only are you dealing with the child (and more commonly, adolescent malingerers), now you are dealing with the parents who are of this type. The extent of social work becomes less manageable.

I'm in an outpatient hospital-based child/adolescent psychiatry job and absolutely love it. Sure, there are issues with some patients, parents, and administrators, but these aren't getting in the way of me doing the job I want to do and enjoy it. I don't know if this says more about me or the specific job I have, but it's worth noting for the OP that this is possible.

 

[futuredo32]

Wait, are you a resident or attending? If you're close or done with training anyway, why not just get super chill gigs that pay a ton of money and then go to a different career altogether? Are you sure that the same things that you dislike about psych would not be present in any other medical field?

I graduated residency in 2015. There is VARIETY in FP. I miss the variety. I WANT to be a physician. There's always the paperwork and insurance BS. I am bored mainly with JUST psych. There's a fair amount of psych in FP. I like the doctor patient relationship. If I won millions of dollars in a lottery (and I don't think that's likely), I still would want to do FP. My patients show me their red throats, their rashes, and mention symptoms outside of psych and I would love to be treating those in addition to their psych issues. I knew I wanted to do FP my first year of residency and considered leaving but stayed thinking I would do a FP residency after not knowing how hard it was to get a 2nd residency in FP. I just find psych SO repetitive. I'm glad there are people who love psych. I don't care that FP pays less, I want to be HAPPY with my career.

 

[liquidshadow22]

I graduated residency in 2015. There is VARIETY in FP. I miss the variety. I WANT to be a physician. There's always the paperwork and insurance BS. I am bored mainly with JUST psych. There's a fair amount of psych in FP. I like the doctor patient relationship. If I won millions of dollars in a lottery (and I don't think that's likely), I still would want to do FP. My patients show me their red throats, their rashes, and mention symptoms outside of psych and I would love to be treating those in addition to their psych issues. I knew I wanted to do FP my first year of residency and considered leaving but stayed thinking I would do a FP residency after not knowing how hard it was to get a 2nd residency in FP. I just find psych SO repetitive. I'm glad there are people who love psych. I don't care that FP pays less, I want to be HAPPY with my career.

Its funny cause the grass is always greener... i know one attending who switched from medicine to psych and her reasoning was "it was so repetitive and boring". Also know a FP dr who said to me" i love psych. its so interesting. FM is the same stuff over and over."

I think the moral of the story is that no matter what you do...things become repetitive and it takes creativity to keep things interesting.

 

[TexasPhysician]

I graduated residency in 2015. There is VARIETY in FP. I miss the variety. I WANT to be a physician. There's always the paperwork and insurance BS. I am bored mainly with JUST psych. There's a fair amount of psych in FP. I like the doctor patient relationship. If I won millions of dollars in a lottery (and I don't think that's likely), I still would want to do FP. My patients show me their red throats, their rashes, and mention symptoms outside of psych and I would love to be treating those in addition to their psych issues. I knew I wanted to do FP my first year of residency and considered leaving but stayed thinking I would do a FP residency after not knowing how hard it was to get a 2nd residency in FP. I just find psych SO repetitive. I'm glad there are people who love psych. I don't care that FP pays less, I want to be HAPPY with my career.

This is a thread about choosing psychiatry, so I’m going to make my case for psych based on your post above. In no way is this advise specific to you or necessarily attempting to sway you.

There are many psychiatry jobs where I would be equal psychiatrist and family physician simultaneously. I’ve worked weekend moonlighting on a 150 bed unit with about 35 of those being geri. A NP is available for med consults on weekends. They don’t view a FP as necessary. I’m handling virtually everything and determining if/when transfer to ER happens. No luxury of consulting a specialist on a locked unit.

I’ve worked addiction medicine jobs that encourage psych to handle as much as possible. ER doc is available within 36 hours to consult whatever I can’t figure out. HTN, rashes, DM, etc is all me anytime I want.

I have an unrestricted medical license which means I can practice medicine in general. If I completely exit a reasonable scope and botch an appendectomy, I expect the lawsuit to be harder to win without a surgery residency. On the flip side, derm doesn’t own the skin. I evaluate rashes from my meds all the time, and on inpatient, there is no derm. FP and IM do derm all the time. Now if we catch skin cancer, no one but derm should be doing the surgery imo. Obviously know your limitations.

I read about medical issues, and I have an IM friend that I chat with from time to time to see where my knowledge could be better.

The simple takeaway is that psychiatrists can find roles in which they can essentially be psych + FM to their heart’s content. It isn’t hard to find either.

 

[Monocles]

I graduated residency in 2015. There is VARIETY in FP. I miss the variety. I WANT to be a physician. There's always the paperwork and insurance BS. I am bored mainly with JUST psych. There's a fair amount of psych in FP. I like the doctor patient relationship. If I won millions of dollars in a lottery (and I don't think that's likely), I still would want to do FP. My patients show me their red throats, their rashes, and mention symptoms outside of psych and I would love to be treating those in addition to their psych issues. I knew I wanted to do FP my first year of residency and considered leaving but stayed thinking I would do a FP residency after not knowing how hard it was to get a 2nd residency in FP. I just find psych SO repetitive. I'm glad there are people who love psych. I don't care that FP pays less, I want to be HAPPY with my career.

ahhhh gotcha. Well good luck to you friend! I hope you find happiness in your future no matter what you end up doing!

 

[Merovinge]

Child, in the employed facilities context, is way worse. Not only are you dealing with the child (and more commonly, adolescent malingerers), now you are dealing with the parents who are of this type. The extent of social work becomes less manageable.

I'm not sure where sluox works at, but that is absolutely counter to my experiences both in CAP fellowship and as an attending in very different geographical locations (and both times as an employee of a healthcare system). I see severe depression, crippling social anxiety disorder, horrendous PTSD/complex trauma, severe autism, and genetic disorders presentations on a daily basis. Most of my ADHD cases are actually coaxing families and pt's into taking medication and not the other way around. I had one case of a teenager recently from a much more affluent family that was presenting at 13 for ADHD evaluation sending off all sorts of alarm bells. Well low and behold his neuropsychologic testing came back with >2 std dev splits with his working memory and processing speed compared to other domains in a manner extremely consistent with ADHD. He already is performing the best at school of his entire life on a very modest dose of Focalin.

Most of the parents I meet are so thankful that someone can put to words what they have known, validate their feelings/concerns, or even tell them that they are responsible for taking their kid's phone away at night. I did have a family providing $$ for a teen to smoke 5g of marijuana a day but those families are definitely a minority.