Would you still choose psych?

[Dharma]

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.

How do I go about making this happen? With love, PGY3.

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[Monocles]

How do I go about making this happen? With love, PGY3.

Negotiate the ability to set your own schedule. For example 9-5 jobs can be closer to 10-3 if you cram all your patient slots to the middle and put your admin time at the beginning and end of your day. As long as you're seeing all your patients and finishing your paperwork, I don't think too many places care if you get a coffee and show up at 8:15 instead of 8:00

 

[Mad Jack]

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

I know that feel

 

[Dharma]

Negotiate the ability to set your own schedule. For example 9-5 jobs can be closer to 10-3 if you cram all your patient slots to the middle and put your admin time at the beginning and end of your day. As long as you're seeing all your patients and finishing your paperwork, I don't think too many places care if you get a coffee and show up at 8:15 instead of 8:00

Most interested in eventually being my own boss (as much as possible at least since someone is always pulling the strings someplace).

 

[futuredo32]

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.

I don't see how FP could be repetitive. You can see babies, psych issues , htn, DM, serious illnesses, zebras, preventive medicine, do minor procedures. It's a bit of EVERYTHING we learned in med school.

 

[futuredo32]

There are many psychiatry jobs where I would be equal psychiatrist and family physician simultaneously.

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.

In all of the hospitals where I have moonlighted they had IM cover medicine. I actually did a TRI so I could work in an urgent care but I really like the Dr/Patient relationship in FP. In reality, you cant do a scope or do an appendectomy if you are a psychiatrist. (assuming you didn't do a surgery residency as well) - the hospital wouldn't let you and malpractice wouldn't cover you. I can say a patient can have Tylenol or Colace when I am moonlighting but that's where it ends for me. I look for skin rashes from med side effects, order labs to see about metabolic syndrome but it's not the full spectrum. I would LOVE a job where I could handle the IM role and psych.

 

[Merovinge]

I don't see how FP could be repetitive. You can see babies, psych issues , htn, DM, serious illnesses, zebras, preventive medicine, do minor procedures. It's a bit of EVERYTHING we learned in med school.

I think you have a very rose colored description of this field, there is a reason it is consistently the least competitive in all of medicine (and for the record I do think its a hugely important and bada** field). I rotated with at least 8 different FP attendings in 3 different cities in medical school and their clinics are packed to the brim with routine DM, HTN, COPD, basic heart failure. You see such a huge percentage more zebras in basically every specialty field than you do as a PCP. Some rural FP docs do have a more varied practice like you describe doing some OB or office procedural work as a non-insignificant part of their practice but lets not pretend that is representative of the field. FP docs are not exactly leading specialties in low burn out or high job satisfaction despite having a stereotype of being super cool/chill people.

 

[futuredo32]

I think you have a very rose colored description of this field, there is a reason it is consistently the least competitive in all of medicine (and for the record I do think its a hugely important and bada** field). I rotated with at least 8 different FP attendings in 3 different cities in medical school and their clinics are packed to the brim with routine DM, HTN, COPD, basic heart failure. You see such a huge percentage more zebras in basically every specialty field than you do as a PCP. Some rural FP docs do have a more varied practice like you describe doing some OB or office procedural work as a non-insignificant part of their practice but lets not pretend that is representative of the field. FP docs are not exactly leading specialties in low burn out or high job satisfaction despite having a stereotype of being super cool/chill people.

FPs are often the catalyst to finding the zebras. I guess it depends on the FP docs you talk to, all I know are really happy in their field, maybe because they are DO's ? I don't know . As a DO you can also do OMM, which is one of many things I miss in psych. FP also has preventative medicine which is a big interest for me. Again it's awesome that people love psych, but I just get SO bored. ALL of the evals are the SAME questions and follow up med checks the same and at least for me, although I do like therapy the most, you can only do so much therapy until you are really burned out on it. It's draining. But seriously and sincerely kudos to those of you who truly like psych.

 

[3lefts]

I’m only a late first year intern, but 100% would choose again. Best and most rewarding year of my life.

 

[When is graduation again?]

FPs are often the catalyst to finding the zebras. I guess it depends on the FP docs you talk to, all I know are really happy in their field, maybe because they are DO's ? I don't know . As a DO you can also do OMM, which is one of many things I miss in psych. FP also has preventative medicine which is a big interest for me. Again it's awesome that people love psych, but I just get SO bored. ALL of the evals are the SAME questions and follow up med checks the same and at least for me, although I do like therapy the most, you can only do so much therapy until you are really burned out on it. It's draining. But seriously and sincerely kudos to those of you who truly like psych.

I understand your point. I think this comes down to how you approach things and what you enjoy in medicine. FP does have variety in diagnosis, and patient population, but personally I'm not too keen on treating HTN and DM most of the day, everyday. Overall, it does have less grey-area than psych.... except maybe Geri med, there's a lot of grey there.

Personally, I find the variety in Psych in the patient presentation. Schizophrenic and manic patients are great to interact with and each of their presentations is unique. My favorite moments in residency/ the only things I've really enjoyed are laughing at some of the situations I find myself in. Even potential malingering evals can be fun, trying to find ways to trip up malingering patients.

But the gist is, to each their own. I hope you find FP fulfilling. As most of us can relate, there are few things worse than doing things you don't enjoy doing for long periods of time for money.

 

[Evidence Based]

I understand your point. I think this comes down to how you approach things and what you enjoy in medicine. FP does have variety in diagnosis, and patient population, but personally I'm not too keen on treating HTN and DM most of the day, everyday. Overall, it does have less grey-area than psych.... except maybe Geri med, there's a lot of grey there.

I do want to highlight the above for any medical students or folks trying to discern a specialty. Most of any medical field (or any job) is taken up by bread and butter conditions, of course with some variety in presentation from person to person and some more unusual stuff sprinkled in.

Outpatient family practice: lots of DM, HTN, a couple of other chronic conditions.
Outpatient psych: depression, anxiety, maybe some psychosis or BPAD
Hospitalist medicine: ACS rule outs, pneumonia, COPD, heart failure.
General surgery: cholecystectomies, appendectomies, and hernia repairs
ICU medicine: septic shock, COPD w/ respiratory failure, DKA

I'm not at all trying to denigrate any of the above fields in any way by saying this! Getting good at bread and butter issues in your field is literally why we have specialists, and believe me I'm not trying to take out anyone's gallbladder on the psych floor. It's just crucially important to realize that every field will have some routine, and part of choosing a field is choosing what kind of bread and butter you want to deal with. If you don't find the bread and butter of psych interesting, like futuredo, that's totally fine! Just realize that literally every single field (including the sexy exciting ones like surgery or intensive care) will be mostly "routine" cases, with some differences in presentation, the kind of patient that has the disease, etc, and that chasing zebras or managing exotic things will be the minority of your time wherever you practice. Medicine is not House, MD.

 

[deleted736562]

In a heartbeat. Psychiatry can be as intellectually and personally stimulating as you want it to be. I don't think there as any other field in medicine that allows you to develop the kind of connections you can in psych.

On the practical side, the flexibility is incomparable. You can pick your geographical region, your setting, your hours, your practise. Even residency is pleasurable relative to other specialties.

 

[thepoopologist]

I wouldn't do medical school again but yes psych has worked out well. Its interesting at times and I work 4 days a week with no call.

 

[ridethecliche]

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

I know that feel

Oy vey... Me too.

 

[EarlyCareerAcademicPsych]

Thanks for the question! I really enjoyed reading these responses.

I would definitely choose to psychiatry again. I was a neuroscience major as an undergrad and I got into functional brain imaging in medical school. I love brain biology. I seriously considered neurology as I loved the hunt for a single explanation to a variety of symptoms. However, it was hearing from my wife about her therapy clients - she was getting a master's degree in counseling psychology while I was in medical school - which prompted me to seek out psychiatry.

I am hardly ever bored in my work. I use my creativity to flex how I think and how I relate to patients. Every day, there is something new to learn and someone new to learn from.

I am blessed in that my current position involves equal parts: resident education (including formal classroom teaching and clinical supervision), individual and group psychotherapy and general outpatient psychiatry. Since completing my psychiatry residency, I have also worked in emergency psychiatry, inpatient psychiatry and in a co-located psychiatry/internal medicine clinic. I enjoyed those some but not as much as what I do now.

I am also blessed with fantastic colleagues. I do not believe that I would enjoy the work so much if I didn't get to regularly consult with such brilliant, compassionate, savvy, funny people. We have a lot of fun and we help a lot of people. This can happen in any field.

Good luck with it!

 

[Merovinge]

Update to the family providing 4-5g of marijuana a day to teenage son. Recently came to see me after pt began to experience severe panic attacks (had been continuing to use 4-5g/day since our last visit 4 months ago). He stopped using for 3 days which is the longest he has abstained in years, family committed to not providing for this habit, agreed to start Zoloft for his anxiety and is starting psychotherapy next week. Pt hugged me at the end of the session after being furious about my description of his THC use disorder on first evaluation.

 

[Marasmus1]

I would not choose medicine. Among options I have in medicine, psychiatry is the one that appeals to me most. So my answer is yes.

 

[nexus73]

It's a pretty interesting job with good job security (or so it seems). You can basically find work anywhere you want to live. Some specialties are limited by population need...like how many pediatric neurosurgeons do you need in a town of 50,000 people? Whereas psych demand is high in small towns and big cities.

You get to choose your work venue and hours to an extreme degree if you want to. For example, you can work inpatient 60 hours per week and make lots of money. Or you can work 1 day a week at an outpatient community clinic (and make a lot less money). Most other specialties don't have this flexibility. Many require you to work at or in conjunction with a hospital like surgeons, interventional cardiology, etc. Or you have to be working close to full time to generate the revenue to cover overhead for the clinic and pay your salary.

Psychiatry has it's difficulties, but that's true of all specialties. I would choose it again.