I’d like to become a psychiatrist, not a surgeon or doctor-doctor. Any advice about how to cope with all the other stuff one has to do to get to psychiatry?
study, pass, get into medical school, take boards, match into psychiatry.
You have to go through the entire process.
Well. . .clearly I’m no psychiatrist, but my uncle is. He would tell you not to do it. 
He practiced in TX, which may not be as neurotic as other parts of the country, but he had trouble making ends meet even after ~15 yrs in practice. He ended up re-enlisting in the military (as a psychiatrist) before he reached the age cut-off. Just like everything else, be sure this is a good specialty to be in where you want to practice.
You do have to go through a lot of training that seems irrelevant, like surgery, if you are “sold” on psychiatry. How do you mentally reconcile the fact that you are learning a lot of useless stuff? I don’t know how you deal with that, but I personally think I’d be more inclined to be a masters-level clinician unless I thought I might have an interest in another facet of medicine, too. What if you didn’t match into a psychiatry residency? Are there other specialities you would consider? I know there are at least 3 I’d be happy with now, although that will probably all change before this whole thing is over. 
Hey thanks!
The med school near my house has a great psychiatric program and I’m interested in geriatric psychiatry- I want to help old people and maybe find a cure to make getting really old, better. But, I’m also keeping an eye on the future and my finances, though. And if you want to hear about the drama of not making enough money, go be a math teacher with a master’s degree and get treated like an elephant; paid with peanuts and whipped all day long!
Also, you do bring up a good point about learning “useless” information. I’m not into that ‘learning for learning’s sake’ anymore like I used to be.
Other specialties? GP or sports medicine. If I can get over my discomfort with blood, I’d be willing to make Surgeon a profession. And the irony of your question is not lost on me. I’ve been told that people go into psychiatry because they aren’t a good fit elsewhere, sort of the med school door prize. It would be funny if I turn out to be a fit as brain or heart surgeon instead. Would it still be considered a door prize? 
When learning medicine, nothing is useless. Think about it:
An elderly patient is referred to you in the ED because of an altered personality. The patient’s family tells you that over the last year their father was getting worse and worse since his wife died. He barely eats and his drinking has gotten worse. The patient denies any headaches or chest pain. His blood pressure is within normal limits. He has no history of cancer but you notice that it is taking a while for him to answer your questions. He tells you that he eats whenever he can but has an “occasional” drink. What are the possibilities?
A) Alzheimer’s DIsease
B) Brain Tumor
C) Wernike-Korsikoff Syndrome
D) Cobalamine Deficiency
E) Dementia
Thank you for your response. I get it, though I’m certain that your rationale is shared with those who decided that psychiatrists should be physicians. Because I’m sure *enis Envy or Oedipus/Electra Complex would not be the correct response in any case 
Psychiatrists are physicians!
And yes, I agree, some things they make us learn in med school, we might never use, except from during exams. But most of them are really relevant - no matter into what specialty someone decides to go. And while surgery might not be directly applicable for a psychiatrist, it’s not like people really learn how to perform surgeries during their medical school. There’s a lot of medicine during a surgical rotation, and this knowledge is vital even for a psychiatrist, who is going to treat people with multiple medical problems and he needs to be aware how they are being treated, and how any medications he’s going to prescribe to them are going to interact with medications that they might be already taking.
And finally, looking at the whole thing from a purely materialistic point of view: there is such a huge shortage of psychiatrists these days, that many states have a repayment programs for psychiatrists who agree to work for some time in an underserved area. Thus, it might not be the best paying specialty, but whoever decides to go into this area of medicine, they should be able to pay off their loans and afford relatively comfortable living. And the satisfaction and fulfillments are priceless!
Kasia
Hey,
Thanks for your response! I hadn’t heard of an ‘underserved’ program for psychiatrists, though it was in the back of my mind only because they have that for teachers. But regarding that, caveat (pre-)emptor, there are a lot of conditions one has to meet in order to qualify, at least for the teacher pay-back program. I thought I was a shoe-in for the teacher’s program. M.Ed for Cross Cultural Education, bilingual (Spanish/English), Math, great classroom management, LOTS of experience and I STILL didn’t qualify! They got me on a loan-type technicality! Grrrr!
So while my appetite is whetting with the smell of free $, I’ll proceed cautiously. The Feds are loathe to give away money like that, unless of course I were to change my name to AIG!
P.S. I’m willing to learn things I’d never use because I really, really, really want to be a psychiatrist, always have! I feel ya!
Neuro residents by their nature befriend psychiatry residents since the have to rotate with us; thus many of my good friends in residency are psych residents. Unfortunately, when many psych patients come to the ER, the ER will pass on evaluating them and just call psych. A young man came to the ER, not talking, sitting up bent over. My friend the psych resident knew this wasn’t psych. Finally she got him to mumble a few words. He told her he couldn’t talk because the chest pain was so bad, it hurt to breathe. She diagnosed his raging pericarditis, NOT the ER.
One of my favorite rotations in medical school was the community psychiatry rotation (I considered med-psych as a specialty). Community psychiatry is a sub-specialty of psychiatry where psychiatrists go out into the community and take care of the sickest of the sick, mostly severely ill bipolar and schizophrenics. They spend months to years gaining the trust of these patients, then visit them weekly, ensuring they get and take their meds, as well as monitor their social situation. This program has significantly reduced inpatient stays for these patients. One of the things the community psychiatrists also do is make sure that their patients have their general medicine preventive things taken care of, helping coordinate their care. A 50-year old schizophrenic still needs a colonoscopy like other 50-year olds.
Clearly psychiatrists use their medical training.
Also, what we’re learning in med school is that many psychiatric conditions have physical causes, e.g. an arterial occlusion in a part of the brain that controls speech and comprehension may lead to signs of dementia or other mental problems.
The body and mind are inextricably intertwined and increasingly I’m coming to believe that a good psychotherapist should have a thorough knowledge of anatomy and physiology, plus a healthy dose of neurology.
I don’t know how easy it would be to shadow a psychiatrist, but you might try doing so, or investigate volunteering opportunities at psychiatric clinics. It does seem like a fascinating field to go into.
There’s a book about the internship year, The House of God by Samuel Shem (pseudonym) written in the 1970s. It’s a rather sobering look into the goings on inside a big city hospital from the point of view of innocent young med school grads. One of them finally gets fed up with all the baloney of medicine and switches to psychiatry. A fun read.
Best of luck,
- ttraub Said:
...increasingly I'm coming to believe that a good psychotherapist should have a thorough knowledge of anatomy and physiology, plus a healthy dose of neurology.
I'd actually disagree with this on purely practical grounds... as it would take longer and cost more to train therapists that way. I'll be happy if therapists can "know what they don't know," and recognize when a situation is outside their area of expertise, a'la a good nurse-midwife who knows her stuff, and knows when to call in reinforcements.
There was a time when at least some psychiatrists trained in doing therapy. That is becoming less and less common.
Everything comes back to the almighty dollar. The state of behavioral health care is far worse than other kinds of health care, I'm sorry to say. As a result, primary care docs are pretty much in over our collective heads with psych stuff on a daily basis. It is an area that I have to learn more and more about... and I feel out on a limb every day. Very scary for everyone.
- Mary Renard Said:
- ttraub Said:
...increasingly I'm coming to believe that a good psychotherapist should have a thorough knowledge of anatomy and physiology, plus a healthy dose of neurology.
I'd actually disagree with this on purely practical grounds... as it would take longer and cost more to train therapists that way. I'll be happy if therapists can "know what they don't know," and recognize when a situation is outside their area of expertise, a'la a good nurse-midwife who knows her stuff, and knows when to call in reinforcements.
There was a time when at least some psychiatrists trained in doing therapy. That is becoming less and less common.
Everything comes back to the almighty dollar. The state of behavioral health care is far worse than other kinds of health care, I'm sorry to say. As a result, primary care docs are pretty much in over our collective heads with psych stuff on a daily basis. It is an area that I have to learn more and more about... and I feel out on a limb every day. Very scary for everyone.
Our psych teachers keep telling us about the kinds of pathologies we're going to encounter in our practices. It's a little scary. I would have no idea what to do with someone coming in with a borderline personality disorder or narcissistic disorder. Just the thought of diagnosing them is daunting. What can you do, send them to the nearest mental health clinic?
Now I know I’m meant to be a psychiatrist. Everything you said ‘lights my fire’! I wish I could have said that about teaching math 
Thank you ttraub and Mary,
I have to admit, since my first day of freshmen year in college I wanted to delve into the human mind and while I can completely understand Mary’s cautious nature about body v. mind, I believe in the body-mind connection to which ttraub alludes. There IS a reason why the placebo effect exists! And even with the Heisenberg Effect described in quantum physics, I have to wonder “why is it real?” and for that matter “what is real?” Anyway, I am even more jazzed about the prospects ahead of me, difficult or not, about becoming a psychiatrist! Bring it on! For me, it is “the undiscovered country!” Thank you all! Really! “Really, really?” “Really, really.” (What movie is that from?)
- cocogoldsmith Said:
Thank you all! Really! "Really, really?" "Really, really." (What movie is that from?)
madeline
If I could offer my humble opinion on the subject, there is a use for the medical training that psychiatrists receive. With the medical conditions of patients that can interact with psychiatric medications, as well as diseases that have symptoms that mimic psychiatric conditions, it is always interesting. Monitoring side effects from psychiatric medications is also always a challenge. Though I am not yet a medical student, it is my goal to become a psychiatrist and I also become a bit insulted when someone insists that they are the lowest of the low on the totem pole, so to speak. I have worked for a while at an inpatient psychiatric facility on the child/adolescent ward and in addition to providing basic medical care and group/personal therapy, a host of psychotropic agents are always being added in or taken out of a patient’s treatment plan and the effects of this have to be observed and monitored carefully. It’s rather like detective work. Especially when your patient can’t/won’t speak to you!
Actually, I was thinking “Shrek” and just about the ‘really’ thing. As I’m always looking for good movies, I’ll see about the one you mentioned
Hello mindseye,
Humility is always a welcomed thing! And I completely agree with you about the misbegotten judgment that somehow psychiatry is less than other medical professions, I think that it is equal and many have posted how truly important it is in treatment of the whole person; mind, body and if you will, soul. What I most loved from my undergrad studies in psych was that even now, we’re still asking the question, “who’s in there?”. I’ve always believed that psychiatry (and neuroscience) was the best tool for figuring that out.
The personality d/os are the scary ones, especially Borderline (BPD). Clearly clinical and often relevant, but there’s… nothing we can really do for it. For those who remember the SAT…
broken arm : bipolar d/o :: bipolar d/o : BPD
IMHO (and as others have said here), psych problems are increasingly relevant and decreasingly compensated. The MH Parity Act that recently passed both houses of Congress (IIRC) might help address that. Having worked at a Community Mental Health Center, it’s disturbing to me that a psychiatrist has about 10 minutes to meet and diagnose somebody suffering from schizophrenia, schizoaffective d/o, bipolar, etc. And that’s the initial visit. Follow ups are covered at around 5 minutes.
Sounds bad, right? But it’s just at Medicaid-funded places, right? Well… as Mary said, how many Psychiatrists do therapy these days, too? Or how many are just 15 minute med management appts, outsourcing the actual talking to a therapist? It’s unavoidable, with the way reimbursement is. And that’s a shame, for a lot of reasons.
But that’s not to discourage anyone from going into the field. On the contrary, we really need qualified and caring folks there. And as the OP was implying in some other posts - going through her 3rd & 4th year rotations, she might find something else that makes her eyes sparkle even more.
- cocogoldsmith Said:
Really! "Really, really?" "Really, really." (What movie is that from?)
Shrek, Shrek II and [probably] Shrek III