I wanted to share this email exchange I recently had with a reader (yes! I have a reader!). With her permission I wanted to share the dialogue here because she mentions issues that are really common among med students who struggle with choosing psychiatry as a specialty:
So, I have a question to ask you and I have a feeling that you’re the right person to ask. I am sort of going through the same process that you are going through in your very first post – I went from wanting to do Ob/gyn (but came to terms with the fact that I can’t stay up all night and still be functional) to then realizing that Ophtho is the way to go (I’m on ophtho right now and in the process of ruling it out), and psych was my last rotation and I seriously became enamored with it. This was (obviously) very very unexpected.
So now I’m sitting here toying (very seriously) with the idea of going in psych now, but I wanted to hear what you had to say about the sort of common doubts that people have when applying. I’ve spoken with a few other students considering it and I know there is an idea that 1) you’re not a real doctor, 2) you are a drug-dealer, 3) wouldn’t a therapist do a better job than you in an out-patient setting (and be cheaper too)?
Keeping those questions in mind, can you also comment on what programs are good, or how to spot a strong program when you see one and honestly what is the best way to get in!
Anyways, it would be nice to hear what you have to say about anything above!
All the best
It was great hearing from another potential future surgeon toying with the idea of psychiatry. Even through these specialties seem very different on the surface, I meet people all the time debating between the two. And the issues she brings up are common to almost everyone I know who decided on psych. ESPECIALLY if you switch from another specialty (like surgery or medicine) to psychiatry, you will probably go through the following mental process:
I won’t be a “real” doctor, and I won’t ever use 95% of the information I spent four years toiling to learn in medical school.
I’ll let down my family/friends/myself who thought I was going to go into a more prestigious specialty.
Psychiatry doesn’t fit in with the life plan I already figured out for myself.
It won’t sound as cool when I tell people I’m a psychiatrist.
You won’t practice in same way your internal med/family med/surgeon friends are, but you are a doctor, you have the M.D., and everyone forgets 95% of what they learn in med school anyway. I’ve already forgotten almost everything and I just graduated a few weeks ago.
Choosing psychiatry is kind of like deciding to drive a Dodge Caravan instead of a Lexus. If you want the Lexus, it’s possible that the Lexus if really the right fit for you, or it’s possible that you’re just listening to what everyone else around you is saying you should want. If you want the Dodge Caravan, it’s probably because you really want it because there certainly isn’t anyone telling you it’s cool.
If you choose psychiatry, you will go through the process of letting go of whatever previous expectations you had for yourself. You will need to let go of the idea that you will practice medicine in the way you always imagined you would. This process will probably take at least a few months after you first start seriously considering psych and possibly much longer. If you love psychiatry and it interests you and makes you happy, and when you finally take the plunge and switch you feel relieved, you’ve probably made the right decision.
There are definitely times when I talk to a non med-savvy person and they don’t realize that psychiatrists are M.D.’s or I say I’m going into psychiatry and they say, “Oh, psychology is really cool,” but really, who cares? I know what my roll is, I know I’m doing will positively impacting other people, and I know it makes me happy. Plus, 90% of the time I tell people I’m going into psychiatry they half-joke, “I could use your help.” There will never be shortage of work for psychiatrists, my friend.
You also may have the concerns that this particular med student mentioned, such as that all psychiatrists do is dole out drugs and that the idea of the psychiatrist as a therapist is becoming obsolete. It’s true that more and more, psychiatrists do medication management while psychologists/MFTs take over therapy. But this doesn’t mean you can’t do therapy if you want to (my dad is an old-school psychiatrist who does hour therapy sessions with all of his patients), or that the therapeutic relationship isn’t important during med management visits (plus, there is more nuance to prescribing psychiatric medications than you might imagine). In psychiatry there are so many different ways to practice (outpatient, inpatient, ER, medication management, therapy, academics, private practice, research, writing, teaching etc…) and you can take the part that interests you the most and turn it into your career, or practice in multiple modalities at once. Someday I hope to write books and combine my interest in psychiatry with my interest in business/entrepreneurship.
Anyway, I wanted to an email I later got about this student’s struggle deciding between ophthalmology and psychiatry, because it’s really articulate and mirrors almost the exact same process I went through giving up urology for psych. Plus (spoiler alert here) she ended up choosing psych . I’ve bolded the key parts of the story and my favorite parts.
I was wondering if I could get your input on my personal situation because I feel like you have gone through the same process and can sort of identify with what I’m going through. This is basically what is going on with me and I had a few questions for you at the end:
Ok, here goes. Before I rotated through psychiatry, I applied for the Dean’s grant in ophthalmology because I was planning on doing a research year in ophtho and then trying to go for the match after that. Basically, something inside me was saying to go for ophtho (and I have my reasons which I will explain in a little while) and I know I’ve wanted to do academics in whatever I’ve chosen and it just seemed like “I had my whole life figured out”. Anyway, when I rotated through psych, I really really enjoyed myself and this was not expected at all. It was like wow, I’m laughing and smiling and who would have thought that you could feel so good listening to people’s problems and helping them with their mental diseases? It blew me away. And it made me realize that I do not need to necessarily work with my hands to be happy. But now I am kind of in this mental rut because I really don’t know what to do…it’s so hard when you think for a long time that you should do one thing and then your world goes a topsy-turvy because of something that you didn’t even imagine yourself going to med school for. There are aspects of both fields that I am enamored with. Ophthalmology is a very gadget-oriented, high-tech, highly advanced field. It is extremely scientific, precise, exact, cut and dry yet also high-impact. Almost everyone in the field has some form of OCD, because you kind of have to be OCD to be a good ophthalmologist. It is such a tiny and important area…you can’t be sloppy! (I do have OCD tendencies myself so I wonder if that is why I found it alluring to begin with but who knows…). And then there is also the wow-factor for me. In one hour you can perform a cataract operation and give someone sight – literally. It’s kind of amazing and all of those things I love, and were originally the reasons I wanted to do ophthalmology. And now enter psychiatry. OK, now, if I were an overworked New York businessman, psychiatry would be the Argentinian study abroad student who I met on a Sunday at the local SoHo coffee shop who allured me from the moment I laid eyes on her. It is one of the most artistic, creative, imaginative fields of medicine, and in one day you can see something that is loopy, comical, tragic, ironic, dramatic, hilarious, or serious. The degree of randomness that can occur within a few hours span is astounding and makes me smile because I seriously do not know what to expect with any patient that I see. For someone who was seriously considering becoming a theater/literature major in college, this counts for something to me. And I can’t forget to mention the human element to the whole equation of psychiatry. Every patient, no matter what he or she is diagnosed with, will present their disease differently because of the variety of the human mind. To me, that is beautiful and awe-inspiring. There is so much subtlety in realizing this, and I don’t know if anyone outside the field can appreciate the beauty of the diversity of the human mind and its application to psychiatry. Now, in terms of being a “hard science”, yes, there are definitely some “scientific” aspects of psychiatry (neurobiologically based) but the field (in my opinion) still has a ways to go in this department and let’s be honest, gadgets are few and far between.
So getting back to the point, I found out last week that I got the Dean’s grant. Personally I wish I had not gotten the grant, because it would have made my specialty decision so much easier. But now unfortunately I have to chose between the two fields and make a decision for myself. It has gotten kind of crazy now for me personally, because Dr. X (the doctor who I set up the research with) is supposed to be a big deal or something (everyone always raves about how amazing he is and how amazing my research year would be with him and how I’d match into a stellar program because of him and all the publications I’d get blah blah blah) and I know that if I told Dr. X I don’t want to take a year off (hypothetically) he would pretty much write me off and I will have essentially burned the bridge to ophthalmology. And that makes me feel hurt and guilty for some reason. And who likes feeling hurt and guilty, you know? So my options have come down to 1) take a year off and match into ophthalmology or 2) don’t take a year off and go into psychiatry. I am totally OK with taking a year off, but only if I want to become an ophthalmologist yet I would be so OK simultaneously matching into psychiatry right now in some sweet academic research-driven program. The question is what do I do!?
Here are my question(s) to you: When you finally realized that you wanted to become a psychiatrist (which was right after you were a budding urologist), how did you deal with all the hype and pressure you had built up for yourself in the urology department and all the people who thought and hoped that you would become a urologist? And did you ever face anyone personally in the Urology department when you made your final decision to go into psychiatry? Were you ever scared about burning the bridge to urology after thinking for so long that that was for you? Did you ever wonder if you may not end up liking psychiatry and will have wished you had become a urologist still? And finally, do you have ANY advice for me in this particular situation?
Here’s what I wrote in response:
I want to get back to you when I get back from my trip with a more detailed answer, but I read your email and your decision seems pressing so I wanted to give you at least some words of wisdom that might help you before I leave…
You don’t need to do something just because you told yourself you would do it! Trust me, I know this one. I thought from the age of 10 that I would become a surgeon. When I was considering switching, I imagined all the scenarios that you are talking about letting the urology department down and letting myself down (at least in terms of what my expectations had been). I struggled with this for months. But when I switched, it was the most FREEING feeling I had ever felt. It’s amazing how much what you’re describing sounds like what I felt at the end of 3rd year. I remember feeling so guilty when I had to tell my urology mentor that I was switching. But you know what? He was happy for me! And he even wrote me a great letter of recommendation for psychiatry. Even thought surgeons seem really specialty-centric, no one who you’ve worked with is going to want you to go into optho because of them. I bet all your residents/attendings will be happy you’ve found what you really love to do, whatever that ends up being. Even though you think you’d be disappointing Dr. X by not taking the grant, you might be surprised by how understanding he would be if you explained that you discovered that what you love is another specialty, or if you explained that you weren’t sure yet.
Despite surgery and psychiatry being such different specialties, they actually attract people with similar personality characteristics. I totally get the sorta-OCD thing, because I’m like that myself. Psychiatrists don’t work with their hands, but they are very analytical, intellectual, rational people. But unlike surgeons, you also get to be creative and imaginative. I had that same feeling about having a hard time letting go of the idea of working with my hands. I LOVED anatomy and was a suturing champ. But the day to day of being a surgeon wasn’t interesting to be and definitely wasn’t worth giving up so many key years of my life for.
Another point- the farther you get along in medical training, the less you will care about what others think about you. It’s a losing battle to do anything in life because of external expectations. It’s crazy because after making this decision I’ve felt so much more free in other areas of my life to do what makes me happy, even if it’s not what other people expect or want.
I don’t want to tell you to do or not do psychiatry because it’s definitely an internal decision you need to make, but in reading between the lines of your email it really seems that you WANT to do psychiatry, but you’re afraid of changing paths. Don’t be afraid! You can be that Argentinean study abroad student if you want to (I love that analogy, btw). There are no limits to what you do with your life or career other than the limits you place yourself. It sounds cliché, but it’s true.
I hope you choose psychiatry! Not because surgery can’t also be a great field, but because you sound just like me and seem to be experiencing the same spectrum of emotions I want through last year and I know how happy I am with my decision. Optho is also a great field, and it sound like it’s a good fit for your personality as well. Just ask yourself what you really want more, and then go for it, unapologetically. It’s your life after all. Good luck with everything and I’ll talk to you soon!
I was SUPER excited and happy for her when I got this email a few weeks later:
Happy travels! I just wanted to tell you that after extensive internal struggle, I took the plunge, listened to my heart and admitted to myself that I belong in psychiatry. Although I was slowing transforming (as you accurately predicted) all along, the actual tipping point happened last week in ophthalmology clinic. There was this female patient who came in with decreasing vision X 3 months, but on eye exam and imaging, she was completely normal. We all concluded that she was most likely malingering or had some sort of conversion syndrome. The patient walked away and the doctors went about their business but inside I wondered what her story was, what motivated her to travel 3 hours from Bakersfield to be told there is nothing wrong with her vision when clearly she had some issue. It was then that a tiny part of me yelled inside, “What are you doing here??”. I realized then that psychiatry is my home, it truly is. For every patient who comes to see a doctor, there is a story behind that visit. Like this, there are hundreds of stories in medicine, but in my opinion the best stories come from psychiatry. And the best part is that in psychiatry you actually have the time to listen to these stories! In ophthalmology, they were spending like no more than 6-10 minutes with patients and it just wasn’t the right fit with me. But holy shit, it has just been really hard for me to be honest with myself and admit this!
Even though this process was mentally and physically exhausting (and felt so expedited because of a deadline), I know that I have come to the right conclusion because I feel so much better now. This morning I told Dr. X that I’m going into psychiatry and you were right, he took the news just fine and was happy that I found this out before committing to the grant for a year. God, I feel like I just got off a rollercoaster!
Anyway, I want to thank you from the bottom of my heart for replying back to me so quickly and with such an in-depth answer. Your email seriously helped me out in more ways than you will know. I’m not sure if when you started your blog your intention was to help change people’s lives, but just know that you have at least helped one person move forward tremendously. And for this, I will always be grateful for your help.
But now that I’ve finally made a decision, I’ve realized that there is still much work ahead! Now comes the questions of residency programs, where to apply, etc., etc., I’m sure you’ll have loads to say about this and I can’t wait to hear it too! So for now I hope you’re having a great vacation. And again, thank you for everything!!!
All the best,
Yes! I was so excited to hear this news, and really grateful that my advice helped along the way. I hope other people struggling with specialty selection will come across this post and maybe get a helpful perspective to help them with their choice. If anyone out there has a similar story and wants to share it, I’d love to hear from you.