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.
I am foreign medical graduate and interested in psychiatry residency in USA, but my whole experience is around medicine. How could I explain program director that how I developed interest in psychiatry?
Elana Miller says
I think a lot of people find out they love psych when they’re on a non-psych rotation- I was on surgery when I realized I really liked talking in depth with patients about the psychosocial aspects of what brought them into the hospital. Do you have a similar experience in medicine you can talk about on your interviews?
a detailed history taking is so important.
Wow, thanks for sharing this exchange. The medical student put to words EXACTLY how I feel about choosing between psychiatry and OB/GYN (yeah, second year med student here and I know everyone says you have time to figure it out…whatevs…). And your response – insightful!
Elana Miller says
Oh man, if you’re deciding between psych and ob/gyn, go with psych :-). My best friend and roommate from med school is doing ob/gyn, and she loves it, but even she says- if there’s any other specialty you could do and love, do that. Thanks for reading and for your comment!
thank you verey much ,you eally helped me to set up my priorities in taking the right decision about choosing speciality .. god bless you
kingdom of Saudi Arabia
Glad I was able to help!
I have some friends who are interested in switching to psych! I’ll share your post with them!
Thanks Joyce! It’s funny because I hear all the time of people deciding between surgery and psych. It sounds like such a drastic change, but I think the specialties are more related that people realize in terms of the relationship you have with the patient. If you have any friends who want some psych advice, let them know they’re free to send me an email too!
Yeah I told my friends that. ^^ You’re very nice to help med students figure out their life goals. 🙂 I enjoyed reading the decision-making process too. It makes so much sense. I have a lot of respect for psych. and I agree–it is a very intelligent career choice! so great in many ways.
Elana, if you were so interested in talking with patients in depth, why did you not become a psychologist? Was this because it was too late to decide since you were almost through with medical school and could not give up those years? I mean, a psychiatrist is usually more concerned with a quick diagnosis, rather than a deep conversation with their patients. They prescribe medicine, but I believe these are the only two major factors of a psychiatrist, hasty diagnosis and prescribing. I do not think there is much about psychiatry, rather than its prestige of course, so whats the big deal? Am I missing something here? Your input would be greatly appreciated, thanks.
Hey Hung, I think it’s a mistake that people compare psychology and psychiatry so much – they’re very different fields. Psychiatry is more related to medicine, and psychology is primarily a research field, although there are psychologists who do clinical work as well. I would say MFTs have the most clinically-focused roll when it comes to doing therapy. That being said, why didn’t I consider becoming an MFT? Probably because I was choosing a subspecialty of medicine :-). I would disagree that psychiatrist don’t have an opportunity to talk to their patients in depth.
Ah, I forgot about how some, if not most, psychologists also participate in research. I always assumed all of them did talk-therapy by using psychotherapy or of some sort. Anyway, regarding psychiatry now, do you feel frightened when face-to-face with patients with a severe mental illness? I know I am slightly referring to the stereotype here where psychiatrists deal with the aggressively crazed, but I still wonder if a tiny part of it is true. Also, have you seen a lot of cases where psychiatric medication has prevailed in patients? And if it did, how rewarding was it, to know that you have truly impacted someone’s life in a way that fulfilled you as human being. Once I start undergrad, I will try as hard as I can to obtain any position in a clinical hospital just to see this for myself :D. Thanks again!
While I do think medications are only a part of psychiatry, and not the only solution, I have DEFINITELY seen cases where medications turned someone with a really severe mental illness around, especially very sick psychotic or manic patients. It’s pretty amazing and makes you feel like you’ve made a difference in that person’s life. I do come across aggressive patients every once in a while but it’s not that often, and you also become more skilled and comfortable dealing with those types of patients (and when you can handle a difficult patient, you really feel like you can handle anything!). Definitely shadow some doctors when you’re in undergrad so you can explore your interest a little more. Hope this helps!
I’m debating between psychiatry and opthalmology right now! I came in very focused on psych (did psych undergrad and psych research before med school), but surgery is pretty amazing too. Everyone I talk with says they are such disparate specialties. I don’t think so – both are analytical specialties that help you figure out what is going on inside a patient and deal with the nervous system. This is the first helpful website I’ve found, and I’ve looked a fair amount. I’m actually doing a year off in a combined optho / psych research study. I love this discussion. Super helpful.
Hi Amy! I actually meet a ton of people who have chosen or are choosing between surgery and psych. I think there is something about the specialties that attracts a common type of personality. That’s awesome you are combining psych and optho with your research – what kind of project is it? I’m obviously partial, but am so happy that I chose psych, and think the material is much more interesting (and the lifestyle better) than for surgery. You gotta do what you love though!
Hey Elana, I am very appreciative of you posting this.
I am in my second year at a nearby junior college but will soon be going to a higher university. I have been planning on mental health/drug abuse Social Work but lately I have been considering Psychiatry instead. What kind of psychiatry would you recommend? I would like to be one on one with patients&counsel them. Thank You!
Hey Suzy, if you’re interested in 1:1 patient work in the mental health field, there are a number of ways you could go – SW is a good option (and they often do therapy), as well as an MFT or PhD in psychology. If you go the psychiatry route, it’s a big longer (4 years med school + 4 years residency), but you’ll have a more in depth medical knowledge that can help you with sicker patients. You wouldn’t need to specialize within psychiatry (although you could, such as addition or child). Take the chance in college to test your interest in psychology and see which path might be a good fit for you. Hope this helps!
This is a very thought provoking article! I am a final year med student in England and currrently on my Psych attachment which consists mainly of adult Psych. I would be very interested to know what a Psychiatrist’s job is like in America as compared to the UK in terms of the main types of mental disorders dealt with and actual job description. As a student in the UK system, I have found Psych the least appealing of specialities, especially when taking histories from inpatients. I find it rather draining and time consuming to glean information from most patients due to many people having some form of thought disorder. I know it’s an art to listen to patients concerns in full whilst keeping them focused, but I find in Psych that is such a laborious and time consuming task in unwell patients. Perhaps I do not have the patience, but I do love talking to patients which are able to communicate with greater ease. So far most patients I have seen are either too unwell or too “drugged up” on meds… Generally outpatients clinics are much better, but even then I find it difficult in the same way as inpatients. Perhaps someone can debunk my naivety but until then I feel I would not be suited to this field…
Hi Harris, I’ve found too that inpatient work can be draining, although for me the most difficult patients aren’t the thought disordered ones (actually I find treating acute psychosis or mania pretty straightforward on the ward) but the personality disordered ones (borderline, narcissistic, etc). That being said, now that I’m doing outpatient I find the work MUCH more manageable and rewarding. Another thing to consider is that once you’re practicing you’ll have more ability to shape what type of patient you see. A psychiatrist’s work here varies from general adult outpatient to child to inpatient to ER to consult… although general adult outpatient is probably the most common way to practice.
Thanks for sharing. I am a returning student who out of high school went into technology. I always loved my psych classes in college, but felt like tech was what everyone wanted me to do. Well, I hate the tech field and have recently decided to go back to school and finish up the classes I need to apply for med school and go into psychiatry. I feel a bit too old sometimes, but I love the way the human mind works and have decided life is too short to do anything else aside from what your heart truly desires.
Hey Chris, congrats on deciding to go back to med school! I’m not sure how old you are but I doubt you’re too old – I have coresidents who did other careers before medicine (teaching, finance, entertainment, etc) and are now in their 30s/40s. You’re right, life’s too short to not follow your heart!
Thanks so much for publishing this. I am a med-grad and on my way to choosing a specialization. Your post has given me a huge amount of perspective! 🙂
My question is a little different from what others asked. Before i go ahead and ask you that, I would like to give you some background about me. In my drop year after graduation,i had several ups and downs in life which pushed me to a psychiatrist and later also to a psychologist. Both of them were simply fantastic as therapists and i am totally in awe of them. I always had a liking for psychiatry but not so much that I would consider it a career option. Both my therapists diagnosed me to have BPD and i have now come to a stage that i can accept and embrace it and identify when i get symptoms.
Now the question. I am considering specializing in psychiatry.
a) How could I know this is my genuine interest that’s been triggered by life situations, and is not a wannabe-feeling that has risen by seeing two fantastic therapists?
b) I have always been a little bit on the sensitive side as a person.Now i know i am a borderline personality.Knowing this,would it be wise to venture further and take psychiatry as a career? I read about Marsha Linehan, the pioneer of DBT and she confesses she had been diagnosed with a borderline personality too. I cannot compare myself to her but I am really not sure if my own disorder will ever come in the way of my being a psychiatrist.
Kindly advise. Thank you from the bottom of my heart.
Hi Radhika, thanks for your very thoughtful question. That’s great you had such positive experiences with psychiatry and psychology in the past. I see commonly that people are drawn to psych because of their own personal experiences or experiences with family members, and it doesn’t mean your desire to go into psych is “wanna be” or anything like that. Like you might have read with Marsha Linehan, her personal experience with BPD helped her directly connect and emphathize with patients in a way that helped treat them more effectively.
The one thing to keep in mind (and this is true for everyone going into psychiatry), is to be careful of your own feelings of countertransference with your patients, which will be colored by your past experiences with BPD. For example, you want to be careful that you listen to your patients careful, and not make assumptions that their experiences are the same as yours. You may have a tendency to over-identify with patients you feel are similar to you (all psychiatrists/psychologists do this, so it’s important to be aware of the tendency so you can avoid acting on it). This is something you will get more experience with in psychiatry residency.
I think it’s great you’re interested in psych! I feel your past experiences will be a real asset to you in the field, whether or not you specialize in treating BPD.
I am in medical school and will be taking my Psych clerkship in January. I have found the human psyche always fascinating and have gone through so many transformations through yoga and meditation. How feasible is it to bring alternative practices into a psychiatric practice? Is it necessary to do private practice? This is the first post I read on your site and I’m going to explore more. Thank you for any guidance! 😀
Hi Ritika, great question. It is definitely possible to integrate these types of alternative practices into psychiatry. In fact, there is a lot of interesting research going on in this area (especially with regards to mindfulness and meditation). Private practice would make it easier, since you’d have total control over the work you do with your patients (compared with working for a clinic or hospital and having a med management type of job). If you’re creative, though, there are lots of other opportunities – writing, starting your own wellness center, doing mindfulness/meditation research, etc. The sky’s the limit!
Hey Elana, MS4 here. I currently got accepted to a radiology residency program and I’m now having second thoughts. I say to myself that my good grades and inclination for technology drove me towards rads, but once I got the position I wondered if that was what I really wanted in life. Now my dilemma is pursuing a career in primary care/psychiatry or sticking with my choice. I love talking with patients and learning their stories and helping them in anyway that I can. That along with the fact that I’ve received help from psychologists and psychiatrists and am very pleased with what they did to help me, I want to be able to do that too. I never even liked anatomy in the first place, I’m such a retard for even considering rads for the money/lifestyle. I’ve come to realize that doing what you really like (and being happy about it) is more important than the prestige or money one can get out of it.
I got good grades during my 3rd year clerkship and did a sub-internship during 4th year in psychiatry (C&L and Addiction) . I’m at the point where I’m disgusted with the idea of being a radiologist and entertaining very seriously the idea of changing fields to psychiatry. I’m going to do a transitional year and see if I can squeeze a lot of psychiatry rotations before applying full on by September of this year. Do you have any insights or info regarding my choice or what else can I do to see if I really want to be a psychiatrist? Thanks!
Hey there, sounds like you definitely feel rads is not the right choice for you! I don’t know if you really need to get a ton more experience in psych if your gut is telling you so strongly that it’s what you want to do… I actually changed to psych BEFORE my psych rotation in 3rd year because I just knew it was the right move for me. If you matched in rads I’m sure you’d be an awesome psych applicant. You should both apply through ERAS this fall for first year positions and investigate open 2nd year positions (to give yourself the best chance of ending up at a program you want to be at). If you are not sure about the change, you have some time to think it out. But if imaging yourself in a psych residency in a year and a half from now makes you feel relieved and happy, then I say go for it!
Thank you so much for the wonderful and insightful post! 🙂
I am a graduating med student from Australia, just about to choose my residency program in Singapore. (is a bit of confusion here. Haha)
The post is a total reflection of what I have been through. Just thought it may be interesting to share of story too.
I was “inspired” to be an ENT suregon since my early med school days, I have published more than a handful of papers and got to know people. I thought i have my whole life “figured out”. I then did a whole 6 months of just ENT posting.
To my surprise, I realized myself losing interest in it! Mainly because of the intensity of work,and the small area it focuses on. In addition, I am a more ‘chill’ person, I would like to find a speciality and work with colleagues who are more “chill”, I am not sure andy his makes sense to you and if this is a valid argument. 🙂
I was lost at what to choose for the past few months, then psych came in my final med student posting. it just “blew my mind”! I really like it!
Love the nature of practice, love the rather “chill” colleagues and environment , love how I can gain an insight of how everyone think!
I could not have
I am now half way through my final exams and I realized I excel in all my psych questions and OSCE!
I am now deciding on psych, peds or public health.
Peds, cos that is my another other med school posting that I have truly enjoyed. Love kids. 🙂
Yes, public health too, I thought that will make a huge difference in life of many people, although it seems less satisfying due to the lack of pt contact.
The 2 only things that are holding me back are:
1) I am just a bit more ‘sensitive’ of my own safety when I in psych, and this is basically not applicable in other specialities.
2) The inpatients seem often a bit taunting or ‘scary’ to me at times.
I was told that I can opt for full outpatient work after I just my training, and things are much better. But i am not sure if i can stand the 4/5 years of training with all the inpatients. (or i may just spend a few months with inpatients, I am actually not sure. Oops)
I know you have briefly touched on that, would u just expand on it a bit more please?
I am wondering if you can share some of your wisdom on my situation, and any advice will be deeply appreciated.
Best wishes from Sydney!
Hello Elana, I was so relieved to read from your website. I am currently a psychiatry attending and I was in the same exact situation in choosing between surgery and psychiatry. In my fourth year of medical school, I decided to go into pain medicine through psychiatry because I felt it combined aspects of psychiatry with general medicine/surgery. I almost did a combined residency in psych/medicine but decided to stick just with psych.
Even though I am still happy with psychiatry, I still wish I did something that also was more “medical” or “procedural” because going into pain medicine as a psychiatrist has been a tough road as I have not been able to match into any pain fellowships. In my 3rd year of psych residency from a great hospital, I applied to over 25 fellowships but no luck. This past year I applied again, to only one program, and they at least interviewed me but I did not match. They gave me feedback that they thought I was a great applicant but they had many great applicants.
I think the pain medicine field is very competitive since they can make so much money in their career and it seems most of the fellowship program directors, who happen to be anesthesiologists, have some bias against psychiatrists and may not understand that we had the same schooling. I know a few psychiatrists who got a pain fellowship but it seems most had to jump through a lot of hoops that I don’t see anesthesiologists having to jump through. My sister is an anesthesiologist so I do have that inside track into that field. I ended up doing an addiction fellowship instead because it combined some of the aspects of pain medicine.
I am now looking into just simple just doing “pain medicine” since I have so much experience though my internship, residency, fellowship, current job and I am already double board certified. Even though I can’t be officially”board certified” in pain medicine; I think I can still work in that field and make up my own practice as I move forward. There is an alternative pain board that I was looking into that is not under the typical board system. The main issue with that is insurance companies may not recognize it but I also think there is the route to work outside of using insurance.
I am also starting to see my experience is a bit more unique compared to those who simply did a pain fellowship since most of the pain fellowships appear to focus mainly on injections and “mini-surgeries”. Many of the pain fellowships I researched don’t teach much in terms of medications, psychology of pain or alternative therapies.
If I go into practice for myself, I can integrate all of my experiences and I can call it “integrative medicine” or ”integrative psychiatry” or something like that. I am thinking of going entrepreneurial as well. Writing this entry has helped me to organize my thoughts and I am feeling more positive already! Any recommendations? Thank you for taking the time to my (and everyone else’s) posts and it has been helpful reading your previous replies.
Hey Fritz, thanks for your comment and sharing your story! I don’t really have any suggestions to add because I think you’ve nailed it on the head. It’s a bummer you weren’t given a chance to do the pain fellowship, but patients care more that you’re a competent, caring doctor than they do about your fellowship training. As a psychiatrist, I think you’d bring a really unique perspective to the field that an anesthesiologist wouldn’t. I say go for it! One of the wonderful things about psychiatry is that there is little limitation to the direction we can take our careers, since our training is so broad. Apart from entrepreneurship, have you considered writing? Maybe a book on integrative pain medicine and pain medicine from a psychiatrist’s perspective? Keep me updated on how things go for you!
Hello Elana, though late at commenting here but i am really glad to find this blog that corresponds with what i feel about psych. Actually, i had an exposure of about a year in this field doing my house job, then after finishing it, i never really wanted to back into this field, not because i didn’t like the field but because of lots of stress that i had to face in my initial days in adjusting with it that i had less known or maybe i never thought about it as a med student. I wanted to go into Internal medicine, but after a year of preparation, i got the opportunity to choose this field for my residency & i did choose it, as i am PGY1 in psych now. Though it may sound funny, but it was like i didn’t choose psych but psych has chosen me & now i am really glad to accept this fact & now things are also different, i feel really comfortable & enjoying my residency.
I am quite aware about many doubts revolving around this field, it is even worse from where i belong(South asia) because many med students don’t want to go for it because of similar things that you have mentioned but more due to stigma & cultural things that is deeply rooted in the society regarding mental illness but for me it is also like a great opportunity to make people aware about mental illness & moreover, psychiatry taught me that before reaching to a conclusion about something or somebody, one should always need to step back & think as we will be in more comfortable position to consider things that we might miss.
Well, I admire your interest on integrating western medicine with eastern approaches & hope to hear & learn more about it that may be helpful to me. keep up the good work.
Hi Karasu, it sounds like you could be in a great position to help educate and spread a positive message about psychiatry in your culture. Share your open-mindedness with your community and help change the stigma!
Thanks so much for sharing. I’m in my third year of medicine and currently finishing up a rotation in psychiatry. I (totally unexpectedly) have really enjoyed psychiatry. I love talking to the patients and watching their improvement. It is amazing to help give them back their mind and sanity. I also have liked general medicine. Working with a doctor trained in both medicine and psych, I’ve come to love the idea of holistic medicine, treating the mind and the body. I’m seriously thinking about a combined residency in IM and Psychiatry. Any ideas? Advice?
Hey Jen, I don’t know much about combined residencies, but I’ve heard that people who do these residencies will tend to practice either one specialty or the other, as opposed to combining them both. I know that both fam med and internal med physicians who are single-boarded, though, practice a TON of psychiatry (at least the basics) because that’s what comes to their office. If you did a combined residency, it definitely would give you a unique perspective in doing mind-body medicine. I don’t think it’s necessary, though—one residency is long enough, and most of what you do in integrative medicine you will have to learn on your own, anyway. Either way, kudos to you for wanted to practice holistic medicine!
I grew up telling people around that I am gonna be a great surgeon with a surgery named after me(only because I was good at playing video games and at drawing). Ever since I have experienced this, new found love for psychiatry in my internship, it has all changed so very drastically. “After i finish my post graduation in psychiatry, i m gonna use those acquired skills in becoming an entrepreneur and as a final salvation, i wanna explore the ‘GOD COMPONENT’ involved and combine it with mysticism and philosophy(I’d rather call it, the unearthly knowledge) to write a book named ‘WHY WE ARE, WHAT WE ARE’..” is what I keep telling people around. Reading what you have shared, just got me connected.. I wonder if this is telepathic psychiatry 🙂
Bottom line, it was very inspiring and I felt so connected.
Thank you (and my fellow med student) for sharing this post! So much of this resonates with me as I’ve been having this exact struggle. I recently realized making this decision, to change from the kick-ass surgeon I thought I could be to the kick-ass psychiatrist I never even fathomed I could be has been taking a rather large toll on me. Reading this really helped reassure me and by the end I felt a huge sigh of relief. So glad I found your site today!
Thank you so much for this. I’m currently struggling to make a decision between psychiatry and ophthalmology residency. This really helped me put things in perspective. Which of these specialties would I love to do for the rest of my life, that I won’t feel like I’m stuck in a rut somewhere down the line? My answer’s psychiatry. But still, a part of me doesn’t want to let ophthalmology go. I wish there was a way for me to do both 🙁
Choose psychiatry!! You will never feel in a rut with psychiatry. As a psychiatrist, I can also be a writer, a speaker, a voice on social media, etc… the possibilities for satisfaction and meaning are endless 🙂