Monday, January 08, 2007

Lifestyles of the Shrink Rappers

[posted by dinah]
It suddenly got very quiet here at Shrink Rap. I think ClinkShrink's geek roar has drowned everyone out. I'm wondering if she even noticed that I'd claimed her post as my own. As I've said, "Dream on."

So this is dedicated to Jessica, a 3rd year medical student, who commented on one of my recent posts. Jessica writes:

Hi, I am a 3rd year medical student that will probably go into psychiatry. I
enjoy your blog a great deal.This post contained a lot of new info for me - when
I tell people my intended field, they say, "Well, at least the lifestyle is
good." I had no idea that you were expected to be available by phone within 30
minutes 24 hours/day. I had always heard that psychs told their patients to go
to the ER if there was an emergency. Or if they were faculty at a learning
institution, to "page the on call psych resident." Also, can you comment on
psychs not having secretaries, and group v. solo practices? Thanks, Jessica

Thank you, Jessica, we Rappers (or Shrinksters) always like hearing that our blog is enjoyed. I've been thinking about your questions since I saw them and this is what I come back to.

When it comes to choosing a medical specialty, go with your heart. There is no other way. Psychiatry is so different from everything else that it needs to call you, even if just a little. If nothing or everything calls you, think long and hard about it, visit docs in their offices, talk to everyone you can, and hey, visit a blog or two!

In my eighth grade English class, we were assigned to do a research "career report." One classmate ventured into New York City and met with Chuck Scarborogh-- he wanted to be an anchorman.
Newton (Now NJ), I am pleased to report, is now a newsman with Eyewitness News, and apparently I'm not the only member of Mrs. Garelick's class to have a podcast.
I wrote about how I was going to be a psychiatrist. What was I thinking? At that point in my junior high school life, I'd never met a psychiatrist and I'd never even met anyone with a mental illness. The best I can figure is that I liked teeny bopper magazines and thought it would be cool to be one of the "experts" who got quoted about human behavior. I found a book on Freud's theories in the library and thought this was really weird stuff. I did not, I repeat, did not, have penis envy.

In med school, I had several profs express concern that I was wasting my life. One suggested I would be more useful to society as a cosmetic surgeon. During internship, a cardiology fellow told me he'd wanted to be a psychiatrist but instead he had his own psychotherapy and realized that was what he was looking for. That actually is a good point: if you're looking for answers to your own problems, get a shrink, don't be one, at least not for that reason alone. Many people told me that in psychiatry no one ever gets cured. They were wrong.

But what if you wrote your career report on becoming a ballerina, and now you're in the throes of a medical education, having survived organic chemistry and MCAT's, trudged through biochem, anatomy lab, and 4:45 AM cardiothoracic rounds (do they still do that?) and nothing is screaming your name? I'm not sure what to say, I haven't been there. Process of elimination, maybe. If it's lifestyle you're looking for, I think dermatology is low on crises. There are many ways in many specialties to gain some control over your time: if lifestyle is important, stay away from trauma surgery, OB, and most other surgical subspecialties.
For what it's worth, though, I agree, psychiatry can include a good lifestyle, though easy hours won't bring in the big bucks, but you can have time to spend with your kids and your blog.

Seriously, though, I was unaware of the AMA dictate that psychiatrists be available for emergencies within 30 minutes. Every shrink I've mentioned this to has gotten a bit anxious and no one has heard of this (except Wise CoveringDoc). Even Camel who carries a "Life or Death" line with her was not pleased. This little-known statement applies only to emergencies (not availability on demand for anything your heart desires), doesn't define emergencies (I don't think, hmmm, I've never actually read it having learned of it 3 days ago) and emergencies in private practice are not that common, at least not in my practice. The one time I was called with what was truly an emergency-- a patient on the brink of a suicide attempt-- I answered the phone, thereby being immediately available, not even a one minute wait, and the caller went through with the attempt despite my wise counsel (I did call 911, the caller did survive). I'm not losing sleep over this one, though it did occur to me yesterday that I'd left my phone in the car while I was at the gym for a one-hour work out and if someone had an emergency at the beginning of my workout.... oy...I stayed on the stairmaster.

Solo versus Group: I've done both. I was in a group for 7 years, I liked it, I left when the logistical issues of office space got to be difficult. The group had 3 billing secretaries, I've done better on my own. I've never wanted secretaries to schedule me, though they do in the clinics where I've worked, and usually it's fine.

I'm actually a pretty good secretary, if I do say so myself.

I hope this helps.


Midwife with a Knife said...

For what it's worth, my lifestyle isn't all that bad as an OB. I'm on call when I'm on call, and when I'm not on call, I'm avoiding other work (Admittedly, I've done q2-3 call since New Year's Eve, but after my call tomorrow, I won't have any call the rest of the month).

There are things about OB that get to me much more than the lifestyle. There are also things that I love every single time I do them. I've done hundreds (almost a thousand, maybe, by now) normal vaginal deliveries. Although I do enjoy the high risk stuff and the forceps and breech 2nd twins and all of that; every single time I hand a healthy screaming baby to a loving mother, I feel good about what I do. You're all going to think I'm a wuss, but I still sometimes almost cry at beautiful deliveries. It kind of makes up for all of the bizzarre complications and fetal deaths that I've had recently.

Anyway, I'm sure other professions have both their really crappy moments and their really good moments. I always figure that the question is: Do you enjoy the really good moments enough that they make up for the really bad moments?

I think that figuring that out as a medical student is a real challenge, and it's a tough decision to make.

ClinkShrink said...

Here's my ten cents worth:

If you hate what you're doing your lifestyle is irrelevant. If you love what you're doing your lifestyle is irrelevant. Do what you love.

There is a huge range of lifestyles within psychiatry and our blog represents that. Dinah in private practice (with or without secretary) has a fair amount of control over her patient load and schedule. She has a nice office and a telephone. Her patients for the most part sound fairly stable and have treatment assets.

And then you've got my practice. I've blogged before about work in jail and prison---often with no phone, no designated office, sometimes without a desk or chair or even a room (eg. doing inpatient rounds out of a linen closet). But I love this stuff. I love the fact that I can scoop these folks up and tuck them into my chronic care clinic when they've spent weeks or months getting (or not getting) treatment in free society. I like seeing guys get their act together over time (yes, rehabilitation does happen!). And over the last ten years I've gotten to see increasing numbers of forensic psychiatrists get hooked on it too. Not an easy lifestyle at all, but when you see results like this who cares?

alwaysthegoodgirl said...

Thank you for replying to my questions so thoroughly. I also appreciate you sharing stories about your patients. It is great to hear about the realities of the profession.
I hope I wasn't giving the impression that my interest in psych is because of the lifestyle. Coincidently, this evening my class had a meeting to discuss specialty and residency choice.
Besides thinking psych has the most interesting pathology, I really enjoy being with patients and hearing their stories. I feel like I was made to be a psychiatrist: all of my past experiences, my personality, the way I interact with people, etc.
I am not hoping for a huge salary , but I would like to see my husband and enjoy life more than some specialties would allow. And I would like to have enough time to take care of myself, especially to have good mental health, so I could care for patients.
After seeing a psychiatrist in the past year for anxiety/depression issues, I started seeing a therapist as well. I know it works - I am getting "untangled." I wish I would have gone sooner. Because of that, I feel passionate (and compassionate) about psychiatry and mental health issues.
I should probably have posted this rambling on my blog, rather than clogging up yours with it. The specialty choice issue has been on my mind a lot lately.
You Shrink Rappers are great, and again, I appreciate your blog.

Dinah said...

roy, the podcast notes look great (your co-blogger here). Won't you comment on your lifestyle to make my Lifestyles of the Rappers post complete? --

Anonymous said...

Consultation-liaison psychiatry lifestyle is great for folks who like their worklife a bit unpredictable, and you never know what the next challenge will be. It's very similar to ER work, but somewhat less acute, and more satisfying. The other thing about it is that you work intensely with patients and families for a brief period of time, and then you are done.

If you like to get home at a specific time every day, then this probably isn't for you (at least, that's how I and my other colleagues seem to find it). However, if you need a flexible schedule, this works well. It also helps that you are a good communicator, as it requires lots of calls to family members, outpatient providers, and hospital attendings, social workers, case managers, utilization reviewers, and hospital administrators. You have to like being a problem-solver, because often is the time that someone calls you and says, "I don't know what to do with this case."

There are also some weekends and night call, depending on how you have coverage arranged.

And, most importantly, like Clink said, you have to love it.

Steve & Barb said...

That was me (%&#@!$ Blogger).

Dr. Shock said...

A terrific post, posted it to my blog, but more important I did send it to medical students in the Netherlands, hope this helps them as well, thanks,
Dr Shock

Anonymous said...

A third year med student also considering psychiatry. I have liked many different things in all of my rotations but I keep coming back to psych. I just had a daughter and suddenly lifestyle is very important. Have psychiatrists on this blog found that they could have controllable hours/live decently/pay back loans with psych? I would love to work part-time when I complete residency, but is this even possible? I don't need anything too fancy but I don't want to be doomed to hamburger helper and pert shampoo for the rest of my life.

When I did my psych clerkship I loved the focus on mental illness (versus it only being a small piece of the pie in general practice), the interactions, the variety of settings, the team approach, and the pharmacology/brain physiology stuff.

When I tell docs in other specialties I am considering psych/child psych I often hear, "You aren't wierd enough". I don't know what to say to this. I don't really think psychiatrists are wierd (or any wierder than anyone else in medicine), but they seem a fairly serious group. I am a pretty funny outgoing and normal girl (my mom says "effervescent"). Can I retain my fun-loving self if I become a psychiatrist? Obviously I am serious, sincere and compassionate in my patient encounters. I wouldn't be considering psych if I was otherwise. But could psych drag me down?

Thanks for any input.

Dinah said...

I'm not weird. Roy, am I weird?