Thursday, February 15, 2007

Who Wants to be a Psychiatrist?

[begun by dinah]

There are lots of wonderful things about being a psychiatrist.

Is this a good way to start a post? Seriously, there are. The med school stereotype includes real downers, and not that many docs go into psychiatry: All psychiatrists are crazy (I would say Most psychiatrists are perhaps a little odd, present company excepted, but what's the thrill of being "normal"?). Psychiatric patients don't get better. This is just wrong: they do get better and many are effusive with their appreciation. Psychiatrists don't get paid well. Umm, compared to the neurosurgeon who gets thousands for an operation, that's true. Okay, shrinks are at the bottom of the doctor pay-pole, but money isn't everything.

So this is what's great about psychiatry: the field is huge. One can become a psychoanalyst, never touch a patient, never prescribe a medication (still? not sure, I'm not a psychoanlyst and only know a handful), see patients 4 or 5 times a week (rich ones) to get to the bottom of their defended conflicts: this is all Art and No Science. One can see patients in a multitude of settings ranging from prison to public clinics to private offices, inpatient, outpatient, partially hospitalized, college health clinics, emergency rooms, psych hospitals, general hospitals, or everyone's favorite: hospitals for the criminally insane-- okay, okay, ClinkShrink says I have to call it a secure forensic facility. One can become an an administrator and never deal with a live patient. Or an academic researcher and write grants, run clinical trials on patients, or study neurotransmitters and receptors and also have little to do with whole people--this is all Science and a little Art. There's room as a psychiatrist for a second life: parent, novelist, fine artist, even blogger. I suppose that's true of other medical specialties as well, but psychiatry tends to attract (some) folks who are interested in the introspective, the artistic side of life and its creative outlets. Am I right? No clue.

I write a lot about doing psychotherapy. It's not all I do, I write a fair number of scripts and I've always identified myself as a community psychiatrist--a shrink who works in publically-funded clinics with chronically mentally ill patients. I was even an administrator for a while there-- But I like to write about psychotherapy, I think because it's illusive, it's hard to pinpoint why it's helpful to talk to someone, how it effects cure or change or even what value we place on comfort in the absence of cure or change.

And why do I like doing psychotherapy? In a word, intimacy. Nowhere do people touch so close, let you in with such trust, then change and get better not because of a drug, or just because of a drug, but because of what you do with your being: listen, reflect, and sometimes just care.

[ClinkShrink says:]

I was destined to be a forensic psychiatrist. I didn't know it at the time, but growing up on a steady diet of Agatha Christie, Ellery Queen and Arthur Conan Doyle (not to mention Ed Gein jokes) pretty much determined my professional future.

When I was in medical school I never planned to be a shrink. I was considering almost everything else---emergency medicine or oncology being the foremost---until I took my psych rotation. It was the high point of my medical school experience. I had some pretty amazing and unusual cases (even compared to what I've seen since then), including one famous case involving a patient who is still discussed in forensic training programs. Our civil commitment hearings were held in an actual courtroom so as a medical student I also got to see my first expert testimony in front of a real judge. One of my progress notes was even quoted at the hearing. Pretty darn cool.

Meanwhile I saw residents in other specialties dragging their butts around the hospital exhausted and demoralized. While they intellectually liked their specialties they just didn't seem happy. Psych residents, on the other hand, loved what they were doing and smiled a lot. They also tended to have delightfully twisted senses of humor. I fit in there.

I've never regretted my decision. I still like my patients and my colleagues. I still like the predictable chaos of institutional work and the knowledge that I'm doing the right thing. It's fun to see people gradually get better and to know you had something to do with it. When I hear an interesting delusion I wonder why anyone would want to do anything else. And I particularly liked it today when my patient told me, "Thanks, doc. You're a blessing. You really are."

Pretty darn cool.

[finished by Roy]
Fine, I'm being forced to talk about why I like being a psychiatrist, by threat of emasculation. I'm not going to talk about why I became a psychiatrist, but why I love it. Keep in mind I'm a Consultation-Liaison psychiatrist (also called psychosomatic medicine), which is essentially psychiatry in the general hospital. I see all sorts of people with all sorts of problems, from the mundane to the fascinomas. You get to help solve problems by thinking of things in ways others haven't. It's a bit of Sherlock Holmes plus Marcus Welby, with some Dr Huxstable and a bit of House thrown in.

I can do any kind of psychiatry I choose (inpatient, outpatient, administrative, research), in any type of practice (solo private practice, group practice, clinic, hospital-based, large single specialty practice), part-time or full-time, and pretty much always be able to get a job that pays well while being independent enough to be able to vote with my feet if I disagree with how an employer treats patients. I have, in fact, done all of the above at various times (as Dinah can attest), sometimes many of them at once.

At one point I thought of being a psychologist, but found it too theoretical, and it didn't answer all my questions about how the brain works, how the body works, etc. The best part is being a physician and having the confidence of knowing the difference between, say, a seizure and a pseudoseizure, because I learned about both these things, learned how to examine for these things, and know the importance of getting it right or wrong.

At another point I thought of becoming a neuroscientist, but found that I missed the people contact. I really like working with folks whose brain is on the fritz, and helping them get their picture back so they can enjoy life more. That is satisfying.

(I hope Dinah's happy now :-)
And now that you've heard why we all love our jobs
And now that you want to be a shrink, too,
I thought I'd post
This poem for you.


alwaysthegoodgirl said...

Thank you, thank you, thank you. One for each of you.
That was a great post and very informative. Maybe one day I can put a "I love my job" pin on my white coat.

Rach said...

wonderful post! in my mind, it's the highpoint of your blog so far!!! I think you've hit the nail on the head on the elusive question of "why?"

I wonder how many other psychiatrists feel as positive as you do about your line of work.


After reading Turboglacier's latest post, 'Fecal-Oral Transmission,' I'm not quite sold on the whole psychiatrist thing.

NeoNurseChic said...
This comment has been removed by the author.
Dr Michelle Tempest said...

Just to say I love your blog and it's great to have company in the psychiatry blogosphere! Michelle. Sorry, in my last comment I clicked incorrectly and it was deleted!

Sarebear said...

GREAT, GREAT post!!! Even if I picture Roy being dragged kicking and screaming, sort of like the bad guy in Ghost, when the shadows come to take him away, except w/out the horror of where that guy is going.


I thought through some feelings on the therapeutic relationship last night, so I've got more to add in the comments on that one! When I pull myself together . . .

Patient Anonymous said...

Great post. Nicely done.

Gerbil said...

The psychiatrist I saw while in college was a little miffed that I wanted to be a psychologist and not a psychiatrist. He got very excited when I considered medical school (for about two weeks)--and then bummed again when I went back to plan A.

"How come you don't want to go to med school?" he asked.

"It's not med school so much as those horribly long shifts during internship and residency," I said.

"Yeah, um, well. I've kinda repressed those memories," he said. "But as long as I still get to call you Doctor someday..."

DrivingMissMolly said...

Call me Negative Nellie, but why don't I completely trust this set of posts?

Something seems off. The picture is too rosy.

Maybe it's just that you are "normal" people and I cannot imagine being in such a contented, satisfied place?

I'm not sure, but I'm surprised at myself for not gushing about this post like everyone else.


Anonymous said...

Thanks for the kind words.

Lily: There's a bit of self-selection in 3 shrinks who choose to spend their free time talking about/blogging about/ podcasting about psychiatry. If we hated our jobs, we wouldn't be doing this. However, I will point out that this is the Why I Love Being A Psychiatrist post. Maybe someday we'll do a What I Hate About Being A Psychiatrist. No world is perfect.

And Roy, yes I'm happy now and I would never do it.

Curtis and Shae said...

Again...I love this post. I love psychology! And I am so happy it is the field I picked to study. It truly is my calling in life. Though I don't want to become a psychiatrist, being a psychologist has it's ties. I want to love my job one of these days. And if things keep going like they have been going...well, I am on the right track. Thanks again for the awesome post. I am so glad to hear what all of you have to say!

Steve & Barb said...

N. Nellie- I am also a bit surprised at the amount of positive regard for this post. Mostly because I was raised to believe that one should do what one loves, and the rewards will follow. So, to me, it's like... duh, of course I love it... if I didn't then I wouldn't do it.

That sounds a bit pompous, I guess. But it's well-meaning, if not always practical. Do what you love.

Sarebear said...

Lily, given how broken mental health care is (I can't say system, cause, um, WHAT system?), I guess it does seem surprising. I'm glad you brought that up. It made me realize, wait, I'm not sure any of these three deal with insurance co.'s, or at least not much . . .

That's the worst thing about being a psychiatrist, for many, many of em. From what I've read, anyway.

Managed care (oxymoron, ugh).

sophizo said...

Roy - I agree that a person should do what they love, but that isn't always possible. I can't do what I love because there are no jobs. As a result, I'm still trying to find a career doing something else that I'll love. Unfortunately, searching for that can take years. You were lucky that you knew what you wanted to do very early on and had the ability to head down that road. Not everyone is that lucky. That is probably why there are so many positive responses to your post. You three are very lucky to be doing what you love.

Just trying to give the other perspective from the view of someone still searching for that "something" to love. Unless you can convince the world that ancient Greek archaeology is still an important field of study, I'm SOL.

BTW...I too enjoyed the post.

Midwife with a Knife said...

Y'all seem to have made the switch to bogger 2.0.

Steve & Barb said...

Good point, Sara. The psychiatrist I know who must deal with insurance companies a lot do, in fact, hate that aspect of their job.

Clink, working in the prison, does not deal with insurance at all. And I'm guessing that -- for those prisoners who still have insurance when they are released -- she doesn't call Aetna and make sure that all their meds are pre-authorized.

Dinah, working in her own private practice, sets her own rules on insurance. I think her rule is, you pay me directly, I'll give you a bill and fill out your forms, but you must deal with the hassles of getting paid by the insurance companies.

I, working in a hospital, rarely have to deal directly with an insurance company, as I have other staff who have that pleasure. In the ED, the social worker calls and get authorizations. In the inpatient unit, the UR nurse calls and gets authorizations. When a doc-to-doc call is required (that's when the company says NO and we say APPEAL), that's where I may get involved.

For more info, check out this 1996 survey on US psychiatrist medical director job satisfaction, this 2002 UK survey, and this 2005 Norwegian survey (that's almost Finnish :-) stating that psychiatrists are more satisfied than anesthesiologists.

Dinah said...

You've all got me thinking about my What I Don't Like About Being A Psychiatrist post.

Life is not black or white, I love my job even if every moment isn't filled with joy. It's the Overall satisfaction, my tendency to selectively dwell on the positive moments (at least while writing a Why I Love My Career post!) and the awareness that nothing ever is perfect that allow me to conclude that I'm happy despite the bad moments. Note my feelings about those beloved Pain Forms, Medicare Forms (Endless aggrevation) and my past discussions of criminal and angry patients.

But yes, overall every aspect of my life from the ability to pursue a career I was interested in to the absolute wonders of my terrific family (yes, Max, that means you!) has been blessed.
From being born into a family that encouraged and expected my academic success to getting financial aide in heavy doses to allow that pursuit, I have been lucky.

Sarebear said...

My iatrist closed his practice last November because of the more unpleasant sides of private practice (wrestling w/ins. co's, patients not paying, patients not showing up, other stuff. I suspect his 4 month suspension from the year before had something to do with it, too (I don't think her claim against him had any merit, but shrinks are vulnerable I 'spose, that'd make a good post sometime too . . .))

If that's not a long double parenthetical, I don't know what is . . . doh, reminds me I better call the potential new shrink's office back, I MUST get a shrink.

Anonymous said...

testing, I'm letting my blocked addresses come through

Prahalathan said...

Good one! I agree with you, maybe bottom of the pay ladder but imensely more satisfying and room for a second life. After all what's the use of working and earning all the time if you can't do anything else in life?

Anonymous said...

Heyah, I'm only 14 years old and lately i have been really interested in becoming a psychiatrist. I have always wanted to do something in science, and I'm really interested in mental health. After doing some research into psychiatry and coming across this site, I am convinced that this is what i want to do in life! Well i read somewhere that is takes 13 years to train...but I'm still gonna go for it! So thankyou!! x

laura said...

"how it effects cure or change or even what value we place on comfort in the absence of cure or change."

i think you mean how it "affects" :)

Anonymous said...

plz watch "Psychiatry is not an industry of death" on youtube

I know that 95% of it is one sided & goes in same category as Michal Moore doc's BUT it has a point
I leave it up to you is it 100% BS or 95% But in latter case this blog is a Little hypocritical...

Anonymous said...

sry I copy-pasted wrong title, real one is:

"Psychiatry: Industry of Death"

Unknown said...

I want to thank all of you for adding your opinion. I am contemplating med school myself. PhD or MD? I after reading your posts I feel much more confident in my choice to go after med. school!

Thanks again!!

Destined117 said...

Who wouldn't wanna be a psychiatrist. It helps you learn more of who you are and what others think. Its the next best thing to mind reading. Lol. I just think that psychiatrists know how to deal with people and must have very happy lives. :)

InnocentlyGreen said...

Well, I'm a Psychologist not a Psychiatrist but I do work closely with one. This post made me smile a lot remembering some of the things I was told as well :)