Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Wednesday, July 27, 2011
Today's blog post can be found over on Shrink Rap News on our Clinical Psychiatry News site.
In it, I talk about why psychiatry is the best medical specialty : ~ ) and I reveal the results of a question we asked to Maryland psychiatrists: “Overall, are you satisfied with your career as a clinical psychiatrist?”
So what percentage of respondents do you think said "Yes, I find my work rewarding and would chose this career again?" Take a guess, then click over to Shrink Rap News and find out the answer! The article is entitled "Would You Do It Again? Psychiatrists and Career Satisfaction."
In case you missed it, Roy also has a post up from last week on Health Insurance Exchanges and Accurate Provider Directories. If you've ever tried to find an In-Network doc, only to discover that everyone listed on the insurance company website is now 6 feet under, you may want to read this.
Ooooh...it's going to annoy Roy that I fooled with the color scheme. [fixed it. ~Roy]
Posted by Dinah on Wednesday, July 27, 2011
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Pediatricians tend to be a pretty happy bunch and there is a glut of pediatricians. What does that prove?
So why aren't there more psychiatrists if psychiatrists are so happy? One answer might be that one doesn't need to go to medical school to do psychiatry. All the MD gets you is a sanction to prescribe drugs, and in 3 states even the MD isn't necessary. Why should an aspiring therapist spend the time and money, not to mention the stress?
wv = demuff. To remove hair from the chin or "exhaust system" so to speak.
I read your post on Shrink Rap News. You draw conclusions from an 'informal' and unpublished survey (no accountability--methodology please)? Does that make psychiatrists seem responsible?
Anon: I believe that as long as we've said it's informal and unpublished, then it's fine. I listed the question that was asked and the options for responses. It's hard to validate happiness! The results were surprising to me. And I imagine they might publishable. In fact, they've now been "published" on the Clinical Psychiatry News website.
Rob: My point was that people (meaning med students) have misconceptions about psychiatry that likely prevent them from even considering it as a specialty and that if they had a better understanding of the field, more might be interested, and that we as shrinks have done a lousy job of selling our field.
I understand that you don't believe psychiatry is a medical sub-specialty.
Believing that psychiatry is not a medical sub-specialty is like saying you don't believe Manhattan is a borough of New York City.
I insist that psychiatry needn't be, and arguably shouldn't be a medical specialty. The difference is crucial.
wv = stroffet. The skin that hangs down from an old hag's neck (equine or otherwise)
One of the more important factors in physician stress and dissatisfaction is the extent to which the need of the physician to satisfy his own perfectionistic tendencies, to meet his own superego demands, to practice in a manner that meets his own standards, crumbles as he gets increasingly busy.
Additionally the psychiatrist, particularly those that do psychotherapy, not only are able to discuss problems with the patient but are attuned to recognizing them as important clues to the difficulties that the patient faces.
You often see, therefore, psychiatrists in clinical practice working successfully far longer than those in other speciaties.
Pediatricians, too, are a happy group.
Rob, your remarks strain the atmosphere in this living room. They are increasingly negative and discouraging.
I am a pre-med college student. Right now, psychiatry interests me more than any other specialty. : )
Rob, there are many reasons why someone would choose psychiatry over other mental health professions. I want to be a psychiatrist, rather than any other type of therapist, because medical biology interests me. I am very interested in how the body works...including how its most complex organ creates the mind. Because so little is known about the etiology of mental illness, I would like to dedicate a substantial portion of my career to research. Obviously, once we have a better understanding of where mental illness comes from, we will be able to develop better treatments for it. I can only embark on this sort of a research career if I obtain an MD or a PhD in psychology (which is about as much work). My love for biology makes med school more appealing than psychology grad school.
Also, I am one of the few people who actually likes the "medical model" approach to dealing with psychological problems. I've been diagnosed with bipolar II, and I have no problem seeing myself as "sick" or labeling my more prominent highs and lows as "pathological". My mood disorder has affected my life in too many ways to be simply a "normal reaction to life events" or a problem stemming from the society I live in. I believe that the treatment of medical problems should be overseen by medical doctors.
Psychiatry is decades behind the rest of medicine right now, which makes it unattractive to future doctors. This lag is due to the complexity of the brain. Once we gain a better understanding of the brain, I predict that psychiatry's fast pace of growth will make it one of the most exciting, attractive specialties.
wv= benest. A word used by those knowing Italian and English, like to mix the two, and get confused between adjectives and adverbs when forming superlatives.
Anon: pre-med student
I think that what you want to do is the guts of non-pharmaceutical research. Etiologies of psychiatric illness may one day as with neurology,lead to treatment solutions. What I am saying here, is that you need to watch the amount of student loan debt you take on--it is the lesson of everyone from my age on down... You must be hearing that private and government insurance pays poorly for psychiatric treatment. Well, seeking grant funding for psychiatric neuroscience with no back end pharmaceutical company lobbying for the thing you are researching must be a rough go. I am not trying to discourage you. I am just practical when I am trying to do something; I want to make sure I can do that thing when I get there.
And just get ready to ignore all the grouches and the people who say you don't count or your work isn't real. To be a shrink is to take a risk in a lot of ways, one of which is to join the club of people (w)rapped like shrinks which is weird in a cool way I think.... (Anyone who doesn't believe the living room is real could always leave the living room.)
Question for Rob and Jesse: You are both physicians so why are you commenting here on the blog when you have the special right granted to you to comment on the Clinical Psychiatry website? According to the caste system, you should comment there and proles, here.
It's because I'm a socialist, right, that you know I like to hang with the proles?
I'm sorry, but I have to hold you to a higher standard. "Anon: I believe that as long as we've said it's informal and unpublished, then it's fine." If you want to say you think we need more psychiatrists and it has proven to be a fulfilling job for you, no one would ever argue with you. When you try to support your opinion by invoking unreliable data, and make comparative claims about other specialties based on that same data--then your opinion becomes only as reliable as your data. Why don't you do psychiatry a real favor and publish your full survey complete with methodology in CPN?
Blah...I have studiously been avoiding any involvement in the discussion Rob is insisting on continuing. However, now have something to say! Scenario...I (or anyone) goes to psychiatrist for med check. psychiatrists notices that in the first 15 minutes of appointment I have finished one bottle of water and opened a second I retrieved from my bag. Psychiatrist questions my thirst (dry mouth possibly from meds?), to which I explain that no, I don't really have a dry mouth, I am just REALLY thirsty ALL the time...and it's really weird because along with that I am going to the restroom WAY too often so I fell dehydrated but that doesn't quite fit what is going on. Psychiatrist orders several labs (including an A1c)with instructions that the results be sent to her and my GP, and calls my GP to get me an urgent appointment. Same scenario... my psychologist/therapist. Psychologist notices same issue, asks same questions. Then tells me this could be something serious, I should make an appointment with my GP to discuss this...getting an appointment on my own could take anywhere from 1 to 4 weeks since I have no way of knowing how serious or what this could be (I actually do, but the average layperson may not).
Just one example of the difference an M.D. makes, I am sure there are MANY other examples.
I make referrals to specialists to manage problems in which they have expertise. The medical problems are my domain. Patient management works best this way. The problem is, nobody practices this way any more. As a result, care is fragmented beyond recognition and the individual suffers because of it.
I would no more have a psychiatrist manage my kid's medical problems than I would have an orthopedist, ophthalmologist, or otolaryngologist manage their medical problems. That's my job.
wv = chaillo. A tasty tapas dish consisting of chard and leeks and various other unpronounceable Spanish spices.
I am no expert here, but I think a psychiatrist should have a medical degree to be able to distinguish whether someone is suffering from a physiological illness that is manifesting itself with psychiatric symptoms.
Physiological disease is the domain of the family doc, internist, or pediatrician. Once physiological disease is ruled out, I reach out to a mental health provider.
wv = ackbut. What you develop from spending too much time on Nantucket.
Of course I knew you were socialist. Actually, your comment was not up yet when mine was submitted for moderation or I would have asked you the same as I did Rob and Jesse. What I find interesting is that it is not a CPN requirement that only physicians can comment on a post and the way it was worded made it pretty clear that this was the Shrink Rap bloggers rule. Of course, CPN does not check with credentialing bodies to screen comments. They may have other guidlelines but one's professional degree is not one of them.
P.S. Most psychiatrists I know are champagne socialists. I suppose that qualifies. And yes, I know that psychs make less than other specialists but there is cheap bubbly, too.
P.P.S. My shrink does not know the difference between HDL and LDL.
CPN has a registration first, and I believe they check something--I initially was told only psychiatrists could comment, but their parent company, Elsevier, does many medical publications and their site says Physicians. This is was not a Shrink Rapper thing. Also, it's not a very user friendly log in--- it's a random password (string of letters/numbers) and I couldn't figure out how to change it (ok, I only tried for a few seconds) to something I'd remember, so every time I want to comment, I have to hit "forgot my password."
I added the link back to Shrink Rap for those who want to talk in an easier forum. The editor there has been fine with this.
It's curious that the topic of psychiatry as a specialty in which the practitioners are happier than those in other specialties has generated this response. I have at times commented on CPN but actually find the comments here, coming from a wider group than just physicians, enjoyable and thought-provoking.
CPN accepts registration from physicians, students, and allied health professionals. They do not check anything. To do that, they would need some sort of log in from a university email or a hospital email --something along those lines. The other thing they could do would be to check the creds of everyone who registers and that would take a very long time especially given the numerous allied health fields and the fact that it is catch all term.
Thanks for clarifying your reasons.
Rob - "I insist that psychiatry needn't be, and arguably shouldn't be a medical specialty. The difference is crucial."
Who else do you want prescribing antipsychotics and treating schizophrenics? Do you want PhD Psychologist's who took a 300 hour course instead of 4 years of med-school and another 4 years of residency?
It's certainly not going to be another medical specialty - I've watched how quickly all other specialties shun the mentally ill and don't want to deal with them. ER doctors loved me on rotation because they said - "you go deal with the psycho, I don't have time to hold hands."
Yes we understand mental illness poorly - Our choice of drugs is limited, our understanding of mechanisms is flawed, and our diagnostic criteria is subjective. But what else is there? These people need help, and medications help - so who's going to help them and prescribe these meds if not a medical doctor?
By the way - I love psychiatry, and I hated psychology all through undergrad. I couldn't stand the psycho-babble and overanalyzing. Then I got to med-school - still hated it. Then I did a Psychiatry rotation and met a patient - a mathematical genius reduced to a nomadic invalid - that no other physician wanted to help. That's when I knew.
Rob...I did not say the psychiatrist would MANAGE the medical issue. In fact, I said pretty much the same thing you did! The psych notices it, orders some labs to get the ball rolling and refers me to my GP with urgency stated to said GP.
You seem to have a lot of time on your hands...shouldn't you be doing some kindergarten exams or arguing with parents about the "link" between autism and vaccines instead of beating a dead horse on someone else's blog?
To everyone else...why is it that people who troll nearly NEVER have a place where we can go harass them!?! (no blog, no comments allowed, etc)
Repost due to sign-in error!
I'm pretty sure I've read several times that psychiatrists have a much higher suicide rate than the general population and the highest suicide rate of any medical specialty. That doesn't sound like a really happy group to me. It would suggest that they also have an unusually high rate of depression as well.
Re CPN registration, I was wrong; anyone can register. Here is the link:
"a mathematical genius reduced to a nomadic invalid - that no other physician wanted to help. That's when I knew."
So did you help him? Did he go on to publish more works of genius?
And shouldn't helping the garbage collector be just as important? I'm just saying your life-changing delight at helping a genius sounds...well, vain, really. but maybe you were just trying to say that curing mental illness can have really important social effects, beyond helping an individual, right?
Anon's comment on Shrink2B's post sounds, well, just cruel. To see someone with ability reduced to nothing is powerful, and the effort to help important. Nothing vain in it at all. The vanity is in the unwarranted criticism.
I agree with Jesse on that last post. Not only is it unwarranted, it sounds cruel. We are in this living room to talk about exactly what the title says: Happy Shrinks! We should do that in a more positive way.
A lot of nastiness here in the comments.. .
I just wanted to say to the person who wants to be a psychiatrist, who got advice on not taking on too much debt, that I wholeheartedly agree with that advice.
When I was college age,I was managing off and on in school, and probably already had bipolar, which would have been bipolar II, probably. I got sicker as I aged. It could have been the antidepressants, and I think it was, but maybe it was random worsening. Anyway, I got kicked out of graduate school, tried to work a couple more times, and then went on total disability and 15 years later, I have not recovered, and medication treatment didn't help (lithium did, but hey, hypomania is NOT the problem!).
You already know you have bipolar, so there is a significant chance the same thing could happen to you as it did to me. I was able to get my student loans forgiven, but I don't know if you can anymore. I should have tried harder to live on my RA stipend. Mania was part of the problem - my apartment was packed with crap I didn't need. didn't know I had bipolar, though.
So be careful - be ready to change your career path if things get worse. always have an escape route. I hope things go well for you.
Returning to the "Happy Shrink" topic-
My psychiatrist knew in high school that he wanted to be a psychiatrist. He's been a practicing psychiatrist for over 40 years and he says that he has been very happy as a psychiatrist and lucky to have had a career so rewarding. He is now past age 65 and plans to continue on in his practice as long as he is able.
As a patient, I like going to a "happy shrink". I changed veterinarians once because at each appointment w/ my dog my vet talked about wanting to change careers. I now go to a veterinarian who loves veterinary medicine. My psychiatrist is still interested in patient problems, still interested in advances in the field, and still wanting to be in his office with patients every day. How many people in any profession feel that way after more than 40 years? I appreciate the fact that I go to an MD psychiatrist rather than another type of therapist. He does take the medical possibilities into account and I feel he has seen more mental health scenarios having been trained in part on in-patient psych wards, which is a part of training that non-MD therapists miss.
An aside is that my psychiatrist has practiced psychiatry in the way that he personally feels is best which is 50 minute appointments for all patients (except longer appointments for initial evaluation). I realize there are psychiatrists who specialize in medication management, but my psychiatrist has remained true to the model that he feels is best for himself (and he feels it is best for his patients) and so he has remained true to himself rather than cave in to pressure from insurance companies or to change his practice to earn more money. "Happy" shrinks make for "happy" patients in my opinion.
I think the question is...are patients satisfied with the psychiatry profession. I bet the answer is a resounding "no". Psychiatrists are the least personable bunch of people I have ever encountered (towards patients themselves). I have always wondered why this is so.
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