so you want to be a psychiatrist you
like the idea of being a shrink
doing talk therapy and having people all
figured out
let's debunk the public perception myths
of what it means to be a psychiatrist
and give it to you straight this is the
reality of psychiatry
dr jubal med schoolinsiders.com welcome
to our next installment in so you want
to be
in this series we highlight a specific
specialty within medicine such as
psychiatry
and help you decide if it's a good fit
for you you can find the other
specialties in our so you want to be
playlist
if you want to vote in upcoming polls to
decide what future specialties we cover
make sure you are subscribed if you'd
like to see what being a psychiatrist
looks like
check out my second channel md where we
featured dr pd cass
in a day in the life of a psychiatrist
link in the description
psychiatry is the field of medicine
focused on understanding and treating
mental health disorders and
psychological distress
psychiatrists use the diagnosable and
statistics manual
currently in its fifth iteration hence
the name dsm-5
in assessing a patient's constellation
of symptoms and determining if they
exhibit a diagnosable disorder
but psychiatrists can help patients with
other conditions even if they
aren't classified dsm illnesses
including psychological distress from
pain
trauma difficult relationships or other
high stress situations
if you've ever confused psychiatrists
with psychologists
you're not alone psychiatrists are
medical doctors meaning they have either
their md
or do and they've completed four years
of medical school
followed by residency and sometimes also
fellowship
they can diagnose and treat mental
conditions using either medication or
non-medication treatments
such as psychotherapy while
psychiatrists can use medications to
treat patients more severe symptoms they
rely on talk therapy training to
help people with more mild symptoms or
with problems that wouldn't necessarily
respond to medications
psychologists on the other hand have
either masters or phd level training
and while they're able to diagnose and
treat mental illness they can only use
non-medication treatments
sometimes you'll see psychiatrists and
psychologists working together with
psychologists focusing on therapy and
psychiatrists usually focusing their
expertise on medication
although they can do either while some
think that psychiatrists go into the
field because they
subconsciously want to fix their own
problems or that
they're highly eclectic and strange this
isn't quite true
as a psychiatrist you'll have to be
adept at relating to a wide range of
individuals
and that also requires well-developed
interpersonal skills
and while it has a useful handbook
psychiatry is much more than just
memorizing dsm criteria and slapping on
diagnoses to patients
psychiatrists use the dsm as a guide but
they formulate patients
more holistically than that they're
looking at the psychological
socioeconomic and physiologic causes of
their symptoms as well
not just the symptoms themselves there
are a few ways to categorize psychiatry
as a clinical psychiatrist you'll be
seeing patients doing therapy
and generating treatment plans if
practicing inpatient you'll see patients
admitted to the psychiatric ward or
consult service meaning those treated
primarily in other areas of the hospital
but requiring secondary psychiatric care
as a consultant
you'll educate primary teams on various
psychiatric
and psychological conditions affecting
their patients
and provide them with your psychiatric
treatment recommendations
with inpatient you're dealing with more
severe cases that often require
more critical treatment these patients
often have multiple psychiatric
conditions
and are generally more complicated than
those you would see in an
outpatient clinic there's also a great
deal of medicine involved as
these patients often have multiple
medical issues that either worsen or
mimic psychiatric symptoms for example
certain medical issues like
cancer brain injuries or covet can
result in delirium or
agitation which can both look like
psychosis or depression
with outpatient you'll be primarily
combining psychotherapy with medication
management for patients with whom you'll
have more longitudinal relationships
as they'll come to the office multiple
times over months to
years with outpatient you also have more
flexibility in managing things beyond
traditional psychiatric diagnoses
like sleep pain or distress from various
stressors
if you focus on research you can choose
from bench or clinical work
with bench research you often work in a
lab and do research at the cellular
or molecular level to explore
foundational neurobiology
that may help explain the brain function
of people with psychiatric conditions
with clinical research you could explore
the efficacy of different medications
and treatment options in treating
specific patient populations
or psychiatric conditions interventional
psychiatry is an exciting new area
exploring brain stimulation through
transcranial magnetic stimulation or
tms for short ketamine and deep brain
stimulation
in an academic setting you can work
either primarily inpatient
or outpatient but associated with an
academic teaching hospital
this offers less flexibility in your
practice but will allow you the
opportunity
to do research work with medical
students and residents
and pursue academic leadership you'll be
working at a medical center that is
likely pushing to advance the field
but will be at the whim of the
bureaucracy of the hospital
and your appointment types meaning
appointment length and therapy versus
medication management ratios will have a
limit set by the institution
in a community setting you'll work with
hospitals or outpatient clinics run by
the county or
city public health departments patients
will primarily be medicaid or uninsured
meaning you'll have the opportunity to
work with underserved patients and a
greater proportion who are severely
mentally ill
dual diagnoses amongst this patient
population is
not uncommon meaning a substance use
disorder plus a separate mental health
diagnosis
for these reasons this work can be
highly rewarding as this is a population
with less access
but it can also be highly frustrating
working with a socioeconomically
disadvantaged
population as medication and appointment
adherence may be problematic
as is access to other resources private
practice entails one or more physicians
setting up their own shop outside of a
larger medical center
they have complete control and autonomy
seeing patients as they choose
this has the greatest amount of
flexibility in most domains
including how much they charge which
insurances they take
the balance of therapy versus medication
and visit durations
however this is running a business and
there are
of course risks associated with that at
the beginning you'll have to do more
work to build a patient population which
may mean
making less money at first then you
would with an established group or
medical center
with psychiatry you don't have to choose
a single type of practice
you could do academia a few days per
week and some private practice on other
days with
a smaller psychiatry group after four
years of medical school
psychiatry residency is four years
unless you go into
child psychiatry fellowship in which
case you can skip the final year
making it a three year residency more on
fellowship
shortly as a pgy1 meaning your first
year out from medical school
you'll do primarily general medicine
rotations like
inpatient and outpatient medicine
emergency medicine
neurology and the like you'll spend some
time on psychiatry
usually inpatient from a few months up
to half a year depending on your program
as a pgy2 you're now completely immersed
in your psychiatry training
primarily on inpatient and consult
psychiatry services
though some programs will offer a small
amount of outpatient training in this
year
as a pgy3 you'll focus on outpatient
psychiatry
rotating in different specialty clinics
each devoted to a specific diagnosis
patient population or age group for
example
you can attend bipolar clinic or anxiety
clinic or go to
child clinic or lgbt clinic your fourth
and final year will be highly variable
although most commonly this will be
repetitions of rotations you've done in
previous years
you'll also have more opportunity for
elective and research time to pursue
your interests
hours in psychiatry residency are pretty
relaxed mostly eight to five on most
rotations
with some overnight and weekend call
shifts the frequency of which is highly
dependent on the program
with some programs having none in terms
of competitiveness
psychiatry is more attainable with an
average step one in the 2020 cycle of
227
and step 2 ck of 241 and a 90
match rate in the msi competitive index
psychiatry ranks at 18 out of 22 in
terms of competitiveness
psychiatry has increased in
competitiveness in recent years for a
few reasons
more medical students are understanding
the importance of work-life balance for
which psychiatry has a strong advantage
there are more options within the field
than ever thus attracting a wider
variety of individuals
and it's also becoming a less
stigmatized field
mental health is finally becoming more
mainstream as it should
after completing residency you can
sub-specialize further with fellowship
all fellowships are one year in duration
except for child psychiatry which is two
years
in child psychiatry you'll be working
with children and adolescents
most commonly dealing with depression
anxiety eating disorders adhd
and autism you'll work closely with
their parents as well
thus incorporating a high degree of
psycho-education and family counseling
child psychiatry is more focused on
non-medication-based strategies
including therapy and mindfulness
practice compared to other psychiatry
specialties
psychosomatic is best suited for those
who want to work in the overlap between
psych and medicine
specifically with medically hospitalized
patients who have psychiatric needs
you'll manage complicated patients such
as someone with schizophrenia who is
also
on chemotherapy and finding the best
medication for the mental disorder
that won't negatively interact with the
chemotherapeutic agent
psychosomatic specialists are often
embedded in clinics for a particular
medicine sub-specialty
such as oncology or palliative care
which allows psychiatrists to further
sub-specialize with patient populations
they are most interested in
geriatric psychiatry includes working
with older adults
and learning how to manage psychiatric
illness in more medically frail and
complicated patients with other
comorbidities
you'll also be doing life processing
meaning coping with end-of-life
stressors
such as death of friends spouses and
one's own mortality
if you're interested in this field
you'll have great flexibility in where
you work
even in big cities as there's a high
demand for the specialty with our aging
population
but currently low supply forensic
psychiatry focuses on the overlap
between psych
and the law you'll evaluate patience in
situations related to legal matters
such as insanity evaluations if the
defendant pleads insane
when it comes to legal issues related to
psych these are the experts
for example you'll act as an expert
witness in court cases
and evaluate medical records to assess
malpractice
this is not a clinically focused
subspecialty rather
you'll be serving as an expert evaluator
but most forensic psychiatrists
also do part-time outpatient general
psychiatry work
as well addiction focuses on substance
use disorders and
dual diagnoses patients meaning they
have both substance use disorder and a
primary psychiatric disorder
you'll often find yourself working in
rehabilitation facilities
or outpatient clinics public
psychiatrists practice in community or
underserved patient populations
doing advocacy work for legislation that
affects these communities
op-ed writing for publication and
lobbying you'll be working with the most
vulnerable patient populations which can
be very satisfying
interventional psychiatry is not an
acgme accredited sub-specialty
meaning it's not as official as the rest
this is for those who are interested in
psychiatric procedures
like electroconvulsive therapy for
severe depression
or transcranial magnetic stimulation for
ocd
and depression treatment this also
includes ketamine-assisted therapy
or ketamine infusions for depression
some of your patients will have deep
brain stimulation electrodes placed by
neurosurgeons
and you'll manage the patient's
psychiatric care before
and after surgery psychiatry is a unique
specialty within medicine
it's the least algorithmic meaning
you'll never simply follow an
algorithm when treating a patient rather
you must think deeply and holistically
about each of your patients
if two patients have the same disorder
you likely
won't be using the same two treatment
plans if you enjoy spending time with
patients
psychiatry is hard to beat it's one of
the few specialties left where you can
regularly have
45 to 60 minute appointments and most of
your patients will need your treatment
long term if you prefer longitudinal
relationships and having a deeper
connection
you'll see them develop and improve with
time and being a part of that
is satisfying psychiatry offers
flexibility in your career
you can work in multiple clinical
settings or with multiple patient
populations
and even have multiple jobs at once
you're able to tailor your career to
meet your goals
unlike other specialties where you
generally must take one job
in one setting and finally the quality
of life and hours are hard to beat
both during and after residency it's
pretty much
just regular business hours and
overnight emergencies or weekend call
are infrequent psychiatry is not for
everyone
it's a hands-off specialty so if you
enjoy the physical exam or procedures
you won't get that with psychiatry
unless of course you go with
interventional psych it's also a less
concrete specialty dealing with
uncertainty
our understanding of mental illness is
still developing
and it can be difficult to know exactly
how to help patients
you'll sometimes try multiple treatment
options with little success
and that can be frustrating
psychiatrists also often deal with
difficult patient populations such as
those
with substance use disorders severe
mental illness or personality disorders
that can be challenging to manage
and in private practice it can be
isolating although this
is less of an issue in other practice
settings you may come across some
anti-psychiatry stigma
amongst the general population due to
influences from conspiracy theorists
scientology and cruel treatments from
decades ago
such as lobotomy and shock therapy
modern-day electroconvulsive therapy is
done
under anesthesia is safe does not
involve any convulsions or broken limbs
as the patient is on paralytics and
they're completely unaware of the
seizure
the most common adverse effect is
headache how can you decide if
psychiatry is for you
if you're interested in the brain both
in how it works and how it can cause
mental illness
and if you enjoy talking with people in
depth and hearing their stories
psychiatry may be for you many medical
students enter their psychiatry rotation
assuming they won't like it but when
they give it a chance
they'll often find it more interesting
than they expected
if you're the kind of person who wants
to help support others through their
challenges
no other field goes as deep you must be
comfortable helping people work through
emotionally heavy situations
while holding space with them as they
share upsetting and tragic stories
if you're considering psychiatry and
neurology they're similar but
different psychiatry is best for those
interested in how the mind works
and how to treat the emotional disorders
requiring comfort with ambiguity
complexity and holistic formulation it
can be
more messy if you prefer more concrete
answers
localizing brain lesions with cut and
dry black and white pathophysiology
neurology may be a better fit huge
thanks to dr
pd cass psychiatrist and insider at med
school insiders for helping me with the
creation of this video
for anyone who wants to take their
medical school or residency application
to the next level
med school insiders has your back
thousands of students have used our
services and courses
and we have over a 95 success rate for
our comprehensive packages
but don't just take our word for it our
customers have left
hundreds of glowing reviews and we have
an industry-leading
99 satisfaction rating visit
medschoolinsiders.com to learn more
thank you all so much for watching if
you enjoyed this episode
check out our other specialties in the
so you want to be playlist
much love and i'll see you guys in that
next one