I saw a thought-provoking post by Dr. Sana L. Johnson-Quijada, MD about a young man who is considering psychiatry as a career, A Young Man’s Wrenching Journey | A Friend to Yourself. Her questions for readers to consider on how to advise the young man were about how to learn more about psychiatry “before pursuing years of study” as well as how others had investigated psychiatry before deciding on it as a career. She also asked about how others talk about their own family of origin history and find the courage to share it.
I didn’t know how to do that in a comment section, but the questions made me reflect. When I think of all the “hate psychiatry” people out there, I sometimes wonder why I chose psychiatry in medical school. What helped me decide on psychiatry was my fascination with those who had both medical and psychiatric health challenges and the impression that those issues were often connected. That’s how I got into consultation-liaison psychiatry. It was a way to combine internal medicine and psychiatry without having to go through a 5 year combined specialty residency, although we have an excellent program here, Department of Psychiatry :: University of Iowa Carver College of Medicine.
Considering my family of origin issues was important although I’m not sure I considered them as deeply as I do today, and nowadays I share them on my very public blog, Ain’t That Nuthin’? – The Practical Psychosomaticist.
I think it’s a good idea for an undergraduate to shadow a doctor, too. I’ve done that several times and it’s a very satisfying experience for both me and the student.
The other way to get a sense of whether one wants to be a psychiatrist is to scan some of the so-called “throwaway” professional newspapers for articles in which authors talk about more than just neuroreceptors and a couple are below:
The article about how psychiatry needs new paradigms is important for those considering psychiatry because it’s evolving as the underlying scientific basis evolves. The author, Aaron Levin, points out that 95% of papers published in psychiatry are about what he calls the “technological paradigm.” However, we definitely need to move beyond that paradigm because psychiatry is not just about technology. It’s about relationships and meaning.
And Dr. Fink’s essay about legacies is critically important. I can feel him searching for the meaning of what he’s done in his career. It would be valuable to think about the importance of leaving a legacy before one embarks on a career in psychiatry as well.
Psychiatry, like the rest of the medical specialties, is beset by over-regulation in the form of Maintenance of Certification (MOC) and it’s kissing cousin, Maintenance of Licensure (MOL). Thousands of physicians support the principle of lifelong learning and oppose the wasteful, time-consuming MOC which has no acceptable data showing it changes patient outcomes, as well as the duplicative MOL, an extraordinary process that the Federation of State Medical Boards (FSMB) has no legal authority to impose on state medical boards. If you choose psychiatry, or any other specialty in medicine including primary care–your creativity will be chained by this regulatory capture. You will be compelled to accept it or be driven to reform it or to drive it out of existence as the American Association of Physicians and Surgeons (AAPS) has done recently by filing a lawsuit in Federal court against the American Board of Medical Specialties (ABMS), AAPS
Takes MOC to Court.
Furthermore, the Affordable Care Act (ACA) will bring thousands more patients into the health care system, for which there will be an inadequate number of primary care physicians. They prescribe 80% of the antidepressants, but because of the threshold effect, when they feel overwhelmed they’ll likely shift patients to psychiatrists. There will never be enough psychiatrists to meet the need. Talk about being overwhelmed. I hope that U.S. payers, primary care physicians and psychiatrists will truly embrace the spirit and the nuts and bolts of integrated care systems to address this impending challenge because it will influence the decision of those who consider psychiatry as a career choice, IMPACT – Evidence Based Depression Care.
Psychiatry can be a hazardous profession. Nearly every day in the general hospital, I’m involved in situations in which patients could become or already are dangerous to themselves or others. They are called “Code Green” events and they are all about protecting everyone, especially the patient, from violence. The issue of violence in patients with mental illness is often front-page news. You have to consider that if you’re interested in a career in psychiatry. Sometimes, on the bad days, I wrestle with my doubts and dread.
Psychiatry can be very rewarding in terms of the quality and meaning of the relationships we have with patients. Often the rewards are unrelated to any specific pharmacologic or psychotherapeutic intervention. The best examples of that are found in the winning 2013 Gold Foundation Humanism in Medicine Essay Contest this year, Gold Foundation: Essay Contest. They were forwarded to me by The Arnold P. Gold Foundation and they are poignant reminders of why anyone goes into medicine, let alone psychiatry.
I’ve been a teacher in an academic medical center for 17 years. Every year about this time, I have to say goodbye to those doctors I’ve had the privilege of guiding–and who’ve taught me more than a thing or two. This feeling of pride, loss, and hope I treasure more than I can say. Welcoming the incoming class is a joy.
So what would I finally say to this promising young man? I have a few regrets about my career choice. You can’t get through life without collecting them. Learning how to let them go is an art, and it necessarily involves letting others help me. And when I reflect on what my legacy will ultimately be–I sometimes stare into a void. This is painful, but rare.
But I can’t imagine doing anything else as exciting, challenging, or as fulfilling as what I do now. Consultation psychiatry lets me roam all over the hospital, connecting with the rest of medicine and surgery. Nothing about psychiatry is free and easy, but it’s the life I love.