Liz (evil_winky) wrote in med_school,
Liz
evil_winky
med_school

Psychiatry

I'm still considering medical school after recently graduating and getting my teaching license. I am strongly considering specializing in psychiatry. Does anyone have any experience in this field who could point me in the right directions as far as programs go? I'm really trying to decide if I can do the same this with a PhD in pysch but going to med school is becoming the idea I just keep going back to. Pros and cons of both would be appreciated.
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It seems to me that nurse practitioners have similar duties to P.As. I think the arrogant side of me just wants to call myself a doctor, but I hadn't considered being a nurse practitioner. I'd have to decide if that is really what I want-it seems to me that it could be easy to end up in a family practice being either a p.a or a nurse practitioner and I'm not sure that I really want to do that. You've given me something to think about, though that wouldn't cost nearly as much as med school.

My only reservation about psychiatry is that I believe medication is over prescribed. I do enjoy talk therapy, but I also want the training to be able to assess whether or not someone actually needs a psychoactive drug or not. I've seen some of my good friends be prescribed antidepressants without really exploring better coping mechanisms for their problems and, trust me, it only ended up in worse situations.

I suppose my biggest worry is that I will not get in. As a teacher, I know that means something, but I'm not published scientifically, and probably won't be through my post-bac training. I feel as though those things matter for admission. Everything I have done up until know has been completely in the liberal arts. Cross cultural studies, French (my degree) and music (I play violin). I'm also an artist (acrylics and photography.) These things would help me be well rounded but even with my grades (3.88 gpa) which will probably drop slightly upon taking science classes, I just don't know that I will really stand out. One of my friends was so qualified to go to medical school. She applied to University of Iowa with wonderful credentials and a great MCAT score. Her GPA was a little low, like 3.4 or something, but considering how busy she was it wasn't bad. She didn't get in. So, it sort of makes me doubt that this would actually happen.
I might be a little biased because I went the M.D. route, but if these are your concerns I would seriously consider medical school. There are also a lot of programs with different focuses. For instance, my residency has a strong focus on theraputic approaches and neuroscience/anatomy. A friend's program has more of a research emphysis. There are also a lot of subspecialties in psychiatry--forensics, child, consult liaison (this is almost like a medicine consult and why I actually chose psych), geriatrics, addiction medicine, and even more areas that fellowships are not offered in--disaster relief, inpatient, emergency psychiatry, neuropsychiatry (might have a fellow?) and other areas I am sure I am forgetting. There's also training availible for someone who wants to do psychoanalysis. Takes a lot longer, but I have an instructor who only does this and teaches.

I agree with you that medication is overprescribed and therefore I don't overprescribe it. I have very few patients taking more then one medication and require that all my patients on meds engage in therapy of some sorts (unless there's a good reason not to). I also have some pure therapy cases. I came into the field sceptical of psychotropic medications and have since seen them work and have more faith. Having the knowledge required to adequately prescribe these medications I think is a huge advantage with the MD approach because their side effects and interactions with other medications (and the medical side of mental health--ie, reading MRIs, ordering labs on pts, considering medical conditions that lead to mental health symptoms, etc) adds an extra tool to your repitoir. Understanding the biochemistry behind this--and not just even neurobiology--is something you will probably only get in medical school. If you go the MD route and want to only do therapy, you can. Its not often done because its not as cost effective, but you can still do it.

As far as acceptance is concerned, yes, it is competative, but it is also doable. You do not need to be published at all, although it does look good. Sometimes getting published is more about being in the right place at the right time as an undergrad. Some research experience can help your application, but its not always a requirement and probably something you could do as a post-bac if you have time. What looks more impressive are the grades and clinic experience. I gave interviews when in medical school and one thing we looked for were students who were motivated, really wanted this, and knew what they were getting into. They had shadowed a doctor, worked as an EMT, even had a job in a hospital or volunteered, although direct access to at least observing patient care will be the most helpful. All that you described above WILL make you stand out, so don't worry about that. A lot of it depends on the interview too.


Sorry, but kinda rambling a little, but I hope that answered some of your question...yes, a lot of this is my opinion, but I would vote MD.
No, I appreciate the rambling more than you believe.

I was talking to my mother earlier who works in medicine and she had suggested that I not become a nurse practitioner or p.a for the very reasons you discussed. I might as well go to medical school if I have essentially the same duties.

I had been thinking about becoming an EMT to get the real patient care aspect. I've been told me several people that getting certified in something is the best way to be with patients.

Right now, I am not in a position to go back to school. I will be teaching for the next two years. However, I would like to start taking post-bac classes next spring or summer if I really decide this is what I want. My way of trying to get more in touch in the meantime is to read extensively. I actually purchased an abnormal psych book and bio book to just read in the meantime. I've taken several psych courses for education, so the abnormal psych book is a great next step. I also want to see how capable I am of sifting through science on my own. I get the impression that medical school requires an absurd amount of studying, particularly on one's own. I'd like to find study habits for science that are effective. I've taken few exams in college that were not subjective, essay exams.

I'm noticing that as I read this bio book, things DO make sense to me, even if they are hard to imagine. But I have also noticed that things stick better if I know how it relates to medicine and how it is actually important. I mean, I understand that it is important to know what glucose molecule looks like or how many types of carbohydrates there are, but it really only clicks with me when the connection to the body and functionality is made. I know I have to take o-chem to get in, but I'm wondering how often a doc actually usual o-chem. It's the basis for understanding how certain systems work, but beyond that, I'm wondering how often it is really stressed. It's just overwhelming how much information a doctor needs to know. I'm worried there isn't enough room in my head. :-)
also, forgive the typos in this. I replied to this while taking a break from a painting I'm working on, so my mind is in a totally different place at the moment.
As was said before, the medicine aspect of it is essentially medication management. There are different psychiatric settings though and there's enough of a need for psychiatrists for you to do what. You would do something similar as a P.A./NPP but you would be paid less though it will take considerable less stress and testing to get there. You have to essentially learn all of medicine, you will be doing surgery and other rotations and you have to really consider if you want to go through that to ultimately get to psychiatry.

There's inpatient, outpatient, hospital consults and ED psych at some places. Hospital and ED psych are more like deciding if this person needs a sitter, what medications, whether they need to be admitted to the inpatient ward or need outpatient follow-up. Inpatient has various settings, I didn't work at a heavy duty institution with straight jackets and stuff, they were mostly suicide risk/depression cases or psychotic disorders that stay until their hallucinations resolved, you change medications and decide when to discharge people or justify keeping them. You do a lot of court for invols.

Outpatient is essentially doing a history with a mental state exam for new patients, exploring anything that comes up in the interview. And then medication management, and follow ups are pretty much strictly prescribing or changing doses or medications.

If you like giving behavioral therapy and not just prescribing it, psychiatry isn't really the place for actually getting your "hands dirty" so to speak. Think of yourself as a manager for psychiatric problems that present at a hospital with the aim of keeping people out while making sure they are not a threat to themselves or others with a basic capacity of being able to take care of things.

After exploring the field I kind of felt like psychiatry should be separated from medical school as a whole. I feel like the knowledge I gained will be useful for other specialties and professions, but I feel like someone who simply wants to go into psychiatry would have a hard time with all the other courses.
Psychiatry probably should be separate from medical school. Its focus on the mind-body relationship is probably what puts it in that category, plus the whole pharmacology aspect. But psychiatry often deals with problems through which the cause is not so concrete as running a test or looking under a microscope. I'm sure psychiatrists that favor the biological paradigm would argue with me on that, but I'll wager to bet regardless.

My thing is that if I want to do psychiatry, then I could just go and get a PhD in psychology and do essentially the same sorts of things minus prescribing medication. I've thought of doing geriatrics (I seem to have this gift interacting with the elderly) but I'm not even sure really how to get there either. Is it a branch of psychiatry? Its own field entirely?

Once upon a time I wanted to be a surgeon but I definitely do NOT want to spend THAT much time in school. My mother works for an infectious disease/pulmonary practice. Some of those doctors also have a specialty in sleep medicine and seem to enjoy that a lot. Is it kosher to go to medical with a narrow list of specialties and discovering what you want to later, say in your third or fourth year? I have interests, just not the experience in either to really make a concrete decision. I'm not sure if medical schools want a concrete decision upon entry or not.

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