Thread: Pros and Cons of Family Med and Psychiatry

After completing these rotations (or not), can you please share your opinion on what the Pros and Cons are of doing Family Medicine or Psychiatry as a residency? (Aside from it being less competitive and more IMG friendly).

PROS: Family Medicine broadly covers IM, Peds, EM, Sports Medicine, Psychiatry and OBGYN.

CONS: Family Medicine broadly covers IM, Peds, EM, Sports Medicine, Psychiatry and OBGYN.

When considering a residency, I rarely hear someone discuss its pros and cons. It's all about whether you really want it or not. You can weigh the relevant factors all you want (salary, lifestyle, ease of matching, etc). After rotations, you'll have a pretty good feeling as to want you want to do and as long as you're realistic, shoot for it.

Family Medicine covers a broader range of medicine, and you will have to handle more serious physical health problems - such as intervening in acute M.I., deciding when to (or not) order a stress test, suture wounds & otherwise deal with lacerations & other traumatic injuries, and (at least during residency) handle obstetric cases. One Family Doc. told me years ago delivering babies is fun till the first time you get sued.

My overall impression from those I've observed of the 2 professions is that, in terms of hours and intensity, Psychiatry tends to be less demanding (some people would bitterly argue with that; that's my personal impression and I'm sticking to it), the range of medications and the main disorders you treat is broad but not as huge as an F.P. deals with, and you're less likely to have to jump in & manage acute physical crises (such as injecting epinephrine into the heart of somebody in cardiac arrest, or running a code with advanced cardiac life support measures, etc...). Some Psychiatrists have jobs where they don't do physicals for years on end (though that's not true of all of them).

In the U.S., there's a powerful Psychologist lobby trying to secure prescribing rights, and Psychologists outnumber Psychiatrists heavily (way back when I think the figure was said to be 3:1), and unlike Nursing Practioners under F.P.s, they're more apt to see themselves as 'on the same level' (or such was the case with one or two ambitious examples I knew personally).

I'm a Psychiatrist (U.S. trained; got a buddy going to a Caribbean school now so I frequent this forum to follow current developments). I have my hard days in a state hospital, but there are some family practice doc.s who have awful workloads.

Interestingly, it's been said some people interested in Psychiatry may also like Pathology (ironic because you're going from the mind to (often) the mindless). I don't know about for Caribbean students, but historically Pathology was not too competitive, money was pretty good, I once quipped to a buddy 2 things I'd never seen a Pathologist break into were a run & a sweat. Don't know whether it'd be right for you, but just thought I'd mention it.

Richard.

That last part is interesting, just based on the general impressions of those two specialties. Pathology is usually pinned as the specialty where if you don't like dealing with people, you'll fit it. But with Psychiatry, I feel the opposite is key, where it's critical to be able to talk to a patient in order to find out what's going on with them. I know not all psychiatrists use psychotherapy as often, but you do have to have the ability to listen to people, and be able to not be mentally drained hearing patient's stories(apparently this does happen...curious to know your input).

Family Med does get pinned as being the "jack of all trades" specialty, but it's all about best fit, what you like/dislike, and where you see yourself happy and interested in going to work. Don't be scared to pick a specialty because it's not "competitive" or people have stigmas about it. Cause remember, it's your life and career that you are doing, not theirs. Do what makes you feel content

Not every Psychiatrist is a great listener (supposed to be) or even much of a 'people person' (I imagine it helps, but I think it's probably just about as important in Family Medicine). I work in a state mental hospital where the large majority of patients are admitted under court order, and we prefer to keep the patient population down, do I don't wear a suit, great people with a warm handshake and emphasize eye contact, etc..., whereas a private practice Psychiatrist working outpatient who relies on repeat business might do all those things. My point is that there are a range of careers in Psychiatry. As for traditional psychotherapy (e.g.: 50 minute to an hour sessions once per week or two for several weeks or longer), I believe that is NOT the care model the majority of Psychiatrists are doing in the U.S. now. Here, if you're working outpt you're probably doing 15 to 20 minute 'med. checks,' get 45 to 60 minutes for a new patient diagnostic eval./history, and in some settings they may double (or even triple) book your schedule so that if some patients are no-shows, they're still cramming in billable productivity. Varies with work setting, though.

Family Practice is right for some people. Of course, it's not just your lifestyle being determined. Your spouse's & your children's (if any) lifestyle will also be impacted. And you can make better money for less work doing something else, and maybe suffer less burnout. If I were going to do general medicine, I'd aim for Internal Medicine (so I didn't have to worry about Pediatrics, Obstetrics or Surgery - and my field would still be broad & diverse, with fellowship options like G.I., Nephrology, etc...). The traditional Family Physician who works his butt off in the outpatient clinic, and also makes hospital rounds on his patients early morning and in the evening (once or twice per day, basically), can work a brutal schedule. Some doc.s break the mold - let the Hospitalists take care of your hospitalized patients (or be a hospitalist and enjoy off-time that's really off!).

Richard.

Thanks for the great feedback guys...I do enjoy the mind aspect of psychiatry but when I did the rotation I didn't enjoy it as much as I hoped. It seemed as though the docs were just following routine, continuing their patient notes day in day out, and just focusing on the medication aspect. I think my perception of psychiatry before the rotation was that of PSYCHOLOGY, where they study the mind and try to further the knowledge of disease processes. In psychiatry, it was more about maintenance and how many patients the hospital can get in and out. I worked Detox and Inpatient, i heard outpatient is alot better. But I have to say, I was disappointed in the lack of passion I hoped to gain from my rotation. Family Medicine was the same for me, the physicians I worked with were more bitter about non compliant patients and heavy work loads than they were passionate about their line of work. Both rotations had residents that loved their job, but I assume its because they're fresh into residency.

drrich2 - can you tell me what you love most about ur job?

I would love to do psychiatry if I could be the person that researches the mind and fills the unknown gaps, because there's still SO MUCH we don't know about psychology/psychiatry. Its interesting you mentioned that pathology is another alternative, I did consider it, but haven't done an elective on it so Im not sure if I can consider it yet.

I like that the money for now is good, I don't have to use my hands much (you do NOT want to trying to suture human flesh), the mind is indeed interesting (though I think Theology, Psychology and Sociology are more interesting subjects than which neurotransmitter systems in which brain sections might determine negative & positive symptom manifestation in schizophrenia), and I don't have to independently manage severe medical crises often.

In inpatient Psychiatry, you've got the burden of call & holiday coverage, but your day isn't as micromanaged as outpatient (where holidays are off and call is less burdensome if even an issue).

If Psychology gets widespread prescription rights, it'll be bad for down the road. Maybe more of an issue for those of you earlier in your careers.

As for family practice, as a matter of personal taste, I'd skip it. I like to narrow down the range of what I'm supposed to know & deal with. You like kids? Be a Pediatrician (though their pay is pour) & skip adults. Prefer working with adults? Do Internal Medicine & don't bother with kids, OB or surgery. Why mess with surgery if you're not going to be a surgeon, or OB if you're not going to be an Obstetrician? In some cities it can be harder for FP's to get OB privileges at hospitals (or so I was told when I was in medical school in the mid. 90's) - if you want to live in a big city, find out the current status on that.

Make no mistake, I believe there are a lot of Family Physicians who are good, and the profession does a great deal of medical good in the world. I also believe the U.S. military has a lot of good people and does a lot of good in the world. But I don't want to enlist & go through boot camp, and I didn't want to work harder work longer hours for less money probably with a greater likelihood of a screw up killing somebody (though that can happen in most any field).

Pathology has some range of careers; you could be over a hospital lab, or involved with the blood bank (cross typing blood for trauma victims, etc...), do microscope assessment of surgical excision specimens to determine if the whole tumor was extracted, do autopsies (Forensic Path. is a 1 year fellowship, I think). Pathology is a 5 year residency, which may be a bit of a turn off for some.

I hope you find the passion you're looking for, but changes over the years have left an awful lot of Physicians disenchanted with the medical field. I found Family Practice (in a University setting) one of (& maybe the) most idealistic specialties when I was in medical school.

Be wary of picking FP for somebody else's agenda, though. Many will heartily encourage you to go the way of solo practice FP in some underserved poor rural area. Sounds noble, until you realize you're on call a LOT, bear a lot of responsibility, may not have ready access to a good range of consultants, make less money, live in an area where there are relatively few highly educated people you enjoy socializing with, there's a lack of private schools to give your kids the best prospects for lifestyle success...all because some forces in society want you increasing care accessibility while costing less than specialists. And running your own business can be a nightmare.

Remember: a prospective employer does NOT offer you a job to benefit you or your family. It's not even necessary that the position be long term viable in the area. They offer you a job to serve THEIR agenda.They look out for their agenda. Be sure you look out for yours. If you don't have a family (at least a spouse) yet, you probably will.

Richard.

I'm thinking of FP and IM, but I feel I would rather go with FP. The thing that turns me off about IM is

1) Rounding. Dude....I hate rounds.
2) Ward medicine in general. I love clinic, hate wards

Personally, I might find myself depressed if I have to be a doc who works in a hospital. I'll suck it up and deal with it as a resident. As an attending, clinic only, or the bulk of the time would be nice. And for IM, I hear the "if you don't wanna specialize or be in the wards, why not FP?". Plus, I genuinely do like Family Medicine, I feel if you work hard and get the most out of residency, you can get a great doc. I like kids and adults, and don't mind outpt gyn. I fear with Internal Medicine, they might not do any outpatient training, which I would want to spend almost 100% of my time doing after I finish.

As far as location, I dont think all family medicine doctors only stick to rural. I know that is big as far as $$$ goes, but like you mentioned, in those places, you NEED to do a lot. It's too far to project, but right now, rural isn't too bad of an idea, to an extent. Although I like big cities, metropolitan areas, places where you can meet a lot of people, etc. who knows what's gonna happen in 3+ years. And then factor in being single vs. partnered into the mix. Eh.

Be mindful not all IM Doc.s are hospitalists, and that after residency, rounds are about getting work done, not a group standing around with sore feet listening to an attending lecture & pimp residents or students with questions.

An IM doc. can do all outpatient clinic much like an FP, minus kids, pregnancy management & surgical cases. It's IM's who often go on to do fellowships and go into specialties, but they don't have to.

Richard.