Psychiatry Vs Family Medicine

[dynomedasaur]

I've long been a family medicine 'gunner', but recently, I've noticed that I gravitate a lot more to psycho-social aspects of patient care and really seem to enjoy it. I also quite enjoyed my psychiatry rotation overall. 

I'm just wondering if I can get swayed either way right now.... please help me add to this list of Pros and Cons for either specialty. 

Family Medicine:
PROs:

- 2 years

- Retain broad medicine knowledge
 

CONs:

- lower billings per patient

- overall lower billings for same amount of hours worked on average (?true?)

- *no opportunities to contribute to presentations locally or overseas?

 

Psychiatry:
PROs:

- Higher billing

- Specialist status

- *More opportunities to work for drug companies (dinner presentations that pay 1500-2000/evening etc.)

- *Opportunities for international presentations with trips paid etc. 

- *Ability to do a lot of medico-legal work for court cases that pay $$$

- Ability to do research

 

CONs:

- 5 year residency (although I hear it is one of the easiest residencies to live life during... on at 8 off at 4, call 1/7 etc.)

 

I AM NOT SURE ABOUT ITALICIZED ITEMS
- are those things I listed true? They are only things I've over heard

- can GP's do presentations for new drugs/diseases and get reimbursed similarly to specialists?

- can GP's do presentations overseas (drug talks or anything else)?

Thanks in advance!

 

[Mithcah]

I don't know if this counts but one reason I am attracted more to psych is b/c there is more time to spend per patient. Forget altruism, I just can't fit everything I need into 15 minutes. I really did not like the feeling of being rushed in the family medicine clinic, felt like I was a runner trying to cut down my lap time. I realize it gets easier and more comfortable as experience builds, but I figured I was just a better fit for psych in that regard. Residency is going to be more than hard enough without having to completely overhaul my work style.

[ralk]

Overall pay in FM and Psych depends on practice location and set-up. Generally they're fairly comparable in terms of salary on average, though I'd argue FM has a higher ceiling. Billings per patient isn't an overly meaningful point, since FM will usually see far more patients per unit of time than a Psychiatrist will.

 

Research can be done in FM, though you're right, it's far more common in Psych.

 

GPs can get involved in the pharmaceutical industry. There are far more drugs coming out with relevance to FM docs than there are for Psychiatrists, simply due to the broader scope. FM tends to be more local though, so if international trips are your thing, Psych would probably have more opportunities. However, speaking on behalf of drugs companies is an ethical grey zone even in the best of circumstances - say, an expert in the field getting paid to speak for a drug they studied as being efficacious and which they were already promoting before receiving payment. For a medical student, a non-expert without a natural fit into that role yet, to weigh that potential set-up in their residency decision-making sends up a ton of red flags. You're essentially going into it hoping to get paid for a conflict of interest. To me, that's no longer a grey zone, that's just straight-up unethical. Keep in mind these set-ups are under scrutiny already and may become far less lucrative by the time you enter practice. They're unpopular with the public, so both legislatures and regulatory colleges are under pressure to crack down on them to some extent.

 

Anyway, back to the original question. I was in a similar situation as you, going for FM but enjoying my Psych rotations and considering it quite heavily for a time. There is a ton of psychosocial work in FM, so it's not like you'd be missing it much in FM, but the nature of the work is of course different. Generally the patients will have more common, less severe mental health issues. Lower-intensity anxiety and depression are bread-and-butter stuff in FM. Psychiatry will get a heavier mix of severe anxiety and depression, psychotic disorders, bipolar, personality disorder, etc. These things can show up in FM, but far less frequently and a referral to a Psychiatrist will usually become necessary for these cases. I ultimately chose FM because I liked treating anxiety and depression more than I liked getting into things like psychotic disorders or bipolar. Felt I could do more for what are typically egodystonic conditions, rather than the egosyntoic ones. As with any specialty, look at the common presentations and see what you like best - it's what you'll be spending most of you time with, so you'd better enjoy it!

[LittleDaisy]

FM and Psychiatry make around the comparable salary. So pay should not be a factor.

I guess that when you will be doing your psychiatry and FM core rotations, it would give you a better sense of which speciality you like the most.

In FM, you will be seeing the bread and butter anxiety and depression, and your patients tend to get better eventually. In Psychiatry, you will get referrals from GPS for refractory depression, bipolar disorder, psychotic disorders ,and personality disorders...I.E, the patients are sicker and they often relapse.

Ralk's post is perfect!!! I can't add more

[psychiatry2017]

Out of curiosity, the psych and GP bill around the same in Ontario (i.e: after the overhead)?

Thanks for your input guys. 

[rmorelan]

Out of curiosity, the psych and GP bill around the same in Ontario (i.e: after the overhead)?

Thanks for your input guys. 

 

ahhh, this was probably answered elsewhere but yeah it is very similar. 

[gsmith]

Someone should do a research study using this forum as source data, looking into how much the discussions by med students revolve around income and money.

[ellorie]

In order to demonstrate what? That we are humans who need a roof over our heads?

[gsmith]

In order to demonstrate what? That we are humans who need a roof over our heads?

 

 

1. It could demonstrate how difficult it is to obtain information around income.  Mentors and staff should be more open to their students about it and there shouldn't be this discomfort.  In Ontario doctors seem to be fiercely opposing publishing their billing numbers, since it can be taken out of context of overhead expenses.  

 

As a result of this trend to keep it under wraps, it makes me sad that med students and premeds have to resort to forums where anyone can post anything.  Furthermore, I have noticed that some people who are not even in medical school (yet or ever) are posting with so much authority, that at a first glance it can be quite convincing.  

 

2. It also demonstrates if/how income sways people into one specialty over another. 

 

3. To reply to your comment about roof over our heads, I would venture that every specialty in Canada will allow them to have a roof over their heads.  

[forensicmed]

Although I am not a practicing Psychiatrist and am in medical school I think that certain subspecialties of Psych have a higher ceiling than FM. I've been doing a lot of work in Forensic Psych and these guys are doing VERY well.

[flyingmonkeys]

Just want to note the idea of "- 5 year residency (although I hear it is one of the easiest residencies to live life during... on at 8 off at 4, call 1/7 etc.)"

 

Not necessarily true. I have friends who are psychiatry residents and depending on the rotation, some easily have 8-6:30/7 days consistently, especially on in-hospital rotations. Some sites have more call than others too.

[RadCdn]

Psych any day over FM for me. I don't like the factory-style medicine I've seen in FM. 15 min visits are far too short for me. I had to do a lot of this in IM primary care in the US. It never quite fit my personality. I then did a Geriatrics fellowship where each visit is 30 mins and even 1 hour for new patients. What a difference! I love it so much! So much more comprehensive. I feel like I'm doing such a thorough job for my patients. I love it! 

[asthecrowflies]

How do you feel about inpatient psychiatry? Like it, love it, hate it? 
While you may choose to work as a psychiatrist mostly on an outpatient basis, you will have to spend a decent portion of your residency learning to care for hospitalized psychiatric patients and for those experiencing psychiatric emergencies. 

I see that as another difference between family medicine + focus on psychotherapy and psychiatry, at least in terms of your years in training. 

 

How passionate are you about the neuroscience behind mental illness and the psychopharmacology? I think family doctors who are attentive to their patients psychosocial factors can do wonderful things in general practice, and in areas like addictions medicine for example, without necessarily having to be really into the nitty gritty of some of the psychopharmacology and neuroscience. (though I'm sure some psychiatrists might argue that they necessarily don't need to be into the nitty gritty of those aspects either). 

[Edict]

Someone should do a research study using this forum as source data, looking into how much the discussions by med students revolve around income and money.

 

Forum data isn't going to be very representative of medical students as a whole...