Psych or FM

[crossled]

Which one would you choose and why if money was not the issue? 

[shikimate]

FMD - more wide variety of skills and more options. You can do as much or as little as you desire, and basically have the option of working anywhere.

I find people who do psych can't do much else after a while, like they're afraid to even interpret CBC lol. When I was on psych we had to consult IM for low potassium...

It's great if you love psych, but after a while you might wanna do something else, but now you can't really do much else.

[hero147]

2 minutes ago, shikimate said:

FMD - more wide variety of skills and more options. You can do as much or as little as you desire, and basically have the option of working anywhere.

I find people who do psych can't do much else after a while, like they're afraid to even interpret CBC lol. When I was on psych we had to consult IM for low potassium...

It's great if you love psych, but after a while you might wanna do something else, but now you can't really do much else.

That's like every non-generalist though. Granted, psychiatry is probably on the worse side of that spectrum. 

[Persephone]

I don't really enjoy other parts of medicine in a deep or meaningful way, so it's all psych for me. That's not to say there aren't psychiatrists that didn't leave behind interests in other parts of medicine to pursue psych. That being said there is tons of low-ish acuity psych in FM and a lot of visits will have a psych flavour to them despite being about something else, so it just depends on why you like psych/why you like FM (that being said you can encounter high acuity psych issues anywhere, you just won't be managing them as directly in FM).

[unarmed walrus]

I'm a new CC4 with the same dilemma as the OP. I find the most meaning in the mental health side of medicine and I'm considering psychiatry, but I'm also uneasy about closing the door on everything else. I'm wondering if all the psychosocial elements of family medicine practice will be enough for me to be satisfied from a psychiatry point of view and be happy in family med.

[LostLamb]

Wow, tough crowd. Wonder if you’d say the same thing about or to surgeons 

please don’t paint all of psych with the stereotype that we don’t know any medicine and can’t interpret a CBC.

we are physicians, we can treat things, but sometimes it makes more sense for stuff to go back to primary care—I am not going to treat your infections or sort out your microcytic anemia; but if my meds or treatments are contributing I will do my best to manage and treat from my side to minimize or solve problems. 
 

I can only speak for myself but even early in practice i do make a point of not working outside my scope of practice—there’s lots of things that have evolved since I graduated in 2014…even since early residency. 
 

that said, think about what you like in life. Bread and butter FM was not for me, nor was the pace. Psychiatric presentation acuity varies depending on where you live and access to specialists. 
 

I love that I can get to know my patients because my work permits it AND requires it to get the job done. Plus for me is that there will be a burst of knowledge and likely many newer treatments that will arise over the course of my training because we are a “young” field scientifically speaking. 

[JohnGrisham]

2 hours ago, unarmed walrus said:

I'm a new CC4 with the same dilemma as the OP. I find the most meaning in the mental health side of medicine and I'm considering psychiatry, but I'm also uneasy about closing the door on everything else. I'm wondering if all the psychosocial elements of family medicine practice will be enough for me to be satisfied from a psychiatry point of view and be happy in family med.

You aren't paid well enough to spend quality time for mental health concerns in FM.  If thats where you find most meaning, go with psych.

[crossled]

Thanks for all the responses. 

 

So what are the downsides to FM? In the states there are a lot. Dealing with insurance companies, lots of paperwork/charting, etc. In canada I know FM is a lot better, what are the downsides though? 

Same thing for psych (specifically child/adolescent) what are the downsides in Canada? 

 

 

[bearded frog]

12 minutes ago, crossled said:

So what are the downsides to FM? In the states there are a lot. Dealing with insurance companies, lots of paperwork/charting, etc. In canada I know FM is a lot better, what are the downsides though? 

Same thing for psych (specifically child/adolescent) what are the downsides in Canada?

The downsides of any specialty are going to be personal. In general, billing in Canada is simpler because most things are publicly funded and you just bill the government directly. There's still charting obviously, but less regimented vs required charting for insurance purposes in the states. Otherwise if you want to spend a lot of time with patients then that's less well compensated in FM vs a specialty. FM you will see patients of all ages, which is a downside of you don't like children or geriatrics, for example. You're not as well compensated for diagnostic medicine, compared to a consulting specialty.

Downside of psych is that its all psych, if you don't like psych (but a boon if you hate everything else I guess). Specifically child psych, from the outside perspective it seems that its somewhat more supported than regular psych, but you have to deal with parent/family dynamics relatively more then adult psych.

[Persephone]

1 hour ago, bearded frog said:

Specifically child psych, from the outside perspective it seems that its somewhat more supported than regular psych, but you have to deal with parent/family dynamics relatively more then adult psych.

If you're interested in child/psych already though, parent/family dynamics can be part of what make child psych so interesting. You get to see a wider context for the child's presentation because you can meet with parents as well. There are also family therapy supports and parental skill building supports that can be referred out to from a child psychiatrist. That's part of child psych being more supported than adult psych as you mentioned.

In terms of downsides, I think having your patient age out of your care could be difficult, especially if they require supports that suddenly become unavailable to them after the age of 18. Transitioning to care from child to adult can result in some patients being lost to follow up unfortunately. Psych in general is hard because you can only do so much to help people when their mental illness is being exacerbated by sociopolitical and economic factors beyond your control.

I love psych because I find human behaviour and the mind fascinating and so I never tire of the subject matter. I also find a lot of meaning out of getting to know people's stories and offering support in times of crisis. The combo works out perfectly for me.

[Edict]

On 7/1/2021 at 9:08 PM, shikimate said:

FMD - more wide variety of skills and more options. You can do as much or as little as you desire, and basically have the option of working anywhere.

I find people who do psych can't do much else after a while, like they're afraid to even interpret CBC lol. When I was on psych we had to consult IM for low potassium...

It's great if you love psych, but after a while you might wanna do something else, but now you can't really do much else.

It's done more for medicolegal reasons at times. 

[JohnGrisham]

14 hours ago, Edict said:

It's done more for medicolegal reasons at times. 

Exactly. And availability of providers - if your centre has IM available to your ward for simple consults like this, you utilize them - because it also keeps them happy and fed.

In some hospitals - the hospitalist docs or palliative docs would do their on paracentesis and thoracentesis for pain/symptom relief.  In others where you readily have respirology available, then of course you are going to consult them - even if you feel comfortable doing it yourself. It helps optimize work flows and justify on-site specialists.