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Is there anything a psychiatrist would tell someone interested in being a psychiatrist?

Is there anything that you wish someone had told you before you decided to become a psychiatrist? Is there anything that might potentially deter anyone from becoming a psychiatrist?

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Candace’s Answer

This role comes with with an above-average level of stress. Consider the burn out rate; is this a role that can take a toll on you?
Working with patients with mental illnesses and maintaining a strong emotional front can be more challenging for some than others.
Will this also mentally affect you?
Remember you want to show up as your best self to help your patients
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Gregory’s Answer

Courtney,

You ask two very difficult but important questions. I am a psychiatrist, and have been in some form of clinical practice for almost 40 years. Wow...!I would answer the first question by clarifying that the answer is based on the way things were when I first decided to become a psychiatrist in the 1980's. I was practicing as a general medical officer in the US Navy at the time, and what drew me to consider psychiatry was a yearning to relate to my patients at a deeper level than physical medicine allowed, in other words, to enter the world of their fears, impulses, emotions, past and current experiences, failures, and abuses which I suspected then (and what we know now to be true) affected many physical conditions. I wanted to be able to conduct psychotherapy and work intensively with my patients at understanding the resolving those issues that created such limitations to them and would make some of them want to end their lives. So, what I wish someone had told me then was this: "Psychiatry is no longer what you think it is. It is now very medical, which means you are expected to prescribe medication and not do much, if any, therapy, since there are therapists out there who see themselves as therapy experts and expect you to confine your role to medications only if you wish to see any patients who see them". While I have truly enjoyed many aspects of my career and the opportunities to affect (hopefully positively) the lives of so many over the past 40 years, what I did not enjoy or appreciate was the expectation that I prescribe drugs for anything and everything and to be disrespected and devalued by colleagues and therapists for doing psychotherapy, a craft I spent many years in my residency training learning and mastering. I did continue to do psychotherapy, incidentally, during my career, but it was a significant cost to me because it was threatening to others who needed to see me as a "prescriber" (as we are now referred to, instead of "psychiatrist").

So, this brings me to your second question. If you are drawn to psychiatry because you want to conduct psychotherapy and work intensively with your patients, it is still possible but there are a lot of forces that would deter you. For one, most physician colleagues want (and need) you to be their "go to" person for patients with complex psychiatric problems requiring multiple combinations of medications and physical treatments. They do not want or need you to be a therapist - most have rolodex's filled with non-medical therapists eager to take their referrals. Similarly, therapists out there will refuse to send you any referrals because they need (and want) you to prescribe medication - certainly if you challenge their request or raise psychotherapy issues with them, they will never refer to you again. Finally, the American insurance-based health care system provides a lot of financial incentives to see patients every 10-15 minutes for "med checks" while there are disincentives to seeing patients for 45-60 minute therapy appointments. An additional deterrant relates to how you will be treated by colleagues and friends and acquaintances if you are a psychiatrist. Some will avoid you or laugh nervously at parties when they find out your profession, others will joke that they have a relative you need to "analyze", doctors will disparage you as someone who isn't a "real" blood and guts doctor, and family members will forever be uncomfortable with you (except for your spouse and children, that is).

Don't get me wrong. I feel very good about my career as it winds down and have come to terms with many of the issues above and put them in perspective or, in my own way, worked around them. You can and will likely do this yourself too, with time. And things have changed over the past 40 years. But when I was younger, the issues did affect me and had I known them then, might have sufficiently deterred me to not go into psychiatry. In the world you are growing up, however, medicine is an evolving science and the roles of all physicians, including psychiatrists, are changing away from direct primary patient care to that of consultants who work with teams of professionals who do the direct care, while they work with the exceptional cases. Certainly, you should know that (and that is good, or bad, depending on if you envisioned yourself as a therapist in an office doing psychotherapy with paying clients every day or not) going into the field now.

Good luck Courtney! I am sure you will become a great physician (and if you choose, psychiatrist). I can tell by your questions that you are a deep thinker and that is what medicine needs. While your questions steered towards the negative, I hope you also can tell that I have enjoyed much of my career in spite of the negatives!
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