A lifetime of Psychiatry

Someone asked me the other day if I would consider a career in Psychiatry. I have always liked all things regarding mental health and since entering medical school I have considered psychiatry as a viable option. However, one of my biggest concerns about psychiatry is that a lot of the medical aspects of medical training I like so much are eroded away as you focus more specifically on the psychiatric illnesses. For example, if I mention to my attending psychiatrist that I think our schizophrenic patient may have a UTI the response will be; "Why are you telling me about a UTI that is medicine's problem not our problem we only deal with the mental illnesses." I guess any field you specialize in you will give up knowledge and skills in other areas of medicine but it seems like in psychiatry you are often caught defending the specialty as "real" doctors. 

Mental illness in the USA carries a big stigma and this stigma flows into the doctors as well. Many of the psychiatrists have told me that when they told their friends or family that they decided to go into psychiatry they sensed disappointment. On psychiatrist told me her mother cried when she told her and asked why she was not going to become a real doctor. This does not bother me so much but the field in general has an uphill battle in fighting these uneducated view points. It can be exceedingly difficult to treat illnesses that many patients and their families do not believe exist. 

There are also some turf wars in many areas of the country where psychologists are moving in on some of psychiatry's work. The psychologists are fighting for prescribing rights which if allowed could potentially decrease the value and the pay of psychiatrists in general. Turf wars are not unique to psychiatry. You have optometrists taking on ophthalmology, nurse anesthetists tacking on anesthesiology, chiropractors trying to do primary care work, and many fields within medicine fighting over certain procedures or patients. However psychology seems prone to these kinds of battles. 

There is not a perfect specialty in medicine, all of them have there strengths and weaknesses but I do not think I will end up going into psychiatry. I certainly have liked this rotation and have learned a ton. It is fascinating how fragile the brain can be and the illnesses present in such curious ways. There is nothing like treating a patient in the middle of a psychotic break.