Monday, January 08, 2007

Lifestyles of the Shrink Rappers

[posted by dinah]
It suddenly got very quiet here at Shrink Rap. I think ClinkShrink's geek roar has drowned everyone out. I'm wondering if she even noticed that I'd claimed her post as my own. As I've said, "Dream on."

So this is dedicated to Jessica, a 3rd year medical student, who commented on one of my recent posts. Jessica writes:

Hi, I am a 3rd year medical student that will probably go into psychiatry. I
enjoy your blog a great deal.This post contained a lot of new info for me - when
I tell people my intended field, they say, "Well, at least the lifestyle is
good." I had no idea that you were expected to be available by phone within 30
minutes 24 hours/day. I had always heard that psychs told their patients to go
to the ER if there was an emergency. Or if they were faculty at a learning
institution, to "page the on call psych resident." Also, can you comment on
psychs not having secretaries, and group v. solo practices? Thanks, Jessica

Thank you, Jessica, we Rappers (or Shrinksters) always like hearing that our blog is enjoyed. I've been thinking about your questions since I saw them and this is what I come back to.

When it comes to choosing a medical specialty, go with your heart. There is no other way. Psychiatry is so different from everything else that it needs to call you, even if just a little. If nothing or everything calls you, think long and hard about it, visit docs in their offices, talk to everyone you can, and hey, visit a blog or two!

In my eighth grade English class, we were assigned to do a research "career report." One classmate ventured into New York City and met with Chuck Scarborogh-- he wanted to be an anchorman.
Newton (Now NJ), I am pleased to report, is now a newsman with Eyewitness News, and apparently I'm not the only member of Mrs. Garelick's class to have a podcast.
I wrote about how I was going to be a psychiatrist. What was I thinking? At that point in my junior high school life, I'd never met a psychiatrist and I'd never even met anyone with a mental illness. The best I can figure is that I liked teeny bopper magazines and thought it would be cool to be one of the "experts" who got quoted about human behavior. I found a book on Freud's theories in the library and thought this was really weird stuff. I did not, I repeat, did not, have penis envy.

In med school, I had several profs express concern that I was wasting my life. One suggested I would be more useful to society as a cosmetic surgeon. During internship, a cardiology fellow told me he'd wanted to be a psychiatrist but instead he had his own psychotherapy and realized that was what he was looking for. That actually is a good point: if you're looking for answers to your own problems, get a shrink, don't be one, at least not for that reason alone. Many people told me that in psychiatry no one ever gets cured. They were wrong.

But what if you wrote your career report on becoming a ballerina, and now you're in the throes of a medical education, having survived organic chemistry and MCAT's, trudged through biochem, anatomy lab, and 4:45 AM cardiothoracic rounds (do they still do that?) and nothing is screaming your name? I'm not sure what to say, I haven't been there. Process of elimination, maybe. If it's lifestyle you're looking for, I think dermatology is low on crises. There are many ways in many specialties to gain some control over your time: if lifestyle is important, stay away from trauma surgery, OB, and most other surgical subspecialties.
For what it's worth, though, I agree, psychiatry can include a good lifestyle, though easy hours won't bring in the big bucks, but you can have time to spend with your kids and your blog.

Seriously, though, I was unaware of the AMA dictate that psychiatrists be available for emergencies within 30 minutes. Every shrink I've mentioned this to has gotten a bit anxious and no one has heard of this (except Wise CoveringDoc). Even Camel who carries a "Life or Death" line with her was not pleased. This little-known statement applies only to emergencies (not availability on demand for anything your heart desires), doesn't define emergencies (I don't think, hmmm, I've never actually read it having learned of it 3 days ago) and emergencies in private practice are not that common, at least not in my practice. The one time I was called with what was truly an emergency-- a patient on the brink of a suicide attempt-- I answered the phone, thereby being immediately available, not even a one minute wait, and the caller went through with the attempt despite my wise counsel (I did call 911, the caller did survive). I'm not losing sleep over this one, though it did occur to me yesterday that I'd left my phone in the car while I was at the gym for a one-hour work out and if someone had an emergency at the beginning of my workout.... oy...I stayed on the stairmaster.

Solo versus Group: I've done both. I was in a group for 7 years, I liked it, I left when the logistical issues of office space got to be difficult. The group had 3 billing secretaries, I've done better on my own. I've never wanted secretaries to schedule me, though they do in the clinics where I've worked, and usually it's fine.

I'm actually a pretty good secretary, if I do say so myself.

I hope this helps.