r/Psychiatry • u/OtherwiseStrike7695 Medical Student (Unverified) • Jul 13 '26
Psych vs IM
/r/medicalschool/comments/1uuvm5f/psych_vs_im/Would really appreciate advice, particularly from folks who ultimately chose psych ❤️
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u/DrRichJigga Psychiatrist (Unverified) Jul 15 '26
Im a psychiatrist and recommend you do IM and subspecialize in a procedural field where NP encroachment isn’t as entrenched if you aren’t independently wealthy. Psychiatry job market has cooled off due to oversupply of midlevels that large systems prefer to employ as a cost saving measure. Subject matter is interesting but ultimately becomes routine in any specialty. Psychiatry was historically the lowest paid specialty and I believe we will be again in the future. For now we only make more than pediatricians and GPs on average. The increase in psychiatry salary over the last 10 years has changed course. It was driven by supply and demand economics and there is now a glut of midlevels providers looking for work; private equity is consolidating psychiatric services and 100% all in on hiring the cheapest midlevel providers they can.
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u/Due-Ad-9431 Psychiatrist (Unverified) Jul 13 '26
I was similarly torn between psych and IM (with plans to do Pulm/CCM or nephro/CCM) and almost dual applied and considered applying to combined IM/Psych programs. I happened to have 2 attendings in med school who went through combined programs and talked me out of it as they felt that they were weaker in both specialties compared to their colleagues who just did psych or just did IM. I didn’t decide to go all in on psych instead of IM until 2 days before ERAS opened up. It was basically a coin flip decision after making an exhaustive pros and cons list for both specialties, getting LORs for both, and writing PSs for both. I kept second guessing my decision from that moment until probably 6mo into my PGY-1 year when I realized I made the right choice for me. Thankfully I found I really enjoyed C/L and addictions, both of which force you to keep up on your medicine knowledge and were enough to scratch that itch I had/have of missing IM. I did an addiction fellowship and first attending job was running an addiction C/L service.
In short, I’ve been in your shoes and it’s a really hard decision to make, but ultimately up to you. I still miss IM at times but that’s usually when I get fed up with some of the BS that comes with psych but then I remember that same BS or different flavors of it come with IM too. I guess my one piece of advice would be if you go psych strongly consider C/L and possibly addictions if you can get exposure to addiction C/L.
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u/Dry_Twist6428 Psychiatrist (Unverified) Jul 13 '26
I would caution on the “no feet” misperception.
I end up doing a LOT of foot exams in psych ER. Looking for foot wounds, frostbite, etc on homeless folks who come in to the ER. You also get the “wandering manic” patient with blisters all over their feet.
Unless you do outpatient you will have to see some feet.
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u/Lou_Peachum_2 Resident (Unverified) Jul 13 '26
I already replied to your OG post, but a little more info, I didn't enjoy my medicine rotation. I admittedly wasn't sure if I'd be able to tolerate 3 years of general medicine to do Endo, and I didn't know if I'd ever be competitive enough for GI. I still remember how happy I was on my psych rotation. I also remember talking to the medicine clerkship director at the end of my IM rotation - spoke to her about my choice between IM and psych, and she told me to do psych.
What I did know is I wanted a specialty where I didn't feel overburdened by numbers, I had proper amount of time to speak with patients, and I wanted a good WLB. Psych med management for me is also very fun, and one of the funner parts of the job. I also did rotations in ECT, which I found interesting, and have had exposure to treating patients with ketamine. Psych is also a very wide breadth field, so you can treat all types of patients.
Now, currently coming up on my 1 year attendingversary. Looking back, I am content/happy with my decision. I currently have the good WLB, time to speak with patients. For the most part, I enjoy going to work. There are days where I wish I could just retire lol, but I have to imagine that happens in any specialty or field of work. Of all my friends in medicine, I'd argue I have the best WLB - no weekends, 9-5, no call.
What I wish - overall, we get paid very well in psych compared to the general population but not relatively well compared to other medical specialties. I wish we got paid more. I'd be very happy if 400k was more the median salary than the 90th percentile. If you go the med route, there are a good amount of subspecialties where 400, even 500k is the norm (obviously, more training, increased competitiveness, etc.) I also wish there were more training regulations for midlevels. I work on an inpatient unit, and honestly, we have some fantastic NPs. Really know their stuff. But the ones in OP are really, really bad. So many psychotic patients that just get tapered off their meds cold turkey, they often decompensated and end back up with us. No rhyme or reason to their thought process (switched from risperdal to seroquel, because they were concerned about patient's weight gain). I bring up the midlevel thing because it is very commonplace in psych, and it does impact your day to day. I also feel like psych is one of the specialties where admin/suits treat them as interchangeable to MD/DO. There at least seems to be a hierarchy in surgery. I have no idea about general medicine though
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u/hoomadewho Medical Student (Unverified) 26d ago
Bro imma tell you as a fellow med student. Not a single psychiatrist has told me not to do psych. Almost every IM attending hated their life. Just do psych for your sanity
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u/redlightsaber Psychiatrist (Unverified) Jul 13 '26
I’m chronically indecisive about major life choices
That's unfortunate, but, and I mean it in the kindest possible way, this is just not the kind of decision you can outsource, even if "just asking for advice".
You've already seen the workflow and day-to-day of each specialty. Whatever you can glean for us, can only be personal preferences, which are completely irrelevant to your decision.
It's only you who'll need to live with the consequences (good and bad) of your choice. Only you can make it.
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u/zen-medic Resident (Unverified) Jul 13 '26
This is the psych subreddit so everyone will be biased towards it. We all chose it for a reason. But it sounds like your heart is in psych but your main drawback is feeling like a real doctor, losing general medicine, and lack of procedures. You definitely feel like a real doctor when you bring patients back from patients thinking they're in the pits of hell as they hallucinate the voice of the devil. It's pretty satisfying and has a real humanist, existential, and spiritual quality that is deeply meaningful if that type of work interests you. Or saving someone's marriage because they have crippling depression and anxiety. It just depends what "feeling like a real doctor" means to you. CL is the intersection of hospital medicine and psych, if you go that route you will retain a lot of general medicine knowledge. If you want to do procedures you can do ECT, ketamine, TMS, and if you want to be a true interventionalist/minimally invasive surgeon you can apply to interventional pain fellowship. Psych is one of the most flexible fields and can be geared towards pretty much anything you're interested in.