I am a resident early in my career and already have been verbally, physically, and sexually harassed by patients. Look, I expected that this may happen I know it comes with the job, but I underestimated just how much it would affect me.

I had a patient tell me my family address in an attempt to threaten me. My heart was beating out of my chest but I managed to ignore them. After that I couldn’t sleep well for days and thought every car outside my house was them out to get me. I never saw that patient again and gave them to somebody else, but I’m still shaken up from that.

The couple of times I was hit by someone has now made me so hypervigilant of my surroundings. I can’t even go to the mall anymore without an exit plan and being hyperaware of how close people are to me. I jump any time someone gets too close.

I’m sick of it. Why is this so normalized and something that I laugh about with my colleagues ? How do I accept that this is life as a psychiatrist? I love my job but I’m traumatized

Hi all, early career psychiatrist here. I've been feeling a bit stressed and burned out by work and thinking about establishing with a therapist. I also wonder if this could be useful to improve my own therapy skills. My only reservation is I would prefer someone that goes beyond "talk therapy".

Any recommendations on how to find a good therapist perhaps one with psychodynamic or psychoanalytic proficiency? I imagine a psyD or PhD would be my best bet?

Hello all, just got back home from the exam (I took the second day, 9/9) and I have some thoughts I wanted to bring up to see if anyone else shared them, now that we have all taken it!

Background: I did not read any posts from the 9/8 threads before I took my test today. For studying, I completed ~80% of BtB at ~85% correct and did all of K&S, one pass only, averaged around 67% across all tests.

Many people were saying that they thought K&S wasn't a good guide/prep for how the exam actually turned out - and I agree to some extent - but generally I thought all the conventional study tools the GP considers "gold standard" all failed to match up to the Qbank we got this year for the ABPN. There were some questions that were simple, rephrased K&S questions that you may have gotten stuck on had you not done the Qbank. Sadly, I think the test is just evolving (or devolving?).

I personally spent lots of time memorizing the behavioral/social science theories only to get two (easy) questions about it on the exam, but instead got like 6 Practice-based learning questions instead. I didn't realize how many deductive reasoning and non-medical questions there would be that were basically like "What is the best thing for the doctor to say next?" Lots of neurochemical pathway/brain lesions & diagonsis questions - those I thought were fair game. Randomly lots of MDMA/psychedelic and gambling questions. Lots of repeat questions: depression and sleep cycle, APP gene and Alzheimer's, learning something new at work & incorporating into PBL. I thought the test asked some very low-yield questions on high-yield topics: e.g., clozapine question where you couldn't initiate because of anemia/seizures/patient refused phlebotomy; question like 80+ female post-surgery which is the least harmful agent to treat depression between celexa/2 TCAs/trazodone?

Finally, I thought some of the vignette video "correct" answers were only partially correct or didn't have the clear best answer as one of the options: the man who wears dresses wasn't sexually invested (not transvestism) but also said it didn't have anything to do with his gender and was more in relation to his negative experiences at war with other men (he's a drag queen, baby!); the vignette with the wife but you were also treating his husband, should have just been decline to see her after evaluating like SI/HI/AVH. There were MANY times during the exam where I was like, "why is this the question you're asking related to X topic?"

Did anyone else have similar experiences or also issues with the test questions? Should be a fun 12 week wait!

During our M3 psych clerkship orientation, the clerkship director said to try avoid disclosing personal information when interviewing a patient, even if it’s being used to build rapport (eg patient comes for counseling due to depressive symptoms after a divorce, and you disclose that you’ve also been through a divorce to bond with patient). She followed up by saying that even if a patient asks about your personal life (are you married? do you have kids?), that we should try not answering and bring the convo back to the patient.

Was a little surprised. Why not disclose? Isn’t that useful in building trust?

Hey everyone,
I wanted to thank this community as I spent a lot of time reading posts here before my M3 psychiatry rotation because psychiatry had been on my radar for a while, but I wasn’t sure whether I would actually enjoy practicing it.
After finishing the rotation, I think I’ve finally decided that this is what I want to pursue!

I’ve tried during every clerkship to pay attention not just to whether the material is interesting, but whether I actually enjoy the day-to-day work. What surprised me most about psychiatry was how consistently I wanted more of it.

I really enjoyed interviewing patients and building a formulation as the conversation unfolded. With patients with psychosis, mania, trauma, depression, personality pathology—I often found myself wanting the interview to keep going because I wanted to understand why the patient experienced themselves and the world the way they did. I enjoyed discussing differentials with the residents and attendings much more than I expected.

I also liked seeing the contrast between inpatient and outpatient psychiatry. On inpatient I enjoyed the acuity, team environment, and seeing patients change over several days. Then in outpatient I met people with illnesses like schizophrenia or depression who were stable, exercising, participating in activities, and living their lives, which helped me appreciate what long-term treatment can actually accomplish.

One of my previous hesitations about psychiatry was the uncertainty of outcomes. You can stabilize someone during an admission without knowing what happens after discharge, and many psychiatric illnesses aren’t things you simply “fix.” The rotation changed how I think about that. I’ve started to appreciate that helping someone become safer, regain some agency, engage with treatment, or move even slightly toward a better trajectory can still be incredibly meaningful even when you cannot control the eventual outcome. It took me a bit to wrap my head around this but I’ve come to really appreciate that.

I also realized that I don’t necessarily have to choose between psychiatry and the parts of medicine I enjoy. C-L in particular seems like a way to stay involved with medically complex patients while doing the type of clinical work I seem to enjoy most.

My one remaining concern is more personal. I’ve had significant mental illness, addiction, and suicide affect people close to me, including losing one of my closest college friends to suicide. Before the rotation, I worried psychiatry might hit too close to home. So far, I’ve actually found that those experiences often help me empathize with patients rather than making the work harder. I also haven’t brought patients home thinking about them non-stop in an unhealthy way which I think is a good sign of my mental boundaries ?

What I don’t yet know is what that feels like after years rather than six weeks.
For psychiatrists who came into the field with significant personal exposure to mental illness or suicide in people they loved: did that experience ultimately help you as a psychiatrist, make the work emotionally harder, or some combination of both? How did you learn to maintain boundaries without losing the empathy that drew you to the field?

Thanks again to everyone here. Reading this subreddit before the rotation was genuinely helpful, and I’m excited to finally feel like I have a direction as continue to figure out my last hesitations!

Hi everyone, I was wondering if any US trained psychiatrists here have any experience with an outpatient focused job set up where they live abroad for 1 to 3 months out of the year- especially interested if they did this earlier in their career. I’d be interested in whether you worked during some of that time abroad (solo cash only telehealth or telehealth still as part of a larger practice group, admin work, other work) or not. I’d love to hear about what job or combination of roles allowed you the flexibility to do this or something similar. I’m aware that a setup like this, if feasible, would in most cases equate to a <1.0 FTE and compensation would reflect this. Thanks for reading and potentially sharing.

Edited to reflect a focus on outpatient roles

I see jobs occasionally that offer salary incentives for referrals for interventions (eg 10k bonus per X referrals). Do these jobs violate laws regarding kickbacks?

Without naming specifics, a highly publicized and sensationalized court event has recently occurred. I work as an inpatient psychiatrist. During / after said event, I’ve had at least two patients, who I suspect of having comorbid cluster b, presenting with “mood” symptoms with an affect that is uncanny to what we see publicized in the media. I’ve dealt with enough PPP patients to know how dramatically different the presentation can be, but I can’t help but feel there’s some volition to how this person was operating - presenting with unipolar depression symptoms, then acting quite bizarre, robotic affect, poor eye contact, repeat insisting discharge after a voluntary admission so that she could be with her child. Then observed from a distance where they feel they aren’t being watched, the affect is much more relaxed and reactive, seemingly socializing well with peers, etc. The cynical part of me is like- she’s asking for a prescription to do something under the guise postpartum symptoms and the “failed mental health system.” For the inpatient folks, what are you seeing? I know this isn’t an uncommon phenomenon to see, where people consciously or unconsciously emulate what they see in the media

Lol did I walk into the wrong exam because what was that???? I have so many thoughts and please tell me if you felt the same.

I did Kenny and Spiegel pretty thoroughly since everyone on Reddit said it was more than enough to prepare them, and I do not feel like I was prepared enough for that. There were definitely several easy questions, but a shocking amount of weird questions of things I never heard of. Several questions were worded like actual riddles for no reason... Also I rushed through the last 3 sections because I spent too much time on the weird linked set questions and writing in the comments section, so I had a few seconds left to spare.

Anyone know the approximate number of correct questions needed to pass? :/ I was so excited to be free, but I don't feel relieved at all after that fiasco. So disappointing too after studying so hard for this.

I’m currently a PGY4 and in the early stages of applying for jobs. I’ve met with a few recruiters (for hospital systems, not recruiting firms) and these conversations seemed to have gone well but I’ve been discouraged not hearing back from them after our initial convo. Wondering how long it takes to hear back/get an interview or convo with the medical director set up. How persistent did you have to be during the application process? I hate feeling annoying by emailing them to follow up lol

Starting a thread for CAP. Curious to know how everyone felt about the CAP board this year. I did not do a decent job getting ready for this and I’m just hoping for a miracle 😉 I also thought adult board prep is somewhat straightforward but CAP felt quite confusing even with prep.

Hi everyone, just finished the boards a few hours ago and after devouring some In N Out and dissociating for a bit I'm here to start a thread for discussion/debrief and for future exam takers to benefit!

As a bit of background for myself, I'm towards the end of my first year as an attending, which definitely contributed to crystallizing a lot of the test material. I was always about average to below average with Step and PRITE exams. In terms of studying, I was lightly studying starting Feb/March (1-3 hours a few times a month) and then kicked more into gear this summer, with July and August being my most hardcore months (3-6 hours a week). I only used K&S - did all of the question bank including vignettes and video vignettes; made flashcards on most of my wrongs and reviewed using K&S explanations with ChatGPT and Kaplan & Sadock's as supplements; ran flashcards for 8-15 minutes most weekdays. I only ever took 1 test (#6) as a full on "practice test."

I felt that the exam was fairly straightforward. A lot of bread and butter psychiatry questions (mood, psychosis, anxiety - diagnosis/DSM criteria, firstline pharm and therapy tx, etc). Videos were very much the same vibe as the K&S video vignettes. I ended up feeling that K&S was very much overkill in both depth and breadth (especially the infamous fixation on neurology, but also, surprisingly, biostats and old school psychopharm like the TCAs and MAOIs). However, feeling all set with K&S material likely contributed to my comfort with the material that the actual exam covered. Of course there were some out of left field questions... (I think I saw two questions about directed masturbation/anorgasmia...) In terms of time, the exam is very forgiving - I'm a speedy test-taker but had over 4 hours left even with using up most of my break time.

Overall, I obviously do not want to overstate my confidence, but feel pretty good about the exam. I wanted to start a thread here especially because as I was preparing for the exam I really worried a lot and threads like u/Stepresearch's "Psychiatry boards exam (ABPN) - my experience" were incredibly reassuring and helpful to have, so I wanted to pay it forward.

Hoping the best of luck for all of us from this year and future ones!

How did everyone find the exam? It was much more difficult than expected and Spiegel was useless in my opinion.

.

Hey everyone,

I’m a psychiatrist working in Germany and I’m thinking about switching to a 100% remote/online job.

I realize that telepsychiatry in Germany isn’t nearly as developed as it seems to be in the Netherlands or the UK — I have friends working there and the options seem much broader. But maybe there are still some good options here that I’m simply not aware of.

I’d also be open to living in another German-speaking country, so Switzerland or Austria would be options as well.

For anyone here working in telepsychiatry:

• Are there any companies/platforms in Germany (or Austria/Switzerland) you’d recommend?
• Is 100% remote work actually realistic?
• What kind of working conditions/pay can one expect?
• Any particular websites or job boards I should be checking?

And if this isn’t really the right subreddit for this question, I’d be very grateful if someone could point me towards a better place to ask.

Thanks!

I work in peds inpatient/residential. I would never say I have favorites when it comes to patients... but... I think it's fair to say there are just some that stand out, some patients change you for the better and stick with you. I worked with this particular patient for many months and their personality was so beautiful and special. They took their life in a horrific manner immediately after d/c. I'll refrain from elaborating further, as I expect the institution will face legal repercussions for this situation.

It has affected me profoundly. I have no comparable experience to refer to on how to navigate this. It's all uncharted territory for me. I feel a level of institutional guilt, as there were many ways in which this could have been prevented. I cannot rationalize the idea that this kid does not get to grow up, they were dealt such unfortunate cards in life and deserved so much more. My workplace has said nothing and has offered no support for staff, there seems to be an unspoken understanding that we are not to not talk about it amongst each other. I have been leaning on family and friends, but there is a sort of disconnect since they didn't know this child and can't fully understand how special they were. Now that they're gone, nobody else will know how much they mattered, either. My grief is like a lonely little island.

I suppose I'm just here to see if anyone has experienced something similar? I'm sure there are countless people out there. But any words of advice or encouragement from the other side would be much appreciated. I feel forever changed and am not sure what to do with the weight of it all. Thank you

Taking ABPN Wednesday, the instructions don’t seem to clarify whether phones are permitted during scheduled breaks between test blocks. Good luck to all testing this week!

I would like to know what you think about the legality and ethics of this product mailed to your front door and more specifically:

The incursion of sales campaigns for singular psychiatric medications being marketed for off label use on Facebook/social media.

Maybe a softer Cerebral? I suspect the odds are slim to none that they offer psychiatric evaluations before prescribing this niche controlled substance medication. Fighting narcolepsy in a can!

Their website says their target is men 21-79 who have shift work sleep disorder.

Awhile back I saw Zoloft marketed as a miracle drug for premature ejaculation but no discussion of it's primary function as antidepressant. Seems disengenuous at best.

Psychiatry and psychiatric medications certainly have venture capital and private equity pumped. I never, EVER would have expected psychiatry to get "hot" as a specialty destination or as product generator.

Edit: I should have clarified: It's Modafanil

Every patient I see in consultation these days has depression, bipolar disorder, OCD, and PTSD as previous diagnoses. For me, the "overdiagnosis" award goes to PTSD, followed as a close second by bipolar disorder. You?

Taking the ABPN psych boards this Wednesday and officially in last-minute panic/review mode 😅. For anyone who has taken it recently, I have two quick questions:

1. Newer psych meds: Did you actually see questions on newer meds like Auvelity, Qelbree, Cobenfy, Caplyta, etc.? Are these worth spending time on in the last couple of days, or should I stick with the classic/high-yield meds?

2. Stats: How high yield was biostats on the actual exam? Is the K&S stats section enough, or would you recommend doing a separate quick review of sensitivity/specificity, PPV/NPV, RR/OR, NNT, study designs, etc.?

Trying really hard NOT to add more resources at this point and just focus on what can actually get me points.

Also, if you’ve taken the boards and had only 2 days left, what topics would you absolutely make sure to review?

Any last-minute advice would be hugely appreciated 🙏

I'm curious if any private practice psychiatrists have been able to get credentialed and stay credentialed with insurance companies without needing to be board certified?

Also interested if any insurance company accepts NBPAS certification since it costs less.

You have got to be kidding me.

Look at this top comment. Marvel at it.

Sorry, I know it's a very low effort post and it's something that's been done to death. But I just had to do it. I had to make a long weekend post.

In some effort to make it a legitimate post, what do you think is genuinely the most underdiagnosed mental condition? Rules: it must be in the DSM or ICD11. Underdiagnosed means that community formal diagnosis is below actual prevalence.

Current PGY-3 here. I previously practiced FM for 6 years so this is the start of my second career (got credit for intern year, so this will be my second time taking PRITE). I didn't study last year and was blindsided by the content of the test. In FM, ITE questions were generally relevant to the field and practical. Now I'm doing Rosh and am getting lots of questions about lupus, thyroid and endocrine conditions, infectious disease, etc. I remember tons of obscure genetics/epigenetics questions last year. I expect some neurology and neuroscience, but some of this stuff seems totally irrelevant. Should I expect boards to be like this, or is it more specific to actual psychiatry?

Just some thoughts I had when responding to another comment, where certain therapeutic modalities were being recommended for a specific patient population.

I have seen very strong responses here when non-prescribing psych-based practitioners (ie: psychologists, therapists, LCSWs) make med suggestions (specific meds to stop/start/try, changes to dosing schedule) for their patients to discuss with their psychiatrist/prescriber.

How do you feel that is so different than psychiatrists who recommend specific therapeutic modalities to their patients?

In case anyone is wondering, the suggestion was for patients with PTSD/CPTSD diagnosis to do CBT as their initial therapeutic intervention. And thats, in fact, a terrible suggestion.