Any predictions as to why or when psychiatry is going to crash? Everyone is talking about a boom, bubble, and burst cycle.

[nebuchadnezzarII]

I'm a 4th year medical student hoping to match into psychiatry. A lot of the threads I've read here indicate that at some point soon, the field is going to crash from over-saturation or some other vague reason. There seems to be this feeling that the "pendulum will swing" in the opposite direction and growth of the field will dry up. Going on this interview season alone, I was shocked to see the massive increase in applicants. Last year, it appears 1 in 6 (approximately 17%?) of applicants didn't match into psychiatry. There's no doubt that it is a competitive specialty now and will be more so this year.

Does anyone have any thoughts or predictions on this? What is the outlook for people just starting their training in psychiatry? Will the job market be more competitive and less rewarding?

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[Sushirolls]

Current forecast for psychiatry for the next 5 years will include rising competitiveness amongst medical student applicants, and residents seeking to jump ship from their current specialty. This competitive trend will continue year over year. Driving this demand is declining health care market forces and the ability of Psychiatry to escape this mess. The ability to abstain from hospital based practices, and preserve the integrity of what Physicians have been for thousands of years by opening and managing their practices. This level of freedom is priceless and as more people became aware, so too shall the drive to become a Psychiatrist.

Rising acknowledgement of mental health in the community at large, and the media drawing attention to needs both in a positive and in a negative light will further the job market expansion. Increase societal shift in certain political policies will further the market demand for mental health. Some dampening may occur due to inlays made by mid-levels, but this will be nominal as expertise will continue to be valued in certain clinical settings.

Their will be a mix of pay increase, no change and decrease based upon the employers and influences like funding for these employers. Some decrease will be seen in employers seeking cheaper mid level labor. Many jobs that place an emphasis on expertise will likely see no change, and in cash based private practices steady growth in salary potential is likely.

Psychiatry at this time by the Sushirolls analyst is considered Strong Buy.

At market closure today:
Psychiatry was ^2.08% and +12 arbitrary medical competitiveness units.
Anesthesiology was v1.20% and -8 arbitrary medical competitiveness units.

 

[PassionForever]

What is this notion of over saturation? The number of residency positions has stayed relatively stagnant, and they were previously getting filled. It's just that they're now getting filled by more competitive applicants (less IMG's, DO's). Combine that with so many psychiatrists looking to retire in the next 10-15 years, and over saturation isn't likely.

 

[BiscoDisco]

I believe psych is the second oldest field (mean age of practicing physician) in medicine. Unless the field of psychiatry goes away, I don't see how the cush factor doesn't continue to rise for the foreseeable future.

 

[calvnandhobbs68]

Yeah I think the "boom" that you're seeing is purely in med student applicants to existing resident positions now that psychiatry is a bit less of the red headed stepchild of medicine, everyone is really into "mental health" and more and more med students care about lifestyle and less about working themselves to death on the altar of medicine. Most psych residencies you're doing 40 hour weeks your last 2 years of residency and people can sense that vibe from the psych residents who tell them all the stuff they do outside of being at work lol.

The possible oversaturation may come just in general from the explosion of midlevels as more and more "take anybody with a nursing degree and a pulse" NP programs expand. I do truly think this is something to be worried about 10+ years down the line as for some reason FM and Psych NPs are much more prone to be granted very loose supervision than NPs in other specialities (excluding CRNAs). NPs have also gotten wise to the fact that psych is pretty laid back for the same or more pay and it's pretty hard to be caught doing something overtly "wrong" in psych (which makes it easier for incompetent people to limp along without getting in trouble). They're also going to play up the whole "mental health shortage" aspect to lobby hard for independent practice in all 50 states which is going to be fairly hard to argue against.

 

[dl2dp2]

It's more competitive now because it's pretty clearly a better gig than general IM, general peds, cognitive specialty IM/peds (endo/rheum), neuro. Lifestyle wise (pay/hour, flexibility) it's probably better than or equivalent to EM/anesthesia/gen surg/OB. For a variety of reasons, this field is just never very call heavy, even for facility-based jobs. Subspecialties in this field are pretty cool and interesting so relatively more immune to midlevel penetration.

Still, we are not anywhere close to the true top fields, in terms of overall competitiveness: derm, subspecialty surgery (including ophthal, OB specialties, etc), radiology (esp. interventional), other procedure heavy gigs (i.e. pain anesthesia, GI/cards etc).

If you are an average candidate going into psych you can hope for a 300k job that's fairly chill. But if you go into subspecialty surgery the general expectation coming out of training (non-academic) is now 500k. They do work harder though. If you are savvy on your own in psych you can make 500k+, but no facility will ever pay you 500k. Department chairs at facilities rarely get paid 500k. Meanwhile, these days if you do well in private derm or plastics, or even rads, you can comfortably hit close to 1M...

So your assumptions aren't right. Psychiatry isn't really in a "bubble state". It's just crawling out of the bottom barrel...

 

[adaptation1]

Nah. Meds students are just finding out what many of us realized a long time ago: diverse speciality with great flexibility, minimal call, and good lifestyle.

 

[finalpsychyear]

It's more competitive now because it's pretty clearly a better gig than general IM, general peds, cognitive specialty IM/peds (endo/rheum), neuro. Lifestyle wise (pay/hour, flexibility) it's probably better than or equivalent to EM/anesthesia/gen surg/OB. For a variety of reasons, this field is just never very call heavy, even for facility-based jobs. Subspecialties in this field are pretty cool and interesting so relatively more immune to midlevel penetration.

Still, we are not anywhere close to the true top fields, in terms of overall competitiveness: derm, subspecialty surgery (including ophthal, OB specialties, etc), radiology (esp. interventional), other procedure heavy gigs (i.e. pain anesthesia, GI/cards etc).

If you are an average candidate going into psych you can hope for a 300k job that's fairly chill. But if you go into subspecialty surgery the general expectation coming out of training (non-academic) is now 500k. They do work harder though. If you are savvy on your own in psych you can make 500k+, but no facility will ever pay you 500k. Department chairs at facilities rarely get paid 500k. Meanwhile, these days if you do well in private derm or plastics, or even rads, you can comfortably hit close to 1M...

So your assumptions aren't right. Psychiatry isn't really in a "bubble state". It's just crawling out of the bottom barrel...

"Meanwhile, these days if you do well in private derm or plastics, or even rads, you can comfortably hit close to 1M... "

Most people will get 200-250k in psych. I don't see the 300k jobs in my area unless you are doing wknd calls. My anesthesia friend just took a job paying 700k right out of residency. I have pain friends nearing 7 figs. Yes, psych has a great lifestyle but your ceiling is much lower for most people who will be employed. For what its worth the push for a lot of places is to hire as many NPs per psych provider. No one is saying you won't get a job but people have unrealistic expectations

 

[PikminOC]

"Meanwhile, these days if you do well in private derm or plastics, or even rads, you can comfortably hit close to 1M... "

Most people will get 200-250k in psych. I don't see the 300k jobs in my area unless you are doing wknd calls. My anesthesia friend just took a job paying 700k right out of residency. I have pain friends nearing 7 figs. Yes, psych has a great lifestyle but your ceiling is much lower for most people who will be employed. For what its worth the push for a lot of places is to hire as many NPs per psych provider. No one is saying you won't get a job but people have unrealistic expectations

Many fields are hiring as many np as possible per Physician

 

[dl2dp2]

No one is saying you won't get a job but people have unrealistic expectations

Agree, esp public facilities the initial ask is usually 200 and they are replacing with NPs. I’m talking the average private group partnership track a few years into the job would be 300 (ie an average job).

A typical starting salary in say rads or ophthal is also not that high tho (say mid 300) — u r right the ceiling is much higher — but you also have to compare apples with apples.

 

[PikminOC]

Yeah I think the "boom" that you're seeing is purely in med student applicants to existing resident positions now that psychiatry is a bit less of the red headed stepchild of medicine, everyone is really into "mental health" and more and more med students care about lifestyle and less about working themselves to death on the altar of medicine. Most psych residencies you're doing 40 hour weeks your last 2 years of residency and people can sense that vibe from the psych residents who tell them all the stuff they do outside of being at work lol.

The possible oversaturation may come just in general from the explosion of midlevels as more and more "take anybody with a nursing degree and a pulse" NP programs expand. I do truly think this is something to be worried about 10+ years down the line as for some reason FM and Psych NPs are much more prone to be granted very loose supervision than NPs in other specialities (excluding CRNAs). NPs have also gotten wise to the fact that psych is pretty laid back for the same or more pay and it's pretty hard to be caught doing something overtly "wrong" in psych (which makes it easier for incompetent people to limp along without getting in trouble). They're also going to play up the whole "mental health shortage" aspect to lobby hard for independent practice in all 50 states which is going to be fairly hard to argue against.

The saturation is already happening with mid-levels infiltration

 

[MacDonaldTriad]

The saturation is already happening with mid-levels infiltration

I will believe this when psychiatrists have trouble finding a job. Mid levels are probably more of a consequence of a huge vacuum in supply. They really aren't capable of replacing us. Our department has proven this a couple of times and we aren't looking to prove it again. The amount of supervision and monitoring necessary to do it right plus their salary doesn't pencil out as well as people think.

 

[WisNeuro]

I will believe this when psychiatrists have trouble finding a job. Mid levels are probably more of a consequence of a huge vacuum in supply. They really aren't capable of replacing us. Our department has proven this a couple of times and we aren't looking to prove it again. The amount of supervision and monitoring necessary to do it right plus their salary doesn't pencil out as well as people think.

This is the case in our system. We've had an opening in our outpatient clinic for a psychiatrist for a while. Management seems content with hiring a few more NPs rather than increase incentives for Psychiatrist recruitment, though. Kind of the case with all doctoral level providers, though. We have 4 inpatient MH units, and 1 dedicated psychologist for inpatient in the entire hospital. They keep asking me to do general psych stuff on those units. I happily decline due to my long waiting list and tell them to advocate for new hires. Seems to be the way some systems are moving in terms of management types looking at numbers on a spreadsheet rather than talking to staff about actual needs.

 

[PikminOC]

This is the case in our system. We've had an opening in our outpatient clinic for a psychiatrist for a while. Management seems content with hiring a few more NPs rather than increase incentives for Psychiatrist recruitment, though. Kind of the case with all doctoral level providers, though. We have 4 inpatient MH units, and 1 dedicated psychologist for inpatient in the entire hospital. They keep asking me to do general psych stuff on those units. I happily decline due to my long waiting list and tell them to advocate for new hires. Seems to be the way some systems are moving in terms of management types looking at numbers on a spreadsheet rather than talking to staff about actual needs.

Yes. Exactly what I've seen too. Management doesn't care about supervision time as they don't do it. Just more work foisted upon others

 

[Sushirolls]

I will believe this when psychiatrists have trouble finding a job. Mid levels are probably more of a consequence of a huge vacuum in supply. They really aren't capable of replacing us. Our department has proven this a couple of times and we aren't looking to prove it again. The amount of supervision and monitoring necessary to do it right plus their salary doesn't pencil out as well as people think.

I've found it to be the exception and not the rule that organizations recognize this. Places are more likely suit driven, and 'Penny wise, pound foolish.'

 

[calvnandhobbs68]

Yeah more great reasons for me to never work for a hospital system. The hospital doesn’t love you back baby.

 

[Techmed07]

The market will correct! I think we are in a boom right now because of the demand. It should correct once hospitals starting hiring mid levels. However, we have no idea if this is the peak. What is clear is that the silent epidemic of a shortage of psychiatrists and decrease mental health stigma played in our favor. We make more than internists now. That’s wild.

 

[meow1985]

I'm a 4th year medical student hoping to match into psychiatry. A lot of the threads I've read here indicate that at some point soon, the field is going to crash from over-saturation or some other vague reason. There seems to be this feeling that the "pendulum will swing" in the opposite direction and growth of the field will dry up. Going on this interview season alone, I was shocked to see the massive increase in applicants. Last year, it appears 1 in 6 (approximately 17%?) of applicants didn't match into psychiatry. There's no doubt that it is a competitive specialty now and will be more so this year.

Does anyone have any thoughts or predictions on this? What is the outlook for people just starting their training in psychiatry? Will the job market be more competitive and less rewarding?

The bottleneck is at level of residency spots, and competition is rising because lifestyle specialties are becoming more popular while mental health is less stigmatized.

But the demand for psychiatry *attendings* far outstrips supply and is not likely to dry up anytime soon. Arguably this will not happen in our lifetimes. This is not true for other specialties.

 

[meow1985]

Most people will get 200-250k in psych. I don't see the 300k jobs in my area unless you are doing wknd calls. My anesthesia friend just took a job paying 700k right out of residency. I have pain friends nearing 7 figs. Yes, psych has a great lifestyle but your ceiling is much lower for most people who will be employed. For what its worth the push for a lot of places is to hire as many NPs per psych provider. No one is saying you won't get a job but people have unrealistic expectations

Yeah, at the risk of the discussion turning political this is due to procedures just being reimbursed so much better, and may change if there's some sort of overhaul to that paradigm.

But psych is probably the best paid and cushiest field for someone who wouldn't be able to hold a scalpel straight if it was taped to their hand *coughthiswriter*

 

[VA Hopeful Dr]

The bottleneck is at level of residency spots, and competition is rising because lifestyle specialties are becoming more popular while mental health is less stigmatized.

But the demand for psychiatry *attendings* far outstrips supply and is not likely to dry up anytime soon. Arguably this will not happen in our lifetimes. This is not true for other specialties.

Its a nice side effect of being an "undesirable" specialty for so long. Same thing has happened with my field (FM). I live in a fairly small state, population wise, and there are 51+ job openings on Practicelink currently.

There are 11 psych jobs but that doesn't include the state DMH which has jobs at 6 facilities (doesn't say how many per location) and some of the listings are for multiple jobs within the same system so probably closer to 20-25 jobs.

 

[hebel]

It's hard to predict the future, but I'll give it a shot:

I think overall, psych is in a great place with an even better outlook for the foreseeable future. Currently, the only threat on my radar to psych's outlook as a whole is psychiatric nurse practitioners.

Realistically, however, I think this will mostly affect healthcare-system employed positions:

1. through hospital systems hiring NP's to fill positions that in the past would have been filled by an MD.
2. through hospital systems hiring MD's to serve in clinical leadership positions in which they supervise one or multiple NP's in some capacity (note, that this could transiently increase psych salaries similar to the bump in salaries anesthesiologists experienced when the CRNA supervision model started developing into the norm).

Here's why I don't think this will result in any sort of "crash:"

1. even with midlevels, the shortage of mental health care services is massive and is only getting worse (PLENTY of patients to go around).
2. NP's are generally squeamish to treating more severe mental illness, which is still a lot of people.
3. psychiatrists can still very realistically open a private practice, removing themselves almost entirely from the NP issue and the drawbacks of being an employee. *This is huge and is perhaps one of psychiatry's greatest features and safeguards for the future.*
4. compared to hospital-based specialties where midlevels are also a growing presence (EM, anesthesia, hospitalists, etc.), psychiatry is a field where patients generally have more control in choosing who they're treated by, which again gives a psychiatrist the power to differentiate themselves and attract patients to them. We are generally not a specialty that provides a service to patients based solely on what department's services the patient is utilizing (e.g. providing anesthesia to patients in the OR), but like surgeons are the provider a patient is seeking out for specialized care.

There's much more to be said about all of this, but I need to go to bed. But to med students interested in psych, I think it's a fantastic choice for a really fulfilling and potentially lucrative career.

 

[bronx43]

It's more competitive now because it's pretty clearly a better gig than general IM, general peds, cognitive specialty IM/peds (endo/rheum), neuro. Lifestyle wise (pay/hour, flexibility) it's probably better than or equivalent to EM/anesthesia/gen surg/OB. For a variety of reasons, this field is just never very call heavy, even for facility-based jobs. Subspecialties in this field are pretty cool and interesting so relatively more immune to midlevel penetration.

Still, we are not anywhere close to the true top fields, in terms of overall competitiveness: derm, subspecialty surgery (including ophthal, OB specialties, etc), radiology (esp. interventional), other procedure heavy gigs (i.e. pain anesthesia, GI/cards etc).

If you are an average candidate going into psych you can hope for a 300k job that's fairly chill. But if you go into subspecialty surgery the general expectation coming out of training (non-academic) is now 500k. They do work harder though. If you are savvy on your own in psych you can make 500k+, but no facility will ever pay you 500k. Department chairs at facilities rarely get paid 500k. Meanwhile, these days if you do well in private derm or plastics, or even rads, you can comfortably hit close to 1M...

So your assumptions aren't right. Psychiatry isn't really in a "bubble state". It's just crawling out of the bottom barrel...

Wait, how is psych Clearly better than cognitive IM specialty?
Not saying it’s not, but most rheum and endo don’t take much if any call and work 36-40 hours a week tops.

 

[Splenda88]

Not going to happen any time soon since there are too many mentally ill people in the US

 

[dl2dp2]

Wait, how is psych Clearly better than cognitive IM specialty?
Not saying it’s not, but most rheum and endo don’t take much if any call and work 36-40 hours a week tops.

Because they get paid quite a bit less these days, as a rule of thumb. ~ 30% or about 50k. Psych also 1) higher ceiling 2) more jobs around 3) can do cash/more control. Very few subspecialty IM cash practices.

 

[qwerty89]

I believe psych is the second oldest field (mean age of practicing physician) in medicine. Unless the field of psychiatry goes away, I don't see how the cush factor doesn't continue to rise for the foreseeable future.

Not to mention, at least in my experience, a lot of the old guard were FMGs who worked tons of hours. I know at least a few anecdotally. The new generation of psychiatrists are increasingly US graduates who want a nice lifestyle.

Takes a lot more folks working 40 hours a week to replace people who previously worked 60 hours.

The key variable though is increasing use of midlevels. There is no doubt that employers will take the cheapest labor they can get away with. This affects nearly all specialties. The key that psychiatry has is that is has very low overhead and has a cash only option as a way of mitigating against this.

 

[thepoopologist]

I'm a 4th year medical student hoping to match into psychiatry. A lot of the threads I've read here indicate that at some point soon, the field is going to crash from over-saturation or some other vague reason. There seems to be this feeling that the "pendulum will swing" in the opposite direction and growth of the field will dry up. Going on this interview season alone, I was shocked to see the massive increase in applicants. Last year, it appears 1 in 6 (approximately 17%?) of applicants didn't match into psychiatry. There's no doubt that it is a competitive specialty now and will be more so this year.

Does anyone have any thoughts or predictions on this? What is the outlook for people just starting their training in psychiatry? Will the job market be more competitive and less rewarding?

Go into it if it suits you. The most profitable specialty is the one you can stand the longest. I'm guessing psych is more competitive now because it offers a work schedule and generally lower risk that won't drive a person to despair.

The job market in general consists of businessmen trying to offer you the least amount of money for the most amount of work. The good offers and the bad offers both come from smiling polite people in suits who tell you the piece of paper you're about to sign is "boiler plate" and that you shouldn't read it.

The patient population in general consists of actual psychiatry, horrible people who arrive under the guise of mental illness, good people in horrible circumstances, and everything in between. Dealing with the patients is probably the least stressful aspect of the entire thing.

 

[psyguru]

As a forensic psychiatric expert witness, the 2nd oldest profession market forces plays out. However, not worried about np expert witnesses. Only case they can take is med mal involving NPs. The lower paying casses that do not involve medical aspects heavily can be done by Forensic psychologists.

 

[birchswing]

My opinions on parenting are rather controversial by today's standards, but based on how I see people raising (in my opinion not raising) their children and what I find bizarre attitude's toward having children (people having them and putting them in an institution while still in the infant stage and being outraged that taking care of an infant should cost them more than their cable bill), I don't see a shortage of people in need of fast fixes to paste over the cracks of skipping important stages of childhood development. Unfortunately I don't think medication can really paste over those cracks.

 

[hallowmann]

My opinions on parenting are rather controversial by today's standards, but based on how I see people raising (in my opinion not raising) their children and what I find bizarre attitude's toward having children (people having them and putting them in an institution while still in the infant stage and being outraged that taking care of an infant should cost them more than their cable bill), I don't see a shortage of people in need of fast fixes to paste over the cracks of skipping important stages of childhood development. Unfortunately I don't think medication can really paste over those cracks.

What? Where did most of that even come from?

I may regret this and I don't mean to derail, but...in many areas childcare costs >10x the amount of an expensive "cable bill" ($1000-$1500/mo), and the majority of people that are sticking their kids in "institutions" are doing so because the alternative would be to lose their job, because at best our country requires employers only hold a job for an unpaid 12 wk period. What exactly are parents supposed to do? That choice has nothing to do with a "fast fix". Barely anyone truly wants to send their kid to daycare instead of stay at home with them, but unlike many European countries where parents are guaranteed leave for 6-12 mos and better yet have safety nets for food and housing instability, many areas of our country have neither.

/rant

 

[BiscoDisco]

My opinions on parenting are rather controversial by today's standards, but based on how I see people raising (in my opinion not raising) their children and what I find bizarre attitude's toward having children (people having them and putting them in an institution while still in the infant stage and being outraged that taking care of an infant should cost them more than their cable bill), I don't see a shortage of people in need of fast fixes to paste over the cracks of skipping important stages of childhood development. Unfortunately I don't think medication can really paste over those cracks.

This is short sighted and completely oblivious to the reality faced by the majority of Americans. Including what I would guess are most of your patients.

 

[calvnandhobbs68]

My opinions on parenting are rather controversial by today's standards, but based on how I see people raising (in my opinion not raising) their children and what I find bizarre attitude's toward having children (people having them and putting them in an institution while still in the infant stage and being outraged that taking care of an infant should cost them more than their cable bill), I don't see a shortage of people in need of fast fixes to paste over the cracks of skipping important stages of childhood development. Unfortunately I don't think medication can really paste over those cracks.

I usually have your posts set on ignore but I had to see what all the fuss was about...

Who knows where this came from. I'm much more concerned about the large population of kids that are actually physically and sexually abused (which unfortunately there are many, many of and many of whom I see on a daily basis) than the kids that are put in daycare and preschool because their parents have to work during the day due to our abysmal non-existent parental leave policies in the US and non-existent childcare system.

 

[birchswing]

What? Where did most of that even come from?

I may regret this and I don't mean to derail, but...in many areas childcare costs >10x the amount of an expensive "cable bill" ($1000-$1500/mo), and the majority of people that are sticking their kids in "institutions" are doing so because the alternative would be to lose their job, because at best our country requires employers only hold a job for an unpaid 12 wk period. What exactly are parents supposed to do? That choice has nothing to do with a "fast fix". Barely anyone truly wants to send their kid to daycare instead of stay at home with them, but unlike many European countries where parents are guaranteed leave for 6-12 mos and better yet have safety nets for food and housing instability, many areas of our country have neither.

/rant

Edit 2: I know this will be accused of taking this thread off topic, so I wanted to remind why I think this is relevant to the question: In an era where people want or need quick fixes when bringing humans into this world (a surrogate parent at only several weeks of age), I think quick fixes will continue to be demanded from mental health professionals. Can psychiatrists here who see children honestly say they have not seen problems due to children being lost in the shuffle? From parents who put their interests or love lives or work lives so far above their children's needs that the children are brought in to be fixed when they could benefit most from an interested caregiver?

 

[hallowmann]

I have lived in both Sweden and the United States.

In Sweden there is guaranteed paid parental leave for 16 months for each child, and in the United States there is none. I don't need an education on this.

I think if you cannot afford to have a child in the United States it is incredibly irresponsible to have one. The needs of children don't change based on your needs, wants, or the prevailing political system.

What are parents supposed to do? Not have children that they cannot afford to raise. It's like asking why a person would be married if they didn't plan to live in the same state as the spouse. I suppose they could hire a prostitute to be a proxy spouse, but what would be the point?

I am very sympathetic with antinatalism, but if a person does decide to have a child they should at least allow it to have a chance to bond with a primary caregiver to have the best chances.

Consider the following: No one in the history of the world has had a child for the benefit of that child.

Now more than ever having a child is an incredibly selfish act (and I don't mean selfish perjoratively—objectively I don't see how you could argue that making something that does not exist in any form and then manifesting it could be for the benefit of anyone but the person creating it). I say now more than ever because people want to have children when there is every method available to prevent having one and when they know they will not have the time or resources to bond with that child.

If you look at dog rescues and the adoption process you have to go through to prove that you are willing to put in the time and energy and have the financial resources to take care of that dog, those rescue places would never hand over a dog to you the way some parents plan (or fail to plan) when having children.

I was reading recently on a reddit subreddit where a new parent was complaining that their infant was in some sort of large crib (I didn't really understand how it could be a normal sized crib) with 12 other infants and that it cost too much money. What shocked me the most was that she didn't take the child out of the daycare. She was ranting about it instead. It was $198 a week. No responsibility.

I believe in a lot of the Swedish model. But just as I would not think it wise to have a child in the middle of a violent war torn region, I don't think it's wise to have children in a system that does not allow you to provide for their needs no matter how unfair you may think that is to you (again it always goes back to the wants of the parent, which is a mindset I think needs to change). It does not change anything about the child's needs. It's a lot harder in the US. There's also a lot of consumerism where people spend beyond their means, or they are cajoled into thinking they should work (I think corporatist interests have pushed a lot of that lean in thinking—in a system where labor is increasingly unneeded but people are unwilling to demand public redistribution of wealth, it's to capital owners' benefit to continue emphasizing work as the means of income distribution with stagnant wages and making people feel as if it is a form of gender empowerment and downplaying motherhood as a form of empowerment). Anyhow because of economic factors or desire for different lifestyles that involve more consumerism or a desire to work long hours, I think a lot of people should not be having children who are having children. I think we should consider the morality of having children in general, but that's a slightly different conversation.

I have seen so many posts recently that really make me sad. On the Nextdoor app (and I live in a wealthy neighborhood), I recently saw this:

"We are looking for a dependable babysitter for before and after school care for two boys, 3 and 7 years old 5 days a week. This includes: waking them up, getting them ready for school (breakfast, getting dressed etc), putting the 7 year old on the bus at 9 am, and driving the little one to his daycare, which is about 5-7 mins away from the house. After school care will be until 5 pm"

I didn't write it but I felt like asking why they had kids and why they don't just put them up for adoption. They want a babysitter to take them to the daycare. What sort of childhood is that? How are they not even there in the morning?

I know the answer: economic reasons! Well it really is not that hard not to have a child. I've not been having a child for many decades now.

Edit: And to the idea that no one wants to send their child to daycare, I have friends where both spouses are doctors, work crazy hours, and have kids in daycare full time. If you go on some of the reddit forums (like TwoXChromosones) you'll find people who are making less than they are spending in childcare. They know this. They complain about it. But they continue it.

You're posts are very narrow-minded for someone that acts like they are culturally well-versed.

With all do respect, to put things into a little bit of perspective: I was in daycare at 6 wks, and that didn't stop my parents from caring for, raising me, and me becoming a well adjusted and successful physician.

My parents came to this country with barely anything. My brothers were born when my parents had plenty of means in their home country to care for them. But you know **** happens that you can't necessarily predict, you know like coups, wars, dictatorships, genocide, and complete economic turmoil. They came here with nothing but their 2 suitcases of clothes and their education. Perhaps they should have put my brothers up for adoption right then and there?

I was an accident, the result of a broken condom, or so I've heard. Would you have preferred that my parents abort me because they were both residents on a visa and taking more than the allotted 6 wks following a C-section would potentially make it impossible for them to complete their training, get citizenship, and give me the privileged life I actually lived?

Sometimes where people are coming from is very different than you can comprehend. The world isn't black and white. Daycare doesn't equal not raising your kids or having inadequate attachment.

I'm done with this. No more derailing the thread from me. But I just couldn't leave it there.

 

[birchswing]

You're posts are very narrow-minded for someone that acts like they are culturally well-versed.

With all do respect, to put things into a little bit of perspective: I was in daycare at 6 wks, and that didn't stop my parents from caring for, raising me, and me becoming a well adjusted and successful physician.

My parents came to this country with barely anything. My brothers were born when my parents had plenty of means in their home country to care for them. But you know **** happens that you can't necessarily predict, you know like coups, wars, dictatorships, genocide, and complete economic turmoil. They came here with nothing but their 2 suitcases of clothes and their education. Perhaps they should have put my brothers up for adoption right then and there?

I was an accident, the result of a broken condom, or so I've heard. Would you have preferred that my parents abort me because they were both residents on a visa and taking more than the allotted 6 wks following a C-section would potentially make it impossible for them to complete their training, get citizenship, and give me the privileged life I actually lived?

Sometimes where people are coming from is very different than you can comprehend. The world isn't black and white. Daycare doesn't equal not raising your kids or having inadequate attachment.

I'm done with this. No more derailing the thread from me. But I just couldn't leave it there.

I had a whole conversation with myself where I imagined discussing this further. I find it interesting and like your points and would love to discuss more, but I think I've taken up my allotted space here.

 

[Stagg737]

A lot of the threads I've read here indicate that at some point soon, the field is going to crash from over-saturation or some other vague reason.

I think you need to get out of the Allo/Osteo threads, because I've heard very little about the psych "bubble" popping anytime soon...

Most people will get 200-250k in psych. I don't see the 300k jobs in my area unless you are doing wknd calls.

Eh, in my city our academic center starts at $220k with ridiculous benefits (total compensation closer to $300k) and we're on the low end for our area. Idk what the norm for every region is, but it can vary a lot.

 

[punkedoutriffs]

I think you need to get out of the Allo/Osteo threads, because I've heard very little about the psych "bubble" popping anytime soon...



Eh, in my city our academic center starts at $220k with ridiculous benefits (total compensation closer to $300k) and we're on the low end for our area. Idk what the norm for every region is, but it can vary a lot.

What area is this?

 

[tr]

Edit 2: I know this will be accused of taking this thread off topic, so I wanted to remind why I think this is relevant to the question: In an era where people want or need quick fixes when bringing humans into this world (a surrogate parent at only several weeks of age), I think quick fixes will continue to be demanded from mental health professionals. Can psychiatrists here who see children honestly say they have not seen problems due to children being lost in the shuffle? From parents who put their interests or love lives or work lives so far above their children's needs that the children are brought in to be fixed when they could benefit most from an interested caregiver?

Actually there is a huge body of research literature on this and overall there is little in the way of good or ill effects from nonparental care overall. Effects of care quality can be observed on a more nuanced level. Generally, children from poorer families benefit from day care, while children from richer families see little in the way of either good or ill effects.

Mostly it is the socioeconomic, employment, and educational status of the parents that best predicts child outcomes, not whether the child was in nonparental care.

 

[MacDonaldTriad]

Mowgli was raised by Wolfs and Tarzan was raised by great apes and they turned out OK. Honestly, aristocrats have been outsourcing the raising of their children for a very long time and there may be some examples of this not going well, but mostly it is fine and the attachment is surprisingly normal. It is only relatively recently that this is frowned upon.

 

[whopper]

There will always be mentally ill people. I don't know what is meant by "crash." This isn't the stock market (although I did find the 2nd post making it like a Jim Cramer report very funny). There will always be a need for mental health treatment so long as there's people.

If anything there's a nationwide shortage of psychiatrists and even if more people apply into residencies, it's not like that increased number will affect the number of licensed/practicing psychiatrists for years. Further it's not like the number of residencies are then increasing dramatically to accommodate the increased number of applicants. There's still open spots. If you have a field where there's not enough applicants, open spots after MATCH, and more people apply, that doesn't translate to many many more psychiatrists available for practice for even years unless the number of spots significantly increases. If the number of spots remain relatively static it'll just mean psych residencies become more competitive, doesn't mean there'll be more out there.

But getting onto an interpretation of "crash" from my own perspective, I personally believe MDs (not completely, but will be decimated in need) will become obsolete within the next 100 years. Why do I say this? IBM's Watson was able to not only beat Jeopardy champions, it was able to take in medical information completing a medical school curriculum in months.

Yes of course it can't do a physical exam, but it can do a heck of a lot of stuff that will make several MDs not needed as much.

IBM Watson supercomputer turns to medicine

Computer maker says Watson can speed diagnosis and help doctors make better treatment decisions

www.cbsnews.com

Mind you the above link is from 2011!

Also frankly, I personally think Watson would do a better job than some physicians I've seen in practice. Now take in that processing speeds double every 18 months, extrapolate that and IMHO within years to decades you'll have a Watson able to outdo several MDs.

Just as truckers will at some point be replaced by self-driving trucks, I believe the same will happen to physicians. A large impediment to this is simply that people won't feel comfortable about it. Just as self-driving automobiles will one day be common, there'll be a generational backlash against it delaying it for years, but it will happen.

When it gets to this point in time I wonder just what will happen to humanity. A human population that doesn't work will be a population without a sense of purpose. Automation will eventually take away jobs even from those that use their brains, not just the labor force. Reminds me of the sci-fi novel-series Dune hundreds of years before the story actually begins. Humans got technology to the point where none of them needed to work. Computers took over. Then computers decided humans were no longer needed and humans being in a cultural state of no self-regulation, and no self determination were easy prey. (Thus then it started killing humans, humans fought back and it was called the Butlerian Jihad, computers were banned, religion again became a major force, a new monarchy is established, thus starts the story of Dune, a future with future technology but no computers, and with a monarchial government).

I've noticed that among people that are wealthy and don't have to work, it's very mentally unhealthy unless that person can find something to invest their time into that they find meaningful.

 

[Stagg737]

What area is this?

Midwest. PM me if you’d like more details.

 

[Merovinge]

When it gets to this point in time I wonder just what will happen to humanity. A human population that doesn't work will be a population without a sense of purpose. Automation will eventually take away jobs even from those that use their brains, not just the labor force. Reminds me of the sci-fi novel-series Dune hundreds of years before the story actually begins. Humans got technology to the point where none of them needed to work. Computers took over. Then computers decided humans were no longer needed and humans being in a cultural state of no self-regulation, and no self determination were easy prey. (Thus then it started killing humans, humans fought back and it was called the Butlerian Jihad, computers were banned, religion again became a major force, a new monarchy is established, thus starts the story of Dune, a future with future technology but no computers, and with a monarchial government).

I've noticed that among people that are wealthy and don't have to work, it's very mentally unhealthy unless that person can find something to invest their time into that they find meaningful.

Bah I think I need to rewatch this movie now...

 

[WisNeuro]

Bah I think I need to rewatch this movie now...

All the computer/Terminator type stuff happens in the prequel type novels. The movie just has Sting flying around like a spaz and that guy from Twin Peaks riding sandworms.

 

[MacDonaldTriad]

I remember not being able to get through it.

 

[whopper]

The movies was what happened thousands of years after the revolution. The movie doesn't cover that situation I talked about.

This however does cover that part.


I'd say it was like reverse-Star Trek with instead of ideal humans it was lazy, hedonistic and decadent ones. I'd say the closest sci-fi I can think of was that casino planet in Last Jedi, or the people in Sanctuary in Logan's Run (both bad movies).

 

[keolu hills]

It won't crash. There is a huge shortage for psychiatrists!

 

[VA Hopeful Dr]

The movies was what happened thousands of years after the revolution. The movie doesn't cover that situation I talked about.

This however does cover that part.


I'd say it was like reverse-Star Trek with instead of ideal humans it was lazy, hedonistic and decadent ones. I'd say the closest sci-fi I can think of was that casino planet in Last Jedi, or the people in Sanctuary in Logan's Run (both bad movies).

Asimov's Robot series addresses this pretty well

 

[TexasPhysician]

Just for giggles: The “collapse” will happen when the next big recession comes about. 50%+ (est) of psychiatrists are cash only. What will happen when people can’t afford it? Cash practices that are not well established may fold. More psychiatrists will look for PT or FT employed work. They will supplement their practice or get out entirely. Add in the midlevels and you will see a big influx of psychiatric supply for similar demand. This will drop rates.
This isn’t a true “collapse”, but it will likely drop rates.

 

[calvnandhobbs68]

Just for giggles: The “collapse” will happen when the next big recession comes about. 50%+ (est) of psychiatrists are cash only. What will happen when people can’t afford it? Cash practices that are not well established may fold. More psychiatrists will look for PT or FT employed work. They will supplement their practice or get out entirely. Add in the midlevels and you will see a big influx of psychiatric supply for similar demand. This will drop rates.
This isn’t a true “collapse”, but it will likely drop rates.

lol I doubt it. I didn’t see many plastic surgeons or dermatologists who ran cash only operations out on the streets in 2008-2009.

 

[calvnandhobbs68]

There will always be mentally ill people. I don't know what is meant by "crash." This isn't the stock market (although I did find the 2nd post making it like a Jim Cramer report very funny). There will always be a need for mental health treatment so long as there's people.

If anything there's a nationwide shortage of psychiatrists and even if more people apply into residencies, it's not like that increased number will affect the number of licensed/practicing psychiatrists for years. Further it's not like the number of residencies are then increasing dramatically to accommodate the increased number of applicants. There's still open spots. If you have a field where there's not enough applicants, open spots after MATCH, and more people apply, that doesn't translate to many many more psychiatrists available for practice for even years unless the number of spots significantly increases. If the number of spots remain relatively static it'll just mean psych residencies become more competitive, doesn't mean there'll be more out there.

But getting onto an interpretation of "crash" from my own perspective, I personally believe MDs (not completely, but will be decimated in need) will become obsolete within the next 100 years. Why do I say this? IBM's Watson was able to not only beat Jeopardy champions, it was able to take in medical information completing a medical school curriculum in months.

Yes of course it can't do a physical exam, but it can do a heck of a lot of stuff that will make several MDs not needed as much.

IBM Watson supercomputer turns to medicine

Computer maker says Watson can speed diagnosis and help doctors make better treatment decisions

www.cbsnews.com

Mind you the above link is from 2011!

Also frankly, I personally think Watson would do a better job than some physicians I've seen in practice. Now take in that processing speeds double every 18 months, extrapolate that and IMHO within years to decades you'll have a Watson able to outdo several MDs.

Just as truckers will at some point be replaced by self-driving trucks, I believe the same will happen to physicians. A large impediment to this is simply that people won't feel comfortable about it. Just as self-driving automobiles will one day be common, there'll be a generational backlash against it delaying it for years, but it will happen.

When it gets to this point in time I wonder just what will happen to humanity. A human population that doesn't work will be a population without a sense of purpose. Automation will eventually take away jobs even from those that use their brains, not just the labor force. Reminds me of the sci-fi novel-series Dune hundreds of years before the story actually begins. Humans got technology to the point where none of them needed to work. Computers took over. Then computers decided humans were no longer needed and humans being in a cultural state of no self-regulation, and no self determination were easy prey. (Thus then it started killing humans, humans fought back and it was called the Butlerian Jihad, computers were banned, religion again became a major force, a new monarchy is established, thus starts the story of Dune, a future with future technology but no computers, and with a monarchial government).

I've noticed that among people that are wealthy and don't have to work, it's very mentally unhealthy unless that person can find something to invest their time into that they find meaningful.

yeahhh that hasn’t worked out so well so far

IBM’s Watson gave unsafe recommendations for treating cancer

Doctors fed it hypothetical scenarios, not real patient data

www.google.com

Basically they ended up giving Watson hypothetical scenarios to learn off of bc real patient data was too complex and changing too quickly for it. Then when the tried to generate recs off that data it gave bizarre results at times. One of the oncologists called it a total piece of crap.

and this is basically the best supercomputer in the world right now working on a very highly protocolized field of medicine. Don’t think we’re getting replaced anytime soon.

 

[whopper]

Agree, but I do think decades down the road it'll be different, if not sooner.