Most "future proof specialty"; or one with the least likely chance to have to deal with BS in the future

[deleted831695]

I came into this thread seeking clarity, and now leave more confused than ever.

ITT: If you don't like anything surgical, or don't have the app for it, you're SOL.

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[InternistDO]

I came into this thread seeking clarity, and now leave more confused than ever.

ITT: If you don't like anything surgical, or don't have the app for it, you're SOL.

The real career advice should be to not take career advice from SDN, especially in the part of the forum that is mostly med students--who know nothing of the job market other than what they read on here and what grumpy attendings tell them.

 

[Epilepsy365]

I came into this thread seeking clarity, and now leave more confused than ever.

ITT: If you don't like anything surgical, or don't have the app for it, you're SOL.

Nope, the general advice from your residents and soon to be residents is to choose the specialty that you enjoy bc all specialties including those surgical ones are prone to encroachment to mid level providers in some capacity.

If you want to make bank, you need to run a business or be excellent at stock market investment.

 

[Rekt]

The real career advice should be to not take career advice from SDN, especially in the part of the forum that is mostly med students--who know nothing of the job market other than what they read on here and what grumpy attendings tell them.

Yeah, ignore attendings and residents and listen to the medical students and premeds saying everything is fine and to stop worrying.

 

[BorntobeDO?]

Yeah, ignore attendings and residents and listen to the medical students and premeds saying everything is fine and to stop worrying.

Don’t forget the ‘verified expert’s’ and preclinical advisors. The sun is always shinning. Nobody knows the market better than those who stay in the ivory tower and never enter it...

 

[deleted941485]

The real career advice should be to not take career advice from SDN, especially in the part of the forum that is mostly med students--who know nothing of the job market other than what they read on here and what grumpy attendings tell them.

They aren't grumpy for no reason. Clinical medicine is a grind. Students may not want to hear it day in and day out but soon enough they'll be residents and then attendings bitching just like the ones they shadowed.

Think of it this way. What are the chances things turn out in your favor versus not? there are more ways that a specialty can be screwed over than can go right.

But if you must have an answer to a future proof medical career, here is my 2 cents: Physician Manager

Benefits:

1. Better Hours/Risk:Reward ratio
2. Always have underlings to blame
3. Less stress
4. No Fee Schedule (Which is cut every year btw)

Look, Its probably a little hard to hear but there are already several speciaties that aren't worth the effort and in the coming decades its entirely plausable that clinical medicine is entirely devoid of any real financial rewards.

In the coming years I think clinical medicine will be WIDE open. Its just how long will you tolerate eating **** for?

 

[yesmaster]

In radiation oncology, we have many types of physician managers, including directors (suits with MBA's or a bogus healthcare management certificate, or former nurses), managed care (happy to give you 30 min of my time to do a P2P so you can pay for routine procedure), and academic chairs, who are constantly undercutting our clinical and financial independence.

Medical students: pay attention to which way the wind is blowing! Do not sail your ship against the wind.

 

[Postictal Raiden]

Recently, I have encountered a medical geneticist who is an NP.

A freaking medical geneticist. Usually you'd need a residency (Peds/IM/or neuro) followed by 2-3 year fellowship. An NP is doing it.

 

[IsWhat]

The answer to OPs question is easy.

Psychiatry.

Every other specialty has already bent the knee, or eventually will bend the knee, to corporate medicine. I’ll graduate from residency with the option to start my own practice right off the bat, and that is just something money can’t buy.

 

[Dr. Rafiki]

The answer to OPs question is easy.

Psychiatry.

Every other specialty has already bent the knee, or eventually will bend the knee, to corporate medicine. I’ll graduate from residency with the option to start my own practice right off the bat, and that is just something money can’t buy.

With the (re)emergence of DPC, one could make the same argument for FM or primary care IM.

 

[Drrrrrr. Celty]

The answer to OPs question is easy.

Psychiatry.

Every other specialty has already bent the knee, or eventually will bend the knee, to corporate medicine. I’ll graduate from residency with the option to start my own practice right off the bat, and that is just something money can’t buy.

Tbh, psychiatry's success has gotten a lot of moves from outside forces. Most FM programs these days train their grads to be pretty good at pretty much all non-psychotic disease. The FM guys in my house don't even refer to psych unless their patient is actively psychotic or schizophrenic. Bipolar and etc is pretty much all in house. Psych NPs are also so common these days that it hurts.

And this aside from the fact that Psych is heading towards becoming EM like. I.e lots of programs opening up every year.

 

[Drrrrrr. Celty]

With the (re)emergence of DPC, one could make the same argument for FM or primary care IM.

Most primary care even generic non DPC can do that. The issue is that it costs money to open up a practice or to buy an existing practice. Most people will join a group because it's easier and sure it's not 'freedom' it's not awful. Psych obviously is a lot easier to start because essentially you're going to be buying well, an office space and a blood pressure and spo2 device. Maybe a weight or something.

 

[Drrrrrr. Celty]

Recently, I have encountered a medical geneticist who is an NP.

A freaking medical geneticist. Usually you'd need a residency (Peds/IM/or neuro) followed by 2-3 year fellowship. An NP is doing it.

Don't get me wrong. I'm not as militant as some here about NPs/PAs. I think some easy return visit patients probably can be handled with a PA or NP once in a while. But I'm not entirely sure what a medical geneticist NP is supposed to do since a medical geneticist by definition is tackling pretty specific ****.

 

[Postictal Raiden]

Tbh, psychiatry's success has gotten a lot of moves from outside forces. Most FM programs these days train their grads to be pretty good at pretty much all non-psychotic disease. The FM guys in my house don't even refer to psych unless their patient is actively psychotic or schizophrenic. Bipolar and etc is pretty much all in house. Psych NPs are also so common these days that it hurts.

And this aside from the fact that Psych is heading towards becoming EM like. I.e lots of programs opening up every year.

I’d add that even psychiatrists themselves don’t manage active psychosis in an outpatient setting and would refer the patient to inpatient psych.

 

[LutGholein]

Recently, I have encountered a medical geneticist who is an NP.

A freaking medical geneticist. Usually you'd need a residency (Peds/IM/or neuro) followed by 2-3 year fellowship. An NP is doing it.

this is straight up aggravating to hear—how is this anywhere near their scope????

 

[IsWhat]

Tbh, psychiatry's success has gotten a lot of moves from outside forces. Most FM programs these days train their grads to be pretty good at pretty much all non-psychotic disease. The FM guys in my house don't even refer to psych unless their patient is actively psychotic or schizophrenic. Bipolar and etc is pretty much all in house. Psych NPs are also so common these days that it hurts.

And this aside from the fact that Psych is heading towards becoming EM like. I.e lots of programs opening up every year.

Yeah, but one thing still remains true with Psychiatry - You can start your own practice and the success of your career is 100% in your hands. Psychiatry is an entrepreneurs dream. If an FM doc or NP/PA wants to start their own psych practice and compete against me then be my guest. I will never have to sign my life over to a large company to make a decent living as a Psychiatrist and that’s something you simply cannot put a price on.

 

[Drrrrrr. Celty]

Yeah, but one thing still remains true with Psychiatry - You can start your own practice and the success of your career is 100% in your hands. Psychiatry is an entrepreneurs dream. If an FM doc or NP/PA wants to start their own psych practice and compete against me then be my guest. I will never have to sign my life over to a large company to make a decent living as a Psychiatrist and that’s something you simply cannot put a price on.

It is, for now. I'm just saying that the difference really between starting a psych practice and a FM practice is largely start up costs though. PCPs are just as highly in demand. I didn't say start their own psych practice. But rather take care of most psychiatric conditions. And in truth it makes economic sense to add it on.

I don't think any psychiatrists are going to be pushed out. But in 10 years I think it'll be a more contracted field.

 

[libertyyne]

It is, for now. I'm just saying that the difference really between starting a psych practice and a FM practice is largely start up costs though. PCPs are just as highly in demand. I didn't say start their own psych practice. But rather take care of most psychiatric conditions. And in truth it makes economic sense to add it on.

I don't think any psychiatrists are going to be pushed out. But in 10 years I think it'll be a more contracted field.

~80% of antidepressant scripts are already written by pcps.

 

[Sardonix]

this is straight up aggravating to hear—how is this anywhere near their scope????

How is that surprising? There are neonatology NPs and GI NPs and cardio NPs etc.

Having a fellowship doesn't mean NPs are blocked out from the field. If anything, it makes them more likely to go for it if it pays well.

 

[Sardonix]

~80% of antidepressant scripts are already written by pcps.

Tbh, psychiatry's success has gotten a lot of moves from outside forces. Most FM programs these days train their grads to be pretty good at pretty much all non-psychotic disease. The FM guys in my house don't even refer to psych unless their patient is actively psychotic or schizophrenic. Bipolar and etc is pretty much all in house. Psych NPs are also so common these days that it hurts.

I'd venture a guess you both are on pretty similar pages.

 

[Drrrrrr. Celty]

How is that surprising? There are neonatology NPs and GI NPs and cardio NPs etc.

Having a fellowship doesn't mean NPs are blocked out from the field. If anything, it makes them more likely to go for it if it pays well.

I don't think medical genetics pays well though. It's kind of a dry field for very nerdy folks.

 

[UnoMas]

Psych NPs (PMHNP- Psychiatric Mental Health Nurse Practitioner) nowadays take care of all psych conditions 'across the life span' after 3 years of direct entry DNP and passing a 125 questions 'board exams.' In the independent practice states, they can open their own 'practice' as well. Low-stake patient care, complications hard to measure or track.

Psychiatry is definitely NOT the answer; if anything it's one of the lowest hanging fruits.

 

[calivianya]

Psych NPs (PMHNP- Psychiatric Mental Health Nurse Practitioner) nowadays take care of all psych conditions 'across the life span' after 3 years of direct entry DNP and passing a 125 questions 'board exams.' In the independent practice states, they can open their own 'practice' as well. Low-stake patient care, complications hard to measure or track.

Psychiatry is definitely NOT the answer; if anything it's one of the lowest hanging fruits.

I was surprised when people kept saying psych for this reason. Some PMHNPs were talking about receiving offers for $200k in rural/high demand areas back in the day, though this wasn’t common. I can’t say anything about the degree today because I haven’t kept up with it. All I know was at the time it looked very attractive from the outside. Might not be a real problem yet but it could certainly become a real problem in the future.

That being said, I wouldn’t pick a specialty or rule out a specialty because of any of this. Every field either has LLP or AI creep or both in some way, and as others have said, it wouldn’t take much to completely change every specialty’s pay with the right governmental changes (unless you’re a cash only practice).

I think pretty much all physicians can count on finding a job somewhere after finishing residency right now, even if it’s not in your preferred city/region, and the job is going to pay good six figures. This is a whole lot better than some degree programs where the person graduates, spends months looking for jobs, and ends up having to stock shelves in a grocery store because they can’t find anything at all. The perspective on this forum has always seemed a bit off to me.

 

[WhereMyLiberalsAt]

I was surprised when people kept saying psych for this reason. When I used to frequent the allnurses forum, PMHNP was one of the hot things everyone was talking about. Some PMHNPs were talking about receiving offers for $200k in rural/high demand areas at the time, though this wasn’t common. I can’t say anything about the degree today because I haven’t kept up with it. All I know was at the time it looked very attractive from the outside. Might not be a real problem yet but it could certainly become a real problem in the future.

That being said, I wouldn’t pick a specialty or rule out a specialty because of any of this. Every field either has LLP or AI creep or both in some way, and as others have said, it wouldn’t take much to completely change every specialty’s pay with the right governmental changes (unless you’re a cash only practice).

I think pretty much all physicians can count on finding a job somewhere after finishing residency right now, even if it’s not in your preferred city/region, and the job is going to pay good six figures. This is a whole lot better than some degree programs where the person graduates, spends months looking for jobs, and ends up having to stock shelves in a grocery store because they can’t find anything at all. The perspective on this forum has always seemed a bit off to me.

Medicine is not “some” degree...

Your comfort level with a bunch of leeches undermining your “degree” is alarming.

Yes, when an individual doesn’t play their role in the system (providing care in underserved area) and they take jobs from more capable minds... They are leeches.

The sensitivity to mid-levels and their feelings on this forum seems a bit off to me. More times than not, posters preface their comment with some banal nicety to appease mid-level sympathizers.

 

[slowthai]

Every field either has LLP or AI creep or both in some way

Low level practitioner?

 

[Drrrrrr. Celty]

I was surprised when people kept saying psych for this reason. When I used to frequent the allnurses forum, PMHNP was one of the hot things everyone was talking about. Some PMHNPs were talking about receiving offers for $200k in rural/high demand areas at the time, though this wasn’t common. I can’t say anything about the degree today because I haven’t kept up with it. All I know was at the time it looked very attractive from the outside. Might not be a real problem yet but it could certainly become a real problem in the future.

That being said, I wouldn’t pick a specialty or rule out a specialty because of any of this. Every field either has LLP or AI creep or both in some way, and as others have said, it wouldn’t take much to completely change every specialty’s pay with the right governmental changes (unless you’re a cash only practice).

I think pretty much all physicians can count on finding a job somewhere after finishing residency right now, even if it’s not in your preferred city/region, and the job is going to pay good six figures. This is a whole lot better than some degree programs where the person graduates, spends months looking for jobs, and ends up having to stock shelves in a grocery store because they can’t find anything at all. The perspective on this forum has always seemed a bit off to me.

When your top 20 city with a pop >1million has a 6month wait list to see psychiatry for a non-cash paying or good private insurance patient it's going to draw in a ton of midlevels, get more pcps practicing, etc.

 

[calivianya]

Medicine is not “some” degree...

Your comfort level with a bunch of leeches undermining your “degree” is alarming.

Yes, when an individual doesn’t play their role in the system (providing care in underserved area) and they take jobs from more capable minds... They are leeches.

The sensitivity to mid-levels and their feelings on this forum seems a bit off to me. More times than not, posters preface their comment with some banal nicety to appease mid-level sympathizers.

I disagree that medicine isn’t just some degree, but that’s just me. It’s longer training, with more prerequisites, higher cost, and more paid training at the end than other programs, but medical school is still fundamentally a job training program. We might think we’re special, but we’ve got to remember that we also need to impress others in a much more objective way since we don’t reimburse ourselves.

The main problem as I see it is we keep arguing about merit and ability when we discuss LLPs, but the healthcare industry today is a money-driven business foremost. We’re more educated, we are better at diagnosing and treating the patients, blah blah blah... and while I agree that those things are intrinsically the most important things, the bean counters at the top care less about merit than they do about cold hard cash. As long as LLPs can do a lot of the same things we can for a much lower cost, we’ve got a real problem - either we need to do a better job at preventing LLPs from practicing independently and minimize their scope of practice in the first place, or we need to somehow prove hiring us is going to save money compared to hiring LLPs. I’m not too optimistic about either of those things at this point.

Low level practitioner?

Yep! Found that term in this thread and it made me laugh, so I’m going to use it.

 

[Candidate2017]

Tbh, psychiatry's success has gotten a lot of moves from outside forces. Most FM programs these days train their grads to be pretty good at pretty much all non-psychotic disease. The FM guys in my house don't even refer to psych unless their patient is actively psychotic or schizophrenic. Bipolar and etc is pretty much all in house. Psych NPs are also so common these days that it hurts.

And this aside from the fact that Psych is heading towards becoming EM like. I.e lots of programs opening up every year.

I get you're still bent from not getting into psych but stop the misinformation. If you think you are trained well enough, then you'd be a fool to not open a clinic seeing psych patients when you are done with FM residency.

PCPs prescribe the majority of meds for the majority of conditions (cardiac, GI, endo, ID etc). It's their job to be comfortable with many different diseases and generally be the first point of contact for patients and provide ongoing chronic care. It doesn't mean PCPs are the experts. And waiting for a pt to get "actively" psychotic prior to referring to psych is bad, bad medicine.

At the same time, there is a range of mental health conditions, patients, and services. PCP, NP, publicly funded clinic, PP insurance psychiatrist, PP cash pay psychiatrist, inpatient hospitalization, partial hospitalization, detox, prison, SW, MSW, PhD, and even cash pay Walmart counseling fill different niches. Not everyone requires a PP psychiatrist and not all patients are appropriate for a PP clinic.

 

[Candidate2017]

I was surprised when people kept saying psych for this reason. When I used to frequent the allnurses forum, PMHNP was one of the hot things everyone was talking about. Some PMHNPs were talking about receiving offers for $200k in rural/high demand areas at the time, though this wasn’t common. I can’t say anything about the degree today because I haven’t kept up with it. All I know was at the time it looked very attractive from the outside. Might not be a real problem yet but it could certainly become a real problem in the future.

NPs do the stuff psychiatrists don't want to do, like work for The Man and take heavy call. They leave when they realize its easier to see sniffles in the ED or PCP clinic. A minority will open their own cash clinics and charge about half the going cash rate. They provide much needed service when I turn away the addy and benzo seeking crowd.

 

[Candidate2017]

It is, for now. I'm just saying that the difference really between starting a psych practice and a FM practice is largely start up costs though. PCPs are just as highly in demand. I didn't say start their own psych practice. But rather take care of most psychiatric conditions. And in truth it makes economic sense to add it on.

I don't think any psychiatrists are going to be pushed out. But in 10 years I think it'll be a more contracted field.

About 50% of psychiatrists don't take insurance, compared to only 1-2% of PCPs.

The differences in starting a PCP vs psych practice is more than cost. It's societal attitudes toward mental health vs general healthcare. There is the expectation that healthcare is close to a right and PCPs should take tax-funded insurance/Medicare/caid.

Whereas insurance/Medicare/caid/govt/taxpayers never really loved psychiatrists. Most of us have literally and figuratively left the insane asylum that is healthcare and our patients and their families appreciate us and are willing to vote with their pocketbooks.

 

[libertyyne]

I get you're still bent from not getting into psych but stop the misinformation. If you think you are trained well enough, then you'd be a fool to not open a clinic seeing psych patients when you are done with FM residency.

PCPs prescribe the majority of meds for the majority of conditions (cardiac, GI, endo, ID etc). It's their job to be comfortable with many different diseases and generally be the first point of contact for patients and provide ongoing chronic care. It doesn't mean PCPs are the experts. And waiting for a pt to get "actively" psychotic prior to referring to psych is bad, bad medicine.

At the same time, there is a range of mental health conditions, patients, and services. PCP, NP, publicly funded clinic, PP insurance psychiatrist, PP cash pay psychiatrist, inpatient hospitalization, partial hospitalization, detox, prison, SW, MSW, PhD, and even cash pay Walmart counseling fill different niches. Not everyone requires a PP psychiatrist and not all patients are appropriate for a PP clinic.

Contrary to what you may think, not everyone wants to be a psychiatrist, im not going out of a limb when I say many physicians probably actively avoid trying to become one.

NPs do the stuff psychiatrists don't want to do, like work for The Man and take heavy call. They leave when they realize its easier to see sniffles in the ED or PCP clinic. A minority will open their own cash clinics and charge about half the going cash rate. They provide much needed service when I turn away the addy and benzo seeking crowd.

NPs have a habit of poaching the easiest least complicated patients from a panel, im not sure why this would be a good thing for psychiatrists considering mixed acuity panels allow you to offset some of the higher acuity patients where you might not get reimbursed as you should.

About 50% of psychiatrists don't take insurance, compared to only 1-2% of PCPs.

The differences in starting a PCP vs psych practice is more than cost. It's societal attitudes toward mental health vs general healthcare. There is the expectation that healthcare is close to a right and PCPs should take tax-funded insurance/Medicare/caid.

Whereas insurance/Medicare/caid/govt/taxpayers never really loved psychiatrists. Most of us have literally and figuratively left the insane asylum that is healthcare and our patients and their families appreciate us and are willing to vote with their pocketbooks.

Its hardly a choice to not take insurance when most of the time insurance doesnt provide much coverage and you have to go to private pay to make things work.

 

[Drrrrrr. Celty]

I get you're still bent from not getting into psych but stop the misinformation. If you think you are trained well enough, then you'd be a fool to not open a clinic seeing psych patients when you are done with FM residency.

PCPs prescribe the majority of meds for the majority of conditions (cardiac, GI, endo, ID etc). It's their job to be comfortable with many different diseases and generally be the first point of contact for patients and provide ongoing chronic care. It doesn't mean PCPs are the experts. And waiting for a pt to get "actively" psychotic prior to referring to psych is bad, bad medicine.

At the same time, there is a range of mental health conditions, patients, and services. PCP, NP, publicly funded clinic, PP insurance psychiatrist, PP cash pay psychiatrist, inpatient hospitalization, partial hospitalization, detox, prison, SW, MSW, PhD, and even cash pay Walmart counseling fill different niches. Not everyone requires a PP psychiatrist and not all patients are appropriate for a PP clinic.

Not in FM. Also not doing PCP. Yes, I did want to do Psych. Actually quite happy that I'm not, but I'll avoid touching on the topics of how I came to conclude that.

I don't disagree that Psych has an important place in medicine, that's literally not what I'm saying. I'm just saying that I literally cannot even get a single one of my patients to get to see one. So in fact yes, most of the time I'm doing their prescribing. And honestly, compared to managing life threatening diseases it's not that hard and most of my patients are doing well.

I would love to not be doing this and get my patients in to see psychiatrists for half the time. But it's literally a problem.

 

[Drrrrrr. Celty]

About 50% of psychiatrists don't take insurance, compared to only 1-2% of PCPs.

The differences in starting a PCP vs psych practice is more than cost. It's societal attitudes toward mental health vs general healthcare. There is the expectation that healthcare is close to a right and PCPs should take tax-funded insurance/Medicare/caid.

Whereas insurance/Medicare/caid/govt/taxpayers never really loved psychiatrists. Most of us have literally and figuratively left the insane asylum that is healthcare and our patients and their families appreciate us and are willing to vote with their pocketbooks.

Insurance still pays to keep the lights on. I've known more than a few folks who started their own practices. More just join groups because it is easier. Likewise most medical specialties do have inpatient privileges or enjoy doing that which again feeds into that. Personally when I finish fellowship I'll probably look for something that has a mix of out and inpatient medicine. It's more enjoyable to me than to just be exclusively outpatient.

 

[Sardonix]

I get you're still bent from not getting into psych but stop the misinformation. If you think you are trained well enough, then you'd be a fool to not open a clinic seeing psych patients when you are done with FM residency.

PCPs prescribe the majority of meds for the majority of conditions (cardiac, GI, endo, ID etc). It's their job to be comfortable with many different diseases and generally be the first point of contact for patients and provide ongoing chronic care. It doesn't mean PCPs are the experts. And waiting for a pt to get "actively" psychotic prior to referring to psych is bad, bad medicine.

At the same time, there is a range of mental health conditions, patients, and services. PCP, NP, publicly funded clinic, PP insurance psychiatrist, PP cash pay psychiatrist, inpatient hospitalization, partial hospitalization, detox, prison, SW, MSW, PhD, and even cash pay Walmart counseling fill different niches. Not everyone requires a PP psychiatrist and not all patients are appropriate for a PP clinic.

Wow, uncalled for.

 

[Candidate2017]

NPs have a habit of poaching the easiest least complicated patients from a panel, im not sure why this would be a good thing for psychiatrists considering mixed acuity panels allow you to offset some of the higher acuity patients where you might not get reimbursed as you should.

Difficult psych patients aren't necessarily the same as "high acuity" patients. Difficult outpatients generally have personality and substance issues. They prefer NPs because NPs are easier to manipulate into prescribing controlled substances or doing whatever it is the patient wants.

PhD therapists have the "easiest" patients: high functioning, engaged in treatment, weekly/daily visits, motivated to seek behavioral change not a prescription pad. This is where some overlap with cash psychiatrists occur.

 

[Candidate2017]

Not in FM. Also not doing PCP. Yes, I did want to do Psych. Actually quite happy that I'm not, but I'll avoid touching on the topics of how I came to conclude that.

I don't disagree that Psych has an important place in medicine, that's literally not what I'm saying. I'm just saying that I literally cannot even get a single one of my patients to get to see one. So in fact yes, most of the time I'm doing their prescribing. And honestly, compared to managing life threatening diseases it's not that hard and most of my patients are doing well.

I would love to not be doing this and get my patients in to see psychiatrists for half the time. But it's literally a problem.

Not everyone is motivated to see a psychiatrist. That's ok, the pt has to engage. I also often hear physicians and patients complain that access to psychiatrists is difficult/impossible, but I'm ok with that too. I can't see everyone, I don't want to see everyone, and just like surgeons who decline to operate, I can decline to take on cases. Resources are finite after all. Many illnesses would be prevented and more lives saved if we had nutritionists, personal trainers and chefs stop by everyone's house but we don't.

Yes, every healthcare professional with pt contact has an important role to play in mental health. I'm glad your pts are doing ok. But some psych illnesses and many psych meds aren't less life threatening. After all, the 80 hr work rule is due to a pt's death from interactions with psych meds.

 

[Drrrrrr. Celty]

Not everyone is motivated to see a psychiatrist. That's ok, the pt has to engage. I also often hear physicians and patients complain that access to psychiatrists is difficult/impossible, but I'm ok with that too. I can't see everyone, I don't want to see everyone, and just like surgeons who decline to operate, I can decline to take on cases. Resources are finite after all. Many illnesses would be prevented and more lives saved if we had nutritionists, personal trainers and chefs stop by everyone's house but we don't.

Yes, every healthcare professional with pt contact has an important role to play in mental health. I'm glad your pts are doing ok. But some psych illnesses and many psych meds aren't less life threatening. After all, the 80 hr work rule is due to a pt's death from interactions with psych meds.

That's near whataboutism. There are enough resources. We are simply a society that doesn't believe in justice. We just don't giving the people who need it them. It's the same reality in all fields of medicine.