Psych vs Radiology vs Pathology

[initialize]

Wasn’t sure where to post this — I’m still a med student but figured the people in this subsection would have better knowledge about this question:

Which of the aforementioned specialties has the best lifestyle when it comes to hours, stress levels, ease-of-learning during residency, etc?

I’m a non-trad student and older than most other students and have worked my fair share of stressful jobs before med school… I’m honestly at the point of my life where lifestyle is pretty much the only thing that matters to me lol.

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[gutonc]

Moving to Gen Res.

Good luck and godspeed.

 

[Clean7795]

Psychiatry.

You need to study a lot in a radiology and pathology residencies.

 

[gutonc]

Psychiatry.

You need to study a lot in a radiology and pathology residencies.

But you have to talk...a lot...in psych.

Not arguing one vs the others (because they all sound like hell to me despite my own practice involving aspects of all 3 on a daily basis), but it's a good way to break down ones own preferences.

 

[guytakingboards]

Radiology is a lot of studying during residency and the learning curve at the beginning is pretty steep. Call in residency usually sucks. You can find more lifestyle driven residencies. Most residencies that are fellow-heavy aren't too bad lifestyle wise.

Radiology has a wide-spectrum of lifestyles as an attending. There's plenty of M-F, 8-5pm mammo only gigs out there. Day-time telerad and eat-what-you-kill models are becoming more prevalent. The VA radiology gigs are pretty cush when considering production:time. The flip side is the partnership PP model where you take 10-16 weekends of call a year.

Anything radiology job with call is gonna be stressful to some degree. Radiology call varies from bad to awful in most jobs now.

All that is to say, there's a lifestyle path to becoming and working as a radiology attending but I'd probably guess it's less likely than something like psych would be.

 

[Spikebd]

Wasn’t sure where to post this — I’m still a med student but figured the people in this subsection would have better knowledge about this question:

Which of the aforementioned specialties has the best lifestyle when it comes to hours, stress levels, ease-of-learning during residency, etc?

I’m a non-trad student and older than most other students and have worked my fair share of stressful jobs before med school… I’m honestly at the point of my life where lifestyle is pretty much the only thing that matters to me lol.

Hard to beat the pathology lifestyle. Pathology also has a seemingly infinite amount of potential job prospects. You can try for a private practice gig - some are chill and you aren’t churning a ton of glass, others are more of a sweatshop style (probably pay well but you work hard). You can run a blood bank. You can be a dermpath expert. You can be a molecular pathologist working for a cutting edge diagnostic company. You can go into forensics. You could even become a Medical Microbiologist and be a leader in that field, if that interests you.

There’s certainly a learning curve as anatomic pathology isn’t really taught in med school, but with a little practice you begin to figure it all out. It will suck up some of your time off work, mostly during the first two years of residency.

Just pick a program where you aren’t getting excessively pimped out to the gross room and you should have plenty of time to get your cases done during the work day.

Pathology call does exist, but it’s more of a nuisance rather than soul-crushing. Frozen sections on weekends, organ harvests at night, blood bank call are a few of the things pathologists get woken up for. They aren’t that frequent though, even at a big academic center. As an attending, it’s more of a “I might have to stay until 6 to finish up the OR cases from the day” instead of “I’m going to be here all night until 12 on call” Radiology is a lot busier during nights and weekends. Not even comparable, really.

You’re wise to even be entertaining Path. Lifestyle is crucial for longevity. Just don’t be a ham like some other pathologists and be willing to settle for a scam academic salary. It’s the only thing holding the field back.

 

[forchinet121]

Psychiatry.

You need to study a lot in a radiology and pathology residencies.

You have to study in all residencies including psych

 

[clausewitz2]

You have to study in all residencies including psych

In some sense psych studying is worse because there are very few definitive answers to most questions of interest and to be any good you have to be able to conceptualize clinical situations in multiple different paradigms simultaneously, all of which are mutually contradictory. It's a bit like if you had to assess someone with liver dz based on MELD criteria but also be aware that their moon is in the fourth house and they are under the rising influence of Saturn and their hypos are up and they have an excess of choleric humor.

You can also just be a c**p psychiatrist, which is much easier, but not many people can bring themselves to go into a residency deciding in advance that they're going to s**k.

 

[Candidate2017]

But you have to talk...a lot...in psych.

It's the other way around. In rads, you talk all day long... into your dictaphone. In psych, you listen all day long.

Anyway, OP needs to define "stress" because hours/lifestyle for psych, rads, and path are fine as an attending. I suppose path is stressful if being unemployed or having to move to random places to get a job is not OP's cup of tea. Rads is stressful if OP doesn't like reviewing imaging studies at breakneck speeds.

Since OP is considering path and rads, perhaps OP finds patient contact stressful. Not everyone can deal with suicidal, homicidal, psychotic, substance using, threatening, non-cooperative, and/or personality disordered patients every day. Granted, you can limit your panel to "less serious" patients as an attending in private practice, to an extent. Even so, anxious, depressed, needy patients may stress someone who prefers to look at slides or stay in a reading room all day.

 

[RangerBob]

Psych and rads are dramatically different from one another. I was interested in psych as a med student. I did a rads rotation in internship and despite my attending telling me I didn't have to show up until 8-8:30 and sending me out by noon, I was actually more worn out those days than my 12-hr ICU days. Sitting and staring at that screen in the dark just wore me out so much. I literally took a nap everyday I got home! And you're getting much interaction with people-- I consider myself more introverted, but there's really much limited opportunities to have conversations with others in rads. It just got lonely.

I'm sure actual practice feels quite different since you're the one doing the reading and know what you're looking for (compared to me just watching the radiologist/looking at what they're looking at), but unless you can see yourself being happy literally sitting there for hours at a time reading study after study (and doing it quickly!), rads (to me!) sounds like a quick recipe for boredom/burnout. Obviously many disagree and are happy in the specialty, and I am thankful for the radiologists that enjoy doing what they do, just as they probably are thankful I like inpatient rehab!

Psych certainly is a unique one too. You hear some weird stuff and deal with some weird people. And sometimes you deal with the "woe-is-me, life is hard as a millionaire suburbanite..." type. I found all that quite interesting though! Ultimately I enjoyed rehab just a little bit more and went that way.

Everything looked the same to me in pathology, so it was clear that wasn't a good fit for me...

All three specialties have potential for great lifestyle, though I believe rads is getting much more hectic (maybe ask in the rads forum). So I'd ignore which has the best lifestyle and do the one you enjoy the most, as they're quite different and you may be substantially happier doing one specialty than the other that the small differences in time commitment are moot.

If you're just throwing out lifestyle specialties, you could consider PM&R. I do inpatient rehab and make a nice living working about 40hrs/week on inpatient rehab. Outpt have nice lifestyles too. But like the above specialties, if you don't like what you do, those are a miserable 40hrs/week, so find something you can at least tolerate!

 

[Splenda88]

Radiology

You can work from home while having a $$$ printing machine... 600k+/yr

 

[Mad Jack]

Do you like to talk to people or stare at things? Are you detail oriented or a big picture kind of person? How comfortable are you with uncertainty? Do you find it easier to navigate social situations or learn hard facts? Answer those questions and the specialty choice should be clear.

 

[vm26]

Radiology

You can work from home while having a $$$ printing machine... 600k+/yr

True but overrated in my experience as a rad. There's something unique to diagnostic radiology that makes it soul-sucking. Only real breaks are when you are not reading. Otherwise its very prolonged focus on a screen and dictating in the dark at a never-ending increasing volume and increasing case complexity. It's also becoming more and more isolating (particular in our Covid/Post-covid world) which contributes to burn-out. I would imagine that even surgeons can go on auto-pilot during a case and have light social interactions with staff-this stuff really matters when compounded over time...Don't get me wrong, I am very grateful and overall fairly content with being a rad. Just want to point out that sometimes things look/sound much better than they are.

With this said, I think psych has an advantage in the sense that it's more AI/mid-level resilient. Also think psych rotations as a med student are somewhat misleading (eg. hardcore in-pt care versus dealing with the worried well out-pts)...going cash-only is also nice

 

[Splenda88]

True but overrated in my experience as a rad. There's something unique to diagnostic radiology that makes it soul-sucking. Only real breaks are when you are not reading. Otherwise its very prolonged focus on a screen and dictating in the dark at a never-ending increasing volume and increasing case complexity. It's also becoming more and more isolating (particular in our Covid/Post-covid world) which contributes to burn-out. I would imagine that even surgeons can go on auto-pilot during a case and have light social interactions with staff-this stuff really matters when compounded over time...Don't get me wrong, I am very grateful and overall fairly content with being a rad. Just want to point out that sometimes things look/sound much better than they are.

With this said, I think psych has an advantage in the sense that it's more AI/mid-level resilient. Also think psych rotations as a med student are somewhat misleading (eg. hardcore in-pt care versus dealing with the worried well out-pts)...going cash-only is also nice

I don't know about other places but I always see these rad docs in the physician lounge or dinning room talking about politics.

Psych is NOT mid level resilient. Every NP these days wants to do psych. A friend of mine who is a psych NP has her own private practice in south FL and she is making banks.

I would have done rad if it was a 3-yr residency. The money is great, and patient interaction is overrated IMO.

 

[odyssey2]

True but overrated in my experience as a rad. There's something unique to diagnostic radiology that makes it soul-sucking. Only real breaks are when you are not reading. Otherwise its very prolonged focus on a screen and dictating in the dark at a never-ending increasing volume and increasing case complexity. It's also becoming more and more isolating (particular in our Covid/Post-covid world) which contributes to burn-out. I would imagine that even surgeons can go on auto-pilot during a case and have light social interactions with staff-this stuff really matters when compounded over time...Don't get me wrong, I am very grateful and overall fairly content with being a rad. Just want to point out that sometimes things look/sound much better than they are.

With this said, I think psych has an advantage in the sense that it's more AI/mid-level resilient. Also think psych rotations as a med student are somewhat misleading (eg. hardcore in-pt care versus dealing with the worried well out-pts)...going cash-only is also nice

I’ll also say that I think radiology student rotations are a little misleading in the opposite direction, ie, making it seem easier than it really is. Academics is more relaxed than private practice and students are never there during call when the workload gets insane. Unlike most other rotations med students are basically entirely useless in radiology and are often sent home after a couple hours just shadowing, watching a resident slowly work through a case at a pace that would be unacceptable in PP.

 

[vm26]

I don't know about other places but I always see these rad docs in the physician lounge or dinning room talking about politics.

Psych is NOT mid level resilient. Every NP these days wants to do psych. A friend of mine who is a psych NP has her own private practice in south FL and she is making banks.

I would have done rad if it was a 3-yr residency. The money is great, and patient interaction is overrated IMO.

Was unaware of mid-level infiltration into psych-can they actually prescribe meds? Truly alarming...Personally I don't even think PCP's should be prescribing psychotropics unless it's simply refilling for a stabilized patient that was under a psych's direct care...Guess I also have a biased, perspective in the sense that I/most of us on this forum, would never consider going to a mid-level for psychiatric care as a realistic option.

Most PP rads that are earning good money are also churning significant volume. I've been out about 10 years and have never really taken an official lunch break aside from the 10-15 minutes it takes to get the food etc. Then again I read at an average PP rate so its possible that the faster readers can get some down time to chill

 

[vm26]

I’ll also say that I think radiology student rotations are a little misleading in the opposite direction, ie, making it seem easier than it really is. Academics is more relaxed than private practice and students are never there during call when the workload gets insane. Unlike most other rotations med students are basically entirely useless in radiology and are often sent home after a couple hours just shadowing, watching a resident slowly work through a case at a pace that would be unacceptable in PP.

Def true. Its semi-useless aside from the fact that you can ask the resident/attending questions about the field etc

 

[Splenda88]

Was unaware of mid-level infiltration into psych-can they actually prescribe meds? Truly alarming...Personally I don't even think PCP's should be prescribing psychotropics unless it's simply refilling for a stabilized patient that was under a psych's direct care...Guess I also have a biased, perspective in the sense that I/most of us on this forum, would never consider going to a mid-level for psychiatric care as a realistic option.

Most PP rads that are earning good money are also churning significant volume. I've been out about 10 years and have never really taken an official lunch break aside from the 10-15 minutes it takes to get the food etc. Then again I read at an average PP rate so its possible that the faster readers can get some down time to chill

Most RN these days wanna become psych NP because 200k is not difficult to make as a psych NP. There is a big shortage in psych and mid level take advantage of that... Now they have psych certificate that any NP can get in 8-12 months and start prescribing psychotropic meds. Our healthcare system is [insert].

I think FM should be able to treat MDD and anxiety.

 

[vm26]

Most RN these days wanna become psych NP because 200k is not difficult to make as a psych NP. There is a big shortage in psych and mid level take advantage of that... Now they have psych certificate that any NP can get in 8-12 months and start prescribing psychotropic meds. Our healthcare system is [insert].

I think FM should be able to treat MDD and anxiety.

Yes our HC system is a mess. Unique blend of competing forces. Not sure how long it lasts-average CMS pt pays in about 150K and uses about 500K in benefits. Throw in our obesity/diabetic epidemic and rising costs of just about everything including medical education...Mid-levels did a nice job of lobbying. Wonder what their malpractice insurance costs. Interestingly I've heard that physicians are unable to testify against mid-levels in malpractice suits...Again nice job of lobbying and adjusting "standard of care" while collecting 85% of what physicians get from CMS/commercial insurers. I know somewhat off topic but related to the future of all our professions

 

[Splenda88]

Yes our HC system is a mess. Unique blend of competing forces. Not sure how long it lasts-average CMS pt pays in about 150K and uses about 500K in benefits. Throw in our obesity/diabetic epidemic and rising costs of just about everything including medical education...Mid-levels did a nice job of lobbying. Wonder what their malpractice insurance costs. Interestingly I've heard that physicians are unable to testify against mid-levels in malpractice suits...Again nice job of lobbying and adjusting "standard of care" while collecting 85% of what physicians get from CMS/commercial insurers. I know somewhat off topic but related to the future of all our professions

State like Oregon reimburses them 100%... Now midlevels want to supervise midlevels. Where will this end?

 

[vm26]

State like Oregon reimburses them 100%... Now midlevels want to supervise midlevels. Where will this end?

View attachment 360627

I guess if they have the skill-set to manage a complex case or an apparently straight forward case that goes south real fast, then G*d Bless. I suspect that there will be a tipping point where med-malpractice plaintiff attorneys have enough mid-level "expert" witnesses and begin to smell blood in the water. Ensuing feeding frenzy should play some role in scope of practice

A friend of mine from med-school is an anesthesiologist practicing in Long Island. NY. CRNA's compensation had been slowing getting close to those of a physician. Got to a point where hospitals/groups decided to go with physicians purely based on economics/expertise. Long Island is clearly not Oregon so this is geographical but funny how perceived success can come and bite you in the a$$.

 

[90sportsfan]

I think it kind of depends on how you are looking at “stress.” If you are an introvert working with some of the types of people/personalities could could encounter in Psych, that could be really stressful, depending on the environment. On the other hand, stress of “making the call” and putting your name on the report in Radiology/Path could be really stressful.

Psychiatry is one of the lowest-risk specialty in terms malpractice risk, along with Derm. Rads is on the higher end in terms of malpractice risk, and Path has one of the highest payouts for malpractice (which is not surprising since you are making calls on whether something’s malignant or not). So if you’re looking at stress from a malpractice perspective, it could be different.

So it totally depends on the “kind of stress” you are looking to avoid.

 

[tr]

I think it kind of depends on how you are looking at “stress.” If you are an introvert working with some of the types of people/personalities could could encounter in Psych, that could be really stressful, depending on the environment.

I don't think introversion is a contraindication to psychiatry. I'm a huge introvert and outpatient psych works great for me. The patient contact is all focused, one-on-one conversations with predetermined, controllable hours. (It helps that I'm in academics and hover around a 50/50 or 40/60 split between research and clinic time.)

I wouldn't want to do psych ER for my job though. But for sure spending all day looking at slides or images would not be for me.

 

[dozitgetchahi]

It's the other way around. In rads, you talk all day long... into your dictaphone. In psych, you listen all day long.

Anyway, OP needs to define "stress" because hours/lifestyle for psych, rads, and path are fine as an attending. I suppose path is stressful if being unemployed or having to move to random places to get a job is not OP's cup of tea. Rads is stressful if OP doesn't like reviewing imaging studies at breakneck speeds.

Since OP is considering path and rads, perhaps OP finds patient contact stressful. Not everyone can deal with suicidal, homicidal, psychotic, substance using, threatening, non-cooperative, and/or personality disordered patients every day. Granted, you can limit your panel to "less serious" patients as an attending in private practice, to an extent. Even so, anxious, depressed, needy patients may stress someone who prefers to look at slides or stay in a reading room all day.

Yeah, this to me is the main point.

Path and rads have some similarities, in that they’re practiced primarily “off stage” away from patients. Sometimes doctors who want less contact with other humans head into these specialties (no joke, it’s true).

Psych is basically the exact opposite in that the practice of psych is almost entirely “on stage” - you’re almost always interacting directly with patients. Psych generally attracts very different personality types of doctors than rads/path.

“Best lifestyle” is something that can be hard to quantify when comparing specialties as different as these. Perhaps a better question is “which specialty offers the best lifestyle for you and your personality”. If your goal is purely to spend as few hours working as possible and to feel less stressed while you do, then the classic answers are things like derm, rheumatology, allergy/immunology, etc. However, someone attracted to psych may dread dermatology…someone who doesn’t want to round and doesn’t like long extended relationships with patients may love anesthesia and hate IM subspecialties that require clinic…someone who loves procedures may hate thinking subspecialties like renal and heme/onc…etc etc etc. You need to know yourself and also experience these specialties firsthand to know what you want.

I kinda liked rads as a medical student, until I realized I didn’t necessarily want a medical desk job and hanging out in a dark room all day reading into a microphone seemed a bit weird. I’m now a rheumatologist.

 

[dozitgetchahi]

In some sense psych studying is worse because there are very few definitive answers to most questions of interest and to be any good you have to be able to conceptualize clinical situations in multiple different paradigms simultaneously, all of which are mutually contradictory. It's a bit like if you had to assess someone with liver dz based on MELD criteria but also be aware that their moon is in the fourth house and they are under the rising influence of Saturn and their hypos are up and they have an excess of choleric humor.

You can also just be a c**p psychiatrist, which is much easier, but not many people can bring themselves to go into a residency deciding in advance that they're going to s**k.

Unfortunately, if you look around you will notice a surprising number of psychiatrists who are ok being “crap”. I think part of the problem is that, as you alluded to, it’s one of the harder specialties intellectually and yet for years it was considered not especially competitive and thus drew from the bottom of the talent pool at the residency match.

 

[clausewitz2]

Unfortunately, if you look around you will notice a surprising number of psychiatrists who are ok being “crap”. I think part of the problem is that, as you alluded to, it’s one of the harder specialties intellectually and yet for years it was considered not especially competitive and thus drew from the bottom of the talent pool at the residency match.

Oh, I am very aware that there are, I just don't think they go into residency intending to be that way. We are getting more competitive candidates now in psychiatry by match statistics but I fear the reputation as a lifestyle specialty means that we are selecting mainly for the accomplished-but-workshy.

 

[PB2464]

Radiology

You can work from home while having a $$$ printing machine... 600k+/yr

Psych also has the ability to work from home. Tons of telepsych opportunities.