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Career as a Psychiatry


PSYCHIATRY:

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.

Initial psychiatric assessment of a person typically begins with a case history and mental status examination. Physical examinations and psychological tests may be conducted. On occasion, neuroimaging or other neurophysiological techniques are used. Mental disorders are often diagnosed in accordance with clinical concepts listed in diagnostic manuals such as the International Classification of Diseases (ICD), edited and used by the World Health Organization (WHO) and the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA). The fifth edition of the DSM (DSM-5) was published in 2013 which re-organized the larger categories of various diseases and expanded upon the previous edition to include information/insights that are consistent with current research.

The combined treatment of psychiatric medication and psychotherapy has become the most common mode of psychiatric treatment in current practice, but contemporary practice also includes a wide variety of other modalities, e.g., assertive community treatment, community reinforcement, and supported employment. Treatment may be delivered on an inpatient or outpatient basis, depending on the severity of functional impairment or on other aspects of the disorder in question. An inpatient may be treated in a psychiatric hospital. Research and treatment within psychiatry as a whole are conducted on an interdisciplinary basis with other professionals, such as epidemiologists, nurses, or psychologists.


WHAT DO THEY DO?

Although the location of the problem is the brain, unlike neurologists, psychiatrists do not treat organic or structural disorders such as epilepsy, consequences of strokes, or brain cancers. However, these disorders may also cause psychiatric symptoms and mental alteration in certain patients, which requires the ability to make a differential diagnosis and apply correct treatment.

Psychiatrists need to have an excellent understanding of basic psychology and must possess psychotherapy skills to attempt to influence the patient's disorder with less medication. In fact, many psychiatric disorders such as depression, anxiety and certain phobias may be effectively treated through psychotherapy. Medication in psychiatry is used only when counselling and therapy fail to produce noticeable results.

Psychiatrists are doctors who are dedicated to providing the best treatment and care for mental disorders with compassion and patience. They must have excellent communication skills and a high degree of emotional intelligence to understand the patient's emotional and mental problems and formulate the best course of action for their treatment.

Unlike other fields of medicine, the treatment regimen in psychiatry may change significantly depending on the patient's response to medication or psychotherapy. With proper psychological, emotional and social support, many patients who have severe mental symptoms are able to improve and reconnect with society, which allows mental health professionals to lower medication dosages. In certain cases, relapse of symptoms may occur, which requires a new treatment strategy and elaboration of alternative therapies for a particular patient.

Psychiatrists treat a great variety of mental disorders ranging from mild and temporary to severe and chronic. For example, depression, which is a mental disorder that involves intense feelings of sadness and lack of motivation, may be effectively treated through psychotherapy, and does not require medication in all cases.

Mild depression may be a transient condition, and may be the result of emotional trauma and tragic events in the patient's life. Psychiatrists must be able to identify early signs of depression and find its roots, and then apply psychotherapy techniques and potentially antidepressants to treat the patient.

Anxiety disorders are another common category of mental disorders that are addressed by psychiatrists. They involve unexplained fear, panic or phobias that are manifested in certain situations and greatly affect the patient's career, social life and mood. Along with depression, anxiety disorders are considered mild psychiatric disorders because they are usually temporary and respond well to treatment, which frequently results in full recovery.

Patients who suffer from hallucinations and delusions may have more severe psychiatric disorders such as schizophrenia. This mental disorder requires careful evaluation of each case, and is usually treated through medication. Although schizophrenia is considered a chronic mental disorder, there are many cases of effective recovery and elimination of medication in certain patients. Moreover, some patients who suffer from delusions may gradually reintegrate into society through psychotherapy, work and friendships, and are able to function as normal individuals on low doses of medication or no medication at all. The final results greatly depend on the ability of the psychiatrist to recognize the potential for a patient to recover and cope with his or her mental disorder.


REQUIREMENTS;

Psychiatrists have distinct personalities. They tend to be investigative individuals, which means they’re intellectual, introspective, and inquisitive. They are curious, methodical, rational, analytical, and logical. Some of them are also artistic, meaning they’re creative, intuitive, sensitive, articulate, and expressive.

There are various requirements for Psychiatrists that they need to fulfil to pursue a career in being a Psychiatrist. The requirements are classified under three heads –


EDUCATIONAL AND GENERAL QUALIFICATIONS:

Complete a Bachelor’s Degree Program

The first step to becoming a psychiatrist is to earn a bachelor’s degree from an accredited institution. In preparation for medical school, a good choice would be to focus on pre-med, physical sciences or psychology — or a combination of the three by utilizing a double major or minor.

The courses a student takes during the bachelor’s program depend upon the major and minor, but some courses are recommended for those who intend to apply to medical schools. For instance, students majoring in psychology will likely take the following courses:

  • Developmental psychology

  • Statistics

  • Personality psychology

  • Biopsychology

  • Abnormal psychology

  • Ethics

  • Life science

Medical school admissions are very competitive, so high grades and an impressive list of courses during undergraduate study are essential. Students should also plan ahead for the next step in their journey by taking advantage of any prep classes offered for the MCAT.

Take the Medical College Admissions Test

The MCAT is a vital component of the admissions process for medical school. This examination is a standard test comprised of three multiple-choice sections. Students should take the MCAT the year before they intend to apply to medical school; they are allowed to take it as many times as necessary in order to pass. Those who need to retake the MCAT can sign up for a new testing period two days after their previous examination.

Medical schools evaluate prospective students’ score on the MCAT and their undergraduate performance to determine whether to offer the student enrollment.

Complete an MD or DO Degree Program

Students who enter medical school can choose between two designations to eventually become a psychiatrist: a Doctor of Medicine (MD) program or a Doctor of Osteopathic Medicine (DO) program. Each degree focuses on the same methods of treatment, but a DO degree also focuses on osteopathic manipulative medicine.

No matter the degree, students can expect to complete four to five years of training in medical school. The first few years focus on basic classes in pathology, anatomy, biology and other science-related fields. The second half of the program focuses on clinical rotations with doctors and other healthcare professionals, allowing students to hone their skills in psychiatric practice. Students might also be invited to participate in research programs.

Courses taken during medical school vary widely depending upon the program, but students studying psychiatry can expect to take the following, among others:

  • Behavioral science

  • Psychopathology

  • Psychiatry clerkship

Complete a Residency

Once students have graduated from medical school, they still need some supervised training. During their residency, students work for three to eight years in a clinical or hospital setting. They are given the opportunity to further hone their skills during this time as they work under the direction of licensed psychiatrists.

Get Licensed and Board-Certified

Students who complete medical school and a successful residency can then apply for their medical license and board certification. Those who graduate from an MD program take the U.S. Medical Licensing Examination (USMLE), while those who graduate from a DO program take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA).

After receiving their medical license, students can take the examination for board certification, which is offered through the American Board of Psychiatry and Neurology (ABPN). Students who sit for board certification can take the test as many times as necessary in order to pass. Certification must be renewed every ten years.

Continue Learning

Earning a psychiatry degree and becoming licensed does not mean the education ends. Those who earn their board certification must enter into continuing education programs throughout their career in order to remain certified. For most psychiatrists, this includes an average of 30 credits earned per year. Some states might require even more continuing medical education (CME) credits in order to continue practicing.


With faster-than-average growth projected for the field, those with a psychiatry degree can expect employment opportunities. According to the Bureau of Labor Statistics, psychiatric position openings should grow by 16.2 percent from 2012 to 2022. Much of this growth can be attributed to more attention paid to psychiatric services as well as recent legislation expanding healthcare coverage. Those with psychiatry degrees can often find work in every corner of the healthcare industry, including hospitals, private clinics, home healthcare, residential care facilities, community services and even local and state government.

The following jobs related to psychiatry are also expected to be in high demand in the coming years:

Hot Job Related To Psychiatric

  • Advanced practice psychiatric nurse

  • Health specialties teacher (postsecondary)

  • Healthcare social worker

  • Marriage and family therapist

  • Mental health and substance abuse social worker

  • Neurologist

  • Registered nurse

  • Substance abuse and behavioral disorder counselor


SKILLS:

Psychiatrists work closely with a variety of patients on a daily basis and thus must have excellent communication skills, including a top-notch ability to listen and develop a good rapport with patients. Good observational skills are a must, as a psychiatrist should be able to study patient behavior and reactions to medications or other treatments. The job requires a significant amount of patience and compassion, social perceptiveness, and the ability to make judgments and decisions based on both prior and new information.


KNOWLEDGE:

Using medical software is a requirement for today’s psychiatrist. In addition to a variety of software that facilities electronic health records, psychiatrists must become familiar with software specific to mental health professions, such as SoftPsych Psychiatric Diagnosis, MEDITECH Behavioral Health Clinicals and Advantage Software Psych Advantage. They must also have familiarity with some of the medical devices used in an office setting, such as blood pressure cuffs and stethoscopes. Finally, they must have a basic knowledge of certain procedures and the equipment used in those procedures, such as PET scans and CT scans.

Psychiatrist Credentials

In addition to the medical license and board certification in psychiatry, there are several subspecialties in the field that also offer certification. These usually require additional training or fellowships. Some of the possibilities include:

  • Geriatric psychiatry

  • Psychosomatic medicine

  • Addiction psychiatry

  • Forensic psychiatry

  • Clinical neurophysiology

  • Child and adolescent psychiatry

  • Brain injury medicine

  • Hospice and palliative medicine

Once these credentials are earned, they are subject to the same CME requirements as any other board certification through the ABPN.


SALARY;

Psychiatrists earn an average yearly salary of ₹145k. Wages typically start from ₹101k.

Salary

₹101k - ₹2m

Bonus

₹1k - ₹360k

Profit Sharing

₹0 - ₹430k

Commission

₹0 - ₹13k

Total Pay

₹117k - ₹4m


JOB OUTLOOK;

Psychiatrists usually work in hospitals, psychiatric clinics or other mental health institutions. They may also work at private medical offices. Primary care units and emergency departments usually don't have psychiatrists because mental disorder symptoms are not considered emergencies, although, if severe enough, they may require sedation until the patient is transported to a psychiatric clinic. Psychiatrists may also work part-time in prisons or other correctional facilities.

The Bureau of Labor Statistics projects growth of 16.2 percent from 2012 to 2022 for psychiatrists, a number that is higher than the national average for all other occupations. A great deal of this growth could be spurred by more attention to mental health matters, as well as healthcare legislation that makes health insurance more affordable for many Americans. As a result, more people are expected to reach out for help from the medical establishment, including those who need the skills of a psychiatrist.

Another reason for growth is that the baby boomer generation is rapidly aging. As more individuals suffer medical issues due to aging, the skills of a psychiatrist will be needed to help them through the changes and challenges they will inevitably face. Psychiatrists can expect better job opportunities in areas with a higher aging population.


Frequently Asked Questions;

Both psychiatrists and psychologists conduct psychotherapy and research, but there are significant differences between the two professions.

The first difference is in education: a psychiatrist has a degree in medicine, and is a medical doctor, whereas the psychologist has a degree (a masters or a doctorate) in psychology. The second difference is that a psychiatrist can prescribe medication, whereas a psychologist cannot.

If you are trying to choose between the two careers, you will need to determine if you would prefer to assess, diagnose, treat and prevent mental illness and be able to prescribe medications to your patients (psychiatrist), or if you would prefer to conduct psychotherapy, administer psychological tests, and conduct research (a psychologist).


It's good for a psychiatrist to think of a patient in a holistic way, and to ask the patient about diet, exercise, sleep, relationships, support systems, and different stressors in their life in order to make an informed assessment and a proper evaluation.

It is also important for the psychiatrist to possess some degree of humility when speaking to the patient, even admitting to not knowing something if that is the case, and telling the patient that he will look into the matter. This shows a partnership and a collaboration with the patient, which will produce more success in the end.

It also goes without saying that a psychiatrist needs to be able to really listen to his/her client, and convey authentic concern, always being respectful of the patient's feelings.


A student will typically get into the field of psychiatry because it is almost like a calling to them. Psychiatry can be quite stressful sometimes, especially if one chooses to work with more acutely ill patients. But for the most part, the culture of this career tends to be more laid back than others. People who have psychiatric illnesses often need quite a bit of time in order to make positive changes and will tend to have a longterm relationship with their psychiatrist. Therefore, a psychiatrist needs to be patient and have a relaxed attitude, knowing that he or she will be having a long, intense relationship with the patient.

There are many choices of career paths within the psychiatric field, so one can choose a calm, predictable outpatient practice, or a busy acute inpatient unit or ER. One can construct a schedule as busy or as calm as one may like.


Psychiatry is different from other areas of medicine - and mental suffering is different from other areas of illness. When the body is ill, it impacts the body. When the mind is sick, it impacts the person—the very substance of who that person is. And that can be unsettling. No wonder there is a stigma among the general public that psychiatry is a pseudoscience and that one should be slow to trust mental health care providers. It's both unfair and unfortunate that a doctor saying they are a psychiatrist at a dinner party earns far less respect than a doctor saying they are a neurosurgeon or a cardiologist.

The brain is one of the most important and most complex things that exists, however our understanding of brain science is still in its infancy. Psychiatrists are at the frontline of the many ethical, legal, moral, and medical issues that confront them when they encounter patients who are hallucinating, catatonic, aggressive, suicidal, paranoid, high on drugs, and physically sick. They need to base their assessments through clinical observations and history-taking, as opposed to predominantly using laboratory tests. This is because diagnostic imaging or blood tests don’t exist for most psychiatric disorders.

As doctors, psychiatrists understand the ins and outs of the body as well as the mind. Their training - four years of medical school followed by four years of psychiatric residency - allows them to diagnose basic and complex psychiatric conditions which include: psychosis; affective disorders; anxiety disorders; and behavioural disorders. They are also able to prescribe medications, to deliver psychotherapy, and to administer somatic therapies. Some psychiatrists specialize in liason psychiatry, childhood and adolescent psychiatry, or forensic psychiatry.

There are those with the opinion that psychiatric treatment (medication) is dangerous, unnecessary, and should be avoided at all costs. Others say that psychiatrists have dramatically improved their quality of life. Unfortunately, while other medical professions benefit from online reviews or word-of-mouth referrals, psychiatric care still carries a stigma and most people who see psychiatrists keep their opinions and experiences to themselves. People don't tend to feel comfortable posting public reviews and sometimes avoid even telling their close family/friends about their psychiatrist.


A psychiatrist's day-to-day schedule will vary by setting and area of practice - and their work and time commitments are set according to their personal lifestyles and needs. However all psychiatrists have similar duties during the course of a day.

Patient Assessments A psychiatrist's day is typically filled with individual patient appointments. When first meeting a patient, a psychiatrist will perform a psychiatric evaluation and an assessment, which involves talking about the patient's reason for seeking help. The presenting problem can span from depression, substance abuse, or job stress to more serious forms of illness such as schizophrenia. The psychiatrist will provide a diagnosis and recommend a course of treatment based on the assessment outcome.

Patient Rounds For psychiatrists who are employed in substance abuse treatment centres or hospitals, a typical day begins by performing patient rounds. This involves going through the psychiatrist's caseload, discussing cases with interns or residents, touching base with each patient to see if any changes to medications or treatments are needed, and keeping up-to-date with any off-duty admissions and issues.

Treatment Treating patients is a large part of a psychiatrist's day, and involves far more than prescribing medication. They can either specialize in offering specific forms of treatment or in offering a wide array of treatment (such as psychoanalytic psychotherapy, short-term psychotherapy, cognitive-behavioural therapy, or electroconvulsive therapy).

Psychotherapy is a method which involves regularly scheduled meetings between a patient and the psychiatrist. In this scenario, the patient discusses their problems/feelings, and the psychiatrist attempts to help the patient discover and understand the root of their issue(s) and helps to change a patient's thought patterns and behaviours. Treatment may take just a few sessions over a few weeks or months, or many sessions over several years.

Psychoanalysis is a treatment method that requires the psychiatrist to have additional years of training in psychoanalysis. It requires frequent sessions with a patient over several years, and is an intensive form of individual psychotherapy. Psychoanalysis helps patients connect their present feelings and behaviours to events and memories from the past (many which may be long forgotten).

Electroconvulsive therapy (ECT) is done under general anesthesia. It is a procedure in which small electric currents are passed through the brain which will trigger a brief seizure. This procedure may be able to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. ECT often works when other treatments are proven unsuccessful, but it may not work for everyone.

Other Duties Psychiatrists may be involved with a variety of additional duties, depending on their area of practice and their area of interest. For example, there may be administrative duties such as writing case notes or discussing billing issues with office staff, or other types of duties such as doing research, writing academic papers or journal articles, teaching in universities and medical schools, or even acting as expert witnesses in court cases.


Clinical psychologists and psychiatrists often work in tandem to treat their patient's symptoms from both a behavioural and clinical standpoint. They share a common goal - the desire to help people feel better. The fields of psychology and psychiatry are both essential in offering treatment for improving mental and emotional health.

After seeing a family doctor for a referral, a patient might meet regularly with a clinical psychologist to address behavioural patterns. That clinical psychologist may refer the patient to a psychiatrist who is able to prescribe and monitor medication.

Because clinical psychologists and psychiatrists often work together for the well-being of the client, their job descriptions may overlap somewhat. While they both work in the mental health field, they perform very different roles (particularly in the type of treatment they administer). Each profession also requires different educational paths.

The Role Of A Clinical Psychologist Clinical psychologists conduct psychological tests, focus primarily on psychotherapy, and often treat both emotional and mental suffering with behavioural intervention (behavioural intervention involves having patients replace problematic behaviours with more positive ones).

Clinical psychologists tailor their treatment plans to each individual patient, as different people have different problems, and respond best to different forms of therapy. Even two people with the same problem may respond very differently to treatment and recovery plans. Clinical psychologists do not typically prescribe medication.

In terms of education, a clinical psychologist must complete four years of university, a two-year master's degree, and a further two years of supervised clinical training. Graduate school provides aspiring clinical psychologists with extensive preparation for a career in psychology by teaching students how to diagnose mental and emotional disorders in a variety of situations.

Throughout their years of education, students study personality development, the history of psychological problems, and the science of psychological research.

The Role Of A Psychiatrist Psychiatrists are medical doctors who are dedicated to providing the best treatment and care for people with mental disorders.

Because psychiatrists are trained medical doctors, they are able to prescribe medications. They spend a significant portion of their time with patients on medication management as a course of treatment. Medication in psychiatry is used when counseling and therapy fail to produce noticeable results.

As doctors, psychiatrists understand the ins and outs of the body as well as the mind. Their training - four years of medical school followed by four years of psychiatric residency - allows them to diagnose basic and complex psychiatric conditions which include: psychosis; affective disorders; anxiety disorders; and behavioural disorders.

They are also able to deliver psychotherapy, and to administer somatic therapies. Some psychiatrists specialize in liaison psychiatry, childhood and adolescent psychiatry, or forensic psychiatry.


Spotlight Career Interview

David M. Reiss, MD, is a psychiatrist in private practice. This is part of his detailed journey from aspiring engineer to psychiatrist.

Please describe your educational path to becoming a psychiatrist.

In high school, my interests were always more intellectual than physical. My deepest curiosities tended to be more philosophical, but my practical abilities showed most promise in the applied sciences. I was told, and it made sense to me, that I should become an engineer.

I entered the Northwestern University Technological Institute. At that time, there was no Department of Biomedical Engineering at Northwestern, but I was able to graduate with a degree in chemical engineering with an option in biomedical engineering. Having moved into biomedical engineering, in my last years in college I took courses in physiology and biochemistry such that I ended up having sufficient prerequisites to apply to medical school.

I was formally accepted to Northwestern Medical School. Arriving at NUMS, not having been “a pre-med” I was a fish out of water – and I absolutely hated my first year. Memorizing Latin terms in anatomy class was the furthest thing from taking on challenging engineering problems. The more I learned about psychiatry, the more interested I became. I had the good fortune to be able to work with excellent teachers and mentors in psychiatry.

What does your day-to-day work entail?

Currently, my time is split between three areas. I have been involved in the California workers’ compensation system as a qualified medical examiner for over 25 years, performing medical-legal evaluations and providing treatment.

Roughly one-third of my time has been spent staying active in frontline treatment in other milieu, providing both psychotherapeutic and psychopharmacological intervention, mostly in psychiatric hospitals. As at this point in my career I am not seeking a full hospital practice, I have done “locum tenens” [temporary] assignments ranging from two weeks to four months. The remainder of my time is spent on personal projects related to my practice of psychiatry.

Do you have any advice for students interested in becoming a psychiatrist?

Observe. Study. Question. Challenge. Integrate the best of “old” ideas with the advantages of new theories and understanding. But most importantly – discover how to talk to patients — all patients — even those who are psychotic. Explore, respect and honor the opportunity to get to know and relate to people from every walk of life with every type of circumstance and challenge, and through that process, making a positive difference in the person’s life. It is an opportunity that is available in few if any fields other than psychiatry.


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