Psychiatry as a “Lifestyle Specialty”
Posted by Dr. Vollmer on November 23, 2016
With Thanksgiving approaching, I want to publicly thank my patients for giving me the privilege of entering their interior, knowing the courage and strength it takes to expose one’s deepest thoughts and feelings, both conscious and unconscious. My inner world is deeper and richer as a result of my work, and for that, I am eternally grateful. Having said that, I now return to my rant about the changing nature of my profession. Psychiatry is becoming a more popular specialty choice for medical students. The word on the street is that these students classify career choices based on how lucrative they are, and/or how “sensible” they are, meaning that certain specialties, are what they call “lifestyle specialties” in that the profession offers the opportunity to spend time doing other things, which usually means spending time with family. These “lifestyle specialties” contrast with surgical specialties, or life and death professions, like cardiology, where the commitment to one’s career has to trump other activities. Psychiatry, as a “lifestyle specialty” sends me flying with outrage and confusion. How does listening to physical and sexual abuse, deeply traumatic losses, and terribly self-destructive thoughts, create a “good lifestyle”? The emotional toll of getting down deep with patients is significant, thereby decreasing the bandwidth for listening to other important people in your life. This is a major occupational hazard, and as such, the “lifestyle” is compromised. When I challenge medical students with this notion, the feedback is the following: “I plan on just doing medications, so it won’t be so bad.” Oh my, I say to myself. How do I respond to that? First, I want to say that I do not understand what “just doing medication” means. I understand that they think they will be doing 15 minute visits in which they will be tweaking medications, for the most part. So, they are creating a superficial interaction, on purpose? They are signing up for boredom, in exchange for leaving the office by 6 pm? I am horrified. They, these students who claim that psychiatry is a “lifestyle specialty” are embracing the dullness of the work, when, in fact, by my way of thinking, psychiatry is the most stimulating field, in that one has no algorithms. The psychiatrist, at least in my day, must constantly be thinking on his feet. These “med checks” involve little thought, in that the medication is either increased, decreased, or stays the same, and in so doing, no deep conversation is had or sought after. And this is OK because the hours are good? I continue to be beside myself with a deep sense of grief, that the profession I entered is not the profession that exists today. I know that with technology, with global trade and with clean energy, many professions of yesterday are gone forever. I am slowly accepting that mine is too.