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Choosing a Career in Psychiatry

The Surgeon General’s report, Mental Health: Culture, Race and Ethnicity, unequivocally states that “mental health is fundamental to overall health and productivity. It is the basis for successful contributions to family, community, and society. Throughout the lifespan, mental health is the wellspring of thinking and communication skills, learning, resilience, and self-esteem.” Psychiatrists make a difference because they can apply medical knowledge and understanding to the treatment of the mentally ill in a cultural competent manner. There is untold richness in diversity in being a psychiatrist and each year more and more medical students are choosing a career as a psychiatrist.

Medical students follow a standard curriculum. In addition to anatomy, biochemistry, and physiology, students take courses in psychiatry, behavioral science and neuroscience in the first two years of medical school. In the last two years, students are assigned to medical specialty clerkships where they study and work with physicians in at least six different medical specialties, including psychiatry. Medical students rotating through their psychiatry clerkship take care of patients with mental health in the hospital and in outpatient settings. They also have an opportunity to work with medical and surgical patients who may have psychiatric problems or who have difficulty coping with their illness. Because modern psychiatry places special emphasis on the relationship between mind and body, students pay special attention to issues of stress and physical illness, prevention, and behavior change, in addition to learning to care for severely mentally ill patients. Upon graduating from medical students, doctors can elect to specialize in psychiatry through a 4+ year residency. Doctors spend the first year of residency training in a hospital taking care of patients with a wide range of medical illnesses. He or she then spends at least three additional years in psychiatry residency learning the diagnosis and treatment of mental health, gaining valuable skills in various forms of psychotherapy, and in the use of psychiatric medications and other treatments.

The education and training requirements for psychiatry are set by the ACGME. Upon completing residency, a psychiatrist can apply for board certification from the American Board of Psychiatry and Neurology. Many psychiatrists choose to go on to additional years of training in a subspecialty.

Yes. Many psychiatrists continue training beyond the initial four years. They may study child and adolescent psychiatry, geriatric psychiatry, forensic (legal) psychiatry, administrative psychiatry, addiction psychiatry, emergency psychiatry, psychiatry in general medical settings (called "consultation/liaison psychiatry" or psychosomatic medicine), neurodevelopmental disorders (e.g. autism spectrum disorders), community psychiatry and public health, military psychiatry, and psychiatric research. Some choose additional training in psychoanalysis at psychoanalytic institutes.

Psychiatrists practice in diverse settings including private practice, general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, schools and universities, rehabilitation programs, emergency rooms, hospices, and many other places. About half the 42,000 psychiatrists in the nation maintain private practice.

The hallmark of a psychiatrist's career is diversity and flexibility. Although some psychiatrists prefer working only in one setting, others work in several areas, combining, for instance, a private practice with hospital or community mental health center work.

Practitioners set their own work and time commitments according to their personal lifestyles and needs.

Also, because mental health affects all races, ethnic groups, and cultures, the specialty of psychiatry offers special opportunities for members of minority groups.

Psychiatrists earn about the same as pediatricians and family physicians, depending on the type of practice, hours worked, geographic location, and whether the psychiatrist works in the public or private sector. According to the Bureau of Labor Statistics, mean annual wage for a psychiatrist is $163,660.

The average psychiatrist spends approximately 48 hours each week at work. Most psychiatrists spend 60% of their time with patients. Two-thirds of these patients are seen as outpatients, with the rest being seen in a hospital setting or, increasingly, in partial hospitalization or day programs and community residential programs. Psychiatric hospitalization is now more intense, more focused, and much shorter in duration than in previous years. Additional professional activities include administration, teaching, consultation, and research.

Today's psychiatrist provides a wide range of biological, psychotherapeutic and psychosocial treatments which are tailored to the specific needs of the patient. The psychiatrist also serves as the medical expert for the mind/brain/body interface. Psychiatrists use a wide variety of treatments including various forms of psychotherapy, medications, and hospitalization in accordance with the needs of each patient.

There are a number of effective medications that psychiatrist may prescribe to treat mental illness. A psychiatrist prescribes these medications in the context of the patient’s overall medical condition. A psychiatrist may recommend combining medications any number of psychotherapies.

Psychotherapy is a systematic treatment method in which, during regularly scheduled meetings, the psychiatrist and patient discuss troubling problems and feelings. The physician helps patients understand the basis of these problems and find solutions. Depending on the extent of the problem, treatment may take just a few sessions over one or two weeks, or many sessions over several years.

Psychiatrists use many forms of psychotherapy. There are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, psychotherapies that treat troubled couples or families together, and more treatments that are tailored to help solve other problems in specific ways.

Psychoanalysis is an intensive form of individual psychotherapy which requires frequent sessions over several years. The psychiatrist, who must have additional years of training in psychoanalysis, helps the patient to recall and examine events, memories, and feelings from the past, many of them long forgotten, as a means of helping the patient understand present feelings and behavior.

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