Psychiatry is a wonderful medical specialty; as a career, it is both diverse and flexible. Psychiatric careers can encompass the entire spectrum of clinical practice where the doctor sees many patients infrequently and focuses on symptoms and medications, or they can include psychodynamic and psychoanalytic treatments where the psychiatrist sees fewer patients but gets to know the details of their psyches and their lives. Psychiatrists can work in settings where they concentrate on administration, research, teaching, writing, or public policy and never go near a patient. It’s an easy specialty to mix-and-match any of the above components, and it’s feasible to have a fulfilling career while working part-time, and most psychiatrists get uninterrupted nights to sleep.

Still, psychiatry has trouble attracting enough doctors to fill the need. According to Stephanie Steinberg in a July 2010 article in USA Today titled “Of Medical Specialties, Demand for Psychiatrists Growing Fast":

Though demand is growing, fewer medical students are entering careers in psychiatry. Health officials say the field garners little interest because psychiatrists earn less than other specialties, even though they spend the same amount of time in medical training.

This is not surprising, and I’d venture to guess that the stigma associated with all-things-psychiatric does not help the recruiting process. The myth on the street continues to be that psychiatric patients are difficult to work with, that psychiatric disorders are not “real” diseases, that no one gets better, and that psychiatrists live in the pockets of the pharmaceutical companies. Lousy pay for lousy work, why would anyone go in to this field?  Perhaps because it’s not true.

In Maryland, we conducted an informal e-mail survey of the members of the Maryland Psychiatric Society. We asked, “Overall, are you satisfied with your career as a clinical psychiatrist?” Ninety percent of respondents answered, “Yes, I find my work rewarding and would choose this career again.” You may want to read that last sentence one more time. Four percent answered, “No, I don’t find my work rewarding and would not choose this career again.” Of those who chose to comment, the remarks centered on frustration with reimbursements and insurance and 22% of respondents qualified their response by checking “Other” as well as “Yes.”

Physicians in other specialties get paid better. Do 90% of surgeons find their work to be rewarding? The American College of Surgeons did its own survey. The surgeons’ survey population was a bit larger, with 7,905 respondents (compared to our 245 psychiatrists), and they found that 40% of their sample suffered from burnout, while 30% had symptoms of depression. One might conclude that more psychiatrists are needed to treat the depressed surgeons.

Psychiatry really is a wonderful career and the word on the street is wrong. Somehow, we allow ourselves to be sold short, and we need to do a better job of conveying what we do, and how rewarding it is, to the medical students.

-- Dinah Miller, M.D.