by DrDave » Sun Aug 14, 2005 9:37 am
Junior in HS,
You did provide some accurate information there, but it's not quite complete. I think it's great that you already have an idea of what you want to do with your life, but I would suggest keeping an open mind throughout college and medical school - you might be surprised to find something even more interesting to you than psychiatry.
The other thing to realize is that while you said after college you need to get some experience working in a medical setting, you are accurate - but not complete. You actually need to do well enough in college with your grades and MCAT test scores to get into medical school - which is very competitive. Med school is 4 VERY challenging years.
During your last year of medical school, you apply for residency. Psychiatry residency programs are generally not that competitive, but the top programs are. The residency program is 4 years, during which time you do clinical work under the supervision of other physicians. Parts of psychiatry residency are very hard work with little sleep and long hours. At some programs, the entire residency may be that way. At many psychiatry residencies, you do get a little bit less work the last 2 years - but it is still a lot of time at most programs.
You obviously pay for college. You have to pay for medical school, but most people can get educational loans (lots of them) for medical school. Residency pays around $35k-$40k, which doesn't sound too bad, but based on an hourly rate is probably close to minimum wage. Most people defer their loans throughout that time, but some will start paying them off near the end of residency. With somewhat less work the last two years, some programs will allow residents to do moonlighting work. This type of work can vary a lot, but can pay fairly well. Some very motivated residents have made a decent living, but they were VERY busy.
Once done with residency, you are "board eligible" which means you can work as a psychiatrist at most places. There is then a two step certification exam that takes about 1 year to complete if you are lucky and pass everything your first try. There is first a written exam - multiple choice, typical type of exam, that I believe has around an 80% pass rate. It has a lot of very tough questions as 1/3 of it is neurology and 2/3 are psychiatry. From what I recall, the neurology questions were VERY hard. You have to get a certain percent right on each part to pass. So, if you ace the psychiatry part, you can still fail the exam if you don't get enough right on the neurology part.
The second part of the exam is the more controversial. Once you've passed the written exam, you will get scheduled for an oral exam. The oral exam consists of 2 parts - a video portion and a live patient. For the video portion, you watch a 30 minute video of part of an interview, and then you meet with 2 examiners (I heard it may now go to 1 examiner plus a floating examiner who comes in and out of the various rooms) for a 30 minute test. You are expected to present the patient and then answer questions from the examiners.
For the live patient part of the test, you have a real patient you've never seen before come in the room, and you have 30 minutes to interview that patient. You then have a 30 minute test where you present the case to 2 (now maybe 1?) examiner and then answer questions.
While the American Board of Psychiatry and Neurology has tried to make this an objective exam. Personally, I think it is an awful test. Not only is it very anxiety provoking which effects some candidates much more than others, but there are many many random factors. The particular patient, the particular examiners, what questions you might get asked and whether they fit in with your knowledge areas or not. Of course, the entire interview is an artificial situation.
I'm not sure there is a better way to test candidates, though - as the ability to interview patients is a vital part of psychiatry. And the field of psychiatry is trying to maintain credibility of the profession - so it is important to make sure board certified candidates are able to effectively talk with patients. Of course, I think this is important for almost all fields of medicine - yet very few other fields require an oral exam. Most of the abilities to interview, present, and understand patients are observed during residency, but I suppose completion of residency does not necessarily mean you are competent. My thought is that just passing the exam doesn't mean you are competent either.
And did I mention that the oral exam has around a 50% pass rate? This is for people who have done well enough in college to get into med school. Have completed med school and matched in a residency. Have completed a residency and passed a challenging written exam.
Your target age for finishing training is probably about right.
Complete High School around age 18, complete college around age 22, complete medical school around age 26, and complete residency around age 30. That's if you go straight through.
More and more people are taking extra time in college (5 years instead of 4), having a career before going back to med school and taking time off during med school (to do things like research or pursue a second degree).
In my case, I happily went straight through the whole process - actually cut one year off of college but added an extra year of residency to do a combined internal medicine / psychiatry residency program. I am very glad to be done with the training aspect of things.
I probably should have broken my answer down into several different threads, but maybe eventually I'll put together one thread of frequently asked questions or something like that.
Thanks for your comments!