Podcast Episodes

Podcast Episode 24: Specialty Spotlight: Psychiatry

On this edition of Speciality Spotlight, we talk with Dr. Aubrey Jordan about psychiatry. She shares with us the broad range of work that psychiatrists perform and what they talk about with their patients. We learn about the path of becoming a psychiatrist, including how to fast track your residency and fellowship experience from being six years to five.

Aubrey informs us of the difference between psychiatrists and psychologists, as they are often confused. She then discusses why she loves psychiatry along with some of the challenges that psychiatrists deal with. To end today’s episode, we receive advice about getting into the psychiatry field.

[0:49] What it’s like being a psychiatrist.

Every psychiatrist’s job can be different. The prototypical psychiatrist works in an outpatient setting, seeing people for both medication management for psychiatric illness and therapy. Most psychiatry appointments are longer than a typical outpatient medical appointment.

Other psychiatrists work in inpatient units with people who are very acutely ill with psychotic illnesses and helped to get back on their feet. Others work in jails or in between medical and psychiatric units.

[2:17] What psychiatrists talk to patients about in a clinical setting.

Something really different about psychiatry is that we don’t touch our patients. Our tool is the interview, and what we talk about is what symptoms are affecting their lives. Aubrey focuses mostly on a patient’s mood. Any symptoms or concerns regarding hallucinations, delusions, energy level, sleep, appetite, orientation, and other cognitive questions give her the ability to process information correctly and determine if the patient has a psychiatric illness.

[3:22] How to become a psychiatrist.

A psychiatrist is a medical doctor who goes through four years of med school and then a four-year residency program. It can be difficult getting direct psychiatry exposure prior to med school. It’s difficult because the interaction between a patient and a psychiatrist is very private. Something you can do, though, is shadow primary care physicians. They see a lot of psychiatric illness in their practices. There are also a lot of advocacy options, like joining the National Association for Mental Illness.

[04:59] The difference between psychiatry and psychology.

Psychologists have been trained to do therapy, and there are many types of people that would call themselves psychologists. A psychologist, technically, has gotten a PhD in psychology and has done a lot of clinical research in psychology. They mostly focus on therapy; usually exclusively.

Psychiatrists, in addition to being trained to do therapy, have been trained to prescribe psychiatric medication which is an exclusive area. In general, psychiatrists are used to treat illnesses that are a bit more severe. There are many psychiatrists who spend most of their time doing therapy and others who do none.

[6:45] What the training is like in residency.

About half of your time in the first year doing a medical internship. The remainder of the first two years is usually spent entirely on inpatient. That includes being in the hospital and seeing patients in the psychiatric unit which is for people with very severe psychiatric illness, and being part of a consult service.

The third year is usually exclusively outpatient. It’s in a variety of clinics such as addictions clinics, geriatrics clinics, child psychiatry clinics, and so on. In the fourth year, you continue your continuity clinic, but a lot have a lot of room for electives.

[8:28] The types of fellowships available after residency.

The most popular are consult liaison, which is an extra year after the four-year residency, where you become an expert at being the consult for hospitalized patients with psychiatric concerns. Psychiatric presentations can have neurologic or organic roots, and you need to become an expert to be able to differentiate them.

Other popular ones are geriatric fellowships, women’s mental health, and child and adolescent psychiatry. There’s a great need throughout most of the country for more child psychiatrists. In response to that, we’ve changed how that fellowship works. Now, you can go from doing just three years at the residency and make the fourth year, which is usually electives, into the start of your two-year child psychiatry fellowship. This brings the total time of residency and fellow ship from six years to five.

[10:16] What Aubrey loves about psychiatry and some of the challenges.

There’s still so much to discover. We know very little about what causes psychiatric illness and how/why medications work. There are still a lot of illnesses that we don’t have great medications for. We’re going to be in a process of discovery for the next hundred years.

Aubrey also really enjoys the interview. She was originally interested in surgery, and she finds the interview to be very skill-based; you are very precise in why you ask certain things certain ways.

Sometimes patients don’t get the resources that they should. They are often very vulnerable. Many patients, when they compensate, can become homeless or even put in jail. It can be difficult to see patients suffering and not be able to help them because there’s not enough social support to back up your medication recommendations or therapeutic relationship with them.

It can be really frustrating to not know why your medications work and not have that understanding. We’re still even learning how to name and differentiate conditions.

[12:55] Closing words.

Keep your mind open. It can be easy to know where you’re headed and pick a field, but you’re closing doors. You can only benefit from keeping your options open. It can be difficult to be compassionate and empathize with patients that are going through really severe psychiatric illness, but it’s a great way to build up your empathy for all patients.

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